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-00105: Dario Nakashima

59M · MRN69585565 · Hospital Medicine · admitted Fri Nov 06, 2026 09:42 AM · discharged Tue Nov 10, 2026 10:32 AM · attending Dr. Cyrus Ellingham · resident Dr. Noor Halvorsen · 176 cm, 76.9 kg

Documented diagnoses (current)

Principal: “urinary tract infection” · N39.0 Urinary tract infection, site not specified

Illustrative grouping now: MS-DRG 690 Kidney and urinary tract infections without 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=1.038, 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=1.038, t.ratio_s3=3.0, creat_peak=1.09, 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=1.038, 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 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=14.92, 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=0.0, 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=False, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=False, hgb_drop=0.0, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=14.92, 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=275, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=82.7, egfr_late=81.8	82.7
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=82.7, t.g2=60, egfr_late=81.8	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=82.7, 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=82.7, egfr_late=81.8, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=82.7, t.g2=60	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=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 not met

No gap

Not documented and not supported.

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=59, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=24.8, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=24.8, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=24.8, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=24.8, 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

Specificity gap

Criteria support Acute respiratory failure with hypoxia (J96.01); no corresponding diagnosis is documented.

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=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=84.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=31.0, t.rr_distress=28, wob_increased=unknown, 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 not met

No gap

Not documented and not supported.

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=37.6, t.t_hi=38, temp_min_48h=36.5, 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=31.0, 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=10.4, t.wbc_hi=12, wbc_min_48h=8.36, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	false
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=False, sirs_hr=False, sirs_rr=True, sirs_wbc=False	1
derived: sofa_resp	`coalesce(case(pf_min_48h < 100 and adv_resp_support, 4, pf_min_48h < 200 and adv_resp_support, 3, pf_min_48h < 300, 2, pf_min_48h < 400, 1, 0), 0)`	pf_min_48h=unknown, adv_resp_support=False	0
derived: sofa_coag	`coalesce(case(platelets_min_48h < 20, 4, platelets_min_48h < 50, 3, platelets_min_48h < 100, 2, platelets_min_48h < 150, 1, 0), 0)`	platelets_min_48h=229.0	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=0.66	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=79.0	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=1.08	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=1.05	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=True, sofa_delta=0, t.sofa_delta=2	false
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=False, 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=False, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=False	false
outcome: definitions_disagree	`sepsis2`	sepsis2=False	false
outcome: neither	`true`	—	true

Structured data

Labs (28)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-003562	Wed Oct 22, 2025 09:15 AM	creatinine	1.04 mg/dL
LAB-003563	Fri Jul 24, 2026 10:05 AM	creatinine	1.05 mg/dL
LAB-003564	Fri Nov 06, 2026 10:42 AM	creatinine	1.04 mg/dL
LAB-003569	Fri Nov 06, 2026 10:42 AM	sodium	141.0 mmol/L
LAB-003574	Fri Nov 06, 2026 10:42 AM	hemoglobin	14.92 g/dL
LAB-003579	Fri Nov 06, 2026 10:42 AM	wbc	10.4 x10^3/uL
LAB-003580	Fri Nov 06, 2026 10:42 AM	platelets	229.0 x10^3/uL
LAB-003589	Fri Nov 06, 2026 10:42 AM	bilirubin	0.66 mg/dL
LAB-003565	Sat Nov 07, 2026 05:00 AM	creatinine	1.05 mg/dL
LAB-003570	Sat Nov 07, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-003575	Sat Nov 07, 2026 05:00 AM	hemoglobin	15.35 g/dL
LAB-003581	Sat Nov 07, 2026 05:00 AM	wbc	8.36 x10^3/uL
LAB-003582	Sat Nov 07, 2026 05:00 AM	platelets	303.0 x10^3/uL
LAB-003566	Sun Nov 08, 2026 05:00 AM	creatinine	1.08 mg/dL
LAB-003571	Sun Nov 08, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-003576	Sun Nov 08, 2026 05:00 AM	hemoglobin	15.09 g/dL
LAB-003583	Sun Nov 08, 2026 05:00 AM	wbc	10.13 x10^3/uL
LAB-003584	Sun Nov 08, 2026 05:00 AM	platelets	287.0 x10^3/uL
LAB-003567	Mon Nov 09, 2026 05:00 AM	creatinine	1.09 mg/dL
LAB-003572	Mon Nov 09, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-003577	Mon Nov 09, 2026 05:00 AM	hemoglobin	15.23 g/dL
LAB-003585	Mon Nov 09, 2026 05:00 AM	wbc	9.24 x10^3/uL
LAB-003586	Mon Nov 09, 2026 05:00 AM	platelets	282.0 x10^3/uL
LAB-003568	Tue Nov 10, 2026 05:00 AM	creatinine	1.05 mg/dL
LAB-003573	Tue Nov 10, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-003578	Tue Nov 10, 2026 05:00 AM	hemoglobin	15.35 g/dL
LAB-003587	Tue Nov 10, 2026 05:00 AM	wbc	5.78 x10^3/uL
LAB-003588	Tue Nov 10, 2026 05:00 AM	platelets	191.0 x10^3/uL

