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-00111: Wes Hartwell

89F · MRN77598128 · Hospital Medicine · admitted Thu Oct 29, 2026 04:40 PM · discharged Tue Nov 03, 2026 01:16 PM · attending Dr. Kenji Stavros · 169 cm, 78.0 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“worsening renal function” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
“acute hypoxic respiratory failure” · J96.01 Acute respiratory failure with hypoxia
“hypertension” · I10 Essential (primary) hypertension
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 193 Simple pneumonia and pleurisy with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 193.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

Specificity gap

Documented “worsening renal function” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 1) (N17.9).

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=1.885, t.ratio_s1=1.5, creat_rise_48h=0.21, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	true
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=True, creat_ratio=1.885, t.ratio_s3=3.0, creat_peak=0.98, 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=1.885, 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=True	1
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.21, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=1, baseline_independent=True	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=12.71, 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=0.4, 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=0.4, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=12.71, 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=173, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=88.3, egfr_late=88.8	88.8
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=88.3, t.g2=60, egfr_late=88.8	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=88.8, 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=88.3, egfr_late=88.8, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=88.8, 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=137.0, 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=137.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=137.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=137.0, 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=89, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=27.3, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=27.3, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=27.3, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=27.3, 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

Clinical judgement required

Clinical judgement required: Hypoxaemia without a charted sign of respiratory distress.

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=87.0, 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=87.0, 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=23.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=True	false
outcome: met	`hypoxemia and distress`	hypoxemia=True, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=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=37.3, 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=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=22.0, 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=9.44, t.wbc_hi=12, wbc_min_48h=7.3, 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=207.0	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=0.69	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=0.98	0
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=0.52	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 (33)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-003764	Fri Jan 16, 2026 09:15 AM	creatinine	0.53 mg/dL
LAB-003765	Thu Jul 09, 2026 10:05 AM	creatinine	0.52 mg/dL
LAB-003766	Thu Oct 29, 2026 05:40 PM	creatinine	0.77 mg/dL
LAB-003772	Thu Oct 29, 2026 05:40 PM	sodium	139.0 mmol/L
LAB-003778	Thu Oct 29, 2026 05:40 PM	hemoglobin	12.99 g/dL
LAB-003784	Thu Oct 29, 2026 05:40 PM	wbc	7.3 x10^3/uL
LAB-003785	Thu Oct 29, 2026 05:40 PM	platelets	207.0 x10^3/uL
LAB-003796	Thu Oct 29, 2026 05:40 PM	bilirubin	0.69 mg/dL
LAB-003767	Fri Oct 30, 2026 05:00 AM	creatinine	0.98 mg/dL
LAB-003773	Fri Oct 30, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-003779	Fri Oct 30, 2026 05:00 AM	hemoglobin	13.01 g/dL
LAB-003786	Fri Oct 30, 2026 05:00 AM	wbc	7.47 x10^3/uL
LAB-003787	Fri Oct 30, 2026 05:00 AM	platelets	214.0 x10^3/uL
LAB-003768	Sat Oct 31, 2026 05:00 AM	creatinine	0.89 mg/dL
LAB-003774	Sat Oct 31, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003780	Sat Oct 31, 2026 05:00 AM	hemoglobin	13.08 g/dL
LAB-003788	Sat Oct 31, 2026 05:00 AM	wbc	9.44 x10^3/uL
LAB-003789	Sat Oct 31, 2026 05:00 AM	platelets	253.0 x10^3/uL
LAB-003769	Sun Nov 01, 2026 05:00 AM	creatinine	0.74 mg/dL
LAB-003775	Sun Nov 01, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-003781	Sun Nov 01, 2026 05:00 AM	hemoglobin	13.06 g/dL
LAB-003790	Sun Nov 01, 2026 05:00 AM	wbc	10.9 x10^3/uL
LAB-003791	Sun Nov 01, 2026 05:00 AM	platelets	185.0 x10^3/uL
LAB-003770	Mon Nov 02, 2026 05:00 AM	creatinine	0.61 mg/dL
LAB-003776	Mon Nov 02, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003782	Mon Nov 02, 2026 05:00 AM	hemoglobin	12.82 g/dL
LAB-003792	Mon Nov 02, 2026 05:00 AM	wbc	10.67 x10^3/uL
LAB-003793	Mon Nov 02, 2026 05:00 AM	platelets	177.0 x10^3/uL
LAB-003771	Tue Nov 03, 2026 05:00 AM	creatinine	0.55 mg/dL
LAB-003777	Tue Nov 03, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-003783	Tue Nov 03, 2026 05:00 AM	hemoglobin	12.71 g/dL
LAB-003794	Tue Nov 03, 2026 05:00 AM	wbc	10.33 x10^3/uL
LAB-003795	Tue Nov 03, 2026 05:00 AM	platelets	241.0 x10^3/uL

