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-00145: Jun Ivers

87F · MRN29444894 · Hospital Medicine · admitted Tue Oct 27, 2026 06:20 PM · discharged Wed Nov 04, 2026 11:54 AM · attending Dr. Rosalind Quillan · resident Dr. Elena Nakashima · 163 cm, 73.8 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“CKD stage 3b” · N18.32 Chronic kidney disease, stage 3b
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“hypertension” · I10 Essential (primary) hypertension

Illustrative grouping now: MS-DRG 195 Simple pneumonia and pleurisy without CC/MCC. 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=1.046, t.ratio_s1=1.5, creat_rise_48h=0.08, 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=1.046, t.ratio_s3=3.0, creat_peak=1.37, 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=1.046, 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=0.08, 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=12.25, 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=12.25, anaemic=False	true

Chronic kidney disease

Criteria met

No gap

Supported as documented (N18.32).

Trace

Rule trace (rule ckd v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: chronic	`egfr_n >= 2 and egfr_span_days >= t.chronic_days`	egfr_n=2, egfr_span_days=341, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=37.4, egfr_late=39.4	39.4
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=37.4, t.g2=60, egfr_late=39.4	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=39.4, 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=37.4, egfr_late=39.4, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=39.4, 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 met

Specificity gap

Criteria support Hyponatraemia (profound) (E87.1); no corresponding diagnosis is documented.

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=123.0, t.profound=125, t.moderate=130, t.low=135	profound
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=123.0, t.low=135, na_low_count=6, t.repeat=2, na_treated=True	true

Malnutrition

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule malnutrition v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: a_sev_intake	`intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days`	intake_pct=unknown, t.a_sev_intake_pct=50, intake_days=unknown, t.a_sev_intake_days=5	unknown
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=unknown, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7	unknown
derived: a_sev_wt	`(wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: a_mod_wt	`(wt_loss_days <= 7 and wt_loss_pct >= 1) or (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_sev_wt	`(wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_mod_wt	`(wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) or (wt_loss_days <= 183 and wt_loss_pct >= 10) or (wt_loss_days <= 366 and wt_loss_pct >= 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=unknown, wt_loss_pct=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown	0
derived: n_severe	`case(nutr_context == 'acute', count(a_sev_intake, a_sev_wt, fat_loss >= 2, muscle_loss >= 2, fluid >= 2, grip_reduced), nutr_context == 'chronic', count(c_sev_intake, c_sev_wt, fat_loss >= 3, muscle_loss >= 3, fluid >= 3, grip_reduced), null)`	nutr_context=unknown, a_sev_intake=unknown, a_sev_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_sev_wt=unknown	unknown
derived: n_moderate	`case(nutr_context == 'acute', count(a_sev_intake or a_mod_intake, a_sev_wt or a_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), nutr_context == 'chronic', count(c_sev_intake or c_mod_intake, c_sev_wt or c_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), null)`	nutr_context=unknown, a_sev_intake=unknown, a_mod_intake=unknown, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_mod_intake=unknown, c_sev_wt=unknown, c_mod_wt=unknown	unknown
outcome: severe	`n_severe >= 2`	n_severe=unknown	unknown
outcome: moderate	`n_moderate >= 2`	n_moderate=unknown	unknown
outcome: one_characteristic	`n_moderate == 1`	n_moderate=unknown	unknown
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=unknown, n_assessed=0	false

