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-00148: Esme Bellweather

87F · MRN40275993 · Hospital Medicine · admitted Mon Nov 02, 2026 08:59 AM · discharged Sat Nov 07, 2026 04:55 PM · attending Dr. Rosalind Quillan · 170 cm, 65.4 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“acute on chronic diastolic heart failure” · I50.33 Acute on chronic diastolic (congestive) heart failure
“hypertension” · I10 Essential (primary) hypertension
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications

Illustrative grouping now: MS-DRG 193 Simple pneumonia and pleurisy with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 193.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

Specificity gap

Criteria support Acute kidney injury (KDIGO stage 1) (N17.9); no corresponding diagnosis is documented.

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=1.714, t.ratio_s1=1.5, creat_rise_48h=0.19, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	true
derived: stage3	`meets_definition and (creat_ratio >= t.ratio_s3 or creat_peak >= t.scr_s3 or rrt_started or coalesce(uo_hours_lt_0_3 >= t.uo_s3_h, false) or coalesce(anuria_hours >= t.anuria_h, false))`	meets_definition=True, creat_ratio=1.714, t.ratio_s3=3.0, creat_peak=0.84, 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=1.714, 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=True	1
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.19, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=1, baseline_independent=True	true

Acute blood loss anaemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=F, hgb_nadir=13.22, 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=0.1, 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=0.1, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=13.22, anaemic=False	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=250, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=91.2, egfr_late=91.2	91.2
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=91.2, t.g2=60, egfr_late=91.2	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=91.2, 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=91.2, egfr_late=91.2, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=91.2, t.g2=60	true

Heart failure

Criteria met

No gap

Supported as documented (I50.33).

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=1643.0, 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=65.0, 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=65.0, 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=diastolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=acute on chronic	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=diastolic, acuity=acute on chronic	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=acute on chronic	false
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=diastolic, 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=136.0, t.profound=125, t.moderate=130, t.low=135	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=136.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, t.low=135	true

Malnutrition

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule malnutrition v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: a_sev_intake	`intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days`	intake_pct=100.0, t.a_sev_intake_pct=50, intake_days=unknown, t.a_sev_intake_days=5	false
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=100.0, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7	false
derived: a_sev_wt	`(wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: a_mod_wt	`(wt_loss_days <= 7 and wt_loss_pct >= 1) or (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=100.0, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	false
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=100.0, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	false
derived: c_sev_wt	`(wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_mod_wt	`(wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) or (wt_loss_days <= 183 and wt_loss_pct >= 10) or (wt_loss_days <= 366 and wt_loss_pct >= 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=100.0, wt_loss_pct=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown	4
derived: n_severe	`case(nutr_context == 'acute', count(a_sev_intake, a_sev_wt, fat_loss >= 2, muscle_loss >= 2, fluid >= 2, grip_reduced), nutr_context == 'chronic', count(c_sev_intake, c_sev_wt, fat_loss >= 3, muscle_loss >= 3, fluid >= 3, grip_reduced), null)`	nutr_context=acute, a_sev_intake=False, a_sev_wt=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=unknown	0
derived: n_moderate	`case(nutr_context == 'acute', count(a_sev_intake or a_mod_intake, a_sev_wt or a_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), nutr_context == 'chronic', count(c_sev_intake or c_mod_intake, c_sev_wt or c_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), null)`	nutr_context=acute, a_sev_intake=False, a_mod_intake=False, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=unknown, c_mod_wt=unknown	0
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=0	false
outcome: one_characteristic	`n_moderate == 1`	n_moderate=0	false
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=0, n_assessed=4	true

