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-00106: Dmitri Greaves

83F · MRN92245369 · Hospital Medicine · admitted Mon Nov 09, 2026 12:02 PM · in hospital · attending Dr. Cyrus Ellingham · resident Dr. Noor Halvorsen · 159 cm, 57.9 kg

Documented diagnoses (current)

Principal: “urinary tract infection” · N39.0 Urinary tract infection, site not specified
“malnourished” · E46 Unspecified protein-calorie malnutrition
“acute on chronic systolic heart failure” · I50.23 Acute on chronic systolic (congestive) heart failure
“hyponatremia” · E87.1 Hypo-osmolality and hyponatremia
“hypertension” · I10 Essential (primary) hypertension
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

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 690.

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=0.02, 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=1.18, 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=0.02, 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=12.22, 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=0.5, 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=0.5, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=12.22, anaemic=False	true

Chronic kidney disease

Criteria met

Specificity gap

Criteria support Chronic kidney disease stage 3a (N18.31); no corresponding diagnosis is documented.

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=207, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=51.5, egfr_late=48.8	51.5
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=51.5, t.g2=60, egfr_late=48.8	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=51.5, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G3a
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=True, egfr_early=51.5, egfr_late=48.8, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=51.5, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3a	true

Heart failure

Criteria met

Clinical validation gap

Documented “acute on chronic systolic heart failure” (I50.23) is more specific than the criteria support (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=52.0, 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=27.0, 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=27.0, 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

Clinical judgement required

Clinical judgement required: Low sodium without documented treatment or repeat values; clinical significance is a clinician judgement.

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=133.0, t.profound=125, t.moderate=130, t.low=135	mild
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=133.0, t.low=135, na_low_count=1, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=133.0, t.low=135	true

Malnutrition

Criteria met

Specificity gap

Documented “malnourished” (E46); criteria support the more specific Moderate (non-severe) protein-calorie malnutrition (chronic 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=80.0, t.a_sev_intake_pct=50, intake_days=41.0, 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=80.0, t.a_mod_intake_pct=75, intake_days=41.0, 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=180.0, wt_loss_pct=10.0	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=180.0, wt_loss_pct=10.0	false
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=80.0, t.c_intake_pct=75, intake_days=41.0, 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=80.0, t.c_intake_pct=75, intake_days=41.0, 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=180.0, wt_loss_pct=10.0	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=180.0, wt_loss_pct=10.0	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=80.0, wt_loss_pct=10.0, 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=chronic, 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=chronic, a_sev_intake=False, a_mod_intake=False, 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=True	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=83, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=22.9, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=22.9, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=22.9, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=22.9, 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=37.6, t.t_hi=38, temp_min_48h=36.8, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=89.0, 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=10.72, t.wbc_hi=12, wbc_min_48h=6.2, 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=166.0	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=0.78	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=1.18	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=1.12	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=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=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 (29)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-003590	Tue Dec 16, 2025 09:15 AM	creatinine	1.07 mg/dL
LAB-003591	Sun Jul 12, 2026 10:05 AM	creatinine	1.12 mg/dL
LAB-003592	Mon Nov 09, 2026 01:02 PM	creatinine	1.16 mg/dL
LAB-003597	Mon Nov 09, 2026 01:02 PM	bnp	52.0 pg/mL
LAB-003598	Mon Nov 09, 2026 01:02 PM	sodium	133.0 mmol/L
LAB-003603	Mon Nov 09, 2026 01:02 PM	hemoglobin	12.76 g/dL
LAB-003608	Mon Nov 09, 2026 01:02 PM	wbc	7.63 x10^3/uL
LAB-003609	Mon Nov 09, 2026 01:02 PM	platelets	166.0 x10^3/uL
LAB-003618	Mon Nov 09, 2026 01:02 PM	bilirubin	0.78 mg/dL
LAB-003593	Tue Nov 10, 2026 05:00 AM	creatinine	1.18 mg/dL
LAB-003599	Tue Nov 10, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-003604	Tue Nov 10, 2026 05:00 AM	hemoglobin	12.22 g/dL
LAB-003610	Tue Nov 10, 2026 05:00 AM	wbc	6.2 x10^3/uL
LAB-003611	Tue Nov 10, 2026 05:00 AM	platelets	181.0 x10^3/uL
LAB-003594	Wed Nov 11, 2026 05:00 AM	creatinine	1.12 mg/dL
LAB-003600	Wed Nov 11, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003605	Wed Nov 11, 2026 05:00 AM	hemoglobin	12.49 g/dL
LAB-003612	Wed Nov 11, 2026 05:00 AM	wbc	10.72 x10^3/uL
LAB-003613	Wed Nov 11, 2026 05:00 AM	platelets	245.0 x10^3/uL
LAB-003595	Thu Nov 12, 2026 05:00 AM	creatinine	1.14 mg/dL
LAB-003601	Thu Nov 12, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003606	Thu Nov 12, 2026 05:00 AM	hemoglobin	12.77 g/dL
LAB-003614	Thu Nov 12, 2026 05:00 AM	wbc	9.61 x10^3/uL
LAB-003615	Thu Nov 12, 2026 05:00 AM	platelets	231.0 x10^3/uL
LAB-003596	Fri Nov 13, 2026 05:00 AM	creatinine	1.11 mg/dL
LAB-003602	Fri Nov 13, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-003607	Fri Nov 13, 2026 05:00 AM	hemoglobin	12.52 g/dL
LAB-003616	Fri Nov 13, 2026 05:00 AM	wbc	6.78 x10^3/uL
LAB-003617	Fri Nov 13, 2026 05:00 AM	platelets	200.0 x10^3/uL

