[
  {
    "medical_text": "An older man came to the emergency room with fever and cough. He had chest pain when he breathed and felt short of breath. He has COPD and diabetes. A chest x-ray showed a pneumonia in the right lower lung. His blood work showed signs of infection. He got IV antibiotics and oxygen through a small tube in his nose. The sputum test grew a common germ called pneumococcus. Blood cultures did not grow any germs. After two days, his fever went away and he switched to pills. He went home on day four with more pills and a pneumonia shot.",
    "subclaim": "Blood cultures were negative.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with T2DM, HTN, and active cigarette use presented with 2 hours of exertional, pressure-like chest pain. Vitals were stable; initial ECG demonstrated 1\u20132 mm ST depressions in leads V5\u2013V6 without ST elevation. High-sensitivity troponin I rose from 78 ng/L to 1,240 ng/L, consistent with NSTEMI. He received 325 mg aspirin load, ticagrelor 180 mg load, and weight-based enoxaparin, along with sublingual nitroglycerin. Coronary angiography identified a critical 90% proximal LAD lesion; a drug-eluting stent was deployed with TIMI-3 flow and no complications. Transthoracic echocardiography showed normal wall motion and LVEF ~55%. Serum creatinine was 0.9 mg/dL; LDL-C was 152 mg/dL; no known drug allergies. He was discharged on aspirin plus ticagrelor for 12 months, atorvastatin 80 mg nightly, and lisinopril, with smoking-cessation counseling and diabetes follow-up.",
    "subclaim": "He received thrombolytic therapy for reperfusion.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 45-year-old woman with asthma presented with fever, productive cough, and pleuritic right-sided chest pain. On triage her SpO2 was 90% on room air, with HR 105 and RR 24. Chest examination revealed right basilar crackles and mild wheeze. Chest radiograph showed a right lower lobe consolidation consistent with community-acquired pneumonia. WBC was 14,000/\u00b5L and lactate 1.2 mmol/L. Two sets of blood cultures were drawn before antibiotics. She reported a penicillin allergy, so azithromycin was started and albuterol was given for wheeze. Oxygen via nasal cannula at 2 L/min improved her saturation to 95%. A SARS-CoV-2 test was negative, and she was planned for a 5-day course and outpatient follow-up without ICU care.",
    "subclaim": "Nasal cannula oxygen raised her SpO2 to 95%.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male with T2DM (A1c 8.2%) presented with 2 hours of exertional substernal pressure and diaphoresis. Initial ECG demonstrated sinus rhythm without ST-segment elevation or new Q waves. High-sensitivity troponin I rose from 36 ng/L to 412 ng/L over 3 hours. NSTEMI was diagnosed; guideline-directed medical therapy was initiated with chewable aspirin 325 mg, IV unfractionated heparin infusion, metoprolol tartrate, and atorvastatin 80 mg. Creatinine was 1.1 mg/dL (eGFR 72 mL/min/1.73 m\u00b2). Coronary angiography showed a critical 90% proximal LAD stenosis with TIMI 2 flow. PCI with a drug-eluting stent restored TIMI 3 flow without complications. At discharge, medications included aspirin 81 mg daily, ticagrelor 90 mg twice daily, atorvastatin 80 mg nightly, and continuation of metformin.",
    "subclaim": "Thrombolytic therapy was administered.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman came to the hospital with fever and cough. She felt short of breath. She has type 2 diabetes. A chest X-ray showed pneumonia in the right lower lung. Her oxygen level was low, so she got oxygen through a small tube in the nose. She was given two IV antibiotics: ceftriaxone and azithromycin. Blood tests and blood cultures were taken before the antibiotics. She is not allergic to any drugs. She did not need the ICU. By the next day, she was breathing easier.",
    "subclaim": "She was treated with systemic corticosteroids.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the ER with chest pain at rest. The pain started two hours earlier and went to his left arm. He has high blood pressure and type 2 diabetes. He smokes every day. His vital signs were stable, with no fever and no need for oxygen. The heart tracing did not show ST elevation. The blood test for heart damage, troponin, was high and rose again three hours later. He was given aspirin, a statin pill, a beta blocker, and a blood thinner shot. His pain eased after a nitroglycerin tablet under the tongue. The team planned a heart artery test (angiogram) for the next morning, and he was told not to eat after midnight.",
    "subclaim": "The patient is 58 years old.",
    "label": "supported"
  },
  {
    "medical_text": "A 38-year-old adult presented with four days of productive cough, fever, and fatigue. Vitals showed T 38.5\u00b0C, HR 104, RR 22, BP 120/76, and SpO2 93% on room air. Chest radiograph demonstrated a right lower lobe infiltrate. Nasopharyngeal PCR for SARS-CoV-2 and influenza A/B was negative. The patient reported an immediate-type penicillin allergy. Community-acquired pneumonia was diagnosed. Outpatient therapy with doxycycline 100 mg twice daily for seven days was started. Acetaminophen and an albuterol inhaler were provided for symptom relief. The patient received return precautions and a 48-hour phone follow-up. At 48 hours, they were afebrile, coughing less, and their SpO2 was 96%.",
