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-00161: Ximena Delacroix

56F · MRN12690536 · Cardiology · admitted Wed Nov 04, 2026 06:10 PM · discharged Sat Nov 07, 2026 01:36 PM · attending Dr. Kenji Stavros · resident Dr. Keira Upfield · 164 cm, 66.4 kg

Documented diagnoses (current)

“acute renal insufficiency” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
Principal: “CHF” · I50.9 Heart failure, unspecified
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 293 Heart failure and shock without CC/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 met

Specificity gap

Documented “acute renal insufficiency” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 2) (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=2.506, t.ratio_s1=1.5, creat_rise_48h=0.48, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	true
derived: stage3	`meets_definition and (creat_ratio >= t.ratio_s3 or creat_peak >= t.scr_s3 or rrt_started or coalesce(uo_hours_lt_0_3 >= t.uo_s3_h, false) or coalesce(anuria_hours >= t.anuria_h, false))`	meets_definition=True, creat_ratio=2.506, t.ratio_s3=3.0, creat_peak=2.18, 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=2.506, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	true
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=True, meets_definition=True	2
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.48, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=2, baseline_independent=True	true

Acute blood loss anaemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=F, hgb_nadir=12.62, 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=0.2, 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=0.2, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=12.62, 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=253, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=80.4, egfr_late=78.1	80.4
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=80.4, t.g2=60, egfr_late=78.1	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=80.4, 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=80.4, egfr_late=78.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=80.4, t.g2=60	true

Heart failure

Criteria met

Specificity gap

Documented “CHF” (I50.9); criteria support the more specific Acute diastolic (HFpEF) heart failure (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=2356.0, 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=58.0, 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=58.0, 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=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

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=139.0, 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=139.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=139.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=139.0, t.low=135	true

Malnutrition

Criteria not met

No gap

Not documented and not supported.

Trace

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

Obesity

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule obesity v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=56, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=24.7, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=24.7, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=24.7, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=24.7, 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 met

Specificity gap

Criteria support Acute respiratory failure with hypoxia (J96.01); no corresponding diagnosis is documented.

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=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=85.0, 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=29.0, t.rr_distress=28, wob_increased=True, 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 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=36.5, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=86.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=29.0, 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=10.01, t.wbc_hi=12, wbc_min_48h=6.65, 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=230.0	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=0.7	0
derived: sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`	norepi_max_48h=0.0, map_min_48h=76.0	0
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=2.18	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=0.87	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=False, sofa_delta=2, 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 (24)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-005490	Mon Dec 29, 2025 09:15 AM	creatinine	0.85 mg/dL
LAB-005491	Wed Sep 09, 2026 10:05 AM	creatinine	0.87 mg/dL
LAB-005492	Wed Nov 04, 2026 07:10 PM	creatinine	1.7 mg/dL
LAB-005496	Wed Nov 04, 2026 07:10 PM	bnp	2356.0 pg/mL
LAB-005497	Wed Nov 04, 2026 07:10 PM	sodium	140.0 mmol/L
LAB-005501	Wed Nov 04, 2026 07:10 PM	hemoglobin	12.82 g/dL
LAB-005505	Wed Nov 04, 2026 07:10 PM	wbc	8.85 x10^3/uL
LAB-005506	Wed Nov 04, 2026 07:10 PM	platelets	230.0 x10^3/uL
LAB-005513	Wed Nov 04, 2026 07:10 PM	bilirubin	0.7 mg/dL
LAB-005493	Thu Nov 05, 2026 05:00 AM	creatinine	2.18 mg/dL
LAB-005498	Thu Nov 05, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-005502	Thu Nov 05, 2026 05:00 AM	hemoglobin	12.62 g/dL
LAB-005507	Thu Nov 05, 2026 05:00 AM	wbc	10.01 x10^3/uL
LAB-005508	Thu Nov 05, 2026 05:00 AM	platelets	282.0 x10^3/uL
LAB-005494	Fri Nov 06, 2026 05:00 AM	creatinine	1.96 mg/dL
LAB-005499	Fri Nov 06, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-005503	Fri Nov 06, 2026 05:00 AM	hemoglobin	12.82 g/dL
LAB-005509	Fri Nov 06, 2026 05:00 AM	wbc	6.65 x10^3/uL
LAB-005510	Fri Nov 06, 2026 05:00 AM	platelets	268.0 x10^3/uL
LAB-005495	Sat Nov 07, 2026 05:00 AM	creatinine	1.64 mg/dL
LAB-005500	Sat Nov 07, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-005504	Sat Nov 07, 2026 05:00 AM	hemoglobin	12.7 g/dL
LAB-005511	Sat Nov 07, 2026 05:00 AM	wbc	9.84 x10^3/uL
LAB-005512	Sat Nov 07, 2026 05:00 AM	platelets	261.0 x10^3/uL

