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-00063: Orrin Foxhall

87M · MRN28397919 · Hospital Medicine · admitted Mon Nov 02, 2026 03:19 PM · discharged Thu Nov 05, 2026 12:26 PM · attending Dr. Cyrus Ellingham · resident Dr. Elena Nakashima · 178 cm, 128.4 kg

Documented diagnoses (current)

Principal: “sepsis” · A41.9 Sepsis, unspecified organism
“urinary tract infection” · N39.0 Urinary tract infection, site not specified
“class 3 obesity” · E66.813 Obesity, class 3
“chronic systolic heart failure” · I50.22 Chronic systolic (congestive) heart failure
“hypertension” · I10 Essential (primary) hypertension
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 872 Septicemia or severe sepsis without MV >96 hours without MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 690.

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=1.056, t.ratio_s1=1.5, creat_rise_48h=0.01, 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=1.056, t.ratio_s3=3.0, creat_peak=0.75, 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=1.056, 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=0.01, 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=M, hgb_nadir=14.57, 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=0.4, 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=0.4, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=14.57, anaemic=False	true

Chronic kidney disease

Clinical judgement required

No gap

Not documented; egfr 60 or above; ckd g1-g2 requires markers of kidney damage, which are not assessed here.

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=179, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=88.1, egfr_late=88.8	88.8
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=88.1, t.g2=60, egfr_late=88.8	false
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=88.8, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
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=False, egfr_early=88.1, egfr_late=88.8, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=88.8, t.g2=60	true

Heart failure

Criteria met

No gap

Supported as documented (I50.22).

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=67.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	false
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=False, np_elevated=False, new_o2=False	0
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=21.0, t.ref=40, t.pres=50	systolic
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=21.0, 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=0, hf_history=True	chronic
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=systolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=chronic	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=systolic, acuity=chronic	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=systolic, acuity=chronic	true

Hyponatraemia

Criteria not met

No gap

Not documented and not supported.

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=137.0, t.profound=125, t.moderate=130, t.low=135	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=137.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=137.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=137.0, t.low=135	true

Malnutrition

Criteria not met

No gap

Not documented and not supported.

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=100.0, t.a_sev_intake_pct=50, intake_days=unknown, 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=100.0, t.a_mod_intake_pct=75, intake_days=unknown, 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=unknown, wt_loss_pct=unknown	unknown
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=unknown, wt_loss_pct=unknown	unknown
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=100.0, t.c_intake_pct=75, intake_days=unknown, 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=100.0, t.c_intake_pct=75, intake_days=unknown, 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=unknown, wt_loss_pct=unknown	unknown
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=unknown, wt_loss_pct=unknown	unknown
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=100.0, wt_loss_pct=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown	4
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=acute, a_sev_intake=False, a_sev_wt=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=unknown	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=acute, a_sev_intake=False, a_mod_intake=False, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=unknown, c_mod_wt=unknown	0
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=0	false
outcome: one_characteristic	`n_moderate == 1`	n_moderate=0	false
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=0, n_assessed=4	true

Obesity

Criteria met

No gap

Supported as documented (E66.813).

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=87, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=40.5, t.c3=40	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

Clinical validation gap

Documented “sepsis” (A41.9) but the criteria are not met: Neither definition met: 0 SIRS criteria, SOFA change 0.

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=37.6, t.t_hi=38, temp_min_48h=37.0, 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=18.0, 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=8.88, t.wbc_hi=12, wbc_min_48h=8.04, 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=228.0	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=0.58	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=74.0	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=0.75	0
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=0.71	0
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=0, sofa_renal_baseline=0	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, 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=True	false
outcome: septic_shock	`shock`	shock=False	false
outcome: both	`sepsis3 and sepsis2`	sepsis3=False, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=False	false
outcome: definitions_disagree	`sepsis2`	sepsis2=False	false
outcome: neither	`true`	—	true

