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-00134: Florian Treadwell

52M · MRN75281212 · Hospital Medicine · admitted Tue Nov 03, 2026 06:49 PM · discharged Sat Nov 07, 2026 03:32 PM · attending Dr. Cyrus Ellingham · resident Dr. Greta Kowalczyk · 166 cm, 58.4 kg

Documented diagnoses (current)

Principal: “sepsis” · A41.9 Sepsis, unspecified organism
“community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“malnutrition” · E46 Unspecified protein-calorie malnutrition
“CKD stage 3a” · N18.31 Chronic kidney disease, stage 3a
“renal insufficiency” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
“sacral pressure ulcer” · L89.159 Pressure ulcer of sacral region, unspecified stage
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis
“hypertension” · I10 Essential (primary) hypertension
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications

Illustrative grouping now: MS-DRG 871 Septicemia or severe sepsis without MV >96 hours with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 871.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

Specificity gap

Documented “renal insufficiency” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 2) (N17.9).

Trace

Rule trace (rule aki v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: meets_definition	`creat_ratio >= t.ratio_s1 or creat_rise_48h >= t.rise_abs or coalesce(uo_hours_lt_0_5 >= t.uo_s1_h, false)`	creat_ratio=2.198, t.ratio_s1=1.5, creat_rise_48h=0.79, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	true
derived: stage3	`meets_definition and (creat_ratio >= t.ratio_s3 or creat_peak >= t.scr_s3 or rrt_started or coalesce(uo_hours_lt_0_3 >= t.uo_s3_h, false) or coalesce(anuria_hours >= t.anuria_h, false))`	meets_definition=True, creat_ratio=2.198, t.ratio_s3=3.0, creat_peak=3.56, 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=2.198, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	true
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=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=0.79, 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=14.39, 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=14.39, anaemic=False	true

Chronic kidney disease

Criteria met

No gap

Supported as documented (N18.31).

Trace

Rule trace (rule ckd v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: chronic	`egfr_n >= 2 and egfr_span_days >= t.chronic_days`	egfr_n=2, egfr_span_days=223, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=57.0, egfr_late=50.8	57.0
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=57.0, t.g2=60, egfr_late=50.8	true
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=57.0, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G3a
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=True, egfr_early=57.0, egfr_late=50.8, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=57.0, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3a	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=137.0, 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=137.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=137.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=137.0, 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=52, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=21.2, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=21.2, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=21.2, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=21.2, t.c1=30	true

Pressure injury

Criteria met

Specificity gap

Documented “sacral pressure ulcer” (L89.159); criteria support the more specific Pressure injury of sacral region, unstageable (L89.150).

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=unstageable	false
outcome: other_site	`wound_site != 'sacral'`	wound_site=sacral	false
outcome: stage1	`sacral and wound_stage == '1'`	sacral=True, wound_stage=unstageable	false
outcome: stage2	`sacral and wound_stage == '2'`	sacral=True, wound_stage=unstageable	false
outcome: stage3	`sacral and wound_stage == '3'`	sacral=True, wound_stage=unstageable	false
outcome: stage4	`sacral and wound_stage == '4'`	sacral=True, wound_stage=unstageable	false
outcome: unstageable	`sacral and wound_stage == 'unstageable'`	sacral=True, wound_stage=unstageable	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=95.0, 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=95.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	false
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=20.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=False	false
outcome: met	`hypoxemia and distress`	hypoxemia=False, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=False	false
outcome: not_met	`measured and not hypoxemia and o2_max_lpm <= t.o2_low and not adv_resp_support`	measured=True, hypoxemia=False, o2_max_lpm=0.0, t.o2_low=2, adv_resp_support=False	true

Sepsis

Criteria met

No gap

Supported as documented (A41.9).

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=39.2, t.t_hi=38, temp_min_48h=38.5, t.t_lo=36	true
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=121.0, t.hr=90	true
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=19.0, 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=16.71, t.wbc_hi=12, wbc_min_48h=16.04, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	true
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=True, sirs_hr=True, sirs_rr=False, sirs_wbc=True	3
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=84.0	2
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=0.7	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=65.0	1
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=3.56	3
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=1.62	1
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=2, sofa_liver=0, sofa_cardio=1, sofa_cns=0, sofa_renal=3, sofa_renal_baseline=1	5
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=5, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, sirs_count=3, t.sirs_min=2	true
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=True, norepi_max_48h=0.0, lactate_max_48h=2.55, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=True	false
outcome: septic_shock	`shock`	shock=False	false
outcome: both	`sepsis3 and sepsis2`	sepsis3=True, sepsis2=True	true

