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-00090: Farah Nakashima

78F · MRN80931376 · Cardiology · admitted Wed Nov 04, 2026 06:58 PM · discharged Mon Nov 09, 2026 03:19 PM · attending Dr. Gideon Zeller · 159 cm, 54.7 kg

Documented diagnoses (current)

“malnourished” · E46 Unspecified protein-calorie malnutrition
“AKI” · N17.9 Acute kidney failure, unspecified
Principal: “acute diastolic heart failure” · I50.31 Acute diastolic (congestive) heart failure
“stage 4 sacral pressure ulcer” · L89.154 Pressure ulcer of sacral region, stage 4
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

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 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=2.328, t.ratio_s1=1.5, creat_rise_48h=0.35, 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=2.328, t.ratio_s3=3.0, creat_peak=1.56, 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=2.328, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	true
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=True, meets_definition=True	2
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.35, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=2, baseline_independent=True	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=13.26, 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=13.26, 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=239, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=89.7, egfr_late=89.4	89.7
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=89.7, t.g2=60, egfr_late=89.4	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=89.7, 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=89.7, egfr_late=89.4, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=89.7, t.g2=60	true

Heart failure

Criteria met

No gap

Supported as documented (I50.31).

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=1842.0, 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=False	2
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=60.0, 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=60.0, 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=2, hf_history=False	acute
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	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=diastolic, acuity=acute	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=acute	false
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=acute	false
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=diastolic, acuity=acute	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=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

Clinical validation gap

Documented “malnourished” (E46) but the criteria are not met: 4 characteristics assessed and none met.

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=78, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=21.6, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=21.6, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=21.6, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=21.6, t.c1=30	true

Pressure injury

Criteria met

Clinical validation gap

Documented “stage 4 sacral pressure ulcer” (L89.154) conflicts with what the criteria support (Pressure injury of sacral region, stage 2, L89.152).

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=sacral	true
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=2	false
outcome: other_site	`wound_site != 'sacral'`	wound_site=sacral	false
outcome: stage1	`sacral and wound_stage == '1'`	sacral=True, wound_stage=2	false
outcome: stage2	`sacral and wound_stage == '2'`	sacral=True, wound_stage=2	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 not met

No gap

Not documented and not supported.

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=37.4, t.t_hi=38, temp_min_48h=36.6, 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=19.0, 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=8.68, t.wbc_hi=12, wbc_min_48h=7.38, 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=False, sirs_wbc=False	0
derived: sofa_resp	`coalesce(case(pf_min_48h < 100 and adv_resp_support, 4, pf_min_48h < 200 and adv_resp_support, 3, pf_min_48h < 300, 2, pf_min_48h < 400, 1, 0), 0)`	pf_min_48h=unknown, adv_resp_support=False	0
derived: sofa_coag	`coalesce(case(platelets_min_48h < 20, 4, platelets_min_48h < 50, 3, platelets_min_48h < 100, 2, platelets_min_48h < 150, 1, 0), 0)`	platelets_min_48h=238.0	0
derived: sofa_liver	`coalesce(case(bili_max_48h >= 12, 4, bili_max_48h >= 6, 3, bili_max_48h >= 2, 2, bili_max_48h >= 1.2, 1, 0), 0)`	bili_max_48h=0.97	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=75.0	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=1.56	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=0.67	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=1, sofa_renal_baseline=0	1
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=1, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, sirs_count=0, 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-003034	Fri Nov 28, 2025 09:15 AM	creatinine	0.66 mg/dL
LAB-003035	Sun Jul 26, 2026 10:05 AM	creatinine	0.67 mg/dL
LAB-003036	Wed Nov 04, 2026 07:58 PM	creatinine	1.21 mg/dL
LAB-003042	Wed Nov 04, 2026 07:58 PM	bnp	1842.0 pg/mL
LAB-003043	Wed Nov 04, 2026 07:58 PM	sodium	137.0 mmol/L
LAB-003049	Wed Nov 04, 2026 07:58 PM	hemoglobin	13.39 g/dL
LAB-003055	Wed Nov 04, 2026 07:58 PM	wbc	8.68 x10^3/uL
LAB-003056	Wed Nov 04, 2026 07:58 PM	platelets	294.0 x10^3/uL
LAB-003067	Wed Nov 04, 2026 07:58 PM	bilirubin	0.97 mg/dL
LAB-003037	Thu Nov 05, 2026 05:00 AM	creatinine	1.56 mg/dL
LAB-003044	Thu Nov 05, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-003050	Thu Nov 05, 2026 05:00 AM	hemoglobin	13.56 g/dL
LAB-003057	Thu Nov 05, 2026 05:00 AM	wbc	8.59 x10^3/uL
LAB-003058	Thu Nov 05, 2026 05:00 AM	platelets	266.0 x10^3/uL
LAB-003038	Fri Nov 06, 2026 05:00 AM	creatinine	1.4 mg/dL
LAB-003045	Fri Nov 06, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-003051	Fri Nov 06, 2026 05:00 AM	hemoglobin	13.49 g/dL
LAB-003059	Fri Nov 06, 2026 05:00 AM	wbc	7.38 x10^3/uL
LAB-003060	Fri Nov 06, 2026 05:00 AM	platelets	238.0 x10^3/uL
LAB-003039	Sat Nov 07, 2026 05:00 AM	creatinine	1.17 mg/dL
LAB-003046	Sat Nov 07, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-003052	Sat Nov 07, 2026 05:00 AM	hemoglobin	13.54 g/dL
LAB-003061	Sat Nov 07, 2026 05:00 AM	wbc	9.17 x10^3/uL
LAB-003062	Sat Nov 07, 2026 05:00 AM	platelets	202.0 x10^3/uL
LAB-003040	Sun Nov 08, 2026 05:00 AM	creatinine	0.96 mg/dL
LAB-003047	Sun Nov 08, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003053	Sun Nov 08, 2026 05:00 AM	hemoglobin	13.26 g/dL
LAB-003063	Sun Nov 08, 2026 05:00 AM	wbc	10.2 x10^3/uL
LAB-003064	Sun Nov 08, 2026 05:00 AM	platelets	266.0 x10^3/uL
LAB-003041	Mon Nov 09, 2026 05:00 AM	creatinine	0.86 mg/dL
LAB-003048	Mon Nov 09, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-003054	Mon Nov 09, 2026 05:00 AM	hemoglobin	13.47 g/dL
LAB-003065	Mon Nov 09, 2026 05:00 AM	wbc	10.32 x10^3/uL
LAB-003066	Mon Nov 09, 2026 05:00 AM	platelets	276.0 x10^3/uL

