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-00152: Ximena Kestrel

61M · MRN68907732 · Cardiology · admitted Sat Nov 07, 2026 08:24 AM · discharged Thu Nov 12, 2026 02:54 PM · attending Dr. Wes Merriweather · 174 cm, 94.8 kg

Documented diagnoses (current)

“class 1 obesity” · E66.811 Obesity, class 1
“CKD” · N18.9 Chronic kidney disease, unspecified
“acute kidney injury” · N17.9 Acute kidney failure, unspecified
Principal: “acute diastolic heart failure” · I50.31 Acute diastolic (congestive) heart failure
“hyponatremia” · E87.1 Hypo-osmolality and hyponatremia
“stage 4 sacral pressure ulcer” · L89.154 Pressure ulcer of sacral region, stage 4

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

Clinical validation gap

Documented “acute kidney injury” (N17.9) but the criteria are not met: KDIGO creatinine and urine-output criteria not met.

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=1.053, t.ratio_s1=1.5, creat_rise_48h=0.14, 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=1.053, t.ratio_s3=3.0, creat_peak=3.79, 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=1.053, 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=0.14, 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=M, hgb_nadir=13.72, 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=0.6, 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=0.6, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=13.72, anaemic=False	true

Chronic kidney disease

Criteria met

Specificity gap

Documented “CKD” (N18.9); criteria support the more specific Chronic kidney disease stage 4 (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=330, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=18.2, egfr_late=18.4	18.4
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=18.2, t.g2=60, egfr_late=18.4	true
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=18.4, 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=18.2, egfr_late=18.4, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=18.4, 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 (I50.31).

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=2198.0, 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=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=2, 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

Clinical validation gap

Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 138).

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=138.0, 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=138.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=138.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=138.0, t.low=135	true

Malnutrition

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

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

Obesity

Criteria met

No gap

Supported as documented (E66.811).

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=61, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=31.3, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=31.3, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=31.3, t.c1=30	true

Pressure injury

Criteria met

No gap

Supported as documented (L89.154).

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=4	false
outcome: other_site	`wound_site != 'sacral'`	wound_site=sacral	false
outcome: stage1	`sacral and wound_stage == '1'`	sacral=True, wound_stage=4	false
outcome: stage2	`sacral and wound_stage == '2'`	sacral=True, wound_stage=4	false
outcome: stage3	`sacral and wound_stage == '3'`	sacral=True, wound_stage=4	false
outcome: stage4	`sacral and wound_stage == '4'`	sacral=True, wound_stage=4	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=36.5, 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=17.0, 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=8.75, t.wbc_hi=12, wbc_min_48h=8.14, 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=274.0	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=0.48	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=80.0	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=3.76	3
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=3.6	3
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=3, sofa_renal_baseline=3	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 (34)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-005215	Wed Oct 22, 2025 09:15 AM	creatinine	3.64 mg/dL
LAB-005216	Thu Sep 17, 2026 10:05 AM	creatinine	3.6 mg/dL
LAB-005217	Sat Nov 07, 2026 09:24 AM	creatinine	3.76 mg/dL
LAB-005223	Sat Nov 07, 2026 09:24 AM	bnp	2198.0 pg/mL
LAB-005224	Sat Nov 07, 2026 09:24 AM	sodium	140.0 mmol/L
LAB-005230	Sat Nov 07, 2026 09:24 AM	hemoglobin	14.28 g/dL
LAB-005236	Sat Nov 07, 2026 09:24 AM	wbc	8.72 x10^3/uL
LAB-005237	Sat Nov 07, 2026 09:24 AM	platelets	283.0 x10^3/uL
LAB-005248	Sat Nov 07, 2026 09:24 AM	bilirubin	0.48 mg/dL
LAB-005218	Sun Nov 08, 2026 05:00 AM	creatinine	3.69 mg/dL
LAB-005225	Sun Nov 08, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-005231	Sun Nov 08, 2026 05:00 AM	hemoglobin	14.06 g/dL
LAB-005238	Sun Nov 08, 2026 05:00 AM	wbc	8.14 x10^3/uL
LAB-005239	Sun Nov 08, 2026 05:00 AM	platelets	274.0 x10^3/uL
LAB-005219	Mon Nov 09, 2026 05:00 AM	creatinine	3.68 mg/dL
LAB-005226	Mon Nov 09, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-005232	Mon Nov 09, 2026 05:00 AM	hemoglobin	13.83 g/dL
LAB-005240	Mon Nov 09, 2026 05:00 AM	wbc	8.75 x10^3/uL
LAB-005241	Mon Nov 09, 2026 05:00 AM	platelets	285.0 x10^3/uL
LAB-005220	Tue Nov 10, 2026 05:00 AM	creatinine	3.65 mg/dL
LAB-005227	Tue Nov 10, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-005233	Tue Nov 10, 2026 05:00 AM	hemoglobin	13.72 g/dL
LAB-005242	Tue Nov 10, 2026 05:00 AM	wbc	7.86 x10^3/uL
LAB-005243	Tue Nov 10, 2026 05:00 AM	platelets	235.0 x10^3/uL
LAB-005221	Wed Nov 11, 2026 05:00 AM	creatinine	3.68 mg/dL
LAB-005228	Wed Nov 11, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-005234	Wed Nov 11, 2026 05:00 AM	hemoglobin	13.78 g/dL
LAB-005244	Wed Nov 11, 2026 05:00 AM	wbc	10.64 x10^3/uL
LAB-005245	Wed Nov 11, 2026 05:00 AM	platelets	305.0 x10^3/uL
LAB-005222	Thu Nov 12, 2026 05:00 AM	creatinine	3.79 mg/dL
LAB-005229	Thu Nov 12, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-005235	Thu Nov 12, 2026 05:00 AM	hemoglobin	14.26 g/dL
LAB-005246	Thu Nov 12, 2026 05:00 AM	wbc	10.37 x10^3/uL
LAB-005247	Thu Nov 12, 2026 05:00 AM	platelets	182.0 x10^3/uL

