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-00124: Jun Kestrel

47M · MRN31430438 · Pulmonology · admitted Mon Nov 09, 2026 10:02 AM · in hospital · attending Dr. Gideon Zeller · resident Dr. Greta Kowalczyk · 164 cm, 75.3 kg

Documented diagnoses (current)

Principal: “COPD exacerbation” · J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
“stage 4 sacral pressure ulcer” · L89.154 Pressure ulcer of sacral region, stage 4
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

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 met

Specificity gap

Criteria support Acute kidney injury (KDIGO stage 2) (N17.9); no corresponding diagnosis is documented.

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=2.304, t.ratio_s1=1.5, creat_rise_48h=0.69, t.rise_abs=0.3, uo_hours_lt_0_5=18, 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=2.304, t.ratio_s3=3.0, creat_peak=3.11, t.scr_s3=4.0, rrt_started=False, uo_hours_lt_0_3=0, t.uo_s3_h=24, anuria_hours=0, 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=2.304, t.ratio_s2=2.0, uo_hours_lt_0_5=18, t.uo_s2_h=12	true
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=True, meets_definition=True	2
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.69, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=2, 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=14.27, t.hb_m=13, t.hb_f=12	false
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=0.5, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=False, anaemic=False, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=False, hgb_drop=0.5, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=14.27, 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=301, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=68.2, egfr_late=65.2	68.2
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=68.2, t.g2=60, egfr_late=65.2	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=68.2, 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=68.2, egfr_late=65.2, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=68.2, t.g2=60	true

Heart failure

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=False	0
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=0, 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=0	false

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=28.0, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=28.0, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=28.0, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=28.0, 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=sacral	true
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=18.0, 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=37.2, t.t_hi=38, temp_min_48h=36.5, 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=17.0, 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=9.73, t.wbc_hi=12, wbc_min_48h=9.1, 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=239.0	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=0.66	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=76.0	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=3.11	2
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=1.35	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=2, sofa_renal_baseline=1	1
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=1, 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 (28)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-004213	Sat Oct 11, 2025 09:15 AM	creatinine	1.3 mg/dL
LAB-004214	Sat Aug 08, 2026 10:05 AM	creatinine	1.35 mg/dL
LAB-004215	Mon Nov 09, 2026 11:02 AM	creatinine	2.42 mg/dL
LAB-004220	Mon Nov 09, 2026 11:02 AM	sodium	136.0 mmol/L
LAB-004225	Mon Nov 09, 2026 11:02 AM	hemoglobin	14.57 g/dL
LAB-004230	Mon Nov 09, 2026 11:02 AM	wbc	9.54 x10^3/uL
LAB-004231	Mon Nov 09, 2026 11:02 AM	platelets	239.0 x10^3/uL
LAB-004240	Mon Nov 09, 2026 11:02 AM	bilirubin	0.66 mg/dL
LAB-004216	Tue Nov 10, 2026 05:00 AM	creatinine	3.11 mg/dL
LAB-004221	Tue Nov 10, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-004226	Tue Nov 10, 2026 05:00 AM	hemoglobin	14.72 g/dL
LAB-004232	Tue Nov 10, 2026 05:00 AM	wbc	9.1 x10^3/uL
LAB-004233	Tue Nov 10, 2026 05:00 AM	platelets	279.0 x10^3/uL
LAB-004217	Wed Nov 11, 2026 05:00 AM	creatinine	2.8 mg/dL
LAB-004222	Wed Nov 11, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-004227	Wed Nov 11, 2026 05:00 AM	hemoglobin	14.36 g/dL
LAB-004234	Wed Nov 11, 2026 05:00 AM	wbc	9.73 x10^3/uL
LAB-004235	Wed Nov 11, 2026 05:00 AM	platelets	303.0 x10^3/uL
LAB-004218	Thu Nov 12, 2026 05:00 AM	creatinine	2.33 mg/dL
LAB-004223	Thu Nov 12, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-004228	Thu Nov 12, 2026 05:00 AM	hemoglobin	14.27 g/dL
LAB-004236	Thu Nov 12, 2026 05:00 AM	wbc	7.08 x10^3/uL
LAB-004237	Thu Nov 12, 2026 05:00 AM	platelets	265.0 x10^3/uL
LAB-004219	Fri Nov 13, 2026 05:00 AM	creatinine	1.93 mg/dL
LAB-004224	Fri Nov 13, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-004229	Fri Nov 13, 2026 05:00 AM	hemoglobin	14.62 g/dL
LAB-004238	Fri Nov 13, 2026 05:00 AM	wbc	6.27 x10^3/uL
LAB-004239	Fri Nov 13, 2026 05:00 AM	platelets	233.0 x10^3/uL

