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-00080: Priya Nakashima

85F · MRN97032309 · Cardiology · admitted Sun Nov 08, 2026 08:57 PM · in hospital · attending Dr. Wes Merriweather · resident Dr. Elena Nakashima · 162 cm, 84.0 kg

Documented diagnoses (current)

“morbid obesity” · E66.01 Morbid (severe) obesity due to excess calories
Principal: “chronic systolic heart failure” · I50.22 Chronic systolic (congestive) heart failure
“acute respiratory failure with hypoxia” · J96.01 Acute respiratory failure with hypoxia
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“hypertension” · I10 Essential (primary) hypertension
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications

Illustrative grouping now: MS-DRG 291 Heart failure and shock with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 292.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule aki v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: meets_definition	`creat_ratio >= t.ratio_s1 or creat_rise_48h >= t.rise_abs or coalesce(uo_hours_lt_0_5 >= t.uo_s1_h, false)`	creat_ratio=1.057, t.ratio_s1=1.5, creat_rise_48h=0.03, 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=1.057, t.ratio_s3=3.0, creat_peak=1.12, 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=1.057, 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=0.03, 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

No gap

Supported as documented (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=8.04, 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=3.9, 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

Criteria support Chronic kidney disease stage 3a (N18.31); no corresponding diagnosis is documented.

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=372, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=56.6, egfr_late=51.5	56.6
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=56.6, t.g2=60, egfr_late=51.5	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=56.6, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G3a
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=True, egfr_early=56.6, egfr_late=51.5, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=56.6, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3a	true

Heart failure

Criteria met

Specificity gap

Documented “chronic systolic heart failure” (I50.22); criteria support the more specific Acute on chronic systolic (HFrEF) heart failure (I50.23).

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=940.0, 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=30.0, 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=30.0, 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=systolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=acute on 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=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

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown	0
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=unknown, a_sev_intake=unknown, a_sev_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_sev_wt=unknown	unknown
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=unknown, a_sev_intake=unknown, a_mod_intake=unknown, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_mod_intake=unknown, c_sev_wt=unknown, c_mod_wt=unknown	unknown
outcome: severe	`n_severe >= 2`	n_severe=unknown	unknown
outcome: moderate	`n_moderate >= 2`	n_moderate=unknown	unknown
outcome: one_characteristic	`n_moderate == 1`	n_moderate=unknown	unknown
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=unknown, n_assessed=0	false

Obesity

Criteria met

Clinical validation gap

Documented “morbid obesity” (E66.01) conflicts with what the criteria support (Obesity, class 1, E66.811).

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=85, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=32.0, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=32.0, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=32.0, 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

Clinical validation gap

Documented “acute respiratory failure with hypoxia” (J96.01) but the criteria are not met: No hypoxaemia on room air (lowest SpO2 93%), oxygen no more than 2 L/min, no advanced support.

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=93.0, 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=93.0, 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=21.0, 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=2.0, 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=36.6, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=86.0, 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=21.0, 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=10.2, t.wbc_hi=12, wbc_min_48h=6.35, 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=181.0	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=0.82	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=1.12	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=1.06	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=False, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, 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=False	true

