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-00158: Ines Ivers

67M · MRN18356138 · Cardiology · admitted Thu Nov 05, 2026 09:29 AM · discharged Tue Nov 10, 2026 03:05 PM · attending Dr. Jalen Carrow · 161 cm, 85.3 kg

Documented diagnoses (current)

“morbid obesity” · E66.01 Morbid (severe) obesity due to excess calories
Principal: “chronic systolic heart failure” · I50.22 Chronic systolic (congestive) heart failure
“hypoxemia” · R09.02 Hypoxemia
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“hypertension” · I10 Essential (primary) hypertension
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 292 Heart failure and shock with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 293.

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=1.051, t.ratio_s1=1.5, creat_rise_48h=0.07, 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=1.051, t.ratio_s3=3.0, creat_peak=1.24, 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=1.051, 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=0.07, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria met

Clinical validation gap

Documented “acute blood loss anemia” (D62) is more specific than the criteria support (Anemia (acute blood-loss criteria not met), D64.9).

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=M, hgb_nadir=11.1, t.hb_m=13, t.hb_f=12	true
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=0.4, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=True, hgb_drop=0.4, t.drop_min=1.0, prbc_units=0	true

Chronic kidney disease

Clinical judgement required

No gap

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

Trace

Rule trace (rule ckd v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: chronic	`egfr_n >= 2 and egfr_span_days >= t.chronic_days`	egfr_n=2, egfr_span_days=246, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=68.3, egfr_late=67.6	68.3
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=68.3, t.g2=60, egfr_late=67.6	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=68.3, 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=68.3, egfr_late=67.6, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=68.3, t.g2=60	true

Heart failure

Criteria met

Specificity gap

Documented “chronic systolic heart failure” (I50.22); 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=1633.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	true
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=True, np_elevated=True, new_o2=True	3
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=35.0, 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=35.0, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=3, hf_history=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

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

Clinical validation gap

Documented “morbid obesity” (E66.01) conflicts with what the criteria support (Obesity, class 1, 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=67, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=32.9, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=32.9, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=32.9, t.c1=30	true

Pressure injury

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule pressure_injury v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sacral	`wound_site == 'sacral'`	wound_site=unknown	unknown
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=unknown	true

Acute respiratory failure

Clinical judgement required

Clinical judgement required: Hypoxaemia without a charted sign of respiratory distress.

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=87.0, 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=87.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=22.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=True	false
outcome: met	`hypoxemia and distress`	hypoxemia=True, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=True	true

Sepsis

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=37.5, t.t_hi=38, temp_min_48h=36.7, 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=22.0, 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=10.19, t.wbc_hi=12, wbc_min_48h=5.92, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	false
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=False, sirs_hr=False, sirs_rr=True, sirs_wbc=False	1
derived: sofa_resp	`coalesce(case(pf_min_48h < 100 and adv_resp_support, 4, pf_min_48h < 200 and adv_resp_support, 3, pf_min_48h < 300, 2, pf_min_48h < 400, 1, 0), 0)`	pf_min_48h=unknown, adv_resp_support=False	0
derived: sofa_coag	`coalesce(case(platelets_min_48h < 20, 4, platelets_min_48h < 50, 3, platelets_min_48h < 100, 2, platelets_min_48h < 150, 1, 0), 0)`	platelets_min_48h=202.0	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=75.0	0
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=1.23	1
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=1.18	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=1, sofa_renal_baseline=0	1
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=1, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, sirs_count=1, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=False, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=False	true

