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-00147: Avery Treadwell

64M · MRN69716954 · Cardiology · admitted Mon Nov 09, 2026 09:59 AM · discharged Thu Nov 12, 2026 11:01 AM · attending Dr. Gideon Zeller · resident Dr. Greta Kowalczyk · 163 cm, 50.3 kg

Documented diagnoses (current)

“malnutrition” · E46 Unspecified protein-calorie malnutrition
Principal: “CHF” · I50.9 Heart failure, unspecified
“acute respiratory failure with hypoxia” · J96.01 Acute respiratory failure with hypoxia
“anemia” · D64.9 Anemia, unspecified
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis
“hypertension” · I10 Essential (primary) hypertension

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 291.

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=1.01, 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=1.01, t.ratio_s3=3.0, creat_peak=1.03, 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=1.01, 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 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=10.11, 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=0.0, 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=True, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=True, hgb_drop=0.0, t.drop_min=1.0, prbc_units=0	true

Chronic kidney disease

Clinical judgement required

No gap

Not documented; egfr 60 or above; ckd g1-g2 requires markers of kidney damage, which are not assessed here.

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=371, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=86.1, egfr_late=82.1	86.1
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=86.1, t.g2=60, egfr_late=82.1	false
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=86.1, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
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=False, egfr_early=86.1, egfr_late=82.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=86.1, t.g2=60	true

Heart failure

Criteria met

Specificity gap

Documented “CHF” (I50.9); criteria support the more specific Acute diastolic (HFpEF) heart failure (I50.31).

Trace

Rule trace (rule heart_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: np_elevated	`coalesce(bnp_max >= t.bnp, false) or coalesce(ntprobnp_max >= t.ntprobnp, false)`	bnp_max=1618.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	true
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=True, np_elevated=True, new_o2=True	3
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=56.0, 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=56.0, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=3, hf_history=False	acute
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=diastolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=acute	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=diastolic, acuity=acute	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=acute	false
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=acute	false
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=diastolic, acuity=acute	true

Hyponatraemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=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 met

Specificity gap

Documented “malnutrition” (E46); criteria support the more specific 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=70.0, 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=70.0, 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=5.2	true
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=5.2	true
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=70.0, 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=70.0, 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=5.2	true
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=5.2	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=70.0, wt_loss_pct=5.2, 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=True, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=True	1
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=True, a_mod_wt=True, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=True, c_mod_wt=True	4
outcome: severe	`n_severe >= 2`	n_severe=1	false
outcome: moderate	`n_moderate >= 2`	n_moderate=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=64, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=18.9, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=18.9, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=18.9, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=18.9, 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 met

No gap

Supported as documented (J96.01).

Trace

Rule trace (rule respiratory_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: measured	`present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min)`	spo2_min_ra=82.0, 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=82.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=31.0, t.rr_distress=28, wob_increased=True, adv_resp_support=False	true
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=True	false
outcome: met	`hypoxemia and distress`	hypoxemia=True, distress=True	true

