Extended criteria (experimental). This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects for CDI staff. The primary surface is Before you sign (kidney, measurement only). All extended pages.

ENC-00057: Luca Greaves

51F · MRN48242892 · Cardiology · admitted Sat Nov 07, 2026 11:45 AM · in hospital · attending Dr. Gideon Zeller · 156 cm, 51.2 kg

Documented diagnoses (current)

“moderate protein-calorie malnutrition” · E44.0 Moderate protein-calorie malnutrition
“CKD stage 3a” · N18.31 Chronic kidney disease, stage 3a
Principal: “diastolic heart failure” · I50.30 Unspecified diastolic (congestive) heart failure
“hyponatremia” · E87.1 Hypo-osmolality and hyponatremia
“hypertension” · I10 Essential (primary) hypertension
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 292 Heart failure and shock with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 292.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule aki v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: meets_definition	`creat_ratio >= t.ratio_s1 or creat_rise_48h >= t.rise_abs or coalesce(uo_hours_lt_0_5 >= t.uo_s1_h, false)`	creat_ratio=1.046, t.ratio_s1=1.5, creat_rise_48h=0.06, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	false
derived: stage3	`meets_definition and (creat_ratio >= t.ratio_s3 or creat_peak >= t.scr_s3 or rrt_started or coalesce(uo_hours_lt_0_3 >= t.uo_s3_h, false) or coalesce(anuria_hours >= t.anuria_h, false))`	meets_definition=False, creat_ratio=1.046, t.ratio_s3=3.0, creat_peak=1.37, t.scr_s3=4.0, rrt_started=False, uo_hours_lt_0_3=unknown, t.uo_s3_h=24, anuria_hours=unknown, t.anuria_h=12	false
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=1.046, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	false
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=False, meets_definition=False	0
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.06, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=F, hgb_nadir=13.69, t.hb_m=13, t.hb_f=12	false
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=0.3, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=False, anaemic=False, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=False, hgb_drop=0.3, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=13.69, anaemic=False	true

Chronic kidney disease

Criteria met

No gap

Supported as documented (N18.31).

Trace

Rule trace (rule ckd v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: chronic	`egfr_n >= 2 and egfr_span_days >= t.chronic_days`	egfr_n=2, egfr_span_days=247, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=50.7, egfr_late=49.3	50.7
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=50.7, t.g2=60, egfr_late=49.3	true
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=50.7, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G3a
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=True, egfr_early=50.7, egfr_late=49.3, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=50.7, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3a	true

Heart failure

Criteria met

Specificity gap

Documented “diastolic heart failure” (I50.30); criteria support the more specific Acute on chronic diastolic (HFpEF) heart failure (I50.33).

Trace

Rule trace (rule heart_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: np_elevated	`coalesce(bnp_max >= t.bnp, false) or coalesce(ntprobnp_max >= t.ntprobnp, false)`	bnp_max=1416.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	true
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=True, np_elevated=True, new_o2=False	2
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=61.0, t.ref=40, t.pres=50	diastolic
derived: improved	`coalesce(lvef_prior_min <= t.ref and lvef > t.ref and lvef - lvef_prior_min >= t.improved_rise, false)`	lvef_prior_min=unknown, t.ref=40, lvef=61.0, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=2, hf_history=True	acute on chronic
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=diastolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=acute on chronic	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=diastolic, acuity=acute on chronic	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=acute on chronic	false
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=acute on chronic	true

Hyponatraemia

Criteria met

No gap

Supported as documented (E87.1).

Trace

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=121.0, t.profound=125, t.moderate=130, t.low=135	profound
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=121.0, t.low=135, na_low_count=6, t.repeat=2, na_treated=True	true

Malnutrition

Criteria met

No gap

Supported as documented (E44.0).