Vitals (63)

Vitals
Row	When	Kind	Value	Detail
VIT-015782	Wed Nov 04, 2026 06:30 PM	spo2	85.0	room air
VIT-015783	Wed Nov 04, 2026 06:30 PM	rr	29.0
VIT-015809	Wed Nov 04, 2026 06:30 PM	temp_c	36.5
VIT-015810	Wed Nov 04, 2026 06:30 PM	hr	74.0
VIT-015811	Wed Nov 04, 2026 06:30 PM	map	76.0
VIT-015812	Wed Nov 04, 2026 06:30 PM	gcs	15.0
VIT-015784	Wed Nov 04, 2026 06:40 PM	o2_lpm	5.0	nasal cannula
VIT-015785	Thu Nov 05, 2026 02:30 AM	spo2	95.0	nasal cannula
VIT-015786	Thu Nov 05, 2026 02:30 AM	rr	26.0
VIT-015787	Thu Nov 05, 2026 02:30 AM	o2_lpm	4.0	nasal cannula
VIT-015813	Thu Nov 05, 2026 02:30 AM	temp_c	36.7
VIT-015814	Thu Nov 05, 2026 02:30 AM	hr	82.0
VIT-015815	Thu Nov 05, 2026 02:30 AM	map	78.0
VIT-015816	Thu Nov 05, 2026 02:30 AM	gcs	15.0
VIT-015788	Thu Nov 05, 2026 10:30 AM	spo2	93.0	nasal cannula
VIT-015789	Thu Nov 05, 2026 10:30 AM	rr	23.0
VIT-015790	Thu Nov 05, 2026 10:30 AM	o2_lpm	4.0	nasal cannula
VIT-015817	Thu Nov 05, 2026 10:30 AM	temp_c	37.5
VIT-015818	Thu Nov 05, 2026 10:30 AM	hr	79.0
VIT-015819	Thu Nov 05, 2026 10:30 AM	map	90.0
VIT-015820	Thu Nov 05, 2026 10:30 AM	gcs	15.0
VIT-015791	Thu Nov 05, 2026 06:30 PM	spo2	94.0	nasal cannula
VIT-015792	Thu Nov 05, 2026 06:30 PM	rr	20.0
VIT-015793	Thu Nov 05, 2026 06:30 PM	o2_lpm	3.0	nasal cannula
VIT-015821	Thu Nov 05, 2026 06:30 PM	temp_c	37.3
VIT-015822	Thu Nov 05, 2026 06:30 PM	hr	85.0
VIT-015823	Thu Nov 05, 2026 06:30 PM	map	91.0
VIT-015824	Thu Nov 05, 2026 06:30 PM	gcs	15.0
VIT-015794	Fri Nov 06, 2026 02:30 AM	spo2	93.0	nasal cannula
VIT-015795	Fri Nov 06, 2026 02:30 AM	rr	26.0
VIT-015796	Fri Nov 06, 2026 02:30 AM	o2_lpm	3.0	nasal cannula
VIT-015825	Fri Nov 06, 2026 02:30 AM	temp_c	37.1
VIT-015826	Fri Nov 06, 2026 02:30 AM	hr	86.0
VIT-015827	Fri Nov 06, 2026 02:30 AM	map	92.0
VIT-015828	Fri Nov 06, 2026 02:30 AM	gcs	15.0
VIT-015797	Fri Nov 06, 2026 10:30 AM	spo2	94.0	nasal cannula
VIT-015798	Fri Nov 06, 2026 10:30 AM	rr	25.0
VIT-015799	Fri Nov 06, 2026 10:30 AM	o2_lpm	4.0	nasal cannula
VIT-015829	Fri Nov 06, 2026 10:30 AM	temp_c	37.2
VIT-015830	Fri Nov 06, 2026 10:30 AM	hr	71.0
VIT-015831	Fri Nov 06, 2026 10:30 AM	map	87.0
VIT-015832	Fri Nov 06, 2026 10:30 AM	gcs	15.0
VIT-015800	Fri Nov 06, 2026 06:30 PM	spo2	91.0	nasal cannula
VIT-015801	Fri Nov 06, 2026 06:30 PM	rr	24.0
VIT-015802	Fri Nov 06, 2026 06:30 PM	o2_lpm	4.0	nasal cannula
VIT-015833	Fri Nov 06, 2026 06:30 PM	temp_c	37.2
VIT-015834	Fri Nov 06, 2026 06:30 PM	hr	73.0
VIT-015835	Fri Nov 06, 2026 06:30 PM	map	75.0
VIT-015836	Fri Nov 06, 2026 06:30 PM	gcs	15.0
VIT-015803	Sat Nov 07, 2026 02:30 AM	spo2	95.0	nasal cannula
VIT-015804	Sat Nov 07, 2026 02:30 AM	rr	25.0
VIT-015805	Sat Nov 07, 2026 02:30 AM	o2_lpm	2.0	nasal cannula
VIT-015837	Sat Nov 07, 2026 02:30 AM	temp_c	36.6
VIT-015838	Sat Nov 07, 2026 02:30 AM	hr	74.0
VIT-015839	Sat Nov 07, 2026 02:30 AM	map	77.0
VIT-015840	Sat Nov 07, 2026 02:30 AM	gcs	15.0
VIT-015806	Sat Nov 07, 2026 10:30 AM	spo2	91.0	nasal cannula
VIT-015807	Sat Nov 07, 2026 10:30 AM	rr	23.0
VIT-015808	Sat Nov 07, 2026 10:30 AM	o2_lpm	4.0	nasal cannula
VIT-015841	Sat Nov 07, 2026 10:30 AM	temp_c	37.4
VIT-015842	Sat Nov 07, 2026 10:30 AM	hr	70.0
VIT-015843	Sat Nov 07, 2026 10:30 AM	map	90.0
VIT-015844	Sat Nov 07, 2026 10:30 AM	gcs	15.0

