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-00166: Ximena Hartwell

80M · MRN24415470 · Pulmonology · admitted Tue Nov 10, 2026 12:02 PM · in hospital · attending Dr. Wes Merriweather · resident Dr. Priya Thorne · 180 cm, 133.4 kg

Documented diagnoses (current)

Principal: “COPD exacerbation” · J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
“sacral pressure ulcer” · L89.159 Pressure ulcer of sacral region, unspecified stage
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 192 Chronic obstructive pulmonary disease without CC/MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 190.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Clinical judgement required

Clinical judgement required: AKI criteria met only against a presumed baseline (no pre-admission creatinine on file).

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=1.613, t.ratio_s1=1.5, creat_rise_48h=0.0, 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=1.613, t.ratio_s3=3.0, creat_peak=1.21, 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=1.613, 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=True	1
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=False, creat_rise_48h=0.0, t.rise_abs=0.3, rrt_started=False	false
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=1, baseline_independent=False	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=1	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=14.08, t.hb_m=13, t.hb_f=12	false
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=0.0, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=False, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=False, hgb_drop=0.0, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=14.08, anaemic=False	true

Chronic kidney disease

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=0, egfr_span_days=unknown, t.chronic_days=90	false
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=unknown, egfr_late=unknown	unknown
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=unknown, t.g2=60, egfr_late=unknown	unknown
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=unknown, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	unknown
outcome: duration_not_shown	`not chronic`	chronic=False	true

Heart failure

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

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

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 3 (E66.813); 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=80, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=41.2, t.c3=40	true

Pressure injury

Criteria met

Specificity gap

Documented “sacral pressure ulcer” (L89.159); criteria support the more specific Pressure injury of sacral region, stage 3 (L89.153).

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=3	false
outcome: other_site	`wound_site != 'sacral'`	wound_site=sacral	false
outcome: stage1	`sacral and wound_stage == '1'`	sacral=True, wound_stage=3	false
outcome: stage2	`sacral and wound_stage == '2'`	sacral=True, wound_stage=3	false
outcome: stage3	`sacral and wound_stage == '3'`	sacral=True, wound_stage=3	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=19.0, 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=37.5, t.t_hi=38, temp_min_48h=36.6, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=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=19.0, 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=9.27, t.wbc_hi=12, wbc_min_48h=7.77, 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=166.0	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=0.65	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=81.0	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=1.21	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=0.75	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=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 (21)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-005689	Tue Nov 10, 2026 01:02 PM	creatinine	1.21 mg/dL
LAB-005693	Tue Nov 10, 2026 01:02 PM	sodium	141.0 mmol/L
LAB-005697	Tue Nov 10, 2026 01:02 PM	hemoglobin	14.08 g/dL
LAB-005701	Tue Nov 10, 2026 01:02 PM	wbc	7.77 x10^3/uL
LAB-005702	Tue Nov 10, 2026 01:02 PM	platelets	212.0 x10^3/uL
LAB-005709	Tue Nov 10, 2026 01:02 PM	bilirubin	0.65 mg/dL
LAB-005690	Wed Nov 11, 2026 05:00 AM	creatinine	1.0 mg/dL
LAB-005694	Wed Nov 11, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-005698	Wed Nov 11, 2026 05:00 AM	hemoglobin	14.38 g/dL
LAB-005703	Wed Nov 11, 2026 05:00 AM	wbc	9.27 x10^3/uL
LAB-005704	Wed Nov 11, 2026 05:00 AM	platelets	166.0 x10^3/uL
LAB-005691	Thu Nov 12, 2026 05:00 AM	creatinine	0.84 mg/dL
LAB-005695	Thu Nov 12, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-005699	Thu Nov 12, 2026 05:00 AM	hemoglobin	14.1 g/dL
LAB-005705	Thu Nov 12, 2026 05:00 AM	wbc	8.75 x10^3/uL
LAB-005706	Thu Nov 12, 2026 05:00 AM	platelets	210.0 x10^3/uL
LAB-005692	Fri Nov 13, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-005696	Fri Nov 13, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-005700	Fri Nov 13, 2026 05:00 AM	hemoglobin	14.08 g/dL
LAB-005707	Fri Nov 13, 2026 05:00 AM	wbc	7.06 x10^3/uL
LAB-005708	Fri Nov 13, 2026 05:00 AM	platelets	216.0 x10^3/uL

