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-00115: Florian Nakashima

47M · MRN94450843 · Hospital Medicine · admitted Thu Nov 05, 2026 11:53 AM · discharged Mon Nov 09, 2026 11:06 AM · attending Dr. Cyrus Ellingham · resident Dr. Camila Oyelaran · 160 cm, 72.3 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“chronic kidney disease” · N18.9 Chronic kidney disease, unspecified
“renal insufficiency” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
“CHF” · I50.9 Heart failure, unspecified
“hypertension” · I10 Essential (primary) hypertension
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications

Illustrative grouping now: MS-DRG 195 Simple pneumonia and pleurisy without CC/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 “renal insufficiency” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 3) (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=2.634, t.ratio_s1=1.5, creat_rise_48h=0.93, 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=2.634, t.ratio_s3=3.0, creat_peak=4.24, 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	true
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=2.634, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	true
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=True, stage2=True, meets_definition=True	3
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.93, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=3, 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=M, hgb_nadir=14.71, 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=0.3, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=False, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=False, hgb_drop=0.3, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=14.71, anaemic=False	true

Chronic kidney disease

Criteria met

Specificity gap

Documented “chronic kidney disease” (N18.9); criteria support the more specific Chronic kidney disease stage 3a (N18.31).

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=260, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=51.2, egfr_late=52.8	52.8
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=51.2, t.g2=60, egfr_late=52.8	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=52.8, 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=51.2, egfr_late=52.8, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=52.8, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3a	true

Heart failure

Criteria met

Specificity gap

Documented “CHF” (I50.9); criteria support the more specific Acute systolic (HFrEF) heart failure (I50.21).

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=817.0, 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=34.0, 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=34.0, 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=False	acute
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	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=systolic, acuity=acute	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

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=unknown, t.a_sev_intake_pct=50, intake_days=unknown, t.a_sev_intake_days=5	unknown
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=unknown, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7	unknown
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=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
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=unknown, wt_loss_pct=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown	0
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=unknown, a_sev_intake=unknown, a_sev_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_sev_wt=unknown	unknown
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=unknown, a_sev_intake=unknown, a_mod_intake=unknown, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_mod_intake=unknown, c_sev_wt=unknown, c_mod_wt=unknown	unknown
outcome: severe	`n_severe >= 2`	n_severe=unknown	unknown
outcome: moderate	`n_moderate >= 2`	n_moderate=unknown	unknown
outcome: one_characteristic	`n_moderate == 1`	n_moderate=unknown	unknown
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=unknown, n_assessed=0	false

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=47, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=28.2, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=28.2, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=28.2, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=28.2, 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 met

No gap

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

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=37.3, 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=88.0, 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=10.82, t.wbc_hi=12, wbc_min_48h=6.66, 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=173.0	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=0.82	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=4.24	3
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=1.61	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=3, sofa_renal_baseline=1	2
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=2, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, sirs_count=0, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=True, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=True	false
outcome: septic_shock	`shock`	shock=False	false
outcome: both	`sepsis3 and sepsis2`	sepsis3=True, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=True	true

Structured data

Labs (29)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-003922	Tue Dec 16, 2025 09:15 AM	creatinine	1.65 mg/dL
LAB-003923	Thu Sep 03, 2026 10:05 AM	creatinine	1.61 mg/dL
LAB-003924	Thu Nov 05, 2026 12:53 PM	creatinine	3.31 mg/dL
LAB-003929	Thu Nov 05, 2026 12:53 PM	bnp	817.0 pg/mL
LAB-003930	Thu Nov 05, 2026 12:53 PM	sodium	142.0 mmol/L
LAB-003935	Thu Nov 05, 2026 12:53 PM	hemoglobin	14.93 g/dL
LAB-003940	Thu Nov 05, 2026 12:53 PM	wbc	6.66 x10^3/uL
LAB-003941	Thu Nov 05, 2026 12:53 PM	platelets	173.0 x10^3/uL
LAB-003950	Thu Nov 05, 2026 12:53 PM	bilirubin	0.82 mg/dL
LAB-003925	Fri Nov 06, 2026 05:00 AM	creatinine	4.24 mg/dL
LAB-003931	Fri Nov 06, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-003936	Fri Nov 06, 2026 05:00 AM	hemoglobin	14.73 g/dL
LAB-003942	Fri Nov 06, 2026 05:00 AM	wbc	10.68 x10^3/uL
LAB-003943	Fri Nov 06, 2026 05:00 AM	platelets	197.0 x10^3/uL
LAB-003926	Sat Nov 07, 2026 05:00 AM	creatinine	3.82 mg/dL
LAB-003932	Sat Nov 07, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-003937	Sat Nov 07, 2026 05:00 AM	hemoglobin	15.04 g/dL
LAB-003944	Sat Nov 07, 2026 05:00 AM	wbc	10.82 x10^3/uL
LAB-003945	Sat Nov 07, 2026 05:00 AM	platelets	238.0 x10^3/uL
LAB-003927	Sun Nov 08, 2026 05:00 AM	creatinine	3.18 mg/dL
LAB-003933	Sun Nov 08, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-003938	Sun Nov 08, 2026 05:00 AM	hemoglobin	15.04 g/dL
LAB-003946	Sun Nov 08, 2026 05:00 AM	wbc	10.5 x10^3/uL
LAB-003947	Sun Nov 08, 2026 05:00 AM	platelets	302.0 x10^3/uL
LAB-003928	Mon Nov 09, 2026 05:00 AM	creatinine	2.63 mg/dL
LAB-003934	Mon Nov 09, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-003939	Mon Nov 09, 2026 05:00 AM	hemoglobin	14.71 g/dL
LAB-003948	Mon Nov 09, 2026 05:00 AM	wbc	8.45 x10^3/uL
LAB-003949	Mon Nov 09, 2026 05:00 AM	platelets	250.0 x10^3/uL

