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-00071: Mara Okafor

83F · MRN19598507 · Hospital Medicine · admitted Sat Nov 07, 2026 08:52 AM · in hospital · attending Dr. Cyrus Ellingham · resident Dr. Keira Upfield · 161 cm, 75.1 kg

Documented diagnoses (current)

Principal: “sepsis” · A41.9 Sepsis, unspecified organism
“community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“hypertension” · I10 Essential (primary) hypertension

Illustrative grouping now: MS-DRG 871 Septicemia or severe sepsis without MV >96 hours with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 871.

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=1.053, t.ratio_s1=1.5, creat_rise_48h=0.05, 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=1.053, t.ratio_s3=3.0, creat_peak=0.79, 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=1.053, 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=0.05, 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=12.7, 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=12.7, 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=250, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=76.5, egfr_late=78.9	78.9
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=76.5, t.g2=60, egfr_late=78.9	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=78.9, 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=76.5, egfr_late=78.9, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=78.9, 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=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 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=83, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=29.0, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=29.0, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=29.0, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=29.0, 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 met

No gap

Supported as documented (A41.9).

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=39.2, t.t_hi=38, temp_min_48h=38.5, t.t_lo=36	true
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=120.0, t.hr=90	true
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=18.82, t.wbc_hi=12, wbc_min_48h=15.55, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	true
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=True, sirs_hr=True, sirs_rr=False, sirs_wbc=True	3
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=86.0	2
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=0.61	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=64.0	1
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=0.78	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=0.75	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=2, sofa_liver=0, sofa_cardio=1, sofa_cns=0, sofa_renal=0, sofa_renal_baseline=0	3
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=3, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, sirs_count=3, t.sirs_min=2	true
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=True, norepi_max_48h=0.0, lactate_max_48h=2.99, 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=True, sepsis2=True	true

Structured data

Labs (39)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-002410	Thu Jan 29, 2026 09:15 AM	creatinine	0.77 mg/dL
LAB-002411	Wed Oct 07, 2026 10:05 AM	creatinine	0.75 mg/dL
LAB-002412	Sat Nov 07, 2026 09:52 AM	creatinine	0.78 mg/dL
LAB-002419	Sat Nov 07, 2026 09:52 AM	sodium	142.0 mmol/L
LAB-002426	Sat Nov 07, 2026 09:52 AM	hemoglobin	12.82 g/dL
LAB-002433	Sat Nov 07, 2026 09:52 AM	wbc	18.82 x10^3/uL
LAB-002434	Sat Nov 07, 2026 09:52 AM	platelets	95.0 x10^3/uL
LAB-002447	Sat Nov 07, 2026 09:52 AM	bilirubin	0.61 mg/dL
LAB-002448	Sat Nov 07, 2026 09:52 AM	lactate	2.99 mmol/L
LAB-002413	Sun Nov 08, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-002420	Sun Nov 08, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-002427	Sun Nov 08, 2026 05:00 AM	hemoglobin	12.96 g/dL
LAB-002435	Sun Nov 08, 2026 05:00 AM	wbc	15.55 x10^3/uL
LAB-002436	Sun Nov 08, 2026 05:00 AM	platelets	86.0 x10^3/uL
LAB-002414	Mon Nov 09, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-002421	Mon Nov 09, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-002428	Mon Nov 09, 2026 05:00 AM	hemoglobin	12.94 g/dL
LAB-002437	Mon Nov 09, 2026 05:00 AM	wbc	15.88 x10^3/uL
LAB-002438	Mon Nov 09, 2026 05:00 AM	platelets	88.0 x10^3/uL
LAB-002415	Tue Nov 10, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-002422	Tue Nov 10, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-002429	Tue Nov 10, 2026 05:00 AM	hemoglobin	12.86 g/dL
LAB-002439	Tue Nov 10, 2026 05:00 AM	wbc	7.42 x10^3/uL
LAB-002440	Tue Nov 10, 2026 05:00 AM	platelets	262.0 x10^3/uL
LAB-002416	Wed Nov 11, 2026 05:00 AM	creatinine	0.76 mg/dL
LAB-002423	Wed Nov 11, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-002430	Wed Nov 11, 2026 05:00 AM	hemoglobin	12.7 g/dL
LAB-002441	Wed Nov 11, 2026 05:00 AM	wbc	6.18 x10^3/uL
LAB-002442	Wed Nov 11, 2026 05:00 AM	platelets	278.0 x10^3/uL
LAB-002417	Thu Nov 12, 2026 05:00 AM	creatinine	0.74 mg/dL
LAB-002424	Thu Nov 12, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-002431	Thu Nov 12, 2026 05:00 AM	hemoglobin	12.91 g/dL
LAB-002443	Thu Nov 12, 2026 05:00 AM	wbc	7.53 x10^3/uL
LAB-002444	Thu Nov 12, 2026 05:00 AM	platelets	167.0 x10^3/uL
LAB-002418	Fri Nov 13, 2026 05:00 AM	creatinine	0.79 mg/dL
LAB-002425	Fri Nov 13, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-002432	Fri Nov 13, 2026 05:00 AM	hemoglobin	13.17 g/dL
LAB-002445	Fri Nov 13, 2026 05:00 AM	wbc	10.15 x10^3/uL
LAB-002446	Fri Nov 13, 2026 05:00 AM	platelets	239.0 x10^3/uL

