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-00129: Tobias Ivers

78F · MRN95646139 · Cardiology · admitted Mon Oct 26, 2026 11:11 AM · discharged Sun Nov 01, 2026 11:28 AM · attending Dr. Cyrus Ellingham · resident Dr. Keira Upfield · 165 cm, 73.4 kg

Documented diagnoses (current)

“CKD stage 3b” · N18.32 Chronic kidney disease, stage 3b
Principal: “acute on chronic systolic heart failure” · I50.23 Acute on chronic systolic (congestive) heart failure
“hyponatremia” · E87.1 Hypo-osmolality and hyponatremia
“anemia” · D64.9 Anemia, unspecified
“hypertension” · I10 Essential (primary) hypertension

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 292.

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=1.058, t.ratio_s1=1.5, creat_rise_48h=0.09, 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=1.058, t.ratio_s3=3.0, creat_peak=1.64, 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=1.058, 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=0.09, 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 met

Specificity gap

Documented “anemia” (D64.9); criteria support the more specific Acute blood loss anemia (D62).

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=F, hgb_nadir=8.78, 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=3.5, t.drop_major=2.0, prbc_units=2, t.prbc_major=2	true
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=True	true

Chronic kidney disease

Criteria met

No gap

Supported as documented (N18.32).

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=359, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=40.6, egfr_late=34.1	40.6
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=40.6, t.g2=60, egfr_late=34.1	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=40.6, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G3b
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=40.6, egfr_late=34.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=40.6, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3b	false
outcome: g3b	`category == 'G3b'`	category=G3b	true

Heart failure

Criteria met

Clinical validation gap

Documented “acute on chronic systolic heart failure” (I50.23) is more specific than the criteria support (Chronic systolic (HFrEF) heart failure, I50.22).

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=77.0, 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=27.0, 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=27.0, 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=0, hf_history=True	chronic
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=chronic	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=systolic, acuity=chronic	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=systolic, acuity=chronic	true

Hyponatraemia

Criteria not met

Clinical validation gap

Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 136).

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=78, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=27.0, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=27.0, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=27.0, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=27.0, 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=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 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=36.5, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=81.0, 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=9.96, t.wbc_hi=12, wbc_min_48h=8.3, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	false
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=False, sirs_hr=False, sirs_rr=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=227.0	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=0.67	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=1.64	1
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=1.55	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=1, sofa_renal_baseline=1	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=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 (39)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-004382	Thu Sep 04, 2025 09:15 AM	creatinine	1.34 mg/dL
LAB-004383	Sat Aug 29, 2026 10:05 AM	creatinine	1.55 mg/dL
LAB-004384	Mon Oct 26, 2026 12:11 PM	creatinine	1.61 mg/dL
LAB-004391	Mon Oct 26, 2026 12:11 PM	bnp	77.0 pg/mL
LAB-004392	Mon Oct 26, 2026 12:11 PM	sodium	138.0 mmol/L
LAB-004399	Mon Oct 26, 2026 12:11 PM	hemoglobin	12.26 g/dL
LAB-004406	Mon Oct 26, 2026 12:11 PM	wbc	8.3 x10^3/uL
LAB-004407	Mon Oct 26, 2026 12:11 PM	platelets	231.0 x10^3/uL
LAB-004420	Mon Oct 26, 2026 12:11 PM	bilirubin	0.67 mg/dL
LAB-004385	Tue Oct 27, 2026 05:00 AM	creatinine	1.64 mg/dL
LAB-004393	Tue Oct 27, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-004400	Tue Oct 27, 2026 05:00 AM	hemoglobin	10.17 g/dL
LAB-004408	Tue Oct 27, 2026 05:00 AM	wbc	9.96 x10^3/uL
LAB-004409	Tue Oct 27, 2026 05:00 AM	platelets	232.0 x10^3/uL
LAB-004386	Wed Oct 28, 2026 05:00 AM	creatinine	1.55 mg/dL
LAB-004394	Wed Oct 28, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-004401	Wed Oct 28, 2026 05:00 AM	hemoglobin	8.78 g/dL
LAB-004410	Wed Oct 28, 2026 05:00 AM	wbc	8.32 x10^3/uL
LAB-004411	Wed Oct 28, 2026 05:00 AM	platelets	227.0 x10^3/uL
LAB-004387	Thu Oct 29, 2026 05:00 AM	creatinine	1.52 mg/dL
LAB-004395	Thu Oct 29, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-004402	Thu Oct 29, 2026 05:00 AM	hemoglobin	9.58 g/dL
LAB-004412	Thu Oct 29, 2026 05:00 AM	wbc	6.22 x10^3/uL
LAB-004413	Thu Oct 29, 2026 05:00 AM	platelets	229.0 x10^3/uL
LAB-004388	Fri Oct 30, 2026 05:00 AM	creatinine	1.61 mg/dL
LAB-004396	Fri Oct 30, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-004403	Fri Oct 30, 2026 05:00 AM	hemoglobin	9.88 g/dL
LAB-004414	Fri Oct 30, 2026 05:00 AM	wbc	7.07 x10^3/uL
LAB-004415	Fri Oct 30, 2026 05:00 AM	platelets	225.0 x10^3/uL
LAB-004389	Sat Oct 31, 2026 05:00 AM	creatinine	1.56 mg/dL
LAB-004397	Sat Oct 31, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-004404	Sat Oct 31, 2026 05:00 AM	hemoglobin	9.98 g/dL
LAB-004416	Sat Oct 31, 2026 05:00 AM	wbc	8.06 x10^3/uL
LAB-004417	Sat Oct 31, 2026 05:00 AM	platelets	170.0 x10^3/uL
LAB-004390	Sun Nov 01, 2026 05:00 AM	creatinine	1.6 mg/dL
LAB-004398	Sun Nov 01, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-004405	Sun Nov 01, 2026 05:00 AM	hemoglobin	9.98 g/dL
LAB-004418	Sun Nov 01, 2026 05:00 AM	wbc	6.4 x10^3/uL
LAB-004419	Sun Nov 01, 2026 05:00 AM	platelets	234.0 x10^3/uL