Obesity

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule obesity v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=87, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=27.8, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=27.8, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=27.8, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=27.8, 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 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=37.5, 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=86.0, 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=9.16, 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=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=250.0	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=0.64	0
derived: sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`	norepi_max_48h=0.0, map_min_48h=75.0	0
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=1.37	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=1.31	1
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=1, sofa_renal_baseline=1	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=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 (48)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-004955	Thu Sep 04, 2025 09:15 AM	creatinine	1.37 mg/dL
LAB-004956	Tue Aug 11, 2026 10:05 AM	creatinine	1.31 mg/dL
LAB-004957	Tue Oct 27, 2026 07:20 PM	creatinine	1.3 mg/dL
LAB-004966	Tue Oct 27, 2026 07:20 PM	sodium	125.0 mmol/L
LAB-004975	Tue Oct 27, 2026 07:20 PM	hemoglobin	12.25 g/dL
LAB-004984	Tue Oct 27, 2026 07:20 PM	wbc	9.16 x10^3/uL
LAB-004985	Tue Oct 27, 2026 07:20 PM	platelets	271.0 x10^3/uL
LAB-005002	Tue Oct 27, 2026 07:20 PM	bilirubin	0.64 mg/dL
LAB-004958	Wed Oct 28, 2026 05:00 AM	creatinine	1.34 mg/dL
LAB-004967	Wed Oct 28, 2026 05:00 AM	sodium	123.0 mmol/L
LAB-004976	Wed Oct 28, 2026 05:00 AM	hemoglobin	12.41 g/dL
LAB-004986	Wed Oct 28, 2026 05:00 AM	wbc	6.67 x10^3/uL
LAB-004987	Wed Oct 28, 2026 05:00 AM	platelets	250.0 x10^3/uL
LAB-004959	Thu Oct 29, 2026 05:00 AM	creatinine	1.37 mg/dL
LAB-004968	Thu Oct 29, 2026 05:00 AM	sodium	124.0 mmol/L
LAB-004977	Thu Oct 29, 2026 05:00 AM	hemoglobin	12.62 g/dL
LAB-004988	Thu Oct 29, 2026 05:00 AM	wbc	7.42 x10^3/uL
LAB-004989	Thu Oct 29, 2026 05:00 AM	platelets	261.0 x10^3/uL
LAB-004960	Fri Oct 30, 2026 05:00 AM	creatinine	1.28 mg/dL
LAB-004969	Fri Oct 30, 2026 05:00 AM	sodium	127.0 mmol/L
LAB-004978	Fri Oct 30, 2026 05:00 AM	hemoglobin	12.65 g/dL
LAB-004990	Fri Oct 30, 2026 05:00 AM	wbc	10.16 x10^3/uL
LAB-004991	Fri Oct 30, 2026 05:00 AM	platelets	225.0 x10^3/uL
LAB-004961	Sat Oct 31, 2026 05:00 AM	creatinine	1.36 mg/dL
LAB-004970	Sat Oct 31, 2026 05:00 AM	sodium	129.0 mmol/L
LAB-004979	Sat Oct 31, 2026 05:00 AM	hemoglobin	12.72 g/dL
LAB-004992	Sat Oct 31, 2026 05:00 AM	wbc	6.77 x10^3/uL
LAB-004993	Sat Oct 31, 2026 05:00 AM	platelets	295.0 x10^3/uL
LAB-004962	Sun Nov 01, 2026 05:00 AM	creatinine	1.36 mg/dL
LAB-004971	Sun Nov 01, 2026 05:00 AM	sodium	134.0 mmol/L
LAB-004980	Sun Nov 01, 2026 05:00 AM	hemoglobin	12.46 g/dL
LAB-004994	Sun Nov 01, 2026 05:00 AM	wbc	5.58 x10^3/uL
LAB-004995	Sun Nov 01, 2026 05:00 AM	platelets	224.0 x10^3/uL
LAB-004963	Mon Nov 02, 2026 05:00 AM	creatinine	1.35 mg/dL
LAB-004972	Mon Nov 02, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-004981	Mon Nov 02, 2026 05:00 AM	hemoglobin	12.71 g/dL
LAB-004996	Mon Nov 02, 2026 05:00 AM	wbc	6.69 x10^3/uL
LAB-004997	Mon Nov 02, 2026 05:00 AM	platelets	190.0 x10^3/uL
LAB-004964	Tue Nov 03, 2026 05:00 AM	creatinine	1.28 mg/dL
LAB-004973	Tue Nov 03, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-004982	Tue Nov 03, 2026 05:00 AM	hemoglobin	12.41 g/dL
LAB-004998	Tue Nov 03, 2026 05:00 AM	wbc	10.87 x10^3/uL
LAB-004999	Tue Nov 03, 2026 05:00 AM	platelets	217.0 x10^3/uL
LAB-004965	Wed Nov 04, 2026 05:00 AM	creatinine	1.34 mg/dL
LAB-004974	Wed Nov 04, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-004983	Wed Nov 04, 2026 05:00 AM	hemoglobin	12.62 g/dL
LAB-005000	Wed Nov 04, 2026 05:00 AM	wbc	10.91 x10^3/uL
LAB-005001	Wed Nov 04, 2026 05:00 AM	platelets	190.0 x10^3/uL