Structured data

Labs (29)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-004574	Tue Jan 27, 2026 09:15 AM	creatinine	1.47 mg/dL
LAB-004575	Tue Sep 08, 2026 10:05 AM	creatinine	1.62 mg/dL
LAB-004576	Tue Nov 03, 2026 07:49 PM	creatinine	2.77 mg/dL
LAB-004581	Tue Nov 03, 2026 07:49 PM	sodium	137.0 mmol/L
LAB-004586	Tue Nov 03, 2026 07:49 PM	hemoglobin	14.83 g/dL
LAB-004591	Tue Nov 03, 2026 07:49 PM	wbc	16.71 x10^3/uL
LAB-004592	Tue Nov 03, 2026 07:49 PM	platelets	89.0 x10^3/uL
LAB-004601	Tue Nov 03, 2026 07:49 PM	bilirubin	0.7 mg/dL
LAB-004602	Tue Nov 03, 2026 07:49 PM	lactate	2.55 mmol/L
LAB-004577	Wed Nov 04, 2026 05:00 AM	creatinine	3.56 mg/dL
LAB-004582	Wed Nov 04, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-004587	Wed Nov 04, 2026 05:00 AM	hemoglobin	14.39 g/dL
LAB-004593	Wed Nov 04, 2026 05:00 AM	wbc	16.64 x10^3/uL
LAB-004594	Wed Nov 04, 2026 05:00 AM	platelets	87.0 x10^3/uL
LAB-004578	Thu Nov 05, 2026 05:00 AM	creatinine	3.2 mg/dL
LAB-004583	Thu Nov 05, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-004588	Thu Nov 05, 2026 05:00 AM	hemoglobin	14.42 g/dL
LAB-004595	Thu Nov 05, 2026 05:00 AM	wbc	16.04 x10^3/uL
LAB-004596	Thu Nov 05, 2026 05:00 AM	platelets	84.0 x10^3/uL
LAB-004579	Fri Nov 06, 2026 05:00 AM	creatinine	2.67 mg/dL
LAB-004584	Fri Nov 06, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-004589	Fri Nov 06, 2026 05:00 AM	hemoglobin	14.49 g/dL
LAB-004597	Fri Nov 06, 2026 05:00 AM	wbc	10.88 x10^3/uL
LAB-004598	Fri Nov 06, 2026 05:00 AM	platelets	169.0 x10^3/uL
LAB-004580	Sat Nov 07, 2026 05:00 AM	creatinine	2.2 mg/dL
LAB-004585	Sat Nov 07, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-004590	Sat Nov 07, 2026 05:00 AM	hemoglobin	14.73 g/dL
LAB-004599	Sat Nov 07, 2026 05:00 AM	wbc	9.1 x10^3/uL
LAB-004600	Sat Nov 07, 2026 05:00 AM	platelets	166.0 x10^3/uL

Vitals (72)