Vitals (108)

Vitals
Row	When	Kind	Value	Detail
VIT-012587	Mon Oct 26, 2026 11:31 AM	spo2	99.0	room air
VIT-012588	Mon Oct 26, 2026 11:31 AM	rr	17.0
VIT-012623	Mon Oct 26, 2026 11:31 AM	temp_c	36.7
VIT-012624	Mon Oct 26, 2026 11:31 AM	hr	72.0
VIT-012625	Mon Oct 26, 2026 11:31 AM	map	75.0
VIT-012626	Mon Oct 26, 2026 11:31 AM	gcs	15.0
VIT-012589	Mon Oct 26, 2026 07:31 PM	spo2	97.0	room air
VIT-012590	Mon Oct 26, 2026 07:31 PM	rr	16.0
VIT-012627	Mon Oct 26, 2026 07:31 PM	temp_c	36.5
VIT-012628	Mon Oct 26, 2026 07:31 PM	hr	74.0
VIT-012629	Mon Oct 26, 2026 07:31 PM	map	87.0
VIT-012630	Mon Oct 26, 2026 07:31 PM	gcs	15.0
VIT-012591	Tue Oct 27, 2026 03:31 AM	spo2	98.0	room air
VIT-012592	Tue Oct 27, 2026 03:31 AM	rr	14.0
VIT-012631	Tue Oct 27, 2026 03:31 AM	temp_c	37.1
VIT-012632	Tue Oct 27, 2026 03:31 AM	hr	73.0
VIT-012633	Tue Oct 27, 2026 03:31 AM	map	80.0
VIT-012634	Tue Oct 27, 2026 03:31 AM	gcs	15.0
VIT-012593	Tue Oct 27, 2026 11:31 AM	spo2	97.0	room air
VIT-012594	Tue Oct 27, 2026 11:31 AM	rr	20.0
VIT-012635	Tue Oct 27, 2026 11:31 AM	temp_c	37.3
VIT-012636	Tue Oct 27, 2026 11:31 AM	hr	74.0
VIT-012637	Tue Oct 27, 2026 11:31 AM	map	87.0
VIT-012638	Tue Oct 27, 2026 11:31 AM	gcs	15.0
VIT-012595	Tue Oct 27, 2026 07:31 PM	spo2	94.0	room air
VIT-012596	Tue Oct 27, 2026 07:31 PM	rr	17.0
VIT-012639	Tue Oct 27, 2026 07:31 PM	temp_c	36.6
VIT-012640	Tue Oct 27, 2026 07:31 PM	hr	77.0
VIT-012641	Tue Oct 27, 2026 07:31 PM	map	86.0
VIT-012642	Tue Oct 27, 2026 07:31 PM	gcs	15.0
VIT-012597	Wed Oct 28, 2026 03:31 AM	spo2	95.0	room air
VIT-012598	Wed Oct 28, 2026 03:31 AM	rr	16.0
VIT-012643	Wed Oct 28, 2026 03:31 AM	temp_c	37.4
VIT-012644	Wed Oct 28, 2026 03:31 AM	hr	81.0
VIT-012645	Wed Oct 28, 2026 03:31 AM	map	87.0
VIT-012646	Wed Oct 28, 2026 03:31 AM	gcs	15.0
VIT-012599	Wed Oct 28, 2026 11:31 AM	spo2	95.0	room air
VIT-012600	Wed Oct 28, 2026 11:31 AM	rr	19.0
VIT-012647	Wed Oct 28, 2026 11:31 AM	temp_c	37.2
VIT-012648	Wed Oct 28, 2026 11:31 AM	hr	91.0
VIT-012649	Wed Oct 28, 2026 11:31 AM	map	76.0
VIT-012650	Wed Oct 28, 2026 11:31 AM	gcs	15.0
VIT-012601	Wed Oct 28, 2026 07:31 PM	spo2	99.0	room air
VIT-012602	Wed Oct 28, 2026 07:31 PM	rr	15.0
VIT-012651	Wed Oct 28, 2026 07:31 PM	temp_c	36.8
VIT-012652	Wed Oct 28, 2026 07:31 PM	hr	72.0
VIT-012653	Wed Oct 28, 2026 07:31 PM	map	84.0
VIT-012654	Wed Oct 28, 2026 07:31 PM	gcs	15.0
VIT-012603	Thu Oct 29, 2026 03:31 AM	spo2	97.0	room air
VIT-012604	Thu Oct 29, 2026 03:31 AM	rr	20.0
VIT-012655	Thu Oct 29, 2026 03:31 AM	temp_c	37.1
VIT-012656	Thu Oct 29, 2026 03:31 AM	hr	86.0
VIT-012657	Thu Oct 29, 2026 03:31 AM	map	92.0
