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-00177: Nico Merriweather

50M · MRN94797508 · Cardiology · admitted Mon Nov 09, 2026 09:05 PM · in hospital · attending Dr. Jalen Carrow · resident Dr. Keira Upfield · 170 cm, 48.5 kg

Documented diagnoses (current)

“severe malnutrition” · E43 Unspecified severe protein-calorie malnutrition
Principal: “acute on chronic systolic heart failure” · I50.23 Acute on chronic systolic (congestive) heart failure
“hyponatremia” · E87.1 Hypo-osmolality and hyponatremia
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 291 Heart failure and shock with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 292.

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=1.053, 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=1.053, t.ratio_s3=3.0, creat_peak=1.0, 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=1.053, 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 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=11.14, 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=False, 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=298, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=95.1, egfr_late=97.5	97.5
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=95.1, t.g2=60, egfr_late=97.5	false
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=97.5, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=False, egfr_early=95.1, egfr_late=97.5, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=97.5, t.g2=60	true

Heart failure

Criteria met

No gap

Supported as documented (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=1741.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	true
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=True, np_elevated=True, new_o2=False	2
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=30.0, 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=30.0, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=2, hf_history=True	acute on chronic
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=systolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=acute on chronic	true

Hyponatraemia

Criteria not met

Clinical validation gap

Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 136).

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 met

Clinical validation gap

Documented “severe malnutrition” (E43) conflicts with what the criteria support (Moderate (non-severe) protein-calorie malnutrition (acute illness context), E44.0).

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=60.0, t.a_sev_intake_pct=50, intake_days=14.0, 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=60.0, t.a_mod_intake_pct=75, intake_days=14.0, t.a_mod_intake_days=7	true
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=30.0, wt_loss_pct=3.0	false
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=30.0, wt_loss_pct=3.0	false
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=60.0, t.c_intake_pct=75, intake_days=14.0, 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=60.0, t.c_intake_pct=75, intake_days=14.0, 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=30.0, wt_loss_pct=3.0	false
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=30.0, wt_loss_pct=3.0	false
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=60.0, wt_loss_pct=3.0, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown	5
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=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=False	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=True, a_sev_wt=False, a_mod_wt=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=False, c_mod_wt=False	3
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=3	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=50, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=16.8, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=16.8, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=16.8, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=16.8, t.c1=30	true

Pressure injury

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

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

Acute respiratory failure

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule respiratory_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: measured	`present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min)`	spo2_min_ra=94.0, pao2_min_ra=unknown, pf_min=unknown	true
derived: hypoxemia	`coalesce(spo2_min_ra < t.spo2_ra, false) or coalesce(pao2_min_ra < t.pao2, false) or coalesce(pf_min < t.pf, false)`	spo2_min_ra=94.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	false
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=20.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=False	false
outcome: met	`hypoxemia and distress`	hypoxemia=False, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=False	false
outcome: not_met	`measured and not hypoxemia and o2_max_lpm <= t.o2_low and not adv_resp_support`	measured=True, hypoxemia=False, o2_max_lpm=0.0, t.o2_low=2, adv_resp_support=False	true

Sepsis

Criteria 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=37.4, 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=87.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=20.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	false
derived: sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`	wbc_max_48h=10.12, t.wbc_hi=12, wbc_min_48h=8.51, 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=229.0	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=0.55	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=77.0	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=1.0	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=0.95	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=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=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 (29)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-006068	Sun Nov 16, 2025 09:15 AM	creatinine	0.97 mg/dL
LAB-006069	Fri Sep 11, 2026 10:05 AM	creatinine	0.95 mg/dL
LAB-006070	Mon Nov 09, 2026 10:05 PM	creatinine	1.0 mg/dL
LAB-006075	Mon Nov 09, 2026 10:05 PM	bnp	1741.0 pg/mL
LAB-006076	Mon Nov 09, 2026 10:05 PM	sodium	137.0 mmol/L
LAB-006081	Mon Nov 09, 2026 10:05 PM	hemoglobin	11.54 g/dL
LAB-006086	Mon Nov 09, 2026 10:05 PM	wbc	10.12 x10^3/uL
LAB-006087	Mon Nov 09, 2026 10:05 PM	platelets	250.0 x10^3/uL
LAB-006096	Mon Nov 09, 2026 10:05 PM	bilirubin	0.55 mg/dL
LAB-006071	Tue Nov 10, 2026 05:00 AM	creatinine	0.95 mg/dL
LAB-006077	Tue Nov 10, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-006082	Tue Nov 10, 2026 05:00 AM	hemoglobin	11.14 g/dL
LAB-006088	Tue Nov 10, 2026 05:00 AM	wbc	9.83 x10^3/uL
LAB-006089	Tue Nov 10, 2026 05:00 AM	platelets	303.0 x10^3/uL
LAB-006072	Wed Nov 11, 2026 05:00 AM	creatinine	0.97 mg/dL
LAB-006078	Wed Nov 11, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-006083	Wed Nov 11, 2026 05:00 AM	hemoglobin	11.54 g/dL
LAB-006090	Wed Nov 11, 2026 05:00 AM	wbc	8.51 x10^3/uL
LAB-006091	Wed Nov 11, 2026 05:00 AM	platelets	229.0 x10^3/uL
LAB-006073	Thu Nov 12, 2026 05:00 AM	creatinine	0.97 mg/dL
LAB-006079	Thu Nov 12, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-006084	Thu Nov 12, 2026 05:00 AM	hemoglobin	11.14 g/dL
LAB-006092	Thu Nov 12, 2026 05:00 AM	wbc	7.37 x10^3/uL
LAB-006093	Thu Nov 12, 2026 05:00 AM	platelets	299.0 x10^3/uL
LAB-006074	Fri Nov 13, 2026 05:00 AM	creatinine	0.97 mg/dL
LAB-006080	Fri Nov 13, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-006085	Fri Nov 13, 2026 05:00 AM	hemoglobin	11.54 g/dL
LAB-006094	Fri Nov 13, 2026 05:00 AM	wbc	7.83 x10^3/uL
LAB-006095	Fri Nov 13, 2026 05:00 AM	platelets	225.0 x10^3/uL

