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-00144: Nico Holloway

89F · MRN75134266 · Hospital Medicine · admitted Fri Nov 06, 2026 09:43 AM · discharged Wed Nov 11, 2026 12:59 PM · attending Dr. Wes Merriweather · 152 cm, 54.7 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“chronic kidney disease” · N18.9 Chronic kidney disease, unspecified
“chronic diastolic heart failure” · I50.32 Chronic diastolic (congestive) heart failure

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 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=1.052, t.ratio_s1=1.5, creat_rise_48h=0.03, 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=1.052, t.ratio_s3=3.0, creat_peak=1.02, 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=1.052, 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=0.03, 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 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=12.31, 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=12.31, anaemic=False	true

Chronic kidney disease

Criteria met

Specificity gap

Documented “chronic kidney disease” (N18.9); criteria support the more specific Chronic kidney disease stage 3a (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=350, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=48.0, egfr_late=55.9	55.9
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=48.0, t.g2=60, egfr_late=55.9	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=55.9, 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=48.0, egfr_late=55.9, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=55.9, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3a	true

Heart failure

Criteria met

No gap

Supported as documented (I50.32).

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=73.0, 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=60.0, 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=60.0, 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=diastolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=chronic	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=diastolic, acuity=chronic	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=chronic	false
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=chronic	false
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=diastolic, acuity=chronic	false
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=chronic	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=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

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 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=89, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=23.7, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=23.7, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=23.7, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=23.7, 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=37.6, 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=85.0, 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=9.23, t.wbc_hi=12, wbc_min_48h=5.77, 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=239.0	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=0.75	0
derived: sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`	norepi_max_48h=0.0, map_min_48h=76.0	0
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=1.02	0
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=0.97	0
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=0, sofa_renal_baseline=0	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=0, 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 (34)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-004921	Sat Sep 27, 2025 09:15 AM	creatinine	1.1 mg/dL
LAB-004922	Sat Sep 12, 2026 10:05 AM	creatinine	0.97 mg/dL
LAB-004923	Fri Nov 06, 2026 10:43 AM	creatinine	1.02 mg/dL
LAB-004929	Fri Nov 06, 2026 10:43 AM	bnp	73.0 pg/mL
LAB-004930	Fri Nov 06, 2026 10:43 AM	sodium	139.0 mmol/L
LAB-004936	Fri Nov 06, 2026 10:43 AM	hemoglobin	12.4 g/dL
LAB-004942	Fri Nov 06, 2026 10:43 AM	wbc	5.77 x10^3/uL
LAB-004943	Fri Nov 06, 2026 10:43 AM	platelets	239.0 x10^3/uL
LAB-004954	Fri Nov 06, 2026 10:43 AM	bilirubin	0.75 mg/dL
LAB-004924	Sat Nov 07, 2026 05:00 AM	creatinine	1.0 mg/dL
LAB-004931	Sat Nov 07, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-004937	Sat Nov 07, 2026 05:00 AM	hemoglobin	12.57 g/dL
LAB-004944	Sat Nov 07, 2026 05:00 AM	wbc	7.93 x10^3/uL
LAB-004945	Sat Nov 07, 2026 05:00 AM	platelets	279.0 x10^3/uL
LAB-004925	Sun Nov 08, 2026 05:00 AM	creatinine	0.97 mg/dL
LAB-004932	Sun Nov 08, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-004938	Sun Nov 08, 2026 05:00 AM	hemoglobin	12.68 g/dL
LAB-004946	Sun Nov 08, 2026 05:00 AM	wbc	9.23 x10^3/uL
LAB-004947	Sun Nov 08, 2026 05:00 AM	platelets	277.0 x10^3/uL
LAB-004926	Mon Nov 09, 2026 05:00 AM	creatinine	1.0 mg/dL
LAB-004933	Mon Nov 09, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-004939	Mon Nov 09, 2026 05:00 AM	hemoglobin	12.31 g/dL
LAB-004948	Mon Nov 09, 2026 05:00 AM	wbc	8.13 x10^3/uL
LAB-004949	Mon Nov 09, 2026 05:00 AM	platelets	310.0 x10^3/uL
LAB-004927	Tue Nov 10, 2026 05:00 AM	creatinine	0.99 mg/dL
LAB-004934	Tue Nov 10, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-004940	Tue Nov 10, 2026 05:00 AM	hemoglobin	12.5 g/dL
LAB-004950	Tue Nov 10, 2026 05:00 AM	wbc	9.49 x10^3/uL
LAB-004951	Tue Nov 10, 2026 05:00 AM	platelets	279.0 x10^3/uL
LAB-004928	Wed Nov 11, 2026 05:00 AM	creatinine	1.01 mg/dL
LAB-004935	Wed Nov 11, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-004941	Wed Nov 11, 2026 05:00 AM	hemoglobin	12.61 g/dL
LAB-004952	Wed Nov 11, 2026 05:00 AM	wbc	10.2 x10^3/uL
LAB-004953	Wed Nov 11, 2026 05:00 AM	platelets	250.0 x10^3/uL

