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-00157: Vera Rourke

87M · MRN54526580 · Hospital Medicine · admitted Wed Nov 04, 2026 08:39 AM · discharged Wed Nov 11, 2026 12:43 PM · attending Dr. Jalen Carrow · 161 cm, 83.3 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“renal insufficiency” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
“systolic heart failure” · I50.20 Unspecified systolic (congestive) heart failure
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 194 Simple pneumonia and pleurisy with CC. 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

Documented “renal insufficiency” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 3) (N17.9).

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=3.505, t.ratio_s1=1.5, creat_rise_48h=0.74, t.rise_abs=0.3, uo_hours_lt_0_5=30, 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=3.505, t.ratio_s3=3.0, creat_peak=3.33, t.scr_s3=4.0, rrt_started=False, uo_hours_lt_0_3=30, t.uo_s3_h=24, anuria_hours=0, t.anuria_h=12	true
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=3.505, t.ratio_s2=2.0, uo_hours_lt_0_5=30, t.uo_s2_h=12	true
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=True, stage2=True, meets_definition=True	3
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.74, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=3, baseline_independent=True	true

Acute blood loss anaemia

Criteria met

Specificity gap

Criteria support Acute blood loss anemia (D62); no corresponding diagnosis is documented.

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=9.5, 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=3.1, t.drop_major=2.0, prbc_units=2, t.prbc_major=2	true
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=True	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=315, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=75.6, egfr_late=77.5	77.5
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=75.6, t.g2=60, egfr_late=77.5	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=77.5, 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=75.6, egfr_late=77.5, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=77.5, t.g2=60	true

Heart failure

Criteria met

Specificity gap

Documented “systolic heart failure” (I50.20); criteria support the more specific Acute on chronic systolic (HFrEF) heart failure (I50.23).

Trace

Rule trace (rule heart_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: np_elevated	`coalesce(bnp_max >= t.bnp, false) or coalesce(ntprobnp_max >= t.ntprobnp, false)`	bnp_max=2127.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	true
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=True, np_elevated=True, new_o2=False	2
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=25.0, t.ref=40, t.pres=50	systolic
derived: improved	`coalesce(lvef_prior_min <= t.ref and lvef > t.ref and lvef - lvef_prior_min >= t.improved_rise, false)`	lvef_prior_min=unknown, t.ref=40, lvef=25.0, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=2, hf_history=True	acute on chronic
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=systolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=acute on chronic	true

Hyponatraemia

Criteria not met

No gap

Not documented and not supported.

Trace

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

Specificity gap

Criteria support Obesity, class 1 (E66.811); no corresponding diagnosis is documented.