Structured data

Labs (34)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-002709	Tue Sep 30, 2025 09:15 AM	creatinine	0.98 mg/dL
LAB-002710	Wed Oct 07, 2026 10:05 AM	creatinine	1.06 mg/dL
LAB-002711	Sun Nov 08, 2026 09:57 PM	creatinine	1.1 mg/dL
LAB-002717	Sun Nov 08, 2026 09:57 PM	bnp	940.0 pg/mL
LAB-002718	Sun Nov 08, 2026 09:57 PM	sodium	140.0 mmol/L
LAB-002724	Sun Nov 08, 2026 09:57 PM	hemoglobin	11.96 g/dL
LAB-002730	Sun Nov 08, 2026 09:57 PM	wbc	10.2 x10^3/uL
LAB-002731	Sun Nov 08, 2026 09:57 PM	platelets	208.0 x10^3/uL
LAB-002742	Sun Nov 08, 2026 09:57 PM	bilirubin	0.82 mg/dL
LAB-002712	Mon Nov 09, 2026 05:00 AM	creatinine	1.12 mg/dL
LAB-002719	Mon Nov 09, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-002725	Mon Nov 09, 2026 05:00 AM	hemoglobin	9.61 g/dL
LAB-002732	Mon Nov 09, 2026 05:00 AM	wbc	8.06 x10^3/uL
LAB-002733	Mon Nov 09, 2026 05:00 AM	platelets	195.0 x10^3/uL
LAB-002713	Tue Nov 10, 2026 05:00 AM	creatinine	1.12 mg/dL
LAB-002720	Tue Nov 10, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-002726	Tue Nov 10, 2026 05:00 AM	hemoglobin	8.04 g/dL
LAB-002734	Tue Nov 10, 2026 05:00 AM	wbc	6.35 x10^3/uL
LAB-002735	Tue Nov 10, 2026 05:00 AM	platelets	181.0 x10^3/uL
LAB-002714	Wed Nov 11, 2026 05:00 AM	creatinine	1.1 mg/dL
LAB-002721	Wed Nov 11, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-002727	Wed Nov 11, 2026 05:00 AM	hemoglobin	8.84 g/dL
LAB-002736	Wed Nov 11, 2026 05:00 AM	wbc	9.26 x10^3/uL
LAB-002737	Wed Nov 11, 2026 05:00 AM	platelets	262.0 x10^3/uL
LAB-002715	Thu Nov 12, 2026 05:00 AM	creatinine	1.05 mg/dL
LAB-002722	Thu Nov 12, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-002728	Thu Nov 12, 2026 05:00 AM	hemoglobin	9.14 g/dL
LAB-002738	Thu Nov 12, 2026 05:00 AM	wbc	9.13 x10^3/uL
LAB-002739	Thu Nov 12, 2026 05:00 AM	platelets	263.0 x10^3/uL
LAB-002716	Fri Nov 13, 2026 05:00 AM	creatinine	1.08 mg/dL
LAB-002723	Fri Nov 13, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-002729	Fri Nov 13, 2026 05:00 AM	hemoglobin	9.24 g/dL
LAB-002740	Fri Nov 13, 2026 05:00 AM	wbc	8.9 x10^3/uL
LAB-002741	Fri Nov 13, 2026 05:00 AM	platelets	233.0 x10^3/uL

Vitals (92)

