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-00178: Quinn Kestrel

50F · MRN99953773 · Hospital Medicine · admitted Tue Nov 10, 2026 11:09 AM · in hospital · attending Dr. Jalen Carrow · 164 cm, 47.0 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“malnourished” · E46 Unspecified protein-calorie malnutrition
“renal insufficiency” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
“acute on chronic diastolic heart failure” · I50.33 Acute on chronic diastolic (congestive) heart failure
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“sacral pressure ulcer” · L89.159 Pressure ulcer of sacral region, unspecified stage

Illustrative grouping now: MS-DRG 193 Simple pneumonia and pleurisy with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 193.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

Specificity gap

Documented “renal insufficiency” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 3) (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=3.574, t.ratio_s1=1.5, creat_rise_48h=0.79, 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=3.574, t.ratio_s3=3.0, creat_peak=3.61, 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	true
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=3.574, 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=True, stage2=True, meets_definition=True	3
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.79, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=3, baseline_independent=True	true

Acute blood loss anaemia

Clinical judgement required

Clinical judgement required: Haemoglobin fell 1.4 g/dL without transfusion (between 1 and 2 g/dL).

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=9.6, 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=1.4, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=True, hgb_drop=1.4, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=9.6, anaemic=True	false
outcome: no_source	`anaemic and acute_fall`	anaemic=True, acute_fall=False	false
outcome: borderline	`anaemic`	anaemic=True	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=225, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=68.6, egfr_late=67.8	68.6
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=68.6, t.g2=60, egfr_late=67.8	false
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=68.6, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=False, egfr_early=68.6, egfr_late=67.8, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=68.6, t.g2=60	true

Heart failure

Criteria met

Clinical validation gap

Documented “acute on chronic diastolic heart failure” (I50.33) is more specific than the criteria support (Chronic diastolic (HFpEF) heart failure, I50.32).

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=75.0, 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=65.0, 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=65.0, 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=0, hf_history=True	chronic
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=chronic	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=diastolic, acuity=chronic	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=chronic	false
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=chronic	false
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=diastolic, acuity=chronic	false
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=chronic	true

Hyponatraemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=136.0, t.profound=125, t.moderate=130, t.low=135	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=136.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, t.low=135	true

Malnutrition

Clinical judgement required

Clinical judgement required: Only one consensus characteristic documented; two are required.

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=10.0, 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=10.0, 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=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=60.0, t.c_intake_pct=75, intake_days=10.0, 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=10.0, 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=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=60.0, 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=True, 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	1
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=1	false
outcome: one_characteristic	`n_moderate == 1`	n_moderate=1	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=17.5, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=17.5, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=17.5, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=17.5, t.c1=30	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=95.0, 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=95.0, 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 met

No gap

Criteria support Sepsis (Sepsis-3); not documented (this rule does not prompt for an undocumented diagnosis).

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=37.6, t.t_hi=38, temp_min_48h=36.7, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=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=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=9.73, t.wbc_hi=12, wbc_min_48h=7.73, 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=178.0	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=0.57	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=78.0	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=3.61	3
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=1.01	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=3, sofa_renal_baseline=0	3
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=3, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, 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=True, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=True	false
outcome: septic_shock	`shock`	shock=False	false
outcome: both	`sepsis3 and sepsis2`	sepsis3=True, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=True	true

Structured data

Labs (24)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-006097	Tue Dec 09, 2025 09:15 AM	creatinine	1.0 mg/dL
LAB-006098	Thu Jul 23, 2026 10:05 AM	creatinine	1.01 mg/dL
LAB-006099	Tue Nov 10, 2026 12:09 PM	creatinine	2.82 mg/dL
LAB-006103	Tue Nov 10, 2026 12:09 PM	bnp	75.0 pg/mL
LAB-006104	Tue Nov 10, 2026 12:09 PM	sodium	136.0 mmol/L
LAB-006108	Tue Nov 10, 2026 12:09 PM	hemoglobin	11.0 g/dL
LAB-006112	Tue Nov 10, 2026 12:09 PM	wbc	9.73 x10^3/uL
LAB-006113	Tue Nov 10, 2026 12:09 PM	platelets	178.0 x10^3/uL
LAB-006120	Tue Nov 10, 2026 12:09 PM	bilirubin	0.57 mg/dL
LAB-006100	Wed Nov 11, 2026 05:00 AM	creatinine	3.61 mg/dL
LAB-006105	Wed Nov 11, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-006109	Wed Nov 11, 2026 05:00 AM	hemoglobin	10.2 g/dL
LAB-006114	Wed Nov 11, 2026 05:00 AM	wbc	7.73 x10^3/uL
LAB-006115	Wed Nov 11, 2026 05:00 AM	platelets	310.0 x10^3/uL
LAB-006101	Thu Nov 12, 2026 05:00 AM	creatinine	3.25 mg/dL
LAB-006106	Thu Nov 12, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-006110	Thu Nov 12, 2026 05:00 AM	hemoglobin	9.6 g/dL
LAB-006116	Thu Nov 12, 2026 05:00 AM	wbc	9.47 x10^3/uL
LAB-006117	Thu Nov 12, 2026 05:00 AM	platelets	224.0 x10^3/uL
LAB-006102	Fri Nov 13, 2026 05:00 AM	creatinine	2.71 mg/dL
LAB-006107	Fri Nov 13, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-006111	Fri Nov 13, 2026 05:00 AM	hemoglobin	9.7 g/dL
LAB-006118	Fri Nov 13, 2026 05:00 AM	wbc	6.41 x10^3/uL
LAB-006119	Fri Nov 13, 2026 05:00 AM	platelets	279.0 x10^3/uL

