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-00116: Mara Dunmore

85M · MRN98911807 · Pulmonology · admitted Sun Nov 08, 2026 01:44 PM · in hospital · attending Dr. Jalen Carrow · resident Dr. Noor Halvorsen · 169 cm, 48.7 kg

Documented diagnoses (current)

Principal: “COPD exacerbation” · J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
“malnourished” · E46 Unspecified protein-calorie malnutrition
“congestive heart failure” · I50.9 Heart failure, unspecified
“acute respiratory failure with hypoxia” · J96.01 Acute respiratory failure with hypoxia
“stage 4 sacral pressure ulcer” · L89.154 Pressure ulcer of sacral region, stage 4

Illustrative grouping now: MS-DRG 190 Chronic obstructive pulmonary disease with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 190.

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=1.065, t.ratio_s1=1.5, creat_rise_48h=0.06, 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=1.065, t.ratio_s3=3.0, creat_peak=0.82, 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=1.065, 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=0.06, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=M, hgb_nadir=13.49, 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=13.49, 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=257, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=87.1, egfr_late=87.7	87.7
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=87.1, t.g2=60, egfr_late=87.7	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=87.7, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=False, egfr_early=87.1, egfr_late=87.7, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=87.7, t.g2=60	true

Heart failure

Criteria met

Specificity gap

Documented “congestive heart failure” (I50.9); criteria support the more specific Acute on chronic diastolic (HFpEF) heart failure (I50.33).

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=1678.0, 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=True	3
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=61.0, t.ref=40, t.pres=50	diastolic
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=61.0, 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=3, hf_history=True	acute on chronic
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=diastolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=acute on chronic	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=diastolic, acuity=acute on chronic	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=acute on chronic	false
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=diastolic, 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

Clinical judgement required

Clinical judgement required: Only one consensus characteristic documented; two are required.

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=60.0, t.a_sev_intake_pct=50, intake_days=10.0, 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=60.0, 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=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=60.0, 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=60.0, 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=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=60.0, 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=True, 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	1
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=1	false
outcome: one_characteristic	`n_moderate == 1`	n_moderate=1	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=85, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=17.1, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=17.1, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=17.1, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=17.1, 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=sacral	true
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=unknown	true

Acute respiratory failure

Criteria not met

Clinical validation gap

Documented “acute respiratory failure with hypoxia” (J96.01) but the criteria are not met: No hypoxaemia on room air (lowest SpO2 93%), oxygen no more than 2 L/min, no advanced support.

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=93.0, 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=93.0, 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=21.0, 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=2.0, 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=37.4, t.t_hi=38, temp_min_48h=36.7, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=90.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=21.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	true
derived: sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`	wbc_max_48h=10.43, t.wbc_hi=12, wbc_min_48h=6.6, 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=165.0	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=0.95	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=0.8	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=0.77	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=False, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, 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=False	true

Structured data

Labs (34)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-003951	Wed Jan 07, 2026 09:15 AM	creatinine	0.79 mg/dL
LAB-003952	Tue Sep 22, 2026 10:05 AM	creatinine	0.77 mg/dL
LAB-003953	Sun Nov 08, 2026 02:44 PM	creatinine	0.8 mg/dL
LAB-003959	Sun Nov 08, 2026 02:44 PM	bnp	1678.0 pg/mL
LAB-003960	Sun Nov 08, 2026 02:44 PM	sodium	137.0 mmol/L
LAB-003966	Sun Nov 08, 2026 02:44 PM	hemoglobin	13.6 g/dL
LAB-003972	Sun Nov 08, 2026 02:44 PM	wbc	6.6 x10^3/uL
LAB-003973	Sun Nov 08, 2026 02:44 PM	platelets	207.0 x10^3/uL
LAB-003984	Sun Nov 08, 2026 02:44 PM	bilirubin	0.95 mg/dL
LAB-003954	Mon Nov 09, 2026 05:00 AM	creatinine	0.79 mg/dL
LAB-003961	Mon Nov 09, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-003967	Mon Nov 09, 2026 05:00 AM	hemoglobin	13.58 g/dL
LAB-003974	Mon Nov 09, 2026 05:00 AM	wbc	10.0 x10^3/uL
LAB-003975	Mon Nov 09, 2026 05:00 AM	platelets	165.0 x10^3/uL
LAB-003955	Tue Nov 10, 2026 05:00 AM	creatinine	0.76 mg/dL
LAB-003962	Tue Nov 10, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-003968	Tue Nov 10, 2026 05:00 AM	hemoglobin	13.93 g/dL
LAB-003976	Tue Nov 10, 2026 05:00 AM	wbc	10.43 x10^3/uL
LAB-003977	Tue Nov 10, 2026 05:00 AM	platelets	254.0 x10^3/uL
LAB-003956	Wed Nov 11, 2026 05:00 AM	creatinine	0.82 mg/dL
LAB-003963	Wed Nov 11, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-003969	Wed Nov 11, 2026 05:00 AM	hemoglobin	13.49 g/dL
LAB-003978	Wed Nov 11, 2026 05:00 AM	wbc	8.43 x10^3/uL
LAB-003979	Wed Nov 11, 2026 05:00 AM	platelets	268.0 x10^3/uL
LAB-003957	Thu Nov 12, 2026 05:00 AM	creatinine	0.8 mg/dL
LAB-003964	Thu Nov 12, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-003970	Thu Nov 12, 2026 05:00 AM	hemoglobin	13.61 g/dL
LAB-003980	Thu Nov 12, 2026 05:00 AM	wbc	6.58 x10^3/uL
LAB-003981	Thu Nov 12, 2026 05:00 AM	platelets	254.0 x10^3/uL
LAB-003958	Fri Nov 13, 2026 05:00 AM	creatinine	0.77 mg/dL
LAB-003965	Fri Nov 13, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-003971	Fri Nov 13, 2026 05:00 AM	hemoglobin	13.72 g/dL
LAB-003982	Fri Nov 13, 2026 05:00 AM	wbc	8.37 x10^3/uL
LAB-003983	Fri Nov 13, 2026 05:00 AM	platelets	285.0 x10^3/uL

