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-00135: Kenji Juniper

67M · MRN81108673 · Hospital Medicine · admitted Mon Oct 26, 2026 11:42 AM · discharged Sun Nov 01, 2026 01:51 PM · attending Dr. Odette Galloway · resident Dr. Camila Oyelaran · 161 cm, 84.9 kg

Documented diagnoses (current)

Principal: “urinary tract infection” · N39.0 Urinary tract infection, site not specified
“obesity” · E66.9 Obesity, unspecified
“renal insufficiency” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
“diastolic heart failure” · I50.30 Unspecified diastolic (congestive) heart failure
“acute hypoxic respiratory failure” · J96.01 Acute respiratory failure with hypoxia
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 689 Kidney and urinary tract infections with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 689.

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=1.78, t.ratio_s1=1.5, creat_rise_48h=0.02, 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=1.78, t.ratio_s3=3.0, creat_peak=1.94, 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=1.78, 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=0.02, 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 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=14.14, 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=14.14, anaemic=False	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 “diastolic heart failure” (I50.30); 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=1111.0, 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=65.0, 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=65.0, 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=138.0, 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=138.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=138.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=138.0, 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 met

Specificity gap

Documented “obesity” (E66.9); criteria support the more specific Obesity, class 1 (E66.811).

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=67, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=32.8, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=32.8, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=32.8, 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

No gap

Supported as documented (J96.01).

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=84.0, pao2_min_ra=52.0, pf_min=248	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=84.0, t.spo2_ra=88, pao2_min_ra=52.0, t.pao2=60, pf_min=248, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=34.0, t.rr_distress=28, wob_increased=True, 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 met

No gap

Criteria support Sepsis (Sepsis-3); not documented (this rule does not prompt for an undocumented diagnosis).

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=36.6, 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=34.0, 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=9.79, 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=248, adv_resp_support=False	2
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=225.0	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=0.69	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=74.0	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=1.94	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=1.09	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=2, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=1, sofa_renal_baseline=0	3
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=3, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, 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=True, norepi_max_48h=0.0, lactate_max_48h=unknown, 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=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=True	true

Structured data

Labs (39)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-004611	Mon Oct 26, 2026 12:07 PM	pao2	52.0 mmHg
LAB-004612	Mon Oct 26, 2026 12:07 PM	fio2	21.0 %
LAB-004603	Mon Oct 26, 2026 12:42 PM	creatinine	1.94 mg/dL
LAB-004610	Mon Oct 26, 2026 12:42 PM	bnp	1111.0 pg/mL
LAB-004613	Mon Oct 26, 2026 12:42 PM	sodium	140.0 mmol/L
LAB-004620	Mon Oct 26, 2026 12:42 PM	hemoglobin	14.46 g/dL
LAB-004627	Mon Oct 26, 2026 12:42 PM	wbc	8.4 x10^3/uL
LAB-004628	Mon Oct 26, 2026 12:42 PM	platelets	280.0 x10^3/uL
LAB-004641	Mon Oct 26, 2026 12:42 PM	bilirubin	0.69 mg/dL
LAB-004604	Tue Oct 27, 2026 05:00 AM	creatinine	1.61 mg/dL
LAB-004614	Tue Oct 27, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-004621	Tue Oct 27, 2026 05:00 AM	hemoglobin	14.69 g/dL
LAB-004629	Tue Oct 27, 2026 05:00 AM	wbc	9.79 x10^3/uL
LAB-004630	Tue Oct 27, 2026 05:00 AM	platelets	225.0 x10^3/uL
LAB-004605	Wed Oct 28, 2026 05:00 AM	creatinine	1.35 mg/dL
LAB-004615	Wed Oct 28, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-004622	Wed Oct 28, 2026 05:00 AM	hemoglobin	14.15 g/dL
LAB-004631	Wed Oct 28, 2026 05:00 AM	wbc	6.67 x10^3/uL
LAB-004632	Wed Oct 28, 2026 05:00 AM	platelets	225.0 x10^3/uL
LAB-004606	Thu Oct 29, 2026 05:00 AM	creatinine	1.2 mg/dL
LAB-004616	Thu Oct 29, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-004623	Thu Oct 29, 2026 05:00 AM	hemoglobin	14.66 g/dL
LAB-004633	Thu Oct 29, 2026 05:00 AM	wbc	10.17 x10^3/uL
LAB-004634	Thu Oct 29, 2026 05:00 AM	platelets	287.0 x10^3/uL
LAB-004607	Fri Oct 30, 2026 05:00 AM	creatinine	1.11 mg/dL
LAB-004617	Fri Oct 30, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-004624	Fri Oct 30, 2026 05:00 AM	hemoglobin	14.14 g/dL
LAB-004635	Fri Oct 30, 2026 05:00 AM	wbc	7.34 x10^3/uL
LAB-004636	Fri Oct 30, 2026 05:00 AM	platelets	200.0 x10^3/uL
LAB-004608	Sat Oct 31, 2026 05:00 AM	creatinine	1.09 mg/dL
LAB-004618	Sat Oct 31, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-004625	Sat Oct 31, 2026 05:00 AM	hemoglobin	14.39 g/dL
LAB-004637	Sat Oct 31, 2026 05:00 AM	wbc	5.75 x10^3/uL
LAB-004638	Sat Oct 31, 2026 05:00 AM	platelets	210.0 x10^3/uL
LAB-004609	Sun Nov 01, 2026 05:00 AM	creatinine	1.11 mg/dL
LAB-004619	Sun Nov 01, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-004626	Sun Nov 01, 2026 05:00 AM	hemoglobin	14.16 g/dL
LAB-004639	Sun Nov 01, 2026 05:00 AM	wbc	5.55 x10^3/uL
LAB-004640	Sun Nov 01, 2026 05:00 AM	platelets	169.0 x10^3/uL