Vitals (72)

Vitals
Row	When	Kind	Value	Detail
VIT-017475	Mon Nov 09, 2026 09:25 PM	spo2	94.0	room air
VIT-017476	Mon Nov 09, 2026 09:25 PM	rr	14.0
VIT-017499	Mon Nov 09, 2026 09:25 PM	temp_c	36.6
VIT-017500	Mon Nov 09, 2026 09:25 PM	hr	73.0
VIT-017501	Mon Nov 09, 2026 09:25 PM	map	92.0
VIT-017502	Mon Nov 09, 2026 09:25 PM	gcs	15.0
VIT-017477	Tue Nov 10, 2026 05:25 AM	spo2	95.0	room air
VIT-017478	Tue Nov 10, 2026 05:25 AM	rr	20.0
VIT-017503	Tue Nov 10, 2026 05:25 AM	temp_c	37.2
VIT-017504	Tue Nov 10, 2026 05:25 AM	hr	85.0
VIT-017505	Tue Nov 10, 2026 05:25 AM	map	77.0
VIT-017506	Tue Nov 10, 2026 05:25 AM	gcs	15.0
VIT-017479	Tue Nov 10, 2026 01:25 PM	spo2	97.0	room air
VIT-017480	Tue Nov 10, 2026 01:25 PM	rr	15.0
VIT-017507	Tue Nov 10, 2026 01:25 PM	temp_c	37.4
VIT-017508	Tue Nov 10, 2026 01:25 PM	hr	81.0
VIT-017509	Tue Nov 10, 2026 01:25 PM	map	83.0
VIT-017510	Tue Nov 10, 2026 01:25 PM	gcs	15.0
VIT-017481	Tue Nov 10, 2026 09:25 PM	spo2	96.0	room air
VIT-017482	Tue Nov 10, 2026 09:25 PM	rr	18.0
VIT-017511	Tue Nov 10, 2026 09:25 PM	temp_c	37.2
VIT-017512	Tue Nov 10, 2026 09:25 PM	hr	87.0
VIT-017513	Tue Nov 10, 2026 09:25 PM	map	78.0
VIT-017514	Tue Nov 10, 2026 09:25 PM	gcs	15.0
VIT-017483	Wed Nov 11, 2026 05:25 AM	spo2	98.0	room air
VIT-017484	Wed Nov 11, 2026 05:25 AM	rr	20.0
VIT-017515	Wed Nov 11, 2026 05:25 AM	temp_c	36.7
VIT-017516	Wed Nov 11, 2026 05:25 AM	hr	69.0
VIT-017517	Wed Nov 11, 2026 05:25 AM	map	86.0
VIT-017518	Wed Nov 11, 2026 05:25 AM	gcs	15.0
VIT-017485	Wed Nov 11, 2026 01:25 PM	spo2	96.0	room air
VIT-017486	Wed Nov 11, 2026 01:25 PM	rr	15.0
VIT-017519	Wed Nov 11, 2026 01:25 PM	temp_c	36.6
VIT-017520	Wed Nov 11, 2026 01:25 PM	hr	73.0
VIT-017521	Wed Nov 11, 2026 01:25 PM	map	82.0
VIT-017522	Wed Nov 11, 2026 01:25 PM	gcs	15.0
VIT-017487	Wed Nov 11, 2026 09:25 PM	spo2	97.0	room air
VIT-017488	Wed Nov 11, 2026 09:25 PM	rr	20.0
VIT-017523	Wed Nov 11, 2026 09:25 PM	temp_c	36.8
VIT-017524	Wed Nov 11, 2026 09:25 PM	hr	88.0
VIT-017525	Wed Nov 11, 2026 09:25 PM	map	84.0
VIT-017526	Wed Nov 11, 2026 09:25 PM	gcs	15.0
VIT-017489	Thu Nov 12, 2026 05:25 AM	spo2	94.0	room air
VIT-017490	Thu Nov 12, 2026 05:25 AM	rr	17.0
VIT-017527	Thu Nov 12, 2026 05:25 AM	temp_c	37.5
VIT-017528	Thu Nov 12, 2026 05:25 AM	hr	76.0
VIT-017529	Thu Nov 12, 2026 05:25 AM	map	74.0
VIT-017530	Thu Nov 12, 2026 05:25 AM	gcs	15.0
VIT-017491	Thu Nov 12, 2026 01:25 PM	spo2	94.0	room air
VIT-017492	Thu Nov 12, 2026 01:25 PM	rr	20.0
VIT-017531	Thu Nov 12, 2026 01:25 PM	temp_c	36.7
VIT-017532	Thu Nov 12, 2026 01:25 PM	hr	71.0
VIT-017533	Thu Nov 12, 2026 01:25 PM	map	78.0
VIT-017534	Thu Nov 12, 2026 01:25 PM	gcs	15.0
VIT-017493	Thu Nov 12, 2026 09:25 PM	spo2	95.0	room air
VIT-017494	Thu Nov 12, 2026 09:25 PM	rr	20.0
VIT-017535	Thu Nov 12, 2026 09:25 PM	temp_c	37.4
VIT-017536	Thu Nov 12, 2026 09:25 PM	hr	73.0
VIT-017537	Thu Nov 12, 2026 09:25 PM	map	82.0
VIT-017538	Thu Nov 12, 2026 09:25 PM	gcs	15.0
VIT-017495	Fri Nov 13, 2026 05:25 AM	spo2	97.0	room air
VIT-017496	Fri Nov 13, 2026 05:25 AM	rr	18.0
VIT-017539	Fri Nov 13, 2026 05:25 AM	temp_c	36.9
VIT-017540	Fri Nov 13, 2026 05:25 AM	hr	85.0
VIT-017541	Fri Nov 13, 2026 05:25 AM	map	82.0
VIT-017542	Fri Nov 13, 2026 05:25 AM	gcs	15.0
VIT-017497	Fri Nov 13, 2026 01:25 PM	spo2	95.0	room air
VIT-017498	Fri Nov 13, 2026 01:25 PM	rr	14.0
VIT-017543	Fri Nov 13, 2026 01:25 PM	temp_c	36.6
VIT-017544	Fri Nov 13, 2026 01:25 PM	hr	84.0
VIT-017545	Fri Nov 13, 2026 01:25 PM	map	92.0
VIT-017546	Fri Nov 13, 2026 01:25 PM	gcs	15.0