Vitals (96)

Vitals
Row	When	Kind	Value	Detail
VIT-014151	Fri Nov 06, 2026 10:03 AM	spo2	97.0	room air
VIT-014152	Fri Nov 06, 2026 10:03 AM	rr	19.0
VIT-014183	Fri Nov 06, 2026 10:03 AM	temp_c	36.6
VIT-014184	Fri Nov 06, 2026 10:03 AM	hr	68.0
VIT-014185	Fri Nov 06, 2026 10:03 AM	map	83.0
VIT-014186	Fri Nov 06, 2026 10:03 AM	gcs	15.0
VIT-014153	Fri Nov 06, 2026 06:03 PM	spo2	99.0	room air
VIT-014154	Fri Nov 06, 2026 06:03 PM	rr	19.0
VIT-014187	Fri Nov 06, 2026 06:03 PM	temp_c	37.1
VIT-014188	Fri Nov 06, 2026 06:03 PM	hr	71.0
VIT-014189	Fri Nov 06, 2026 06:03 PM	map	84.0
VIT-014190	Fri Nov 06, 2026 06:03 PM	gcs	15.0
VIT-014155	Sat Nov 07, 2026 02:03 AM	spo2	98.0	room air
VIT-014156	Sat Nov 07, 2026 02:03 AM	rr	14.0
VIT-014191	Sat Nov 07, 2026 02:03 AM	temp_c	37.1
VIT-014192	Sat Nov 07, 2026 02:03 AM	hr	77.0
VIT-014193	Sat Nov 07, 2026 02:03 AM	map	76.0
VIT-014194	Sat Nov 07, 2026 02:03 AM	gcs	15.0
VIT-014157	Sat Nov 07, 2026 10:03 AM	spo2	98.0	room air
VIT-014158	Sat Nov 07, 2026 10:03 AM	rr	19.0
VIT-014195	Sat Nov 07, 2026 10:03 AM	temp_c	36.7
VIT-014196	Sat Nov 07, 2026 10:03 AM	hr	82.0
VIT-014197	Sat Nov 07, 2026 10:03 AM	map	91.0
VIT-014198	Sat Nov 07, 2026 10:03 AM	gcs	15.0
VIT-014159	Sat Nov 07, 2026 06:03 PM	spo2	99.0	room air
VIT-014160	Sat Nov 07, 2026 06:03 PM	rr	20.0
VIT-014199	Sat Nov 07, 2026 06:03 PM	temp_c	37.6
VIT-014200	Sat Nov 07, 2026 06:03 PM	hr	85.0
VIT-014201	Sat Nov 07, 2026 06:03 PM	map	81.0
VIT-014202	Sat Nov 07, 2026 06:03 PM	gcs	15.0
VIT-014161	Sun Nov 08, 2026 02:03 AM	spo2	99.0	room air
VIT-014162	Sun Nov 08, 2026 02:03 AM	rr	18.0
VIT-014203	Sun Nov 08, 2026 02:03 AM	temp_c	36.9
VIT-014204	Sun Nov 08, 2026 02:03 AM	hr	70.0
VIT-014205	Sun Nov 08, 2026 02:03 AM	map	85.0
VIT-014206	Sun Nov 08, 2026 02:03 AM	gcs	15.0
VIT-014163	Sun Nov 08, 2026 10:03 AM	spo2	99.0	room air
VIT-014164	Sun Nov 08, 2026 10:03 AM	rr	15.0
VIT-014207	Sun Nov 08, 2026 10:03 AM	temp_c	37.1
VIT-014208	Sun Nov 08, 2026 10:03 AM	hr	73.0
VIT-014209	Sun Nov 08, 2026 10:03 AM	map	76.0
VIT-014210	Sun Nov 08, 2026 10:03 AM	gcs	15.0
VIT-014165	Sun Nov 08, 2026 06:03 PM	spo2	96.0	room air
VIT-014166	Sun Nov 08, 2026 06:03 PM	rr	20.0
VIT-014211	Sun Nov 08, 2026 06:03 PM	temp_c	37.2
VIT-014212	Sun Nov 08, 2026 06:03 PM	hr	74.0
VIT-014213	Sun Nov 08, 2026 06:03 PM	map	77.0
