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-00081: Keira Ravensworth

84F · MRN37040672 · Pulmonology · admitted Sat Nov 07, 2026 02:15 PM · in hospital · attending Dr. Gideon Zeller · resident Dr. Priya Thorne · 160 cm, 87.3 kg

Documented diagnoses (current)

Principal: “COPD exacerbation” · J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
“class 1 obesity” · E66.811 Obesity, class 1
“acute kidney injury” · N17.9 Acute kidney failure, unspecified
“congestive heart failure” · I50.9 Heart failure, unspecified
“hypoxia” · R09.02 Hypoxemia
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia

Illustrative grouping now: MS-DRG 191 Chronic obstructive pulmonary disease with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 190.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

No gap

Supported as documented (N17.9).

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=1.643, t.ratio_s1=1.5, creat_rise_48h=0.25, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	true
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=True, creat_ratio=1.643, t.ratio_s3=3.0, creat_peak=1.15, 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=1.643, 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=True	1
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.25, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=1, baseline_independent=True	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=8.58, 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=4.0, 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=320, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=82.4, egfr_late=85.2	85.2
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=82.4, t.g2=60, egfr_late=85.2	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=85.2, 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=82.4, egfr_late=85.2, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=85.2, t.g2=60	true

Heart failure

Criteria met

Specificity gap

Documented “congestive heart failure” (I50.9); 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=2035.0, 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=32.0, 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=32.0, 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

No gap

Supported as documented (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=84, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=34.1, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=34.1, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=34.1, 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=86.0, 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=86.0, 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=37.6, t.t_hi=38, temp_min_48h=37.0, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=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=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=8.03, t.wbc_hi=12, wbc_min_48h=5.5, 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=251.0	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=0.96	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=1.15	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=0.7	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 (39)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-002743	Wed Oct 22, 2025 09:15 AM	creatinine	0.72 mg/dL
LAB-002744	Mon Sep 07, 2026 10:05 AM	creatinine	0.7 mg/dL
LAB-002745	Sat Nov 07, 2026 03:15 PM	creatinine	0.9 mg/dL
LAB-002752	Sat Nov 07, 2026 03:15 PM	bnp	2035.0 pg/mL
LAB-002753	Sat Nov 07, 2026 03:15 PM	sodium	142.0 mmol/L
LAB-002760	Sat Nov 07, 2026 03:15 PM	hemoglobin	12.56 g/dL
LAB-002767	Sat Nov 07, 2026 03:15 PM	wbc	5.5 x10^3/uL
LAB-002768	Sat Nov 07, 2026 03:15 PM	platelets	251.0 x10^3/uL
LAB-002781	Sat Nov 07, 2026 03:15 PM	bilirubin	0.96 mg/dL
LAB-002746	Sun Nov 08, 2026 05:00 AM	creatinine	1.15 mg/dL
LAB-002754	Sun Nov 08, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-002761	Sun Nov 08, 2026 05:00 AM	hemoglobin	10.18 g/dL
LAB-002769	Sun Nov 08, 2026 05:00 AM	wbc	8.03 x10^3/uL
LAB-002770	Sun Nov 08, 2026 05:00 AM	platelets	261.0 x10^3/uL
LAB-002747	Mon Nov 09, 2026 05:00 AM	creatinine	1.04 mg/dL
LAB-002755	Mon Nov 09, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-002762	Mon Nov 09, 2026 05:00 AM	hemoglobin	8.58 g/dL
LAB-002771	Mon Nov 09, 2026 05:00 AM	wbc	7.74 x10^3/uL
LAB-002772	Mon Nov 09, 2026 05:00 AM	platelets	304.0 x10^3/uL
LAB-002748	Tue Nov 10, 2026 05:00 AM	creatinine	0.86 mg/dL
LAB-002756	Tue Nov 10, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-002763	Tue Nov 10, 2026 05:00 AM	hemoglobin	9.38 g/dL
LAB-002773	Tue Nov 10, 2026 05:00 AM	wbc	8.35 x10^3/uL
LAB-002774	Tue Nov 10, 2026 05:00 AM	platelets	298.0 x10^3/uL
LAB-002749	Wed Nov 11, 2026 05:00 AM	creatinine	0.73 mg/dL
LAB-002757	Wed Nov 11, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-002764	Wed Nov 11, 2026 05:00 AM	hemoglobin	9.68 g/dL
LAB-002775	Wed Nov 11, 2026 05:00 AM	wbc	9.19 x10^3/uL
LAB-002776	Wed Nov 11, 2026 05:00 AM	platelets	203.0 x10^3/uL
LAB-002750	Thu Nov 12, 2026 05:00 AM	creatinine	0.73 mg/dL
LAB-002758	Thu Nov 12, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-002765	Thu Nov 12, 2026 05:00 AM	hemoglobin	9.78 g/dL
LAB-002777	Thu Nov 12, 2026 05:00 AM	wbc	6.08 x10^3/uL
LAB-002778	Thu Nov 12, 2026 05:00 AM	platelets	307.0 x10^3/uL
LAB-002751	Fri Nov 13, 2026 05:00 AM	creatinine	0.73 mg/dL
LAB-002759	Fri Nov 13, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-002766	Fri Nov 13, 2026 05:00 AM	hemoglobin	9.78 g/dL
LAB-002779	Fri Nov 13, 2026 05:00 AM	wbc	9.2 x10^3/uL
LAB-002780	Fri Nov 13, 2026 05:00 AM	platelets	295.0 x10^3/uL