Obesity

Criteria 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=22.6, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=22.6, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=22.6, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=22.6, 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=37.3, 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=8.7, t.wbc_hi=12, wbc_min_48h=6.12, 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=0.46	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=0.84	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=0.49	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-005076	Sun Nov 02, 2025 09:15 AM	creatinine	0.49 mg/dL
LAB-005077	Sat Jul 11, 2026 10:05 AM	creatinine	0.49 mg/dL
LAB-005078	Mon Nov 02, 2026 09:59 AM	creatinine	0.65 mg/dL
LAB-005084	Mon Nov 02, 2026 09:59 AM	bnp	1643.0 pg/mL
LAB-005085	Mon Nov 02, 2026 09:59 AM	sodium	136.0 mmol/L
LAB-005091	Mon Nov 02, 2026 09:59 AM	hemoglobin	13.31 g/dL
LAB-005097	Mon Nov 02, 2026 09:59 AM	wbc	6.12 x10^3/uL
LAB-005098	Mon Nov 02, 2026 09:59 AM	platelets	182.0 x10^3/uL
LAB-005109	Mon Nov 02, 2026 09:59 AM	bilirubin	0.46 mg/dL
LAB-005079	Tue Nov 03, 2026 05:00 AM	creatinine	0.84 mg/dL
LAB-005086	Tue Nov 03, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-005092	Tue Nov 03, 2026 05:00 AM	hemoglobin	13.28 g/dL
LAB-005099	Tue Nov 03, 2026 05:00 AM	wbc	8.05 x10^3/uL
LAB-005100	Tue Nov 03, 2026 05:00 AM	platelets	299.0 x10^3/uL
LAB-005080	Wed Nov 04, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-005087	Wed Nov 04, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-005093	Wed Nov 04, 2026 05:00 AM	hemoglobin	13.26 g/dL
LAB-005101	Wed Nov 04, 2026 05:00 AM	wbc	8.7 x10^3/uL
LAB-005102	Wed Nov 04, 2026 05:00 AM	platelets	192.0 x10^3/uL
LAB-005081	Thu Nov 05, 2026 05:00 AM	creatinine	0.63 mg/dL
LAB-005088	Thu Nov 05, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-005094	Thu Nov 05, 2026 05:00 AM	hemoglobin	13.22 g/dL
LAB-005103	Thu Nov 05, 2026 05:00 AM	wbc	8.78 x10^3/uL
LAB-005104	Thu Nov 05, 2026 05:00 AM	platelets	298.0 x10^3/uL
LAB-005082	Fri Nov 06, 2026 05:00 AM	creatinine	0.52 mg/dL
LAB-005089	Fri Nov 06, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-005095	Fri Nov 06, 2026 05:00 AM	hemoglobin	13.65 g/dL
LAB-005105	Fri Nov 06, 2026 05:00 AM	wbc	6.91 x10^3/uL
LAB-005106	Fri Nov 06, 2026 05:00 AM	platelets	275.0 x10^3/uL
LAB-005083	Sat Nov 07, 2026 05:00 AM	creatinine	0.51 mg/dL
LAB-005090	Sat Nov 07, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-005096	Sat Nov 07, 2026 05:00 AM	hemoglobin	13.52 g/dL
LAB-005107	Sat Nov 07, 2026 05:00 AM	wbc	9.28 x10^3/uL
LAB-005108	Sat Nov 07, 2026 05:00 AM	platelets	178.0 x10^3/uL

Vitals (96)