Vitals (78)

Vitals
Row	When	Kind	Value	Detail
VIT-010332	Mon Nov 09, 2026 12:22 PM	spo2	99.0	room air
VIT-010333	Mon Nov 09, 2026 12:22 PM	rr	17.0
VIT-010358	Mon Nov 09, 2026 12:22 PM	temp_c	37.4
VIT-010359	Mon Nov 09, 2026 12:22 PM	hr	86.0
VIT-010360	Mon Nov 09, 2026 12:22 PM	map	92.0
VIT-010361	Mon Nov 09, 2026 12:22 PM	gcs	15.0
VIT-010334	Mon Nov 09, 2026 08:22 PM	spo2	96.0	room air
VIT-010335	Mon Nov 09, 2026 08:22 PM	rr	18.0
VIT-010362	Mon Nov 09, 2026 08:22 PM	temp_c	37.1
VIT-010363	Mon Nov 09, 2026 08:22 PM	hr	89.0
VIT-010364	Mon Nov 09, 2026 08:22 PM	map	75.0
VIT-010365	Mon Nov 09, 2026 08:22 PM	gcs	15.0
VIT-010336	Tue Nov 10, 2026 04:22 AM	spo2	95.0	room air
VIT-010337	Tue Nov 10, 2026 04:22 AM	rr	20.0
VIT-010366	Tue Nov 10, 2026 04:22 AM	temp_c	37.1
VIT-010367	Tue Nov 10, 2026 04:22 AM	hr	72.0
VIT-010368	Tue Nov 10, 2026 04:22 AM	map	87.0
VIT-010369	Tue Nov 10, 2026 04:22 AM	gcs	15.0
VIT-010338	Tue Nov 10, 2026 12:22 PM	spo2	95.0	room air
VIT-010339	Tue Nov 10, 2026 12:22 PM	rr	18.0
VIT-010370	Tue Nov 10, 2026 12:22 PM	temp_c	36.8
VIT-010371	Tue Nov 10, 2026 12:22 PM	hr	85.0
VIT-010372	Tue Nov 10, 2026 12:22 PM	map	91.0
VIT-010373	Tue Nov 10, 2026 12:22 PM	gcs	15.0
VIT-010340	Tue Nov 10, 2026 08:22 PM	spo2	94.0	room air
VIT-010341	Tue Nov 10, 2026 08:22 PM	rr	20.0
VIT-010374	Tue Nov 10, 2026 08:22 PM	temp_c	37.6
VIT-010375	Tue Nov 10, 2026 08:22 PM	hr	77.0
VIT-010376	Tue Nov 10, 2026 08:22 PM	map	85.0
VIT-010377	Tue Nov 10, 2026 08:22 PM	gcs	15.0
VIT-010342	Wed Nov 11, 2026 04:22 AM	spo2	99.0	room air
VIT-010343	Wed Nov 11, 2026 04:22 AM	rr	19.0
VIT-010378	Wed Nov 11, 2026 04:22 AM	temp_c	37.2
VIT-010379	Wed Nov 11, 2026 04:22 AM	hr	87.0
VIT-010380	Wed Nov 11, 2026 04:22 AM	map	79.0
VIT-010381	Wed Nov 11, 2026 04:22 AM	gcs	15.0
VIT-010344	Wed Nov 11, 2026 12:22 PM	spo2	95.0	room air
VIT-010345	Wed Nov 11, 2026 12:22 PM	rr	15.0