Vitals (132)

Vitals
Row	When	Kind	Value	Detail
VIT-007925	Sat Nov 07, 2026 02:35 PM	spo2	86.0	room air
VIT-007926	Sat Nov 07, 2026 02:35 PM	rr	21.0
VIT-007981	Sat Nov 07, 2026 02:35 PM	temp_c	37.6
VIT-007982	Sat Nov 07, 2026 02:35 PM	hr	77.0
VIT-007983	Sat Nov 07, 2026 02:35 PM	map	91.0
VIT-007984	Sat Nov 07, 2026 02:35 PM	gcs	15.0
VIT-007927	Sat Nov 07, 2026 10:35 PM	spo2	95.0	nasal cannula
VIT-007928	Sat Nov 07, 2026 10:35 PM	rr	18.0
VIT-007929	Sat Nov 07, 2026 10:35 PM	o2_lpm	2.0	nasal cannula
VIT-007985	Sat Nov 07, 2026 10:35 PM	temp_c	37.1
VIT-007986	Sat Nov 07, 2026 10:35 PM	hr	79.0
VIT-007987	Sat Nov 07, 2026 10:35 PM	map	78.0
VIT-007988	Sat Nov 07, 2026 10:35 PM	gcs	15.0
VIT-007930	Sun Nov 08, 2026 06:35 AM	spo2	95.0	nasal cannula
VIT-007931	Sun Nov 08, 2026 06:35 AM	rr	21.0
VIT-007932	Sun Nov 08, 2026 06:35 AM	o2_lpm	2.0	nasal cannula
VIT-007989	Sun Nov 08, 2026 06:35 AM	temp_c	37.4
VIT-007990	Sun Nov 08, 2026 06:35 AM	hr	88.0
VIT-007991	Sun Nov 08, 2026 06:35 AM	map	77.0
VIT-007992	Sun Nov 08, 2026 06:35 AM	gcs	15.0
VIT-007933	Sun Nov 08, 2026 02:35 PM	spo2	94.0	nasal cannula
VIT-007934	Sun Nov 08, 2026 02:35 PM	rr	18.0
VIT-007935	Sun Nov 08, 2026 02:35 PM	o2_lpm	2.0	nasal cannula
VIT-007993	Sun Nov 08, 2026 02:35 PM	temp_c	37.5
VIT-007994	Sun Nov 08, 2026 02:35 PM	hr	77.0
VIT-007995	Sun Nov 08, 2026 02:35 PM	map	76.0
VIT-007996	Sun Nov 08, 2026 02:35 PM	gcs	15.0
VIT-007936	Sun Nov 08, 2026 10:35 PM	spo2	92.0	nasal cannula
VIT-007937	Sun Nov 08, 2026 10:35 PM	rr	18.0
VIT-007938	Sun Nov 08, 2026 10:35 PM	o2_lpm	2.0	nasal cannula
VIT-007997	Sun Nov 08, 2026 10:35 PM	temp_c	37.2
VIT-007998	Sun Nov 08, 2026 10:35 PM	hr	90.0
VIT-007999	Sun Nov 08, 2026 10:35 PM	map	86.0
VIT-008000	Sun Nov 08, 2026 10:35 PM	gcs	15.0
VIT-007939	Mon Nov 09, 2026 06:35 AM	spo2	95.0	nasal cannula
VIT-007940	Mon Nov 09, 2026 06:35 AM	rr	21.0
VIT-007941	Mon Nov 09, 2026 06:35 AM	o2_lpm	2.0	nasal cannula
VIT-008001	Mon Nov 09, 2026 06:35 AM	temp_c	37.0
VIT-008002	Mon Nov 09, 2026 06:35 AM	hr	69.0
VIT-008003	Mon Nov 09, 2026 06:35 AM	map	80.0
VIT-008004	Mon Nov 09, 2026 06:35 AM	gcs	15.0
VIT-007942	Mon Nov 09, 2026 02:35 PM	spo2	94.0	nasal cannula
VIT-007943	Mon Nov 09, 2026 02:35 PM	rr	23.0
