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-00065: Lena Upfield

51M · MRN63913217 · Hospital Medicine · admitted Tue Nov 10, 2026 03:47 PM · in hospital · attending Dr. Rosalind Quillan · resident Dr. Camila Oyelaran · 173 cm, 54.4 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“severe malnutrition” · E43 Unspecified severe protein-calorie malnutrition
“chronic kidney disease” · N18.9 Chronic kidney disease, unspecified
“diastolic heart failure” · I50.30 Unspecified diastolic (congestive) heart failure
“hypoxemia” · R09.02 Hypoxemia
“anemia” · D64.9 Anemia, unspecified

Illustrative grouping now: MS-DRG 193 Simple pneumonia and pleurisy with 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=1.06, t.ratio_s1=1.5, creat_rise_48h=0.17, 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=1.06, t.ratio_s3=3.0, creat_peak=3.71, 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=1.06, 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=0.17, 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=M, hgb_nadir=10.71, 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=2.9, 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

Criteria met

Specificity gap

Documented “chronic kidney disease” (N18.9); criteria support the more specific Chronic kidney disease stage 4 (N18.4).

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=253, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=25.6, egfr_late=20.3	25.6
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=25.6, t.g2=60, egfr_late=20.3	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=25.6, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G4
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=25.6, egfr_late=20.3, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=25.6, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G4	false
outcome: g3b	`category == 'G3b'`	category=G4	false
outcome: g4	`category == 'G4'`	category=G4	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=1284.0, 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=True	3
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=56.0, 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=56.0, 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=3, 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

Specificity gap

Criteria support Hyponatraemia (moderate) (E87.1); no corresponding diagnosis is documented.

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=128.0, t.profound=125, t.moderate=130, t.low=135	moderate
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=128.0, t.low=135, na_low_count=4, t.repeat=2, na_treated=True	true

Malnutrition

Criteria met

Clinical validation gap

Documented “severe malnutrition” (E43) conflicts with what the criteria support (Moderate (non-severe) protein-calorie malnutrition (chronic illness context), 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=unknown, t.a_sev_intake_pct=50, intake_days=unknown, t.a_sev_intake_days=5	unknown
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=unknown, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7	unknown
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=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
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=unknown, wt_loss_pct=unknown, fat_loss=1, muscle_loss=1, fluid=unknown, grip_reduced=unknown	2
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=unknown, a_sev_wt=unknown, fat_loss=1, muscle_loss=1, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, 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=chronic, a_sev_intake=unknown, a_mod_intake=unknown, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=1, muscle_loss=1, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_mod_intake=unknown, c_sev_wt=unknown, c_mod_wt=unknown	2
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=2	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=18.2, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=18.2, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=18.2, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=18.2, 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

Clinical judgement required

Clinical judgement required: Hypoxaemia without a charted sign of respiratory distress.