Vitals (96)

Vitals
Row	When	Kind	Value	Detail
VIT-015011	Sat Nov 07, 2026 08:44 AM	spo2	98.0	room air
VIT-015012	Sat Nov 07, 2026 08:44 AM	rr	15.0
VIT-015043	Sat Nov 07, 2026 08:44 AM	temp_c	37.1
VIT-015044	Sat Nov 07, 2026 08:44 AM	hr	84.0
VIT-015045	Sat Nov 07, 2026 08:44 AM	map	80.0
VIT-015046	Sat Nov 07, 2026 08:44 AM	gcs	15.0
VIT-015013	Sat Nov 07, 2026 04:44 PM	spo2	98.0	room air
VIT-015014	Sat Nov 07, 2026 04:44 PM	rr	17.0
VIT-015047	Sat Nov 07, 2026 04:44 PM	temp_c	36.9
VIT-015048	Sat Nov 07, 2026 04:44 PM	hr	87.0
VIT-015049	Sat Nov 07, 2026 04:44 PM	map	88.0
VIT-015050	Sat Nov 07, 2026 04:44 PM	gcs	15.0
VIT-015015	Sun Nov 08, 2026 12:44 AM	spo2	98.0	room air
VIT-015016	Sun Nov 08, 2026 12:44 AM	rr	14.0
VIT-015051	Sun Nov 08, 2026 12:44 AM	temp_c	37.4
VIT-015052	Sun Nov 08, 2026 12:44 AM	hr	89.0
VIT-015053	Sun Nov 08, 2026 12:44 AM	map	90.0
VIT-015054	Sun Nov 08, 2026 12:44 AM	gcs	15.0
VIT-015017	Sun Nov 08, 2026 08:44 AM	spo2	98.0	room air
VIT-015018	Sun Nov 08, 2026 08:44 AM	rr	15.0
VIT-015055	Sun Nov 08, 2026 08:44 AM	temp_c	36.5
VIT-015056	Sun Nov 08, 2026 08:44 AM	hr	78.0
VIT-015057	Sun Nov 08, 2026 08:44 AM	map	87.0
VIT-015058	Sun Nov 08, 2026 08:44 AM	gcs	15.0
VIT-015019	Sun Nov 08, 2026 04:44 PM	spo2	96.0	room air
VIT-015020	Sun Nov 08, 2026 04:44 PM	rr	16.0
VIT-015059	Sun Nov 08, 2026 04:44 PM	temp_c	37.3
VIT-015060	Sun Nov 08, 2026 04:44 PM	hr	69.0
VIT-015061	Sun Nov 08, 2026 04:44 PM	map	90.0
VIT-015062	Sun Nov 08, 2026 04:44 PM	gcs	15.0
VIT-015021	Mon Nov 09, 2026 12:44 AM	spo2	96.0	room air
VIT-015022	Mon Nov 09, 2026 12:44 AM	rr	15.0
VIT-015063	Mon Nov 09, 2026 12:44 AM	temp_c	37.0
VIT-015064	Mon Nov 09, 2026 12:44 AM	hr	88.0
VIT-015065	Mon Nov 09, 2026 12:44 AM	map	88.0
VIT-015066	Mon Nov 09, 2026 12:44 AM	gcs	15.0
VIT-015023	Mon Nov 09, 2026 08:44 AM	spo2	95.0	room air
VIT-015024	Mon Nov 09, 2026 08:44 AM	rr	15.0
VIT-015067	Mon Nov 09, 2026 08:44 AM	temp_c	36.6
VIT-015068	Mon Nov 09, 2026 08:44 AM	hr	74.0
VIT-015069	Mon Nov 09, 2026 08:44 AM	map	91.0
VIT-015070	Mon Nov 09, 2026 08:44 AM	gcs	15.0
VIT-015025	Mon Nov 09, 2026 04:44 PM	spo2	94.0	room air
VIT-015026	Mon Nov 09, 2026 04:44 PM	rr	19.0
VIT-015071	Mon Nov 09, 2026 04:44 PM	temp_c	36.8
VIT-015072	Mon Nov 09, 2026 04:44 PM	hr	77.0
VIT-015073	Mon Nov 09, 2026 04:44 PM	map	74.0