Vitals
Row	When	Kind	Value	Detail
VIT-007833	Sun Nov 08, 2026 09:17 PM	spo2	94.0	room air
VIT-007834	Sun Nov 08, 2026 09:17 PM	rr	17.0
VIT-007865	Sun Nov 08, 2026 09:17 PM	temp_c	37.6
VIT-007866	Sun Nov 08, 2026 09:17 PM	hr	74.0
VIT-007867	Sun Nov 08, 2026 09:17 PM	map	81.0
VIT-007868	Sun Nov 08, 2026 09:17 PM	gcs	15.0
VIT-007835	Mon Nov 09, 2026 05:17 AM	spo2	96.0	room air
VIT-007836	Mon Nov 09, 2026 05:17 AM	rr	18.0
VIT-007869	Mon Nov 09, 2026 05:17 AM	temp_c	36.6
VIT-007870	Mon Nov 09, 2026 05:17 AM	hr	79.0
VIT-007871	Mon Nov 09, 2026 05:17 AM	map	87.0
VIT-007872	Mon Nov 09, 2026 05:17 AM	gcs	15.0
VIT-007837	Mon Nov 09, 2026 05:22 AM	o2_lpm	2.0	nasal cannula
VIT-007838	Mon Nov 09, 2026 01:17 PM	spo2	97.0	room air
VIT-007839	Mon Nov 09, 2026 01:17 PM	rr	21.0
VIT-007873	Mon Nov 09, 2026 01:17 PM	temp_c	36.9
VIT-007874	Mon Nov 09, 2026 01:17 PM	hr	83.0
VIT-007875	Mon Nov 09, 2026 01:17 PM	map	76.0
VIT-007876	Mon Nov 09, 2026 01:17 PM	gcs	15.0
VIT-007840	Mon Nov 09, 2026 01:22 PM	o2_lpm	2.0	nasal cannula
VIT-007841	Mon Nov 09, 2026 09:17 PM	spo2	94.0	room air
VIT-007842	Mon Nov 09, 2026 09:17 PM	rr	18.0
VIT-007877	Mon Nov 09, 2026 09:17 PM	temp_c	37.1
VIT-007878	Mon Nov 09, 2026 09:17 PM	hr	86.0
VIT-007879	Mon Nov 09, 2026 09:17 PM	map	84.0
VIT-007880	Mon Nov 09, 2026 09:17 PM	gcs	15.0
VIT-007843	Tue Nov 10, 2026 05:17 AM	spo2	95.0	room air
VIT-007844	Tue Nov 10, 2026 05:17 AM	rr	18.0
VIT-007881	Tue Nov 10, 2026 05:17 AM	temp_c	37.2
VIT-007882	Tue Nov 10, 2026 05:17 AM	hr	79.0
VIT-007883	Tue Nov 10, 2026 05:17 AM	map	84.0
VIT-007884	Tue Nov 10, 2026 05:17 AM	gcs	15.0
VIT-007845	Tue Nov 10, 2026 01:17 PM	spo2	96.0	room air
VIT-007846	Tue Nov 10, 2026 01:17 PM	rr	18.0
VIT-007885	Tue Nov 10, 2026 01:17 PM	temp_c	37.6
VIT-007886	Tue Nov 10, 2026 01:17 PM	hr	83.0
VIT-007887	Tue Nov 10, 2026 01:17 PM	map	89.0
VIT-007888	Tue Nov 10, 2026 01:17 PM	gcs	15.0
VIT-007847	Tue Nov 10, 2026 09:17 PM	spo2	96.0	room air
VIT-007848	Tue Nov 10, 2026 09:17 PM	rr	16.0
VIT-007889	Tue Nov 10, 2026 09:17 PM	temp_c	36.5
VIT-007890	Tue Nov 10, 2026 09:17 PM	hr	85.0
VIT-007891	Tue Nov 10, 2026 09:17 PM	map	91.0
VIT-007892	Tue Nov 10, 2026 09:17 PM	gcs	15.0
VIT-007849	Wed Nov 11, 2026 05:17 AM	spo2	93.0	room air
VIT-007850	Wed Nov 11, 2026 05:17 AM	rr	20.0
VIT-007893	Wed Nov 11, 2026 05:17 AM	temp_c	37.4
VIT-007894	Wed Nov 11, 2026 05:17 AM	hr	69.0
VIT-007895	Wed Nov 11, 2026 05:17 AM	map	74.0
VIT-007896	Wed Nov 11, 2026 05:17 AM	gcs	15.0
VIT-007851	Wed Nov 11, 2026 01:17 PM	spo2	97.0	room air
VIT-007852	Wed Nov 11, 2026 01:17 PM	rr	21.0
VIT-007897	Wed Nov 11, 2026 01:17 PM	temp_c	36.6
VIT-007898	Wed Nov 11, 2026 01:17 PM	hr	70.0
VIT-007899	Wed Nov 11, 2026 01:17 PM	map	87.0
VIT-007900	Wed Nov 11, 2026 01:17 PM	gcs	15.0
VIT-007853	Wed Nov 11, 2026 09:17 PM	spo2	94.0	room air
VIT-007854	Wed Nov 11, 2026 09:17 PM	rr	16.0
VIT-007901	Wed Nov 11, 2026 09:17 PM	temp_c	36.6
VIT-007902	Wed Nov 11, 2026 09:17 PM	hr	79.0
VIT-007903	Wed Nov 11, 2026 09:17 PM	map	91.0
VIT-007904	Wed Nov 11, 2026 09:17 PM	gcs	15.0
VIT-007855	Thu Nov 12, 2026 05:17 AM	spo2	94.0	room air
VIT-007856	Thu Nov 12, 2026 05:17 AM	rr	16.0
VIT-007905	Thu Nov 12, 2026 05:17 AM	temp_c	36.6
VIT-007906	Thu Nov 12, 2026 05:17 AM	hr	68.0
VIT-007907	Thu Nov 12, 2026 05:17 AM	map	74.0
VIT-007908	Thu Nov 12, 2026 05:17 AM	gcs	15.0
VIT-007857	Thu Nov 12, 2026 01:17 PM	spo2	97.0	room air
VIT-007858	Thu Nov 12, 2026 01:17 PM	rr	16.0
VIT-007909	Thu Nov 12, 2026 01:17 PM	temp_c	37.6
VIT-007910	Thu Nov 12, 2026 01:17 PM	hr	86.0
VIT-007911	Thu Nov 12, 2026 01:17 PM	map	92.0
VIT-007912	Thu Nov 12, 2026 01:17 PM	gcs	15.0
VIT-007859	Thu Nov 12, 2026 09:17 PM	spo2	95.0	room air
VIT-007860	Thu Nov 12, 2026 09:17 PM	rr	20.0
VIT-007913	Thu Nov 12, 2026 09:17 PM	temp_c	37.2
VIT-007914	Thu Nov 12, 2026 09:17 PM	hr	75.0
VIT-007915	Thu Nov 12, 2026 09:17 PM	map	90.0
VIT-007916	Thu Nov 12, 2026 09:17 PM	gcs	15.0
VIT-007861	Fri Nov 13, 2026 05:17 AM	spo2	96.0	room air
VIT-007862	Fri Nov 13, 2026 05:17 AM	rr	18.0
VIT-007917	Fri Nov 13, 2026 05:17 AM	temp_c	36.9
VIT-007918	Fri Nov 13, 2026 05:17 AM	hr	78.0
VIT-007919	Fri Nov 13, 2026 05:17 AM	map	88.0
VIT-007920	Fri Nov 13, 2026 05:17 AM	gcs	15.0
VIT-007863	Fri Nov 13, 2026 01:17 PM	spo2	95.0	room air
VIT-007864	Fri Nov 13, 2026 01:17 PM	rr	18.0
VIT-007921	Fri Nov 13, 2026 01:17 PM	temp_c	37.4
VIT-007922	Fri Nov 13, 2026 01:17 PM	hr	86.0
VIT-007923	Fri Nov 13, 2026 01:17 PM	map	90.0
VIT-007924	Fri Nov 13, 2026 01:17 PM	gcs	15.0