Trace

Rule trace (rule malnutrition v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: a_sev_intake	`intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days`	intake_pct=80.0, t.a_sev_intake_pct=50, intake_days=53.0, t.a_sev_intake_days=5	false
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=80.0, t.a_mod_intake_pct=75, intake_days=53.0, t.a_mod_intake_days=7	false
derived: a_sev_wt	`(wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5)`	wt_loss_days=180.0, wt_loss_pct=10.0	false
derived: a_mod_wt	`(wt_loss_days <= 7 and wt_loss_pct >= 1) or (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5)`	wt_loss_days=180.0, wt_loss_pct=10.0	false
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=80.0, t.c_intake_pct=75, intake_days=53.0, t.c_intake_days=30	false
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=80.0, t.c_intake_pct=75, intake_days=53.0, t.c_intake_days=30	false
derived: c_sev_wt	`(wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20)`	wt_loss_days=180.0, wt_loss_pct=10.0	false
derived: c_mod_wt	`(wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) or (wt_loss_days <= 183 and wt_loss_pct >= 10) or (wt_loss_days <= 366 and wt_loss_pct >= 20)`	wt_loss_days=180.0, wt_loss_pct=10.0	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=80.0, wt_loss_pct=10.0, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown	5
derived: n_severe	`case(nutr_context == 'acute', count(a_sev_intake, a_sev_wt, fat_loss >= 2, muscle_loss >= 2, fluid >= 2, grip_reduced), nutr_context == 'chronic', count(c_sev_intake, c_sev_wt, fat_loss >= 3, muscle_loss >= 3, fluid >= 3, grip_reduced), null)`	nutr_context=chronic, a_sev_intake=False, a_sev_wt=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=False	0
derived: n_moderate	`case(nutr_context == 'acute', count(a_sev_intake or a_mod_intake, a_sev_wt or a_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), nutr_context == 'chronic', count(c_sev_intake or c_mod_intake, c_sev_wt or c_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), null)`	nutr_context=chronic, a_sev_intake=False, a_mod_intake=False, a_sev_wt=False, a_mod_wt=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=False, c_mod_wt=True	3
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=3	true

Obesity

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule obesity v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=51, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=21.0, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=21.0, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=21.0, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=21.0, t.c1=30	true

Pressure injury

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule pressure_injury v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sacral	`wound_site == 'sacral'`	wound_site=unknown	unknown
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=unknown	true

Acute respiratory failure

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule respiratory_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: measured	`present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min)`	spo2_min_ra=94.0, pao2_min_ra=unknown, pf_min=unknown	true
derived: hypoxemia	`coalesce(spo2_min_ra < t.spo2_ra, false) or coalesce(pao2_min_ra < t.pao2, false) or coalesce(pf_min < t.pf, false)`	spo2_min_ra=94.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	false
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=20.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=False	false
outcome: met	`hypoxemia and distress`	hypoxemia=False, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=False	false
outcome: not_met	`measured and not hypoxemia and o2_max_lpm <= t.o2_low and not adv_resp_support`	measured=True, hypoxemia=False, o2_max_lpm=0.0, t.o2_low=2, adv_resp_support=False	true

Sepsis

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=37.4, t.t_hi=38, temp_min_48h=36.6, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=88.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=20.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	false
derived: sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`	wbc_max_48h=9.85, t.wbc_hi=12, wbc_min_48h=8.54, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	false
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=False, sirs_hr=False, sirs_rr=False, sirs_wbc=False	0
derived: sofa_resp	`coalesce(case(pf_min_48h < 100 and adv_resp_support, 4, pf_min_48h < 200 and adv_resp_support, 3, pf_min_48h < 300, 2, pf_min_48h < 400, 1, 0), 0)`	pf_min_48h=unknown, adv_resp_support=False	0
derived: sofa_coag	`coalesce(case(platelets_min_48h < 20, 4, platelets_min_48h < 50, 3, platelets_min_48h < 100, 2, platelets_min_48h < 150, 1, 0), 0)`	platelets_min_48h=230.0	0
derived: sofa_liver	`coalesce(case(bili_max_48h >= 12, 4, bili_max_48h >= 6, 3, bili_max_48h >= 2, 2, bili_max_48h >= 1.2, 1, 0), 0)`	bili_max_48h=0.73	0
derived: sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`	norepi_max_48h=0.0, map_min_48h=75.0	0
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=1.37	1
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=1.31	1
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=1, sofa_renal_baseline=1	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, sirs_count=0, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=False, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=False	true