VIT-010382	Wed Nov 11, 2026 12:22 PM	temp_c	36.8
VIT-010383	Wed Nov 11, 2026 12:22 PM	hr	73.0
VIT-010384	Wed Nov 11, 2026 12:22 PM	map	74.0
VIT-010385	Wed Nov 11, 2026 12:22 PM	gcs	15.0
VIT-010346	Wed Nov 11, 2026 08:22 PM	spo2	96.0	room air
VIT-010347	Wed Nov 11, 2026 08:22 PM	rr	15.0
VIT-010386	Wed Nov 11, 2026 08:22 PM	temp_c	36.7
VIT-010387	Wed Nov 11, 2026 08:22 PM	hr	84.0
VIT-010388	Wed Nov 11, 2026 08:22 PM	map	75.0
VIT-010389	Wed Nov 11, 2026 08:22 PM	gcs	15.0
VIT-010348	Thu Nov 12, 2026 04:22 AM	spo2	97.0	room air
VIT-010349	Thu Nov 12, 2026 04:22 AM	rr	20.0
VIT-010390	Thu Nov 12, 2026 04:22 AM	temp_c	36.9
VIT-010391	Thu Nov 12, 2026 04:22 AM	hr	90.0
VIT-010392	Thu Nov 12, 2026 04:22 AM	map	75.0
VIT-010393	Thu Nov 12, 2026 04:22 AM	gcs	15.0
VIT-010350	Thu Nov 12, 2026 12:22 PM	spo2	99.0	room air
VIT-010351	Thu Nov 12, 2026 12:22 PM	rr	14.0
VIT-010394	Thu Nov 12, 2026 12:22 PM	temp_c	37.4
VIT-010395	Thu Nov 12, 2026 12:22 PM	hr	91.0
VIT-010396	Thu Nov 12, 2026 12:22 PM	map	74.0
VIT-010397	Thu Nov 12, 2026 12:22 PM	gcs	15.0
VIT-010352	Thu Nov 12, 2026 08:22 PM	spo2	97.0	room air
VIT-010353	Thu Nov 12, 2026 08:22 PM	rr	19.0
VIT-010398	Thu Nov 12, 2026 08:22 PM	temp_c	37.5
VIT-010399	Thu Nov 12, 2026 08:22 PM	hr	86.0
VIT-010400	Thu Nov 12, 2026 08:22 PM	map	82.0
VIT-010401	Thu Nov 12, 2026 08:22 PM	gcs	15.0
VIT-010354	Fri Nov 13, 2026 04:22 AM	spo2	96.0	room air
VIT-010355	Fri Nov 13, 2026 04:22 AM	rr	14.0
VIT-010402	Fri Nov 13, 2026 04:22 AM	temp_c	37.4
VIT-010403	Fri Nov 13, 2026 04:22 AM	hr	89.0
VIT-010404	Fri Nov 13, 2026 04:22 AM	map	85.0
VIT-010405	Fri Nov 13, 2026 04:22 AM	gcs	15.0
VIT-010356	Fri Nov 13, 2026 12:22 PM	spo2	96.0	room air
VIT-010357	Fri Nov 13, 2026 12:22 PM	rr	16.0
VIT-010406	Fri Nov 13, 2026 12:22 PM	temp_c	37.5
VIT-010407	Fri Nov 13, 2026 12:22 PM	hr	88.0
VIT-010408	Fri Nov 13, 2026 12:22 PM	map	82.0
VIT-010409	Fri Nov 13, 2026 12:22 PM	gcs	15.0