Vitals
Row	When	Kind	Value	Detail
VIT-014611	Mon Nov 02, 2026 09:19 AM	spo2	94.0	room air
VIT-014612	Mon Nov 02, 2026 09:19 AM	rr	17.0
VIT-014643	Mon Nov 02, 2026 09:19 AM	temp_c	37.2
VIT-014644	Mon Nov 02, 2026 09:19 AM	hr	80.0
VIT-014645	Mon Nov 02, 2026 09:19 AM	map	82.0
VIT-014646	Mon Nov 02, 2026 09:19 AM	gcs	15.0
VIT-014613	Mon Nov 02, 2026 05:19 PM	spo2	99.0	room air
VIT-014614	Mon Nov 02, 2026 05:19 PM	rr	19.0
VIT-014647	Mon Nov 02, 2026 05:19 PM	temp_c	36.7
VIT-014648	Mon Nov 02, 2026 05:19 PM	hr	75.0
VIT-014649	Mon Nov 02, 2026 05:19 PM	map	80.0
VIT-014650	Mon Nov 02, 2026 05:19 PM	gcs	15.0
VIT-014615	Tue Nov 03, 2026 01:19 AM	spo2	97.0	room air
VIT-014616	Tue Nov 03, 2026 01:19 AM	rr	18.0
VIT-014651	Tue Nov 03, 2026 01:19 AM	temp_c	37.0
VIT-014652	Tue Nov 03, 2026 01:19 AM	hr	73.0
VIT-014653	Tue Nov 03, 2026 01:19 AM	map	84.0
VIT-014654	Tue Nov 03, 2026 01:19 AM	gcs	15.0
VIT-014617	Tue Nov 03, 2026 09:19 AM	spo2	96.0	room air
VIT-014618	Tue Nov 03, 2026 09:19 AM	rr	20.0
VIT-014655	Tue Nov 03, 2026 09:19 AM	temp_c	36.8
VIT-014656	Tue Nov 03, 2026 09:19 AM	hr	86.0
VIT-014657	Tue Nov 03, 2026 09:19 AM	map	87.0
VIT-014658	Tue Nov 03, 2026 09:19 AM	gcs	15.0
VIT-014619	Tue Nov 03, 2026 05:19 PM	spo2	99.0	room air
VIT-014620	Tue Nov 03, 2026 05:19 PM	rr	17.0
VIT-014659	Tue Nov 03, 2026 05:19 PM	temp_c	37.3
VIT-014660	Tue Nov 03, 2026 05:19 PM	hr	68.0
VIT-014661	Tue Nov 03, 2026 05:19 PM	map	76.0
VIT-014662	Tue Nov 03, 2026 05:19 PM	gcs	15.0
VIT-014621	Wed Nov 04, 2026 01:19 AM	spo2	94.0	room air
VIT-014622	Wed Nov 04, 2026 01:19 AM	rr	20.0
VIT-014663	Wed Nov 04, 2026 01:19 AM	temp_c	36.6
VIT-014664	Wed Nov 04, 2026 01:19 AM	hr	86.0
VIT-014665	Wed Nov 04, 2026 01:19 AM	map	77.0
VIT-014666	Wed Nov 04, 2026 01:19 AM	gcs	15.0
VIT-014623	Wed Nov 04, 2026 09:19 AM	spo2	96.0	room air
VIT-014624	Wed Nov 04, 2026 09:19 AM	rr	18.0
VIT-014667	Wed Nov 04, 2026 09:19 AM	temp_c	37.4
VIT-014668	Wed Nov 04, 2026 09:19 AM	hr	70.0
VIT-014669	Wed Nov 04, 2026 09:19 AM	map	74.0
VIT-014670	Wed Nov 04, 2026 09:19 AM	gcs	15.0
VIT-014625	Wed Nov 04, 2026 05:19 PM	spo2	94.0	room air
VIT-014626	Wed Nov 04, 2026 05:19 PM	rr	20.0
VIT-014671	Wed Nov 04, 2026 05:19 PM	temp_c	37.0
VIT-014672	Wed Nov 04, 2026 05:19 PM	hr	74.0
VIT-014673	Wed Nov 04, 2026 05:19 PM	map	89.0
VIT-014674	Wed Nov 04, 2026 05:19 PM	gcs	15.0
VIT-014627	Thu Nov 05, 2026 01:19 AM	spo2	95.0	room air
VIT-014628	Thu Nov 05, 2026 01:19 AM	rr	14.0
VIT-014675	Thu Nov 05, 2026 01:19 AM	temp_c	36.9
VIT-014676	Thu Nov 05, 2026 01:19 AM	hr	79.0
VIT-014677	Thu Nov 05, 2026 01:19 AM	map	87.0
VIT-014678	Thu Nov 05, 2026 01:19 AM	gcs	15.0
VIT-014629	Thu Nov 05, 2026 09:19 AM	spo2	94.0	room air
VIT-014630	Thu Nov 05, 2026 09:19 AM	rr	18.0
VIT-014679	Thu Nov 05, 2026 09:19 AM	temp_c	37.0
VIT-014680	Thu Nov 05, 2026 09:19 AM	hr	83.0
VIT-014681	Thu Nov 05, 2026 09:19 AM	map	85.0
VIT-014682	Thu Nov 05, 2026 09:19 AM	gcs	15.0
VIT-014631	Thu Nov 05, 2026 05:19 PM	spo2	95.0	room air
VIT-014632	Thu Nov 05, 2026 05:19 PM	rr	14.0
VIT-014683	Thu Nov 05, 2026 05:19 PM	temp_c	37.6
VIT-014684	Thu Nov 05, 2026 05:19 PM	hr	68.0
VIT-014685	Thu Nov 05, 2026 05:19 PM	map	89.0
VIT-014686	Thu Nov 05, 2026 05:19 PM	gcs	15.0
VIT-014633	Fri Nov 06, 2026 01:19 AM	spo2	94.0	room air
VIT-014634	Fri Nov 06, 2026 01:19 AM	rr	20.0
VIT-014687	Fri Nov 06, 2026 01:19 AM	temp_c	37.5
VIT-014688	Fri Nov 06, 2026 01:19 AM	hr	71.0
VIT-014689	Fri Nov 06, 2026 01:19 AM	map	89.0
VIT-014690	Fri Nov 06, 2026 01:19 AM	gcs	15.0
VIT-014635	Fri Nov 06, 2026 09:19 AM	spo2	94.0	room air
VIT-014636	Fri Nov 06, 2026 09:19 AM	rr	18.0
VIT-014691	Fri Nov 06, 2026 09:19 AM	temp_c	37.5
VIT-014692	Fri Nov 06, 2026 09:19 AM	hr	87.0
VIT-014693	Fri Nov 06, 2026 09:19 AM	map	74.0
VIT-014694	Fri Nov 06, 2026 09:19 AM	gcs	15.0
VIT-014637	Fri Nov 06, 2026 05:19 PM	spo2	99.0	room air
VIT-014638	Fri Nov 06, 2026 05:19 PM	rr	20.0
VIT-014695	Fri Nov 06, 2026 05:19 PM	temp_c	36.8
VIT-014696	Fri Nov 06, 2026 05:19 PM	hr	89.0
VIT-014697	Fri Nov 06, 2026 05:19 PM	map	84.0
VIT-014698	Fri Nov 06, 2026 05:19 PM	gcs	15.0
VIT-014639	Sat Nov 07, 2026 01:19 AM	spo2	97.0	room air
VIT-014640	Sat Nov 07, 2026 01:19 AM	rr	19.0
VIT-014699	Sat Nov 07, 2026 01:19 AM	temp_c	37.5
VIT-014700	Sat Nov 07, 2026 01:19 AM	hr	80.0
VIT-014701	Sat Nov 07, 2026 01:19 AM	map	89.0
VIT-014702	Sat Nov 07, 2026 01:19 AM	gcs	15.0
VIT-014641	Sat Nov 07, 2026 09:19 AM	spo2	99.0	room air
VIT-014642	Sat Nov 07, 2026 09:19 AM	rr	18.0
VIT-014703	Sat Nov 07, 2026 09:19 AM	temp_c	37.1
VIT-014704	Sat Nov 07, 2026 09:19 AM	hr	77.0
VIT-014705	Sat Nov 07, 2026 09:19 AM	map	78.0
VIT-014706	Sat Nov 07, 2026 09:19 AM	gcs	15.0

