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-00146: Zara Abernath

54M · MRN72407843 · Cardiology · admitted Thu Oct 29, 2026 09:05 AM · discharged Fri Nov 06, 2026 03:15 PM · attending Dr. Kenji Stavros · resident Dr. Camila Oyelaran · 178 cm, 52.4 kg

Documented diagnoses (current)

“severe protein-calorie malnutrition” · E43 Unspecified severe protein-calorie malnutrition
“CKD stage 4” · N18.4 Chronic kidney disease, stage 4 (severe)
Principal: “acute on chronic systolic heart failure” · I50.23 Acute on chronic systolic (congestive) heart failure
“anemia” · D64.9 Anemia, unspecified
“hypertension” · I10 Essential (primary) hypertension
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 291 Heart failure and shock with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 292.

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=1.047, t.ratio_s1=1.5, creat_rise_48h=0.18, 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=1.047, t.ratio_s3=3.0, creat_peak=3.14, 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=1.047, 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=0.18, 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 met

No gap

Supported as documented (D64.9).

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=10.35, t.hb_m=13, t.hb_f=12	true
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=True, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=True, hgb_drop=0.4, t.drop_min=1.0, prbc_units=0	true

Chronic kidney disease

Criteria met

No gap

Supported as documented (N18.4).

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=25.8, egfr_late=23.9	25.8
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=25.8, t.g2=60, egfr_late=23.9	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=25.8, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G4
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=25.8, egfr_late=23.9, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=25.8, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G4	false
outcome: g3b	`category == 'G3b'`	category=G4	false
outcome: g4	`category == 'G4'`	category=G4	true

Heart failure

Criteria met

No gap

Supported as documented (I50.23).

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=819.0, 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=False	2
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=25.0, t.ref=40, t.pres=50	systolic
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=25.0, 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=2, hf_history=True	acute on chronic
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=systolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=acute on 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 met

Clinical validation gap

Documented “severe protein-calorie malnutrition” (E43) conflicts with what the criteria support (Moderate (non-severe) protein-calorie malnutrition (acute illness context), E44.0).

Trace

Rule trace (rule malnutrition v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: a_sev_intake	`intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days`	intake_pct=60.0, t.a_sev_intake_pct=50, intake_days=14.0, t.a_sev_intake_days=5	false
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=60.0, t.a_mod_intake_pct=75, intake_days=14.0, t.a_mod_intake_days=7	true
derived: a_sev_wt	`(wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5)`	wt_loss_days=30.0, wt_loss_pct=3.0	false
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=30.0, wt_loss_pct=3.0	false
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=60.0, t.c_intake_pct=75, intake_days=14.0, t.c_intake_days=30	false
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=60.0, t.c_intake_pct=75, intake_days=14.0, t.c_intake_days=30	false
derived: c_sev_wt	`(wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20)`	wt_loss_days=30.0, wt_loss_pct=3.0	false
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=30.0, wt_loss_pct=3.0	false
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=60.0, wt_loss_pct=3.0, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown	5
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=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=False	0
derived: n_moderate	`case(nutr_context == 'acute', count(a_sev_intake or a_mod_intake, a_sev_wt or a_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), nutr_context == 'chronic', count(c_sev_intake or c_mod_intake, c_sev_wt or c_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), null)`	nutr_context=acute, a_sev_intake=False, a_mod_intake=True, a_sev_wt=False, a_mod_wt=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=False, c_mod_wt=False	3
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=3	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=54, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=16.5, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=16.5, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=16.5, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=16.5, 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=37.4, 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=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=18.0, 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=10.47, t.wbc_hi=12, wbc_min_48h=6.68, 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=182.0	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=0.99	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=3.01	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=3.0	2
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=2	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, 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=False	true