VIT-015074	Mon Nov 09, 2026 04:44 PM	gcs	15.0
VIT-015027	Tue Nov 10, 2026 12:44 AM	spo2	96.0	room air
VIT-015028	Tue Nov 10, 2026 12:44 AM	rr	14.0
VIT-015075	Tue Nov 10, 2026 12:44 AM	temp_c	37.6
VIT-015076	Tue Nov 10, 2026 12:44 AM	hr	69.0
VIT-015077	Tue Nov 10, 2026 12:44 AM	map	83.0
VIT-015078	Tue Nov 10, 2026 12:44 AM	gcs	15.0
VIT-015029	Tue Nov 10, 2026 08:44 AM	spo2	97.0	room air
VIT-015030	Tue Nov 10, 2026 08:44 AM	rr	16.0
VIT-015079	Tue Nov 10, 2026 08:44 AM	temp_c	37.6
VIT-015080	Tue Nov 10, 2026 08:44 AM	hr	82.0
VIT-015081	Tue Nov 10, 2026 08:44 AM	map	89.0
VIT-015082	Tue Nov 10, 2026 08:44 AM	gcs	15.0
VIT-015031	Tue Nov 10, 2026 04:44 PM	spo2	96.0	room air
VIT-015032	Tue Nov 10, 2026 04:44 PM	rr	14.0
VIT-015083	Tue Nov 10, 2026 04:44 PM	temp_c	37.1
VIT-015084	Tue Nov 10, 2026 04:44 PM	hr	75.0
VIT-015085	Tue Nov 10, 2026 04:44 PM	map	78.0
VIT-015086	Tue Nov 10, 2026 04:44 PM	gcs	15.0
VIT-015033	Wed Nov 11, 2026 12:44 AM	spo2	95.0	room air
VIT-015034	Wed Nov 11, 2026 12:44 AM	rr	16.0
VIT-015087	Wed Nov 11, 2026 12:44 AM	temp_c	37.3
VIT-015088	Wed Nov 11, 2026 12:44 AM	hr	69.0
VIT-015089	Wed Nov 11, 2026 12:44 AM	map	90.0
VIT-015090	Wed Nov 11, 2026 12:44 AM	gcs	15.0
VIT-015035	Wed Nov 11, 2026 08:44 AM	spo2	97.0	room air
VIT-015036	Wed Nov 11, 2026 08:44 AM	rr	19.0
VIT-015091	Wed Nov 11, 2026 08:44 AM	temp_c	37.5
VIT-015092	Wed Nov 11, 2026 08:44 AM	hr	71.0
VIT-015093	Wed Nov 11, 2026 08:44 AM	map	87.0
VIT-015094	Wed Nov 11, 2026 08:44 AM	gcs	15.0
VIT-015037	Wed Nov 11, 2026 04:44 PM	spo2	98.0	room air
VIT-015038	Wed Nov 11, 2026 04:44 PM	rr	19.0
VIT-015095	Wed Nov 11, 2026 04:44 PM	temp_c	36.5
VIT-015096	Wed Nov 11, 2026 04:44 PM	hr	91.0
VIT-015097	Wed Nov 11, 2026 04:44 PM	map	87.0
VIT-015098	Wed Nov 11, 2026 04:44 PM	gcs	15.0
VIT-015039	Thu Nov 12, 2026 12:44 AM	spo2	96.0	room air
VIT-015040	Thu Nov 12, 2026 12:44 AM	rr	20.0
VIT-015099	Thu Nov 12, 2026 12:44 AM	temp_c	37.1
VIT-015100	Thu Nov 12, 2026 12:44 AM	hr	89.0
VIT-015101	Thu Nov 12, 2026 12:44 AM	map	89.0
VIT-015102	Thu Nov 12, 2026 12:44 AM	gcs	15.0
VIT-015041	Thu Nov 12, 2026 08:44 AM	spo2	94.0	room air
VIT-015042	Thu Nov 12, 2026 08:44 AM	rr	19.0
VIT-015103	Thu Nov 12, 2026 08:44 AM	temp_c	37.1
VIT-015104	Thu Nov 12, 2026 08:44 AM	hr	84.0
VIT-015105	Thu Nov 12, 2026 08:44 AM	map	82.0
VIT-015106	Thu Nov 12, 2026 08:44 AM	gcs	15.0