Vitals (72)

Vitals
Row	When	Kind	Value	Detail
VIT-011266	Thu Nov 05, 2026 12:13 PM	spo2	98.0	room air
VIT-011267	Thu Nov 05, 2026 12:13 PM	rr	20.0
VIT-011290	Thu Nov 05, 2026 12:13 PM	temp_c	37.3
VIT-011291	Thu Nov 05, 2026 12:13 PM	hr	74.0
VIT-011292	Thu Nov 05, 2026 12:13 PM	map	81.0
VIT-011293	Thu Nov 05, 2026 12:13 PM	gcs	15.0
VIT-011268	Thu Nov 05, 2026 08:13 PM	spo2	96.0	room air
VIT-011269	Thu Nov 05, 2026 08:13 PM	rr	14.0
VIT-011294	Thu Nov 05, 2026 08:13 PM	temp_c	36.6
VIT-011295	Thu Nov 05, 2026 08:13 PM	hr	88.0
VIT-011296	Thu Nov 05, 2026 08:13 PM	map	75.0
VIT-011297	Thu Nov 05, 2026 08:13 PM	gcs	15.0
VIT-011270	Fri Nov 06, 2026 04:13 AM	spo2	99.0	room air
VIT-011271	Fri Nov 06, 2026 04:13 AM	rr	20.0
VIT-011298	Fri Nov 06, 2026 04:13 AM	temp_c	37.3
VIT-011299	Fri Nov 06, 2026 04:13 AM	hr	70.0
VIT-011300	Fri Nov 06, 2026 04:13 AM	map	82.0
VIT-011301	Fri Nov 06, 2026 04:13 AM	gcs	15.0
VIT-011272	Fri Nov 06, 2026 12:13 PM	spo2	95.0	room air
VIT-011273	Fri Nov 06, 2026 12:13 PM	rr	19.0
VIT-011302	Fri Nov 06, 2026 12:13 PM	temp_c	36.6
VIT-011303	Fri Nov 06, 2026 12:13 PM	hr	68.0
VIT-011304	Fri Nov 06, 2026 12:13 PM	map	92.0
VIT-011305	Fri Nov 06, 2026 12:13 PM	gcs	15.0
VIT-011274	Fri Nov 06, 2026 08:13 PM	spo2	96.0	room air
VIT-011275	Fri Nov 06, 2026 08:13 PM	rr	17.0
VIT-011306	Fri Nov 06, 2026 08:13 PM	temp_c	37.1
VIT-011307	Fri Nov 06, 2026 08:13 PM	hr	84.0
VIT-011308	Fri Nov 06, 2026 08:13 PM	map	78.0
VIT-011309	Fri Nov 06, 2026 08:13 PM	gcs	15.0
VIT-011276	Sat Nov 07, 2026 04:13 AM	spo2	96.0	room air
VIT-011277	Sat Nov 07, 2026 04:13 AM	rr	15.0
VIT-011310	Sat Nov 07, 2026 04:13 AM	temp_c	36.6
VIT-011311	Sat Nov 07, 2026 04:13 AM	hr	71.0
VIT-011312	Sat Nov 07, 2026 04:13 AM	map	92.0
VIT-011313	Sat Nov 07, 2026 04:13 AM	gcs	15.0
VIT-011278	Sat Nov 07, 2026 12:13 PM	spo2	96.0	room air
VIT-011279	Sat Nov 07, 2026 12:13 PM	rr	17.0
VIT-011314	Sat Nov 07, 2026 12:13 PM	temp_c	37.3
VIT-011315	Sat Nov 07, 2026 12:13 PM	hr	84.0
VIT-011316	Sat Nov 07, 2026 12:13 PM	map	89.0
VIT-011317	Sat Nov 07, 2026 12:13 PM	gcs	15.0
VIT-011280	Sat Nov 07, 2026 08:13 PM	spo2	97.0	room air
VIT-011281	Sat Nov 07, 2026 08:13 PM	rr	20.0
VIT-011318	Sat Nov 07, 2026 08:13 PM	temp_c	36.9
VIT-011319	Sat Nov 07, 2026 08:13 PM	hr	85.0
VIT-011320	Sat Nov 07, 2026 08:13 PM	map	79.0
VIT-011321	Sat Nov 07, 2026 08:13 PM	gcs	15.0
VIT-011282	Sun Nov 08, 2026 04:13 AM	spo2	97.0	room air
VIT-011283	Sun Nov 08, 2026 04:13 AM	rr	19.0
VIT-011322	Sun Nov 08, 2026 04:13 AM	temp_c	37.2
VIT-011323	Sun Nov 08, 2026 04:13 AM	hr	70.0
VIT-011324	Sun Nov 08, 2026 04:13 AM	map	82.0
VIT-011325	Sun Nov 08, 2026 04:13 AM	gcs	15.0
VIT-011284	Sun Nov 08, 2026 12:13 PM	spo2	95.0	room air
VIT-011285	Sun Nov 08, 2026 12:13 PM	rr	15.0
VIT-011326	Sun Nov 08, 2026 12:13 PM	temp_c	37.1
VIT-011327	Sun Nov 08, 2026 12:13 PM	hr	76.0
VIT-011328	Sun Nov 08, 2026 12:13 PM	map	74.0
VIT-011329	Sun Nov 08, 2026 12:13 PM	gcs	15.0
VIT-011286	Sun Nov 08, 2026 08:13 PM	spo2	97.0	room air
VIT-011287	Sun Nov 08, 2026 08:13 PM	rr	19.0
VIT-011330	Sun Nov 08, 2026 08:13 PM	temp_c	37.3
VIT-011331	Sun Nov 08, 2026 08:13 PM	hr	79.0
VIT-011332	Sun Nov 08, 2026 08:13 PM	map	89.0
VIT-011333	Sun Nov 08, 2026 08:13 PM	gcs	15.0
VIT-011288	Mon Nov 09, 2026 04:13 AM	spo2	94.0	room air
VIT-011289	Mon Nov 09, 2026 04:13 AM	rr	20.0
VIT-011334	Mon Nov 09, 2026 04:13 AM	temp_c	37.5
VIT-011335	Mon Nov 09, 2026 04:13 AM	hr	92.0
VIT-011336	Mon Nov 09, 2026 04:13 AM	map	83.0
VIT-011337	Mon Nov 09, 2026 04:13 AM	gcs	15.0

