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-00102: Tobias Fairbanks

68M · MRN29616770 · Hospital Medicine · admitted Sun Nov 01, 2026 09:46 AM · discharged Thu Nov 05, 2026 11:37 AM · attending Dr. Jalen Carrow · resident Dr. Priya Thorne · 174 cm, 56.2 kg

Documented diagnoses (current)

Principal: “urinary tract infection” · N39.0 Urinary tract infection, site not specified
“CKD stage 4” · N18.4 Chronic kidney disease, stage 4 (severe)
“acute respiratory failure with hypoxia” · J96.01 Acute respiratory failure with hypoxia

Illustrative grouping now: MS-DRG 689 Kidney and urinary tract infections with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 689.

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=1.054, t.ratio_s1=1.5, creat_rise_48h=0.11, 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=1.054, t.ratio_s3=3.0, creat_peak=2.13, 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=1.054, 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=0.11, 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=M, hgb_nadir=13.9, 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=0.1, 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=0.1, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=13.9, anaemic=False	true

Chronic kidney disease

Criteria met

Clinical validation gap

Documented “CKD stage 4” (N18.4) conflicts with what the criteria support (Chronic kidney disease stage 3b, N18.32).

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=183, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=38.7, egfr_late=35.3	38.7
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=38.7, t.g2=60, egfr_late=35.3	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=38.7, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G3b
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=38.7, egfr_late=35.3, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=38.7, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3b	false
outcome: g3b	`category == 'G3b'`	category=G3b	true

Heart failure

Clinical judgement required

No gap

Not documented; only one acute indicator; acuity needs clinical judgement.

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=unknown, 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=True	1
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=unknown, t.ref=40, t.pres=50	unknown
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=unknown, 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=1, hf_history=False	unknown
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=unknown	unknown
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: one_indicator	`acute_count == 1`	acute_count=1	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=138.0, 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=138.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=138.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=138.0, t.low=135	true

Malnutrition

Criteria met

Specificity gap

Criteria support Severe protein-calorie malnutrition (acute illness context) (E43); no corresponding diagnosis is documented.

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=50.0, t.a_sev_intake_pct=50, intake_days=10.0, t.a_sev_intake_days=5	true
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=50.0, t.a_mod_intake_pct=75, intake_days=10.0, 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=6.3	true
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=6.3	true
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=50.0, t.c_intake_pct=75, intake_days=10.0, 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=50.0, t.c_intake_pct=75, intake_days=10.0, 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=6.3	true
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=6.3	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=50.0, wt_loss_pct=6.3, fat_loss=2, muscle_loss=2, 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=True, a_sev_wt=True, fat_loss=2, muscle_loss=2, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=True	4
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=True, a_mod_intake=True, a_sev_wt=True, a_mod_wt=True, fat_loss=2, muscle_loss=2, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=True, c_mod_wt=True	4
outcome: severe	`n_severe >= 2`	n_severe=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=68, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=18.6, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=18.6, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=18.6, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=18.6, 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 met

No gap

Supported as documented (J96.01).

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=84.0, pao2_min_ra=54.0, pf_min=257	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=84.0, t.spo2_ra=88, pao2_min_ra=54.0, t.pao2=60, pf_min=257, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=34.0, t.rr_distress=28, wob_increased=True, adv_resp_support=False	true
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=True	false
outcome: met	`hypoxemia and distress`	hypoxemia=True, distress=True	true

Sepsis

Criteria met

No gap

Criteria support Sepsis (Sepsis-3); not documented (this rule does not prompt for an undocumented diagnosis).