Structured data

Labs (24)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-002126	Wed Jan 21, 2026 09:15 AM	creatinine	0.73 mg/dL
LAB-002127	Mon Jul 20, 2026 10:05 AM	creatinine	0.71 mg/dL
LAB-002128	Mon Nov 02, 2026 04:19 PM	creatinine	0.74 mg/dL
LAB-002132	Mon Nov 02, 2026 04:19 PM	bnp	67.0 pg/mL
LAB-002133	Mon Nov 02, 2026 04:19 PM	sodium	137.0 mmol/L
LAB-002137	Mon Nov 02, 2026 04:19 PM	hemoglobin	14.74 g/dL
LAB-002141	Mon Nov 02, 2026 04:19 PM	wbc	8.25 x10^3/uL
LAB-002142	Mon Nov 02, 2026 04:19 PM	platelets	300.0 x10^3/uL
LAB-002149	Mon Nov 02, 2026 04:19 PM	bilirubin	0.58 mg/dL
LAB-002129	Tue Nov 03, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-002134	Tue Nov 03, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-002138	Tue Nov 03, 2026 05:00 AM	hemoglobin	15.01 g/dL
LAB-002143	Tue Nov 03, 2026 05:00 AM	wbc	8.04 x10^3/uL
LAB-002144	Tue Nov 03, 2026 05:00 AM	platelets	280.0 x10^3/uL
LAB-002130	Wed Nov 04, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-002135	Wed Nov 04, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-002139	Wed Nov 04, 2026 05:00 AM	hemoglobin	14.7 g/dL
LAB-002145	Wed Nov 04, 2026 05:00 AM	wbc	8.88 x10^3/uL
LAB-002146	Wed Nov 04, 2026 05:00 AM	platelets	228.0 x10^3/uL
LAB-002131	Thu Nov 05, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-002136	Thu Nov 05, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-002140	Thu Nov 05, 2026 05:00 AM	hemoglobin	14.57 g/dL
LAB-002147	Thu Nov 05, 2026 05:00 AM	wbc	6.66 x10^3/uL
LAB-002148	Thu Nov 05, 2026 05:00 AM	platelets	302.0 x10^3/uL

Vitals (54)

Vitals
Row	When	Kind	Value	Detail
VIT-006116	Mon Nov 02, 2026 03:39 PM	spo2	99.0	room air
VIT-006117	Mon Nov 02, 2026 03:39 PM	rr	15.0
VIT-006134	Mon Nov 02, 2026 03:39 PM	temp_c	37.0
VIT-006135	Mon Nov 02, 2026 03:39 PM	hr	88.0
VIT-006136	Mon Nov 02, 2026 03:39 PM	map	78.0
VIT-006137	Mon Nov 02, 2026 03:39 PM	gcs	15.0
VIT-006118	Mon Nov 02, 2026 11:39 PM	spo2	95.0	room air
VIT-006119	Mon Nov 02, 2026 11:39 PM	rr	14.0
VIT-006138	Mon Nov 02, 2026 11:39 PM	temp_c	37.3
VIT-006139	Mon Nov 02, 2026 11:39 PM	hr	77.0
VIT-006140	Mon Nov 02, 2026 11:39 PM	map	82.0
VIT-006141	Mon Nov 02, 2026 11:39 PM	gcs	15.0
VIT-006120	Tue Nov 03, 2026 07:39 AM	spo2	97.0	room air
VIT-006121	Tue Nov 03, 2026 07:39 AM	rr	14.0
VIT-006142	Tue Nov 03, 2026 07:39 AM	temp_c	37.1
VIT-006143	Tue Nov 03, 2026 07:39 AM	hr	81.0
VIT-006144	Tue Nov 03, 2026 07:39 AM	map	83.0
VIT-006145	Tue Nov 03, 2026 07:39 AM	gcs	15.0
VIT-006122	Tue Nov 03, 2026 03:39 PM	spo2	98.0	room air
VIT-006123	Tue Nov 03, 2026 03:39 PM	rr	16.0
VIT-006146	Tue Nov 03, 2026 03:39 PM	temp_c	37.1
VIT-006147	Tue Nov 03, 2026 03:39 PM	hr	84.0
VIT-006148	Tue Nov 03, 2026 03:39 PM	map	75.0
VIT-006149	Tue Nov 03, 2026 03:39 PM	gcs	15.0
VIT-006124	Tue Nov 03, 2026 11:39 PM	spo2	99.0	room air
VIT-006125	Tue Nov 03, 2026 11:39 PM	rr	18.0
VIT-006150	Tue Nov 03, 2026 11:39 PM	temp_c	37.5
VIT-006151	Tue Nov 03, 2026 11:39 PM	hr	76.0
VIT-006152	Tue Nov 03, 2026 11:39 PM	map	90.0
VIT-006153	Tue Nov 03, 2026 11:39 PM	gcs	15.0
VIT-006126	Wed Nov 04, 2026 07:39 AM	spo2	94.0	room air
VIT-006127	Wed Nov 04, 2026 07:39 AM	rr	17.0
VIT-006154	Wed Nov 04, 2026 07:39 AM	temp_c	37.6
VIT-006155	Wed Nov 04, 2026 07:39 AM	hr	77.0
VIT-006156	Wed Nov 04, 2026 07:39 AM	map	74.0
VIT-006157	Wed Nov 04, 2026 07:39 AM	gcs	15.0
VIT-006128	Wed Nov 04, 2026 03:39 PM	spo2	97.0	room air
VIT-006129	Wed Nov 04, 2026 03:39 PM	rr	20.0
VIT-006158	Wed Nov 04, 2026 03:39 PM	temp_c	37.7
VIT-006159	Wed Nov 04, 2026 03:39 PM	hr	76.0
VIT-006160	Wed Nov 04, 2026 03:39 PM	map	89.0
VIT-006161	Wed Nov 04, 2026 03:39 PM	gcs	15.0
VIT-006130	Wed Nov 04, 2026 11:39 PM	spo2	94.0	room air
VIT-006131	Wed Nov 04, 2026 11:39 PM	rr	20.0
VIT-006162	Wed Nov 04, 2026 11:39 PM	temp_c	37.5
VIT-006163	Wed Nov 04, 2026 11:39 PM	hr	77.0
VIT-006164	Wed Nov 04, 2026 11:39 PM	map	82.0
VIT-006165	Wed Nov 04, 2026 11:39 PM	gcs	15.0
VIT-006132	Thu Nov 05, 2026 07:39 AM	spo2	98.0	room air
VIT-006133	Thu Nov 05, 2026 07:39 AM	rr	16.0
VIT-006166	Thu Nov 05, 2026 07:39 AM	temp_c	37.6
VIT-006167	Thu Nov 05, 2026 07:39 AM	hr	79.0
VIT-006168	Thu Nov 05, 2026 07:39 AM	map	88.0
VIT-006169	Thu Nov 05, 2026 07:39 AM	gcs	15.0