    "subclaim": "Doxycycline 100 mg twice daily for seven days was prescribed.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman with type 2 diabetes and hypertension presented with three days of fever, productive cough, and dyspnea. Vitals: temperature 38.5\u00b0C, respiratory rate 24, oxygen saturation 90% on room air. Lung exam revealed right basilar crackles with pleuritic chest discomfort. Chest radiograph showed right lower lobe consolidation consistent with community-acquired pneumonia. White blood cell count was 14,000/\u00b5L. Two sets of blood cultures were obtained prior to antibiotics. She was started in the emergency department on supplemental oxygen, ceftriaxone, and azithromycin. Rapid influenza testing was negative. She was admitted for intravenous therapy and monitoring. By 48 hours, her oxygen requirement decreased and symptoms improved.",
    "subclaim": "Two sets of blood cultures were drawn before antibiotics.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man presented with three days of fever, productive cough, and dyspnea. On arrival, oxygen saturation was 90% on room air, temperature 38.3\u00b0C, heart rate 102, and respiratory rate 24. Chest radiograph demonstrated right lower lobe consolidation consistent with community-acquired pneumonia. Blood cultures were obtained prior to starting antibiotics. He was started on supplemental oxygen via nasal cannula and given intravenous ceftriaxone plus azithromycin. A nasopharyngeal PCR for SARS-CoV-2 was negative. Over 48 hours, his oxygenation and fevers improved. He was discharged on oral azithromycin to complete a 5-day course, with follow-up arranged in one week.",
    "subclaim": "Oxygen saturation on room air was 90% at presentation.",
    "label": "supported"
  },
  {
    "medical_text": "A previously healthy 27-year-old man presented with 12 hours of migratory periumbilical-to-RLQ pain, nausea, and a single emetic episode. Vitals showed low-grade fever; abdominal exam revealed RLQ tenderness with mild guarding and rebound. Laboratory studies demonstrated leukocytosis to 14.2 \u00d710^3/\u00b5L with left shift and elevated CRP. Contrast-enhanced CT of the abdomen/pelvis showed a 9 mm, noncompressible, hyperenhancing appendix with periappendiceal fat stranding and no evidence of perforation or abscess. Preoperative antibiotics were administered (ceftriaxone 2 g IV plus metronidazole 500 mg IV). The patient underwent uneventful laparoscopic appendectomy under general anesthesia. Postoperative course was uncomplicated with rapid diet advancement and adequate analgesia. He was discharged home on postoperative day 1; final pathology confirmed acute suppurative appendicitis without perforation.",
    "subclaim": "The patient underwent laparoscopic appendectomy.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the hospital with fever and cough. He felt short of breath for three days. His oxygen level on room air was about 90%. A chest x-ray showed a spot of infection in the right lower lung. The team gave him oxygen through a small tube in his nose. He got antibiotics through a vein. A swab test for COVID was negative. After two days, he felt better and went home with antibiotic pills and a plan to see his doctor in one week.",
    "subclaim": "Oxygen saturation on room air was 90% at presentation.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with poorly controlled type 2 diabetes (HbA1c 9.2%) presented with two days of painful, erythematous swelling of the left lower leg after a minor cut. He was febrile to 38.5\u00b0C and tachycardic at 102 bpm. Labs showed leukocytosis (WBC 14.8 \u00d710^9/L) and elevated CRP; renal function was normal. Bedside soft-tissue ultrasound showed cellulitis without a drainable abscess. Blood cultures were obtained and remained negative at 48 hours. Empiric IV cefazolin (2 g every 8 hours) was started for nonpurulent cellulitis. A MRSA nasal PCR screen was negative. After 48 hours he improved clinically, so therapy was stepped down to oral cephalexin to complete a 5-day total course. He was discharged with wound care instructions and a tetanus booster.",
    "subclaim": "He has type 2 diabetes.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old woman came to the ER with fever, cough with mucus, and trouble breathing for three days. She has type 2 diabetes and high blood pressure. She is allergic to penicillin; it causes a rash. Her oxygen level was low at 90% when she arrived. The doctor heard crackles on the right lower side of her chest. A chest X-ray showed an infection in the right lower lung. She got oxygen through a small tube in her nose, and her level went up to 95%. She started IV antibiotics and was admitted to the hospital.",
