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-00097: Ines Ashgrove

79F · MRN99297123 · Cardiology · admitted Sun Nov 01, 2026 10:21 AM · discharged Thu Nov 05, 2026 02:15 PM · attending Dr. Cyrus Ellingham · resident Dr. Camila Oyelaran · 166 cm, 57.7 kg

Documented diagnoses (current)

“severe protein-calorie malnutrition” · E43 Unspecified severe protein-calorie malnutrition
“CKD stage 3a” · N18.31 Chronic kidney disease, stage 3a
Principal: “congestive heart failure” · I50.9 Heart failure, unspecified

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=1.056, t.ratio_s1=1.5, creat_rise_48h=0.01, 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=0.94, 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=0.01, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=F, hgb_nadir=12.36, 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=True, anaemic=False, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=False, hgb_drop=0.3, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=12.36, anaemic=False	true

Chronic kidney disease

Clinical judgement required

Clinical judgement required: Pre-admission eGFR values fall on both sides of 60.

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=282, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=52.8, egfr_late=65.9	65.9
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=52.8, t.g2=60, egfr_late=65.9	false
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=65.9, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=False, egfr_early=52.8, egfr_late=65.9, t.g2=60	true

Heart failure

Criteria met

Specificity gap

Documented “congestive heart failure” (I50.9); criteria support the more specific Chronic systolic (HFrEF) heart failure (I50.22).

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=65.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	false
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=False, np_elevated=False, new_o2=False	0
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=26.0, 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=26.0, 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=0, hf_history=True	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=chronic	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=systolic, acuity=chronic	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=systolic, acuity=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

Criteria met

Clinical validation gap

Documented “severe protein-calorie malnutrition” (E43) conflicts with what the criteria support (Moderate (non-severe) protein-calorie malnutrition (acute illness context), E44.0).

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=60.0, t.a_sev_intake_pct=50, intake_days=14.0, 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=60.0, t.a_mod_intake_pct=75, intake_days=14.0, t.a_mod_intake_days=7	true
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=30.0, wt_loss_pct=3.0	false
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=30.0, wt_loss_pct=3.0	false
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=60.0, t.c_intake_pct=75, intake_days=14.0, 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=60.0, t.c_intake_pct=75, intake_days=14.0, 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=30.0, wt_loss_pct=3.0	false
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=30.0, wt_loss_pct=3.0	false
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=60.0, wt_loss_pct=3.0, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown	5
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=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=False	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=True, a_sev_wt=False, a_mod_wt=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=False, c_mod_wt=False	3
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=3	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=79, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=20.9, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=20.9, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=20.9, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=20.9, t.c1=30	true

Pressure injury

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule pressure_injury v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sacral	`wound_site == 'sacral'`	wound_site=unknown	unknown
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=unknown	true

Acute respiratory failure

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule respiratory_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: measured	`present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min)`	spo2_min_ra=94.0, pao2_min_ra=unknown, pf_min=unknown	true
derived: hypoxemia	`coalesce(spo2_min_ra < t.spo2_ra, false) or coalesce(pao2_min_ra < t.pao2, false) or coalesce(pf_min < t.pf, false)`	spo2_min_ra=94.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	false
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=20.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=False	false
outcome: met	`hypoxemia and distress`	hypoxemia=False, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=False	false
outcome: not_met	`measured and not hypoxemia and o2_max_lpm <= t.o2_low and not adv_resp_support`	measured=True, hypoxemia=False, o2_max_lpm=0.0, t.o2_low=2, adv_resp_support=False	true