Vitals (98)

Vitals
Row	When	Kind	Value	Detail
VIT-011338	Sun Nov 08, 2026 02:04 PM	spo2	96.0	room air
VIT-011339	Sun Nov 08, 2026 02:04 PM	rr	16.0
VIT-011372	Sun Nov 08, 2026 02:04 PM	temp_c	37.4
VIT-011373	Sun Nov 08, 2026 02:04 PM	hr	82.0
VIT-011374	Sun Nov 08, 2026 02:04 PM	map	75.0
VIT-011375	Sun Nov 08, 2026 02:04 PM	gcs	15.0
VIT-011340	Sun Nov 08, 2026 10:04 PM	spo2	96.0	room air
VIT-011341	Sun Nov 08, 2026 10:04 PM	rr	21.0
VIT-011376	Sun Nov 08, 2026 10:04 PM	temp_c	37.4
VIT-011377	Sun Nov 08, 2026 10:04 PM	hr	90.0
VIT-011378	Sun Nov 08, 2026 10:04 PM	map	89.0
VIT-011379	Sun Nov 08, 2026 10:04 PM	gcs	15.0
VIT-011342	Sun Nov 08, 2026 10:09 PM	o2_lpm	2.0	nasal cannula
VIT-011343	Mon Nov 09, 2026 06:04 AM	spo2	93.0	room air
VIT-011344	Mon Nov 09, 2026 06:04 AM	rr	21.0
VIT-011380	Mon Nov 09, 2026 06:04 AM	temp_c	36.8
VIT-011381	Mon Nov 09, 2026 06:04 AM	hr	70.0
VIT-011382	Mon Nov 09, 2026 06:04 AM	map	78.0
VIT-011383	Mon Nov 09, 2026 06:04 AM	gcs	15.0
VIT-011345	Mon Nov 09, 2026 06:09 AM	o2_lpm	2.0	nasal cannula
VIT-011346	Mon Nov 09, 2026 02:04 PM	spo2	94.0	room air
VIT-011347	Mon Nov 09, 2026 02:04 PM	rr	19.0
VIT-011384	Mon Nov 09, 2026 02:04 PM	temp_c	36.7
VIT-011385	Mon Nov 09, 2026 02:04 PM	hr	68.0
VIT-011386	Mon Nov 09, 2026 02:04 PM	map	81.0
VIT-011387	Mon Nov 09, 2026 02:04 PM	gcs	15.0
VIT-011348	Mon Nov 09, 2026 10:04 PM	spo2	93.0	room air
VIT-011349	Mon Nov 09, 2026 10:04 PM	rr	16.0
VIT-011388	Mon Nov 09, 2026 10:04 PM	temp_c	37.2
VIT-011389	Mon Nov 09, 2026 10:04 PM	hr	87.0
VIT-011390	Mon Nov 09, 2026 10:04 PM	map	82.0
VIT-011391	Mon Nov 09, 2026 10:04 PM	gcs	15.0
VIT-011350	Tue Nov 10, 2026 06:04 AM	spo2	93.0	room air
VIT-011351	Tue Nov 10, 2026 06:04 AM	rr	20.0
VIT-011392	Tue Nov 10, 2026 06:04 AM	temp_c	37.3
VIT-011393	Tue Nov 10, 2026 06:04 AM	hr	76.0
VIT-011394	Tue Nov 10, 2026 06:04 AM	map	91.0
VIT-011395	Tue Nov 10, 2026 06:04 AM	gcs	15.0
VIT-011352	Tue Nov 10, 2026 02:04 PM	spo2	95.0	room air
VIT-011353	Tue Nov 10, 2026 02:04 PM	rr	19.0
VIT-011396	Tue Nov 10, 2026 02:04 PM	temp_c	36.6
VIT-011397	Tue Nov 10, 2026 02:04 PM	hr	69.0
VIT-011398	Tue Nov 10, 2026 02:04 PM	map	76.0
VIT-011399	Tue Nov 10, 2026 02:04 PM	gcs	15.0
VIT-011354	Tue Nov 10, 2026 10:04 PM	spo2	95.0	room air
VIT-011355	Tue Nov 10, 2026 10:04 PM	rr	19.0
VIT-011400	Tue Nov 10, 2026 10:04 PM	temp_c	36.6
VIT-011401	Tue Nov 10, 2026 10:04 PM	hr	70.0