    "subclaim": "Oxygen saturation improved after oxygen therapy.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the emergency room because he was short of breath. His legs were puffy. His heartbeat was fast and uneven. A heart test showed atrial fibrillation. A chest X-ray showed fluid in his lungs. He got oxygen by a small tube in his nose. He was given water pills through a vein. A medicine was used to slow his heart rate. He started a blood thinner to lower stroke risk. He felt less short of breath after treatment.",
    "subclaim": "He was treated with antibiotics in the emergency department.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man with COPD and hypertension presented with three days of fever, productive cough, and dyspnea. He denied any beta-lactam allergy. On arrival, his vitals were HR 105, BP 128/76, RR 24, temperature 38.5 C, and SpO2 90% on room air. Lung exam revealed crackles at the right base. Labs showed leukocytosis to 15,000/\u00b5L with neutrophilia; lactate and creatinine were normal. Chest radiograph demonstrated right lower lobe consolidation. Rapid PCR testing for influenza A/B and SARS-CoV-2 was negative. He was treated for community-acquired pneumonia with IV ceftriaxone plus azithromycin and 2 L/min nasal cannula oxygen, improving SpO2 to 95%. Blood cultures were obtained, and the plan was to transition to oral therapy once clinically stable.",
    "subclaim": "The total antibiotic course was planned for five days.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman presented with febrile illness, productive cough, and pleuritic right-sided chest pain, found hypoxemic with SpO2 89% on ambient air and tachycardic to 110 bpm. Pulmonary exam revealed coarse crackles at the right base. Chest radiograph demonstrated a right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Laboratory studies showed leukocytosis to 15 x10^9/L with left shift, normal creatinine (0.9 mg/dL) and lactate. She was placed on 2 L/min nasal cannula, with SpO2 improving to 95%. Antimicrobial therapy with ceftriaxone and azithromycin was initiated intravenously. Respiratory viral testing (influenza A/B, SARS-CoV-2) was negative, while the pneumococcal urine antigen returned positive. Blood cultures remained without growth at 48 hours; no history of penicillin allergy was reported. She was managed on the general ward, transitioned to oral amoxicillin-clavulanate to complete a 7-day course, and received pneumococcal vaccination prior to discharge. Clinical status improved, allowing discharge home on hospital day 4 with outpatient follow-up arranged.",
    "subclaim": "She received intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with type 2 diabetes mellitus and former tobacco use presented with 48 hours of fever, productive cough, and right-sided pleuritic chest pain. Vitals: T 38.5 C, HR 102, BP 132/76, RR 24, SpO2 91% on room air. Exam showed decreased breath sounds and inspiratory crackles at the right base; he was hemodynamically stable and not confused. Chest radiograph demonstrated focal right lower lobe air-space consolidation without pleural effusion, compatible with community-acquired pneumonia. He was admitted for acute hypoxemic respiratory failure and received supplemental oxygen via nasal cannula with a target saturation of at least 94%. Empiric IV ceftriaxone plus azithromycin were initiated after obtaining blood cultures; sputum was unobtainable. He had no known drug allergies. Supportive measures included pulmonary hygiene and discharge planning. At 24 hours his symptoms improved, oxygen was weaned, and therapy was transitioned to oral agents to complete five total days. He was discharged with primary care follow-up in 48 hours without documented complications.",
    "subclaim": "Blood cultures were positive for Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old man came to the hospital with fever, cough with green mucus, and trouble breathing for three days. He has COPD and diabetes. His oxygen level was 89% in room air. A chest X-ray showed a lung infection in the right lower part. The team started oxygen by a small nose tube and gave IV antibiotics, ceftriaxone and azithromycin. His blood tests showed high white cells. Tests for flu and COVID were negative. After two days, he was breathing better and needed less oxygen. His sputum culture grew Streptococcus pneumoniae that antibiotics can kill. They planned to switch him to amoxicillin pills to finish five days of treatment.",
    "subclaim": "He was admitted to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman with type 2 diabetes presented with fever, productive cough, and pleuritic right-sided chest pain. On arrival, her vital signs showed HR 110, RR 24, BP 128/72, and oxygen saturation 89% on room air. Right lower lung crackles were heard on exam. Chest X-ray demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. WBC count was 15,000 with neutrophil predominance; renal function and lactate were normal. She was started on 2 L/min nasal cannula, improving oxygen saturation to 95%. Empiric IV ceftriaxone plus azithromycin were given. Influenza and SARS-CoV-2 PCRs were negative, and the urine pneumococcal antigen was positive. Blood cultures showed no growth at 48 hours; she had no penicillin allergy. She was transitioned to oral amoxicillin-clavulanate and discharged on hospital day 4.",