Vitals (144)

Vitals
Row	When	Kind	Value	Detail
VIT-014247	Tue Oct 27, 2026 06:40 PM	spo2	94.0	room air
VIT-014248	Tue Oct 27, 2026 06:40 PM	rr	16.0
VIT-014295	Tue Oct 27, 2026 06:40 PM	temp_c	37.4
VIT-014296	Tue Oct 27, 2026 06:40 PM	hr	68.0
VIT-014297	Tue Oct 27, 2026 06:40 PM	map	91.0
VIT-014298	Tue Oct 27, 2026 06:40 PM	gcs	15.0
VIT-014249	Wed Oct 28, 2026 02:40 AM	spo2	95.0	room air
VIT-014250	Wed Oct 28, 2026 02:40 AM	rr	14.0
VIT-014299	Wed Oct 28, 2026 02:40 AM	temp_c	36.6
VIT-014300	Wed Oct 28, 2026 02:40 AM	hr	69.0
VIT-014301	Wed Oct 28, 2026 02:40 AM	map	77.0
VIT-014302	Wed Oct 28, 2026 02:40 AM	gcs	15.0
VIT-014251	Wed Oct 28, 2026 10:40 AM	spo2	95.0	room air
VIT-014252	Wed Oct 28, 2026 10:40 AM	rr	20.0
VIT-014303	Wed Oct 28, 2026 10:40 AM	temp_c	37.3
VIT-014304	Wed Oct 28, 2026 10:40 AM	hr	80.0
VIT-014305	Wed Oct 28, 2026 10:40 AM	map	81.0
VIT-014306	Wed Oct 28, 2026 10:40 AM	gcs	15.0
VIT-014253	Wed Oct 28, 2026 06:40 PM	spo2	96.0	room air
VIT-014254	Wed Oct 28, 2026 06:40 PM	rr	20.0
VIT-014307	Wed Oct 28, 2026 06:40 PM	temp_c	37.5
VIT-014308	Wed Oct 28, 2026 06:40 PM	hr	74.0
VIT-014309	Wed Oct 28, 2026 06:40 PM	map	76.0
VIT-014310	Wed Oct 28, 2026 06:40 PM	gcs	15.0
VIT-014255	Thu Oct 29, 2026 02:40 AM	spo2	95.0	room air
VIT-014256	Thu Oct 29, 2026 02:40 AM	rr	15.0
VIT-014311	Thu Oct 29, 2026 02:40 AM	temp_c	36.8
VIT-014312	Thu Oct 29, 2026 02:40 AM	hr	86.0
VIT-014313	Thu Oct 29, 2026 02:40 AM	map	82.0
VIT-014314	Thu Oct 29, 2026 02:40 AM	gcs	15.0
VIT-014257	Thu Oct 29, 2026 10:40 AM	spo2	94.0	room air
VIT-014258	Thu Oct 29, 2026 10:40 AM	rr	18.0
VIT-014315	Thu Oct 29, 2026 10:40 AM	temp_c	36.6
VIT-014316	Thu Oct 29, 2026 10:40 AM	hr	86.0
VIT-014317	Thu Oct 29, 2026 10:40 AM	map	75.0
VIT-014318	Thu Oct 29, 2026 10:40 AM	gcs	15.0
VIT-014259	Thu Oct 29, 2026 06:40 PM	spo2	94.0	room air
VIT-014260	Thu Oct 29, 2026 06:40 PM	rr	16.0
VIT-014319	Thu Oct 29, 2026 06:40 PM	temp_c	37.1
VIT-014320	Thu Oct 29, 2026 06:40 PM	hr	81.0
VIT-014321	Thu Oct 29, 2026 06:40 PM	map	78.0
VIT-014322	Thu Oct 29, 2026 06:40 PM	gcs	15.0
VIT-014261	Fri Oct 30, 2026 02:40 AM	spo2	96.0	room air
VIT-014262	Fri Oct 30, 2026 02:40 AM	rr	17.0
VIT-014323	Fri Oct 30, 2026 02:40 AM	temp_c	36.7
VIT-014324	Fri Oct 30, 2026 02:40 AM	hr	89.0
VIT-014325	Fri Oct 30, 2026 02:40 AM	map	76.0
