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-00136: Amara Holloway

79F · MRN80557636 · Hospital Medicine · admitted Thu Nov 05, 2026 10:43 AM · discharged Sun Nov 08, 2026 10:07 AM · attending Dr. Gideon Zeller · resident Dr. Elena Nakashima · 166 cm, 88.0 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“class 3 obesity” · E66.813 Obesity, class 3
“CKD” · N18.9 Chronic kidney disease, unspecified
“AKI” · N17.9 Acute kidney failure, unspecified
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“hypertension” · I10 Essential (primary) hypertension

Illustrative grouping now: MS-DRG 194 Simple pneumonia and pleurisy with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 194.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

No gap

Supported as documented (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=2.138, t.ratio_s1=1.5, creat_rise_48h=0.65, 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=2.138, t.ratio_s3=3.0, creat_peak=2.95, 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=2.138, 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=0.65, 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=F, hgb_nadir=12.96, 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=0.0, 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=0.0, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=12.96, anaemic=False	true

Chronic kidney disease

Criteria met

Specificity gap

Documented “CKD” (N18.9); criteria support the more specific Chronic kidney disease stage 3b (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=284, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=36.1, egfr_late=38.9	38.9
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=36.1, t.g2=60, egfr_late=38.9	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=38.9, 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=36.1, egfr_late=38.9, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=38.9, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3b	false
outcome: g3b	`category == 'G3b'`	category=G3b	true

Heart failure

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule heart_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: np_elevated	`coalesce(bnp_max >= t.bnp, false) or coalesce(ntprobnp_max >= t.ntprobnp, false)`	bnp_max=unknown, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	false
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=False, np_elevated=False, new_o2=False	0
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=unknown, t.ref=40, t.pres=50	unknown
derived: improved	`coalesce(lvef_prior_min <= t.ref and lvef > t.ref and lvef - lvef_prior_min >= t.improved_rise, false)`	lvef_prior_min=unknown, t.ref=40, lvef=unknown, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=0, hf_history=False	unknown
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=unknown	unknown
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: one_indicator	`acute_count == 1`	acute_count=0	false

Hyponatraemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=136.0, t.profound=125, t.moderate=130, t.low=135	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=136.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, t.low=135	true

Malnutrition

Criteria not met

No gap

Not documented and not supported.

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=100.0, t.a_sev_intake_pct=50, intake_days=unknown, 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=100.0, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7	false
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=100.0, t.c_intake_pct=75, intake_days=unknown, 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=100.0, t.c_intake_pct=75, intake_days=unknown, 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=100.0, 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=False, 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	0
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=0	false
outcome: one_characteristic	`n_moderate == 1`	n_moderate=0	false
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=0, n_assessed=4	true

Obesity

Criteria met

Clinical validation gap

Documented “class 3 obesity” (E66.813) conflicts with what the criteria support (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=79, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=31.9, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=31.9, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=31.9, 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=19.0, 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=37.5, 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=87.0, 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=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=10.05, t.wbc_hi=12, wbc_min_48h=7.7, 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=229.0	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=0.7	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=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=2.95	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=1.38	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=True, sofa_delta=1, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, 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=True	false
outcome: septic_shock	`shock`	shock=False	false
outcome: both	`sepsis3 and sepsis2`	sepsis3=False, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=False	false
outcome: definitions_disagree	`sepsis2`	sepsis2=False	false
outcome: neither	`true`	—	true

