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-00149: Dmitri Dunmore

88F · MRN42242224 · Hospital Medicine · admitted Tue Nov 10, 2026 10:45 AM · in hospital · attending Dr. Wes Merriweather · resident Dr. Elena Nakashima · 169 cm, 62.0 kg

Documented diagnoses (current)

Principal: “urinary tract infection” · N39.0 Urinary tract infection, site not specified
“malnourished” · E46 Unspecified protein-calorie malnutrition
“acute respiratory failure with hypoxia” · J96.01 Acute respiratory failure with hypoxia
“stage 4 sacral pressure ulcer” · L89.154 Pressure ulcer of sacral region, stage 4

Illustrative grouping now: MS-DRG 689 Kidney and urinary tract infections with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 689.

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=1.041, t.ratio_s1=1.5, creat_rise_48h=0.04, 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=1.041, t.ratio_s3=3.0, creat_peak=0.76, 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=1.041, 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=0.04, 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=12.49, 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=12.49, 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=223, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=81.7, egfr_late=79.1	81.7
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=81.7, t.g2=60, egfr_late=79.1	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=81.7, 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=81.7, egfr_late=79.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=81.7, t.g2=60	true

Heart failure

Clinical judgement required

No gap

Not documented; only one acute indicator; acuity needs clinical judgement.

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=True	1
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=1, 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=1	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

Clinical validation gap

Documented “malnourished” (E46) but the criteria are not met: 4 characteristics assessed and none met.

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=88, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=21.7, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=21.7, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=21.7, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=21.7, t.c1=30	true

Pressure injury

Criteria met

Clinical validation gap

Documented “stage 4 sacral pressure ulcer” (L89.154) conflicts with what the criteria support (Pressure injury of sacral region, stage 2, L89.152).

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=sacral	true
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=2	false
outcome: other_site	`wound_site != 'sacral'`	wound_site=sacral	false
outcome: stage1	`sacral and wound_stage == '1'`	sacral=True, wound_stage=2	false
outcome: stage2	`sacral and wound_stage == '2'`	sacral=True, wound_stage=2	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=85.0, pao2_min_ra=50.0, pf_min=238	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=85.0, t.spo2_ra=88, pao2_min_ra=50.0, t.pao2=60, pf_min=238, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=33.0, t.rr_distress=28, wob_increased=unknown, 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 met

No gap

Criteria support Sepsis (Sepsis-3); not documented (this rule does not prompt for an undocumented diagnosis).

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=33.0, 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=10.16, t.wbc_hi=12, wbc_min_48h=5.55, 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=238, adv_resp_support=False	2
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=193.0	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=0.94	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=0.76	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=0.73	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=2, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=0, sofa_renal_baseline=0	2
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=2, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, 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=True, 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=True, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=True	true

Structured data

Labs (25)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-005110	Wed Jan 14, 2026 09:15 AM	creatinine	0.71 mg/dL
LAB-005111	Wed Aug 26, 2026 10:05 AM	creatinine	0.73 mg/dL
LAB-005116	Tue Nov 10, 2026 11:10 AM	pao2	50.0 mmHg
LAB-005117	Tue Nov 10, 2026 11:10 AM	fio2	21.0 %
LAB-005112	Tue Nov 10, 2026 11:45 AM	creatinine	0.76 mg/dL
LAB-005118	Tue Nov 10, 2026 11:45 AM	sodium	140.0 mmol/L
LAB-005122	Tue Nov 10, 2026 11:45 AM	hemoglobin	12.49 g/dL
LAB-005126	Tue Nov 10, 2026 11:45 AM	wbc	8.55 x10^3/uL
LAB-005127	Tue Nov 10, 2026 11:45 AM	platelets	266.0 x10^3/uL
LAB-005134	Tue Nov 10, 2026 11:45 AM	bilirubin	0.94 mg/dL
LAB-005113	Wed Nov 11, 2026 05:00 AM	creatinine	0.72 mg/dL
LAB-005119	Wed Nov 11, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-005123	Wed Nov 11, 2026 05:00 AM	hemoglobin	12.55 g/dL
LAB-005128	Wed Nov 11, 2026 05:00 AM	wbc	5.55 x10^3/uL
LAB-005129	Wed Nov 11, 2026 05:00 AM	platelets	193.0 x10^3/uL
LAB-005114	Thu Nov 12, 2026 05:00 AM	creatinine	0.76 mg/dL
LAB-005120	Thu Nov 12, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-005124	Thu Nov 12, 2026 05:00 AM	hemoglobin	12.62 g/dL
LAB-005130	Thu Nov 12, 2026 05:00 AM	wbc	10.16 x10^3/uL
LAB-005131	Thu Nov 12, 2026 05:00 AM	platelets	262.0 x10^3/uL
LAB-005115	Fri Nov 13, 2026 05:00 AM	creatinine	0.76 mg/dL
LAB-005121	Fri Nov 13, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-005125	Fri Nov 13, 2026 05:00 AM	hemoglobin	12.53 g/dL
LAB-005132	Fri Nov 13, 2026 05:00 AM	wbc	7.78 x10^3/uL
LAB-005133	Fri Nov 13, 2026 05:00 AM	platelets	291.0 x10^3/uL