Structured data

Labs (49)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-005003	Sun Oct 05, 2025 09:15 AM	creatinine	2.82 mg/dL
LAB-005004	Sun Sep 20, 2026 10:05 AM	creatinine	3.0 mg/dL
LAB-005005	Thu Oct 29, 2026 10:05 AM	creatinine	3.01 mg/dL
LAB-005014	Thu Oct 29, 2026 10:05 AM	bnp	819.0 pg/mL
LAB-005015	Thu Oct 29, 2026 10:05 AM	sodium	137.0 mmol/L
LAB-005024	Thu Oct 29, 2026 10:05 AM	hemoglobin	10.71 g/dL
LAB-005033	Thu Oct 29, 2026 10:05 AM	wbc	10.47 x10^3/uL
LAB-005034	Thu Oct 29, 2026 10:05 AM	platelets	182.0 x10^3/uL
LAB-005051	Thu Oct 29, 2026 10:05 AM	bilirubin	0.99 mg/dL
LAB-005006	Fri Oct 30, 2026 05:00 AM	creatinine	3.0 mg/dL
LAB-005016	Fri Oct 30, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-005025	Fri Oct 30, 2026 05:00 AM	hemoglobin	10.5 g/dL
LAB-005035	Fri Oct 30, 2026 05:00 AM	wbc	6.68 x10^3/uL
LAB-005036	Fri Oct 30, 2026 05:00 AM	platelets	210.0 x10^3/uL
LAB-005007	Sat Oct 31, 2026 05:00 AM	creatinine	2.95 mg/dL
LAB-005017	Sat Oct 31, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-005026	Sat Oct 31, 2026 05:00 AM	hemoglobin	10.65 g/dL
LAB-005037	Sat Oct 31, 2026 05:00 AM	wbc	9.28 x10^3/uL
LAB-005038	Sat Oct 31, 2026 05:00 AM	platelets	222.0 x10^3/uL
LAB-005008	Sun Nov 01, 2026 05:00 AM	creatinine	2.96 mg/dL
LAB-005018	Sun Nov 01, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-005027	Sun Nov 01, 2026 05:00 AM	hemoglobin	10.67 g/dL
LAB-005039	Sun Nov 01, 2026 05:00 AM	wbc	10.41 x10^3/uL
LAB-005040	Sun Nov 01, 2026 05:00 AM	platelets	299.0 x10^3/uL
LAB-005009	Mon Nov 02, 2026 05:00 AM	creatinine	3.14 mg/dL
LAB-005019	Mon Nov 02, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-005028	Mon Nov 02, 2026 05:00 AM	hemoglobin	10.35 g/dL
LAB-005041	Mon Nov 02, 2026 05:00 AM	wbc	6.22 x10^3/uL
LAB-005042	Mon Nov 02, 2026 05:00 AM	platelets	185.0 x10^3/uL
LAB-005010	Tue Nov 03, 2026 05:00 AM	creatinine	3.04 mg/dL
LAB-005020	Tue Nov 03, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-005029	Tue Nov 03, 2026 05:00 AM	hemoglobin	10.64 g/dL
LAB-005043	Tue Nov 03, 2026 05:00 AM	wbc	8.5 x10^3/uL
LAB-005044	Tue Nov 03, 2026 05:00 AM	platelets	243.0 x10^3/uL
LAB-005011	Wed Nov 04, 2026 05:00 AM	creatinine	3.13 mg/dL
LAB-005021	Wed Nov 04, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-005030	Wed Nov 04, 2026 05:00 AM	hemoglobin	10.46 g/dL
LAB-005045	Wed Nov 04, 2026 05:00 AM	wbc	8.37 x10^3/uL
LAB-005046	Wed Nov 04, 2026 05:00 AM	platelets	283.0 x10^3/uL
LAB-005012	Thu Nov 05, 2026 05:00 AM	creatinine	3.1 mg/dL
LAB-005022	Thu Nov 05, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-005031	Thu Nov 05, 2026 05:00 AM	hemoglobin	10.38 g/dL
LAB-005047	Thu Nov 05, 2026 05:00 AM	wbc	6.62 x10^3/uL
LAB-005048	Thu Nov 05, 2026 05:00 AM	platelets	262.0 x10^3/uL
LAB-005013	Fri Nov 06, 2026 05:00 AM	creatinine	2.99 mg/dL
LAB-005023	Fri Nov 06, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-005032	Fri Nov 06, 2026 05:00 AM	hemoglobin	10.47 g/dL
LAB-005049	Fri Nov 06, 2026 05:00 AM	wbc	8.31 x10^3/uL
LAB-005050	Fri Nov 06, 2026 05:00 AM	platelets	235.0 x10^3/uL