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=37.6, t.t_hi=38, temp_min_48h=36.6, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=86.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=34.0, 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=8.84, t.wbc_hi=12, wbc_min_48h=6.39, 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=257, adv_resp_support=False	2
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=168.0	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=0.62	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=74.0	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=2.13	2
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=2.02	2
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=2, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=2, sofa_renal_baseline=2	2
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=2, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, 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=True, norepi_max_48h=0.0, lactate_max_48h=unknown, 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=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=True	true

Structured data

Labs (30)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-003470	Fri Jan 16, 2026 09:15 AM	creatinine	1.87 mg/dL
LAB-003471	Sun Jul 19, 2026 10:05 AM	creatinine	2.02 mg/dL
LAB-003477	Sun Nov 01, 2026 10:11 AM	pao2	54.0 mmHg
LAB-003478	Sun Nov 01, 2026 10:11 AM	fio2	21.0 %
LAB-003472	Sun Nov 01, 2026 10:46 AM	creatinine	2.13 mg/dL
LAB-003479	Sun Nov 01, 2026 10:46 AM	sodium	142.0 mmol/L
LAB-003484	Sun Nov 01, 2026 10:46 AM	hemoglobin	14.04 g/dL
LAB-003489	Sun Nov 01, 2026 10:46 AM	wbc	8.84 x10^3/uL
LAB-003490	Sun Nov 01, 2026 10:46 AM	platelets	217.0 x10^3/uL
LAB-003499	Sun Nov 01, 2026 10:46 AM	bilirubin	0.62 mg/dL
LAB-003473	Mon Nov 02, 2026 05:00 AM	creatinine	2.08 mg/dL
LAB-003480	Mon Nov 02, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003485	Mon Nov 02, 2026 05:00 AM	hemoglobin	13.9 g/dL
LAB-003491	Mon Nov 02, 2026 05:00 AM	wbc	7.99 x10^3/uL
LAB-003492	Mon Nov 02, 2026 05:00 AM	platelets	168.0 x10^3/uL
LAB-003474	Tue Nov 03, 2026 05:00 AM	creatinine	2.0 mg/dL
LAB-003481	Tue Nov 03, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-003486	Tue Nov 03, 2026 05:00 AM	hemoglobin	14.09 g/dL
LAB-003493	Tue Nov 03, 2026 05:00 AM	wbc	6.39 x10^3/uL
LAB-003494	Tue Nov 03, 2026 05:00 AM	platelets	285.0 x10^3/uL
LAB-003475	Wed Nov 04, 2026 05:00 AM	creatinine	2.01 mg/dL
LAB-003482	Wed Nov 04, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-003487	Wed Nov 04, 2026 05:00 AM	hemoglobin	14.02 g/dL
LAB-003495	Wed Nov 04, 2026 05:00 AM	wbc	9.92 x10^3/uL
LAB-003496	Wed Nov 04, 2026 05:00 AM	platelets	253.0 x10^3/uL
LAB-003476	Thu Nov 05, 2026 05:00 AM	creatinine	2.11 mg/dL
LAB-003483	Thu Nov 05, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003488	Thu Nov 05, 2026 05:00 AM	hemoglobin	13.96 g/dL
LAB-003497	Thu Nov 05, 2026 05:00 AM	wbc	10.68 x10^3/uL
LAB-003498	Thu Nov 05, 2026 05:00 AM	platelets	306.0 x10^3/uL

Vitals (91)