Vitals (60)

Vitals
Row	When	Kind	Value	Detail
VIT-016384	Tue Nov 10, 2026 12:22 PM	spo2	95.0	room air
VIT-016385	Tue Nov 10, 2026 12:22 PM	rr	18.0
VIT-016404	Tue Nov 10, 2026 12:22 PM	temp_c	37.1
VIT-016405	Tue Nov 10, 2026 12:22 PM	hr	81.0
VIT-016406	Tue Nov 10, 2026 12:22 PM	map	92.0
VIT-016407	Tue Nov 10, 2026 12:22 PM	gcs	15.0
VIT-016386	Tue Nov 10, 2026 08:22 PM	spo2	94.0	room air
VIT-016387	Tue Nov 10, 2026 08:22 PM	rr	17.0
VIT-016408	Tue Nov 10, 2026 08:22 PM	temp_c	36.8
VIT-016409	Tue Nov 10, 2026 08:22 PM	hr	85.0
VIT-016410	Tue Nov 10, 2026 08:22 PM	map	86.0
VIT-016411	Tue Nov 10, 2026 08:22 PM	gcs	15.0
VIT-016388	Wed Nov 11, 2026 04:22 AM	spo2	94.0	room air
VIT-016389	Wed Nov 11, 2026 04:22 AM	rr	19.0
VIT-016412	Wed Nov 11, 2026 04:22 AM	temp_c	36.6
VIT-016413	Wed Nov 11, 2026 04:22 AM	hr	70.0
VIT-016414	Wed Nov 11, 2026 04:22 AM	map	81.0
VIT-016415	Wed Nov 11, 2026 04:22 AM	gcs	15.0
VIT-016390	Wed Nov 11, 2026 12:22 PM	spo2	99.0	room air
VIT-016391	Wed Nov 11, 2026 12:22 PM	rr	19.0
VIT-016416	Wed Nov 11, 2026 12:22 PM	temp_c	37.5
VIT-016417	Wed Nov 11, 2026 12:22 PM	hr	82.0
VIT-016418	Wed Nov 11, 2026 12:22 PM	map	83.0
VIT-016419	Wed Nov 11, 2026 12:22 PM	gcs	15.0
VIT-016392	Wed Nov 11, 2026 08:22 PM	spo2	96.0	room air
VIT-016393	Wed Nov 11, 2026 08:22 PM	rr	15.0
VIT-016420	Wed Nov 11, 2026 08:22 PM	temp_c	36.8
VIT-016421	Wed Nov 11, 2026 08:22 PM	hr	78.0
VIT-016422	Wed Nov 11, 2026 08:22 PM	map	90.0
VIT-016423	Wed Nov 11, 2026 08:22 PM	gcs	15.0
VIT-016394	Thu Nov 12, 2026 04:22 AM	spo2	96.0	room air
VIT-016395	Thu Nov 12, 2026 04:22 AM	rr	15.0
VIT-016424	Thu Nov 12, 2026 04:22 AM	temp_c	37.1
VIT-016425	Thu Nov 12, 2026 04:22 AM	hr	86.0
VIT-016426	Thu Nov 12, 2026 04:22 AM	map	82.0
VIT-016427	Thu Nov 12, 2026 04:22 AM	gcs	15.0
VIT-016396	Thu Nov 12, 2026 12:22 PM	spo2	94.0	room air
VIT-016397	Thu Nov 12, 2026 12:22 PM	rr	16.0
VIT-016428	Thu Nov 12, 2026 12:22 PM	temp_c	36.7
VIT-016429	Thu Nov 12, 2026 12:22 PM	hr	90.0
VIT-016430	Thu Nov 12, 2026 12:22 PM	map	79.0
VIT-016431	Thu Nov 12, 2026 12:22 PM	gcs	15.0
VIT-016398	Thu Nov 12, 2026 08:22 PM	spo2	97.0	room air
VIT-016399	Thu Nov 12, 2026 08:22 PM	rr	16.0
VIT-016432	Thu Nov 12, 2026 08:22 PM	temp_c	37.4
VIT-016433	Thu Nov 12, 2026 08:22 PM	hr	74.0
VIT-016434	Thu Nov 12, 2026 08:22 PM	map	75.0
VIT-016435	Thu Nov 12, 2026 08:22 PM	gcs	15.0
VIT-016400	Fri Nov 13, 2026 04:22 AM	spo2	94.0	room air
VIT-016401	Fri Nov 13, 2026 04:22 AM	rr	14.0
VIT-016436	Fri Nov 13, 2026 04:22 AM	temp_c	37.6
VIT-016437	Fri Nov 13, 2026 04:22 AM	hr	78.0
VIT-016438	Fri Nov 13, 2026 04:22 AM	map	85.0
VIT-016439	Fri Nov 13, 2026 04:22 AM	gcs	15.0
VIT-016402	Fri Nov 13, 2026 12:22 PM	spo2	96.0	room air
VIT-016403	Fri Nov 13, 2026 12:22 PM	rr	16.0
VIT-016440	Fri Nov 13, 2026 12:22 PM	temp_c	36.9
VIT-016441	Fri Nov 13, 2026 12:22 PM	hr	70.0
VIT-016442	Fri Nov 13, 2026 12:22 PM	map	88.0
VIT-016443	Fri Nov 13, 2026 12:22 PM	gcs	15.0