VIT-014326	Fri Oct 30, 2026 02:40 AM	gcs	15.0
VIT-014263	Fri Oct 30, 2026 10:40 AM	spo2	97.0	room air
VIT-014264	Fri Oct 30, 2026 10:40 AM	rr	14.0
VIT-014327	Fri Oct 30, 2026 10:40 AM	temp_c	37.0
VIT-014328	Fri Oct 30, 2026 10:40 AM	hr	87.0
VIT-014329	Fri Oct 30, 2026 10:40 AM	map	77.0
VIT-014330	Fri Oct 30, 2026 10:40 AM	gcs	15.0
VIT-014265	Fri Oct 30, 2026 06:40 PM	spo2	98.0	room air
VIT-014266	Fri Oct 30, 2026 06:40 PM	rr	20.0
VIT-014331	Fri Oct 30, 2026 06:40 PM	temp_c	37.5
VIT-014332	Fri Oct 30, 2026 06:40 PM	hr	88.0
VIT-014333	Fri Oct 30, 2026 06:40 PM	map	86.0
VIT-014334	Fri Oct 30, 2026 06:40 PM	gcs	15.0
VIT-014267	Sat Oct 31, 2026 02:40 AM	spo2	97.0	room air
VIT-014268	Sat Oct 31, 2026 02:40 AM	rr	18.0
VIT-014335	Sat Oct 31, 2026 02:40 AM	temp_c	37.5
VIT-014336	Sat Oct 31, 2026 02:40 AM	hr	79.0
VIT-014337	Sat Oct 31, 2026 02:40 AM	map	86.0
VIT-014338	Sat Oct 31, 2026 02:40 AM	gcs	15.0
VIT-014269	Sat Oct 31, 2026 10:40 AM	spo2	94.0	room air
VIT-014270	Sat Oct 31, 2026 10:40 AM	rr	20.0
VIT-014339	Sat Oct 31, 2026 10:40 AM	temp_c	37.4
VIT-014340	Sat Oct 31, 2026 10:40 AM	hr	84.0
VIT-014341	Sat Oct 31, 2026 10:40 AM	map	78.0
VIT-014342	Sat Oct 31, 2026 10:40 AM	gcs	15.0
VIT-014271	Sat Oct 31, 2026 06:40 PM	spo2	99.0	room air
VIT-014272	Sat Oct 31, 2026 06:40 PM	rr	14.0
VIT-014343	Sat Oct 31, 2026 06:40 PM	temp_c	37.5
VIT-014344	Sat Oct 31, 2026 06:40 PM	hr	84.0
VIT-014345	Sat Oct 31, 2026 06:40 PM	map	78.0
VIT-014346	Sat Oct 31, 2026 06:40 PM	gcs	15.0
VIT-014273	Sun Nov 01, 2026 02:40 AM	spo2	94.0	room air
VIT-014274	Sun Nov 01, 2026 02:40 AM	rr	14.0
VIT-014347	Sun Nov 01, 2026 02:40 AM	temp_c	36.5
VIT-014348	Sun Nov 01, 2026 02:40 AM	hr	83.0
VIT-014349	Sun Nov 01, 2026 02:40 AM	map	83.0
VIT-014350	Sun Nov 01, 2026 02:40 AM	gcs	15.0
VIT-014275	Sun Nov 01, 2026 10:40 AM	spo2	99.0	room air
VIT-014276	Sun Nov 01, 2026 10:40 AM	rr	20.0
VIT-014351	Sun Nov 01, 2026 10:40 AM	temp_c	36.9
VIT-014352	Sun Nov 01, 2026 10:40 AM	hr	83.0
VIT-014353	Sun Nov 01, 2026 10:40 AM	map	78.0
VIT-014354	Sun Nov 01, 2026 10:40 AM	gcs	15.0
VIT-014277	Sun Nov 01, 2026 06:40 PM	spo2	99.0	room air
VIT-014278	Sun Nov 01, 2026 06:40 PM	rr	15.0
VIT-014355	Sun Nov 01, 2026 06:40 PM	temp_c	37.6
VIT-014356	Sun Nov 01, 2026 06:40 PM	hr	86.0
VIT-014357	Sun Nov 01, 2026 06:40 PM	map	91.0
VIT-014358	Sun Nov 01, 2026 06:40 PM	gcs	15.0