Vitals (91)

Vitals
Row	When	Kind	Value	Detail
VIT-010241	Fri Nov 06, 2026 10:02 AM	spo2	84.0	room air
VIT-010242	Fri Nov 06, 2026 10:02 AM	rr	31.0
VIT-010280	Fri Nov 06, 2026 10:02 AM	temp_c	36.5
VIT-010281	Fri Nov 06, 2026 10:02 AM	hr	90.0
VIT-010282	Fri Nov 06, 2026 10:02 AM	map	88.0
VIT-010283	Fri Nov 06, 2026 10:02 AM	gcs	15.0
VIT-010243	Fri Nov 06, 2026 10:12 AM	o2_lpm	6.0	nasal cannula
VIT-010244	Fri Nov 06, 2026 06:02 PM	spo2	91.0	nasal cannula
VIT-010245	Fri Nov 06, 2026 06:02 PM	rr	23.0
VIT-010246	Fri Nov 06, 2026 06:02 PM	o2_lpm	4.0	nasal cannula
VIT-010284	Fri Nov 06, 2026 06:02 PM	temp_c	37.6
VIT-010285	Fri Nov 06, 2026 06:02 PM	hr	86.0
VIT-010286	Fri Nov 06, 2026 06:02 PM	map	89.0
VIT-010287	Fri Nov 06, 2026 06:02 PM	gcs	15.0
VIT-010247	Sat Nov 07, 2026 02:02 AM	spo2	92.0	nasal cannula
VIT-010248	Sat Nov 07, 2026 02:02 AM	rr	22.0
VIT-010249	Sat Nov 07, 2026 02:02 AM	o2_lpm	3.0	nasal cannula
VIT-010288	Sat Nov 07, 2026 02:02 AM	temp_c	36.9
VIT-010289	Sat Nov 07, 2026 02:02 AM	hr	73.0
VIT-010290	Sat Nov 07, 2026 02:02 AM	map	91.0
VIT-010291	Sat Nov 07, 2026 02:02 AM	gcs	15.0
VIT-010250	Sat Nov 07, 2026 10:02 AM	spo2	95.0	nasal cannula
VIT-010251	Sat Nov 07, 2026 10:02 AM	rr	23.0
VIT-010252	Sat Nov 07, 2026 10:02 AM	o2_lpm	3.0	nasal cannula
VIT-010292	Sat Nov 07, 2026 10:02 AM	temp_c	37.4
VIT-010293	Sat Nov 07, 2026 10:02 AM	hr	85.0
VIT-010294	Sat Nov 07, 2026 10:02 AM	map	79.0
VIT-010295	Sat Nov 07, 2026 10:02 AM	gcs	15.0
VIT-010253	Sat Nov 07, 2026 06:02 PM	spo2	94.0	nasal cannula
VIT-010254	Sat Nov 07, 2026 06:02 PM	rr	21.0
VIT-010255	Sat Nov 07, 2026 06:02 PM	o2_lpm	2.0	nasal cannula
VIT-010296	Sat Nov 07, 2026 06:02 PM	temp_c	36.6
VIT-010297	Sat Nov 07, 2026 06:02 PM	hr	70.0
VIT-010298	Sat Nov 07, 2026 06:02 PM	map	80.0
VIT-010299	Sat Nov 07, 2026 06:02 PM	gcs	15.0
VIT-010256	Sun Nov 08, 2026 02:02 AM	spo2	91.0	nasal cannula
VIT-010257	Sun Nov 08, 2026 02:02 AM	rr	25.0
VIT-010258	Sun Nov 08, 2026 02:02 AM	o2_lpm	3.0	nasal cannula
VIT-010300	Sun Nov 08, 2026 02:02 AM	temp_c	36.5
VIT-010301	Sun Nov 08, 2026 02:02 AM	hr	87.0
VIT-010302	Sun Nov 08, 2026 02:02 AM	map	89.0
VIT-010303	Sun Nov 08, 2026 02:02 AM	gcs	15.0
VIT-010259	Sun Nov 08, 2026 10:02 AM	spo2	94.0	nasal cannula
VIT-010260	Sun Nov 08, 2026 10:02 AM	rr	21.0
VIT-010261	Sun Nov 08, 2026 10:02 AM	o2_lpm	2.0	nasal cannula