VIT-011402	Tue Nov 10, 2026 10:04 PM	map	75.0
VIT-011403	Tue Nov 10, 2026 10:04 PM	gcs	15.0
VIT-011356	Wed Nov 11, 2026 06:04 AM	spo2	94.0	room air
VIT-011357	Wed Nov 11, 2026 06:04 AM	rr	18.0
VIT-011404	Wed Nov 11, 2026 06:04 AM	temp_c	37.1
VIT-011405	Wed Nov 11, 2026 06:04 AM	hr	79.0
VIT-011406	Wed Nov 11, 2026 06:04 AM	map	87.0
VIT-011407	Wed Nov 11, 2026 06:04 AM	gcs	15.0
VIT-011358	Wed Nov 11, 2026 02:04 PM	spo2	97.0	room air
VIT-011359	Wed Nov 11, 2026 02:04 PM	rr	21.0
VIT-011408	Wed Nov 11, 2026 02:04 PM	temp_c	37.1
VIT-011409	Wed Nov 11, 2026 02:04 PM	hr	73.0
VIT-011410	Wed Nov 11, 2026 02:04 PM	map	91.0
VIT-011411	Wed Nov 11, 2026 02:04 PM	gcs	15.0
VIT-011360	Wed Nov 11, 2026 10:04 PM	spo2	95.0	room air
VIT-011361	Wed Nov 11, 2026 10:04 PM	rr	19.0
VIT-011412	Wed Nov 11, 2026 10:04 PM	temp_c	37.4
VIT-011413	Wed Nov 11, 2026 10:04 PM	hr	82.0
VIT-011414	Wed Nov 11, 2026 10:04 PM	map	91.0
VIT-011415	Wed Nov 11, 2026 10:04 PM	gcs	15.0
VIT-011362	Thu Nov 12, 2026 06:04 AM	spo2	97.0	room air
VIT-011363	Thu Nov 12, 2026 06:04 AM	rr	19.0
VIT-011416	Thu Nov 12, 2026 06:04 AM	temp_c	37.5
VIT-011417	Thu Nov 12, 2026 06:04 AM	hr	79.0
VIT-011418	Thu Nov 12, 2026 06:04 AM	map	77.0
VIT-011419	Thu Nov 12, 2026 06:04 AM	gcs	15.0
VIT-011364	Thu Nov 12, 2026 02:04 PM	spo2	96.0	room air
VIT-011365	Thu Nov 12, 2026 02:04 PM	rr	16.0
VIT-011420	Thu Nov 12, 2026 02:04 PM	temp_c	36.9
VIT-011421	Thu Nov 12, 2026 02:04 PM	hr	80.0
VIT-011422	Thu Nov 12, 2026 02:04 PM	map	89.0
VIT-011423	Thu Nov 12, 2026 02:04 PM	gcs	15.0
VIT-011366	Thu Nov 12, 2026 10:04 PM	spo2	96.0	room air
VIT-011367	Thu Nov 12, 2026 10:04 PM	rr	20.0
VIT-011424	Thu Nov 12, 2026 10:04 PM	temp_c	37.0
VIT-011425	Thu Nov 12, 2026 10:04 PM	hr	86.0
VIT-011426	Thu Nov 12, 2026 10:04 PM	map	75.0
VIT-011427	Thu Nov 12, 2026 10:04 PM	gcs	15.0
VIT-011368	Fri Nov 13, 2026 06:04 AM	spo2	94.0	room air
VIT-011369	Fri Nov 13, 2026 06:04 AM	rr	19.0
VIT-011428	Fri Nov 13, 2026 06:04 AM	temp_c	36.9
VIT-011429	Fri Nov 13, 2026 06:04 AM	hr	69.0
VIT-011430	Fri Nov 13, 2026 06:04 AM	map	88.0
VIT-011431	Fri Nov 13, 2026 06:04 AM	gcs	15.0
VIT-011370	Fri Nov 13, 2026 02:04 PM	spo2	95.0	room air
VIT-011371	Fri Nov 13, 2026 02:04 PM	rr	19.0
VIT-011432	Fri Nov 13, 2026 02:04 PM	temp_c	37.0
VIT-011433	Fri Nov 13, 2026 02:04 PM	hr	68.0
VIT-011434	Fri Nov 13, 2026 02:04 PM	map	85.0
VIT-011435	Fri Nov 13, 2026 02:04 PM	gcs	15.0