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=87.0, 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=87.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=23.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=True	false
outcome: met	`hypoxemia and distress`	hypoxemia=True, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=True	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=36.7, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=90.0, 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=23.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	true
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=10.11, t.wbc_hi=12, wbc_min_48h=6.19, 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=True, sirs_wbc=False	1
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=238.0	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=0.4	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=76.0	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=3.67	3
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=3.5	3
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=3, sofa_renal_baseline=3	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=1, 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-002188	Wed Dec 03, 2025 09:15 AM	creatinine	2.88 mg/dL
LAB-002189	Fri Aug 14, 2026 10:05 AM	creatinine	3.5 mg/dL
LAB-002190	Tue Nov 10, 2026 04:47 PM	creatinine	3.5 mg/dL
LAB-002194	Tue Nov 10, 2026 04:47 PM	bnp	1284.0 pg/mL
LAB-002195	Tue Nov 10, 2026 04:47 PM	sodium	130.0 mmol/L
LAB-002199	Tue Nov 10, 2026 04:47 PM	hemoglobin	13.57 g/dL
LAB-002203	Tue Nov 10, 2026 04:47 PM	wbc	10.11 x10^3/uL
LAB-002204	Tue Nov 10, 2026 04:47 PM	platelets	296.0 x10^3/uL
LAB-002211	Tue Nov 10, 2026 04:47 PM	bilirubin	0.4 mg/dL
LAB-002191	Wed Nov 11, 2026 05:00 AM	creatinine	3.67 mg/dL
LAB-002196	Wed Nov 11, 2026 05:00 AM	sodium	128.0 mmol/L
LAB-002200	Wed Nov 11, 2026 05:00 AM	hemoglobin	11.86 g/dL
LAB-002205	Wed Nov 11, 2026 05:00 AM	wbc	6.19 x10^3/uL
LAB-002206	Wed Nov 11, 2026 05:00 AM	platelets	238.0 x10^3/uL
LAB-002192	Thu Nov 12, 2026 05:00 AM	creatinine	3.56 mg/dL
LAB-002197	Thu Nov 12, 2026 05:00 AM	sodium	129.0 mmol/L
LAB-002201	Thu Nov 12, 2026 05:00 AM	hemoglobin	10.71 g/dL
LAB-002207	Thu Nov 12, 2026 05:00 AM	wbc	9.74 x10^3/uL
LAB-002208	Thu Nov 12, 2026 05:00 AM	platelets	243.0 x10^3/uL
LAB-002193	Fri Nov 13, 2026 05:00 AM	creatinine	3.71 mg/dL
LAB-002198	Fri Nov 13, 2026 05:00 AM	sodium	132.0 mmol/L
LAB-002202	Fri Nov 13, 2026 05:00 AM	hemoglobin	11.51 g/dL
LAB-002209	Fri Nov 13, 2026 05:00 AM	wbc	8.27 x10^3/uL
LAB-002210	Fri Nov 13, 2026 05:00 AM	platelets	301.0 x10^3/uL

Vitals (69)