Vitals (104)

Vitals
Row	When	Kind	Value	Detail
VIT-010808	Thu Oct 29, 2026 05:00 PM	spo2	87.0	room air
VIT-010809	Thu Oct 29, 2026 05:00 PM	rr	20.0
VIT-010852	Thu Oct 29, 2026 05:00 PM	temp_c	37.2
VIT-010853	Thu Oct 29, 2026 05:00 PM	hr	72.0
VIT-010854	Thu Oct 29, 2026 05:00 PM	map	82.0
VIT-010855	Thu Oct 29, 2026 05:00 PM	gcs	15.0
VIT-010810	Fri Oct 30, 2026 01:00 AM	spo2	95.0	nasal cannula
VIT-010811	Fri Oct 30, 2026 01:00 AM	rr	21.0
VIT-010812	Fri Oct 30, 2026 01:00 AM	o2_lpm	2.0	nasal cannula
VIT-010856	Fri Oct 30, 2026 01:00 AM	temp_c	36.8
VIT-010857	Fri Oct 30, 2026 01:00 AM	hr	75.0
VIT-010858	Fri Oct 30, 2026 01:00 AM	map	81.0
VIT-010859	Fri Oct 30, 2026 01:00 AM	gcs	15.0
VIT-010813	Fri Oct 30, 2026 09:00 AM	spo2	92.0	nasal cannula
VIT-010814	Fri Oct 30, 2026 09:00 AM	rr	22.0
VIT-010815	Fri Oct 30, 2026 09:00 AM	o2_lpm	2.0	nasal cannula
VIT-010860	Fri Oct 30, 2026 09:00 AM	temp_c	36.6
VIT-010861	Fri Oct 30, 2026 09:00 AM	hr	87.0
VIT-010862	Fri Oct 30, 2026 09:00 AM	map	75.0
VIT-010863	Fri Oct 30, 2026 09:00 AM	gcs	15.0
VIT-010816	Fri Oct 30, 2026 05:00 PM	spo2	94.0	nasal cannula
VIT-010817	Fri Oct 30, 2026 05:00 PM	rr	19.0
VIT-010818	Fri Oct 30, 2026 05:00 PM	o2_lpm	2.0	nasal cannula
VIT-010864	Fri Oct 30, 2026 05:00 PM	temp_c	36.8
VIT-010865	Fri Oct 30, 2026 05:00 PM	hr	89.0
VIT-010866	Fri Oct 30, 2026 05:00 PM	map	82.0
VIT-010867	Fri Oct 30, 2026 05:00 PM	gcs	15.0
VIT-010819	Sat Oct 31, 2026 01:00 AM	spo2	93.0	nasal cannula
VIT-010820	Sat Oct 31, 2026 01:00 AM	rr	20.0
VIT-010821	Sat Oct 31, 2026 01:00 AM	o2_lpm	2.0	nasal cannula
VIT-010868	Sat Oct 31, 2026 01:00 AM	temp_c	37.3
VIT-010869	Sat Oct 31, 2026 01:00 AM	hr	80.0
VIT-010870	Sat Oct 31, 2026 01:00 AM	map	86.0
VIT-010871	Sat Oct 31, 2026 01:00 AM	gcs	15.0
VIT-010822	Sat Oct 31, 2026 09:00 AM	spo2	95.0	nasal cannula
VIT-010823	Sat Oct 31, 2026 09:00 AM	rr	19.0
VIT-010824	Sat Oct 31, 2026 09:00 AM	o2_lpm	2.0	nasal cannula
VIT-010872	Sat Oct 31, 2026 09:00 AM	temp_c	37.0
VIT-010873	Sat Oct 31, 2026 09:00 AM	hr	74.0
VIT-010874	Sat Oct 31, 2026 09:00 AM	map	75.0
VIT-010875	Sat Oct 31, 2026 09:00 AM	gcs	15.0
VIT-010825	Sat Oct 31, 2026 05:00 PM	spo2	94.0	nasal cannula
VIT-010826	Sat Oct 31, 2026 05:00 PM	rr	18.0
VIT-010827	Sat Oct 31, 2026 05:00 PM	o2_lpm	2.0	nasal cannula
VIT-010876	Sat Oct 31, 2026 05:00 PM	temp_c	37.0
VIT-010877	Sat Oct 31, 2026 05:00 PM	hr	76.0
VIT-010878	Sat Oct 31, 2026 05:00 PM	map	88.0
VIT-010879	Sat Oct 31, 2026 05:00 PM	gcs	15.0
VIT-010828	Sun Nov 01, 2026 01:00 AM	spo2	94.0	nasal cannula
VIT-010829	Sun Nov 01, 2026 01:00 AM	rr	23.0
VIT-010830	Sun Nov 01, 2026 01:00 AM	o2_lpm	2.0	nasal cannula
