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-00064: Keira Merriweather

70F · MRN61729870 · Hospital Medicine · admitted Sat Nov 07, 2026 08:22 AM · in hospital · attending Dr. Cyrus Ellingham · resident Dr. Keira Upfield · 152 cm, 44.6 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“anemia” · D64.9 Anemia, unspecified
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 195 Simple pneumonia and pleurisy without CC/MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 193.

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=0.04, 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=0.76, 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=0.04, 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 met

Specificity gap

Documented “anemia” (D64.9); criteria support the more specific Acute blood loss anemia (D62).

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=8.94, t.hb_m=13, t.hb_f=12	true
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=3.3, t.drop_major=2.0, prbc_units=2, t.prbc_major=2	true
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=True	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=190, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=91.4, egfr_late=89.9	91.4
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=91.4, t.g2=60, egfr_late=89.9	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=91.4, 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=91.4, egfr_late=89.9, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=91.4, t.g2=60	true

Heart failure

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=unknown, 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=unknown, t.ref=40, t.pres=50	unknown
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=unknown, 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=False	unknown
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=unknown	unknown
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: one_indicator	`acute_count == 1`	acute_count=0	false

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=136.0, 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=136.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, t.low=135	true

Malnutrition

Criteria met

Specificity gap

Criteria support Severe protein-calorie malnutrition (chronic illness context) (E43); no corresponding diagnosis is documented.

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=60.0, t.a_sev_intake_pct=50, intake_days=55.0, 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=60.0, t.a_mod_intake_pct=75, intake_days=55.0, t.a_mod_intake_days=7	true
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=12.8	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=12.8	false
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=60.0, t.c_intake_pct=75, intake_days=55.0, t.c_intake_days=30	true
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=60.0, t.c_intake_pct=75, intake_days=55.0, t.c_intake_days=30	true
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=12.8	true
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=12.8	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=60.0, wt_loss_pct=12.8, fat_loss=3, muscle_loss=2, 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=3, muscle_loss=2, fluid=0, grip_reduced=unknown, c_sev_intake=True, c_sev_wt=True	3
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=True, a_sev_wt=False, a_mod_wt=False, fat_loss=3, muscle_loss=2, fluid=0, grip_reduced=unknown, c_sev_intake=True, c_mod_intake=True, c_sev_wt=True, c_mod_wt=True	4
outcome: severe	`n_severe >= 2`	n_severe=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=70, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=19.3, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=19.3, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=19.3, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=19.3, 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=95.0, 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=95.0, 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=37.6, t.t_hi=38, temp_min_48h=36.8, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=89.0, 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=10.9, t.wbc_hi=12, wbc_min_48h=6.97, 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=205.0	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=0.57	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=0.76	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=0.72	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 (38)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-002150	Tue Jan 06, 2026 09:15 AM	creatinine	0.71 mg/dL
LAB-002151	Thu Jul 16, 2026 10:05 AM	creatinine	0.72 mg/dL
LAB-002152	Sat Nov 07, 2026 09:22 AM	creatinine	0.72 mg/dL
LAB-002159	Sat Nov 07, 2026 09:22 AM	sodium	142.0 mmol/L
LAB-002166	Sat Nov 07, 2026 09:22 AM	hemoglobin	12.28 g/dL
LAB-002173	Sat Nov 07, 2026 09:22 AM	wbc	6.97 x10^3/uL
LAB-002174	Sat Nov 07, 2026 09:22 AM	platelets	276.0 x10^3/uL
LAB-002187	Sat Nov 07, 2026 09:22 AM	bilirubin	0.57 mg/dL
LAB-002153	Sun Nov 08, 2026 05:00 AM	creatinine	0.76 mg/dL
LAB-002160	Sun Nov 08, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-002167	Sun Nov 08, 2026 05:00 AM	hemoglobin	10.28 g/dL
LAB-002175	Sun Nov 08, 2026 05:00 AM	wbc	10.9 x10^3/uL
LAB-002176	Sun Nov 08, 2026 05:00 AM	platelets	205.0 x10^3/uL
LAB-002154	Mon Nov 09, 2026 05:00 AM	creatinine	0.73 mg/dL
LAB-002161	Mon Nov 09, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-002168	Mon Nov 09, 2026 05:00 AM	hemoglobin	8.94 g/dL
LAB-002177	Mon Nov 09, 2026 05:00 AM	wbc	7.92 x10^3/uL
LAB-002178	Mon Nov 09, 2026 05:00 AM	platelets	237.0 x10^3/uL
LAB-002155	Tue Nov 10, 2026 05:00 AM	creatinine	0.71 mg/dL
LAB-002162	Tue Nov 10, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-002169	Tue Nov 10, 2026 05:00 AM	hemoglobin	9.74 g/dL
LAB-002179	Tue Nov 10, 2026 05:00 AM	wbc	6.84 x10^3/uL
LAB-002180	Tue Nov 10, 2026 05:00 AM	platelets	171.0 x10^3/uL
LAB-002156	Wed Nov 11, 2026 05:00 AM	creatinine	0.72 mg/dL
LAB-002163	Wed Nov 11, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-002170	Wed Nov 11, 2026 05:00 AM	hemoglobin	10.04 g/dL
LAB-002181	Wed Nov 11, 2026 05:00 AM	wbc	9.54 x10^3/uL
LAB-002182	Wed Nov 11, 2026 05:00 AM	platelets	179.0 x10^3/uL
LAB-002157	Thu Nov 12, 2026 05:00 AM	creatinine	0.71 mg/dL
LAB-002164	Thu Nov 12, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-002171	Thu Nov 12, 2026 05:00 AM	hemoglobin	10.14 g/dL
LAB-002183	Thu Nov 12, 2026 05:00 AM	wbc	8.61 x10^3/uL
LAB-002184	Thu Nov 12, 2026 05:00 AM	platelets	272.0 x10^3/uL
LAB-002158	Fri Nov 13, 2026 05:00 AM	creatinine	0.73 mg/dL
LAB-002165	Fri Nov 13, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-002172	Fri Nov 13, 2026 05:00 AM	hemoglobin	10.14 g/dL
LAB-002185	Fri Nov 13, 2026 05:00 AM	wbc	8.38 x10^3/uL
LAB-002186	Fri Nov 13, 2026 05:00 AM	platelets	273.0 x10^3/uL