Medications, orders, echo, history (9)

MED-000412 11-09 13:02 cefepime per protocol IV
MED-000413 11-10 05:00 cefepime per protocol IV
MED-000414 11-11 05:00 cefepime per protocol IV
MED-000415 11-09 09:02 furosemide 40 mg PO
MED-000416 11-10 09:00 furosemide 40 mg PO
MED-000417 11-11 09:00 furosemide 40 mg PO
ORD-000092 11-09 12:32 blood_culture: blood cultures x2
ECH-000050 2026-05-19 echo LVEF 27.0%
HX-000040 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000357 · Dr. Noor Halvorsen (resident) · Mon Nov 09, 2026 03:02 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

… N92245369 Admitted: 2026-11-09 12:02 Service: Hospital Medicine Attending: Dr. Cyrus Ellingham History of present illness: 83-year-old woman admitted with urinary tract infection. Urinalysis with pyuria; treated for urinary tract infection with cefepime. Past medical history: heart failure with reduced ejection fraction, hypertension, h …

Source document DOC-000357: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Dmitri Greaves   MRN: MRN92245369   Admitted: 2026-11-09 12:02
Service: Hospital Medicine   Attending: Dr. Cyrus Ellingham

History of present illness: 83-year-old woman admitted with urinary tract infection. Urinalysis with pyuria; treated for urinary tract infection with cefepime.
Past medical history: heart failure with reduced ejection fraction, hypertension, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Urinary tract infection: antibiotics.

Nutrition assessment · DOC-000356 · Vera Pemberton, RD (dietitian) · Tue Nov 10, 2026 02:02 PM

Cited facts from this note (8)

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

Show source for fat_loss

… xt: chronic illness Intake: estimated energy intake 80% of needs for 41 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild 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

… 80% of needs for 41 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
intake_days: 41 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Dmitri Greaves MRN: MRN92245369 Context: chronic illness Intake: estimated energy intake 80% of needs for 41 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. R …
intake_pct: 80 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Dmitri Greaves MRN: MRN92245369 Context: chronic illness Intake: estimated energy intake 80% of needs for 41 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. R …
muscle_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… imated energy intake 80% of needs for 41 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
nutrition_context: chronic · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Dmitri Greaves MRN: MRN92245369 Context: chronic illness Intake: estimated energy intake 80% of needs for 41 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcut …
weight_loss_days: 180 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… tered Dietitian) Patient: Dmitri Greaves MRN: MRN92245369 Context: chronic illness Intake: estimated energy intake 80% of needs for 41 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; cal …
weight_loss_pct: 10 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… tered Dietitian) Patient: Dmitri Greaves MRN: MRN92245369 Context: chronic illness Intake: estimated energy intake 80% of needs for 41 days. Weight history: 10.0% weight loss over 180 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; cal …

Source document DOC-000356: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Dmitri Greaves   MRN: MRN92245369

Context: chronic illness
Intake: estimated energy intake 80% of needs for 41 days.
Weight history: 10.0% weight loss over 180 days.
Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation.
Recommendations: high-protein oral supplement; calorie counts; weekly weights.

Progress note · DOC-000358 · Dr. Noor Halvorsen (resident) · Fri Nov 13, 2026 02:55 PM · awaiting cosign

Source document DOC-000358: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Dmitri Greaves   MRN: MRN92245369   Hospital day 5

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Urinary tract infection: continue current management.
2. Malnourished: dietitian following.
3. Acute on chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.
4. Hyponatremia: trend sodium.

Resident: Dr. Noor Halvorsen   Attending cosign: pending