    "subclaim": "The pneumonia had a bacterial cause.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with diabetes has a sore on his right foot. It started three weeks ago after a blister. The skin around it is red and warm, but he has no fever. The doctor says it is a mild skin infection. An X-ray shows no bone infection. Blood tests look okay. A nurse cleans the wound and removes dead skin. He gets amoxicillin-clavulanate pills for seven days. He also gets a special shoe to take pressure off the sore. He receives a tetanus shot and is told to come back in one week.",
    "subclaim": "The foot radiograph showed no osteomyelitis.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old woman presented with two days of fever, dysuria, and right flank pain. Vitals showed temperature 38.5 C, heart rate 110, blood pressure 118/72. She had right costovertebral angle tenderness on exam. Urinalysis was positive for leukocyte esterase and nitrites with pyuria. CBC showed leukocytosis to 14,000; creatinine was 1.0 mg/dL. She received IV fluids and empiric ceftriaxone for presumed acute pyelonephritis. Renal ultrasound showed no hydronephrosis or renal calculi. Urine culture grew Escherichia coli susceptible to ceftriaxone and ciprofloxacin; blood cultures remained negative. After 48 hours she defervesced and symptoms improved. She was transitioned to oral ciprofloxacin to complete a 7-day total antibiotic course.",
    "subclaim": "She required vasopressors for low blood pressure.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man presented with acute shortness of breath and leg swelling. On arrival, his pulse was 130 and irregular, and oxygen saturation was 89% on room air. ECG confirmed atrial fibrillation with rapid ventricular response. Chest X-ray demonstrated pulmonary edema. He received supplemental oxygen by nasal cannula. Intravenous furosemide was given for diuresis. Diltiazem was used for rate control. Apixaban was started for stroke prevention. His breathing improved after initial therapy.",
    "subclaim": "He has a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old man came to the hospital with cough and fever. He also felt short of breath. His oxygen level was low at 89% on room air. A chest x-ray showed a spot in the right lower lung. The doctor said he had a lung infection from the community. He got oxygen through a small tube in his nose. He started IV antibiotics: ceftriaxone and azithromycin. Tests for flu and COVID were negative. Blood cultures were taken before the medicines. He was admitted to a regular ward, not the ICU.",
    "subclaim": "He required mechanical ventilation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 42-year-old woman came to the hospital with fever, chills, and pain in her right lower back. She had burning when she peed. The team said she had a kidney infection. Her urine test showed germs, and later the lab found E. coli. She got fluids in a vein and IV antibiotics. She also got pain medicine. An ultrasound of her kidneys showed no block or stones. She felt better after two days, switched to pills, and went home on day three with 10 days of antibiotics.",
    "subclaim": "She received pain medication.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes and hypertension presented with 45 minutes of substernal chest pressure. ECG showed lateral ST depressions with T-wave inversions. High-sensitivity troponin was elevated and rising. He was treated with aspirin, a P2Y12 inhibitor, and heparin. Coronary angiography demonstrated a 90% mid left anterior descending lesion felt to be the culprit. A drug-eluting stent was deployed with good result. Echocardiogram showed preserved left ventricular ejection fraction (~55%). He was discharged on hospital day 2 on dual antiplatelet therapy (aspirin plus ticagrelor), high-intensity statin, metoprolol, and an ACE inhibitor. He was counseled on diet and glycemic control.",
    "subclaim": "A drug-eluting stent was placed in the LAD.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with poorly controlled type 2 DM and hypertension presented with a 2-week plantar ulcer beneath the left first metatarsal head. Exam showed a 2.5 cm ulcer probing to soft tissue with surrounding erythema (~2 cm), warmth, malodor, and purulent drainage; T 38.3 C, HR 102, BP 138/82. Laboratory evaluation revealed WBC 14.2 \u00d710^3/\u00b5L (neutrophil-predominant), CRP 120 mg/L, ESR 68 mm/h, glucose 220 mg/dL, creatinine 1.0 mg/dL. Plain radiography showed no gas, periosteal reaction, or cortical destruction. MRI with contrast demonstrated marrow edema and enhancement of the first metatarsal head contiguous with the ulcer tract, consistent with early osteomyelitis; no abscess was seen. Superficial wound culture grew MSSA; paired blood cultures were negative at 48 hours. Management included IV cefazolin 2 g q8h, bedside sharp debridement, offloading with a CAM boot, and optimization of glycemic control; tetanus immunization was current. No revascularization or amputation was indicated. Plan was to transition to oral cephalexin to complete a 6-week course if afebrile with improving inflammatory markers after 48 hours. By hospital day 2, fever resolved and local symptoms improved.",