Vitals (90)

Vitals
Row	When	Kind	Value	Detail
VIT-008747	Wed Nov 04, 2026 07:18 PM	spo2	96.0	room air
VIT-008748	Wed Nov 04, 2026 07:18 PM	rr	14.0
VIT-008777	Wed Nov 04, 2026 07:18 PM	temp_c	36.7
VIT-008778	Wed Nov 04, 2026 07:18 PM	hr	90.0
VIT-008779	Wed Nov 04, 2026 07:18 PM	map	86.0
VIT-008780	Wed Nov 04, 2026 07:18 PM	gcs	15.0
VIT-008749	Thu Nov 05, 2026 03:18 AM	spo2	95.0	room air
VIT-008750	Thu Nov 05, 2026 03:18 AM	rr	14.0
VIT-008781	Thu Nov 05, 2026 03:18 AM	temp_c	36.9
VIT-008782	Thu Nov 05, 2026 03:18 AM	hr	81.0
VIT-008783	Thu Nov 05, 2026 03:18 AM	map	75.0
VIT-008784	Thu Nov 05, 2026 03:18 AM	gcs	15.0
VIT-008751	Thu Nov 05, 2026 11:18 AM	spo2	94.0	room air
VIT-008752	Thu Nov 05, 2026 11:18 AM	rr	14.0
VIT-008785	Thu Nov 05, 2026 11:18 AM	temp_c	36.9
VIT-008786	Thu Nov 05, 2026 11:18 AM	hr	90.0
VIT-008787	Thu Nov 05, 2026 11:18 AM	map	77.0
VIT-008788	Thu Nov 05, 2026 11:18 AM	gcs	15.0
VIT-008753	Thu Nov 05, 2026 07:18 PM	spo2	96.0	room air
VIT-008754	Thu Nov 05, 2026 07:18 PM	rr	19.0
VIT-008789	Thu Nov 05, 2026 07:18 PM	temp_c	36.6
VIT-008790	Thu Nov 05, 2026 07:18 PM	hr	84.0
VIT-008791	Thu Nov 05, 2026 07:18 PM	map	79.0
VIT-008792	Thu Nov 05, 2026 07:18 PM	gcs	15.0
VIT-008755	Fri Nov 06, 2026 03:18 AM	spo2	95.0	room air
VIT-008756	Fri Nov 06, 2026 03:18 AM	rr	15.0
VIT-008793	Fri Nov 06, 2026 03:18 AM	temp_c	37.2
VIT-008794	Fri Nov 06, 2026 03:18 AM	hr	84.0
VIT-008795	Fri Nov 06, 2026 03:18 AM	map	87.0
VIT-008796	Fri Nov 06, 2026 03:18 AM	gcs	15.0
VIT-008757	Fri Nov 06, 2026 11:18 AM	spo2	96.0	room air
VIT-008758	Fri Nov 06, 2026 11:18 AM	rr	14.0
VIT-008797	Fri Nov 06, 2026 11:18 AM	temp_c	37.4
VIT-008798	Fri Nov 06, 2026 11:18 AM	hr	68.0
VIT-008799	Fri Nov 06, 2026 11:18 AM	map	80.0
VIT-008800	Fri Nov 06, 2026 11:18 AM	gcs	15.0
VIT-008759	Fri Nov 06, 2026 07:18 PM	spo2	98.0	room air
VIT-008760	Fri Nov 06, 2026 07:18 PM	rr	15.0
VIT-008801	Fri Nov 06, 2026 07:18 PM	temp_c	36.8
VIT-008802	Fri Nov 06, 2026 07:18 PM	hr	73.0
VIT-008803	Fri Nov 06, 2026 07:18 PM	map	89.0
VIT-008804	Fri Nov 06, 2026 07:18 PM	gcs	15.0
VIT-008761	Sat Nov 07, 2026 03:18 AM	spo2	94.0	room air
VIT-008762	Sat Nov 07, 2026 03:18 AM	rr	19.0