Sepsis

Criteria 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=37.5, 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=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=10.79, t.wbc_hi=12, wbc_min_48h=7.16, 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=170.0	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=0.93	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=0.94	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=0.89	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=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 (29)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-003290	Mon Oct 13, 2025 09:15 AM	creatinine	1.07 mg/dL
LAB-003291	Wed Jul 22, 2026 10:05 AM	creatinine	0.89 mg/dL
LAB-003292	Sun Nov 01, 2026 11:21 AM	creatinine	0.94 mg/dL
LAB-003297	Sun Nov 01, 2026 11:21 AM	bnp	65.0 pg/mL
LAB-003298	Sun Nov 01, 2026 11:21 AM	sodium	139.0 mmol/L
LAB-003303	Sun Nov 01, 2026 11:21 AM	hemoglobin	12.65 g/dL
LAB-003308	Sun Nov 01, 2026 11:21 AM	wbc	7.16 x10^3/uL
LAB-003309	Sun Nov 01, 2026 11:21 AM	platelets	257.0 x10^3/uL
LAB-003318	Sun Nov 01, 2026 11:21 AM	bilirubin	0.93 mg/dL
LAB-003293	Mon Nov 02, 2026 05:00 AM	creatinine	0.91 mg/dL
LAB-003299	Mon Nov 02, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003304	Mon Nov 02, 2026 05:00 AM	hemoglobin	12.38 g/dL
LAB-003310	Mon Nov 02, 2026 05:00 AM	wbc	10.79 x10^3/uL
LAB-003311	Mon Nov 02, 2026 05:00 AM	platelets	304.0 x10^3/uL
LAB-003294	Tue Nov 03, 2026 05:00 AM	creatinine	0.92 mg/dL
LAB-003300	Tue Nov 03, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003305	Tue Nov 03, 2026 05:00 AM	hemoglobin	12.6 g/dL
LAB-003312	Tue Nov 03, 2026 05:00 AM	wbc	10.67 x10^3/uL
LAB-003313	Tue Nov 03, 2026 05:00 AM	platelets	170.0 x10^3/uL
LAB-003295	Wed Nov 04, 2026 05:00 AM	creatinine	0.89 mg/dL
LAB-003301	Wed Nov 04, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-003306	Wed Nov 04, 2026 05:00 AM	hemoglobin	12.36 g/dL
LAB-003314	Wed Nov 04, 2026 05:00 AM	wbc	5.61 x10^3/uL
LAB-003315	Wed Nov 04, 2026 05:00 AM	platelets	222.0 x10^3/uL
LAB-003296	Thu Nov 05, 2026 05:00 AM	creatinine	0.89 mg/dL
LAB-003302	Thu Nov 05, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-003307	Thu Nov 05, 2026 05:00 AM	hemoglobin	12.37 g/dL
LAB-003316	Thu Nov 05, 2026 05:00 AM	wbc	9.88 x10^3/uL
LAB-003317	Thu Nov 05, 2026 05:00 AM	platelets	291.0 x10^3/uL

Vitals (78)