Vitals (120)

Vitals
Row	When	Kind	Value	Detail
VIT-006170	Sat Nov 07, 2026 08:42 AM	spo2	97.0	room air
VIT-006171	Sat Nov 07, 2026 08:42 AM	rr	20.0
VIT-006210	Sat Nov 07, 2026 08:42 AM	temp_c	36.8
VIT-006211	Sat Nov 07, 2026 08:42 AM	hr	71.0
VIT-006212	Sat Nov 07, 2026 08:42 AM	map	83.0
VIT-006213	Sat Nov 07, 2026 08:42 AM	gcs	15.0
VIT-006172	Sat Nov 07, 2026 04:42 PM	spo2	96.0	room air
VIT-006173	Sat Nov 07, 2026 04:42 PM	rr	15.0
VIT-006214	Sat Nov 07, 2026 04:42 PM	temp_c	37.6
VIT-006215	Sat Nov 07, 2026 04:42 PM	hr	69.0
VIT-006216	Sat Nov 07, 2026 04:42 PM	map	79.0
VIT-006217	Sat Nov 07, 2026 04:42 PM	gcs	15.0
VIT-006174	Sun Nov 08, 2026 12:42 AM	spo2	99.0	room air
VIT-006175	Sun Nov 08, 2026 12:42 AM	rr	15.0
VIT-006218	Sun Nov 08, 2026 12:42 AM	temp_c	36.8
VIT-006219	Sun Nov 08, 2026 12:42 AM	hr	71.0
VIT-006220	Sun Nov 08, 2026 12:42 AM	map	77.0
VIT-006221	Sun Nov 08, 2026 12:42 AM	gcs	15.0
VIT-006176	Sun Nov 08, 2026 08:42 AM	spo2	95.0	room air
VIT-006177	Sun Nov 08, 2026 08:42 AM	rr	17.0
VIT-006222	Sun Nov 08, 2026 08:42 AM	temp_c	37.6
VIT-006223	Sun Nov 08, 2026 08:42 AM	hr	89.0
VIT-006224	Sun Nov 08, 2026 08:42 AM	map	92.0
VIT-006225	Sun Nov 08, 2026 08:42 AM	gcs	15.0
VIT-006178	Sun Nov 08, 2026 04:42 PM	spo2	96.0	room air
VIT-006179	Sun Nov 08, 2026 04:42 PM	rr	14.0
VIT-006226	Sun Nov 08, 2026 04:42 PM	temp_c	37.6
VIT-006227	Sun Nov 08, 2026 04:42 PM	hr	89.0
VIT-006228	Sun Nov 08, 2026 04:42 PM	map	74.0
VIT-006229	Sun Nov 08, 2026 04:42 PM	gcs	15.0
VIT-006180	Mon Nov 09, 2026 12:42 AM	spo2	97.0	room air
VIT-006181	Mon Nov 09, 2026 12:42 AM	rr	19.0
VIT-006230	Mon Nov 09, 2026 12:42 AM	temp_c	37.3
VIT-006231	Mon Nov 09, 2026 12:42 AM	hr	87.0
VIT-006232	Mon Nov 09, 2026 12:42 AM	map	90.0
VIT-006233	Mon Nov 09, 2026 12:42 AM	gcs	15.0
VIT-006182	Mon Nov 09, 2026 08:42 AM	spo2	99.0	room air
VIT-006183	Mon Nov 09, 2026 08:42 AM	rr	19.0
VIT-006234	Mon Nov 09, 2026 08:42 AM	temp_c	36.6
