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-00107: Sana Thorne

60F · MRN23477437 · Cardiology · admitted Sat Oct 31, 2026 09:40 PM · discharged Tue Nov 03, 2026 01:22 PM · attending Dr. Cyrus Ellingham · resident Dr. Noor Halvorsen · 168 cm, 48.1 kg

Documented diagnoses (current)

“CKD stage 4” · N18.4 Chronic kidney disease, stage 4 (severe)
“AKI” · N17.9 Acute kidney failure, unspecified
Principal: “acute on chronic systolic heart failure” · I50.23 Acute on chronic systolic (congestive) heart failure
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 292 Heart failure and shock with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 291.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

Clinical validation gap

Documented “AKI” (N17.9) but the criteria are not met: KDIGO creatinine and urine-output criteria not met.

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=1.058, t.ratio_s1=1.5, creat_rise_48h=0.08, 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=1.058, t.ratio_s3=3.0, creat_peak=1.65, 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=1.058, 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=0.08, 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=13.06, 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=0.2, 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=0.2, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=13.06, 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=192, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=37.3, egfr_late=37.8	37.8
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=37.3, t.g2=60, egfr_late=37.8	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=37.8, 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=37.3, egfr_late=37.8, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=37.8, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3b	false
outcome: g3b	`category == 'G3b'`	category=G3b	true

Heart failure

Criteria met

No gap

Supported as documented (I50.23).

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=2355.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	true
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=True, np_elevated=True, new_o2=False	2
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=23.0, 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=23.0, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=2, hf_history=True	acute on 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=acute on 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

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=40.0, 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=40.0, 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=6.4	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=6.4	true
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=40.0, 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=40.0, 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=6.4	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=6.4	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=40.0, wt_loss_pct=6.4, 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=60, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=17.0, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=17.0, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=17.0, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=17.0, 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=19.0, 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=36.6, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=87.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=19.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	false
derived: sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`	wbc_max_48h=10.51, t.wbc_hi=12, wbc_min_48h=6.1, 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=235.0	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=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=1.6	1
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=1.56	1
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=1, sofa_renal_baseline=1	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 (24)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-003619	Tue Jan 13, 2026 09:15 AM	creatinine	1.58 mg/dL
LAB-003620	Sat Jul 25, 2026 10:05 AM	creatinine	1.56 mg/dL
LAB-003621	Sat Oct 31, 2026 10:40 PM	creatinine	1.53 mg/dL
LAB-003625	Sat Oct 31, 2026 10:40 PM	bnp	2355.0 pg/mL
LAB-003626	Sat Oct 31, 2026 10:40 PM	sodium	136.0 mmol/L
LAB-003630	Sat Oct 31, 2026 10:40 PM	hemoglobin	13.22 g/dL
LAB-003634	Sat Oct 31, 2026 10:40 PM	wbc	10.51 x10^3/uL
LAB-003635	Sat Oct 31, 2026 10:40 PM	platelets	297.0 x10^3/uL
LAB-003642	Sat Oct 31, 2026 10:40 PM	bilirubin	0.78 mg/dL
LAB-003622	Sun Nov 01, 2026 05:00 AM	creatinine	1.6 mg/dL
LAB-003627	Sun Nov 01, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003631	Sun Nov 01, 2026 05:00 AM	hemoglobin	13.06 g/dL
LAB-003636	Sun Nov 01, 2026 05:00 AM	wbc	6.1 x10^3/uL
LAB-003637	Sun Nov 01, 2026 05:00 AM	platelets	282.0 x10^3/uL
LAB-003623	Mon Nov 02, 2026 05:00 AM	creatinine	1.57 mg/dL
LAB-003628	Mon Nov 02, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-003632	Mon Nov 02, 2026 05:00 AM	hemoglobin	13.23 g/dL
LAB-003638	Mon Nov 02, 2026 05:00 AM	wbc	8.45 x10^3/uL
LAB-003639	Mon Nov 02, 2026 05:00 AM	platelets	235.0 x10^3/uL
LAB-003624	Tue Nov 03, 2026 05:00 AM	creatinine	1.65 mg/dL
LAB-003629	Tue Nov 03, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-003633	Tue Nov 03, 2026 05:00 AM	hemoglobin	13.36 g/dL
LAB-003640	Tue Nov 03, 2026 05:00 AM	wbc	6.9 x10^3/uL
LAB-003641	Tue Nov 03, 2026 05:00 AM	platelets	227.0 x10^3/uL

Vitals (48)