VIT-014214	Sun Nov 08, 2026 06:03 PM	gcs	15.0
VIT-014167	Mon Nov 09, 2026 02:03 AM	spo2	94.0	room air
VIT-014168	Mon Nov 09, 2026 02:03 AM	rr	20.0
VIT-014215	Mon Nov 09, 2026 02:03 AM	temp_c	37.6
VIT-014216	Mon Nov 09, 2026 02:03 AM	hr	78.0
VIT-014217	Mon Nov 09, 2026 02:03 AM	map	83.0
VIT-014218	Mon Nov 09, 2026 02:03 AM	gcs	15.0
VIT-014169	Mon Nov 09, 2026 10:03 AM	spo2	97.0	room air
VIT-014170	Mon Nov 09, 2026 10:03 AM	rr	18.0
VIT-014219	Mon Nov 09, 2026 10:03 AM	temp_c	36.9
VIT-014220	Mon Nov 09, 2026 10:03 AM	hr	70.0
VIT-014221	Mon Nov 09, 2026 10:03 AM	map	81.0
VIT-014222	Mon Nov 09, 2026 10:03 AM	gcs	15.0
VIT-014171	Mon Nov 09, 2026 06:03 PM	spo2	96.0	room air
VIT-014172	Mon Nov 09, 2026 06:03 PM	rr	14.0
VIT-014223	Mon Nov 09, 2026 06:03 PM	temp_c	37.2
VIT-014224	Mon Nov 09, 2026 06:03 PM	hr	73.0
VIT-014225	Mon Nov 09, 2026 06:03 PM	map	89.0
VIT-014226	Mon Nov 09, 2026 06:03 PM	gcs	15.0
VIT-014173	Tue Nov 10, 2026 02:03 AM	spo2	99.0	room air
VIT-014174	Tue Nov 10, 2026 02:03 AM	rr	19.0
VIT-014227	Tue Nov 10, 2026 02:03 AM	temp_c	37.5
VIT-014228	Tue Nov 10, 2026 02:03 AM	hr	84.0
VIT-014229	Tue Nov 10, 2026 02:03 AM	map	78.0
VIT-014230	Tue Nov 10, 2026 02:03 AM	gcs	15.0
VIT-014175	Tue Nov 10, 2026 10:03 AM	spo2	98.0	room air
VIT-014176	Tue Nov 10, 2026 10:03 AM	rr	14.0
VIT-014231	Tue Nov 10, 2026 10:03 AM	temp_c	36.8
VIT-014232	Tue Nov 10, 2026 10:03 AM	hr	83.0
VIT-014233	Tue Nov 10, 2026 10:03 AM	map	81.0
VIT-014234	Tue Nov 10, 2026 10:03 AM	gcs	15.0
VIT-014177	Tue Nov 10, 2026 06:03 PM	spo2	99.0	room air
VIT-014178	Tue Nov 10, 2026 06:03 PM	rr	16.0
VIT-014235	Tue Nov 10, 2026 06:03 PM	temp_c	37.2
VIT-014236	Tue Nov 10, 2026 06:03 PM	hr	91.0
VIT-014237	Tue Nov 10, 2026 06:03 PM	map	77.0
VIT-014238	Tue Nov 10, 2026 06:03 PM	gcs	15.0
VIT-014179	Wed Nov 11, 2026 02:03 AM	spo2	95.0	room air
VIT-014180	Wed Nov 11, 2026 02:03 AM	rr	20.0
VIT-014239	Wed Nov 11, 2026 02:03 AM	temp_c	37.2
VIT-014240	Wed Nov 11, 2026 02:03 AM	hr	70.0
VIT-014241	Wed Nov 11, 2026 02:03 AM	map	82.0
VIT-014242	Wed Nov 11, 2026 02:03 AM	gcs	15.0
VIT-014181	Wed Nov 11, 2026 10:03 AM	spo2	98.0	room air
VIT-014182	Wed Nov 11, 2026 10:03 AM	rr	19.0
VIT-014243	Wed Nov 11, 2026 10:03 AM	temp_c	36.6
VIT-014244	Wed Nov 11, 2026 10:03 AM	hr	84.0
VIT-014245	Wed Nov 11, 2026 10:03 AM	map	85.0
VIT-014246	Wed Nov 11, 2026 10:03 AM	gcs	15.0