Structured data

Labs (23)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-004642	Tue Oct 14, 2025 09:15 AM	creatinine	1.47 mg/dL
LAB-004643	Sat Jul 25, 2026 10:05 AM	creatinine	1.38 mg/dL
LAB-004644	Thu Nov 05, 2026 11:43 AM	creatinine	2.3 mg/dL
LAB-004648	Thu Nov 05, 2026 11:43 AM	sodium	136.0 mmol/L
LAB-004652	Thu Nov 05, 2026 11:43 AM	hemoglobin	12.96 g/dL
LAB-004656	Thu Nov 05, 2026 11:43 AM	wbc	7.7 x10^3/uL
LAB-004657	Thu Nov 05, 2026 11:43 AM	platelets	274.0 x10^3/uL
LAB-004664	Thu Nov 05, 2026 11:43 AM	bilirubin	0.7 mg/dL
LAB-004645	Fri Nov 06, 2026 05:00 AM	creatinine	2.95 mg/dL
LAB-004649	Fri Nov 06, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-004653	Fri Nov 06, 2026 05:00 AM	hemoglobin	13.25 g/dL
LAB-004658	Fri Nov 06, 2026 05:00 AM	wbc	9.9 x10^3/uL
LAB-004659	Fri Nov 06, 2026 05:00 AM	platelets	229.0 x10^3/uL
LAB-004646	Sat Nov 07, 2026 05:00 AM	creatinine	2.65 mg/dL
LAB-004650	Sat Nov 07, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-004654	Sat Nov 07, 2026 05:00 AM	hemoglobin	13.23 g/dL
LAB-004660	Sat Nov 07, 2026 05:00 AM	wbc	10.05 x10^3/uL
LAB-004661	Sat Nov 07, 2026 05:00 AM	platelets	259.0 x10^3/uL
LAB-004647	Sun Nov 08, 2026 05:00 AM	creatinine	2.21 mg/dL
LAB-004651	Sun Nov 08, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-004655	Sun Nov 08, 2026 05:00 AM	hemoglobin	13.16 g/dL
LAB-004662	Sun Nov 08, 2026 05:00 AM	wbc	9.17 x10^3/uL
LAB-004663	Sun Nov 08, 2026 05:00 AM	platelets	205.0 x10^3/uL

Vitals (54)

Vitals
Row	When	Kind	Value	Detail
VIT-013344	Thu Nov 05, 2026 11:03 AM	spo2	98.0	room air
VIT-013345	Thu Nov 05, 2026 11:03 AM	rr	14.0
VIT-013362	Thu Nov 05, 2026 11:03 AM	temp_c	37.5
VIT-013363	Thu Nov 05, 2026 11:03 AM	hr	82.0
VIT-013364	Thu Nov 05, 2026 11:03 AM	map	80.0
VIT-013365	Thu Nov 05, 2026 11:03 AM	gcs	15.0
VIT-013346	Thu Nov 05, 2026 07:03 PM	spo2	95.0	room air
VIT-013347	Thu Nov 05, 2026 07:03 PM	rr	19.0
VIT-013366	Thu Nov 05, 2026 07:03 PM	temp_c	37.2
VIT-013367	Thu Nov 05, 2026 07:03 PM	hr	69.0
VIT-013368	Thu Nov 05, 2026 07:03 PM	map	78.0
VIT-013369	Thu Nov 05, 2026 07:03 PM	gcs	15.0
VIT-013348	Fri Nov 06, 2026 03:03 AM	spo2	97.0	room air
VIT-013349	Fri Nov 06, 2026 03:03 AM	rr	16.0
VIT-013370	Fri Nov 06, 2026 03:03 AM	temp_c	36.6
VIT-013371	Fri Nov 06, 2026 03:03 AM	hr	87.0
VIT-013372	Fri Nov 06, 2026 03:03 AM	map	82.0
VIT-013373	Fri Nov 06, 2026 03:03 AM	gcs	15.0
VIT-013350	Fri Nov 06, 2026 11:03 AM	spo2	98.0	room air
VIT-013351	Fri Nov 06, 2026 11:03 AM	rr	14.0
VIT-013374	Fri Nov 06, 2026 11:03 AM	temp_c	37.5
VIT-013375	Fri Nov 06, 2026 11:03 AM	hr	73.0
VIT-013376	Fri Nov 06, 2026 11:03 AM	map	78.0
VIT-013377	Fri Nov 06, 2026 11:03 AM	gcs	15.0
VIT-013352	Fri Nov 06, 2026 07:03 PM	spo2	97.0	room air
VIT-013353	Fri Nov 06, 2026 07:03 PM	rr	17.0
VIT-013378	Fri Nov 06, 2026 07:03 PM	temp_c	37.0
VIT-013379	Fri Nov 06, 2026 07:03 PM	hr	77.0
VIT-013380	Fri Nov 06, 2026 07:03 PM	map	80.0
VIT-013381	Fri Nov 06, 2026 07:03 PM	gcs	15.0
VIT-013354	Sat Nov 07, 2026 03:03 AM	spo2	96.0	room air
VIT-013355	Sat Nov 07, 2026 03:03 AM	rr	19.0
VIT-013382	Sat Nov 07, 2026 03:03 AM	temp_c	36.5
VIT-013383	Sat Nov 07, 2026 03:03 AM	hr	83.0
VIT-013384	Sat Nov 07, 2026 03:03 AM	map	75.0
VIT-013385	Sat Nov 07, 2026 03:03 AM	gcs	15.0
VIT-013356	Sat Nov 07, 2026 11:03 AM	spo2	94.0	room air
VIT-013357	Sat Nov 07, 2026 11:03 AM	rr	16.0
VIT-013386	Sat Nov 07, 2026 11:03 AM	temp_c	36.9
VIT-013387	Sat Nov 07, 2026 11:03 AM	hr	92.0
VIT-013388	Sat Nov 07, 2026 11:03 AM	map	87.0
VIT-013389	Sat Nov 07, 2026 11:03 AM	gcs	15.0
VIT-013358	Sat Nov 07, 2026 07:03 PM	spo2	99.0	room air
VIT-013359	Sat Nov 07, 2026 07:03 PM	rr	14.0
VIT-013390	Sat Nov 07, 2026 07:03 PM	temp_c	37.3
VIT-013391	Sat Nov 07, 2026 07:03 PM	hr	85.0
VIT-013392	Sat Nov 07, 2026 07:03 PM	map	90.0
VIT-013393	Sat Nov 07, 2026 07:03 PM	gcs	15.0
VIT-013360	Sun Nov 08, 2026 03:03 AM	spo2	95.0	room air
VIT-013361	Sun Nov 08, 2026 03:03 AM	rr	16.0
VIT-013394	Sun Nov 08, 2026 03:03 AM	temp_c	37.4
VIT-013395	Sun Nov 08, 2026 03:03 AM	hr	75.0
VIT-013396	Sun Nov 08, 2026 03:03 AM	map	82.0
VIT-013397	Sun Nov 08, 2026 03:03 AM	gcs	15.0