Vitals
Row	When	Kind	Value	Detail
VIT-010410	Sat Oct 31, 2026 10:00 PM	spo2	97.0	room air
VIT-010411	Sat Oct 31, 2026 10:00 PM	rr	18.0
VIT-010426	Sat Oct 31, 2026 10:00 PM	temp_c	37.3
VIT-010427	Sat Oct 31, 2026 10:00 PM	hr	86.0
VIT-010428	Sat Oct 31, 2026 10:00 PM	map	74.0
VIT-010429	Sat Oct 31, 2026 10:00 PM	gcs	15.0
VIT-010412	Sun Nov 01, 2026 06:00 AM	spo2	94.0	room air
VIT-010413	Sun Nov 01, 2026 06:00 AM	rr	19.0
VIT-010430	Sun Nov 01, 2026 06:00 AM	temp_c	37.6
VIT-010431	Sun Nov 01, 2026 06:00 AM	hr	87.0
VIT-010432	Sun Nov 01, 2026 06:00 AM	map	90.0
VIT-010433	Sun Nov 01, 2026 06:00 AM	gcs	15.0
VIT-010414	Sun Nov 01, 2026 02:00 PM	spo2	99.0	room air
VIT-010415	Sun Nov 01, 2026 02:00 PM	rr	17.0
VIT-010434	Sun Nov 01, 2026 02:00 PM	temp_c	36.6
VIT-010435	Sun Nov 01, 2026 02:00 PM	hr	85.0
VIT-010436	Sun Nov 01, 2026 02:00 PM	map	87.0
VIT-010437	Sun Nov 01, 2026 02:00 PM	gcs	15.0
VIT-010416	Sun Nov 01, 2026 10:00 PM	spo2	95.0	room air
VIT-010417	Sun Nov 01, 2026 10:00 PM	rr	14.0
VIT-010438	Sun Nov 01, 2026 10:00 PM	temp_c	37.1
VIT-010439	Sun Nov 01, 2026 10:00 PM	hr	69.0
VIT-010440	Sun Nov 01, 2026 10:00 PM	map	92.0
VIT-010441	Sun Nov 01, 2026 10:00 PM	gcs	15.0
VIT-010418	Mon Nov 02, 2026 06:00 AM	spo2	98.0	room air
VIT-010419	Mon Nov 02, 2026 06:00 AM	rr	18.0
VIT-010442	Mon Nov 02, 2026 06:00 AM	temp_c	37.3
VIT-010443	Mon Nov 02, 2026 06:00 AM	hr	85.0
VIT-010444	Mon Nov 02, 2026 06:00 AM	map	74.0
VIT-010445	Mon Nov 02, 2026 06:00 AM	gcs	15.0
VIT-010420	Mon Nov 02, 2026 02:00 PM	spo2	95.0	room air
VIT-010421	Mon Nov 02, 2026 02:00 PM	rr	18.0
VIT-010446	Mon Nov 02, 2026 02:00 PM	temp_c	37.2
VIT-010447	Mon Nov 02, 2026 02:00 PM	hr	83.0
VIT-010448	Mon Nov 02, 2026 02:00 PM	map	89.0
VIT-010449	Mon Nov 02, 2026 02:00 PM	gcs	15.0
VIT-010422	Mon Nov 02, 2026 10:00 PM	spo2	96.0	room air
VIT-010423	Mon Nov 02, 2026 10:00 PM	rr	17.0
VIT-010450	Mon Nov 02, 2026 10:00 PM	temp_c	36.7
VIT-010451	Mon Nov 02, 2026 10:00 PM	hr	77.0
VIT-010452	Mon Nov 02, 2026 10:00 PM	map	83.0
VIT-010453	Mon Nov 02, 2026 10:00 PM	gcs	15.0
VIT-010424	Tue Nov 03, 2026 06:00 AM	spo2	96.0	room air
VIT-010425	Tue Nov 03, 2026 06:00 AM	rr	18.0
VIT-010454	Tue Nov 03, 2026 06:00 AM	temp_c	37.1
VIT-010455	Tue Nov 03, 2026 06:00 AM	hr	78.0
VIT-010456	Tue Nov 03, 2026 06:00 AM	map	75.0
VIT-010457	Tue Nov 03, 2026 06:00 AM	gcs	15.0

Medications, orders, echo, history (8)

MED-000418 10-31 08:00 furosemide 40 mg IV
MED-000419 10-31 20:00 furosemide 40 mg IV
MED-000420 11-01 08:00 furosemide 40 mg IV
MED-000421 11-01 20:00 furosemide 40 mg IV
MED-000422 11-02 08:00 furosemide 40 mg IV
MED-000423 11-02 20:00 furosemide 40 mg IV
ECH-000051 2026-11-01 echo LVEF 23.0%
HX-000041 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000360 · Dr. Noor Halvorsen (resident) · Sun Nov 01, 2026 12:40 AM

Source document DOC-000360: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Sana Thorne   MRN: MRN23477437   Admitted: 2026-10-31 21:40
Service: Cardiology   Attending: Dr. Cyrus Ellingham

History of present illness: 60-year-old woman admitted with acute on chronic systolic heart failure. 
Past medical history: heart failure with reduced ejection fraction, GERD, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. CKD stage 4: renally dose medications.
2. Acute on chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000359 · Dario Larkspur, RD (dietitian) · Mon Nov 02, 2026 02:40 AM

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 40% of needs for 10 days. Weight history: 6.4% 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: 6.4% 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: Sana Thorne MRN: MRN23477437 Context: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 6.4% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulat …
intake_pct: 40 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Sana Thorne MRN: MRN23477437 Context: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 6.4% 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 40% of needs for 10 days. Weight history: 6.4% 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: Sana Thorne MRN: MRN23477437 Context: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 6.4% 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

… Registered Dietitian) Patient: Sana Thorne MRN: MRN23477437 Context: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 6.4% 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: 6.4 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… Registered Dietitian) Patient: Sana Thorne MRN: MRN23477437 Context: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 6.4% 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-000359: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Sana Thorne   MRN: MRN23477437

Context: acute illness
Intake: estimated energy intake 40% of needs for 10 days.
Weight history: 6.4% 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-000361 · Dr. Noor Halvorsen (resident) · Mon Nov 02, 2026 10:40 PM

Source document DOC-000361: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Sana Thorne   MRN: MRN23477437   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Acute on chronic systolic heart failure: continue current management.
2. AKI: trend creatinine, hold nephrotoxins, strict intake and output.

Resident: Dr. Noor Halvorsen   Attending cosign: completed

Discharge summary · DOC-000362 · Dr. Cyrus Ellingham (attending) · Tue Nov 03, 2026 01:22 PM

Source document DOC-000362: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Sana Thorne   MRN: MRN23477437
Admitted 2026-10-31; discharged 2026-11-03.

Discharge diagnoses:
- CKD stage 4
- AKI
- acute on chronic systolic heart failure
- GERD
- hyperlipidemia

Disposition: home with follow-up.