Vitals (114)

Vitals
Row	When	Kind	Value	Detail
VIT-006958	Sat Nov 07, 2026 09:12 AM	spo2	97.0	room air
VIT-006959	Sat Nov 07, 2026 09:12 AM	rr	16.0
VIT-006996	Sat Nov 07, 2026 09:12 AM	temp_c	38.8
VIT-006997	Sat Nov 07, 2026 09:12 AM	hr	118.0
VIT-006998	Sat Nov 07, 2026 09:12 AM	map	68.0
VIT-006999	Sat Nov 07, 2026 09:12 AM	gcs	15.0
VIT-006960	Sat Nov 07, 2026 05:12 PM	spo2	99.0	room air
VIT-006961	Sat Nov 07, 2026 05:12 PM	rr	20.0
VIT-007000	Sat Nov 07, 2026 05:12 PM	temp_c	39.1
VIT-007001	Sat Nov 07, 2026 05:12 PM	hr	118.0
VIT-007002	Sat Nov 07, 2026 05:12 PM	map	67.0
VIT-007003	Sat Nov 07, 2026 05:12 PM	gcs	15.0
VIT-006962	Sun Nov 08, 2026 01:12 AM	spo2	99.0	room air
VIT-006963	Sun Nov 08, 2026 01:12 AM	rr	18.0
VIT-007004	Sun Nov 08, 2026 01:12 AM	temp_c	38.6
VIT-007005	Sun Nov 08, 2026 01:12 AM	hr	108.0
VIT-007006	Sun Nov 08, 2026 01:12 AM	map	64.0
VIT-007007	Sun Nov 08, 2026 01:12 AM	gcs	15.0
VIT-006964	Sun Nov 08, 2026 09:12 AM	spo2	96.0	room air
VIT-006965	Sun Nov 08, 2026 09:12 AM	rr	20.0
VIT-007008	Sun Nov 08, 2026 09:12 AM	temp_c	39.1
VIT-007009	Sun Nov 08, 2026 09:12 AM	hr	109.0
VIT-007010	Sun Nov 08, 2026 09:12 AM	map	68.0
VIT-007011	Sun Nov 08, 2026 09:12 AM	gcs	15.0
VIT-006966	Sun Nov 08, 2026 05:12 PM	spo2	94.0	room air
VIT-006967	Sun Nov 08, 2026 05:12 PM	rr	16.0
VIT-007012	Sun Nov 08, 2026 05:12 PM	temp_c	39.2
VIT-007013	Sun Nov 08, 2026 05:12 PM	hr	120.0
VIT-007014	Sun Nov 08, 2026 05:12 PM	map	67.0
VIT-007015	Sun Nov 08, 2026 05:12 PM	gcs	15.0
VIT-006968	Mon Nov 09, 2026 01:12 AM	spo2	97.0	room air
VIT-006969	Mon Nov 09, 2026 01:12 AM	rr	15.0
VIT-007016	Mon Nov 09, 2026 01:12 AM	temp_c	38.5
VIT-007017	Mon Nov 09, 2026 01:12 AM	hr	104.0
VIT-007018	Mon Nov 09, 2026 01:12 AM	map	64.0
VIT-007019	Mon Nov 09, 2026 01:12 AM	gcs	15.0
VIT-006970	Mon Nov 09, 2026 09:12 AM	spo2	95.0	room air
VIT-006971	Mon Nov 09, 2026 09:12 AM	rr	19.0
VIT-007020	Mon Nov 09, 2026 09:12 AM	temp_c	36.9
VIT-007021	Mon Nov 09, 2026 09:12 AM	hr	89.0
VIT-007022	Mon Nov 09, 2026 09:12 AM	map	78.0
VIT-007023	Mon Nov 09, 2026 09:12 AM	gcs	15.0
VIT-006972	Mon Nov 09, 2026 05:12 PM	spo2	97.0	room air
VIT-006973	Mon Nov 09, 2026 05:12 PM	rr	14.0
VIT-007024	Mon Nov 09, 2026 05:12 PM	temp_c	36.5
VIT-007025	Mon Nov 09, 2026 05:12 PM	hr	69.0
VIT-007026	Mon Nov 09, 2026 05:12 PM	map	90.0
VIT-007027	Mon Nov 09, 2026 05:12 PM	gcs	15.0
VIT-006974	Tue Nov 10, 2026 01:12 AM	spo2	94.0	room air
VIT-006975	Tue Nov 10, 2026 01:12 AM	rr	17.0
VIT-007028	Tue Nov 10, 2026 01:12 AM	temp_c	37.1
VIT-007029	Tue Nov 10, 2026 01:12 AM	hr	79.0
VIT-007030	Tue Nov 10, 2026 01:12 AM	map	80.0
VIT-007031	Tue Nov 10, 2026 01:12 AM	gcs	15.0
VIT-006976	Tue Nov 10, 2026 09:12 AM	spo2	95.0	room air
VIT-006977	Tue Nov 10, 2026 09:12 AM	rr	20.0