Vitals
Row	When	Kind	Value	Detail
VIT-009968	Sun Nov 01, 2026 10:06 AM	spo2	84.0	room air
VIT-009969	Sun Nov 01, 2026 10:06 AM	rr	34.0
VIT-010007	Sun Nov 01, 2026 10:06 AM	temp_c	36.6
VIT-010008	Sun Nov 01, 2026 10:06 AM	hr	82.0
VIT-010009	Sun Nov 01, 2026 10:06 AM	map	74.0
VIT-010010	Sun Nov 01, 2026 10:06 AM	gcs	15.0
VIT-009970	Sun Nov 01, 2026 10:16 AM	o2_lpm	5.0	nasal cannula
VIT-009971	Sun Nov 01, 2026 06:06 PM	spo2	95.0	nasal cannula
VIT-009972	Sun Nov 01, 2026 06:06 PM	rr	23.0
VIT-009973	Sun Nov 01, 2026 06:06 PM	o2_lpm	3.0	nasal cannula
VIT-010011	Sun Nov 01, 2026 06:06 PM	temp_c	37.1
VIT-010012	Sun Nov 01, 2026 06:06 PM	hr	86.0
VIT-010013	Sun Nov 01, 2026 06:06 PM	map	91.0
VIT-010014	Sun Nov 01, 2026 06:06 PM	gcs	15.0
VIT-009974	Mon Nov 02, 2026 02:06 AM	spo2	95.0	nasal cannula
VIT-009975	Mon Nov 02, 2026 02:06 AM	rr	26.0
VIT-009976	Mon Nov 02, 2026 02:06 AM	o2_lpm	2.0	nasal cannula
VIT-010015	Mon Nov 02, 2026 02:06 AM	temp_c	37.3
VIT-010016	Mon Nov 02, 2026 02:06 AM	hr	72.0
VIT-010017	Mon Nov 02, 2026 02:06 AM	map	92.0
VIT-010018	Mon Nov 02, 2026 02:06 AM	gcs	15.0
VIT-009977	Mon Nov 02, 2026 10:06 AM	spo2	92.0	nasal cannula
VIT-009978	Mon Nov 02, 2026 10:06 AM	rr	20.0
VIT-009979	Mon Nov 02, 2026 10:06 AM	o2_lpm	3.0	nasal cannula
VIT-010019	Mon Nov 02, 2026 10:06 AM	temp_c	37.6
VIT-010020	Mon Nov 02, 2026 10:06 AM	hr	81.0
VIT-010021	Mon Nov 02, 2026 10:06 AM	map	87.0
VIT-010022	Mon Nov 02, 2026 10:06 AM	gcs	15.0
VIT-009980	Mon Nov 02, 2026 06:06 PM	spo2	92.0	nasal cannula
VIT-009981	Mon Nov 02, 2026 06:06 PM	rr	24.0
VIT-009982	Mon Nov 02, 2026 06:06 PM	o2_lpm	3.0	nasal cannula
VIT-010023	Mon Nov 02, 2026 06:06 PM	temp_c	36.7
VIT-010024	Mon Nov 02, 2026 06:06 PM	hr	74.0
VIT-010025	Mon Nov 02, 2026 06:06 PM	map	87.0
VIT-010026	Mon Nov 02, 2026 06:06 PM	gcs	15.0
VIT-009983	Tue Nov 03, 2026 02:06 AM	spo2	92.0	nasal cannula
VIT-009984	Tue Nov 03, 2026 02:06 AM	rr	21.0
VIT-009985	Tue Nov 03, 2026 02:06 AM	o2_lpm	3.0	nasal cannula
VIT-010027	Tue Nov 03, 2026 02:06 AM	temp_c	37.4
VIT-010028	Tue Nov 03, 2026 02:06 AM	hr	80.0
VIT-010029	Tue Nov 03, 2026 02:06 AM	map	83.0
VIT-010030	Tue Nov 03, 2026 02:06 AM	gcs	15.0
VIT-009986	Tue Nov 03, 2026 10:06 AM	spo2	94.0	nasal cannula
VIT-009987	Tue Nov 03, 2026 10:06 AM	rr	25.0
VIT-009988	Tue Nov 03, 2026 10:06 AM	o2_lpm	4.0	nasal cannula