Medications, orders, echo, history (7)

MED-000650 11-04 08:00 furosemide 40 mg IV
MED-000651 11-04 20:00 furosemide 40 mg IV
MED-000652 11-05 08:00 furosemide 40 mg IV
MED-000653 11-05 20:00 furosemide 40 mg IV
MED-000654 11-06 08:00 furosemide 40 mg IV
MED-000655 11-06 20:00 furosemide 40 mg IV
ECH-000076 2026-11-05 echo LVEF 58.0%

Notes

History and physical · DOC-000542 · Dr. Keira Upfield (resident) · Wed Nov 04, 2026 09:10 PM

Cited facts from this note (1)

work_of_breathing: increased · cited p. 1, line 8 · confidence 0.90

Show source for work_of_breathing

… illness: 56-year-old woman admitted with CHF. Past medical history: type 2 diabetes, hyperlipidemia, GERD. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessory muscle use. Assessment and plan: 1. CHF: diuresis and daily weights; monitor electrolytes.

Source document DOC-000542: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Ximena Delacroix   MRN: MRN12690536   Admitted: 2026-11-04 18:10
Service: Cardiology   Attending: Dr. Kenji Stavros

History of present illness: 56-year-old woman admitted with CHF. 
Past medical history: type 2 diabetes, hyperlipidemia, GERD.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscle use.
Assessment and plan:
1. CHF: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000541 · Viggo Ravensworth, RD (dietitian) · Fri Nov 06, 2026 12:10 AM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN12690536 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: Ximena Delacroix MRN: MRN12690536 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: Ximena Delacroix MRN: MRN12690536 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-000541: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Ximena Delacroix   MRN: MRN12690536

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-000543 · Dr. Keira Upfield (resident) · Fri Nov 06, 2026 06:10 PM

Source document DOC-000543: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Ximena Delacroix   MRN: MRN12690536   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. CHF: continue current management.
2. Acute renal insufficiency: trend creatinine, avoid nephrotoxins.

Resident: Dr. Keira Upfield   Attending cosign: completed

Discharge summary · DOC-000544 · Dr. Kenji Stavros (attending) · Sat Nov 07, 2026 01:36 PM

Source document DOC-000544: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Ximena Delacroix   MRN: MRN12690536
Admitted 2026-11-04; discharged 2026-11-07.

Discharge diagnoses:
- acute renal insufficiency
- CHF
- type 2 diabetes
- hyperlipidemia
- GERD

Disposition: home with follow-up.