Medications, orders, echo, history (4)

MED-000534 11-05 11:43 cefepime per protocol IV
MED-000535 11-06 05:00 cefepime per protocol IV
MED-000536 11-07 05:00 piperacillin-tazobactam per protocol IV
ORD-000120 11-05 11:13 blood_culture: blood cultures x2

Notes

History and physical · DOC-000461 · Dr. Elena Nakashima (resident) · Thu Nov 05, 2026 01:43 PM

Cited facts from this note (1)

infection_source: left lower lobe pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… : Hospital Medicine Attending: Dr. Gideon Zeller History of present illness: 79-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: hyperlipidemia, type 2 diabetes, hypertension. Review of systems otherwise negative. Exam: …

Source document DOC-000461: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Amara Holloway   MRN: MRN80557636   Admitted: 2026-11-05 10:43
Service: Hospital Medicine   Attending: Dr. Gideon Zeller

History of present illness: 79-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: hyperlipidemia, type 2 diabetes, hypertension.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.
2. CKD: renally dose medications.

Nutrition assessment · DOC-000460 · Viggo Ravensworth, RD (dietitian) · Fri Nov 06, 2026 03:43 PM

Cited facts from this note (5)

fat_loss: none · cited p. 1, line 7 · confidence 0.90

Show source for fat_loss

… MRN: MRN80557636 Context: acute illness Intake: eating 100% of meals. 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: well nourished; no malnutrition identified.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… e: eating 100% of meals. 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: well nourished; no malnutrition identified.
intake_pct: 100 · cited p. 1, line 5 · confidence 0.90

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Amara Holloway MRN: MRN80557636 Context: acute illness Intake: eating 100% of meals. 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

… acute illness Intake: eating 100% of meals. 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: well nourished; no malnutrition identified.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Amara Holloway MRN: MRN80557636 Context: acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle was …

Source document DOC-000460: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Amara Holloway   MRN: MRN80557636

Context: acute illness
Intake: eating 100% of meals.
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: well nourished; no malnutrition identified.

Progress note · DOC-000462 · Dr. Elena Nakashima (resident) · Sat Nov 07, 2026 01:43 PM

Source document DOC-000462: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Amara Holloway   MRN: MRN80557636   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Community-acquired pneumonia: continue current management.
2. Class 3 obesity: counsel on weight.
3. AKI: trend creatinine, hold nephrotoxins, strict intake and output.

Resident: Dr. Elena Nakashima   Attending cosign: completed

Discharge summary · DOC-000463 · Dr. Gideon Zeller (attending) · Sun Nov 08, 2026 10:07 AM

Source document DOC-000463: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Amara Holloway   MRN: MRN80557636
Admitted 2026-11-05; discharged 2026-11-08.

Discharge diagnoses:
- community-acquired pneumonia
- class 3 obesity
- CKD
- AKI
- hyperlipidemia
- type 2 diabetes
- hypertension

Disposition: home with follow-up.