Structured data

Labs (39)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001919	Sat Dec 06, 2025 09:15 AM	creatinine	1.28 mg/dL
LAB-001920	Tue Aug 11, 2026 10:05 AM	creatinine	1.31 mg/dL
LAB-001921	Sat Nov 07, 2026 12:45 PM	creatinine	1.31 mg/dL
LAB-001928	Sat Nov 07, 2026 12:45 PM	bnp	1416.0 pg/mL
LAB-001929	Sat Nov 07, 2026 12:45 PM	sodium	123.0 mmol/L
LAB-001936	Sat Nov 07, 2026 12:45 PM	hemoglobin	14.0 g/dL
LAB-001943	Sat Nov 07, 2026 12:45 PM	wbc	9.37 x10^3/uL
LAB-001944	Sat Nov 07, 2026 12:45 PM	platelets	242.0 x10^3/uL
LAB-001957	Sat Nov 07, 2026 12:45 PM	bilirubin	0.73 mg/dL
LAB-001922	Sun Nov 08, 2026 05:00 AM	creatinine	1.33 mg/dL
LAB-001930	Sun Nov 08, 2026 05:00 AM	sodium	121.0 mmol/L
LAB-001937	Sun Nov 08, 2026 05:00 AM	hemoglobin	13.91 g/dL
LAB-001945	Sun Nov 08, 2026 05:00 AM	wbc	8.54 x10^3/uL
LAB-001946	Sun Nov 08, 2026 05:00 AM	platelets	281.0 x10^3/uL
LAB-001923	Mon Nov 09, 2026 05:00 AM	creatinine	1.37 mg/dL
LAB-001931	Mon Nov 09, 2026 05:00 AM	sodium	122.0 mmol/L
LAB-001938	Mon Nov 09, 2026 05:00 AM	hemoglobin	13.69 g/dL
LAB-001947	Mon Nov 09, 2026 05:00 AM	wbc	9.85 x10^3/uL
LAB-001948	Mon Nov 09, 2026 05:00 AM	platelets	230.0 x10^3/uL
LAB-001924	Tue Nov 10, 2026 05:00 AM	creatinine	1.3 mg/dL
LAB-001932	Tue Nov 10, 2026 05:00 AM	sodium	125.0 mmol/L
LAB-001939	Tue Nov 10, 2026 05:00 AM	hemoglobin	13.97 g/dL
LAB-001949	Tue Nov 10, 2026 05:00 AM	wbc	6.27 x10^3/uL
LAB-001950	Tue Nov 10, 2026 05:00 AM	platelets	201.0 x10^3/uL
LAB-001925	Wed Nov 11, 2026 05:00 AM	creatinine	1.36 mg/dL
LAB-001933	Wed Nov 11, 2026 05:00 AM	sodium	127.0 mmol/L
LAB-001940	Wed Nov 11, 2026 05:00 AM	hemoglobin	13.82 g/dL
LAB-001951	Wed Nov 11, 2026 05:00 AM	wbc	9.31 x10^3/uL
LAB-001952	Wed Nov 11, 2026 05:00 AM	platelets	166.0 x10^3/uL
LAB-001926	Thu Nov 12, 2026 05:00 AM	creatinine	1.34 mg/dL
LAB-001934	Thu Nov 12, 2026 05:00 AM	sodium	134.0 mmol/L
LAB-001941	Thu Nov 12, 2026 05:00 AM	hemoglobin	13.86 g/dL
LAB-001953	Thu Nov 12, 2026 05:00 AM	wbc	6.57 x10^3/uL
LAB-001954	Thu Nov 12, 2026 05:00 AM	platelets	254.0 x10^3/uL
LAB-001927	Fri Nov 13, 2026 05:00 AM	creatinine	1.37 mg/dL
LAB-001935	Fri Nov 13, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001942	Fri Nov 13, 2026 05:00 AM	hemoglobin	13.71 g/dL
LAB-001955	Fri Nov 13, 2026 05:00 AM	wbc	5.91 x10^3/uL
LAB-001956	Fri Nov 13, 2026 05:00 AM	platelets	183.0 x10^3/uL

Vitals (114)