VIT-010031	Tue Nov 03, 2026 10:06 AM	temp_c	37.4
VIT-010032	Tue Nov 03, 2026 10:06 AM	hr	72.0
VIT-010033	Tue Nov 03, 2026 10:06 AM	map	74.0
VIT-010034	Tue Nov 03, 2026 10:06 AM	gcs	15.0
VIT-009989	Tue Nov 03, 2026 06:06 PM	spo2	93.0	nasal cannula
VIT-009990	Tue Nov 03, 2026 06:06 PM	rr	20.0
VIT-009991	Tue Nov 03, 2026 06:06 PM	o2_lpm	4.0	nasal cannula
VIT-010035	Tue Nov 03, 2026 06:06 PM	temp_c	36.6
VIT-010036	Tue Nov 03, 2026 06:06 PM	hr	84.0
VIT-010037	Tue Nov 03, 2026 06:06 PM	map	86.0
VIT-010038	Tue Nov 03, 2026 06:06 PM	gcs	15.0
VIT-009992	Wed Nov 04, 2026 02:06 AM	spo2	95.0	nasal cannula
VIT-009993	Wed Nov 04, 2026 02:06 AM	rr	20.0
VIT-009994	Wed Nov 04, 2026 02:06 AM	o2_lpm	4.0	nasal cannula
VIT-010039	Wed Nov 04, 2026 02:06 AM	temp_c	36.6
VIT-010040	Wed Nov 04, 2026 02:06 AM	hr	92.0
VIT-010041	Wed Nov 04, 2026 02:06 AM	map	79.0
VIT-010042	Wed Nov 04, 2026 02:06 AM	gcs	15.0
VIT-009995	Wed Nov 04, 2026 10:06 AM	spo2	91.0	nasal cannula
VIT-009996	Wed Nov 04, 2026 10:06 AM	rr	22.0
VIT-009997	Wed Nov 04, 2026 10:06 AM	o2_lpm	3.0	nasal cannula
VIT-010043	Wed Nov 04, 2026 10:06 AM	temp_c	37.3
VIT-010044	Wed Nov 04, 2026 10:06 AM	hr	84.0
VIT-010045	Wed Nov 04, 2026 10:06 AM	map	76.0
VIT-010046	Wed Nov 04, 2026 10:06 AM	gcs	15.0
VIT-009998	Wed Nov 04, 2026 06:06 PM	spo2	95.0	nasal cannula
VIT-009999	Wed Nov 04, 2026 06:06 PM	rr	21.0
VIT-010000	Wed Nov 04, 2026 06:06 PM	o2_lpm	2.0	nasal cannula
VIT-010047	Wed Nov 04, 2026 06:06 PM	temp_c	36.9
VIT-010048	Wed Nov 04, 2026 06:06 PM	hr	80.0
VIT-010049	Wed Nov 04, 2026 06:06 PM	map	92.0
VIT-010050	Wed Nov 04, 2026 06:06 PM	gcs	15.0
VIT-010001	Thu Nov 05, 2026 02:06 AM	spo2	91.0	nasal cannula
VIT-010002	Thu Nov 05, 2026 02:06 AM	rr	25.0
VIT-010003	Thu Nov 05, 2026 02:06 AM	o2_lpm	3.0	nasal cannula
VIT-010051	Thu Nov 05, 2026 02:06 AM	temp_c	37.5
VIT-010052	Thu Nov 05, 2026 02:06 AM	hr	73.0
VIT-010053	Thu Nov 05, 2026 02:06 AM	map	78.0
VIT-010054	Thu Nov 05, 2026 02:06 AM	gcs	15.0
VIT-010004	Thu Nov 05, 2026 10:06 AM	spo2	95.0	nasal cannula
VIT-010005	Thu Nov 05, 2026 10:06 AM	rr	23.0
VIT-010006	Thu Nov 05, 2026 10:06 AM	o2_lpm	4.0	nasal cannula
VIT-010055	Thu Nov 05, 2026 10:06 AM	temp_c	36.6
VIT-010056	Thu Nov 05, 2026 10:06 AM	hr	81.0
VIT-010057	Thu Nov 05, 2026 10:06 AM	map	86.0
VIT-010058	Thu Nov 05, 2026 10:06 AM	gcs	15.0