Structured data

Labs (34)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-005387	Fri Dec 12, 2025 09:15 AM	creatinine	1.17 mg/dL
LAB-005388	Sun Aug 16, 2026 10:05 AM	creatinine	1.18 mg/dL
LAB-005389	Thu Nov 05, 2026 10:29 AM	creatinine	1.21 mg/dL
LAB-005395	Thu Nov 05, 2026 10:29 AM	bnp	1633.0 pg/mL
LAB-005396	Thu Nov 05, 2026 10:29 AM	sodium	138.0 mmol/L
LAB-005402	Thu Nov 05, 2026 10:29 AM	hemoglobin	11.5 g/dL
LAB-005408	Thu Nov 05, 2026 10:29 AM	wbc	6.42 x10^3/uL
LAB-005409	Thu Nov 05, 2026 10:29 AM	platelets	230.0 x10^3/uL
LAB-005420	Thu Nov 05, 2026 10:29 AM	bilirubin	0.81 mg/dL
LAB-005390	Fri Nov 06, 2026 05:00 AM	creatinine	1.21 mg/dL
LAB-005397	Fri Nov 06, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-005403	Fri Nov 06, 2026 05:00 AM	hemoglobin	11.1 g/dL
LAB-005410	Fri Nov 06, 2026 05:00 AM	wbc	5.92 x10^3/uL
LAB-005411	Fri Nov 06, 2026 05:00 AM	platelets	215.0 x10^3/uL
LAB-005391	Sat Nov 07, 2026 05:00 AM	creatinine	1.23 mg/dL
LAB-005398	Sat Nov 07, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-005404	Sat Nov 07, 2026 05:00 AM	hemoglobin	11.5 g/dL
LAB-005412	Sat Nov 07, 2026 05:00 AM	wbc	10.19 x10^3/uL
LAB-005413	Sat Nov 07, 2026 05:00 AM	platelets	202.0 x10^3/uL
LAB-005392	Sun Nov 08, 2026 05:00 AM	creatinine	1.17 mg/dL
LAB-005399	Sun Nov 08, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-005405	Sun Nov 08, 2026 05:00 AM	hemoglobin	11.1 g/dL
LAB-005414	Sun Nov 08, 2026 05:00 AM	wbc	10.11 x10^3/uL
LAB-005415	Sun Nov 08, 2026 05:00 AM	platelets	254.0 x10^3/uL
LAB-005393	Mon Nov 09, 2026 05:00 AM	creatinine	1.24 mg/dL
LAB-005400	Mon Nov 09, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-005406	Mon Nov 09, 2026 05:00 AM	hemoglobin	11.5 g/dL
LAB-005416	Mon Nov 09, 2026 05:00 AM	wbc	7.62 x10^3/uL
LAB-005417	Mon Nov 09, 2026 05:00 AM	platelets	178.0 x10^3/uL
LAB-005394	Tue Nov 10, 2026 05:00 AM	creatinine	1.18 mg/dL
LAB-005401	Tue Nov 10, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-005407	Tue Nov 10, 2026 05:00 AM	hemoglobin	11.1 g/dL
LAB-005418	Tue Nov 10, 2026 05:00 AM	wbc	10.28 x10^3/uL
LAB-005419	Tue Nov 10, 2026 05:00 AM	platelets	301.0 x10^3/uL

Vitals (111)