VIT-012658	Thu Oct 29, 2026 03:31 AM	gcs	15.0
VIT-012605	Thu Oct 29, 2026 11:31 AM	spo2	96.0	room air
VIT-012606	Thu Oct 29, 2026 11:31 AM	rr	15.0
VIT-012659	Thu Oct 29, 2026 11:31 AM	temp_c	36.9
VIT-012660	Thu Oct 29, 2026 11:31 AM	hr	79.0
VIT-012661	Thu Oct 29, 2026 11:31 AM	map	77.0
VIT-012662	Thu Oct 29, 2026 11:31 AM	gcs	15.0
VIT-012607	Thu Oct 29, 2026 07:31 PM	spo2	98.0	room air
VIT-012608	Thu Oct 29, 2026 07:31 PM	rr	14.0
VIT-012663	Thu Oct 29, 2026 07:31 PM	temp_c	37.4
VIT-012664	Thu Oct 29, 2026 07:31 PM	hr	90.0
VIT-012665	Thu Oct 29, 2026 07:31 PM	map	77.0
VIT-012666	Thu Oct 29, 2026 07:31 PM	gcs	15.0
VIT-012609	Fri Oct 30, 2026 03:31 AM	spo2	96.0	room air
VIT-012610	Fri Oct 30, 2026 03:31 AM	rr	17.0
VIT-012667	Fri Oct 30, 2026 03:31 AM	temp_c	37.4
VIT-012668	Fri Oct 30, 2026 03:31 AM	hr	83.0
VIT-012669	Fri Oct 30, 2026 03:31 AM	map	75.0
VIT-012670	Fri Oct 30, 2026 03:31 AM	gcs	15.0
VIT-012611	Fri Oct 30, 2026 11:31 AM	spo2	96.0	room air
VIT-012612	Fri Oct 30, 2026 11:31 AM	rr	17.0
VIT-012671	Fri Oct 30, 2026 11:31 AM	temp_c	37.4
VIT-012672	Fri Oct 30, 2026 11:31 AM	hr	77.0
VIT-012673	Fri Oct 30, 2026 11:31 AM	map	77.0
VIT-012674	Fri Oct 30, 2026 11:31 AM	gcs	15.0
VIT-012613	Fri Oct 30, 2026 07:31 PM	spo2	94.0	room air
VIT-012614	Fri Oct 30, 2026 07:31 PM	rr	20.0
VIT-012675	Fri Oct 30, 2026 07:31 PM	temp_c	37.5
VIT-012676	Fri Oct 30, 2026 07:31 PM	hr	84.0
VIT-012677	Fri Oct 30, 2026 07:31 PM	map	79.0
VIT-012678	Fri Oct 30, 2026 07:31 PM	gcs	15.0
VIT-012615	Sat Oct 31, 2026 03:31 AM	spo2	97.0	room air
VIT-012616	Sat Oct 31, 2026 03:31 AM	rr	15.0
VIT-012679	Sat Oct 31, 2026 03:31 AM	temp_c	37.5
VIT-012680	Sat Oct 31, 2026 03:31 AM	hr	75.0
VIT-012681	Sat Oct 31, 2026 03:31 AM	map	77.0
VIT-012682	Sat Oct 31, 2026 03:31 AM	gcs	15.0
VIT-012617	Sat Oct 31, 2026 11:31 AM	spo2	97.0	room air
VIT-012618	Sat Oct 31, 2026 11:31 AM	rr	19.0
VIT-012683	Sat Oct 31, 2026 11:31 AM	temp_c	37.4
VIT-012684	Sat Oct 31, 2026 11:31 AM	hr	81.0
VIT-012685	Sat Oct 31, 2026 11:31 AM	map	83.0
VIT-012686	Sat Oct 31, 2026 11:31 AM	gcs	15.0
VIT-012619	Sat Oct 31, 2026 07:31 PM	spo2	99.0	room air
VIT-012620	Sat Oct 31, 2026 07:31 PM	rr	15.0
VIT-012687	Sat Oct 31, 2026 07:31 PM	temp_c	37.3
VIT-012688	Sat Oct 31, 2026 07:31 PM	hr	88.0
VIT-012689	Sat Oct 31, 2026 07:31 PM	map	77.0
VIT-012690	Sat Oct 31, 2026 07:31 PM	gcs	15.0
VIT-012621	Sun Nov 01, 2026 03:31 AM	spo2	96.0	room air
VIT-012622	Sun Nov 01, 2026 03:31 AM	rr	14.0
VIT-012691	Sun Nov 01, 2026 03:31 AM	temp_c	37.3
VIT-012692	Sun Nov 01, 2026 03:31 AM	hr	86.0
VIT-012693	Sun Nov 01, 2026 03:31 AM	map	75.0
VIT-012694	Sun Nov 01, 2026 03:31 AM	gcs	15.0