VIT-014279	Mon Nov 02, 2026 02:40 AM	spo2	96.0	room air
VIT-014280	Mon Nov 02, 2026 02:40 AM	rr	17.0
VIT-014359	Mon Nov 02, 2026 02:40 AM	temp_c	37.5
VIT-014360	Mon Nov 02, 2026 02:40 AM	hr	82.0
VIT-014361	Mon Nov 02, 2026 02:40 AM	map	80.0
VIT-014362	Mon Nov 02, 2026 02:40 AM	gcs	15.0
VIT-014281	Mon Nov 02, 2026 10:40 AM	spo2	96.0	room air
VIT-014282	Mon Nov 02, 2026 10:40 AM	rr	16.0
VIT-014363	Mon Nov 02, 2026 10:40 AM	temp_c	36.9
VIT-014364	Mon Nov 02, 2026 10:40 AM	hr	90.0
VIT-014365	Mon Nov 02, 2026 10:40 AM	map	75.0
VIT-014366	Mon Nov 02, 2026 10:40 AM	gcs	15.0
VIT-014283	Mon Nov 02, 2026 06:40 PM	spo2	97.0	room air
VIT-014284	Mon Nov 02, 2026 06:40 PM	rr	17.0
VIT-014367	Mon Nov 02, 2026 06:40 PM	temp_c	36.8
VIT-014368	Mon Nov 02, 2026 06:40 PM	hr	86.0
VIT-014369	Mon Nov 02, 2026 06:40 PM	map	80.0
VIT-014370	Mon Nov 02, 2026 06:40 PM	gcs	15.0
VIT-014285	Tue Nov 03, 2026 02:40 AM	spo2	95.0	room air
VIT-014286	Tue Nov 03, 2026 02:40 AM	rr	15.0
VIT-014371	Tue Nov 03, 2026 02:40 AM	temp_c	37.2
VIT-014372	Tue Nov 03, 2026 02:40 AM	hr	68.0
VIT-014373	Tue Nov 03, 2026 02:40 AM	map	92.0
VIT-014374	Tue Nov 03, 2026 02:40 AM	gcs	15.0
VIT-014287	Tue Nov 03, 2026 10:40 AM	spo2	97.0	room air
VIT-014288	Tue Nov 03, 2026 10:40 AM	rr	15.0
VIT-014375	Tue Nov 03, 2026 10:40 AM	temp_c	36.6
VIT-014376	Tue Nov 03, 2026 10:40 AM	hr	87.0
VIT-014377	Tue Nov 03, 2026 10:40 AM	map	92.0
VIT-014378	Tue Nov 03, 2026 10:40 AM	gcs	15.0
VIT-014289	Tue Nov 03, 2026 06:40 PM	spo2	96.0	room air
VIT-014290	Tue Nov 03, 2026 06:40 PM	rr	19.0
VIT-014379	Tue Nov 03, 2026 06:40 PM	temp_c	37.4
VIT-014380	Tue Nov 03, 2026 06:40 PM	hr	89.0
VIT-014381	Tue Nov 03, 2026 06:40 PM	map	88.0
VIT-014382	Tue Nov 03, 2026 06:40 PM	gcs	15.0
VIT-014291	Wed Nov 04, 2026 02:40 AM	spo2	95.0	room air
VIT-014292	Wed Nov 04, 2026 02:40 AM	rr	16.0
VIT-014383	Wed Nov 04, 2026 02:40 AM	temp_c	37.6
VIT-014384	Wed Nov 04, 2026 02:40 AM	hr	89.0
VIT-014385	Wed Nov 04, 2026 02:40 AM	map	87.0
VIT-014386	Wed Nov 04, 2026 02:40 AM	gcs	15.0
VIT-014293	Wed Nov 04, 2026 10:40 AM	spo2	98.0	room air
VIT-014294	Wed Nov 04, 2026 10:40 AM	rr	19.0
VIT-014387	Wed Nov 04, 2026 10:40 AM	temp_c	36.9
VIT-014388	Wed Nov 04, 2026 10:40 AM	hr	82.0
VIT-014389	Wed Nov 04, 2026 10:40 AM	map	90.0
VIT-014390	Wed Nov 04, 2026 10:40 AM	gcs	15.0