VIT-006235	Mon Nov 09, 2026 08:42 AM	hr	74.0
VIT-006236	Mon Nov 09, 2026 08:42 AM	map	86.0
VIT-006237	Mon Nov 09, 2026 08:42 AM	gcs	15.0
VIT-006184	Mon Nov 09, 2026 04:42 PM	spo2	95.0	room air
VIT-006185	Mon Nov 09, 2026 04:42 PM	rr	18.0
VIT-006238	Mon Nov 09, 2026 04:42 PM	temp_c	37.1
VIT-006239	Mon Nov 09, 2026 04:42 PM	hr	86.0
VIT-006240	Mon Nov 09, 2026 04:42 PM	map	85.0
VIT-006241	Mon Nov 09, 2026 04:42 PM	gcs	15.0
VIT-006186	Tue Nov 10, 2026 12:42 AM	spo2	95.0	room air
VIT-006187	Tue Nov 10, 2026 12:42 AM	rr	20.0
VIT-006242	Tue Nov 10, 2026 12:42 AM	temp_c	36.7
VIT-006243	Tue Nov 10, 2026 12:42 AM	hr	88.0
VIT-006244	Tue Nov 10, 2026 12:42 AM	map	83.0
VIT-006245	Tue Nov 10, 2026 12:42 AM	gcs	15.0
VIT-006188	Tue Nov 10, 2026 08:42 AM	spo2	97.0	room air
VIT-006189	Tue Nov 10, 2026 08:42 AM	rr	14.0
VIT-006246	Tue Nov 10, 2026 08:42 AM	temp_c	37.1
VIT-006247	Tue Nov 10, 2026 08:42 AM	hr	72.0
VIT-006248	Tue Nov 10, 2026 08:42 AM	map	91.0
VIT-006249	Tue Nov 10, 2026 08:42 AM	gcs	15.0
VIT-006190	Tue Nov 10, 2026 04:42 PM	spo2	95.0	room air
VIT-006191	Tue Nov 10, 2026 04:42 PM	rr	14.0
VIT-006250	Tue Nov 10, 2026 04:42 PM	temp_c	37.0
VIT-006251	Tue Nov 10, 2026 04:42 PM	hr	75.0
VIT-006252	Tue Nov 10, 2026 04:42 PM	map	74.0
VIT-006253	Tue Nov 10, 2026 04:42 PM	gcs	15.0
VIT-006192	Wed Nov 11, 2026 12:42 AM	spo2	98.0	room air
VIT-006193	Wed Nov 11, 2026 12:42 AM	rr	15.0
VIT-006254	Wed Nov 11, 2026 12:42 AM	temp_c	37.1
VIT-006255	Wed Nov 11, 2026 12:42 AM	hr	90.0
VIT-006256	Wed Nov 11, 2026 12:42 AM	map	78.0
VIT-006257	Wed Nov 11, 2026 12:42 AM	gcs	15.0
VIT-006194	Wed Nov 11, 2026 08:42 AM	spo2	97.0	room air
VIT-006195	Wed Nov 11, 2026 08:42 AM	rr	19.0
VIT-006258	Wed Nov 11, 2026 08:42 AM	temp_c	36.8
VIT-006259	Wed Nov 11, 2026 08:42 AM	hr	73.0
VIT-006260	Wed Nov 11, 2026 08:42 AM	map	80.0
VIT-006261	Wed Nov 11, 2026 08:42 AM	gcs	15.0
VIT-006196	Wed Nov 11, 2026 04:42 PM	spo2	96.0	room air
VIT-006197	Wed Nov 11, 2026 04:42 PM	rr	15.0