VIT-007944	Mon Nov 09, 2026 02:35 PM	o2_lpm	2.0	nasal cannula
VIT-008005	Mon Nov 09, 2026 02:35 PM	temp_c	36.9
VIT-008006	Mon Nov 09, 2026 02:35 PM	hr	69.0
VIT-008007	Mon Nov 09, 2026 02:35 PM	map	91.0
VIT-008008	Mon Nov 09, 2026 02:35 PM	gcs	15.0
VIT-007945	Mon Nov 09, 2026 10:35 PM	spo2	95.0	nasal cannula
VIT-007946	Mon Nov 09, 2026 10:35 PM	rr	23.0
VIT-007947	Mon Nov 09, 2026 10:35 PM	o2_lpm	2.0	nasal cannula
VIT-008009	Mon Nov 09, 2026 10:35 PM	temp_c	36.7
VIT-008010	Mon Nov 09, 2026 10:35 PM	hr	82.0
VIT-008011	Mon Nov 09, 2026 10:35 PM	map	78.0
VIT-008012	Mon Nov 09, 2026 10:35 PM	gcs	15.0
VIT-007948	Tue Nov 10, 2026 06:35 AM	spo2	93.0	nasal cannula
VIT-007949	Tue Nov 10, 2026 06:35 AM	rr	20.0
VIT-007950	Tue Nov 10, 2026 06:35 AM	o2_lpm	2.0	nasal cannula
VIT-008013	Tue Nov 10, 2026 06:35 AM	temp_c	37.0
VIT-008014	Tue Nov 10, 2026 06:35 AM	hr	92.0
VIT-008015	Tue Nov 10, 2026 06:35 AM	map	86.0
VIT-008016	Tue Nov 10, 2026 06:35 AM	gcs	15.0
VIT-007951	Tue Nov 10, 2026 02:35 PM	spo2	92.0	nasal cannula
VIT-007952	Tue Nov 10, 2026 02:35 PM	rr	21.0
VIT-007953	Tue Nov 10, 2026 02:35 PM	o2_lpm	2.0	nasal cannula
VIT-008017	Tue Nov 10, 2026 02:35 PM	temp_c	37.0
VIT-008018	Tue Nov 10, 2026 02:35 PM	hr	73.0
VIT-008019	Tue Nov 10, 2026 02:35 PM	map	75.0
VIT-008020	Tue Nov 10, 2026 02:35 PM	gcs	15.0
VIT-007954	Tue Nov 10, 2026 10:35 PM	spo2	93.0	nasal cannula
VIT-007955	Tue Nov 10, 2026 10:35 PM	rr	22.0
VIT-007956	Tue Nov 10, 2026 10:35 PM	o2_lpm	2.0	nasal cannula
VIT-008021	Tue Nov 10, 2026 10:35 PM	temp_c	36.7
VIT-008022	Tue Nov 10, 2026 10:35 PM	hr	79.0
VIT-008023	Tue Nov 10, 2026 10:35 PM	map	85.0
VIT-008024	Tue Nov 10, 2026 10:35 PM	gcs	15.0
VIT-007957	Wed Nov 11, 2026 06:35 AM	spo2	96.0	nasal cannula
VIT-007958	Wed Nov 11, 2026 06:35 AM	rr	20.0
VIT-007959	Wed Nov 11, 2026 06:35 AM	o2_lpm	2.0	nasal cannula
VIT-008025	Wed Nov 11, 2026 06:35 AM	temp_c	36.7
VIT-008026	Wed Nov 11, 2026 06:35 AM	hr	90.0
VIT-008027	Wed Nov 11, 2026 06:35 AM	map	87.0
VIT-008028	Wed Nov 11, 2026 06:35 AM	gcs	15.0
VIT-007960	Wed Nov 11, 2026 02:35 PM	spo2	96.0	nasal cannula
VIT-007961	Wed Nov 11, 2026 02:35 PM	rr	20.0
VIT-007962	Wed Nov 11, 2026 02:35 PM	o2_lpm	2.0	nasal cannula
VIT-008029	Wed Nov 11, 2026 02:35 PM	temp_c	36.8
VIT-008030	Wed Nov 11, 2026 02:35 PM	hr	89.0