VIT-007032	Tue Nov 10, 2026 09:12 AM	temp_c	36.6
VIT-007033	Tue Nov 10, 2026 09:12 AM	hr	74.0
VIT-007034	Tue Nov 10, 2026 09:12 AM	map	77.0
VIT-007035	Tue Nov 10, 2026 09:12 AM	gcs	15.0
VIT-006978	Tue Nov 10, 2026 05:12 PM	spo2	94.0	room air
VIT-006979	Tue Nov 10, 2026 05:12 PM	rr	20.0
VIT-007036	Tue Nov 10, 2026 05:12 PM	temp_c	36.9
VIT-007037	Tue Nov 10, 2026 05:12 PM	hr	72.0
VIT-007038	Tue Nov 10, 2026 05:12 PM	map	82.0
VIT-007039	Tue Nov 10, 2026 05:12 PM	gcs	15.0
VIT-006980	Wed Nov 11, 2026 01:12 AM	spo2	97.0	room air
VIT-006981	Wed Nov 11, 2026 01:12 AM	rr	19.0
VIT-007040	Wed Nov 11, 2026 01:12 AM	temp_c	37.2
VIT-007041	Wed Nov 11, 2026 01:12 AM	hr	92.0
VIT-007042	Wed Nov 11, 2026 01:12 AM	map	86.0
VIT-007043	Wed Nov 11, 2026 01:12 AM	gcs	15.0
VIT-006982	Wed Nov 11, 2026 09:12 AM	spo2	96.0	room air
VIT-006983	Wed Nov 11, 2026 09:12 AM	rr	16.0
VIT-007044	Wed Nov 11, 2026 09:12 AM	temp_c	36.9
VIT-007045	Wed Nov 11, 2026 09:12 AM	hr	92.0
VIT-007046	Wed Nov 11, 2026 09:12 AM	map	83.0
VIT-007047	Wed Nov 11, 2026 09:12 AM	gcs	15.0
VIT-006984	Wed Nov 11, 2026 05:12 PM	spo2	97.0	room air
VIT-006985	Wed Nov 11, 2026 05:12 PM	rr	15.0
VIT-007048	Wed Nov 11, 2026 05:12 PM	temp_c	36.6
VIT-007049	Wed Nov 11, 2026 05:12 PM	hr	84.0
VIT-007050	Wed Nov 11, 2026 05:12 PM	map	75.0
VIT-007051	Wed Nov 11, 2026 05:12 PM	gcs	15.0
VIT-006986	Thu Nov 12, 2026 01:12 AM	spo2	95.0	room air
VIT-006987	Thu Nov 12, 2026 01:12 AM	rr	14.0
VIT-007052	Thu Nov 12, 2026 01:12 AM	temp_c	36.9
VIT-007053	Thu Nov 12, 2026 01:12 AM	hr	80.0
VIT-007054	Thu Nov 12, 2026 01:12 AM	map	92.0
VIT-007055	Thu Nov 12, 2026 01:12 AM	gcs	15.0
VIT-006988	Thu Nov 12, 2026 09:12 AM	spo2	95.0	room air
VIT-006989	Thu Nov 12, 2026 09:12 AM	rr	14.0
VIT-007056	Thu Nov 12, 2026 09:12 AM	temp_c	37.1
VIT-007057	Thu Nov 12, 2026 09:12 AM	hr	70.0
VIT-007058	Thu Nov 12, 2026 09:12 AM	map	87.0
VIT-007059	Thu Nov 12, 2026 09:12 AM	gcs	15.0
VIT-006990	Thu Nov 12, 2026 05:12 PM	spo2	97.0	room air
VIT-006991	Thu Nov 12, 2026 05:12 PM	rr	19.0
VIT-007060	Thu Nov 12, 2026 05:12 PM	temp_c	37.4
VIT-007061	Thu Nov 12, 2026 05:12 PM	hr	86.0
VIT-007062	Thu Nov 12, 2026 05:12 PM	map	85.0
VIT-007063	Thu Nov 12, 2026 05:12 PM	gcs	15.0
VIT-006992	Fri Nov 13, 2026 01:12 AM	spo2	98.0	room air
VIT-006993	Fri Nov 13, 2026 01:12 AM	rr	19.0
VIT-007064	Fri Nov 13, 2026 01:12 AM	temp_c	36.9
VIT-007065	Fri Nov 13, 2026 01:12 AM	hr	86.0
VIT-007066	Fri Nov 13, 2026 01:12 AM	map	84.0
VIT-007067	Fri Nov 13, 2026 01:12 AM	gcs	15.0
VIT-006994	Fri Nov 13, 2026 09:12 AM	spo2	95.0	room air
VIT-006995	Fri Nov 13, 2026 09:12 AM	rr	15.0
VIT-007068	Fri Nov 13, 2026 09:12 AM	temp_c	37.0
VIT-007069	Fri Nov 13, 2026 09:12 AM	hr	87.0
VIT-007070	Fri Nov 13, 2026 09:12 AM	map	91.0
VIT-007071	Fri Nov 13, 2026 09:12 AM	gcs	15.0