VIT-010304	Sun Nov 08, 2026 10:02 AM	temp_c	37.5
VIT-010305	Sun Nov 08, 2026 10:02 AM	hr	87.0
VIT-010306	Sun Nov 08, 2026 10:02 AM	map	78.0
VIT-010307	Sun Nov 08, 2026 10:02 AM	gcs	15.0
VIT-010262	Sun Nov 08, 2026 06:02 PM	spo2	94.0	nasal cannula
VIT-010263	Sun Nov 08, 2026 06:02 PM	rr	25.0
VIT-010264	Sun Nov 08, 2026 06:02 PM	o2_lpm	2.0	nasal cannula
VIT-010308	Sun Nov 08, 2026 06:02 PM	temp_c	37.5
VIT-010309	Sun Nov 08, 2026 06:02 PM	hr	78.0
VIT-010310	Sun Nov 08, 2026 06:02 PM	map	83.0
VIT-010311	Sun Nov 08, 2026 06:02 PM	gcs	15.0
VIT-010265	Mon Nov 09, 2026 02:02 AM	spo2	92.0	nasal cannula
VIT-010266	Mon Nov 09, 2026 02:02 AM	rr	21.0
VIT-010267	Mon Nov 09, 2026 02:02 AM	o2_lpm	2.0	nasal cannula
VIT-010312	Mon Nov 09, 2026 02:02 AM	temp_c	36.6
VIT-010313	Mon Nov 09, 2026 02:02 AM	hr	71.0
VIT-010314	Mon Nov 09, 2026 02:02 AM	map	74.0
VIT-010315	Mon Nov 09, 2026 02:02 AM	gcs	15.0
VIT-010268	Mon Nov 09, 2026 10:02 AM	spo2	93.0	nasal cannula
VIT-010269	Mon Nov 09, 2026 10:02 AM	rr	21.0
VIT-010270	Mon Nov 09, 2026 10:02 AM	o2_lpm	3.0	nasal cannula
VIT-010316	Mon Nov 09, 2026 10:02 AM	temp_c	36.6
VIT-010317	Mon Nov 09, 2026 10:02 AM	hr	80.0
VIT-010318	Mon Nov 09, 2026 10:02 AM	map	78.0
VIT-010319	Mon Nov 09, 2026 10:02 AM	gcs	15.0
VIT-010271	Mon Nov 09, 2026 06:02 PM	spo2	94.0	nasal cannula
VIT-010272	Mon Nov 09, 2026 06:02 PM	rr	25.0
VIT-010273	Mon Nov 09, 2026 06:02 PM	o2_lpm	3.0	nasal cannula
VIT-010320	Mon Nov 09, 2026 06:02 PM	temp_c	37.5
VIT-010321	Mon Nov 09, 2026 06:02 PM	hr	81.0
VIT-010322	Mon Nov 09, 2026 06:02 PM	map	91.0
VIT-010323	Mon Nov 09, 2026 06:02 PM	gcs	15.0
VIT-010274	Tue Nov 10, 2026 02:02 AM	spo2	95.0	nasal cannula
VIT-010275	Tue Nov 10, 2026 02:02 AM	rr	22.0
VIT-010276	Tue Nov 10, 2026 02:02 AM	o2_lpm	2.0	nasal cannula
VIT-010324	Tue Nov 10, 2026 02:02 AM	temp_c	36.9
VIT-010325	Tue Nov 10, 2026 02:02 AM	hr	83.0
VIT-010326	Tue Nov 10, 2026 02:02 AM	map	81.0
VIT-010327	Tue Nov 10, 2026 02:02 AM	gcs	15.0
VIT-010277	Tue Nov 10, 2026 10:02 AM	spo2	91.0	nasal cannula
VIT-010278	Tue Nov 10, 2026 10:02 AM	rr	24.0
VIT-010279	Tue Nov 10, 2026 10:02 AM	o2_lpm	2.0	nasal cannula
VIT-010328	Tue Nov 10, 2026 10:02 AM	temp_c	37.5
VIT-010329	Tue Nov 10, 2026 10:02 AM	hr	73.0
VIT-010330	Tue Nov 10, 2026 10:02 AM	map	87.0
VIT-010331	Tue Nov 10, 2026 10:02 AM	gcs	15.0

