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-00125: Dmitri Jessup

49M · MRN67366837 · Cardiology · admitted Fri Nov 06, 2026 04:00 PM · discharged Mon Nov 09, 2026 02:18 PM · attending Dr. Cyrus Ellingham · 175 cm, 68.4 kg

Documented diagnoses (current)

“malnutrition” · E46 Unspecified protein-calorie malnutrition
“worsening renal function” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
Principal: “congestive heart failure” · I50.9 Heart failure, unspecified
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“hypertension” · I10 Essential (primary) hypertension
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

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

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Clinical judgement required

Clinical judgement required: AKI criteria met only against a presumed baseline (no pre-admission creatinine on file).

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=1.624, t.ratio_s1=1.5, creat_rise_48h=0.0, 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=1.624, t.ratio_s3=3.0, creat_peak=2.03, 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=1.624, 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=False, creat_rise_48h=0.0, t.rise_abs=0.3, rrt_started=False	false
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=1, baseline_independent=False	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=1	true

Acute blood loss anaemia

Criteria met

Clinical validation gap

Documented “acute blood loss anemia” (D62) is more specific than the criteria support (Anemia (acute blood-loss criteria not met), D64.9).

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=11.24, t.hb_m=13, t.hb_f=12	true
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=True, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=True, hgb_drop=0.4, t.drop_min=1.0, prbc_units=0	true

Chronic kidney disease

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=0, egfr_span_days=unknown, t.chronic_days=90	false
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=unknown, egfr_late=unknown	unknown
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=unknown, t.g2=60, egfr_late=unknown	unknown
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=unknown, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	unknown
outcome: duration_not_shown	`not chronic`	chronic=False	true

Heart failure

Criteria met

Specificity gap

Documented “congestive heart failure” (I50.9); criteria support the more specific Acute diastolic (HFpEF) heart failure (I50.31).

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=2099.0, 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=63.0, 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=63.0, 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=False	acute
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	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=diastolic, acuity=acute	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=acute	false
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=acute	false
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=diastolic, 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

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=12.0, 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=12.0, 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=12.0, 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=12.0, 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=49, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=22.3, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=22.3, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=22.3, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=22.3, 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

Criteria met

Specificity gap

Criteria support Acute respiratory failure with hypoxia (J96.01); no corresponding diagnosis is documented.

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=86.0, 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=86.0, 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=33.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	true
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=True	false
outcome: met	`hypoxemia and distress`	hypoxemia=True, distress=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=37.5, 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=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=33.0, 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=8.07, t.wbc_hi=12, wbc_min_48h=6.67, 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=167.0	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=0.8	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=2.03	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=1.25	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=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 (22)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-004241	Fri Nov 06, 2026 05:00 PM	creatinine	2.03 mg/dL
LAB-004245	Fri Nov 06, 2026 05:00 PM	bnp	2099.0 pg/mL
LAB-004246	Fri Nov 06, 2026 05:00 PM	sodium	138.0 mmol/L
LAB-004250	Fri Nov 06, 2026 05:00 PM	hemoglobin	11.64 g/dL
LAB-004254	Fri Nov 06, 2026 05:00 PM	wbc	6.88 x10^3/uL
LAB-004255	Fri Nov 06, 2026 05:00 PM	platelets	254.0 x10^3/uL
LAB-004262	Fri Nov 06, 2026 05:00 PM	bilirubin	0.8 mg/dL
LAB-004242	Sat Nov 07, 2026 05:00 AM	creatinine	1.68 mg/dL
LAB-004247	Sat Nov 07, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-004251	Sat Nov 07, 2026 05:00 AM	hemoglobin	11.24 g/dL
LAB-004256	Sat Nov 07, 2026 05:00 AM	wbc	6.67 x10^3/uL
LAB-004257	Sat Nov 07, 2026 05:00 AM	platelets	261.0 x10^3/uL
LAB-004243	Sun Nov 08, 2026 05:00 AM	creatinine	1.42 mg/dL
LAB-004248	Sun Nov 08, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-004252	Sun Nov 08, 2026 05:00 AM	hemoglobin	11.64 g/dL
LAB-004258	Sun Nov 08, 2026 05:00 AM	wbc	8.07 x10^3/uL
LAB-004259	Sun Nov 08, 2026 05:00 AM	platelets	167.0 x10^3/uL
LAB-004244	Mon Nov 09, 2026 05:00 AM	creatinine	1.25 mg/dL
LAB-004249	Mon Nov 09, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-004253	Mon Nov 09, 2026 05:00 AM	hemoglobin	11.24 g/dL
LAB-004260	Mon Nov 09, 2026 05:00 AM	wbc	9.76 x10^3/uL
LAB-004261	Mon Nov 09, 2026 05:00 AM	platelets	286.0 x10^3/uL