Medications, orders, echo, history (12)

MED-000590 11-02 09:59 ceftriaxone per protocol IV
MED-000591 11-03 05:00 cefepime per protocol IV
MED-000592 11-04 05:00 piperacillin-tazobactam per protocol IV
MED-000593 11-02 08:00 furosemide 40 mg IV
MED-000594 11-02 20:00 furosemide 40 mg IV
MED-000595 11-03 08:00 furosemide 40 mg IV
MED-000596 11-03 20:00 furosemide 40 mg IV
MED-000597 11-04 08:00 furosemide 40 mg IV
MED-000598 11-04 20:00 furosemide 40 mg IV
ORD-000130 11-02 09:29 blood_culture: blood cultures x2
ECH-000070 2026-11-03 echo LVEF 65.0%
HX-000054 history: heart failure with preserved ejection fraction

Notes

History and physical · DOC-000500 · Dr. Rosalind Quillan (attending) · Mon Nov 02, 2026 11:59 AM

Cited facts from this note (1)

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

Show source for infection_source

… ospital Medicine Attending: Dr. Rosalind Quillan History of present illness: 87-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: heart failure with preserved ejection fraction, hypertension, type 2 diabetes. Review of s …

Source document DOC-000500: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Esme Bellweather   MRN: MRN40275993   Admitted: 2026-11-02 08:59
Service: Hospital Medicine   Attending: Dr. Rosalind Quillan

History of present illness: 87-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: heart failure with preserved ejection fraction, hypertension, type 2 diabetes.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.

Nutrition assessment · DOC-000499 · Vera Pemberton, RD (dietitian) · Tue Nov 03, 2026 11:59 AM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN40275993 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: Esme Bellweather MRN: MRN40275993 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: Esme Bellweather MRN: MRN40275993 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-000499: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Esme Bellweather   MRN: MRN40275993

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-000501 · Dr. Rosalind Quillan (attending) · Wed Nov 04, 2026 08:59 AM

Source document DOC-000501: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Esme Bellweather   MRN: MRN40275993   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. Acute on chronic diastolic heart failure: diuresis and daily weights; monitor electrolytes.

Attending: Dr. Rosalind Quillan

Discharge summary · DOC-000502 · Dr. Rosalind Quillan (attending) · Sat Nov 07, 2026 04:55 PM

Source document DOC-000502: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Esme Bellweather   MRN: MRN40275993
Admitted 2026-11-02; discharged 2026-11-07.

Discharge diagnoses:
- community-acquired pneumonia
- acute on chronic diastolic heart failure
- hypertension
- type 2 diabetes

Disposition: home with follow-up.