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-00173: Vera Penhallow

58F · MRN26255814 · Pulmonology · admitted Tue Nov 10, 2026 09:56 PM · in hospital · attending Dr. Rosalind Quillan · resident Dr. Noor Halvorsen · 168 cm, 80.3 kg

Documented diagnoses (current)

Principal: “COPD exacerbation” · J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
“systolic heart failure” · I50.20 Unspecified systolic (congestive) heart failure
“hypoxemia” · R09.02 Hypoxemia
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 191 Chronic obstructive pulmonary disease with CC. 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

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=1.023, t.ratio_s1=1.5, creat_rise_48h=0.02, 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=1.023, t.ratio_s3=3.0, creat_peak=0.9, 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=1.023, 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=0.02, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=F, hgb_nadir=12.55, 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=0.3, 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=0.3, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=12.55, 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=202, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=78.3, egfr_late=76.1	78.3
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=78.3, t.g2=60, egfr_late=76.1	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=78.3, 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=78.3, egfr_late=76.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=78.3, 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=1832.0, 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=28.0, 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=28.0, 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 met

Specificity gap

Criteria support Hyponatraemia (profound) (E87.1); no corresponding diagnosis is documented.

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=124.0, t.profound=125, t.moderate=130, t.low=135	profound
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=124.0, t.low=135, na_low_count=4, t.repeat=2, na_treated=True	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 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=58, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=28.5, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=28.5, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=28.5, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=28.5, 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

Documented “hypoxemia” (R09.02); criteria support the more specific Acute respiratory failure with hypoxia (J96.01).

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=86.0, 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=86.0, 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=90.0, 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=9.75, t.wbc_hi=12, wbc_min_48h=7.36, 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=174.0	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=0.78	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=74.0	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=0.9	0
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=0.88	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=0, sofa_renal_baseline=0	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, sirs_count=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-005925	Sun Jan 11, 2026 09:15 AM	creatinine	0.86 mg/dL
LAB-005926	Sun Aug 02, 2026 10:05 AM	creatinine	0.88 mg/dL
LAB-005927	Tue Nov 10, 2026 10:56 PM	creatinine	0.88 mg/dL
LAB-005931	Tue Nov 10, 2026 10:56 PM	bnp	1832.0 pg/mL
LAB-005932	Tue Nov 10, 2026 10:56 PM	sodium	126.0 mmol/L
LAB-005936	Tue Nov 10, 2026 10:56 PM	hemoglobin	12.81 g/dL
LAB-005940	Tue Nov 10, 2026 10:56 PM	wbc	7.36 x10^3/uL
LAB-005941	Tue Nov 10, 2026 10:56 PM	platelets	251.0 x10^3/uL
LAB-005948	Tue Nov 10, 2026 10:56 PM	bilirubin	0.78 mg/dL
LAB-005928	Wed Nov 11, 2026 05:00 AM	creatinine	0.9 mg/dL
LAB-005933	Wed Nov 11, 2026 05:00 AM	sodium	124.0 mmol/L
LAB-005937	Wed Nov 11, 2026 05:00 AM	hemoglobin	12.55 g/dL
LAB-005942	Wed Nov 11, 2026 05:00 AM	wbc	9.75 x10^3/uL
LAB-005943	Wed Nov 11, 2026 05:00 AM	platelets	174.0 x10^3/uL
LAB-005929	Thu Nov 12, 2026 05:00 AM	creatinine	0.89 mg/dL
LAB-005934	Thu Nov 12, 2026 05:00 AM	sodium	125.0 mmol/L
LAB-005938	Thu Nov 12, 2026 05:00 AM	hemoglobin	12.67 g/dL
LAB-005944	Thu Nov 12, 2026 05:00 AM	wbc	9.5 x10^3/uL
LAB-005945	Thu Nov 12, 2026 05:00 AM	platelets	288.0 x10^3/uL
LAB-005930	Fri Nov 13, 2026 05:00 AM	creatinine	0.88 mg/dL
LAB-005935	Fri Nov 13, 2026 05:00 AM	sodium	128.0 mmol/L
LAB-005939	Fri Nov 13, 2026 05:00 AM	hemoglobin	12.76 g/dL
LAB-005946	Fri Nov 13, 2026 05:00 AM	wbc	10.98 x10^3/uL
LAB-005947	Fri Nov 13, 2026 05:00 AM	platelets	165.0 x10^3/uL