Medications, orders, echo, history (9)

MED-000303 11-08 08:00 furosemide 40 mg IV
MED-000304 11-08 20:00 furosemide 40 mg IV
MED-000305 11-09 08:00 furosemide 40 mg IV
MED-000306 11-09 20:00 furosemide 40 mg IV
MED-000307 11-10 08:00 furosemide 40 mg IV
MED-000308 11-10 20:00 furosemide 40 mg IV
ORD-000070 11-09 09:00 transfusion_prbc: transfuse PRBC
ECH-000037 2026-11-10 echo LVEF 30.0%
HX-000029 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000275 · Dr. Elena Nakashima (resident) · Sun Nov 08, 2026 11:57 PM

Cited facts from this note (1)

bleeding_source: bleeding from the surgical drain · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… y Attending: Dr. Wes Merriweather History of present illness: 85-year-old woman admitted with chronic systolic heart failure. Hospital course complicated by bleeding from the surgical drain. Past medical history: heart failure with reduced ejection fraction, hypertension, GERD, type 2 diabetes. Review of systems otherwise negative. Exam: Lungs: cl …

Source document DOC-000275: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Priya Nakashima   MRN: MRN97032309   Admitted: 2026-11-08 20:57
Service: Cardiology   Attending: Dr. Wes Merriweather

History of present illness: 85-year-old woman admitted with chronic systolic heart failure. Hospital course complicated by bleeding from the surgical drain.
Past medical history: heart failure with reduced ejection fraction, hypertension, GERD, type 2 diabetes.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.

Progress note · DOC-000276 · Dr. Elena Nakashima (resident) · Fri Nov 13, 2026 10:55 AM · awaiting cosign

Source document DOC-000276: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Priya Nakashima   MRN: MRN97032309   Hospital day 5

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Chronic systolic heart failure: continue current management.
2. Morbid obesity: counsel on weight.
3. Acute respiratory failure with hypoxia: supplemental oxygen, wean as tolerated.
4. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Resident: Dr. Elena Nakashima   Attending cosign: pending