Vitals
Row	When	Kind	Value	Detail
VIT-009463	Sun Nov 01, 2026 10:41 AM	spo2	97.0	room air
VIT-009464	Sun Nov 01, 2026 10:41 AM	rr	16.0
VIT-009489	Sun Nov 01, 2026 10:41 AM	temp_c	37.1
VIT-009490	Sun Nov 01, 2026 10:41 AM	hr	80.0
VIT-009491	Sun Nov 01, 2026 10:41 AM	map	77.0
VIT-009492	Sun Nov 01, 2026 10:41 AM	gcs	15.0
VIT-009465	Sun Nov 01, 2026 06:41 PM	spo2	94.0	room air
VIT-009466	Sun Nov 01, 2026 06:41 PM	rr	19.0
VIT-009493	Sun Nov 01, 2026 06:41 PM	temp_c	36.9
VIT-009494	Sun Nov 01, 2026 06:41 PM	hr	86.0
VIT-009495	Sun Nov 01, 2026 06:41 PM	map	89.0
VIT-009496	Sun Nov 01, 2026 06:41 PM	gcs	15.0
VIT-009467	Mon Nov 02, 2026 02:41 AM	spo2	98.0	room air
VIT-009468	Mon Nov 02, 2026 02:41 AM	rr	20.0
VIT-009497	Mon Nov 02, 2026 02:41 AM	temp_c	37.0
VIT-009498	Mon Nov 02, 2026 02:41 AM	hr	78.0
VIT-009499	Mon Nov 02, 2026 02:41 AM	map	88.0
VIT-009500	Mon Nov 02, 2026 02:41 AM	gcs	15.0
VIT-009469	Mon Nov 02, 2026 10:41 AM	spo2	94.0	room air
VIT-009470	Mon Nov 02, 2026 10:41 AM	rr	15.0
VIT-009501	Mon Nov 02, 2026 10:41 AM	temp_c	37.5
VIT-009502	Mon Nov 02, 2026 10:41 AM	hr	80.0
VIT-009503	Mon Nov 02, 2026 10:41 AM	map	78.0
VIT-009504	Mon Nov 02, 2026 10:41 AM	gcs	15.0
VIT-009471	Mon Nov 02, 2026 06:41 PM	spo2	99.0	room air
VIT-009472	Mon Nov 02, 2026 06:41 PM	rr	20.0
VIT-009505	Mon Nov 02, 2026 06:41 PM	temp_c	36.6
VIT-009506	Mon Nov 02, 2026 06:41 PM	hr	84.0
VIT-009507	Mon Nov 02, 2026 06:41 PM	map	91.0
VIT-009508	Mon Nov 02, 2026 06:41 PM	gcs	15.0
VIT-009473	Tue Nov 03, 2026 02:41 AM	spo2	97.0	room air
VIT-009474	Tue Nov 03, 2026 02:41 AM	rr	16.0
VIT-009509	Tue Nov 03, 2026 02:41 AM	temp_c	36.9
VIT-009510	Tue Nov 03, 2026 02:41 AM	hr	75.0
VIT-009511	Tue Nov 03, 2026 02:41 AM	map	76.0
VIT-009512	Tue Nov 03, 2026 02:41 AM	gcs	15.0
VIT-009475	Tue Nov 03, 2026 10:41 AM	spo2	97.0	room air
VIT-009476	Tue Nov 03, 2026 10:41 AM	rr	15.0
VIT-009513	Tue Nov 03, 2026 10:41 AM	temp_c	36.6
VIT-009514	Tue Nov 03, 2026 10:41 AM	hr	89.0
VIT-009515	Tue Nov 03, 2026 10:41 AM	map	80.0
VIT-009516	Tue Nov 03, 2026 10:41 AM	gcs	15.0
VIT-009477	Tue Nov 03, 2026 06:41 PM	spo2	99.0	room air
VIT-009478	Tue Nov 03, 2026 06:41 PM	rr	17.0
VIT-009517	Tue Nov 03, 2026 06:41 PM	temp_c	37.0
VIT-009518	Tue Nov 03, 2026 06:41 PM	hr	86.0
VIT-009519	Tue Nov 03, 2026 06:41 PM	map	81.0
VIT-009520	Tue Nov 03, 2026 06:41 PM	gcs	15.0
VIT-009479	Wed Nov 04, 2026 02:41 AM	spo2	94.0	room air
VIT-009480	Wed Nov 04, 2026 02:41 AM	rr	15.0
VIT-009521	Wed Nov 04, 2026 02:41 AM	temp_c	37.1
VIT-009522	Wed Nov 04, 2026 02:41 AM	hr	69.0
VIT-009523	Wed Nov 04, 2026 02:41 AM	map	90.0
VIT-009524	Wed Nov 04, 2026 02:41 AM	gcs	15.0
VIT-009481	Wed Nov 04, 2026 10:41 AM	spo2	94.0	room air
VIT-009482	Wed Nov 04, 2026 10:41 AM	rr	14.0
VIT-009525	Wed Nov 04, 2026 10:41 AM	temp_c	37.3
VIT-009526	Wed Nov 04, 2026 10:41 AM	hr	89.0
VIT-009527	Wed Nov 04, 2026 10:41 AM	map	78.0
VIT-009528	Wed Nov 04, 2026 10:41 AM	gcs	15.0
VIT-009483	Wed Nov 04, 2026 06:41 PM	spo2	99.0	room air
VIT-009484	Wed Nov 04, 2026 06:41 PM	rr	19.0
VIT-009529	Wed Nov 04, 2026 06:41 PM	temp_c	37.2
VIT-009530	Wed Nov 04, 2026 06:41 PM	hr	90.0
VIT-009531	Wed Nov 04, 2026 06:41 PM	map	76.0
VIT-009532	Wed Nov 04, 2026 06:41 PM	gcs	15.0
VIT-009485	Thu Nov 05, 2026 02:41 AM	spo2	97.0	room air
VIT-009486	Thu Nov 05, 2026 02:41 AM	rr	17.0
VIT-009533	Thu Nov 05, 2026 02:41 AM	temp_c	37.5
VIT-009534	Thu Nov 05, 2026 02:41 AM	hr	90.0
VIT-009535	Thu Nov 05, 2026 02:41 AM	map	78.0
VIT-009536	Thu Nov 05, 2026 02:41 AM	gcs	15.0
VIT-009487	Thu Nov 05, 2026 10:41 AM	spo2	94.0	room air
VIT-009488	Thu Nov 05, 2026 10:41 AM	rr	14.0
VIT-009537	Thu Nov 05, 2026 10:41 AM	temp_c	36.7
VIT-009538	Thu Nov 05, 2026 10:41 AM	hr	90.0
VIT-009539	Thu Nov 05, 2026 10:41 AM	map	86.0
VIT-009540	Thu Nov 05, 2026 10:41 AM	gcs	15.0