VIT-010880	Sun Nov 01, 2026 01:00 AM	temp_c	37.1
VIT-010881	Sun Nov 01, 2026 01:00 AM	hr	75.0
VIT-010882	Sun Nov 01, 2026 01:00 AM	map	76.0
VIT-010883	Sun Nov 01, 2026 01:00 AM	gcs	15.0
VIT-010831	Sun Nov 01, 2026 09:00 AM	spo2	95.0	nasal cannula
VIT-010832	Sun Nov 01, 2026 09:00 AM	rr	19.0
VIT-010833	Sun Nov 01, 2026 09:00 AM	o2_lpm	2.0	nasal cannula
VIT-010884	Sun Nov 01, 2026 09:00 AM	temp_c	36.8
VIT-010885	Sun Nov 01, 2026 09:00 AM	hr	79.0
VIT-010886	Sun Nov 01, 2026 09:00 AM	map	74.0
VIT-010887	Sun Nov 01, 2026 09:00 AM	gcs	15.0
VIT-010834	Sun Nov 01, 2026 05:00 PM	spo2	92.0	nasal cannula
VIT-010835	Sun Nov 01, 2026 05:00 PM	rr	21.0
VIT-010836	Sun Nov 01, 2026 05:00 PM	o2_lpm	2.0	nasal cannula
VIT-010888	Sun Nov 01, 2026 05:00 PM	temp_c	36.8
VIT-010889	Sun Nov 01, 2026 05:00 PM	hr	86.0
VIT-010890	Sun Nov 01, 2026 05:00 PM	map	84.0
VIT-010891	Sun Nov 01, 2026 05:00 PM	gcs	15.0
VIT-010837	Mon Nov 02, 2026 01:00 AM	spo2	92.0	nasal cannula
VIT-010838	Mon Nov 02, 2026 01:00 AM	rr	18.0
VIT-010839	Mon Nov 02, 2026 01:00 AM	o2_lpm	2.0	nasal cannula
VIT-010892	Mon Nov 02, 2026 01:00 AM	temp_c	36.8
VIT-010893	Mon Nov 02, 2026 01:00 AM	hr	86.0
VIT-010894	Mon Nov 02, 2026 01:00 AM	map	87.0
VIT-010895	Mon Nov 02, 2026 01:00 AM	gcs	15.0
VIT-010840	Mon Nov 02, 2026 09:00 AM	spo2	95.0	nasal cannula
VIT-010841	Mon Nov 02, 2026 09:00 AM	rr	18.0
VIT-010842	Mon Nov 02, 2026 09:00 AM	o2_lpm	2.0	nasal cannula
VIT-010896	Mon Nov 02, 2026 09:00 AM	temp_c	36.9
VIT-010897	Mon Nov 02, 2026 09:00 AM	hr	79.0
VIT-010898	Mon Nov 02, 2026 09:00 AM	map	78.0
VIT-010899	Mon Nov 02, 2026 09:00 AM	gcs	15.0
VIT-010843	Mon Nov 02, 2026 05:00 PM	spo2	96.0	nasal cannula
VIT-010844	Mon Nov 02, 2026 05:00 PM	rr	22.0
VIT-010845	Mon Nov 02, 2026 05:00 PM	o2_lpm	2.0	nasal cannula
VIT-010900	Mon Nov 02, 2026 05:00 PM	temp_c	37.4
VIT-010901	Mon Nov 02, 2026 05:00 PM	hr	92.0
VIT-010902	Mon Nov 02, 2026 05:00 PM	map	85.0
VIT-010903	Mon Nov 02, 2026 05:00 PM	gcs	15.0
VIT-010846	Tue Nov 03, 2026 01:00 AM	spo2	95.0	nasal cannula
VIT-010847	Tue Nov 03, 2026 01:00 AM	rr	23.0
VIT-010848	Tue Nov 03, 2026 01:00 AM	o2_lpm	2.0	nasal cannula
VIT-010904	Tue Nov 03, 2026 01:00 AM	temp_c	37.1
VIT-010905	Tue Nov 03, 2026 01:00 AM	hr	88.0
VIT-010906	Tue Nov 03, 2026 01:00 AM	map	87.0
VIT-010907	Tue Nov 03, 2026 01:00 AM	gcs	15.0
VIT-010849	Tue Nov 03, 2026 09:00 AM	spo2	93.0	nasal cannula
VIT-010850	Tue Nov 03, 2026 09:00 AM	rr	20.0
VIT-010851	Tue Nov 03, 2026 09:00 AM	o2_lpm	2.0	nasal cannula
VIT-010908	Tue Nov 03, 2026 09:00 AM	temp_c	36.7
VIT-010909	Tue Nov 03, 2026 09:00 AM	hr	75.0
VIT-010910	Tue Nov 03, 2026 09:00 AM	map	82.0
VIT-010911	Tue Nov 03, 2026 09:00 AM	gcs	15.0