Vitals
Row	When	Kind	Value	Detail
VIT-013139	Tue Nov 03, 2026 07:09 PM	spo2	96.0	room air
VIT-013140	Tue Nov 03, 2026 07:09 PM	rr	15.0
VIT-013163	Tue Nov 03, 2026 07:09 PM	temp_c	38.5
VIT-013164	Tue Nov 03, 2026 07:09 PM	hr	109.0
VIT-013165	Tue Nov 03, 2026 07:09 PM	map	66.0
VIT-013166	Tue Nov 03, 2026 07:09 PM	gcs	15.0
VIT-013141	Wed Nov 04, 2026 03:09 AM	spo2	98.0	room air
VIT-013142	Wed Nov 04, 2026 03:09 AM	rr	16.0
VIT-013167	Wed Nov 04, 2026 03:09 AM	temp_c	38.6
VIT-013168	Wed Nov 04, 2026 03:09 AM	hr	112.0
VIT-013169	Wed Nov 04, 2026 03:09 AM	map	65.0
VIT-013170	Wed Nov 04, 2026 03:09 AM	gcs	15.0
VIT-013143	Wed Nov 04, 2026 11:09 AM	spo2	99.0	room air
VIT-013144	Wed Nov 04, 2026 11:09 AM	rr	19.0
VIT-013171	Wed Nov 04, 2026 11:09 AM	temp_c	38.8
VIT-013172	Wed Nov 04, 2026 11:09 AM	hr	107.0
VIT-013173	Wed Nov 04, 2026 11:09 AM	map	67.0
VIT-013174	Wed Nov 04, 2026 11:09 AM	gcs	15.0
VIT-013145	Wed Nov 04, 2026 07:09 PM	spo2	98.0	room air
VIT-013146	Wed Nov 04, 2026 07:09 PM	rr	15.0
VIT-013175	Wed Nov 04, 2026 07:09 PM	temp_c	38.5
VIT-013176	Wed Nov 04, 2026 07:09 PM	hr	103.0
VIT-013177	Wed Nov 04, 2026 07:09 PM	map	65.0
VIT-013178	Wed Nov 04, 2026 07:09 PM	gcs	15.0
VIT-013147	Thu Nov 05, 2026 03:09 AM	spo2	99.0	room air
VIT-013148	Thu Nov 05, 2026 03:09 AM	rr	16.0
VIT-013179	Thu Nov 05, 2026 03:09 AM	temp_c	39.2
VIT-013180	Thu Nov 05, 2026 03:09 AM	hr	121.0
VIT-013181	Thu Nov 05, 2026 03:09 AM	map	66.0
VIT-013182	Thu Nov 05, 2026 03:09 AM	gcs	15.0
VIT-013149	Thu Nov 05, 2026 11:09 AM	spo2	99.0	room air
VIT-013150	Thu Nov 05, 2026 11:09 AM	rr	14.0
VIT-013183	Thu Nov 05, 2026 11:09 AM	temp_c	39.0
VIT-013184	Thu Nov 05, 2026 11:09 AM	hr	115.0
VIT-013185	Thu Nov 05, 2026 11:09 AM	map	65.0
VIT-013186	Thu Nov 05, 2026 11:09 AM	gcs	15.0
VIT-013151	Thu Nov 05, 2026 07:09 PM	spo2	99.0	room air
VIT-013152	Thu Nov 05, 2026 07:09 PM	rr	17.0
VIT-013187	Thu Nov 05, 2026 07:09 PM	temp_c	36.7
VIT-013188	Thu Nov 05, 2026 07:09 PM	hr	72.0
VIT-013189	Thu Nov 05, 2026 07:09 PM	map	84.0
VIT-013190	Thu Nov 05, 2026 07:09 PM	gcs	15.0
VIT-013153	Fri Nov 06, 2026 03:09 AM	spo2	95.0	room air
VIT-013154	Fri Nov 06, 2026 03:09 AM	rr	16.0
VIT-013191	Fri Nov 06, 2026 03:09 AM	temp_c	36.6
VIT-013192	Fri Nov 06, 2026 03:09 AM	hr	69.0
VIT-013193	Fri Nov 06, 2026 03:09 AM	map	92.0
VIT-013194	Fri Nov 06, 2026 03:09 AM	gcs	15.0
VIT-013155	Fri Nov 06, 2026 11:09 AM	spo2	98.0	room air
VIT-013156	Fri Nov 06, 2026 11:09 AM	rr	18.0
VIT-013195	Fri Nov 06, 2026 11:09 AM	temp_c	36.9
VIT-013196	Fri Nov 06, 2026 11:09 AM	hr	69.0
VIT-013197	Fri Nov 06, 2026 11:09 AM	map	87.0
VIT-013198	Fri Nov 06, 2026 11:09 AM	gcs	15.0
VIT-013157	Fri Nov 06, 2026 07:09 PM	spo2	97.0	room air
VIT-013158	Fri Nov 06, 2026 07:09 PM	rr	20.0
VIT-013199	Fri Nov 06, 2026 07:09 PM	temp_c	37.2
VIT-013200	Fri Nov 06, 2026 07:09 PM	hr	83.0
VIT-013201	Fri Nov 06, 2026 07:09 PM	map	87.0
VIT-013202	Fri Nov 06, 2026 07:09 PM	gcs	15.0
VIT-013159	Sat Nov 07, 2026 03:09 AM	spo2	95.0	room air
VIT-013160	Sat Nov 07, 2026 03:09 AM	rr	19.0
VIT-013203	Sat Nov 07, 2026 03:09 AM	temp_c	36.8
VIT-013204	Sat Nov 07, 2026 03:09 AM	hr	76.0
VIT-013205	Sat Nov 07, 2026 03:09 AM	map	86.0
VIT-013206	Sat Nov 07, 2026 03:09 AM	gcs	15.0
VIT-013161	Sat Nov 07, 2026 11:09 AM	spo2	99.0	room air
VIT-013162	Sat Nov 07, 2026 11:09 AM	rr	14.0
VIT-013207	Sat Nov 07, 2026 11:09 AM	temp_c	36.7
VIT-013208	Sat Nov 07, 2026 11:09 AM	hr	73.0
VIT-013209	Sat Nov 07, 2026 11:09 AM	map	91.0
VIT-013210	Sat Nov 07, 2026 11:09 AM	gcs	15.0