Medications, orders, echo, history (5)

MED-000382 11-01 09:21 furosemide 40 mg PO
MED-000383 11-02 09:00 furosemide 40 mg PO
MED-000384 11-03 09:00 furosemide 40 mg PO
ECH-000046 2026-05-21 echo LVEF 26.0%
HX-000036 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000328 · Dr. Camila Oyelaran (resident) · Sun Nov 01, 2026 01:21 PM

Cited facts from this note (1)

bleeding_source: bleeding · cited p. 1, line 7 · confidence 0.50

Show source for bleeding_source

… story of present illness: 79-year-old woman admitted with congestive heart failure. Past medical history: heart failure with reduced ejection fraction. Denies bleeding, chest pain or fever. Exam: Lungs: clear to auscultation bilaterally. Assessment and plan: 1. CKD stage 3a: renally dose medications. 2. Congestive heart failu …

Source document DOC-000328: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Ines Ashgrove   MRN: MRN99297123   Admitted: 2026-11-01 10:21
Service: Cardiology   Attending: Dr. Cyrus Ellingham

History of present illness: 79-year-old woman admitted with congestive heart failure. 
Past medical history: heart failure with reduced ejection fraction.
Denies bleeding, chest pain or fever.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. CKD stage 3a: renally dose medications.
2. Congestive heart failure: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000327 · Viggo Ravensworth, RD (dietitian) · Mon Nov 02, 2026 03:21 PM

Cited facts from this note (8)

fat_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for fat_loss

… Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… ake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
intake_days: 14 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Ines Ashgrove MRN: MRN99297123 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip …
intake_pct: 60 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Ines Ashgrove MRN: MRN99297123 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip …
muscle_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Ines Ashgrove MRN: MRN99297123 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneo …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… gistered Dietitian) Patient: Ines Ashgrove MRN: MRN99297123 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets cri …
weight_loss_pct: 3 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… gistered Dietitian) Patient: Ines Ashgrove MRN: MRN99297123 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets cri …

Source document DOC-000327: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Ines Ashgrove   MRN: MRN99297123

Context: acute illness
Intake: estimated energy intake 60% of needs for 14 days.
Weight history: 3% weight loss over 30 days.
Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation.
Grip strength: not assessed.
Assessment: meets criteria for non-severe (moderate) malnutrition.

Progress note · DOC-000329 · Dr. Camila Oyelaran (resident) · Tue Nov 03, 2026 12:21 PM

Source document DOC-000329: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Ines Ashgrove   MRN: MRN99297123   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Congestive heart failure: continue current management.
2. Severe protein-calorie malnutrition: dietitian following, supplements.

Resident: Dr. Camila Oyelaran   Attending cosign: completed

Discharge summary · DOC-000330 · Dr. Cyrus Ellingham (attending) · Thu Nov 05, 2026 02:15 PM

Source document DOC-000330: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Ines Ashgrove   MRN: MRN99297123
Admitted 2026-11-01; discharged 2026-11-05.

Discharge diagnoses:
- severe protein-calorie malnutrition
- CKD stage 3a
- congestive heart failure

Disposition: home with follow-up.