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=32.1, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=32.1, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=32.1, 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 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=36.7, 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=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=10.56, t.wbc_hi=12, wbc_min_48h=7.04, 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=267.0	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=0.81	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=78.0	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=3.33	2
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=0.95	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=2, 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=0, 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 (44)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-005343	Sat Oct 04, 2025 09:15 AM	creatinine	0.97 mg/dL
LAB-005344	Sat Aug 15, 2026 10:05 AM	creatinine	0.95 mg/dL
LAB-005345	Wed Nov 04, 2026 09:39 AM	creatinine	2.59 mg/dL
LAB-005353	Wed Nov 04, 2026 09:39 AM	bnp	2127.0 pg/mL
LAB-005354	Wed Nov 04, 2026 09:39 AM	sodium	137.0 mmol/L
LAB-005362	Wed Nov 04, 2026 09:39 AM	hemoglobin	12.64 g/dL
LAB-005370	Wed Nov 04, 2026 09:39 AM	wbc	7.04 x10^3/uL
LAB-005371	Wed Nov 04, 2026 09:39 AM	platelets	267.0 x10^3/uL
LAB-005386	Wed Nov 04, 2026 09:39 AM	bilirubin	0.81 mg/dL
LAB-005346	Thu Nov 05, 2026 05:00 AM	creatinine	3.33 mg/dL
LAB-005355	Thu Nov 05, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-005363	Thu Nov 05, 2026 05:00 AM	hemoglobin	10.76 g/dL
LAB-005372	Thu Nov 05, 2026 05:00 AM	wbc	10.52 x10^3/uL
LAB-005373	Thu Nov 05, 2026 05:00 AM	platelets	269.0 x10^3/uL
LAB-005347	Fri Nov 06, 2026 05:00 AM	creatinine	2.99 mg/dL
LAB-005356	Fri Nov 06, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-005364	Fri Nov 06, 2026 05:00 AM	hemoglobin	9.5 g/dL
LAB-005374	Fri Nov 06, 2026 05:00 AM	wbc	10.56 x10^3/uL
LAB-005375	Fri Nov 06, 2026 05:00 AM	platelets	298.0 x10^3/uL
LAB-005348	Sat Nov 07, 2026 05:00 AM	creatinine	2.49 mg/dL
LAB-005357	Sat Nov 07, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-005365	Sat Nov 07, 2026 05:00 AM	hemoglobin	10.3 g/dL
LAB-005376	Sat Nov 07, 2026 05:00 AM	wbc	6.43 x10^3/uL
LAB-005377	Sat Nov 07, 2026 05:00 AM	platelets	190.0 x10^3/uL
LAB-005349	Sun Nov 08, 2026 05:00 AM	creatinine	2.06 mg/dL
LAB-005358	Sun Nov 08, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-005366	Sun Nov 08, 2026 05:00 AM	hemoglobin	10.6 g/dL
LAB-005378	Sun Nov 08, 2026 05:00 AM	wbc	10.27 x10^3/uL
LAB-005379	Sun Nov 08, 2026 05:00 AM	platelets	251.0 x10^3/uL
LAB-005350	Mon Nov 09, 2026 05:00 AM	creatinine	1.83 mg/dL
LAB-005359	Mon Nov 09, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-005367	Mon Nov 09, 2026 05:00 AM	hemoglobin	10.7 g/dL
LAB-005380	Mon Nov 09, 2026 05:00 AM	wbc	10.01 x10^3/uL
LAB-005381	Mon Nov 09, 2026 05:00 AM	platelets	308.0 x10^3/uL
LAB-005351	Tue Nov 10, 2026 05:00 AM	creatinine	1.66 mg/dL
LAB-005360	Tue Nov 10, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-005368	Tue Nov 10, 2026 05:00 AM	hemoglobin	10.7 g/dL
LAB-005382	Tue Nov 10, 2026 05:00 AM	wbc	6.42 x10^3/uL
LAB-005383	Tue Nov 10, 2026 05:00 AM	platelets	165.0 x10^3/uL
LAB-005352	Wed Nov 11, 2026 05:00 AM	creatinine	1.6 mg/dL
LAB-005361	Wed Nov 11, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-005369	Wed Nov 11, 2026 05:00 AM	hemoglobin	10.7 g/dL
LAB-005384	Wed Nov 11, 2026 05:00 AM	wbc	6.52 x10^3/uL
LAB-005385	Wed Nov 11, 2026 05:00 AM	platelets	258.0 x10^3/uL

Vitals (140)