Medications, orders, echo, history (8)

MED-000457 11-08 08:00 furosemide 40 mg IV
MED-000458 11-08 20:00 furosemide 40 mg IV
MED-000459 11-09 08:00 furosemide 40 mg IV
MED-000460 11-09 20:00 furosemide 40 mg IV
MED-000461 11-10 08:00 furosemide 40 mg IV
MED-000462 11-10 20:00 furosemide 40 mg IV
ECH-000056 2026-11-09 echo LVEF 61.0%
HX-000045 history: heart failure with preserved ejection fraction

Notes

History and physical · DOC-000393 · Dr. Noor Halvorsen (resident) · Sun Nov 08, 2026 04:44 PM

Source document DOC-000393: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Mara Dunmore   MRN: MRN98911807   Admitted: 2026-11-08 13:44
Service: Pulmonology   Attending: Dr. Jalen Carrow

History of present illness: 85-year-old man admitted with COPD exacerbation. 
Past medical history: heart failure with preserved ejection fraction.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. COPD exacerbation: bronchodilators and steroids.

Nutrition assessment · DOC-000391 · Vera Pemberton, RD (dietitian) · Mon Nov 09, 2026 04:44 PM

Cited facts from this note (6)

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

Show source for fat_loss

… acute illness Intake: estimated energy intake 60% of needs for 10 days. 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: at risk; continue calorie counts.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… 0% of needs for 10 days. 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: at risk; continue calorie counts.
intake_days: 10 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Mara Dunmore MRN: MRN98911807 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. …
intake_pct: 60 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Mara Dunmore MRN: MRN98911807 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. 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

… ted energy intake 60% of needs for 10 days. 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: at risk; continue calorie counts.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Mara Dunmore MRN: MRN98911807 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of sub …

Source document DOC-000391: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Mara Dunmore   MRN: MRN98911807

Context: acute illness
Intake: estimated energy intake 60% of needs for 10 days.
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: at risk; continue calorie counts.

Wound care note · DOC-000392 · Elena Jessup, RN, CWOCN (wound_nurse) · Mon Nov 09, 2026 04:44 PM

Cited facts from this note (2)

wound_site: sacral · cited p. 1, line 3 · confidence 0.85

Show source for wound_site

Wound/ostomy nurse follow-up Sacral pressure injury, Stage II. Partial-thickness skin loss with exposed dermis. Measures 2.6 x 3.9 x 0.9 cm. Turning schedule reinforced with staff; low-air-loss surface ordered.
wound_stage: Not found · quoted span not found in source · value withheld

Source document DOC-000392: Wound care note (synthetic)

Wound/ostomy nurse follow-up

Sacral pressure injury, Stage II. Partial-thickness skin loss with exposed dermis. Measures 2.6 x 3.9 x 0.9 cm.
Turning schedule reinforced with staff; low-air-loss surface ordered.

Progress note · DOC-000394 · Dr. Noor Halvorsen (resident) · Fri Nov 13, 2026 03:55 PM · awaiting cosign

Source document DOC-000394: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Mara Dunmore   MRN: MRN98911807   Hospital day 6

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. COPD exacerbation: continue current management.
2. Malnourished: dietitian following.
3. Congestive heart failure: diuresis and daily weights; monitor electrolytes.
4. Acute respiratory failure with hypoxia: supplemental oxygen, wean as tolerated.
5. Stage 4 sacral pressure ulcer: wound care following, offloading.

Resident: Dr. Noor Halvorsen   Attending cosign: pending