Vitals (63)

Vitals
Row	When	Kind	Value	Detail
VIT-012161	Fri Nov 06, 2026 04:20 PM	spo2	86.0	room air
VIT-012162	Fri Nov 06, 2026 04:20 PM	rr	33.0
VIT-012188	Fri Nov 06, 2026 04:20 PM	temp_c	36.6
VIT-012189	Fri Nov 06, 2026 04:20 PM	hr	83.0
VIT-012190	Fri Nov 06, 2026 04:20 PM	map	76.0
VIT-012191	Fri Nov 06, 2026 04:20 PM	gcs	15.0
VIT-012163	Fri Nov 06, 2026 04:30 PM	o2_lpm	4.0	nasal cannula
VIT-012164	Sat Nov 07, 2026 12:20 AM	spo2	92.0	nasal cannula
VIT-012165	Sat Nov 07, 2026 12:20 AM	rr	21.0
VIT-012166	Sat Nov 07, 2026 12:20 AM	o2_lpm	2.0	nasal cannula
VIT-012192	Sat Nov 07, 2026 12:20 AM	temp_c	37.5
VIT-012193	Sat Nov 07, 2026 12:20 AM	hr	88.0
VIT-012194	Sat Nov 07, 2026 12:20 AM	map	83.0
VIT-012195	Sat Nov 07, 2026 12:20 AM	gcs	15.0
VIT-012167	Sat Nov 07, 2026 08:20 AM	spo2	94.0	nasal cannula
VIT-012168	Sat Nov 07, 2026 08:20 AM	rr	20.0
VIT-012169	Sat Nov 07, 2026 08:20 AM	o2_lpm	4.0	nasal cannula
VIT-012196	Sat Nov 07, 2026 08:20 AM	temp_c	36.5
VIT-012197	Sat Nov 07, 2026 08:20 AM	hr	83.0
VIT-012198	Sat Nov 07, 2026 08:20 AM	map	80.0
VIT-012199	Sat Nov 07, 2026 08:20 AM	gcs	15.0
VIT-012170	Sat Nov 07, 2026 04:20 PM	spo2	95.0	nasal cannula
VIT-012171	Sat Nov 07, 2026 04:20 PM	rr	23.0
VIT-012172	Sat Nov 07, 2026 04:20 PM	o2_lpm	4.0	nasal cannula
VIT-012200	Sat Nov 07, 2026 04:20 PM	temp_c	37.4
VIT-012201	Sat Nov 07, 2026 04:20 PM	hr	85.0
VIT-012202	Sat Nov 07, 2026 04:20 PM	map	89.0
VIT-012203	Sat Nov 07, 2026 04:20 PM	gcs	15.0
VIT-012173	Sun Nov 08, 2026 12:20 AM	spo2	91.0	nasal cannula
VIT-012174	Sun Nov 08, 2026 12:20 AM	rr	23.0
VIT-012175	Sun Nov 08, 2026 12:20 AM	o2_lpm	3.0	nasal cannula
VIT-012204	Sun Nov 08, 2026 12:20 AM	temp_c	36.8
VIT-012205	Sun Nov 08, 2026 12:20 AM	hr	87.0
VIT-012206	Sun Nov 08, 2026 12:20 AM	map	81.0
VIT-012207	Sun Nov 08, 2026 12:20 AM	gcs	15.0
VIT-012176	Sun Nov 08, 2026 08:20 AM	spo2	91.0	nasal cannula
VIT-012177	Sun Nov 08, 2026 08:20 AM	rr	25.0
VIT-012178	Sun Nov 08, 2026 08:20 AM	o2_lpm	3.0	nasal cannula
VIT-012208	Sun Nov 08, 2026 08:20 AM	temp_c	37.2
VIT-012209	Sun Nov 08, 2026 08:20 AM	hr	82.0
VIT-012210	Sun Nov 08, 2026 08:20 AM	map	90.0
VIT-012211	Sun Nov 08, 2026 08:20 AM	gcs	15.0
VIT-012179	Sun Nov 08, 2026 04:20 PM	spo2	95.0	nasal cannula
VIT-012180	Sun Nov 08, 2026 04:20 PM	rr	25.0
VIT-012181	Sun Nov 08, 2026 04:20 PM	o2_lpm	2.0	nasal cannula
VIT-012212	Sun Nov 08, 2026 04:20 PM	temp_c	37.3
VIT-012213	Sun Nov 08, 2026 04:20 PM	hr	80.0
VIT-012214	Sun Nov 08, 2026 04:20 PM	map	79.0
VIT-012215	Sun Nov 08, 2026 04:20 PM	gcs	15.0
VIT-012182	Mon Nov 09, 2026 12:20 AM	spo2	91.0	nasal cannula
VIT-012183	Mon Nov 09, 2026 12:20 AM	rr	22.0
VIT-012184	Mon Nov 09, 2026 12:20 AM	o2_lpm	4.0	nasal cannula
VIT-012216	Mon Nov 09, 2026 12:20 AM	temp_c	36.5
VIT-012217	Mon Nov 09, 2026 12:20 AM	hr	77.0
VIT-012218	Mon Nov 09, 2026 12:20 AM	map	92.0
VIT-012219	Mon Nov 09, 2026 12:20 AM	gcs	15.0
VIT-012185	Mon Nov 09, 2026 08:20 AM	spo2	91.0	nasal cannula
VIT-012186	Mon Nov 09, 2026 08:20 AM	rr	23.0
VIT-012187	Mon Nov 09, 2026 08:20 AM	o2_lpm	2.0	nasal cannula
VIT-012220	Mon Nov 09, 2026 08:20 AM	temp_c	36.9
VIT-012221	Mon Nov 09, 2026 08:20 AM	hr	87.0
VIT-012222	Mon Nov 09, 2026 08:20 AM	map	89.0
VIT-012223	Mon Nov 09, 2026 08:20 AM	gcs	15.0