Vitals
Row	When	Kind	Value	Detail
VIT-015469	Thu Nov 05, 2026 09:49 AM	spo2	87.0	room air
VIT-015470	Thu Nov 05, 2026 09:49 AM	rr	21.0
VIT-015516	Thu Nov 05, 2026 09:49 AM	temp_c	37.4
VIT-015517	Thu Nov 05, 2026 09:49 AM	hr	81.0
VIT-015518	Thu Nov 05, 2026 09:49 AM	map	77.0
VIT-015519	Thu Nov 05, 2026 09:49 AM	gcs	15.0
VIT-015471	Thu Nov 05, 2026 05:49 PM	spo2	95.0	nasal cannula
VIT-015472	Thu Nov 05, 2026 05:49 PM	rr	20.0
VIT-015473	Thu Nov 05, 2026 05:49 PM	o2_lpm	2.0	nasal cannula
VIT-015520	Thu Nov 05, 2026 05:49 PM	temp_c	37.3
VIT-015521	Thu Nov 05, 2026 05:49 PM	hr	74.0
VIT-015522	Thu Nov 05, 2026 05:49 PM	map	76.0
VIT-015523	Thu Nov 05, 2026 05:49 PM	gcs	15.0
VIT-015474	Fri Nov 06, 2026 01:49 AM	spo2	96.0	nasal cannula
VIT-015475	Fri Nov 06, 2026 01:49 AM	rr	19.0
VIT-015476	Fri Nov 06, 2026 01:49 AM	o2_lpm	2.0	nasal cannula
VIT-015524	Fri Nov 06, 2026 01:49 AM	temp_c	36.7
VIT-015525	Fri Nov 06, 2026 01:49 AM	hr	89.0
VIT-015526	Fri Nov 06, 2026 01:49 AM	map	86.0
VIT-015527	Fri Nov 06, 2026 01:49 AM	gcs	15.0
VIT-015477	Fri Nov 06, 2026 09:49 AM	spo2	95.0	nasal cannula
VIT-015478	Fri Nov 06, 2026 09:49 AM	rr	20.0
VIT-015479	Fri Nov 06, 2026 09:49 AM	o2_lpm	2.0	nasal cannula
VIT-015528	Fri Nov 06, 2026 09:49 AM	temp_c	37.5
VIT-015529	Fri Nov 06, 2026 09:49 AM	hr	77.0
VIT-015530	Fri Nov 06, 2026 09:49 AM	map	89.0
VIT-015531	Fri Nov 06, 2026 09:49 AM	gcs	15.0
VIT-015480	Fri Nov 06, 2026 05:49 PM	spo2	95.0	nasal cannula
VIT-015481	Fri Nov 06, 2026 05:49 PM	rr	19.0
VIT-015482	Fri Nov 06, 2026 05:49 PM	o2_lpm	2.0	nasal cannula
VIT-015532	Fri Nov 06, 2026 05:49 PM	temp_c	37.1
VIT-015533	Fri Nov 06, 2026 05:49 PM	hr	84.0
VIT-015534	Fri Nov 06, 2026 05:49 PM	map	80.0
VIT-015535	Fri Nov 06, 2026 05:49 PM	gcs	15.0
VIT-015483	Sat Nov 07, 2026 01:49 AM	spo2	94.0	nasal cannula
VIT-015484	Sat Nov 07, 2026 01:49 AM	rr	22.0
VIT-015485	Sat Nov 07, 2026 01:49 AM	o2_lpm	2.0	nasal cannula
VIT-015536	Sat Nov 07, 2026 01:49 AM	temp_c	36.8
VIT-015537	Sat Nov 07, 2026 01:49 AM	hr	79.0
VIT-015538	Sat Nov 07, 2026 01:49 AM	map	75.0
VIT-015539	Sat Nov 07, 2026 01:49 AM	gcs	15.0
VIT-015486	Sat Nov 07, 2026 09:49 AM	spo2	95.0	nasal cannula
VIT-015487	Sat Nov 07, 2026 09:49 AM	rr	21.0
VIT-015488	Sat Nov 07, 2026 09:49 AM	o2_lpm	2.0	nasal cannula
VIT-015540	Sat Nov 07, 2026 09:49 AM	temp_c	36.9
VIT-015541	Sat Nov 07, 2026 09:49 AM	hr	68.0
VIT-015542	Sat Nov 07, 2026 09:49 AM	map	80.0
VIT-015543	Sat Nov 07, 2026 09:49 AM	gcs	15.0
VIT-015489	Sat Nov 07, 2026 05:49 PM	spo2	95.0	nasal cannula
VIT-015490	Sat Nov 07, 2026 05:49 PM	rr	20.0
VIT-015491	Sat Nov 07, 2026 05:49 PM	o2_lpm	2.0	nasal cannula
VIT-015544	Sat Nov 07, 2026 05:49 PM	temp_c	37.0
VIT-015545	Sat Nov 07, 2026 05:49 PM	hr	68.0
VIT-015546	Sat Nov 07, 2026 05:49 PM	map	83.0
VIT-015547	Sat Nov 07, 2026 05:49 PM	gcs	15.0