VIT-008805	Sat Nov 07, 2026 03:18 AM	temp_c	36.6
VIT-008806	Sat Nov 07, 2026 03:18 AM	hr	69.0
VIT-008807	Sat Nov 07, 2026 03:18 AM	map	90.0
VIT-008808	Sat Nov 07, 2026 03:18 AM	gcs	15.0
VIT-008763	Sat Nov 07, 2026 11:18 AM	spo2	96.0	room air
VIT-008764	Sat Nov 07, 2026 11:18 AM	rr	18.0
VIT-008809	Sat Nov 07, 2026 11:18 AM	temp_c	37.0
VIT-008810	Sat Nov 07, 2026 11:18 AM	hr	92.0
VIT-008811	Sat Nov 07, 2026 11:18 AM	map	84.0
VIT-008812	Sat Nov 07, 2026 11:18 AM	gcs	15.0
VIT-008765	Sat Nov 07, 2026 07:18 PM	spo2	97.0	room air
VIT-008766	Sat Nov 07, 2026 07:18 PM	rr	19.0
VIT-008813	Sat Nov 07, 2026 07:18 PM	temp_c	36.8
VIT-008814	Sat Nov 07, 2026 07:18 PM	hr	81.0
VIT-008815	Sat Nov 07, 2026 07:18 PM	map	80.0
VIT-008816	Sat Nov 07, 2026 07:18 PM	gcs	15.0
VIT-008767	Sun Nov 08, 2026 03:18 AM	spo2	98.0	room air
VIT-008768	Sun Nov 08, 2026 03:18 AM	rr	20.0
VIT-008817	Sun Nov 08, 2026 03:18 AM	temp_c	36.5
VIT-008818	Sun Nov 08, 2026 03:18 AM	hr	73.0
VIT-008819	Sun Nov 08, 2026 03:18 AM	map	88.0
VIT-008820	Sun Nov 08, 2026 03:18 AM	gcs	15.0
VIT-008769	Sun Nov 08, 2026 11:18 AM	spo2	98.0	room air
VIT-008770	Sun Nov 08, 2026 11:18 AM	rr	15.0
VIT-008821	Sun Nov 08, 2026 11:18 AM	temp_c	37.2
VIT-008822	Sun Nov 08, 2026 11:18 AM	hr	72.0
VIT-008823	Sun Nov 08, 2026 11:18 AM	map	76.0
VIT-008824	Sun Nov 08, 2026 11:18 AM	gcs	15.0
VIT-008771	Sun Nov 08, 2026 07:18 PM	spo2	94.0	room air
VIT-008772	Sun Nov 08, 2026 07:18 PM	rr	14.0
VIT-008825	Sun Nov 08, 2026 07:18 PM	temp_c	37.0
VIT-008826	Sun Nov 08, 2026 07:18 PM	hr	88.0
VIT-008827	Sun Nov 08, 2026 07:18 PM	map	84.0
VIT-008828	Sun Nov 08, 2026 07:18 PM	gcs	15.0
VIT-008773	Mon Nov 09, 2026 03:18 AM	spo2	97.0	room air
VIT-008774	Mon Nov 09, 2026 03:18 AM	rr	17.0
VIT-008829	Mon Nov 09, 2026 03:18 AM	temp_c	36.5
VIT-008830	Mon Nov 09, 2026 03:18 AM	hr	70.0
VIT-008831	Mon Nov 09, 2026 03:18 AM	map	78.0
VIT-008832	Mon Nov 09, 2026 03:18 AM	gcs	15.0
VIT-008775	Mon Nov 09, 2026 11:18 AM	spo2	95.0	room air
VIT-008776	Mon Nov 09, 2026 11:18 AM	rr	14.0
VIT-008833	Mon Nov 09, 2026 11:18 AM	temp_c	36.5
VIT-008834	Mon Nov 09, 2026 11:18 AM	hr	78.0
VIT-008835	Mon Nov 09, 2026 11:18 AM	map	91.0
VIT-008836	Mon Nov 09, 2026 11:18 AM	gcs	15.0