Medications, orders, echo, history (11)

MED-000448 11-05 12:53 ceftriaxone per protocol IV
MED-000449 11-06 05:00 ceftriaxone per protocol IV
MED-000450 11-07 05:00 cefepime per protocol IV
MED-000451 11-05 08:00 furosemide 40 mg IV
MED-000452 11-05 20:00 furosemide 40 mg IV
MED-000453 11-06 08:00 furosemide 40 mg IV
MED-000454 11-06 20:00 furosemide 40 mg IV
MED-000455 11-07 08:00 furosemide 40 mg IV
MED-000456 11-07 20:00 furosemide 40 mg IV
ORD-000098 11-05 12:23 blood_culture: blood cultures x2
ECH-000055 2026-11-06 echo LVEF 34.0%

Notes

History and physical · DOC-000388 · Dr. Camila Oyelaran (resident) · Thu Nov 05, 2026 02:53 PM

Cited facts from this note (2)

bleeding_source: bleeding · cited p. 1, line 7 · confidence 0.50

Show source for bleeding_source

… -ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: hypertension, hyperlipidemia, type 2 diabetes. Denies bleeding, chest pain or fever. Exam: Lungs: scattered crackles at the bases, no distress. Assessment and plan: 1. Community-acquired pneumonia: antibiotics. 2. Chronic …
infection_source: left lower lobe pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… : Hospital Medicine Attending: Dr. Cyrus Ellingham History of present illness: 47-year-old man admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: hypertension, hyperlipidemia, type 2 diabetes. Denies bleeding, chest pain or fever. Exam: …

Source document DOC-000388: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Florian Nakashima   MRN: MRN94450843   Admitted: 2026-11-05 11:53
Service: Hospital Medicine   Attending: Dr. Cyrus Ellingham

History of present illness: 47-year-old man admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: hypertension, hyperlipidemia, type 2 diabetes.
Denies bleeding, chest pain or fever.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.
2. Chronic kidney disease: renally dose medications.

Progress note · DOC-000389 · Dr. Camila Oyelaran (resident) · Sat Nov 07, 2026 11:53 AM

Source document DOC-000389: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Florian Nakashima   MRN: MRN94450843   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. Renal insufficiency: trend creatinine, avoid nephrotoxins.
3. CHF: diuresis and daily weights; monitor electrolytes.

Resident: Dr. Camila Oyelaran   Attending cosign: completed

Discharge summary · DOC-000390 · Dr. Cyrus Ellingham (attending) · Mon Nov 09, 2026 11:06 AM

Source document DOC-000390: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Florian Nakashima   MRN: MRN94450843
Admitted 2026-11-05; discharged 2026-11-09.

Discharge diagnoses:
- community-acquired pneumonia
- chronic kidney disease
- renal insufficiency
- CHF
- hypertension
- hyperlipidemia
- type 2 diabetes

Disposition: home with follow-up.