Medications, orders, echo, history (4)

MED-000279 11-07 09:52 piperacillin-tazobactam per protocol IV
MED-000280 11-08 05:00 piperacillin-tazobactam per protocol IV
MED-000281 11-09 05:00 ceftriaxone per protocol IV
ORD-000061 11-07 09:22 blood_culture: blood cultures x2

Notes

History and physical · DOC-000245 · Dr. Keira Upfield (resident) · Sat Nov 07, 2026 11:52 AM

Cited facts from this note (1)

infection_source: right lower lobe pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… -11-07 08:52 Service: Hospital Medicine Attending: Dr. Cyrus Ellingham History of present illness: 83-year-old woman admitted with sepsis. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: type 2 diabetes, hypertension. Review of systems otherwise negative. Exam: Lungs: clear to …

Source document DOC-000245: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Mara Okafor   MRN: MRN19598507   Admitted: 2026-11-07 08:52
Service: Hospital Medicine   Attending: Dr. Cyrus Ellingham

History of present illness: 83-year-old woman admitted with sepsis. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: type 2 diabetes, hypertension.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Sepsis: antibiotics, fluids.
2. Community-acquired pneumonia: antibiotics.

Nutrition assessment · DOC-000244 · Dario Larkspur, RD (dietitian) · Sun Nov 08, 2026 11:52 AM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN19598507 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: Mara Okafor MRN: MRN19598507 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: Mara Okafor MRN: MRN19598507 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-000244: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Mara Okafor   MRN: MRN19598507

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-000246 · Dr. Keira Upfield (resident) · Fri Nov 13, 2026 01:55 PM · awaiting cosign

Source document DOC-000246: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Mara Okafor   MRN: MRN19598507   Hospital day 7

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Sepsis: continue current management.

Resident: Dr. Keira Upfield   Attending cosign: pending