Medications, orders, echo, history (6)

MED-000574 10-27 19:20 cefepime per protocol IV
MED-000575 10-28 05:00 piperacillin-tazobactam per protocol IV
MED-000576 10-29 05:00 piperacillin-tazobactam per protocol IV
MED-000577 10-27 22:20 sodium chloride 3% 100 mL IV
ORD-000128 10-27 18:50 blood_culture: blood cultures x2
ORD-000129 10-27 21:20 fluid_restriction: fluid restriction 1.2 L/day

Notes

History and physical · DOC-000488 · Dr. Elena Nakashima (resident) · Tue Oct 27, 2026 09:20 PM

Cited facts from this note (1)

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

Show source for infection_source

… ospital Medicine Attending: Dr. Rosalind Quillan History of present illness: 87-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: GERD, type 2 diabetes, hypertension. Review of systems otherwise negative. Exam: Lungs: cl …

Source document DOC-000488: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Jun Ivers   MRN: MRN29444894   Admitted: 2026-10-27 18:20
Service: Hospital Medicine   Attending: Dr. Rosalind Quillan

History of present illness: 87-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: GERD, type 2 diabetes, hypertension.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.
2. CKD stage 3b: renally dose medications.

Progress note · DOC-000489 · Dr. Elena Nakashima (resident) · Thu Oct 29, 2026 07:20 PM

Source document DOC-000489: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Jun Ivers   MRN: MRN29444894   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.

Resident: Dr. Elena Nakashima   Attending cosign: completed

Discharge summary · DOC-000490 · Dr. Rosalind Quillan (attending) · Wed Nov 04, 2026 11:54 AM

Source document DOC-000490: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Jun Ivers   MRN: MRN29444894
Admitted 2026-10-27; discharged 2026-11-04.

Discharge diagnoses:
- community-acquired pneumonia
- CKD stage 3b
- GERD
- type 2 diabetes
- hypertension

Disposition: home with follow-up.