Vitals
Row	When	Kind	Value	Detail
VIT-015337	Wed Nov 04, 2026 08:59 AM	spo2	98.0	room air
VIT-015338	Wed Nov 04, 2026 08:59 AM	rr	19.0
VIT-015381	Wed Nov 04, 2026 08:59 AM	temp_c	37.4
VIT-015382	Wed Nov 04, 2026 08:59 AM	hr	88.0
VIT-015383	Wed Nov 04, 2026 08:59 AM	map	78.0
VIT-015384	Wed Nov 04, 2026 08:59 AM	gcs	15.0
VIT-015329	Wed Nov 04, 2026 02:39 PM	urine_ml_6h	549.8
VIT-015339	Wed Nov 04, 2026 04:59 PM	spo2	96.0	room air
VIT-015340	Wed Nov 04, 2026 04:59 PM	rr	20.0
VIT-015385	Wed Nov 04, 2026 04:59 PM	temp_c	36.7
VIT-015386	Wed Nov 04, 2026 04:59 PM	hr	87.0
VIT-015387	Wed Nov 04, 2026 04:59 PM	map	80.0
VIT-015388	Wed Nov 04, 2026 04:59 PM	gcs	15.0
VIT-015330	Wed Nov 04, 2026 08:39 PM	urine_ml_6h	110.0
VIT-015341	Thu Nov 05, 2026 12:59 AM	spo2	95.0	room air
VIT-015342	Thu Nov 05, 2026 12:59 AM	rr	18.0
VIT-015389	Thu Nov 05, 2026 12:59 AM	temp_c	36.7
VIT-015390	Thu Nov 05, 2026 12:59 AM	hr	81.0
VIT-015391	Thu Nov 05, 2026 12:59 AM	map	92.0
VIT-015392	Thu Nov 05, 2026 12:59 AM	gcs	15.0
VIT-015331	Thu Nov 05, 2026 02:39 AM	urine_ml_6h	110.0
VIT-015332	Thu Nov 05, 2026 08:39 AM	urine_ml_6h	110.0
VIT-015343	Thu Nov 05, 2026 08:59 AM	spo2	96.0	room air
VIT-015344	Thu Nov 05, 2026 08:59 AM	rr	19.0
VIT-015393	Thu Nov 05, 2026 08:59 AM	temp_c	37.5
VIT-015394	Thu Nov 05, 2026 08:59 AM	hr	69.0
VIT-015395	Thu Nov 05, 2026 08:59 AM	map	81.0
VIT-015396	Thu Nov 05, 2026 08:59 AM	gcs	15.0
VIT-015333	Thu Nov 05, 2026 02:39 PM	urine_ml_6h	110.0
VIT-015345	Thu Nov 05, 2026 04:59 PM	spo2	95.0	room air
VIT-015346	Thu Nov 05, 2026 04:59 PM	rr	16.0
VIT-015397	Thu Nov 05, 2026 04:59 PM	temp_c	37.5
VIT-015398	Thu Nov 05, 2026 04:59 PM	hr	73.0
VIT-015399	Thu Nov 05, 2026 04:59 PM	map	87.0
VIT-015400	Thu Nov 05, 2026 04:59 PM	gcs	15.0
VIT-015334	Thu Nov 05, 2026 08:39 PM	urine_ml_6h	110.0
VIT-015347	Fri Nov 06, 2026 12:59 AM	spo2	97.0	room air
VIT-015348	Fri Nov 06, 2026 12:59 AM	rr	20.0
VIT-015401	Fri Nov 06, 2026 12:59 AM	temp_c	37.1
VIT-015402	Fri Nov 06, 2026 12:59 AM	hr	89.0
VIT-015403	Fri Nov 06, 2026 12:59 AM	map	85.0
VIT-015404	Fri Nov 06, 2026 12:59 AM	gcs	15.0
VIT-015335	Fri Nov 06, 2026 02:39 AM	urine_ml_6h	549.8
VIT-015336	Fri Nov 06, 2026 08:39 AM	urine_ml_6h	549.8
VIT-015349	Fri Nov 06, 2026 08:59 AM	spo2	98.0	room air
VIT-015350	Fri Nov 06, 2026 08:59 AM	rr	19.0
VIT-015405	Fri Nov 06, 2026 08:59 AM	temp_c	36.6
VIT-015406	Fri Nov 06, 2026 08:59 AM	hr	90.0
VIT-015407	Fri Nov 06, 2026 08:59 AM	map	86.0
VIT-015408	Fri Nov 06, 2026 08:59 AM	gcs	15.0
VIT-015351	Fri Nov 06, 2026 04:59 PM	spo2	97.0	room air
VIT-015352	Fri Nov 06, 2026 04:59 PM	rr	17.0
VIT-015409	Fri Nov 06, 2026 04:59 PM	temp_c	36.9
VIT-015410	Fri Nov 06, 2026 04:59 PM	hr	71.0
VIT-015411	Fri Nov 06, 2026 04:59 PM	map	83.0
VIT-015412	Fri Nov 06, 2026 04:59 PM	gcs	15.0
VIT-015353	Sat Nov 07, 2026 12:59 AM	spo2	98.0	room air
VIT-015354	Sat Nov 07, 2026 12:59 AM	rr	18.0
VIT-015413	Sat Nov 07, 2026 12:59 AM	temp_c	36.5
VIT-015414	Sat Nov 07, 2026 12:59 AM	hr	85.0
VIT-015415	Sat Nov 07, 2026 12:59 AM	map	89.0
VIT-015416	Sat Nov 07, 2026 12:59 AM	gcs	15.0
VIT-015355	Sat Nov 07, 2026 08:59 AM	spo2	98.0	room air
VIT-015356	Sat Nov 07, 2026 08:59 AM	rr	19.0
VIT-015417	Sat Nov 07, 2026 08:59 AM	temp_c	37.2
VIT-015418	Sat Nov 07, 2026 08:59 AM	hr	83.0
VIT-015419	Sat Nov 07, 2026 08:59 AM	map	85.0
VIT-015420	Sat Nov 07, 2026 08:59 AM	gcs	15.0
VIT-015357	Sat Nov 07, 2026 04:59 PM	spo2	98.0	room air