Vitals (70)

Vitals
Row	When	Kind	Value	Detail
VIT-014707	Tue Nov 10, 2026 11:05 AM	spo2	85.0	room air
VIT-014708	Tue Nov 10, 2026 11:05 AM	rr	33.0
VIT-014737	Tue Nov 10, 2026 11:05 AM	temp_c	36.9
VIT-014738	Tue Nov 10, 2026 11:05 AM	hr	89.0
VIT-014739	Tue Nov 10, 2026 11:05 AM	map	83.0
VIT-014740	Tue Nov 10, 2026 11:05 AM	gcs	15.0
VIT-014709	Tue Nov 10, 2026 11:15 AM	o2_lpm	6.0	nasal cannula
VIT-014710	Tue Nov 10, 2026 07:05 PM	spo2	95.0	nasal cannula
VIT-014711	Tue Nov 10, 2026 07:05 PM	rr	23.0
VIT-014712	Tue Nov 10, 2026 07:05 PM	o2_lpm	2.0	nasal cannula
VIT-014741	Tue Nov 10, 2026 07:05 PM	temp_c	36.6
VIT-014742	Tue Nov 10, 2026 07:05 PM	hr	86.0
VIT-014743	Tue Nov 10, 2026 07:05 PM	map	83.0
VIT-014744	Tue Nov 10, 2026 07:05 PM	gcs	15.0
VIT-014713	Wed Nov 11, 2026 03:05 AM	spo2	94.0	nasal cannula
VIT-014714	Wed Nov 11, 2026 03:05 AM	rr	21.0
VIT-014715	Wed Nov 11, 2026 03:05 AM	o2_lpm	2.0	nasal cannula
VIT-014745	Wed Nov 11, 2026 03:05 AM	temp_c	37.2
VIT-014746	Wed Nov 11, 2026 03:05 AM	hr	87.0
VIT-014747	Wed Nov 11, 2026 03:05 AM	map	88.0
VIT-014748	Wed Nov 11, 2026 03:05 AM	gcs	15.0
VIT-014716	Wed Nov 11, 2026 11:05 AM	spo2	95.0	nasal cannula
VIT-014717	Wed Nov 11, 2026 11:05 AM	rr	22.0
VIT-014718	Wed Nov 11, 2026 11:05 AM	o2_lpm	2.0	nasal cannula
VIT-014749	Wed Nov 11, 2026 11:05 AM	temp_c	37.5
VIT-014750	Wed Nov 11, 2026 11:05 AM	hr	83.0
VIT-014751	Wed Nov 11, 2026 11:05 AM	map	85.0
VIT-014752	Wed Nov 11, 2026 11:05 AM	gcs	15.0
VIT-014719	Wed Nov 11, 2026 07:05 PM	spo2	91.0	nasal cannula
VIT-014720	Wed Nov 11, 2026 07:05 PM	rr	26.0
VIT-014721	Wed Nov 11, 2026 07:05 PM	o2_lpm	3.0	nasal cannula
VIT-014753	Wed Nov 11, 2026 07:05 PM	temp_c	37.1
VIT-014754	Wed Nov 11, 2026 07:05 PM	hr	76.0
VIT-014755	Wed Nov 11, 2026 07:05 PM	map	87.0
VIT-014756	Wed Nov 11, 2026 07:05 PM	gcs	15.0
VIT-014722	Thu Nov 12, 2026 03:05 AM	spo2	94.0	nasal cannula
VIT-014723	Thu Nov 12, 2026 03:05 AM	rr	26.0
VIT-014724	Thu Nov 12, 2026 03:05 AM	o2_lpm	2.0	nasal cannula
VIT-014757	Thu Nov 12, 2026 03:05 AM	temp_c	37.4
VIT-014758	Thu Nov 12, 2026 03:05 AM	hr	89.0
VIT-014759	Thu Nov 12, 2026 03:05 AM	map	77.0
VIT-014760	Thu Nov 12, 2026 03:05 AM	gcs	15.0
VIT-014725	Thu Nov 12, 2026 11:05 AM	spo2	94.0	nasal cannula
VIT-014726	Thu Nov 12, 2026 11:05 AM	rr	20.0
VIT-014727	Thu Nov 12, 2026 11:05 AM	o2_lpm	3.0	nasal cannula
VIT-014761	Thu Nov 12, 2026 11:05 AM	temp_c	37.4
VIT-014762	Thu Nov 12, 2026 11:05 AM	hr	75.0
VIT-014763	Thu Nov 12, 2026 11:05 AM	map	90.0
VIT-014764	Thu Nov 12, 2026 11:05 AM	gcs	15.0
VIT-014728	Thu Nov 12, 2026 07:05 PM	spo2	94.0	nasal cannula
VIT-014729	Thu Nov 12, 2026 07:05 PM	rr	23.0
VIT-014730	Thu Nov 12, 2026 07:05 PM	o2_lpm	4.0	nasal cannula
VIT-014765	Thu Nov 12, 2026 07:05 PM	temp_c	36.7
VIT-014766	Thu Nov 12, 2026 07:05 PM	hr	87.0
VIT-014767	Thu Nov 12, 2026 07:05 PM	map	77.0
VIT-014768	Thu Nov 12, 2026 07:05 PM	gcs	15.0
VIT-014731	Fri Nov 13, 2026 03:05 AM	spo2	95.0	nasal cannula
VIT-014732	Fri Nov 13, 2026 03:05 AM	rr	23.0
VIT-014733	Fri Nov 13, 2026 03:05 AM	o2_lpm	3.0	nasal cannula
VIT-014769	Fri Nov 13, 2026 03:05 AM	temp_c	37.4
VIT-014770	Fri Nov 13, 2026 03:05 AM	hr	76.0
VIT-014771	Fri Nov 13, 2026 03:05 AM	map	83.0
VIT-014772	Fri Nov 13, 2026 03:05 AM	gcs	15.0
VIT-014734	Fri Nov 13, 2026 11:05 AM	spo2	95.0	nasal cannula
VIT-014735	Fri Nov 13, 2026 11:05 AM	rr	21.0
VIT-014736	Fri Nov 13, 2026 11:05 AM	o2_lpm	4.0	nasal cannula
VIT-014773	Fri Nov 13, 2026 11:05 AM	temp_c	37.0
VIT-014774	Fri Nov 13, 2026 11:05 AM	hr	68.0
VIT-014775	Fri Nov 13, 2026 11:05 AM	map	77.0
VIT-014776	Fri Nov 13, 2026 11:05 AM	gcs	15.0