VIT-008031	Wed Nov 11, 2026 02:35 PM	map	74.0
VIT-008032	Wed Nov 11, 2026 02:35 PM	gcs	15.0
VIT-007963	Wed Nov 11, 2026 10:35 PM	spo2	96.0	nasal cannula
VIT-007964	Wed Nov 11, 2026 10:35 PM	rr	22.0
VIT-007965	Wed Nov 11, 2026 10:35 PM	o2_lpm	2.0	nasal cannula
VIT-008033	Wed Nov 11, 2026 10:35 PM	temp_c	37.6
VIT-008034	Wed Nov 11, 2026 10:35 PM	hr	82.0
VIT-008035	Wed Nov 11, 2026 10:35 PM	map	84.0
VIT-008036	Wed Nov 11, 2026 10:35 PM	gcs	15.0
VIT-007966	Thu Nov 12, 2026 06:35 AM	spo2	92.0	nasal cannula
VIT-007967	Thu Nov 12, 2026 06:35 AM	rr	23.0
VIT-007968	Thu Nov 12, 2026 06:35 AM	o2_lpm	2.0	nasal cannula
VIT-008037	Thu Nov 12, 2026 06:35 AM	temp_c	36.7
VIT-008038	Thu Nov 12, 2026 06:35 AM	hr	90.0
VIT-008039	Thu Nov 12, 2026 06:35 AM	map	90.0
VIT-008040	Thu Nov 12, 2026 06:35 AM	gcs	15.0
VIT-007969	Thu Nov 12, 2026 02:35 PM	spo2	96.0	nasal cannula
VIT-007970	Thu Nov 12, 2026 02:35 PM	rr	20.0
VIT-007971	Thu Nov 12, 2026 02:35 PM	o2_lpm	2.0	nasal cannula
VIT-008041	Thu Nov 12, 2026 02:35 PM	temp_c	37.0
VIT-008042	Thu Nov 12, 2026 02:35 PM	hr	77.0
VIT-008043	Thu Nov 12, 2026 02:35 PM	map	89.0
VIT-008044	Thu Nov 12, 2026 02:35 PM	gcs	15.0
VIT-007972	Thu Nov 12, 2026 10:35 PM	spo2	95.0	nasal cannula
VIT-007973	Thu Nov 12, 2026 10:35 PM	rr	20.0
VIT-007974	Thu Nov 12, 2026 10:35 PM	o2_lpm	2.0	nasal cannula
VIT-008045	Thu Nov 12, 2026 10:35 PM	temp_c	36.8
VIT-008046	Thu Nov 12, 2026 10:35 PM	hr	77.0
VIT-008047	Thu Nov 12, 2026 10:35 PM	map	90.0
VIT-008048	Thu Nov 12, 2026 10:35 PM	gcs	15.0
VIT-007975	Fri Nov 13, 2026 06:35 AM	spo2	96.0	nasal cannula
VIT-007976	Fri Nov 13, 2026 06:35 AM	rr	22.0
VIT-007977	Fri Nov 13, 2026 06:35 AM	o2_lpm	2.0	nasal cannula
VIT-008049	Fri Nov 13, 2026 06:35 AM	temp_c	37.1
VIT-008050	Fri Nov 13, 2026 06:35 AM	hr	88.0
VIT-008051	Fri Nov 13, 2026 06:35 AM	map	83.0
VIT-008052	Fri Nov 13, 2026 06:35 AM	gcs	15.0
VIT-007978	Fri Nov 13, 2026 02:35 PM	spo2	96.0	nasal cannula
VIT-007979	Fri Nov 13, 2026 02:35 PM	rr	23.0
VIT-007980	Fri Nov 13, 2026 02:35 PM	o2_lpm	2.0	nasal cannula
VIT-008053	Fri Nov 13, 2026 02:35 PM	temp_c	37.2
VIT-008054	Fri Nov 13, 2026 02:35 PM	hr	82.0
VIT-008055	Fri Nov 13, 2026 02:35 PM	map	76.0
VIT-008056	Fri Nov 13, 2026 02:35 PM	gcs	15.0