Medications, orders, echo, history (7)

MED-000491 11-06 08:00 furosemide 40 mg IV
MED-000492 11-06 20:00 furosemide 40 mg IV
MED-000493 11-07 08:00 furosemide 40 mg IV
MED-000494 11-07 20:00 furosemide 40 mg IV
MED-000495 11-08 08:00 furosemide 40 mg IV
MED-000496 11-08 20:00 furosemide 40 mg IV
ECH-000060 2026-11-07 echo LVEF 63.0%

Notes

History and physical · DOC-000422 · Dr. Cyrus Ellingham (attending) · Fri Nov 06, 2026 07:00 PM

Source document DOC-000422: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Dmitri Jessup   MRN: MRN67366837   Admitted: 2026-11-06 16:00
Service: Cardiology   Attending: Dr. Cyrus Ellingham

History of present illness: 49-year-old man admitted with congestive heart failure. 
Past medical history: hypertension, hyperlipidemia, GERD.
Review of systems otherwise negative.
Exam: Lungs: labored respirations.
Assessment and plan:
1. Congestive heart failure: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000421 · Viggo Ravensworth, RD (dietitian) · Sat Nov 07, 2026 08:00 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 12 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 12 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: 12 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Dmitri Jessup MRN: MRN67366837 Context: acute illness Intake: estimated energy intake 60% of needs for 12 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: Dmitri Jessup MRN: MRN67366837 Context: acute illness Intake: estimated energy intake 60% of needs for 12 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 12 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: Dmitri Jessup MRN: MRN67366837 Context: acute illness Intake: estimated energy intake 60% of needs for 12 days. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of sub …

Source document DOC-000421: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Dmitri Jessup   MRN: MRN67366837

Context: acute illness
Intake: estimated energy intake 60% of needs for 12 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.

Progress note · DOC-000423 · Dr. Cyrus Ellingham (attending) · Sun Nov 08, 2026 05:00 PM

Source document DOC-000423: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Dmitri Jessup   MRN: MRN67366837   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Congestive heart failure: continue current management.
2. Malnutrition: dietitian following.
3. Worsening renal function: trend creatinine, avoid nephrotoxins.
4. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Attending: Dr. Cyrus Ellingham

Discharge summary · DOC-000424 · Dr. Cyrus Ellingham (attending) · Mon Nov 09, 2026 02:18 PM

Source document DOC-000424: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Dmitri Jessup   MRN: MRN67366837
Admitted 2026-11-06; discharged 2026-11-09.

Discharge diagnoses:
- malnutrition
- worsening renal function
- congestive heart failure
- acute blood loss anemia
- hypertension
- hyperlipidemia
- GERD

Disposition: home with follow-up.