Medications, orders, echo, history (6)

MED-000503 10-26 09:11 furosemide 40 mg PO
MED-000504 10-27 09:00 furosemide 40 mg PO
MED-000505 10-28 09:00 furosemide 40 mg PO
ORD-000110 10-27 09:00 transfusion_prbc: transfuse PRBC
ECH-000061 2026-10-27 echo LVEF 27.0%
HX-000047 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000435 · Dr. Keira Upfield (resident) · Mon Oct 26, 2026 02:11 PM

Cited facts from this note (1)

bleeding_source: bleeding from the surgical drain · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… nding: Dr. Cyrus Ellingham History of present illness: 78-year-old woman admitted with acute on chronic systolic heart failure. Hospital course complicated by bleeding from the surgical drain. Past medical history: heart failure with reduced ejection fraction, hypertension. Review of systems otherwise negative. Exam: Lungs: clear to auscultation bil …

Source document DOC-000435: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Tobias Ivers   MRN: MRN95646139   Admitted: 2026-10-26 11:11
Service: Cardiology   Attending: Dr. Cyrus Ellingham

History of present illness: 78-year-old woman admitted with acute on chronic systolic heart failure. Hospital course complicated by bleeding from the surgical drain.
Past medical history: heart failure with reduced ejection fraction, hypertension.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. CKD stage 3b: renally dose medications.
2. Acute on chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.

Progress note · DOC-000436 · Dr. Keira Upfield (resident) · Wed Oct 28, 2026 01:11 PM

Source document DOC-000436: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Tobias Ivers   MRN: MRN95646139   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Acute on chronic systolic heart failure: continue current management.
2. Hyponatremia: trend sodium.
3. Anemia: trend hemoglobin.

Resident: Dr. Keira Upfield   Attending cosign: completed

Discharge summary · DOC-000437 · Dr. Cyrus Ellingham (attending) · Sun Nov 01, 2026 11:28 AM

Source document DOC-000437: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Tobias Ivers   MRN: MRN95646139
Admitted 2026-10-26; discharged 2026-11-01.

Discharge diagnoses:
- CKD stage 3b
- acute on chronic systolic heart failure
- hyponatremia
- anemia
- hypertension

Disposition: home with follow-up.