Medications, orders, echo, history (7)

MED-000351 11-04 08:00 furosemide 40 mg IV
MED-000352 11-04 20:00 furosemide 40 mg IV
MED-000353 11-05 08:00 furosemide 40 mg IV
MED-000354 11-05 20:00 furosemide 40 mg IV
MED-000355 11-06 08:00 furosemide 40 mg IV
MED-000356 11-06 20:00 furosemide 40 mg IV
ECH-000042 2026-11-05 echo LVEF 60.0%

Notes

History and physical · DOC-000306 · Dr. Gideon Zeller (attending) · Wed Nov 04, 2026 09:58 PM

Source document DOC-000306: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Farah Nakashima   MRN: MRN80931376   Admitted: 2026-11-04 18:58
Service: Cardiology   Attending: Dr. Gideon Zeller

History of present illness: 78-year-old woman admitted with acute diastolic heart failure. 
Past medical history: type 2 diabetes, GERD.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Acute diastolic heart failure: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000304 · Vera Pemberton, RD (dietitian) · Thu Nov 05, 2026 09:58 PM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN80931376 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: Farah Nakashima MRN: MRN80931376 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: Farah Nakashima MRN: MRN80931376 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-000304: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Farah Nakashima   MRN: MRN80931376

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.

Wound care note · DOC-000305 · Ines Ingram, RN, CWOCN (wound_nurse) · Thu Nov 05, 2026 10:58 PM

Cited facts from this note (2)

wound_site: sacral · cited p. 1, line 4 · confidence 0.95

Show source for wound_site

WOUND CARE NOTE Patient: Farah Nakashima MRN: MRN80931376 Location: sacrum Stage: 2 (NPIAP) Description: partial-thickness skin loss with exposed dermis. Size: 3.0 x 2.4 x 0.3 cm. Plan: offloading every 2 hours, foam dressing, nutriti …
wound_stage: 2 · cited p. 1, line 5 · confidence 0.95

Show source for wound_stage

WOUND CARE NOTE Patient: Farah Nakashima MRN: MRN80931376 Location: sacrum Stage: 2 (NPIAP) Description: partial-thickness skin loss with exposed dermis. Size: 3.0 x 2.4 x 0.3 cm. Plan: offloading every 2 hours, foam dressing, nutrition consul …

Source document DOC-000305: Wound care note (synthetic)

WOUND CARE NOTE
Patient: Farah Nakashima   MRN: MRN80931376

Location: sacrum
Stage: 2 (NPIAP)
Description: partial-thickness skin loss with exposed dermis.
Size: 3.0 x 2.4 x 0.3 cm.
Plan: offloading every 2 hours, foam dressing, nutrition consult.

Progress note · DOC-000307 · Dr. Gideon Zeller (attending) · Fri Nov 06, 2026 08:58 PM

Source document DOC-000307: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Farah Nakashima   MRN: MRN80931376   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Acute diastolic heart failure: continue current management.
2. Malnourished: dietitian following.
3. AKI: trend creatinine, hold nephrotoxins, strict intake and output.
4. Stage 4 sacral pressure ulcer: wound care following, offloading.

Attending: Dr. Gideon Zeller

Discharge summary · DOC-000308 · Dr. Gideon Zeller (attending) · Mon Nov 09, 2026 03:19 PM

Source document DOC-000308: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Farah Nakashima   MRN: MRN80931376
Admitted 2026-11-04; discharged 2026-11-09.

Discharge diagnoses:
- malnourished
- AKI
- acute diastolic heart failure
- stage 4 sacral pressure ulcer
- type 2 diabetes
- GERD

Disposition: home with follow-up.