VIT-015358	Sat Nov 07, 2026 04:59 PM	rr	15.0
VIT-015421	Sat Nov 07, 2026 04:59 PM	temp_c	37.1
VIT-015422	Sat Nov 07, 2026 04:59 PM	hr	89.0
VIT-015423	Sat Nov 07, 2026 04:59 PM	map	84.0
VIT-015424	Sat Nov 07, 2026 04:59 PM	gcs	15.0
VIT-015359	Sun Nov 08, 2026 12:59 AM	spo2	95.0	room air
VIT-015360	Sun Nov 08, 2026 12:59 AM	rr	16.0
VIT-015425	Sun Nov 08, 2026 12:59 AM	temp_c	37.4
VIT-015426	Sun Nov 08, 2026 12:59 AM	hr	70.0
VIT-015427	Sun Nov 08, 2026 12:59 AM	map	80.0
VIT-015428	Sun Nov 08, 2026 12:59 AM	gcs	15.0
VIT-015361	Sun Nov 08, 2026 08:59 AM	spo2	95.0	room air
VIT-015362	Sun Nov 08, 2026 08:59 AM	rr	18.0
VIT-015429	Sun Nov 08, 2026 08:59 AM	temp_c	36.9
VIT-015430	Sun Nov 08, 2026 08:59 AM	hr	76.0
VIT-015431	Sun Nov 08, 2026 08:59 AM	map	83.0
VIT-015432	Sun Nov 08, 2026 08:59 AM	gcs	15.0
VIT-015363	Sun Nov 08, 2026 04:59 PM	spo2	98.0	room air
VIT-015364	Sun Nov 08, 2026 04:59 PM	rr	18.0
VIT-015433	Sun Nov 08, 2026 04:59 PM	temp_c	37.0
VIT-015434	Sun Nov 08, 2026 04:59 PM	hr	84.0
VIT-015435	Sun Nov 08, 2026 04:59 PM	map	85.0
VIT-015436	Sun Nov 08, 2026 04:59 PM	gcs	15.0
VIT-015365	Mon Nov 09, 2026 12:59 AM	spo2	99.0	room air
VIT-015366	Mon Nov 09, 2026 12:59 AM	rr	15.0
VIT-015437	Mon Nov 09, 2026 12:59 AM	temp_c	37.0
VIT-015438	Mon Nov 09, 2026 12:59 AM	hr	91.0
VIT-015439	Mon Nov 09, 2026 12:59 AM	map	78.0
VIT-015440	Mon Nov 09, 2026 12:59 AM	gcs	15.0
VIT-015367	Mon Nov 09, 2026 08:59 AM	spo2	99.0	room air
VIT-015368	Mon Nov 09, 2026 08:59 AM	rr	18.0
VIT-015441	Mon Nov 09, 2026 08:59 AM	temp_c	36.8
VIT-015442	Mon Nov 09, 2026 08:59 AM	hr	77.0
VIT-015443	Mon Nov 09, 2026 08:59 AM	map	83.0
VIT-015444	Mon Nov 09, 2026 08:59 AM	gcs	15.0
VIT-015369	Mon Nov 09, 2026 04:59 PM	spo2	94.0	room air
VIT-015370	Mon Nov 09, 2026 04:59 PM	rr	18.0
VIT-015445	Mon Nov 09, 2026 04:59 PM	temp_c	37.4
VIT-015446	Mon Nov 09, 2026 04:59 PM	hr	91.0
VIT-015447	Mon Nov 09, 2026 04:59 PM	map	88.0
VIT-015448	Mon Nov 09, 2026 04:59 PM	gcs	15.0
VIT-015371	Tue Nov 10, 2026 12:59 AM	spo2	99.0	room air
VIT-015372	Tue Nov 10, 2026 12:59 AM	rr	14.0
VIT-015449	Tue Nov 10, 2026 12:59 AM	temp_c	37.1
VIT-015450	Tue Nov 10, 2026 12:59 AM	hr	78.0
VIT-015451	Tue Nov 10, 2026 12:59 AM	map	90.0
VIT-015452	Tue Nov 10, 2026 12:59 AM	gcs	15.0
VIT-015373	Tue Nov 10, 2026 08:59 AM	spo2	99.0	room air
VIT-015374	Tue Nov 10, 2026 08:59 AM	rr	14.0
VIT-015453	Tue Nov 10, 2026 08:59 AM	temp_c	36.6
VIT-015454	Tue Nov 10, 2026 08:59 AM	hr	72.0
VIT-015455	Tue Nov 10, 2026 08:59 AM	map	77.0
VIT-015456	Tue Nov 10, 2026 08:59 AM	gcs	15.0
VIT-015375	Tue Nov 10, 2026 04:59 PM	spo2	95.0	room air
VIT-015376	Tue Nov 10, 2026 04:59 PM	rr	20.0
VIT-015457	Tue Nov 10, 2026 04:59 PM	temp_c	36.6
VIT-015458	Tue Nov 10, 2026 04:59 PM	hr	85.0
VIT-015459	Tue Nov 10, 2026 04:59 PM	map	84.0
VIT-015460	Tue Nov 10, 2026 04:59 PM	gcs	15.0
VIT-015377	Wed Nov 11, 2026 12:59 AM	spo2	95.0	room air
VIT-015378	Wed Nov 11, 2026 12:59 AM	rr	14.0
VIT-015461	Wed Nov 11, 2026 12:59 AM	temp_c	36.9
VIT-015462	Wed Nov 11, 2026 12:59 AM	hr	77.0
VIT-015463	Wed Nov 11, 2026 12:59 AM	map	86.0
VIT-015464	Wed Nov 11, 2026 12:59 AM	gcs	15.0
VIT-015379	Wed Nov 11, 2026 08:59 AM	spo2	94.0	room air
VIT-015380	Wed Nov 11, 2026 08:59 AM	rr	15.0
VIT-015465	Wed Nov 11, 2026 08:59 AM	temp_c	36.8
VIT-015466	Wed Nov 11, 2026 08:59 AM	hr	74.0
VIT-015467	Wed Nov 11, 2026 08:59 AM	map	78.0
VIT-015468	Wed Nov 11, 2026 08:59 AM	gcs	15.0