Vitals (150)

Vitals
Row	When	Kind	Value	Detail
VIT-014391	Thu Oct 29, 2026 09:25 AM	spo2	94.0	room air
VIT-014392	Thu Oct 29, 2026 09:25 AM	rr	17.0
VIT-014441	Thu Oct 29, 2026 09:25 AM	temp_c	37.4
VIT-014442	Thu Oct 29, 2026 09:25 AM	hr	85.0
VIT-014443	Thu Oct 29, 2026 09:25 AM	map	91.0
VIT-014444	Thu Oct 29, 2026 09:25 AM	gcs	15.0
VIT-014393	Thu Oct 29, 2026 05:25 PM	spo2	95.0	room air
VIT-014394	Thu Oct 29, 2026 05:25 PM	rr	15.0
VIT-014445	Thu Oct 29, 2026 05:25 PM	temp_c	36.6
VIT-014446	Thu Oct 29, 2026 05:25 PM	hr	84.0
VIT-014447	Thu Oct 29, 2026 05:25 PM	map	82.0
VIT-014448	Thu Oct 29, 2026 05:25 PM	gcs	15.0
VIT-014395	Fri Oct 30, 2026 01:25 AM	spo2	97.0	room air
VIT-014396	Fri Oct 30, 2026 01:25 AM	rr	18.0
VIT-014449	Fri Oct 30, 2026 01:25 AM	temp_c	37.1
VIT-014450	Fri Oct 30, 2026 01:25 AM	hr	86.0
VIT-014451	Fri Oct 30, 2026 01:25 AM	map	76.0
VIT-014452	Fri Oct 30, 2026 01:25 AM	gcs	15.0
VIT-014397	Fri Oct 30, 2026 09:25 AM	spo2	98.0	room air
VIT-014398	Fri Oct 30, 2026 09:25 AM	rr	16.0
VIT-014453	Fri Oct 30, 2026 09:25 AM	temp_c	37.2
VIT-014454	Fri Oct 30, 2026 09:25 AM	hr	72.0
VIT-014455	Fri Oct 30, 2026 09:25 AM	map	83.0
VIT-014456	Fri Oct 30, 2026 09:25 AM	gcs	15.0
VIT-014399	Fri Oct 30, 2026 05:25 PM	spo2	97.0	room air
VIT-014400	Fri Oct 30, 2026 05:25 PM	rr	16.0
VIT-014457	Fri Oct 30, 2026 05:25 PM	temp_c	36.7
VIT-014458	Fri Oct 30, 2026 05:25 PM	hr	86.0
VIT-014459	Fri Oct 30, 2026 05:25 PM	map	83.0
VIT-014460	Fri Oct 30, 2026 05:25 PM	gcs	15.0
VIT-014401	Sat Oct 31, 2026 01:25 AM	spo2	94.0	room air
VIT-014402	Sat Oct 31, 2026 01:25 AM	rr	14.0
VIT-014461	Sat Oct 31, 2026 01:25 AM	temp_c	37.2
VIT-014462	Sat Oct 31, 2026 01:25 AM	hr	84.0
VIT-014463	Sat Oct 31, 2026 01:25 AM	map	87.0
VIT-014464	Sat Oct 31, 2026 01:25 AM	gcs	15.0
VIT-014403	Sat Oct 31, 2026 09:25 AM	spo2	97.0	room air
VIT-014404	Sat Oct 31, 2026 09:25 AM	rr	17.0
VIT-014465	Sat Oct 31, 2026 09:25 AM	temp_c	37.2
VIT-014466	Sat Oct 31, 2026 09:25 AM	hr	85.0
VIT-014467	Sat Oct 31, 2026 09:25 AM	map	88.0
VIT-014468	Sat Oct 31, 2026 09:25 AM	gcs	15.0
VIT-014405	Sat Oct 31, 2026 05:25 PM	spo2	96.0	room air
VIT-014406	Sat Oct 31, 2026 05:25 PM	rr	17.0
VIT-014469	Sat Oct 31, 2026 05:25 PM	temp_c	37.3
VIT-014470	Sat Oct 31, 2026 05:25 PM	hr	88.0
VIT-014471	Sat Oct 31, 2026 05:25 PM	map	75.0
VIT-014472	Sat Oct 31, 2026 05:25 PM	gcs	15.0
VIT-014407	Sun Nov 01, 2026 01:25 AM	spo2	97.0	room air