Medications, orders, echo, history (8)

MED-000699 11-09 08:00 furosemide 40 mg IV
MED-000700 11-09 20:00 furosemide 40 mg IV
MED-000701 11-10 08:00 furosemide 40 mg IV
MED-000702 11-10 20:00 furosemide 40 mg IV
MED-000703 11-11 08:00 furosemide 40 mg IV
MED-000704 11-11 20:00 furosemide 40 mg IV
ECH-000082 2026-11-10 echo LVEF 30.0%
HX-000063 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000593 · Dr. Keira Upfield (resident) · Tue Nov 10, 2026 12:05 AM

Source document DOC-000593: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Nico Merriweather   MRN: MRN94797508   Admitted: 2026-11-09 21:05
Service: Cardiology   Attending: Dr. Jalen Carrow

History of present illness: 50-year-old man admitted with acute on chronic systolic heart failure. 
Past medical history: heart failure with reduced ejection fraction, hyperlipidemia, GERD.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Acute on chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000592 · Viggo Ravensworth, RD (dietitian) · Wed Nov 11, 2026 01:05 AM

Cited facts from this note (8)

fat_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for fat_loss

… Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… ake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
intake_days: 14 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nico Merriweather MRN: MRN94797508 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip …
intake_pct: 60 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nico Merriweather MRN: MRN94797508 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip …
muscle_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nico Merriweather MRN: MRN94797508 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneo …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… ered Dietitian) Patient: Nico Merriweather MRN: MRN94797508 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets cri …
weight_loss_pct: 3 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… ered Dietitian) Patient: Nico Merriweather MRN: MRN94797508 Context: acute illness Intake: estimated energy intake 60% of needs for 14 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets cri …

Source document DOC-000592: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Nico Merriweather   MRN: MRN94797508

Context: acute illness
Intake: estimated energy intake 60% of needs for 14 days.
Weight history: 3% weight loss over 30 days.
Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation.
Grip strength: not assessed.
Assessment: meets criteria for non-severe (moderate) malnutrition.

Progress note · DOC-000594 · Dr. Keira Upfield (resident) · Fri Nov 13, 2026 02:55 PM · awaiting cosign

Source document DOC-000594: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Nico Merriweather   MRN: MRN94797508   Hospital day 4

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Acute on chronic systolic heart failure: continue current management.
2. Severe malnutrition: dietitian following, supplements.
3. Hyponatremia: trend sodium.
4. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Resident: Dr. Keira Upfield   Attending cosign: pending