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-00087: Lena Northam

78M · MRN97875486 · Hospital Medicine · admitted Mon Nov 09, 2026 01:46 PM · in hospital · attending Dr. Kenji Stavros · resident Dr. Elena Nakashima · 162 cm, 106.8 kg

Documented diagnoses (current)

Principal: “sepsis” · A41.9 Sepsis, unspecified organism
“urinary tract infection” · N39.0 Urinary tract infection, site not specified
“CKD” · N18.9 Chronic kidney disease, unspecified
“congestive heart failure” · I50.9 Heart failure, unspecified
“acute respiratory failure with hypoxia” · J96.01 Acute respiratory failure with hypoxia
“anemia” · D64.9 Anemia, unspecified

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=1.056, t.ratio_s1=1.5, creat_rise_48h=0.04, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	false
derived: stage3	`meets_definition and (creat_ratio >= t.ratio_s3 or creat_peak >= t.scr_s3 or rrt_started or coalesce(uo_hours_lt_0_3 >= t.uo_s3_h, false) or coalesce(anuria_hours >= t.anuria_h, false))`	meets_definition=False, creat_ratio=1.056, t.ratio_s3=3.0, creat_peak=1.52, t.scr_s3=4.0, rrt_started=False, uo_hours_lt_0_3=unknown, t.uo_s3_h=24, anuria_hours=unknown, t.anuria_h=12	false
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=1.056, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	false
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=False, meets_definition=False	0
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.04, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria met

No gap

Supported as documented (D64.9).

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=10.5, 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=0.0, 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=True, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=True, hgb_drop=0.0, t.drop_min=1.0, prbc_units=0	true

Chronic kidney disease

Criteria met

Specificity gap

Documented “CKD” (N18.9); criteria support the more specific Chronic kidney disease stage 3a (N18.31).

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=181, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=53.7, egfr_late=49.7	53.7
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=53.7, t.g2=60, egfr_late=49.7	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=53.7, 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=53.7, egfr_late=49.7, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=53.7, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3a	true

Heart failure

Criteria met

Specificity gap

Documented “congestive heart failure” (I50.9); 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=2364.0, 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=65.0, 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=65.0, 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 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

Specificity gap

Criteria support Obesity, class 3 (E66.813); no corresponding diagnosis is documented.

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=78, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=40.7, t.c3=40	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 1 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=1.0, 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=39.0, t.t_hi=38, temp_min_48h=38.4, t.t_lo=36	true
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=118.0, 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=17.83, t.wbc_hi=12, wbc_min_48h=16.1, 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=89.0	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=0.73	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=1.52	1
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=1.44	1
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=1, sofa_renal_baseline=1	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=2.9, 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 (30)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-002917	Mon Jan 19, 2026 09:15 AM	creatinine	1.35 mg/dL
LAB-002918	Mon Jul 20, 2026 10:05 AM	creatinine	1.44 mg/dL
LAB-002919	Mon Nov 09, 2026 02:46 PM	creatinine	1.48 mg/dL
LAB-002924	Mon Nov 09, 2026 02:46 PM	bnp	2364.0 pg/mL
LAB-002925	Mon Nov 09, 2026 02:46 PM	sodium	138.0 mmol/L
LAB-002930	Mon Nov 09, 2026 02:46 PM	hemoglobin	10.5 g/dL
LAB-002935	Mon Nov 09, 2026 02:46 PM	wbc	16.1 x10^3/uL
LAB-002936	Mon Nov 09, 2026 02:46 PM	platelets	89.0 x10^3/uL
LAB-002945	Mon Nov 09, 2026 02:46 PM	bilirubin	0.73 mg/dL
LAB-002946	Mon Nov 09, 2026 02:46 PM	lactate	2.9 mmol/L
LAB-002920	Tue Nov 10, 2026 05:00 AM	creatinine	1.52 mg/dL
LAB-002926	Tue Nov 10, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-002931	Tue Nov 10, 2026 05:00 AM	hemoglobin	10.75 g/dL
LAB-002937	Tue Nov 10, 2026 05:00 AM	wbc	17.83 x10^3/uL
LAB-002938	Tue Nov 10, 2026 05:00 AM	platelets	89.0 x10^3/uL
LAB-002921	Wed Nov 11, 2026 05:00 AM	creatinine	1.46 mg/dL
LAB-002927	Wed Nov 11, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-002932	Wed Nov 11, 2026 05:00 AM	hemoglobin	10.54 g/dL
LAB-002939	Wed Nov 11, 2026 05:00 AM	wbc	17.8 x10^3/uL
LAB-002940	Wed Nov 11, 2026 05:00 AM	platelets	94.0 x10^3/uL
LAB-002922	Thu Nov 12, 2026 05:00 AM	creatinine	1.5 mg/dL
LAB-002928	Thu Nov 12, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-002933	Thu Nov 12, 2026 05:00 AM	hemoglobin	10.58 g/dL
LAB-002941	Thu Nov 12, 2026 05:00 AM	wbc	10.9 x10^3/uL
LAB-002942	Thu Nov 12, 2026 05:00 AM	platelets	300.0 x10^3/uL
LAB-002923	Fri Nov 13, 2026 05:00 AM	creatinine	1.5 mg/dL
LAB-002929	Fri Nov 13, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-002934	Fri Nov 13, 2026 05:00 AM	hemoglobin	10.6 g/dL
LAB-002943	Fri Nov 13, 2026 05:00 AM	wbc	10.27 x10^3/uL
LAB-002944	Fri Nov 13, 2026 05:00 AM	platelets	170.0 x10^3/uL