Vitals
Row	When	Kind	Value	Detail
VIT-005525	Sat Nov 07, 2026 12:05 PM	spo2	97.0	room air
VIT-005526	Sat Nov 07, 2026 12:05 PM	rr	18.0
VIT-005563	Sat Nov 07, 2026 12:05 PM	temp_c	36.6
VIT-005564	Sat Nov 07, 2026 12:05 PM	hr	70.0
VIT-005565	Sat Nov 07, 2026 12:05 PM	map	83.0
VIT-005566	Sat Nov 07, 2026 12:05 PM	gcs	15.0
VIT-005527	Sat Nov 07, 2026 08:05 PM	spo2	95.0	room air
VIT-005528	Sat Nov 07, 2026 08:05 PM	rr	16.0
VIT-005567	Sat Nov 07, 2026 08:05 PM	temp_c	37.0
VIT-005568	Sat Nov 07, 2026 08:05 PM	hr	73.0
VIT-005569	Sat Nov 07, 2026 08:05 PM	map	80.0
VIT-005570	Sat Nov 07, 2026 08:05 PM	gcs	15.0
VIT-005529	Sun Nov 08, 2026 04:05 AM	spo2	99.0	room air
VIT-005530	Sun Nov 08, 2026 04:05 AM	rr	18.0
VIT-005571	Sun Nov 08, 2026 04:05 AM	temp_c	37.2
VIT-005572	Sun Nov 08, 2026 04:05 AM	hr	88.0
VIT-005573	Sun Nov 08, 2026 04:05 AM	map	79.0
VIT-005574	Sun Nov 08, 2026 04:05 AM	gcs	15.0
VIT-005531	Sun Nov 08, 2026 12:05 PM	spo2	95.0	room air
VIT-005532	Sun Nov 08, 2026 12:05 PM	rr	18.0
VIT-005575	Sun Nov 08, 2026 12:05 PM	temp_c	36.9
VIT-005576	Sun Nov 08, 2026 12:05 PM	hr	84.0
VIT-005577	Sun Nov 08, 2026 12:05 PM	map	86.0
VIT-005578	Sun Nov 08, 2026 12:05 PM	gcs	15.0
VIT-005533	Sun Nov 08, 2026 08:05 PM	spo2	98.0	room air
VIT-005534	Sun Nov 08, 2026 08:05 PM	rr	20.0
VIT-005579	Sun Nov 08, 2026 08:05 PM	temp_c	37.4
VIT-005580	Sun Nov 08, 2026 08:05 PM	hr	71.0
VIT-005581	Sun Nov 08, 2026 08:05 PM	map	75.0
VIT-005582	Sun Nov 08, 2026 08:05 PM	gcs	15.0
VIT-005535	Mon Nov 09, 2026 04:05 AM	spo2	94.0	room air
VIT-005536	Mon Nov 09, 2026 04:05 AM	rr	19.0
VIT-005583	Mon Nov 09, 2026 04:05 AM	temp_c	36.6
VIT-005584	Mon Nov 09, 2026 04:05 AM	hr	83.0
VIT-005585	Mon Nov 09, 2026 04:05 AM	map	75.0
VIT-005586	Mon Nov 09, 2026 04:05 AM	gcs	15.0
VIT-005537	Mon Nov 09, 2026 12:05 PM	spo2	99.0	room air
VIT-005538	Mon Nov 09, 2026 12:05 PM	rr	17.0
VIT-005587	Mon Nov 09, 2026 12:05 PM	temp_c	36.9
VIT-005588	Mon Nov 09, 2026 12:05 PM	hr	73.0
VIT-005589	Mon Nov 09, 2026 12:05 PM	map	76.0
VIT-005590	Mon Nov 09, 2026 12:05 PM	gcs	15.0
VIT-005539	Mon Nov 09, 2026 08:05 PM	spo2	97.0	room air
VIT-005540	Mon Nov 09, 2026 08:05 PM	rr	18.0
VIT-005591	Mon Nov 09, 2026 08:05 PM	temp_c	37.1
VIT-005592	Mon Nov 09, 2026 08:05 PM	hr	87.0
VIT-005593	Mon Nov 09, 2026 08:05 PM	map	90.0
VIT-005594	Mon Nov 09, 2026 08:05 PM	gcs	15.0
VIT-005541	Tue Nov 10, 2026 04:05 AM	spo2	98.0	room air
VIT-005542	Tue Nov 10, 2026 04:05 AM	rr	18.0
VIT-005595	Tue Nov 10, 2026 04:05 AM	temp_c	37.1
VIT-005596	Tue Nov 10, 2026 04:05 AM	hr	73.0
VIT-005597	Tue Nov 10, 2026 04:05 AM	map	83.0
VIT-005598	Tue Nov 10, 2026 04:05 AM	gcs	15.0
VIT-005543	Tue Nov 10, 2026 12:05 PM	spo2	94.0	room air
VIT-005544	Tue Nov 10, 2026 12:05 PM	rr	15.0
VIT-005599	Tue Nov 10, 2026 12:05 PM	temp_c	37.4