Medications, orders, echo, history (7)

MED-000608 11-07 08:00 furosemide 40 mg IV
MED-000609 11-07 20:00 furosemide 40 mg IV
MED-000610 11-08 08:00 furosemide 40 mg IV
MED-000611 11-08 20:00 furosemide 40 mg IV
MED-000612 11-09 08:00 furosemide 40 mg IV
MED-000613 11-09 20:00 furosemide 40 mg IV
ECH-000072 2026-11-08 echo LVEF 56.0%

Notes

History and physical · DOC-000515 · Dr. Wes Merriweather (attending) · Sat Nov 07, 2026 11:24 AM

Source document DOC-000515: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Ximena Kestrel   MRN: MRN68907732   Admitted: 2026-11-07 08:24
Service: Cardiology   Attending: Dr. Wes Merriweather

History of present illness: 61-year-old man admitted with acute diastolic heart failure. 
Past medical history: none significant.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. CKD: renally dose medications.
2. Acute diastolic heart failure: diuresis and daily weights; monitor electrolytes.

Wound care note · DOC-000514 · Elena Jessup, RN, CWOCN (wound_nurse) · Sun Nov 08, 2026 11:24 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: Ximena Kestrel MRN: MRN68907732 Location: sacrum Stage: 4 (NPIAP) Description: full-thickness tissue loss with palpable bone. Size: 5.3 x 3.6 x 1.2 cm. Plan: offloading every 2 hours, foam dressing, nutrition …
wound_stage: 4 · cited p. 1, line 5 · confidence 0.95

Show source for wound_stage

WOUND CARE NOTE Patient: Ximena Kestrel MRN: MRN68907732 Location: sacrum Stage: 4 (NPIAP) Description: full-thickness tissue loss with palpable bone. Size: 5.3 x 3.6 x 1.2 cm. Plan: offloading every 2 hours, foam dressing, nutrition consult.

Source document DOC-000514: Wound care note (synthetic)

WOUND CARE NOTE
Patient: Ximena Kestrel   MRN: MRN68907732

Location: sacrum
Stage: 4 (NPIAP)
Description: full-thickness tissue loss with palpable bone.
Size: 5.3 x 3.6 x 1.2 cm.
Plan: offloading every 2 hours, foam dressing, nutrition consult.

Progress note · DOC-000516 · Dr. Wes Merriweather (attending) · Mon Nov 09, 2026 10:24 AM

Source document DOC-000516: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Ximena Kestrel   MRN: MRN68907732   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Acute diastolic heart failure: continue current management.
2. Class 1 obesity: counsel on weight.
3. Acute kidney injury: trend creatinine, hold nephrotoxins, strict intake and output.
4. Hyponatremia: trend sodium.
5. Stage 4 sacral pressure ulcer: wound care following, offloading.

Attending: Dr. Wes Merriweather

Discharge summary · DOC-000517 · Dr. Wes Merriweather (attending) · Thu Nov 12, 2026 02:54 PM

Source document DOC-000517: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Ximena Kestrel   MRN: MRN68907732
Admitted 2026-11-07; discharged 2026-11-12.

Discharge diagnoses:
- class 1 obesity
- CKD
- acute kidney injury
- acute diastolic heart failure
- hyponatremia
- stage 4 sacral pressure ulcer

Disposition: home with follow-up.