Medications, orders, echo, history (9)

MED-000239 11-02 16:19 ceftriaxone per protocol IV
MED-000240 11-03 05:00 cefepime per protocol IV
MED-000241 11-04 05:00 piperacillin-tazobactam per protocol IV
MED-000242 11-02 09:19 furosemide 40 mg PO
MED-000243 11-03 09:00 furosemide 40 mg PO
MED-000244 11-04 09:00 furosemide 40 mg PO
ORD-000051 11-02 15:49 blood_culture: blood cultures x2
ECH-000030 2026-11-03 echo LVEF 21.0%
HX-000023 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000218 · Dr. Elena Nakashima (resident) · Mon Nov 02, 2026 06:19 PM

Cited facts from this note (1)

infection_source: urinary tract infection · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… vice: Hospital Medicine Attending: Dr. Cyrus Ellingham History of present illness: 87-year-old man admitted with sepsis. Urinalysis with pyuria; treated for urinary tract infection with cefepime. Past medical history: heart failure with reduced ejection fraction, hypertension, GERD. Review of systems otherwise negative. Exam: Lungs: scatt …

Source document DOC-000218: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Orrin Foxhall   MRN: MRN28397919   Admitted: 2026-11-02 15:19
Service: Hospital Medicine   Attending: Dr. Cyrus Ellingham

History of present illness: 87-year-old man admitted with sepsis. Urinalysis with pyuria; treated for urinary tract infection with cefepime.
Past medical history: heart failure with reduced ejection fraction, hypertension, GERD.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Sepsis: antibiotics, fluids.
2. Urinary tract infection: antibiotics.

Nutrition assessment · DOC-000217 · Viggo Ravensworth, RD (dietitian) · Tue Nov 03, 2026 09:19 PM

Cited facts from this note (5)

fat_loss: none · cited p. 1, line 7 · confidence 0.90

Show source for fat_loss

… MRN: MRN28397919 Context: acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. Assessment: well nourished; no malnutrition identified.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… e: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. Assessment: well nourished; no malnutrition identified.
intake_pct: 100 · cited p. 1, line 5 · confidence 0.90

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Orrin Foxhall MRN: MRN28397919 Context: acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. …
muscle_loss: none · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. Assessment: well nourished; no malnutrition identified.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Orrin Foxhall MRN: MRN28397919 Context: acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle was …

Source document DOC-000217: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Orrin Foxhall   MRN: MRN28397919

Context: acute illness
Intake: eating 100% of meals.
Weight history: weight stable over the past 3 months.
Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation.
Assessment: well nourished; no malnutrition identified.

Progress note · DOC-000219 · Dr. Elena Nakashima (resident) · Wed Nov 04, 2026 03:19 PM

Source document DOC-000219: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Orrin Foxhall   MRN: MRN28397919   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Sepsis: continue current management.
2. Class 3 obesity: counsel on weight.
3. Chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.

Resident: Dr. Elena Nakashima   Attending cosign: completed

Discharge summary · DOC-000220 · Dr. Cyrus Ellingham (attending) · Thu Nov 05, 2026 12:26 PM

Source document DOC-000220: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Orrin Foxhall   MRN: MRN28397919
Admitted 2026-11-02; discharged 2026-11-05.

Discharge diagnoses:
- sepsis
- urinary tract infection
- class 3 obesity
- chronic systolic heart failure
- hypertension
- GERD

Disposition: home with follow-up.