Sepsis

Criteria 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=89.0, 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=31.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	true
derived: sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`	wbc_max_48h=7.88, t.wbc_hi=12, wbc_min_48h=5.81, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	false
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=False, sirs_hr=False, sirs_rr=True, sirs_wbc=False	1
derived: sofa_resp	`coalesce(case(pf_min_48h < 100 and adv_resp_support, 4, pf_min_48h < 200 and adv_resp_support, 3, pf_min_48h < 300, 2, pf_min_48h < 400, 1, 0), 0)`	pf_min_48h=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=195.0	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=77.0	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=1.03	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=1.02	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=False, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, sirs_count=1, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=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 (24)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-005052	Sun Sep 21, 2025 09:15 AM	creatinine	0.98 mg/dL
LAB-005053	Sun Sep 27, 2026 10:05 AM	creatinine	1.02 mg/dL
LAB-005054	Mon Nov 09, 2026 10:59 AM	creatinine	1.0 mg/dL
LAB-005058	Mon Nov 09, 2026 10:59 AM	bnp	1618.0 pg/mL
LAB-005059	Mon Nov 09, 2026 10:59 AM	sodium	142.0 mmol/L
LAB-005063	Mon Nov 09, 2026 10:59 AM	hemoglobin	10.11 g/dL
LAB-005067	Mon Nov 09, 2026 10:59 AM	wbc	6.4 x10^3/uL
LAB-005068	Mon Nov 09, 2026 10:59 AM	platelets	195.0 x10^3/uL
LAB-005075	Mon Nov 09, 2026 10:59 AM	bilirubin	0.7 mg/dL
LAB-005055	Tue Nov 10, 2026 05:00 AM	creatinine	1.02 mg/dL
LAB-005060	Tue Nov 10, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-005064	Tue Nov 10, 2026 05:00 AM	hemoglobin	10.28 g/dL
LAB-005069	Tue Nov 10, 2026 05:00 AM	wbc	7.88 x10^3/uL
LAB-005070	Tue Nov 10, 2026 05:00 AM	platelets	279.0 x10^3/uL
LAB-005056	Wed Nov 11, 2026 05:00 AM	creatinine	1.03 mg/dL
LAB-005061	Wed Nov 11, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-005065	Wed Nov 11, 2026 05:00 AM	hemoglobin	10.26 g/dL
LAB-005071	Wed Nov 11, 2026 05:00 AM	wbc	5.81 x10^3/uL
LAB-005072	Wed Nov 11, 2026 05:00 AM	platelets	292.0 x10^3/uL
LAB-005057	Thu Nov 12, 2026 05:00 AM	creatinine	1.02 mg/dL
LAB-005062	Thu Nov 12, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-005066	Thu Nov 12, 2026 05:00 AM	hemoglobin	10.15 g/dL
LAB-005073	Thu Nov 12, 2026 05:00 AM	wbc	9.39 x10^3/uL
LAB-005074	Thu Nov 12, 2026 05:00 AM	platelets	223.0 x10^3/uL

Vitals (70)