Vitals (86)

Vitals
Row	When	Kind	Value	Detail
VIT-012083	Mon Nov 09, 2026 10:22 AM	spo2	99.0	room air
VIT-012084	Mon Nov 09, 2026 10:22 AM	rr	14.0
VIT-012109	Mon Nov 09, 2026 10:22 AM	temp_c	36.5
VIT-012110	Mon Nov 09, 2026 10:22 AM	hr	90.0
VIT-012111	Mon Nov 09, 2026 10:22 AM	map	92.0
VIT-012112	Mon Nov 09, 2026 10:22 AM	gcs	15.0
VIT-012075	Mon Nov 09, 2026 04:02 PM	urine_ml_6h	497.0
VIT-012085	Mon Nov 09, 2026 06:22 PM	spo2	95.0	room air
VIT-012086	Mon Nov 09, 2026 06:22 PM	rr	15.0
VIT-012113	Mon Nov 09, 2026 06:22 PM	temp_c	36.6
VIT-012114	Mon Nov 09, 2026 06:22 PM	hr	72.0
VIT-012115	Mon Nov 09, 2026 06:22 PM	map	76.0
VIT-012116	Mon Nov 09, 2026 06:22 PM	gcs	15.0
VIT-012076	Mon Nov 09, 2026 10:02 PM	urine_ml_6h	189.8
VIT-012087	Tue Nov 10, 2026 02:22 AM	spo2	95.0	room air
VIT-012088	Tue Nov 10, 2026 02:22 AM	rr	14.0
VIT-012117	Tue Nov 10, 2026 02:22 AM	temp_c	37.2
VIT-012118	Tue Nov 10, 2026 02:22 AM	hr	75.0
VIT-012119	Tue Nov 10, 2026 02:22 AM	map	78.0
VIT-012120	Tue Nov 10, 2026 02:22 AM	gcs	15.0
VIT-012077	Tue Nov 10, 2026 04:02 AM	urine_ml_6h	189.8
VIT-012078	Tue Nov 10, 2026 10:02 AM	urine_ml_6h	189.8
VIT-012089	Tue Nov 10, 2026 10:22 AM	spo2	95.0	room air
VIT-012090	Tue Nov 10, 2026 10:22 AM	rr	16.0
VIT-012121	Tue Nov 10, 2026 10:22 AM	temp_c	36.6
VIT-012122	Tue Nov 10, 2026 10:22 AM	hr	81.0
VIT-012123	Tue Nov 10, 2026 10:22 AM	map	84.0
VIT-012124	Tue Nov 10, 2026 10:22 AM	gcs	15.0
VIT-012079	Tue Nov 10, 2026 04:02 PM	urine_ml_6h	497.0
VIT-012091	Tue Nov 10, 2026 06:22 PM	spo2	94.0	room air
VIT-012092	Tue Nov 10, 2026 06:22 PM	rr	17.0
VIT-012125	Tue Nov 10, 2026 06:22 PM	temp_c	36.8
VIT-012126	Tue Nov 10, 2026 06:22 PM	hr	89.0
VIT-012127	Tue Nov 10, 2026 06:22 PM	map	84.0
VIT-012128	Tue Nov 10, 2026 06:22 PM	gcs	15.0
VIT-012080	Tue Nov 10, 2026 10:02 PM	urine_ml_6h	497.0
VIT-012093	Wed Nov 11, 2026 02:22 AM	spo2	95.0	room air
VIT-012094	Wed Nov 11, 2026 02:22 AM	rr	16.0
VIT-012129	Wed Nov 11, 2026 02:22 AM	temp_c	37.0
VIT-012130	Wed Nov 11, 2026 02:22 AM	hr	83.0
VIT-012131	Wed Nov 11, 2026 02:22 AM	map	88.0
VIT-012132	Wed Nov 11, 2026 02:22 AM	gcs	15.0
VIT-012081	Wed Nov 11, 2026 04:02 AM	urine_ml_6h	497.0
VIT-012082	Wed Nov 11, 2026 10:02 AM	urine_ml_6h	497.0
VIT-012095	Wed Nov 11, 2026 10:22 AM	spo2	94.0	room air
VIT-012096	Wed Nov 11, 2026 10:22 AM	rr	17.0
VIT-012133	Wed Nov 11, 2026 10:22 AM	temp_c	37.5
VIT-012134	Wed Nov 11, 2026 10:22 AM	hr	82.0
VIT-012135	Wed Nov 11, 2026 10:22 AM	map	89.0
VIT-012136	Wed Nov 11, 2026 10:22 AM	gcs	15.0
VIT-012097	Wed Nov 11, 2026 06:22 PM	spo2	99.0	room air
VIT-012098	Wed Nov 11, 2026 06:22 PM	rr	15.0
VIT-012137	Wed Nov 11, 2026 06:22 PM	temp_c	37.0
VIT-012138	Wed Nov 11, 2026 06:22 PM	hr	87.0
VIT-012139	Wed Nov 11, 2026 06:22 PM	map	80.0
VIT-012140	Wed Nov 11, 2026 06:22 PM	gcs	15.0
VIT-012099	Thu Nov 12, 2026 02:22 AM	spo2	94.0	room air
VIT-012100	Thu Nov 12, 2026 02:22 AM	rr	18.0
VIT-012141	Thu Nov 12, 2026 02:22 AM	temp_c	36.6
VIT-012142	Thu Nov 12, 2026 02:22 AM	hr	77.0
VIT-012143	Thu Nov 12, 2026 02:22 AM	map	81.0
VIT-012144	Thu Nov 12, 2026 02:22 AM	gcs	15.0
VIT-012101	Thu Nov 12, 2026 10:22 AM	spo2	95.0	room air
VIT-012102	Thu Nov 12, 2026 10:22 AM	rr	17.0
VIT-012145	Thu Nov 12, 2026 10:22 AM	temp_c	36.5
VIT-012146	Thu Nov 12, 2026 10:22 AM	hr	81.0
VIT-012147	Thu Nov 12, 2026 10:22 AM	map	88.0
VIT-012148	Thu Nov 12, 2026 10:22 AM	gcs	15.0
VIT-012103	Thu Nov 12, 2026 06:22 PM	spo2	94.0	room air
VIT-012104	Thu Nov 12, 2026 06:22 PM	rr	14.0
VIT-012149	Thu Nov 12, 2026 06:22 PM	temp_c	37.5
VIT-012150	Thu Nov 12, 2026 06:22 PM	hr	90.0
VIT-012151	Thu Nov 12, 2026 06:22 PM	map	86.0
VIT-012152	Thu Nov 12, 2026 06:22 PM	gcs	15.0
VIT-012105	Fri Nov 13, 2026 02:22 AM	spo2	97.0	room air
VIT-012106	Fri Nov 13, 2026 02:22 AM	rr	17.0
VIT-012153	Fri Nov 13, 2026 02:22 AM	temp_c	37.4
VIT-012154	Fri Nov 13, 2026 02:22 AM	hr	74.0
VIT-012155	Fri Nov 13, 2026 02:22 AM	map	84.0
VIT-012156	Fri Nov 13, 2026 02:22 AM	gcs	15.0
VIT-012107	Fri Nov 13, 2026 10:22 AM	spo2	98.0	room air
VIT-012108	Fri Nov 13, 2026 10:22 AM	rr	18.0
VIT-012157	Fri Nov 13, 2026 10:22 AM	temp_c	37.5
VIT-012158	Fri Nov 13, 2026 10:22 AM	hr	87.0
VIT-012159	Fri Nov 13, 2026 10:22 AM	map	85.0
VIT-012160	Fri Nov 13, 2026 10:22 AM	gcs	15.0