Vitals (60)

Vitals
Row	When	Kind	Value	Detail
VIT-017547	Tue Nov 10, 2026 11:29 AM	spo2	95.0	room air
VIT-017548	Tue Nov 10, 2026 11:29 AM	rr	14.0
VIT-017567	Tue Nov 10, 2026 11:29 AM	temp_c	36.7
VIT-017568	Tue Nov 10, 2026 11:29 AM	hr	76.0
VIT-017569	Tue Nov 10, 2026 11:29 AM	map	81.0
VIT-017570	Tue Nov 10, 2026 11:29 AM	gcs	15.0
VIT-017549	Tue Nov 10, 2026 07:29 PM	spo2	97.0	room air
VIT-017550	Tue Nov 10, 2026 07:29 PM	rr	20.0
VIT-017571	Tue Nov 10, 2026 07:29 PM	temp_c	37.6
VIT-017572	Tue Nov 10, 2026 07:29 PM	hr	84.0
VIT-017573	Tue Nov 10, 2026 07:29 PM	map	80.0
VIT-017574	Tue Nov 10, 2026 07:29 PM	gcs	15.0
VIT-017551	Wed Nov 11, 2026 03:29 AM	spo2	99.0	room air
VIT-017552	Wed Nov 11, 2026 03:29 AM	rr	16.0
VIT-017575	Wed Nov 11, 2026 03:29 AM	temp_c	37.1
VIT-017576	Wed Nov 11, 2026 03:29 AM	hr	88.0
VIT-017577	Wed Nov 11, 2026 03:29 AM	map	83.0
VIT-017578	Wed Nov 11, 2026 03:29 AM	gcs	15.0
VIT-017553	Wed Nov 11, 2026 11:29 AM	spo2	95.0	room air
VIT-017554	Wed Nov 11, 2026 11:29 AM	rr	17.0
VIT-017579	Wed Nov 11, 2026 11:29 AM	temp_c	37.4
VIT-017580	Wed Nov 11, 2026 11:29 AM	hr	90.0
VIT-017581	Wed Nov 11, 2026 11:29 AM	map	82.0
VIT-017582	Wed Nov 11, 2026 11:29 AM	gcs	15.0
VIT-017555	Wed Nov 11, 2026 07:29 PM	spo2	98.0	room air
VIT-017556	Wed Nov 11, 2026 07:29 PM	rr	20.0
VIT-017583	Wed Nov 11, 2026 07:29 PM	temp_c	36.7
VIT-017584	Wed Nov 11, 2026 07:29 PM	hr	71.0
VIT-017585	Wed Nov 11, 2026 07:29 PM	map	91.0
VIT-017586	Wed Nov 11, 2026 07:29 PM	gcs	15.0
VIT-017557	Thu Nov 12, 2026 03:29 AM	spo2	96.0	room air
VIT-017558	Thu Nov 12, 2026 03:29 AM	rr	16.0
VIT-017587	Thu Nov 12, 2026 03:29 AM	temp_c	37.5
VIT-017588	Thu Nov 12, 2026 03:29 AM	hr	69.0
VIT-017589	Thu Nov 12, 2026 03:29 AM	map	78.0
VIT-017590	Thu Nov 12, 2026 03:29 AM	gcs	15.0
VIT-017559	Thu Nov 12, 2026 11:29 AM	spo2	96.0	room air
VIT-017560	Thu Nov 12, 2026 11:29 AM	rr	20.0
VIT-017591	Thu Nov 12, 2026 11:29 AM	temp_c	36.7
VIT-017592	Thu Nov 12, 2026 11:29 AM	hr	69.0
VIT-017593	Thu Nov 12, 2026 11:29 AM	map	91.0
VIT-017594	Thu Nov 12, 2026 11:29 AM	gcs	15.0
VIT-017561	Thu Nov 12, 2026 07:29 PM	spo2	98.0	room air
VIT-017562	Thu Nov 12, 2026 07:29 PM	rr	15.0
VIT-017595	Thu Nov 12, 2026 07:29 PM	temp_c	37.0
VIT-017596	Thu Nov 12, 2026 07:29 PM	hr	72.0
VIT-017597	Thu Nov 12, 2026 07:29 PM	map	89.0
VIT-017598	Thu Nov 12, 2026 07:29 PM	gcs	15.0
VIT-017563	Fri Nov 13, 2026 03:29 AM	spo2	98.0	room air
VIT-017564	Fri Nov 13, 2026 03:29 AM	rr	20.0
VIT-017599	Fri Nov 13, 2026 03:29 AM	temp_c	36.5
VIT-017600	Fri Nov 13, 2026 03:29 AM	hr	87.0
VIT-017601	Fri Nov 13, 2026 03:29 AM	map	87.0
VIT-017602	Fri Nov 13, 2026 03:29 AM	gcs	15.0
VIT-017565	Fri Nov 13, 2026 11:29 AM	spo2	96.0	room air
VIT-017566	Fri Nov 13, 2026 11:29 AM	rr	16.0
VIT-017603	Fri Nov 13, 2026 11:29 AM	temp_c	37.6
VIT-017604	Fri Nov 13, 2026 11:29 AM	hr	86.0
VIT-017605	Fri Nov 13, 2026 11:29 AM	map	79.0
VIT-017606	Fri Nov 13, 2026 11:29 AM	gcs	15.0