Medications, orders, echo, history (4)

MED-000409 11-06 10:42 piperacillin-tazobactam per protocol IV
MED-000410 11-07 05:00 ceftriaxone per protocol IV
MED-000411 11-08 05:00 cefepime per protocol IV
ORD-000091 11-06 10:12 blood_culture: blood cultures x2

Notes

History and physical · DOC-000353 · Dr. Noor Halvorsen (resident) · Fri Nov 06, 2026 12:42 PM

Cited facts from this note (1)

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

Show source for infection_source

… MRN69585565 Admitted: 2026-11-06 09:42 Service: Hospital Medicine Attending: Dr. Cyrus Ellingham History of present illness: 59-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 …

Source document DOC-000353: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Dario Nakashima   MRN: MRN69585565   Admitted: 2026-11-06 09:42
Service: Hospital Medicine   Attending: Dr. Cyrus Ellingham

History of present illness: 59-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: labored respirations.
Assessment and plan:
1. Urinary tract infection: antibiotics.

Nutrition assessment · DOC-000352 · Dario Larkspur, RD (dietitian) · Sat Nov 07, 2026 02:42 PM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN69585565 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: Dario Nakashima MRN: MRN69585565 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: Dario Nakashima MRN: MRN69585565 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-000352: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Dario Nakashima   MRN: MRN69585565

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.

Progress note · DOC-000354 · Dr. Noor Halvorsen (resident) · Sun Nov 08, 2026 09:42 AM

Source document DOC-000354: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Dario Nakashima   MRN: MRN69585565   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.

Resident: Dr. Noor Halvorsen   Attending cosign: completed

Discharge summary · DOC-000355 · Dr. Cyrus Ellingham (attending) · Tue Nov 10, 2026 10:32 AM

Source document DOC-000355: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Dario Nakashima   MRN: MRN69585565
Admitted 2026-11-06; discharged 2026-11-10.

Discharge diagnoses:
- urinary tract infection

Disposition: home with follow-up.