Vitals (133)

Vitals
Row	When	Kind	Value	Detail
VIT-013211	Mon Oct 26, 2026 12:02 PM	spo2	84.0	room air
VIT-013212	Mon Oct 26, 2026 12:02 PM	rr	34.0
VIT-013268	Mon Oct 26, 2026 12:02 PM	temp_c	37.4
VIT-013269	Mon Oct 26, 2026 12:02 PM	hr	90.0
VIT-013270	Mon Oct 26, 2026 12:02 PM	map	88.0
VIT-013271	Mon Oct 26, 2026 12:02 PM	gcs	15.0
VIT-013213	Mon Oct 26, 2026 12:12 PM	o2_lpm	5.0	nasal cannula
VIT-013214	Mon Oct 26, 2026 08:02 PM	spo2	91.0	nasal cannula
VIT-013215	Mon Oct 26, 2026 08:02 PM	rr	23.0
VIT-013216	Mon Oct 26, 2026 08:02 PM	o2_lpm	3.0	nasal cannula
VIT-013272	Mon Oct 26, 2026 08:02 PM	temp_c	36.6
VIT-013273	Mon Oct 26, 2026 08:02 PM	hr	90.0
VIT-013274	Mon Oct 26, 2026 08:02 PM	map	83.0
VIT-013275	Mon Oct 26, 2026 08:02 PM	gcs	15.0
VIT-013217	Tue Oct 27, 2026 04:02 AM	spo2	93.0	nasal cannula
VIT-013218	Tue Oct 27, 2026 04:02 AM	rr	21.0
VIT-013219	Tue Oct 27, 2026 04:02 AM	o2_lpm	4.0	nasal cannula
VIT-013276	Tue Oct 27, 2026 04:02 AM	temp_c	37.0
VIT-013277	Tue Oct 27, 2026 04:02 AM	hr	73.0
VIT-013278	Tue Oct 27, 2026 04:02 AM	map	84.0
VIT-013279	Tue Oct 27, 2026 04:02 AM	gcs	15.0
VIT-013220	Tue Oct 27, 2026 12:02 PM	spo2	91.0	nasal cannula
VIT-013221	Tue Oct 27, 2026 12:02 PM	rr	22.0
VIT-013222	Tue Oct 27, 2026 12:02 PM	o2_lpm	3.0	nasal cannula
VIT-013280	Tue Oct 27, 2026 12:02 PM	temp_c	37.0
VIT-013281	Tue Oct 27, 2026 12:02 PM	hr	87.0
VIT-013282	Tue Oct 27, 2026 12:02 PM	map	77.0
VIT-013283	Tue Oct 27, 2026 12:02 PM	gcs	15.0
VIT-013223	Tue Oct 27, 2026 08:02 PM	spo2	95.0	nasal cannula
VIT-013224	Tue Oct 27, 2026 08:02 PM	rr	24.0
VIT-013225	Tue Oct 27, 2026 08:02 PM	o2_lpm	4.0	nasal cannula
VIT-013284	Tue Oct 27, 2026 08:02 PM	temp_c	37.4
VIT-013285	Tue Oct 27, 2026 08:02 PM	hr	79.0
VIT-013286	Tue Oct 27, 2026 08:02 PM	map	74.0
VIT-013287	Tue Oct 27, 2026 08:02 PM	gcs	15.0
VIT-013226	Wed Oct 28, 2026 04:02 AM	spo2	95.0	nasal cannula
VIT-013227	Wed Oct 28, 2026 04:02 AM	rr	23.0
VIT-013228	Wed Oct 28, 2026 04:02 AM	o2_lpm	4.0	nasal cannula
VIT-013288	Wed Oct 28, 2026 04:02 AM	temp_c	36.6
VIT-013289	Wed Oct 28, 2026 04:02 AM	hr	70.0
VIT-013290	Wed Oct 28, 2026 04:02 AM	map	86.0
VIT-013291	Wed Oct 28, 2026 04:02 AM	gcs	15.0
VIT-013229	Wed Oct 28, 2026 12:02 PM	spo2	94.0	nasal cannula
VIT-013230	Wed Oct 28, 2026 12:02 PM	rr	24.0