VIT-015492	Sun Nov 08, 2026 01:49 AM	spo2	96.0	nasal cannula
VIT-015493	Sun Nov 08, 2026 01:49 AM	rr	18.0
VIT-015494	Sun Nov 08, 2026 01:49 AM	o2_lpm	2.0	nasal cannula
VIT-015548	Sun Nov 08, 2026 01:49 AM	temp_c	37.0
VIT-015549	Sun Nov 08, 2026 01:49 AM	hr	84.0
VIT-015550	Sun Nov 08, 2026 01:49 AM	map	86.0
VIT-015551	Sun Nov 08, 2026 01:49 AM	gcs	15.0
VIT-015495	Sun Nov 08, 2026 09:49 AM	spo2	96.0	nasal cannula
VIT-015496	Sun Nov 08, 2026 09:49 AM	rr	21.0
VIT-015497	Sun Nov 08, 2026 09:49 AM	o2_lpm	2.0	nasal cannula
VIT-015552	Sun Nov 08, 2026 09:49 AM	temp_c	37.1
VIT-015553	Sun Nov 08, 2026 09:49 AM	hr	72.0
VIT-015554	Sun Nov 08, 2026 09:49 AM	map	85.0
VIT-015555	Sun Nov 08, 2026 09:49 AM	gcs	15.0
VIT-015498	Sun Nov 08, 2026 05:49 PM	spo2	96.0	nasal cannula
VIT-015499	Sun Nov 08, 2026 05:49 PM	rr	20.0
VIT-015500	Sun Nov 08, 2026 05:49 PM	o2_lpm	2.0	nasal cannula
VIT-015556	Sun Nov 08, 2026 05:49 PM	temp_c	37.4
VIT-015557	Sun Nov 08, 2026 05:49 PM	hr	74.0
VIT-015558	Sun Nov 08, 2026 05:49 PM	map	79.0
VIT-015559	Sun Nov 08, 2026 05:49 PM	gcs	15.0
VIT-015501	Mon Nov 09, 2026 01:49 AM	spo2	94.0	nasal cannula
VIT-015502	Mon Nov 09, 2026 01:49 AM	rr	20.0
VIT-015503	Mon Nov 09, 2026 01:49 AM	o2_lpm	2.0	nasal cannula
VIT-015560	Mon Nov 09, 2026 01:49 AM	temp_c	36.8
VIT-015561	Mon Nov 09, 2026 01:49 AM	hr	80.0
VIT-015562	Mon Nov 09, 2026 01:49 AM	map	78.0
VIT-015563	Mon Nov 09, 2026 01:49 AM	gcs	15.0
VIT-015504	Mon Nov 09, 2026 09:49 AM	spo2	93.0	nasal cannula
VIT-015505	Mon Nov 09, 2026 09:49 AM	rr	22.0
VIT-015506	Mon Nov 09, 2026 09:49 AM	o2_lpm	2.0	nasal cannula
VIT-015564	Mon Nov 09, 2026 09:49 AM	temp_c	37.3
VIT-015565	Mon Nov 09, 2026 09:49 AM	hr	70.0
VIT-015566	Mon Nov 09, 2026 09:49 AM	map	90.0
VIT-015567	Mon Nov 09, 2026 09:49 AM	gcs	15.0
VIT-015507	Mon Nov 09, 2026 05:49 PM	spo2	96.0	nasal cannula
VIT-015508	Mon Nov 09, 2026 05:49 PM	rr	21.0
VIT-015509	Mon Nov 09, 2026 05:49 PM	o2_lpm	2.0	nasal cannula
VIT-015568	Mon Nov 09, 2026 05:49 PM	temp_c	36.9
VIT-015569	Mon Nov 09, 2026 05:49 PM	hr	70.0
VIT-015570	Mon Nov 09, 2026 05:49 PM	map	83.0
VIT-015571	Mon Nov 09, 2026 05:49 PM	gcs	15.0
VIT-015510	Tue Nov 10, 2026 01:49 AM	spo2	92.0	nasal cannula
VIT-015511	Tue Nov 10, 2026 01:49 AM	rr	21.0
VIT-015512	Tue Nov 10, 2026 01:49 AM	o2_lpm	2.0	nasal cannula
VIT-015572	Tue Nov 10, 2026 01:49 AM	temp_c	37.1
VIT-015573	Tue Nov 10, 2026 01:49 AM	hr	75.0
VIT-015574	Tue Nov 10, 2026 01:49 AM	map	82.0
VIT-015575	Tue Nov 10, 2026 01:49 AM	gcs	15.0
VIT-015513	Tue Nov 10, 2026 09:49 AM	spo2	95.0	nasal cannula
VIT-015514	Tue Nov 10, 2026 09:49 AM	rr	22.0
VIT-015515	Tue Nov 10, 2026 09:49 AM	o2_lpm	2.0	nasal cannula
VIT-015576	Tue Nov 10, 2026 09:49 AM	temp_c	36.8
VIT-015577	Tue Nov 10, 2026 09:49 AM	hr	86.0
VIT-015578	Tue Nov 10, 2026 09:49 AM	map	77.0
VIT-015579	Tue Nov 10, 2026 09:49 AM	gcs	15.0