Vitals (63)

Vitals
Row	When	Kind	Value	Detail
VIT-017062	Tue Nov 10, 2026 10:16 PM	spo2	86.0	room air
VIT-017063	Tue Nov 10, 2026 10:16 PM	rr	29.0
VIT-017089	Tue Nov 10, 2026 10:16 PM	temp_c	37.4
VIT-017090	Tue Nov 10, 2026 10:16 PM	hr	76.0
VIT-017091	Tue Nov 10, 2026 10:16 PM	map	90.0
VIT-017092	Tue Nov 10, 2026 10:16 PM	gcs	15.0
VIT-017064	Tue Nov 10, 2026 10:26 PM	o2_lpm	5.0	nasal cannula
VIT-017065	Wed Nov 11, 2026 06:16 AM	spo2	95.0	nasal cannula
VIT-017066	Wed Nov 11, 2026 06:16 AM	rr	25.0
VIT-017067	Wed Nov 11, 2026 06:16 AM	o2_lpm	3.0	nasal cannula
VIT-017093	Wed Nov 11, 2026 06:16 AM	temp_c	37.4
VIT-017094	Wed Nov 11, 2026 06:16 AM	hr	71.0
VIT-017095	Wed Nov 11, 2026 06:16 AM	map	74.0
VIT-017096	Wed Nov 11, 2026 06:16 AM	gcs	15.0
VIT-017068	Wed Nov 11, 2026 02:16 PM	spo2	91.0	nasal cannula
VIT-017069	Wed Nov 11, 2026 02:16 PM	rr	22.0
VIT-017070	Wed Nov 11, 2026 02:16 PM	o2_lpm	2.0	nasal cannula
VIT-017097	Wed Nov 11, 2026 02:16 PM	temp_c	37.2
VIT-017098	Wed Nov 11, 2026 02:16 PM	hr	90.0
VIT-017099	Wed Nov 11, 2026 02:16 PM	map	77.0
VIT-017100	Wed Nov 11, 2026 02:16 PM	gcs	15.0
VIT-017071	Wed Nov 11, 2026 10:16 PM	spo2	93.0	nasal cannula
VIT-017072	Wed Nov 11, 2026 10:16 PM	rr	25.0
VIT-017073	Wed Nov 11, 2026 10:16 PM	o2_lpm	2.0	nasal cannula
VIT-017101	Wed Nov 11, 2026 10:16 PM	temp_c	37.5
VIT-017102	Wed Nov 11, 2026 10:16 PM	hr	82.0
VIT-017103	Wed Nov 11, 2026 10:16 PM	map	86.0
VIT-017104	Wed Nov 11, 2026 10:16 PM	gcs	15.0
VIT-017074	Thu Nov 12, 2026 06:16 AM	spo2	95.0	nasal cannula
VIT-017075	Thu Nov 12, 2026 06:16 AM	rr	21.0
VIT-017076	Thu Nov 12, 2026 06:16 AM	o2_lpm	4.0	nasal cannula
VIT-017105	Thu Nov 12, 2026 06:16 AM	temp_c	36.5
VIT-017106	Thu Nov 12, 2026 06:16 AM	hr	84.0
VIT-017107	Thu Nov 12, 2026 06:16 AM	map	76.0
VIT-017108	Thu Nov 12, 2026 06:16 AM	gcs	15.0
VIT-017077	Thu Nov 12, 2026 02:16 PM	spo2	91.0	nasal cannula
VIT-017078	Thu Nov 12, 2026 02:16 PM	rr	21.0
VIT-017079	Thu Nov 12, 2026 02:16 PM	o2_lpm	3.0	nasal cannula
VIT-017109	Thu Nov 12, 2026 02:16 PM	temp_c	37.5
VIT-017110	Thu Nov 12, 2026 02:16 PM	hr	75.0
VIT-017111	Thu Nov 12, 2026 02:16 PM	map	77.0
VIT-017112	Thu Nov 12, 2026 02:16 PM	gcs	15.0
VIT-017080	Thu Nov 12, 2026 10:16 PM	spo2	91.0	nasal cannula
VIT-017081	Thu Nov 12, 2026 10:16 PM	rr	25.0
VIT-017082	Thu Nov 12, 2026 10:16 PM	o2_lpm	4.0	nasal cannula
VIT-017113	Thu Nov 12, 2026 10:16 PM	temp_c	36.6
VIT-017114	Thu Nov 12, 2026 10:16 PM	hr	81.0
VIT-017115	Thu Nov 12, 2026 10:16 PM	map	84.0
VIT-017116	Thu Nov 12, 2026 10:16 PM	gcs	15.0
VIT-017083	Fri Nov 13, 2026 06:16 AM	spo2	95.0	nasal cannula
VIT-017084	Fri Nov 13, 2026 06:16 AM	rr	24.0
VIT-017085	Fri Nov 13, 2026 06:16 AM	o2_lpm	4.0	nasal cannula
VIT-017117	Fri Nov 13, 2026 06:16 AM	temp_c	36.6
VIT-017118	Fri Nov 13, 2026 06:16 AM	hr	90.0
VIT-017119	Fri Nov 13, 2026 06:16 AM	map	79.0
VIT-017120	Fri Nov 13, 2026 06:16 AM	gcs	15.0
VIT-017086	Fri Nov 13, 2026 02:16 PM	spo2	91.0	nasal cannula
VIT-017087	Fri Nov 13, 2026 02:16 PM	rr	22.0
VIT-017088	Fri Nov 13, 2026 02:16 PM	o2_lpm	3.0	nasal cannula
VIT-017121	Fri Nov 13, 2026 02:16 PM	temp_c	37.1
VIT-017122	Fri Nov 13, 2026 02:16 PM	hr	79.0
VIT-017123	Fri Nov 13, 2026 02:16 PM	map	92.0
VIT-017124	Fri Nov 13, 2026 02:16 PM	gcs	15.0