Vitals
Row	When	Kind	Value	Detail
VIT-006290	Tue Nov 10, 2026 04:07 PM	spo2	87.0	room air
VIT-006291	Tue Nov 10, 2026 04:07 PM	rr	23.0
VIT-006319	Tue Nov 10, 2026 04:07 PM	temp_c	37.4
VIT-006320	Tue Nov 10, 2026 04:07 PM	hr	79.0
VIT-006321	Tue Nov 10, 2026 04:07 PM	map	88.0
VIT-006322	Tue Nov 10, 2026 04:07 PM	gcs	15.0
VIT-006292	Wed Nov 11, 2026 12:07 AM	spo2	96.0	nasal cannula
VIT-006293	Wed Nov 11, 2026 12:07 AM	rr	21.0
VIT-006294	Wed Nov 11, 2026 12:07 AM	o2_lpm	2.0	nasal cannula
VIT-006323	Wed Nov 11, 2026 12:07 AM	temp_c	37.0
VIT-006324	Wed Nov 11, 2026 12:07 AM	hr	90.0
VIT-006325	Wed Nov 11, 2026 12:07 AM	map	92.0
VIT-006326	Wed Nov 11, 2026 12:07 AM	gcs	15.0
VIT-006295	Wed Nov 11, 2026 08:07 AM	spo2	96.0	nasal cannula
VIT-006296	Wed Nov 11, 2026 08:07 AM	rr	21.0
VIT-006297	Wed Nov 11, 2026 08:07 AM	o2_lpm	2.0	nasal cannula
VIT-006327	Wed Nov 11, 2026 08:07 AM	temp_c	36.7
VIT-006328	Wed Nov 11, 2026 08:07 AM	hr	69.0
VIT-006329	Wed Nov 11, 2026 08:07 AM	map	82.0
VIT-006330	Wed Nov 11, 2026 08:07 AM	gcs	15.0
VIT-006298	Wed Nov 11, 2026 04:07 PM	spo2	94.0	nasal cannula
VIT-006299	Wed Nov 11, 2026 04:07 PM	rr	21.0
VIT-006300	Wed Nov 11, 2026 04:07 PM	o2_lpm	2.0	nasal cannula
VIT-006331	Wed Nov 11, 2026 04:07 PM	temp_c	37.3
VIT-006332	Wed Nov 11, 2026 04:07 PM	hr	76.0
VIT-006333	Wed Nov 11, 2026 04:07 PM	map	80.0
VIT-006334	Wed Nov 11, 2026 04:07 PM	gcs	15.0
VIT-006301	Thu Nov 12, 2026 12:07 AM	spo2	96.0	nasal cannula
VIT-006302	Thu Nov 12, 2026 12:07 AM	rr	19.0
VIT-006303	Thu Nov 12, 2026 12:07 AM	o2_lpm	2.0	nasal cannula
VIT-006335	Thu Nov 12, 2026 12:07 AM	temp_c	37.4
VIT-006336	Thu Nov 12, 2026 12:07 AM	hr	75.0
VIT-006337	Thu Nov 12, 2026 12:07 AM	map	76.0
VIT-006338	Thu Nov 12, 2026 12:07 AM	gcs	15.0
VIT-006304	Thu Nov 12, 2026 08:07 AM	spo2	96.0	nasal cannula
VIT-006305	Thu Nov 12, 2026 08:07 AM	rr	21.0
VIT-006306	Thu Nov 12, 2026 08:07 AM	o2_lpm	2.0	nasal cannula
VIT-006339	Thu Nov 12, 2026 08:07 AM	temp_c	36.8
VIT-006340	Thu Nov 12, 2026 08:07 AM	hr	84.0
VIT-006341	Thu Nov 12, 2026 08:07 AM	map	84.0
VIT-006342	Thu Nov 12, 2026 08:07 AM	gcs	15.0
VIT-006307	Thu Nov 12, 2026 04:07 PM	spo2	92.0	nasal cannula
VIT-006308	Thu Nov 12, 2026 04:07 PM	rr	22.0
VIT-006309	Thu Nov 12, 2026 04:07 PM	o2_lpm	2.0	nasal cannula
VIT-006343	Thu Nov 12, 2026 04:07 PM	temp_c	36.9
VIT-006344	Thu Nov 12, 2026 04:07 PM	hr	79.0
VIT-006345	Thu Nov 12, 2026 04:07 PM	map	79.0
VIT-006346	Thu Nov 12, 2026 04:07 PM	gcs	15.0
VIT-006310	Fri Nov 13, 2026 12:07 AM	spo2	95.0	nasal cannula
VIT-006311	Fri Nov 13, 2026 12:07 AM	rr	21.0
VIT-006312	Fri Nov 13, 2026 12:07 AM	o2_lpm	2.0	nasal cannula
VIT-006347	Fri Nov 13, 2026 12:07 AM	temp_c	37.4
VIT-006348	Fri Nov 13, 2026 12:07 AM	hr	83.0
VIT-006349	Fri Nov 13, 2026 12:07 AM	map	88.0
VIT-006350	Fri Nov 13, 2026 12:07 AM	gcs	15.0
VIT-006313	Fri Nov 13, 2026 08:07 AM	spo2	94.0	nasal cannula
VIT-006314	Fri Nov 13, 2026 08:07 AM	rr	23.0
VIT-006315	Fri Nov 13, 2026 08:07 AM	o2_lpm	2.0	nasal cannula
VIT-006351	Fri Nov 13, 2026 08:07 AM	temp_c	36.7
VIT-006352	Fri Nov 13, 2026 08:07 AM	hr	68.0
VIT-006353	Fri Nov 13, 2026 08:07 AM	map	84.0
VIT-006354	Fri Nov 13, 2026 08:07 AM	gcs	15.0
VIT-006316	Fri Nov 13, 2026 04:07 PM	spo2	94.0	nasal cannula
VIT-006317	Fri Nov 13, 2026 04:07 PM	rr	19.0
VIT-006318	Fri Nov 13, 2026 04:07 PM	o2_lpm	2.0	nasal cannula
VIT-006355	Fri Nov 13, 2026 04:07 PM	temp_c	37.4
VIT-006356	Fri Nov 13, 2026 04:07 PM	hr	68.0
VIT-006357	Fri Nov 13, 2026 04:07 PM	map	85.0
VIT-006358	Fri Nov 13, 2026 04:07 PM	gcs	15.0

Medications, orders, echo, history (14)