VIT-006262	Wed Nov 11, 2026 04:42 PM	temp_c	36.5
VIT-006263	Wed Nov 11, 2026 04:42 PM	hr	81.0
VIT-006264	Wed Nov 11, 2026 04:42 PM	map	77.0
VIT-006265	Wed Nov 11, 2026 04:42 PM	gcs	15.0
VIT-006198	Thu Nov 12, 2026 12:42 AM	spo2	99.0	room air
VIT-006199	Thu Nov 12, 2026 12:42 AM	rr	19.0
VIT-006266	Thu Nov 12, 2026 12:42 AM	temp_c	37.2
VIT-006267	Thu Nov 12, 2026 12:42 AM	hr	72.0
VIT-006268	Thu Nov 12, 2026 12:42 AM	map	89.0
VIT-006269	Thu Nov 12, 2026 12:42 AM	gcs	15.0
VIT-006200	Thu Nov 12, 2026 08:42 AM	spo2	96.0	room air
VIT-006201	Thu Nov 12, 2026 08:42 AM	rr	19.0
VIT-006270	Thu Nov 12, 2026 08:42 AM	temp_c	37.0
VIT-006271	Thu Nov 12, 2026 08:42 AM	hr	87.0
VIT-006272	Thu Nov 12, 2026 08:42 AM	map	89.0
VIT-006273	Thu Nov 12, 2026 08:42 AM	gcs	15.0
VIT-006202	Thu Nov 12, 2026 04:42 PM	spo2	95.0	room air
VIT-006203	Thu Nov 12, 2026 04:42 PM	rr	15.0
VIT-006274	Thu Nov 12, 2026 04:42 PM	temp_c	37.5
VIT-006275	Thu Nov 12, 2026 04:42 PM	hr	71.0
VIT-006276	Thu Nov 12, 2026 04:42 PM	map	85.0
VIT-006277	Thu Nov 12, 2026 04:42 PM	gcs	15.0
VIT-006204	Fri Nov 13, 2026 12:42 AM	spo2	99.0	room air
VIT-006205	Fri Nov 13, 2026 12:42 AM	rr	19.0
VIT-006278	Fri Nov 13, 2026 12:42 AM	temp_c	37.4
VIT-006279	Fri Nov 13, 2026 12:42 AM	hr	69.0
VIT-006280	Fri Nov 13, 2026 12:42 AM	map	82.0
VIT-006281	Fri Nov 13, 2026 12:42 AM	gcs	15.0
VIT-006206	Fri Nov 13, 2026 08:42 AM	spo2	96.0	room air
VIT-006207	Fri Nov 13, 2026 08:42 AM	rr	16.0
VIT-006282	Fri Nov 13, 2026 08:42 AM	temp_c	36.7
VIT-006283	Fri Nov 13, 2026 08:42 AM	hr	76.0
VIT-006284	Fri Nov 13, 2026 08:42 AM	map	90.0
VIT-006285	Fri Nov 13, 2026 08:42 AM	gcs	15.0
VIT-006208	Fri Nov 13, 2026 04:42 PM	spo2	98.0	room air
VIT-006209	Fri Nov 13, 2026 04:42 PM	rr	15.0
VIT-006286	Fri Nov 13, 2026 04:42 PM	temp_c	37.5
VIT-006287	Fri Nov 13, 2026 04:42 PM	hr	81.0
VIT-006288	Fri Nov 13, 2026 04:42 PM	map	75.0
VIT-006289	Fri Nov 13, 2026 04:42 PM	gcs	15.0