Vitals
Row	When	Kind	Value	Detail
VIT-014541	Mon Nov 09, 2026 10:19 AM	spo2	82.0	room air
VIT-014542	Mon Nov 09, 2026 10:19 AM	rr	31.0
VIT-014571	Mon Nov 09, 2026 10:19 AM	temp_c	37.5
VIT-014572	Mon Nov 09, 2026 10:19 AM	hr	88.0
VIT-014573	Mon Nov 09, 2026 10:19 AM	map	90.0
VIT-014574	Mon Nov 09, 2026 10:19 AM	gcs	15.0
VIT-014543	Mon Nov 09, 2026 10:29 AM	o2_lpm	6.0	nasal cannula
VIT-014544	Mon Nov 09, 2026 06:19 PM	spo2	95.0	nasal cannula
VIT-014545	Mon Nov 09, 2026 06:19 PM	rr	24.0
VIT-014546	Mon Nov 09, 2026 06:19 PM	o2_lpm	4.0	nasal cannula
VIT-014575	Mon Nov 09, 2026 06:19 PM	temp_c	36.7
VIT-014576	Mon Nov 09, 2026 06:19 PM	hr	76.0
VIT-014577	Mon Nov 09, 2026 06:19 PM	map	85.0
VIT-014578	Mon Nov 09, 2026 06:19 PM	gcs	15.0
VIT-014547	Tue Nov 10, 2026 02:19 AM	spo2	94.0	nasal cannula
VIT-014548	Tue Nov 10, 2026 02:19 AM	rr	26.0
VIT-014549	Tue Nov 10, 2026 02:19 AM	o2_lpm	3.0	nasal cannula
VIT-014579	Tue Nov 10, 2026 02:19 AM	temp_c	36.7
VIT-014580	Tue Nov 10, 2026 02:19 AM	hr	80.0
VIT-014581	Tue Nov 10, 2026 02:19 AM	map	87.0
VIT-014582	Tue Nov 10, 2026 02:19 AM	gcs	15.0
VIT-014550	Tue Nov 10, 2026 10:19 AM	spo2	95.0	nasal cannula
VIT-014551	Tue Nov 10, 2026 10:19 AM	rr	20.0
VIT-014552	Tue Nov 10, 2026 10:19 AM	o2_lpm	3.0	nasal cannula
VIT-014583	Tue Nov 10, 2026 10:19 AM	temp_c	36.6
VIT-014584	Tue Nov 10, 2026 10:19 AM	hr	78.0
VIT-014585	Tue Nov 10, 2026 10:19 AM	map	88.0
VIT-014586	Tue Nov 10, 2026 10:19 AM	gcs	15.0
VIT-014553	Tue Nov 10, 2026 06:19 PM	spo2	91.0	nasal cannula
VIT-014554	Tue Nov 10, 2026 06:19 PM	rr	26.0
VIT-014555	Tue Nov 10, 2026 06:19 PM	o2_lpm	4.0	nasal cannula
VIT-014587	Tue Nov 10, 2026 06:19 PM	temp_c	37.4
VIT-014588	Tue Nov 10, 2026 06:19 PM	hr	84.0
VIT-014589	Tue Nov 10, 2026 06:19 PM	map	77.0
VIT-014590	Tue Nov 10, 2026 06:19 PM	gcs	15.0
VIT-014556	Wed Nov 11, 2026 02:19 AM	spo2	92.0	nasal cannula
VIT-014557	Wed Nov 11, 2026 02:19 AM	rr	23.0
VIT-014558	Wed Nov 11, 2026 02:19 AM	o2_lpm	3.0	nasal cannula
VIT-014591	Wed Nov 11, 2026 02:19 AM	temp_c	37.1
VIT-014592	Wed Nov 11, 2026 02:19 AM	hr	89.0
VIT-014593	Wed Nov 11, 2026 02:19 AM	map	89.0
VIT-014594	Wed Nov 11, 2026 02:19 AM	gcs	15.0
VIT-014559	Wed Nov 11, 2026 10:19 AM	spo2	91.0	nasal cannula
VIT-014560	Wed Nov 11, 2026 10:19 AM	rr	25.0
VIT-014561	Wed Nov 11, 2026 10:19 AM	o2_lpm	4.0	nasal cannula
VIT-014595	Wed Nov 11, 2026 10:19 AM	temp_c	37.1
VIT-014596	Wed Nov 11, 2026 10:19 AM	hr	68.0
VIT-014597	Wed Nov 11, 2026 10:19 AM	map	80.0
VIT-014598	Wed Nov 11, 2026 10:19 AM	gcs	15.0
VIT-014562	Wed Nov 11, 2026 06:19 PM	spo2	91.0	nasal cannula
VIT-014563	Wed Nov 11, 2026 06:19 PM	rr	24.0
VIT-014564	Wed Nov 11, 2026 06:19 PM	o2_lpm	4.0	nasal cannula
VIT-014599	Wed Nov 11, 2026 06:19 PM	temp_c	36.5
VIT-014600	Wed Nov 11, 2026 06:19 PM	hr	72.0
VIT-014601	Wed Nov 11, 2026 06:19 PM	map	90.0
VIT-014602	Wed Nov 11, 2026 06:19 PM	gcs	15.0
VIT-014565	Thu Nov 12, 2026 02:19 AM	spo2	95.0	nasal cannula
VIT-014566	Thu Nov 12, 2026 02:19 AM	rr	23.0
VIT-014567	Thu Nov 12, 2026 02:19 AM	o2_lpm	4.0	nasal cannula
VIT-014603	Thu Nov 12, 2026 02:19 AM	temp_c	37.4
VIT-014604	Thu Nov 12, 2026 02:19 AM	hr	74.0
VIT-014605	Thu Nov 12, 2026 02:19 AM	map	91.0
VIT-014606	Thu Nov 12, 2026 02:19 AM	gcs	15.0
VIT-014568	Thu Nov 12, 2026 10:19 AM	spo2	94.0	nasal cannula
VIT-014569	Thu Nov 12, 2026 10:19 AM	rr	21.0
VIT-014570	Thu Nov 12, 2026 10:19 AM	o2_lpm	3.0	nasal cannula
VIT-014607	Thu Nov 12, 2026 10:19 AM	temp_c	36.8
VIT-014608	Thu Nov 12, 2026 10:19 AM	hr	91.0
VIT-014609	Thu Nov 12, 2026 10:19 AM	map	82.0
VIT-014610	Thu Nov 12, 2026 10:19 AM	gcs	15.0