Medications, orders, echo, history (4)

MED-000436 10-29 17:40 cefepime per protocol IV
MED-000437 10-30 05:00 ceftriaxone per protocol IV
MED-000438 10-31 05:00 cefepime per protocol IV
ORD-000095 10-29 17:10 blood_culture: blood cultures x2

Notes

History and physical · DOC-000374 · Dr. Kenji Stavros (attending) · Thu Oct 29, 2026 07:40 PM

Cited facts from this note (1)

infection_source: multifocal pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… : Hospital Medicine Attending: Dr. Kenji Stavros History of present illness: 89-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: hypertension, hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: scattered …

Source document DOC-000374: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Wes Hartwell   MRN: MRN77598128   Admitted: 2026-10-29 16:40
Service: Hospital Medicine   Attending: Dr. Kenji Stavros

History of present illness: 89-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: hypertension, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.

Nutrition assessment · DOC-000373 · Vera Pemberton, RD (dietitian) · Fri Oct 30, 2026 09:40 PM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN77598128 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: Wes Hartwell MRN: MRN77598128 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: Wes Hartwell MRN: MRN77598128 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-000373: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Wes Hartwell   MRN: MRN77598128

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-000375 · Dr. Kenji Stavros (attending) · Sat Oct 31, 2026 08:40 PM

Source document DOC-000375: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Wes Hartwell   MRN: MRN77598128   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Community-acquired pneumonia: continue current management.
2. Worsening renal function: trend creatinine, avoid nephrotoxins.
3. Acute hypoxic respiratory failure: supplemental oxygen, wean as tolerated.

Attending: Dr. Kenji Stavros

Discharge summary · DOC-000376 · Dr. Kenji Stavros (attending) · Tue Nov 03, 2026 01:16 PM

Source document DOC-000376: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Wes Hartwell   MRN: MRN77598128
Admitted 2026-10-29; discharged 2026-11-03.

Discharge diagnoses:
- community-acquired pneumonia
- worsening renal function
- acute hypoxic respiratory failure
- hypertension
- hyperlipidemia

Disposition: home with follow-up.