Medications, orders, echo, history (0)

Notes

History and physical · DOC-000561 · Dr. Priya Thorne (resident) · Tue Nov 10, 2026 03:02 PM

Cited facts from this note (1)

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

Show source for bleeding_source

… tending: Dr. Wes Merriweather History of present illness: 80-year-old man admitted with COPD exacerbation. Past medical history: GERD, hyperlipidemia. Denies bleeding, chest pain or fever. Exam: Lungs: scattered crackles at the bases, no distress. Assessment and plan: 1. COPD exacerbation: bronchodilators and steroids.

Source document DOC-000561: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Ximena Hartwell   MRN: MRN24415470   Admitted: 2026-11-10 12:02
Service: Pulmonology   Attending: Dr. Wes Merriweather

History of present illness: 80-year-old man admitted with COPD exacerbation. 
Past medical history: GERD, hyperlipidemia.
Denies bleeding, chest pain or fever.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. COPD exacerbation: bronchodilators and steroids.

Wound care note · DOC-000560 · Ines Ingram, RN, CWOCN (wound_nurse) · Wed Nov 11, 2026 01:02 PM

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 Hartwell MRN: MRN24415470 Location: sacrum Stage: 3 (NPIAP) Description: full-thickness skin loss, adipose visible, no tendon or bone. Size: 2.0 x 3.2 x 0.2 cm. Plan: offloading every 2 hours, foam dres …
wound_stage: 3 · cited p. 1, line 5 · confidence 0.95

Show source for wound_stage

WOUND CARE NOTE Patient: Ximena Hartwell MRN: MRN24415470 Location: sacrum Stage: 3 (NPIAP) Description: full-thickness skin loss, adipose visible, no tendon or bone. Size: 2.0 x 3.2 x 0.2 cm. Plan: offloading every 2 hours, foam dressing, nut …

Source document DOC-000560: Wound care note (synthetic)

WOUND CARE NOTE
Patient: Ximena Hartwell   MRN: MRN24415470

Location: sacrum
Stage: 3 (NPIAP)
Description: full-thickness skin loss, adipose visible, no tendon or bone.
Size: 2.0 x 3.2 x 0.2 cm.
Plan: offloading every 2 hours, foam dressing, nutrition consult.

Nutrition assessment · DOC-000559 · Vera Pemberton, RD (dietitian) · Wed Nov 11, 2026 02:02 PM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN24415470 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 Hartwell MRN: MRN24415470 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 Hartwell MRN: MRN24415470 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-000559: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Ximena Hartwell   MRN: MRN24415470

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-000562 · Dr. Priya Thorne (resident) · Fri Nov 13, 2026 10:55 AM · awaiting cosign

Source document DOC-000562: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Ximena Hartwell   MRN: MRN24415470   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. COPD exacerbation: continue current management.
2. Sacral pressure ulcer: wound care following, offloading.

Resident: Dr. Priya Thorne   Attending cosign: pending