Vitals (80)

Vitals
Row	When	Kind	Value	Detail
VIT-008391	Mon Nov 09, 2026 02:06 PM	spo2	94.0	room air
VIT-008392	Mon Nov 09, 2026 02:06 PM	rr	20.0
VIT-008419	Mon Nov 09, 2026 02:06 PM	temp_c	38.9
VIT-008420	Mon Nov 09, 2026 02:06 PM	hr	108.0
VIT-008421	Mon Nov 09, 2026 02:06 PM	map	67.0
VIT-008422	Mon Nov 09, 2026 02:06 PM	gcs	15.0
VIT-008393	Mon Nov 09, 2026 10:06 PM	spo2	95.0	room air
VIT-008394	Mon Nov 09, 2026 10:06 PM	rr	19.0
VIT-008423	Mon Nov 09, 2026 10:06 PM	temp_c	38.8
VIT-008424	Mon Nov 09, 2026 10:06 PM	hr	114.0
VIT-008425	Mon Nov 09, 2026 10:06 PM	map	68.0
VIT-008426	Mon Nov 09, 2026 10:06 PM	gcs	15.0
VIT-008395	Mon Nov 09, 2026 10:11 PM	o2_lpm	1.0	nasal cannula
VIT-008396	Tue Nov 10, 2026 06:06 AM	spo2	93.0	room air
VIT-008397	Tue Nov 10, 2026 06:06 AM	rr	19.0
VIT-008427	Tue Nov 10, 2026 06:06 AM	temp_c	39.0
VIT-008428	Tue Nov 10, 2026 06:06 AM	hr	114.0
VIT-008429	Tue Nov 10, 2026 06:06 AM	map	68.0
VIT-008430	Tue Nov 10, 2026 06:06 AM	gcs	15.0
VIT-008398	Tue Nov 10, 2026 06:11 AM	o2_lpm	1.0	nasal cannula
VIT-008399	Tue Nov 10, 2026 02:06 PM	spo2	95.0	room air
VIT-008400	Tue Nov 10, 2026 02:06 PM	rr	19.0
VIT-008431	Tue Nov 10, 2026 02:06 PM	temp_c	38.4
VIT-008432	Tue Nov 10, 2026 02:06 PM	hr	118.0
VIT-008433	Tue Nov 10, 2026 02:06 PM	map	68.0
VIT-008434	Tue Nov 10, 2026 02:06 PM	gcs	15.0
VIT-008401	Tue Nov 10, 2026 10:06 PM	spo2	97.0	room air
VIT-008402	Tue Nov 10, 2026 10:06 PM	rr	19.0
VIT-008435	Tue Nov 10, 2026 10:06 PM	temp_c	38.8
VIT-008436	Tue Nov 10, 2026 10:06 PM	hr	115.0
VIT-008437	Tue Nov 10, 2026 10:06 PM	map	67.0
VIT-008438	Tue Nov 10, 2026 10:06 PM	gcs	15.0
VIT-008403	Wed Nov 11, 2026 06:06 AM	spo2	96.0	room air
VIT-008404	Wed Nov 11, 2026 06:06 AM	rr	19.0
VIT-008439	Wed Nov 11, 2026 06:06 AM	temp_c	38.5
VIT-008440	Wed Nov 11, 2026 06:06 AM	hr	116.0
VIT-008441	Wed Nov 11, 2026 06:06 AM	map	64.0
VIT-008442	Wed Nov 11, 2026 06:06 AM	gcs	15.0
VIT-008405	Wed Nov 11, 2026 02:06 PM	spo2	93.0	room air
VIT-008406	Wed Nov 11, 2026 02:06 PM	rr	18.0
VIT-008443	Wed Nov 11, 2026 02:06 PM	temp_c	36.8
VIT-008444	Wed Nov 11, 2026 02:06 PM	hr	88.0
VIT-008445	Wed Nov 11, 2026 02:06 PM	map	89.0
VIT-008446	Wed Nov 11, 2026 02:06 PM	gcs	15.0
VIT-008407	Wed Nov 11, 2026 10:06 PM	spo2	97.0	room air
VIT-008408	Wed Nov 11, 2026 10:06 PM	rr	21.0
VIT-008447	Wed Nov 11, 2026 10:06 PM	temp_c	37.1
VIT-008448	Wed Nov 11, 2026 10:06 PM	hr	89.0
VIT-008449	Wed Nov 11, 2026 10:06 PM	map	83.0
VIT-008450	Wed Nov 11, 2026 10:06 PM	gcs	15.0
VIT-008409	Thu Nov 12, 2026 06:06 AM	spo2	96.0	room air
VIT-008410	Thu Nov 12, 2026 06:06 AM	rr	20.0
VIT-008451	Thu Nov 12, 2026 06:06 AM	temp_c	36.8
VIT-008452	Thu Nov 12, 2026 06:06 AM	hr	74.0
VIT-008453	Thu Nov 12, 2026 06:06 AM	map	88.0
VIT-008454	Thu Nov 12, 2026 06:06 AM	gcs	15.0
VIT-008411	Thu Nov 12, 2026 02:06 PM	spo2	93.0	room air
VIT-008412	Thu Nov 12, 2026 02:06 PM	rr	21.0
VIT-008455	Thu Nov 12, 2026 02:06 PM	temp_c	36.9
VIT-008456	Thu Nov 12, 2026 02:06 PM	hr	85.0
VIT-008457	Thu Nov 12, 2026 02:06 PM	map	84.0
VIT-008458	Thu Nov 12, 2026 02:06 PM	gcs	15.0
VIT-008413	Thu Nov 12, 2026 10:06 PM	spo2	97.0	room air
VIT-008414	Thu Nov 12, 2026 10:06 PM	rr	17.0
VIT-008459	Thu Nov 12, 2026 10:06 PM	temp_c	36.7
VIT-008460	Thu Nov 12, 2026 10:06 PM	hr	84.0
VIT-008461	Thu Nov 12, 2026 10:06 PM	map	92.0
VIT-008462	Thu Nov 12, 2026 10:06 PM	gcs	15.0
VIT-008415	Fri Nov 13, 2026 06:06 AM	spo2	94.0	room air
VIT-008416	Fri Nov 13, 2026 06:06 AM	rr	16.0
VIT-008463	Fri Nov 13, 2026 06:06 AM	temp_c	36.9
VIT-008464	Fri Nov 13, 2026 06:06 AM	hr	92.0
VIT-008465	Fri Nov 13, 2026 06:06 AM	map	91.0
VIT-008466	Fri Nov 13, 2026 06:06 AM	gcs	15.0
VIT-008417	Fri Nov 13, 2026 02:06 PM	spo2	95.0	room air
VIT-008418	Fri Nov 13, 2026 02:06 PM	rr	20.0
VIT-008467	Fri Nov 13, 2026 02:06 PM	temp_c	36.5
VIT-008468	Fri Nov 13, 2026 02:06 PM	hr	82.0
VIT-008469	Fri Nov 13, 2026 02:06 PM	map	82.0
VIT-008470	Fri Nov 13, 2026 02:06 PM	gcs	15.0