VIT-013231	Wed Oct 28, 2026 12:02 PM	o2_lpm	2.0	nasal cannula
VIT-013292	Wed Oct 28, 2026 12:02 PM	temp_c	37.6
VIT-013293	Wed Oct 28, 2026 12:02 PM	hr	83.0
VIT-013294	Wed Oct 28, 2026 12:02 PM	map	77.0
VIT-013295	Wed Oct 28, 2026 12:02 PM	gcs	15.0
VIT-013232	Wed Oct 28, 2026 08:02 PM	spo2	91.0	nasal cannula
VIT-013233	Wed Oct 28, 2026 08:02 PM	rr	26.0
VIT-013234	Wed Oct 28, 2026 08:02 PM	o2_lpm	4.0	nasal cannula
VIT-013296	Wed Oct 28, 2026 08:02 PM	temp_c	37.4
VIT-013297	Wed Oct 28, 2026 08:02 PM	hr	74.0
VIT-013298	Wed Oct 28, 2026 08:02 PM	map	81.0
VIT-013299	Wed Oct 28, 2026 08:02 PM	gcs	15.0
VIT-013235	Thu Oct 29, 2026 04:02 AM	spo2	95.0	nasal cannula
VIT-013236	Thu Oct 29, 2026 04:02 AM	rr	23.0
VIT-013237	Thu Oct 29, 2026 04:02 AM	o2_lpm	3.0	nasal cannula
VIT-013300	Thu Oct 29, 2026 04:02 AM	temp_c	36.9
VIT-013301	Thu Oct 29, 2026 04:02 AM	hr	85.0
VIT-013302	Thu Oct 29, 2026 04:02 AM	map	74.0
VIT-013303	Thu Oct 29, 2026 04:02 AM	gcs	15.0
VIT-013238	Thu Oct 29, 2026 12:02 PM	spo2	93.0	nasal cannula
VIT-013239	Thu Oct 29, 2026 12:02 PM	rr	20.0
VIT-013240	Thu Oct 29, 2026 12:02 PM	o2_lpm	2.0	nasal cannula
VIT-013304	Thu Oct 29, 2026 12:02 PM	temp_c	37.3
VIT-013305	Thu Oct 29, 2026 12:02 PM	hr	76.0
VIT-013306	Thu Oct 29, 2026 12:02 PM	map	87.0
VIT-013307	Thu Oct 29, 2026 12:02 PM	gcs	15.0
VIT-013241	Thu Oct 29, 2026 08:02 PM	spo2	92.0	nasal cannula
VIT-013242	Thu Oct 29, 2026 08:02 PM	rr	24.0
VIT-013243	Thu Oct 29, 2026 08:02 PM	o2_lpm	2.0	nasal cannula
VIT-013308	Thu Oct 29, 2026 08:02 PM	temp_c	36.7
VIT-013309	Thu Oct 29, 2026 08:02 PM	hr	70.0
VIT-013310	Thu Oct 29, 2026 08:02 PM	map	80.0
VIT-013311	Thu Oct 29, 2026 08:02 PM	gcs	15.0
VIT-013244	Fri Oct 30, 2026 04:02 AM	spo2	94.0	nasal cannula
VIT-013245	Fri Oct 30, 2026 04:02 AM	rr	24.0
VIT-013246	Fri Oct 30, 2026 04:02 AM	o2_lpm	2.0	nasal cannula
VIT-013312	Fri Oct 30, 2026 04:02 AM	temp_c	37.6
VIT-013313	Fri Oct 30, 2026 04:02 AM	hr	70.0
VIT-013314	Fri Oct 30, 2026 04:02 AM	map	86.0
VIT-013315	Fri Oct 30, 2026 04:02 AM	gcs	15.0
VIT-013247	Fri Oct 30, 2026 12:02 PM	spo2	93.0	nasal cannula
VIT-013248	Fri Oct 30, 2026 12:02 PM	rr	23.0
VIT-013249	Fri Oct 30, 2026 12:02 PM	o2_lpm	2.0	nasal cannula
VIT-013316	Fri Oct 30, 2026 12:02 PM	temp_c	36.6