Medications, orders, echo, history (10)

MED-000685 11-10 08:00 furosemide 40 mg IV
MED-000686 11-10 20:00 furosemide 40 mg IV
MED-000687 11-11 08:00 furosemide 40 mg IV
MED-000688 11-11 20:00 furosemide 40 mg IV
MED-000689 11-12 08:00 furosemide 40 mg IV
MED-000690 11-12 20:00 furosemide 40 mg IV
MED-000691 11-11 01:56 sodium chloride 3% 100 mL IV
ORD-000152 11-11 00:56 fluid_restriction: fluid restriction 1.2 L/day
ECH-000079 2026-11-12 echo LVEF 28.0%
HX-000060 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000581 · Dr. Noor Halvorsen (resident) · Wed Nov 11, 2026 12:56 AM

Cited facts from this note (1)

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

Show source for work_of_breathing

… Past medical history: heart failure with reduced ejection fraction, GERD, type 2 diabetes, hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessory muscle use. Assessment and plan: 1. COPD exacerbation: bronchodilators and steroids.

Source document DOC-000581: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Vera Penhallow   MRN: MRN26255814   Admitted: 2026-11-10 21:56
Service: Pulmonology   Attending: Dr. Rosalind Quillan

History of present illness: 58-year-old woman admitted with COPD exacerbation. 
Past medical history: heart failure with reduced ejection fraction, GERD, type 2 diabetes, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscle use.
Assessment and plan:
1. COPD exacerbation: bronchodilators and steroids.

Progress note · DOC-000582 · Dr. Noor Halvorsen (resident) · Fri Nov 13, 2026 03:55 PM · awaiting cosign

Source document DOC-000582: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Vera Penhallow   MRN: MRN26255814   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. Systolic heart failure: diuresis and daily weights; monitor electrolytes.
3. Hypoxemia: supplemental oxygen, wean as tolerated.

Resident: Dr. Noor Halvorsen   Attending cosign: pending