VIT-005600	Tue Nov 10, 2026 12:05 PM	hr	72.0
VIT-005601	Tue Nov 10, 2026 12:05 PM	map	91.0
VIT-005602	Tue Nov 10, 2026 12:05 PM	gcs	15.0
VIT-005545	Tue Nov 10, 2026 08:05 PM	spo2	94.0	room air
VIT-005546	Tue Nov 10, 2026 08:05 PM	rr	16.0
VIT-005603	Tue Nov 10, 2026 08:05 PM	temp_c	36.8
VIT-005604	Tue Nov 10, 2026 08:05 PM	hr	68.0
VIT-005605	Tue Nov 10, 2026 08:05 PM	map	80.0
VIT-005606	Tue Nov 10, 2026 08:05 PM	gcs	15.0
VIT-005547	Wed Nov 11, 2026 04:05 AM	spo2	99.0	room air
VIT-005548	Wed Nov 11, 2026 04:05 AM	rr	20.0
VIT-005607	Wed Nov 11, 2026 04:05 AM	temp_c	37.1
VIT-005608	Wed Nov 11, 2026 04:05 AM	hr	92.0
VIT-005609	Wed Nov 11, 2026 04:05 AM	map	88.0
VIT-005610	Wed Nov 11, 2026 04:05 AM	gcs	15.0
VIT-005549	Wed Nov 11, 2026 12:05 PM	spo2	95.0	room air
VIT-005550	Wed Nov 11, 2026 12:05 PM	rr	14.0
VIT-005611	Wed Nov 11, 2026 12:05 PM	temp_c	36.8
VIT-005612	Wed Nov 11, 2026 12:05 PM	hr	86.0
VIT-005613	Wed Nov 11, 2026 12:05 PM	map	87.0
VIT-005614	Wed Nov 11, 2026 12:05 PM	gcs	15.0
VIT-005551	Wed Nov 11, 2026 08:05 PM	spo2	97.0	room air
VIT-005552	Wed Nov 11, 2026 08:05 PM	rr	14.0
VIT-005615	Wed Nov 11, 2026 08:05 PM	temp_c	36.9
VIT-005616	Wed Nov 11, 2026 08:05 PM	hr	80.0
VIT-005617	Wed Nov 11, 2026 08:05 PM	map	82.0
VIT-005618	Wed Nov 11, 2026 08:05 PM	gcs	15.0
VIT-005553	Thu Nov 12, 2026 04:05 AM	spo2	94.0	room air
VIT-005554	Thu Nov 12, 2026 04:05 AM	rr	18.0
VIT-005619	Thu Nov 12, 2026 04:05 AM	temp_c	37.2
VIT-005620	Thu Nov 12, 2026 04:05 AM	hr	74.0
VIT-005621	Thu Nov 12, 2026 04:05 AM	map	77.0
VIT-005622	Thu Nov 12, 2026 04:05 AM	gcs	15.0
VIT-005555	Thu Nov 12, 2026 12:05 PM	spo2	96.0	room air
VIT-005556	Thu Nov 12, 2026 12:05 PM	rr	16.0
VIT-005623	Thu Nov 12, 2026 12:05 PM	temp_c	37.2
VIT-005624	Thu Nov 12, 2026 12:05 PM	hr	86.0
VIT-005625	Thu Nov 12, 2026 12:05 PM	map	75.0
VIT-005626	Thu Nov 12, 2026 12:05 PM	gcs	15.0
VIT-005557	Thu Nov 12, 2026 08:05 PM	spo2	95.0	room air
VIT-005558	Thu Nov 12, 2026 08:05 PM	rr	16.0
VIT-005627	Thu Nov 12, 2026 08:05 PM	temp_c	36.7
VIT-005628	Thu Nov 12, 2026 08:05 PM	hr	79.0
VIT-005629	Thu Nov 12, 2026 08:05 PM	map	84.0
VIT-005630	Thu Nov 12, 2026 08:05 PM	gcs	15.0
VIT-005559	Fri Nov 13, 2026 04:05 AM	spo2	94.0	room air
VIT-005560	Fri Nov 13, 2026 04:05 AM	rr	17.0
VIT-005631	Fri Nov 13, 2026 04:05 AM	temp_c	37.5
VIT-005632	Fri Nov 13, 2026 04:05 AM	hr	90.0
VIT-005633	Fri Nov 13, 2026 04:05 AM	map	89.0
VIT-005634	Fri Nov 13, 2026 04:05 AM	gcs	15.0
VIT-005561	Fri Nov 13, 2026 12:05 PM	spo2	99.0	room air
VIT-005562	Fri Nov 13, 2026 12:05 PM	rr	19.0
VIT-005635	Fri Nov 13, 2026 12:05 PM	temp_c	36.7
VIT-005636	Fri Nov 13, 2026 12:05 PM	hr	75.0
VIT-005637	Fri Nov 13, 2026 12:05 PM	map	89.0
VIT-005638	Fri Nov 13, 2026 12:05 PM	gcs	15.0