MED-000248 11-10 16:47 ceftriaxone per protocol IV
MED-000249 11-11 05:00 piperacillin-tazobactam per protocol IV
MED-000250 11-12 05:00 cefepime per protocol IV
MED-000251 11-10 08:00 furosemide 40 mg IV
MED-000252 11-10 20:00 furosemide 40 mg IV
MED-000253 11-11 08:00 furosemide 40 mg IV
MED-000254 11-11 20:00 furosemide 40 mg IV
MED-000255 11-12 08:00 furosemide 40 mg IV
MED-000256 11-12 20:00 furosemide 40 mg IV
ORD-000054 11-10 16:17 blood_culture: blood cultures x2
ORD-000055 11-10 18:47 fluid_restriction: fluid restriction 1.2 L/day
ORD-000056 11-11 09:00 transfusion_prbc: transfuse PRBC
ECH-000031 2026-11-11 echo LVEF 56.0%
HX-000024 history: heart failure with preserved ejection fraction

Notes

History and physical · DOC-000225 · Dr. Camila Oyelaran (resident) · Tue Nov 10, 2026 06:47 PM

Cited facts from this note (2)

bleeding_source: bright red blood per rectum · 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 bright red blood per rectum. Past medical history: heart failure with preserved ejection fraction. Review of systems otherwise negative. Exam: Lungs: scattered crackles at the bases, no d …
infection_source: multifocal pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… Hospital Medicine Attending: Dr. Rosalind Quillan History of present illness: 51-year-old man admitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by bright red blood per rectum. Past medical history: heart failure with preserved e …

Source document DOC-000225: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Lena Upfield   MRN: MRN63913217   Admitted: 2026-11-10 15:47
Service: Hospital Medicine   Attending: Dr. Rosalind Quillan

History of present illness: 51-year-old man admitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by bright red blood per rectum.
Past medical history: heart failure with preserved ejection fraction.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.
2. Chronic kidney disease: renally dose medications.

Nutrition assessment · DOC-000224 · Viggo Ravensworth, RD (dietitian) · Wed Nov 11, 2026 06:47 PM

Cited facts from this note (3)

fat_loss: mild · cited p. 1, line 3 · confidence 0.90

Show source for fat_loss

… in the setting of chronic illness. Eating about half of meals for the past 7 weeks. Weight 54.4 kg, down from 60.5 kg three months ago. Mild temporal wasting; mild fat loss at the triceps. No edema. Hand grip not assessed. Plan: oral supplement twice daily; recheck weight weekly.
muscle_loss: mild · cited p. 1, line 3 · confidence 0.90

Show source for muscle_loss

… follow-up note Pt seen in the setting of chronic illness. Eating about half of meals for the past 7 weeks. Weight 54.4 kg, down from 60.5 kg three months ago. Mild temporal wasting; mild fat loss at the triceps. No edema. Hand grip not assessed. Plan: oral supplement twice daily; recheck weight weekly.
nutrition_context: chronic · cited p. 1, line 3 · confidence 0.80

Show source for nutrition_context

RD follow-up note Pt seen in the setting of chronic illness. Eating about half of meals for the past 7 weeks. Weight 54.4 kg, down from 60.5 kg three months ago. Mild temporal wasting; mild fat loss at the triceps. No e …

Source document DOC-000224: Nutrition assessment (synthetic)

RD follow-up note

Pt seen in the setting of chronic illness. Eating about half of meals for the past 7 weeks. Weight 54.4 kg, down from 60.5 kg three months ago. Mild temporal wasting; mild fat loss at the triceps. No edema. Hand grip not assessed.
Plan: oral supplement twice daily; recheck weight weekly.

Progress note · DOC-000226 · Dr. Camila Oyelaran (resident) · Fri Nov 13, 2026 01:55 PM · awaiting cosign

Source document DOC-000226: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Lena Upfield   MRN: MRN63913217   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Community-acquired pneumonia: continue current management.
2. Severe malnutrition: dietitian following, supplements.
3. Diastolic heart failure: diuresis and daily weights; monitor electrolytes.
4. Hypoxemia: supplemental oxygen, wean as tolerated.
5. Anemia: trend hemoglobin.

Resident: Dr. Camila Oyelaran   Attending cosign: pending