Medications, orders, echo, history (4)

MED-000397 11-01 10:46 piperacillin-tazobactam per protocol IV
MED-000398 11-02 05:00 piperacillin-tazobactam per protocol IV
MED-000399 11-03 05:00 cefepime per protocol IV
ORD-000089 11-01 10:16 blood_culture: blood cultures x2

Notes

History and physical · DOC-000343 · Dr. Priya Thorne (resident) · Sun Nov 01, 2026 12:46 PM

Cited facts from this note (2)

infection_source: urinary tract infection · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… N: MRN29616770 Admitted: 2026-11-01 09:46 Service: Hospital Medicine Attending: Dr. Jalen Carrow History of present illness: 68-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime. Past medical history: none significant. Review of systems otherwise negative. Exam: Lu …
work_of_breathing: increased · cited p. 1, line 8 · confidence 0.90

Show source for work_of_breathing

… nalysis with pyuria; treated for acute pyelonephritis with cefepime. Past medical history: none significant. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessory muscle use. Assessment and plan: 1. Urinary tract infection: antibiotics. 2. CKD stage 4: renally dose medications.

Source document DOC-000343: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Tobias Fairbanks   MRN: MRN29616770   Admitted: 2026-11-01 09:46
Service: Hospital Medicine   Attending: Dr. Jalen Carrow

History of present illness: 68-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime.
Past medical history: none significant.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscle use.
Assessment and plan:
1. Urinary tract infection: antibiotics.
2. CKD stage 4: renally dose medications.

Nutrition assessment · DOC-000342 · Dario Larkspur, RD (dietitian) · Mon Nov 02, 2026 03:46 PM

Cited facts from this note (8)

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

Show source for fat_loss

… ontext: acute illness Intake: estimated energy intake 50% of needs for 10 days. Weight history: 6.3% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… needs for 10 days. Weight history: 6.3% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
intake_days: 10 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Tobias Fairbanks MRN: MRN29616770 Context: acute illness Intake: estimated energy intake 50% of needs for 10 days. Weight history: 6.3% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulat …
intake_pct: 50 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Tobias Fairbanks MRN: MRN29616770 Context: acute illness Intake: estimated energy intake 50% of needs for 10 days. Weight history: 6.3% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulat …
muscle_loss: moderate · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… ated energy intake 50% of needs for 10 days. Weight history: 6.3% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Tobias Fairbanks MRN: MRN29616770 Context: acute illness Intake: estimated energy intake 50% of needs for 10 days. Weight history: 6.3% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subc …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… tered Dietitian) Patient: Tobias Fairbanks MRN: MRN29616770 Context: acute illness Intake: estimated energy intake 50% of needs for 10 days. Weight history: 6.3% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplem …
weight_loss_pct: 6.3 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… tered Dietitian) Patient: Tobias Fairbanks MRN: MRN29616770 Context: acute illness Intake: estimated energy intake 50% of needs for 10 days. Weight history: 6.3% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplem …

Source document DOC-000342: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Tobias Fairbanks   MRN: MRN29616770

Context: acute illness
Intake: estimated energy intake 50% of needs for 10 days.
Weight history: 6.3% weight loss over 30 days.
Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation.
Recommendations: high-protein oral supplement; calorie counts; weekly weights.

Progress note · DOC-000344 · Dr. Priya Thorne (resident) · Tue Nov 03, 2026 11:46 AM

Source document DOC-000344: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Tobias Fairbanks   MRN: MRN29616770   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Urinary tract infection: continue current management.
2. Acute respiratory failure with hypoxia: supplemental oxygen, wean as tolerated.

Resident: Dr. Priya Thorne   Attending cosign: completed

Discharge summary · DOC-000345 · Dr. Jalen Carrow (attending) · Thu Nov 05, 2026 11:37 AM

Source document DOC-000345: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Tobias Fairbanks   MRN: MRN29616770
Admitted 2026-11-01; discharged 2026-11-05.

Discharge diagnoses:
- urinary tract infection
- CKD stage 4
- acute respiratory failure with hypoxia

Disposition: home with follow-up.