VIT-013317	Fri Oct 30, 2026 12:02 PM	hr	89.0
VIT-013318	Fri Oct 30, 2026 12:02 PM	map	81.0
VIT-013319	Fri Oct 30, 2026 12:02 PM	gcs	15.0
VIT-013250	Fri Oct 30, 2026 08:02 PM	spo2	92.0	nasal cannula
VIT-013251	Fri Oct 30, 2026 08:02 PM	rr	20.0
VIT-013252	Fri Oct 30, 2026 08:02 PM	o2_lpm	3.0	nasal cannula
VIT-013320	Fri Oct 30, 2026 08:02 PM	temp_c	37.0
VIT-013321	Fri Oct 30, 2026 08:02 PM	hr	86.0
VIT-013322	Fri Oct 30, 2026 08:02 PM	map	80.0
VIT-013323	Fri Oct 30, 2026 08:02 PM	gcs	15.0
VIT-013253	Sat Oct 31, 2026 04:02 AM	spo2	91.0	nasal cannula
VIT-013254	Sat Oct 31, 2026 04:02 AM	rr	24.0
VIT-013255	Sat Oct 31, 2026 04:02 AM	o2_lpm	2.0	nasal cannula
VIT-013324	Sat Oct 31, 2026 04:02 AM	temp_c	36.8
VIT-013325	Sat Oct 31, 2026 04:02 AM	hr	79.0
VIT-013326	Sat Oct 31, 2026 04:02 AM	map	80.0
VIT-013327	Sat Oct 31, 2026 04:02 AM	gcs	15.0
VIT-013256	Sat Oct 31, 2026 12:02 PM	spo2	95.0	nasal cannula
VIT-013257	Sat Oct 31, 2026 12:02 PM	rr	26.0
VIT-013258	Sat Oct 31, 2026 12:02 PM	o2_lpm	4.0	nasal cannula
VIT-013328	Sat Oct 31, 2026 12:02 PM	temp_c	37.5
VIT-013329	Sat Oct 31, 2026 12:02 PM	hr	82.0
VIT-013330	Sat Oct 31, 2026 12:02 PM	map	82.0
VIT-013331	Sat Oct 31, 2026 12:02 PM	gcs	15.0
VIT-013259	Sat Oct 31, 2026 08:02 PM	spo2	95.0	nasal cannula
VIT-013260	Sat Oct 31, 2026 08:02 PM	rr	25.0
VIT-013261	Sat Oct 31, 2026 08:02 PM	o2_lpm	4.0	nasal cannula
VIT-013332	Sat Oct 31, 2026 08:02 PM	temp_c	36.7
VIT-013333	Sat Oct 31, 2026 08:02 PM	hr	91.0
VIT-013334	Sat Oct 31, 2026 08:02 PM	map	85.0
VIT-013335	Sat Oct 31, 2026 08:02 PM	gcs	15.0
VIT-013262	Sun Nov 01, 2026 04:02 AM	spo2	93.0	nasal cannula
VIT-013263	Sun Nov 01, 2026 04:02 AM	rr	20.0
VIT-013264	Sun Nov 01, 2026 04:02 AM	o2_lpm	2.0	nasal cannula
VIT-013336	Sun Nov 01, 2026 04:02 AM	temp_c	37.2
VIT-013337	Sun Nov 01, 2026 04:02 AM	hr	83.0
VIT-013338	Sun Nov 01, 2026 04:02 AM	map	84.0
VIT-013339	Sun Nov 01, 2026 04:02 AM	gcs	15.0
VIT-013265	Sun Nov 01, 2026 12:02 PM	spo2	92.0	nasal cannula
VIT-013266	Sun Nov 01, 2026 12:02 PM	rr	25.0
VIT-013267	Sun Nov 01, 2026 12:02 PM	o2_lpm	4.0	nasal cannula
VIT-013340	Sun Nov 01, 2026 12:02 PM	temp_c	37.4
VIT-013341	Sun Nov 01, 2026 12:02 PM	hr	81.0
VIT-013342	Sun Nov 01, 2026 12:02 PM	map	76.0
VIT-013343	Sun Nov 01, 2026 12:02 PM	gcs	15.0

