RT
Robert Tran Critical Risk
MRN 02981 · 71 yrs · Male · Riverside Main · DOB 04 Mar 1955
Composite Risk Score
88
of 100
Last assessed Jun 14, 2026 · 08:12
31
Lab
23
Vitals
34
Diagnosis
Score Composition
Lab results 35%
Vital signs 26%
Diagnoses 39%
90-Day Trend
Score rose from 62 → 88 over 3 months +26
Risk Factor Breakdown
| Category | Risk Factor | Value | Threshold | Points |
|---|---|---|---|---|
| Lab | HbA1c | 9.5% | ≥ 9.0% | +15 |
| Lab | Creatinine | 2.5 mg/dL | 2.0–3.9 | +8 |
| Lab | eGFR | 38 | < 45 | +8 |
| Vitals | Blood Pressure | 185/125 | ≥ 180/120 | +15 |
| Vitals | SpO₂ | 91% | < 94% | +8 |
| Diagnosis | Heart Failure I50 | — | prefix I50 | +15 |
| Diagnosis | Type 2 Diabetes E11 | — | prefix E11 | +12 |
| Composite Risk Score | 88 | |||
Recommended Actions
- Enroll in CHF Management care plan template
- Schedule nephrology referral (eGFR declining)
- Initiate 14-day BP home-monitoring
- Diabetes educator follow-up within 7 days
Care Team
AP
Dr. Anjali Patel
Primary Care · Cardiology
RN
Nadia Brooks, RN
Care Manager
SC
Sofia Cruz, LPN
Clinical Coordinator