Medications, orders, echo, history (4)

MED-000522 11-03 19:49 cefepime per protocol IV
MED-000523 11-04 05:00 ceftriaxone per protocol IV
MED-000524 11-05 05:00 cefepime per protocol IV
ORD-000118 11-03 19:19 blood_culture: blood cultures x2

Notes

History and physical · DOC-000454 · Dr. Greta Kowalczyk (resident) · Tue Nov 03, 2026 09:49 PM

Cited facts from this note (1)

infection_source: multifocal pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… 26-11-03 18:49 Service: Hospital Medicine Attending: Dr. Cyrus Ellingham History of present illness: 52-year-old man admitted with sepsis. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: GERD, hypertension, type 2 diabetes. Review of systems otherwise negative. Exam: Lungs: sc …

Source document DOC-000454: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Florian Treadwell   MRN: MRN75281212   Admitted: 2026-11-03 18:49
Service: Hospital Medicine   Attending: Dr. Cyrus Ellingham

History of present illness: 52-year-old man admitted with sepsis. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: GERD, hypertension, type 2 diabetes.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Sepsis: antibiotics, fluids.
2. Community-acquired pneumonia: antibiotics.
3. CKD stage 3a: renally dose medications.

Nutrition assessment · DOC-000452 · Dario Larkspur, RD (dietitian) · Wed Nov 04, 2026 10:49 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: Florian Treadwell MRN: MRN75281212 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: Florian Treadwell MRN: MRN75281212 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: Florian Treadwell MRN: MRN75281212 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-000452: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Florian Treadwell   MRN: MRN75281212

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-000453 · Elena Jessup, RN, CWOCN (wound_nurse) · Wed Nov 04, 2026 11:49 PM

Cited facts from this note (2)

wound_site: sacral · cited p. 1, line 4 · confidence 0.95

Show source for wound_site

WOUND CARE NOTE Patient: Florian Treadwell MRN: MRN75281212 Location: sacrum Stage: unstageable (NPIAP) Description: wound bed obscured by eschar. Size: 5.9 x 3.4 x 0.8 cm. Plan: offloading every 2 hours, foam dressing, nutrition consul …
wound_stage: unstageable · cited p. 1, line 5 · confidence 0.95

Show source for wound_stage

WOUND CARE NOTE Patient: Florian Treadwell MRN: MRN75281212 Location: sacrum Stage: unstageable (NPIAP) Description: wound bed obscured by eschar. Size: 5.9 x 3.4 x 0.8 cm. Plan: offloading every 2 hours, foam dressing, nutrition consult.

Source document DOC-000453: Wound care note (synthetic)

WOUND CARE NOTE
Patient: Florian Treadwell   MRN: MRN75281212

Location: sacrum
Stage: unstageable (NPIAP)
Description: wound bed obscured by eschar.
Size: 5.9 x 3.4 x 0.8 cm.
Plan: offloading every 2 hours, foam dressing, nutrition consult.

Progress note · DOC-000455 · Dr. Greta Kowalczyk (resident) · Thu Nov 05, 2026 10:49 PM

Source document DOC-000455: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Florian Treadwell   MRN: MRN75281212   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Sepsis: continue current management.
2. Malnutrition: dietitian following.
3. Renal insufficiency: trend creatinine, avoid nephrotoxins.
4. Sacral pressure ulcer: wound care following, offloading.

Resident: Dr. Greta Kowalczyk   Attending cosign: completed

Discharge summary · DOC-000456 · Dr. Cyrus Ellingham (attending) · Sat Nov 07, 2026 03:32 PM

Source document DOC-000456: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Florian Treadwell   MRN: MRN75281212
Admitted 2026-11-03; discharged 2026-11-07.

Discharge diagnoses:
- sepsis
- community-acquired pneumonia
- malnutrition
- CKD stage 3a
- renal insufficiency
- sacral pressure ulcer
- GERD
- hypertension
- type 2 diabetes

Disposition: home with follow-up.