VIT-014408	Sun Nov 01, 2026 01:25 AM	rr	16.0
VIT-014473	Sun Nov 01, 2026 01:25 AM	temp_c	36.5
VIT-014474	Sun Nov 01, 2026 01:25 AM	hr	84.0
VIT-014475	Sun Nov 01, 2026 01:25 AM	map	80.0
VIT-014476	Sun Nov 01, 2026 01:25 AM	gcs	15.0
VIT-014409	Sun Nov 01, 2026 09:25 AM	spo2	96.0	room air
VIT-014410	Sun Nov 01, 2026 09:25 AM	rr	20.0
VIT-014477	Sun Nov 01, 2026 09:25 AM	temp_c	36.5
VIT-014478	Sun Nov 01, 2026 09:25 AM	hr	86.0
VIT-014479	Sun Nov 01, 2026 09:25 AM	map	92.0
VIT-014480	Sun Nov 01, 2026 09:25 AM	gcs	15.0
VIT-014411	Sun Nov 01, 2026 05:25 PM	spo2	98.0	room air
VIT-014412	Sun Nov 01, 2026 05:25 PM	rr	18.0
VIT-014481	Sun Nov 01, 2026 05:25 PM	temp_c	37.1
VIT-014482	Sun Nov 01, 2026 05:25 PM	hr	68.0
VIT-014483	Sun Nov 01, 2026 05:25 PM	map	91.0
VIT-014484	Sun Nov 01, 2026 05:25 PM	gcs	15.0
VIT-014413	Mon Nov 02, 2026 01:25 AM	spo2	96.0	room air
VIT-014414	Mon Nov 02, 2026 01:25 AM	rr	19.0
VIT-014485	Mon Nov 02, 2026 01:25 AM	temp_c	37.3
VIT-014486	Mon Nov 02, 2026 01:25 AM	hr	82.0
VIT-014487	Mon Nov 02, 2026 01:25 AM	map	91.0
VIT-014488	Mon Nov 02, 2026 01:25 AM	gcs	15.0
VIT-014415	Mon Nov 02, 2026 09:25 AM	spo2	97.0	room air
VIT-014416	Mon Nov 02, 2026 09:25 AM	rr	14.0
VIT-014489	Mon Nov 02, 2026 09:25 AM	temp_c	36.9
VIT-014490	Mon Nov 02, 2026 09:25 AM	hr	88.0
VIT-014491	Mon Nov 02, 2026 09:25 AM	map	88.0
VIT-014492	Mon Nov 02, 2026 09:25 AM	gcs	15.0
VIT-014417	Mon Nov 02, 2026 05:25 PM	spo2	95.0	room air
VIT-014418	Mon Nov 02, 2026 05:25 PM	rr	17.0
VIT-014493	Mon Nov 02, 2026 05:25 PM	temp_c	36.6
VIT-014494	Mon Nov 02, 2026 05:25 PM	hr	77.0
VIT-014495	Mon Nov 02, 2026 05:25 PM	map	85.0
VIT-014496	Mon Nov 02, 2026 05:25 PM	gcs	15.0
VIT-014419	Tue Nov 03, 2026 01:25 AM	spo2	98.0	room air
VIT-014420	Tue Nov 03, 2026 01:25 AM	rr	19.0
VIT-014497	Tue Nov 03, 2026 01:25 AM	temp_c	37.5
VIT-014498	Tue Nov 03, 2026 01:25 AM	hr	78.0
VIT-014499	Tue Nov 03, 2026 01:25 AM	map	85.0
VIT-014500	Tue Nov 03, 2026 01:25 AM	gcs	15.0
VIT-014421	Tue Nov 03, 2026 09:25 AM	spo2	97.0	room air
VIT-014422	Tue Nov 03, 2026 09:25 AM	rr	14.0
VIT-014501	Tue Nov 03, 2026 09:25 AM	temp_c	37.3
VIT-014502	Tue Nov 03, 2026 09:25 AM	hr	77.0
VIT-014503	Tue Nov 03, 2026 09:25 AM	map	87.0
VIT-014504	Tue Nov 03, 2026 09:25 AM	gcs	15.0
VIT-014423	Tue Nov 03, 2026 05:25 PM	spo2	96.0	room air
VIT-014424	Tue Nov 03, 2026 05:25 PM	rr	17.0
VIT-014505	Tue Nov 03, 2026 05:25 PM	temp_c	37.0
VIT-014506	Tue Nov 03, 2026 05:25 PM	hr	85.0