Medications, orders, echo, history (11)

MED-000525 10-26 12:42 cefepime per protocol IV
MED-000526 10-27 05:00 piperacillin-tazobactam per protocol IV
MED-000527 10-28 05:00 ceftriaxone per protocol IV
MED-000528 10-26 08:00 furosemide 40 mg IV
MED-000529 10-26 20:00 furosemide 40 mg IV
MED-000530 10-27 08:00 furosemide 40 mg IV
MED-000531 10-27 20:00 furosemide 40 mg IV
MED-000532 10-28 08:00 furosemide 40 mg IV
MED-000533 10-28 20:00 furosemide 40 mg IV
ORD-000119 10-26 12:12 blood_culture: blood cultures x2
ECH-000063 2026-10-27 echo LVEF 65.0%

Notes

History and physical · DOC-000457 · Dr. Camila Oyelaran (resident) · Mon Oct 26, 2026 02:42 PM

Cited facts from this note (2)

infection_source: urinary tract infection · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… MRN81108673 Admitted: 2026-10-26 11:42 Service: Hospital Medicine Attending: Dr. Odette Galloway History of present illness: 67-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime. Past medical history: hyperlipidemia, type 2 diabetes, GERD. Review of systems otherwi …
work_of_breathing: increased · cited p. 1, line 8 · confidence 0.90

Show source for work_of_breathing

… treated for acute pyelonephritis with cefepime. Past medical history: hyperlipidemia, type 2 diabetes, GERD. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessory muscle use. Assessment and plan: 1. Urinary tract infection: antibiotics.

Source document DOC-000457: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Kenji Juniper   MRN: MRN81108673   Admitted: 2026-10-26 11:42
Service: Hospital Medicine   Attending: Dr. Odette Galloway

History of present illness: 67-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime.
Past medical history: hyperlipidemia, type 2 diabetes, GERD.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscle use.
Assessment and plan:
1. Urinary tract infection: antibiotics.

Progress note · DOC-000458 · Dr. Camila Oyelaran (resident) · Wed Oct 28, 2026 11:42 AM

Source document DOC-000458: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Kenji Juniper   MRN: MRN81108673   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Urinary tract infection: continue current management.
2. Obesity: counsel on weight.
3. Renal insufficiency: trend creatinine, avoid nephrotoxins.
4. Diastolic heart failure: diuresis and daily weights; monitor electrolytes.
5. Acute hypoxic respiratory failure: supplemental oxygen, wean as tolerated.

Resident: Dr. Camila Oyelaran   Attending cosign: completed

Discharge summary · DOC-000459 · Dr. Odette Galloway (attending) · Sun Nov 01, 2026 01:51 PM

Source document DOC-000459: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Kenji Juniper   MRN: MRN81108673
Admitted 2026-10-26; discharged 2026-11-01.

Discharge diagnoses:
- urinary tract infection
- obesity
- renal insufficiency
- diastolic heart failure
- acute hypoxic respiratory failure
- hyperlipidemia
- type 2 diabetes
- GERD

Disposition: home with follow-up.