Medications, orders, echo, history (13)

MED-000626 11-04 09:39 ceftriaxone per protocol IV
MED-000627 11-05 05:00 cefepime per protocol IV
MED-000628 11-06 05:00 ceftriaxone per protocol IV
MED-000629 11-04 08:00 furosemide 40 mg IV
MED-000630 11-04 20:00 furosemide 40 mg IV
MED-000631 11-05 08:00 furosemide 40 mg IV
MED-000632 11-05 20:00 furosemide 40 mg IV
MED-000633 11-06 08:00 furosemide 40 mg IV
MED-000634 11-06 20:00 furosemide 40 mg IV
ORD-000136 11-04 09:09 blood_culture: blood cultures x2
ORD-000137 11-05 09:00 transfusion_prbc: transfuse PRBC
ECH-000073 2026-11-05 echo LVEF 25.0%
HX-000056 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000528 · Dr. Jalen Carrow (attending) · Wed Nov 04, 2026 11:39 AM

Cited facts from this note (2)

bleeding_source: bright red blood per rectum · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… dmitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by bright red blood per rectum. Past medical history: heart failure with reduced ejection fraction, hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: scattered crackles at t …
infection_source: multifocal pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… ice: Hospital Medicine Attending: Dr. Jalen Carrow History of present illness: 87-year-old man admitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by bright red blood per rectum. Past medical history: heart failure with reduced eje …

Source document DOC-000528: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Vera Rourke   MRN: MRN54526580   Admitted: 2026-11-04 08:39
Service: Hospital Medicine   Attending: Dr. Jalen Carrow

History of present illness: 87-year-old man admitted with community-acquired pneumonia. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by bright red blood per rectum.
Past medical history: heart failure with reduced ejection fraction, hyperlipidemia.
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-000527 · Viggo Ravensworth, RD (dietitian) · Thu Nov 05, 2026 12:39 PM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN54526580 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: Vera Rourke MRN: MRN54526580 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: Vera Rourke MRN: MRN54526580 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-000527: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Vera Rourke   MRN: MRN54526580

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-000529 · Dr. Jalen Carrow (attending) · Fri Nov 06, 2026 08:39 AM

Source document DOC-000529: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Vera Rourke   MRN: MRN54526580   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. Renal insufficiency: trend creatinine, avoid nephrotoxins.
3. Systolic heart failure: diuresis and daily weights; monitor electrolytes.

Attending: Dr. Jalen Carrow

Discharge summary · DOC-000530 · Dr. Jalen Carrow (attending) · Wed Nov 11, 2026 12:43 PM

Source document DOC-000530: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Vera Rourke   MRN: MRN54526580
Admitted 2026-11-04; discharged 2026-11-11.

Discharge diagnoses:
- community-acquired pneumonia
- renal insufficiency
- systolic heart failure
- hyperlipidemia

Disposition: home with follow-up.