Medications, orders, echo, history (5)

MED-000245 11-07 09:22 ceftriaxone per protocol IV
MED-000246 11-08 05:00 cefepime per protocol IV
MED-000247 11-09 05:00 ceftriaxone per protocol IV
ORD-000052 11-07 08:52 blood_culture: blood cultures x2
ORD-000053 11-08 09:00 transfusion_prbc: transfuse PRBC

Notes

History and physical · DOC-000222 · Dr. Keira Upfield (resident) · Sat Nov 07, 2026 11:22 AM

Cited facts from this note (2)

bleeding_source: black tarry stools · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… dmitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by black tarry stools. Past medical history: hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: scattered crackles at the bases, no distress. Assessment and plan: 1. …
infection_source: multifocal pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… Hospital Medicine Attending: Dr. Cyrus Ellingham History of present illness: 70-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by black tarry stools. Past medical history: hyperlipidemia. Review of systems other …

Source document DOC-000222: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Keira Merriweather   MRN: MRN61729870   Admitted: 2026-11-07 08:22
Service: Hospital Medicine   Attending: Dr. Cyrus Ellingham

History of present illness: 70-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by black tarry stools.
Past medical history: hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.

Nutrition assessment · DOC-000221 · Viggo Ravensworth, RD (dietitian) · Sun Nov 08, 2026 01:22 PM

Cited facts from this note (8)

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

Show source for fat_loss

… xt: chronic illness Intake: estimated energy intake 60% of needs for 55 days. Weight history: 12.8% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate 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

… needs for 55 days. Weight history: 12.8% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
intake_days: 55 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Keira Merriweather MRN: MRN61729870 Context: chronic illness Intake: estimated energy intake 60% of needs for 55 days. Weight history: 12.8% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulat …
intake_pct: 60 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Keira Merriweather MRN: MRN61729870 Context: chronic illness Intake: estimated energy intake 60% of needs for 55 days. Weight history: 12.8% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulat …
muscle_loss: moderate · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… ated energy intake 60% of needs for 55 days. Weight history: 12.8% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate 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: Keira Merriweather MRN: MRN61729870 Context: chronic illness Intake: estimated energy intake 60% of needs for 55 days. Weight history: 12.8% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subc …
weight_loss_days: 180 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… d Dietitian) Patient: Keira Merriweather MRN: MRN61729870 Context: chronic illness Intake: estimated energy intake 60% of needs for 55 days. Weight history: 12.8% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplemen …
weight_loss_pct: 12.8 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… d Dietitian) Patient: Keira Merriweather MRN: MRN61729870 Context: chronic illness Intake: estimated energy intake 60% of needs for 55 days. Weight history: 12.8% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplemen …

Source document DOC-000221: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Keira Merriweather   MRN: MRN61729870

Context: chronic illness
Intake: estimated energy intake 60% of needs for 55 days.
Weight history: 12.8% weight loss over 180 days.
Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation.
Recommendations: high-protein oral supplement; calorie counts; weekly weights.

Progress note · DOC-000223 · Dr. Keira Upfield (resident) · Fri Nov 13, 2026 10:55 AM · awaiting cosign

Source document DOC-000223: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Keira Merriweather   MRN: MRN61729870   Hospital day 7

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Community-acquired pneumonia: continue current management.
2. Anemia: trend hemoglobin.

Resident: Dr. Keira Upfield   Attending cosign: pending