Medications, orders, echo, history (7)

MED-000584 11-09 08:00 furosemide 40 mg IV
MED-000585 11-09 20:00 furosemide 40 mg IV
MED-000586 11-10 08:00 furosemide 40 mg IV
MED-000587 11-10 20:00 furosemide 40 mg IV
MED-000588 11-11 08:00 furosemide 40 mg IV
MED-000589 11-11 20:00 furosemide 40 mg IV
ECH-000069 2026-11-10 echo LVEF 56.0%

Notes

History and physical · DOC-000496 · Dr. Greta Kowalczyk (resident) · Mon Nov 09, 2026 12:59 PM

Cited facts from this note (1)

work_of_breathing: increased · cited p. 1, line 8 · confidence 0.90

Show source for work_of_breathing

… sent illness: 64-year-old man admitted with CHF. Past medical history: type 2 diabetes, GERD, hypertension. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessory muscle use. Assessment and plan: 1. CHF: diuresis and daily weights; monitor electrolytes.

Source document DOC-000496: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Avery Treadwell   MRN: MRN69716954   Admitted: 2026-11-09 09:59
Service: Cardiology   Attending: Dr. Gideon Zeller

History of present illness: 64-year-old man admitted with CHF. 
Past medical history: type 2 diabetes, GERD, hypertension.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscle use.
Assessment and plan:
1. CHF: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000495 · Viggo Ravensworth, RD (dietitian) · Tue Nov 10, 2026 02:59 PM

Cited facts from this note (8)

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

Show source for fat_loss

… ontext: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.2% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… e 70% of needs for 14 days. Weight history: 5.2% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
intake_days: 14 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Avery Treadwell MRN: MRN69716954 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.2% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Rec …
intake_pct: 70 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Avery Treadwell MRN: MRN69716954 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.2% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Rec …
muscle_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… stimated energy intake 70% of needs for 14 days. Weight history: 5.2% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Avery Treadwell MRN: MRN69716954 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.2% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutan …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… stered Dietitian) Patient: Avery Treadwell MRN: MRN69716954 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.2% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; cal …
weight_loss_pct: 5.2 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… stered Dietitian) Patient: Avery Treadwell MRN: MRN69716954 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.2% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; cal …

Source document DOC-000495: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Avery Treadwell   MRN: MRN69716954

Context: acute illness
Intake: estimated energy intake 70% of needs for 14 days.
Weight history: 5.2% weight loss over 30 days.
Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation.
Recommendations: high-protein oral supplement; calorie counts; weekly weights.

Progress note · DOC-000497 · Dr. Greta Kowalczyk (resident) · Wed Nov 11, 2026 10:59 AM

Source document DOC-000497: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Avery Treadwell   MRN: MRN69716954   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. CHF: continue current management.
2. Malnutrition: dietitian following.
3. Acute respiratory failure with hypoxia: supplemental oxygen, wean as tolerated.
4. Anemia: trend hemoglobin.

Resident: Dr. Greta Kowalczyk   Attending cosign: completed

Discharge summary · DOC-000498 · Dr. Gideon Zeller (attending) · Thu Nov 12, 2026 11:01 AM

Source document DOC-000498: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Avery Treadwell   MRN: MRN69716954
Admitted 2026-11-09; discharged 2026-11-12.

Discharge diagnoses:
- malnutrition
- CHF
- acute respiratory failure with hypoxia
- anemia
- type 2 diabetes
- GERD
- hypertension

Disposition: home with follow-up.