Medications, orders, echo, history (9)

MED-000705 11-10 12:09 cefepime per protocol IV
MED-000706 11-11 05:00 ceftriaxone per protocol IV
MED-000707 11-12 05:00 ceftriaxone per protocol IV
MED-000708 11-10 09:09 furosemide 40 mg PO
MED-000709 11-11 09:00 furosemide 40 mg PO
MED-000710 11-12 09:00 furosemide 40 mg PO
ORD-000154 11-10 11:39 blood_culture: blood cultures x2
ECH-000083 2026-11-11 echo LVEF 65.0%
HX-000064 history: heart failure with preserved ejection fraction

Notes

History and physical · DOC-000597 · Dr. Jalen Carrow (attending) · Tue Nov 10, 2026 02:09 PM

Cited facts from this note (2)

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

Show source for bleeding_source

… ay shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: heart failure with preserved ejection fraction. Denies bleeding, chest pain or fever. Exam: Lungs: scattered crackles at the bases, no distress. Assessment and plan: 1. Community-acquired pneumonia: antibiotics.
infection_source: right lower lobe pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… e: Hospital Medicine Attending: Dr. Jalen Carrow History of present illness: 50-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: heart failure with preserved ejection fraction. Denies bleeding, chest pain or fever. Exam …

Source document DOC-000597: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Quinn Kestrel   MRN: MRN99953773   Admitted: 2026-11-10 11:09
Service: Hospital Medicine   Attending: Dr. Jalen Carrow

History of present illness: 50-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: heart failure with preserved ejection fraction.
Denies bleeding, chest pain or fever.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.

Nutrition assessment · DOC-000595 · Vera Pemberton, RD (dietitian) · Wed Nov 11, 2026 03:09 PM

Cited facts from this note (6)

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

Show source for fat_loss

… acute illness Intake: estimated energy intake 60% of needs for 10 days. 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: at risk; continue calorie counts.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… 0% of needs for 10 days. 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: at risk; continue calorie counts.
intake_days: 10 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Quinn Kestrel MRN: MRN99953773 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. …
intake_pct: 60 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Quinn Kestrel MRN: MRN99953773 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. 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

… ted energy intake 60% of needs for 10 days. 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: at risk; continue calorie counts.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Quinn Kestrel MRN: MRN99953773 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of sub …

Source document DOC-000595: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Quinn Kestrel   MRN: MRN99953773

Context: acute illness
Intake: estimated energy intake 60% of needs for 10 days.
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: at risk; continue calorie counts.

Wound care note · DOC-000596 · Ines Ingram, RN, CWOCN (wound_nurse) · Wed Nov 11, 2026 03:09 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: Quinn Kestrel MRN: MRN99953773 Location: sacrum Stage: 3 (NPIAP) Description: full-thickness skin loss, adipose visible, no tendon or bone. Size: 3.8 x 1.8 x 0.9 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: Quinn Kestrel MRN: MRN99953773 Location: sacrum Stage: 3 (NPIAP) Description: full-thickness skin loss, adipose visible, no tendon or bone. Size: 3.8 x 1.8 x 0.9 cm. Plan: offloading every 2 hours, foam dressing, nut …

Source document DOC-000596: Wound care note (synthetic)

WOUND CARE NOTE
Patient: Quinn Kestrel   MRN: MRN99953773

Location: sacrum
Stage: 3 (NPIAP)
Description: full-thickness skin loss, adipose visible, no tendon or bone.
Size: 3.8 x 1.8 x 0.9 cm.
Plan: offloading every 2 hours, foam dressing, nutrition consult.

Progress note · DOC-000598 · Dr. Jalen Carrow (attending) · Fri Nov 13, 2026 03:55 PM

Source document DOC-000598: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Quinn Kestrel   MRN: MRN99953773   Hospital day 4

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Community-acquired pneumonia: continue current management.
2. Malnourished: dietitian following.
3. Renal insufficiency: trend creatinine, avoid nephrotoxins.
4. Acute on chronic diastolic heart failure: diuresis and daily weights; monitor electrolytes.
5. Acute blood loss anemia: trend hemoglobin, transfuse if needed.
6. Sacral pressure ulcer: wound care following, offloading.

Attending: Dr. Jalen Carrow