Medications, orders, echo, history (9)

MED-000309 11-07 08:00 furosemide 40 mg IV
MED-000310 11-07 20:00 furosemide 40 mg IV
MED-000311 11-08 08:00 furosemide 40 mg IV
MED-000312 11-08 20:00 furosemide 40 mg IV
MED-000313 11-09 08:00 furosemide 40 mg IV
MED-000314 11-09 20:00 furosemide 40 mg IV
ORD-000071 11-08 09:00 transfusion_prbc: transfuse PRBC
ECH-000038 2026-11-08 echo LVEF 32.0%
HX-000030 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000277 · Dr. Priya Thorne (resident) · Sat Nov 07, 2026 05:15 PM

Cited facts from this note (1)

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

Show source for bleeding_source

… vice: Pulmonology Attending: Dr. Gideon Zeller History of present illness: 84-year-old woman admitted with COPD exacerbation. Hospital course complicated by black tarry stools. Past medical history: heart failure with reduced ejection fraction. Review of systems otherwise negative. Exam: Lungs: clear to auscultation bilaterally. Asse …

Source document DOC-000277: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Keira Ravensworth   MRN: MRN37040672   Admitted: 2026-11-07 14:15
Service: Pulmonology   Attending: Dr. Gideon Zeller

History of present illness: 84-year-old woman admitted with COPD exacerbation. Hospital course complicated by black tarry stools.
Past medical history: heart failure with reduced ejection fraction.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. COPD exacerbation: bronchodilators and steroids.

Progress note · DOC-000278 · Dr. Priya Thorne (resident) · Fri Nov 13, 2026 12:55 PM · awaiting cosign

Source document DOC-000278: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Keira Ravensworth   MRN: MRN37040672   Hospital day 6

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. COPD exacerbation: continue current management.
2. Class 1 obesity: counsel on weight.
3. Acute kidney injury: trend creatinine, hold nephrotoxins, strict intake and output.
4. Congestive heart failure: diuresis and daily weights; monitor electrolytes.
5. Hypoxia: supplemental oxygen, wean as tolerated.
6. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Resident: Dr. Priya Thorne   Attending cosign: pending