VIT-014507	Tue Nov 03, 2026 05:25 PM	map	77.0
VIT-014508	Tue Nov 03, 2026 05:25 PM	gcs	15.0
VIT-014425	Wed Nov 04, 2026 01:25 AM	spo2	98.0	room air
VIT-014426	Wed Nov 04, 2026 01:25 AM	rr	18.0
VIT-014509	Wed Nov 04, 2026 01:25 AM	temp_c	37.5
VIT-014510	Wed Nov 04, 2026 01:25 AM	hr	86.0
VIT-014511	Wed Nov 04, 2026 01:25 AM	map	89.0
VIT-014512	Wed Nov 04, 2026 01:25 AM	gcs	15.0
VIT-014427	Wed Nov 04, 2026 09:25 AM	spo2	96.0	room air
VIT-014428	Wed Nov 04, 2026 09:25 AM	rr	18.0
VIT-014513	Wed Nov 04, 2026 09:25 AM	temp_c	37.4
VIT-014514	Wed Nov 04, 2026 09:25 AM	hr	76.0
VIT-014515	Wed Nov 04, 2026 09:25 AM	map	75.0
VIT-014516	Wed Nov 04, 2026 09:25 AM	gcs	15.0
VIT-014429	Wed Nov 04, 2026 05:25 PM	spo2	94.0	room air
VIT-014430	Wed Nov 04, 2026 05:25 PM	rr	17.0
VIT-014517	Wed Nov 04, 2026 05:25 PM	temp_c	37.1
VIT-014518	Wed Nov 04, 2026 05:25 PM	hr	78.0
VIT-014519	Wed Nov 04, 2026 05:25 PM	map	86.0
VIT-014520	Wed Nov 04, 2026 05:25 PM	gcs	15.0
VIT-014431	Thu Nov 05, 2026 01:25 AM	spo2	99.0	room air
VIT-014432	Thu Nov 05, 2026 01:25 AM	rr	18.0
VIT-014521	Thu Nov 05, 2026 01:25 AM	temp_c	36.6
VIT-014522	Thu Nov 05, 2026 01:25 AM	hr	77.0
VIT-014523	Thu Nov 05, 2026 01:25 AM	map	79.0
VIT-014524	Thu Nov 05, 2026 01:25 AM	gcs	15.0
VIT-014433	Thu Nov 05, 2026 09:25 AM	spo2	97.0	room air
VIT-014434	Thu Nov 05, 2026 09:25 AM	rr	15.0
VIT-014525	Thu Nov 05, 2026 09:25 AM	temp_c	36.9
VIT-014526	Thu Nov 05, 2026 09:25 AM	hr	70.0
VIT-014527	Thu Nov 05, 2026 09:25 AM	map	89.0
VIT-014528	Thu Nov 05, 2026 09:25 AM	gcs	15.0
VIT-014435	Thu Nov 05, 2026 05:25 PM	spo2	96.0	room air
VIT-014436	Thu Nov 05, 2026 05:25 PM	rr	14.0
VIT-014529	Thu Nov 05, 2026 05:25 PM	temp_c	37.1
VIT-014530	Thu Nov 05, 2026 05:25 PM	hr	88.0
VIT-014531	Thu Nov 05, 2026 05:25 PM	map	91.0
VIT-014532	Thu Nov 05, 2026 05:25 PM	gcs	15.0
VIT-014437	Fri Nov 06, 2026 01:25 AM	spo2	95.0	room air
VIT-014438	Fri Nov 06, 2026 01:25 AM	rr	15.0
VIT-014533	Fri Nov 06, 2026 01:25 AM	temp_c	37.3
VIT-014534	Fri Nov 06, 2026 01:25 AM	hr	71.0
VIT-014535	Fri Nov 06, 2026 01:25 AM	map	84.0
VIT-014536	Fri Nov 06, 2026 01:25 AM	gcs	15.0
VIT-014439	Fri Nov 06, 2026 09:25 AM	spo2	97.0	room air
VIT-014440	Fri Nov 06, 2026 09:25 AM	rr	17.0
VIT-014537	Fri Nov 06, 2026 09:25 AM	temp_c	37.4
VIT-014538	Fri Nov 06, 2026 09:25 AM	hr	92.0
VIT-014539	Fri Nov 06, 2026 09:25 AM	map	83.0
VIT-014540	Fri Nov 06, 2026 09:25 AM	gcs	15.0