Medications, orders, echo, history (12)

MED-000333 11-09 14:46 cefepime per protocol IV
MED-000334 11-10 05:00 ceftriaxone per protocol IV
MED-000335 11-11 05:00 ceftriaxone per protocol IV
MED-000336 11-09 08:00 furosemide 40 mg IV
MED-000337 11-09 20:00 furosemide 40 mg IV
MED-000338 11-10 08:00 furosemide 40 mg IV
MED-000339 11-10 20:00 furosemide 40 mg IV
MED-000340 11-11 08:00 furosemide 40 mg IV
MED-000341 11-11 20:00 furosemide 40 mg IV
ORD-000078 11-09 14:16 blood_culture: blood cultures x2
ECH-000040 2026-11-10 echo LVEF 65.0%
HX-000031 history: heart failure with preserved ejection fraction

Notes

History and physical · DOC-000296 · Dr. Elena Nakashima (resident) · Mon Nov 09, 2026 04:46 PM

Cited facts from this note (1)

infection_source: acute pyelonephritis · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… ervice: Hospital Medicine Attending: Dr. Kenji Stavros History of present illness: 78-year-old man admitted with sepsis. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime. Past medical history: heart failure with preserved ejection fraction. Review of systems otherwise negative. Exam: Lungs: scattered crackles at t …

Source document DOC-000296: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Lena Northam   MRN: MRN97875486   Admitted: 2026-11-09 13:46
Service: Hospital Medicine   Attending: Dr. Kenji Stavros

History of present illness: 78-year-old man admitted with sepsis. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime.
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. Sepsis: antibiotics, fluids.
2. Urinary tract infection: antibiotics.
3. CKD: renally dose medications.

Progress note · DOC-000297 · Dr. Elena Nakashima (resident) · Fri Nov 13, 2026 10:55 AM · awaiting cosign

Source document DOC-000297: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Lena Northam   MRN: MRN97875486   Hospital day 4

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Sepsis: continue current management.
2. Congestive heart failure: diuresis and daily weights; monitor electrolytes.
3. Acute respiratory failure with hypoxia: supplemental oxygen, wean as tolerated.
4. Anemia: trend hemoglobin.

Resident: Dr. Elena Nakashima   Attending cosign: pending