Medications, orders, echo, history (0)

Notes

History and physical · DOC-000419 · Dr. Greta Kowalczyk (resident) · Mon Nov 09, 2026 01:02 PM

Source document DOC-000419: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Jun Kestrel   MRN: MRN31430438   Admitted: 2026-11-09 10:02
Service: Pulmonology   Attending: Dr. Gideon Zeller

History of present illness: 47-year-old man admitted with COPD exacerbation. 
Past medical history: hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. COPD exacerbation: bronchodilators and steroids.

Wound care note · DOC-000418 · Elena Jessup, RN, CWOCN (wound_nurse) · Tue Nov 10, 2026 11:02 AM

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 3.4 x 3.4 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-000418: Wound care note (synthetic)

Wound/ostomy nurse follow-up

Sacral pressure injury, Stage II. Partial-thickness skin loss with exposed dermis. Measures 3.4 x 3.4 x 0.9 cm.
Turning schedule reinforced with staff; low-air-loss surface ordered.

Progress note · DOC-000420 · Dr. Greta Kowalczyk (resident) · Fri Nov 13, 2026 03:55 PM · awaiting cosign

Source document DOC-000420: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Jun Kestrel   MRN: MRN31430438   Hospital day 5

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. COPD exacerbation: continue current management.
2. Stage 4 sacral pressure ulcer: wound care following, offloading.

Resident: Dr. Greta Kowalczyk   Attending cosign: pending