Medications, orders, echo, history (10)

MED-000198 11-07 08:00 furosemide 40 mg IV
MED-000199 11-07 20:00 furosemide 40 mg IV
MED-000200 11-08 08:00 furosemide 40 mg IV
MED-000201 11-08 20:00 furosemide 40 mg IV
MED-000202 11-09 08:00 furosemide 40 mg IV
MED-000203 11-09 20:00 furosemide 40 mg IV
MED-000204 11-07 15:45 sodium chloride 3% 100 mL IV
ORD-000047 11-07 14:45 fluid_restriction: fluid restriction 1.2 L/day
ECH-000025 2026-11-08 echo LVEF 61.0%
HX-000018 history: heart failure with preserved ejection fraction

Notes

History and physical · DOC-000198 · Dr. Gideon Zeller (attending) · Sat Nov 07, 2026 02:45 PM

Source document DOC-000198: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Luca Greaves   MRN: MRN48242892   Admitted: 2026-11-07 11:45
Service: Cardiology   Attending: Dr. Gideon Zeller

History of present illness: 51-year-old woman admitted with diastolic heart failure. 
Past medical history: heart failure with preserved ejection fraction, hypertension, type 2 diabetes, GERD.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. CKD stage 3a: renally dose medications.
2. Diastolic heart failure: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000197 · Viggo Ravensworth, RD (dietitian) · Sun Nov 08, 2026 02:45 PM

Cited facts from this note (8)

fat_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for fat_loss

… xt: chronic illness Intake: estimated energy intake 80% of needs for 53 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… 80% of needs for 53 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
intake_days: 53 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Luca Greaves MRN: MRN48242892 Context: chronic illness Intake: estimated energy intake 80% of needs for 53 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. R …
intake_pct: 80 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Luca Greaves MRN: MRN48242892 Context: chronic illness Intake: estimated energy intake 80% of needs for 53 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. R …
muscle_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… imated energy intake 80% of needs for 53 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
nutrition_context: chronic · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Luca Greaves MRN: MRN48242892 Context: chronic illness Intake: estimated energy intake 80% of needs for 53 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcut …
weight_loss_days: 180 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… istered Dietitian) Patient: Luca Greaves MRN: MRN48242892 Context: chronic illness Intake: estimated energy intake 80% of needs for 53 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; cal …
weight_loss_pct: 10 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… istered Dietitian) Patient: Luca Greaves MRN: MRN48242892 Context: chronic illness Intake: estimated energy intake 80% of needs for 53 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; cal …

Source document DOC-000197: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Luca Greaves   MRN: MRN48242892

Context: chronic illness
Intake: estimated energy intake 80% of needs for 53 days.
Weight history: 10.0% weight loss over 180 days.
Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation.
Recommendations: high-protein oral supplement; calorie counts; weekly weights.

Progress note · DOC-000199 · Dr. Gideon Zeller (attending) · Fri Nov 13, 2026 10:55 AM

Source document DOC-000199: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Luca Greaves   MRN: MRN48242892   Hospital day 6

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Diastolic heart failure: continue current management.
2. Moderate protein-calorie malnutrition: dietitian following, supplements.
3. Hyponatremia: trend sodium.

Attending: Dr. Gideon Zeller