Medications, orders, echo, history (4)

MED-000599 11-10 11:45 piperacillin-tazobactam per protocol IV
MED-000600 11-11 05:00 ceftriaxone per protocol IV
MED-000601 11-12 05:00 ceftriaxone per protocol IV
ORD-000131 11-10 11:15 blood_culture: blood cultures x2

Notes

History and physical · DOC-000505 · Dr. Elena Nakashima (resident) · Tue Nov 10, 2026 01:45 PM

Cited facts from this note (1)

infection_source: urinary tract infection · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… 42242224 Admitted: 2026-11-10 10:45 Service: Hospital Medicine Attending: Dr. Wes Merriweather History of present illness: 88-year-old woman admitted with urinary tract infection. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime. Past medical history: none significant. Review of systems otherwise negative. Exam: Lu …

Source document DOC-000505: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Dmitri Dunmore   MRN: MRN42242224   Admitted: 2026-11-10 10:45
Service: Hospital Medicine   Attending: Dr. Wes Merriweather

History of present illness: 88-year-old woman admitted with urinary tract infection. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime.
Past medical history: none significant.
Review of systems otherwise negative.
Exam: Lungs: labored respirations.
Assessment and plan:
1. Urinary tract infection: antibiotics.

Wound care note · DOC-000504 · Elena Jessup, RN, CWOCN (wound_nurse) · Wed Nov 11, 2026 11:45 AM

Cited facts from this note (2)

wound_site: sacral · cited p. 1, line 4 · confidence 0.95

Show source for wound_site

WOUND CARE NOTE Patient: Dmitri Dunmore MRN: MRN42242224 Location: sacrum Stage: 2 (NPIAP) Description: partial-thickness skin loss with exposed dermis. Size: 2.8 x 3.7 x 0.8 cm. Plan: offloading every 2 hours, foam dressing, nutriti …
wound_stage: 2 · cited p. 1, line 5 · confidence 0.95

Show source for wound_stage

WOUND CARE NOTE Patient: Dmitri Dunmore MRN: MRN42242224 Location: sacrum Stage: 2 (NPIAP) Description: partial-thickness skin loss with exposed dermis. Size: 2.8 x 3.7 x 0.8 cm. Plan: offloading every 2 hours, foam dressing, nutrition consul …

Source document DOC-000504: Wound care note (synthetic)

WOUND CARE NOTE
Patient: Dmitri Dunmore   MRN: MRN42242224

Location: sacrum
Stage: 2 (NPIAP)
Description: partial-thickness skin loss with exposed dermis.
Size: 2.8 x 3.7 x 0.8 cm.
Plan: offloading every 2 hours, foam dressing, nutrition consult.

Nutrition assessment · DOC-000503 · Vera Pemberton, RD (dietitian) · Wed Nov 11, 2026 01:45 PM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN42242224 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: Dmitri Dunmore MRN: MRN42242224 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: Dmitri Dunmore MRN: MRN42242224 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-000503: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Dmitri Dunmore   MRN: MRN42242224

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-000506 · Dr. Elena Nakashima (resident) · Fri Nov 13, 2026 10:55 AM · awaiting cosign

Source document DOC-000506: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Dmitri Dunmore   MRN: MRN42242224   Hospital day 4

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Urinary tract infection: continue current management.
2. Malnourished: dietitian following.
3. Acute respiratory failure with hypoxia: supplemental oxygen, wean as tolerated.
4. Stage 4 sacral pressure ulcer: wound care following, offloading.

Resident: Dr. Elena Nakashima   Attending cosign: pending