Medications, orders, echo, history (9)

MED-000568 11-06 10:43 ceftriaxone per protocol IV
MED-000569 11-07 05:00 ceftriaxone per protocol IV
MED-000570 11-08 05:00 ceftriaxone per protocol IV
MED-000571 11-06 09:43 furosemide 40 mg PO
MED-000572 11-07 09:00 furosemide 40 mg PO
MED-000573 11-08 09:00 furosemide 40 mg PO
ORD-000127 11-06 10:13 blood_culture: blood cultures x2
ECH-000067 2026-11-07 echo LVEF 60.0%
HX-000052 history: heart failure with preserved ejection fraction

Notes

History and physical · DOC-000485 · Dr. Wes Merriweather (attending) · Fri Nov 06, 2026 12:43 PM

Cited facts from this note (1)

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

Show source for infection_source

… ospital Medicine Attending: Dr. Wes Merriweather History of present illness: 89-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: heart failure with preserved ejection fraction. Review of systems otherwise negative. Exam …

Source document DOC-000485: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Nico Holloway   MRN: MRN75134266   Admitted: 2026-11-06 09:43
Service: Hospital Medicine   Attending: Dr. Wes Merriweather

History of present illness: 89-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: heart failure with preserved ejection fraction.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.
2. Chronic kidney disease: renally dose medications.

Nutrition assessment · DOC-000484 · Viggo Ravensworth, RD (dietitian) · Sat Nov 07, 2026 12:43 PM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN75134266 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: Nico Holloway MRN: MRN75134266 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: Nico Holloway MRN: MRN75134266 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-000484: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Nico Holloway   MRN: MRN75134266

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-000486 · Dr. Wes Merriweather (attending) · Sun Nov 08, 2026 10:43 AM

Source document DOC-000486: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Nico Holloway   MRN: MRN75134266   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. Chronic diastolic heart failure: diuresis and daily weights; monitor electrolytes.

Attending: Dr. Wes Merriweather

Discharge summary · DOC-000487 · Dr. Wes Merriweather (attending) · Wed Nov 11, 2026 12:59 PM

Source document DOC-000487: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Nico Holloway   MRN: MRN75134266
Admitted 2026-11-06; discharged 2026-11-11.

Discharge diagnoses:
- community-acquired pneumonia
- chronic kidney disease
- chronic diastolic heart failure

Disposition: home with follow-up.