Medications, orders, echo, history (8)

MED-000578 10-29 08:00 furosemide 40 mg IV
MED-000579 10-29 20:00 furosemide 40 mg IV
MED-000580 10-30 08:00 furosemide 40 mg IV
MED-000581 10-30 20:00 furosemide 40 mg IV
MED-000582 10-31 08:00 furosemide 40 mg IV
MED-000583 10-31 20:00 furosemide 40 mg IV
ECH-000068 2026-10-30 echo LVEF 25.0%
HX-000053 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000492 · Dr. Camila Oyelaran (resident) · Thu Oct 29, 2026 12:05 PM

Source document DOC-000492: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Zara Abernath   MRN: MRN72407843   Admitted: 2026-10-29 09:05
Service: Cardiology   Attending: Dr. Kenji Stavros

History of present illness: 54-year-old man admitted with acute on chronic systolic heart failure. 
Past medical history: heart failure with reduced ejection fraction, hypertension, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. CKD stage 4: renally dose medications.
2. Acute on chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000491 · Viggo Ravensworth, RD (dietitian) · Fri Oct 30, 2026 11:05 AM

Cited facts from this note (8)

fat_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for fat_loss

… Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… ake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
intake_days: 14 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Zara Abernath MRN: MRN72407843 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip …
intake_pct: 60 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Zara Abernath MRN: MRN72407843 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip …
muscle_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Zara Abernath MRN: MRN72407843 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneo …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… gistered Dietitian) Patient: Zara Abernath MRN: MRN72407843 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets cri …
weight_loss_pct: 3 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… gistered Dietitian) Patient: Zara Abernath MRN: MRN72407843 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets cri …

Source document DOC-000491: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Zara Abernath   MRN: MRN72407843

Context: acute illness
Intake: estimated energy intake 60% of needs for 14 days.
Weight history: 3% weight loss over 30 days.
Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation.
Grip strength: not assessed.
Assessment: meets criteria for non-severe (moderate) malnutrition.

Progress note · DOC-000493 · Dr. Camila Oyelaran (resident) · Sat Oct 31, 2026 12:05 PM

Source document DOC-000493: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Zara Abernath   MRN: MRN72407843   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Acute on chronic systolic heart failure: continue current management.
2. Severe protein-calorie malnutrition: dietitian following, supplements.
3. Anemia: trend hemoglobin.

Resident: Dr. Camila Oyelaran   Attending cosign: completed

Discharge summary · DOC-000494 · Dr. Kenji Stavros (attending) · Fri Nov 06, 2026 03:15 PM

Source document DOC-000494: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Zara Abernath   MRN: MRN72407843
Admitted 2026-10-29; discharged 2026-11-06.

Discharge diagnoses:
- severe protein-calorie malnutrition
- CKD stage 4
- acute on chronic systolic heart failure
- anemia
- hypertension
- hyperlipidemia

Disposition: home with follow-up.