Medications, orders, echo, history (8)

MED-000635 11-05 08:00 furosemide 40 mg IV
MED-000636 11-05 20:00 furosemide 40 mg IV
MED-000637 11-06 08:00 furosemide 40 mg IV
MED-000638 11-06 20:00 furosemide 40 mg IV
MED-000639 11-07 08:00 furosemide 40 mg IV
MED-000640 11-07 20:00 furosemide 40 mg IV
ECH-000074 2026-11-06 echo LVEF 35.0%
HX-000057 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000531 · Dr. Jalen Carrow (attending) · Thu Nov 05, 2026 12:29 PM

Cited facts from this note (1)

bleeding_source: bleeding · cited p. 1, line 7 · confidence 0.50

Show source for bleeding_source

… admitted with chronic systolic heart failure. Past medical history: heart failure with reduced ejection fraction, type 2 diabetes, hypertension, GERD. Denies bleeding, chest pain or fever. Exam: Lungs: scattered crackles at the bases, no distress. Assessment and plan: 1. Chronic systolic heart failure: diuresis and daily wei …

Source document DOC-000531: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Ines Ivers   MRN: MRN18356138   Admitted: 2026-11-05 09:29
Service: Cardiology   Attending: Dr. Jalen Carrow

History of present illness: 67-year-old man admitted with chronic systolic heart failure. 
Past medical history: heart failure with reduced ejection fraction, type 2 diabetes, hypertension, GERD.
Denies bleeding, chest pain or fever.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.

Progress note · DOC-000532 · Dr. Jalen Carrow (attending) · Sat Nov 07, 2026 12:29 PM

Source document DOC-000532: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Ines Ivers   MRN: MRN18356138   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Chronic systolic heart failure: continue current management.
2. Morbid obesity: counsel on weight.
3. Hypoxemia: supplemental oxygen, wean as tolerated.
4. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Attending: Dr. Jalen Carrow

Discharge summary · DOC-000533 · Dr. Jalen Carrow (attending) · Tue Nov 10, 2026 03:05 PM

Source document DOC-000533: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Ines Ivers   MRN: MRN18356138
Admitted 2026-11-05; discharged 2026-11-10.

Discharge diagnoses:
- morbid obesity
- chronic systolic heart failure
- hypoxemia
- acute blood loss anemia
- type 2 diabetes
- hypertension
- GERD

Disposition: home with follow-up.