    "subclaim": "His temperature was 38.3 C.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with fever and cough. He had trouble breathing and thick green mucus. His oxygen level was low at 91% on room air. A chest X-ray showed a spot in the right lower lung. The doctor said he had pneumonia from the community. He is allergic to penicillin; it causes a rash. He got oxygen through a small nose tube and it went up to 96%. He started the antibiotic levofloxacin. After two days, his fever fell and blood cultures showed no growth. He was getting ready to go home with pills to finish five days.",
    "subclaim": "The patient has chronic obstructive pulmonary disease.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man came to the emergency room with cough and fever. He was bringing up yellow mucus and felt short of breath. His temperature was 38.5\u00b0C and his oxygen level was 89% on room air. A chest X-ray showed a patch in the right lower lung. The team said he had pneumonia. He got IV antibiotics in the hospital and oxygen through a small tube in his nose. After two days, his breathing was better and his oxygen level was normal. He went home with antibiotic pills.",
    "subclaim": "He was discharged on oral antibiotics.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man with COPD presented with two days of fever and productive cough. On arrival, his oxygen saturation was 90% on room air with tachypnea. Chest X-ray demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. He was started on ceftriaxone and azithromycin intravenously. Supplemental oxygen was provided via nasal cannula at 2 L/min. Initial labs showed leukocytosis with neutrophilia, and lactate was normal. Blood cultures were obtained and later reported no growth. Within 48 hours he became afebrile, was breathing easier, and maintained 95% saturation on room air. The plan was to transition to oral antibiotics and discharge if stability continued.",
    "subclaim": "He has a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man presented with three days of fever, productive cough, and dyspnea. On arrival, oxygen saturation was 90% on room air, temperature 38.3\u00b0C, heart rate 102, and respiratory rate 24. Chest radiograph demonstrated right lower lobe consolidation consistent with community-acquired pneumonia. Blood cultures were obtained prior to starting antibiotics. He was started on supplemental oxygen via nasal cannula and given intravenous ceftriaxone plus azithromycin. A nasopharyngeal PCR for SARS-CoV-2 was negative. Over 48 hours, his oxygenation and fevers improved. He was discharged on oral azithromycin to complete a 5-day course, with follow-up arranged in one week.",
    "subclaim": "He required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 42-year-old woman came to the hospital with fever, chills, and pain in her right lower back. She had burning when she peed. The team said she had a kidney infection. Her urine test showed germs, and later the lab found E. coli. She got fluids in a vein and IV antibiotics. She also got pain medicine. An ultrasound of her kidneys showed no block or stones. She felt better after two days, switched to pills, and went home on day three with 10 days of antibiotics.",
    "subclaim": "She was switched to oral ciprofloxacin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came in with cough and fever for three days. He felt short of breath and very tired. He has diabetes and high blood pressure, and no drug allergies. In the ER, his oxygen level was 90% on room air and his heart was fast. A chest X-ray showed a lung spot in the right lower part. The team said he had community pneumonia from bacteria. He got oxygen through a small tube in his nose at 2 liters per minute and IV antibiotics. Tests for flu and COVID were negative, and his blood cultures showed no growth after two days. He did not need the ICU or a breathing machine, and after two days he felt better and could go home on pills to finish five days of antibiotics.",
    "subclaim": "He was treated with vancomycin alone.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with poorly controlled T2DM and HTN presented with 72 hours of fever, dysuria, urinary urgency, and right costovertebral angle tenderness. On admission: T 38.6\u00b0C, HR 104 bpm, BP 122/74 mmHg, SpO2 98% on room air. Labs showed WBC 15.2 \u00d7 10^3/\u00b5L with neutrophil predominance; serum creatinine 1.8 mg/dL (baseline 1.0), estimated eGFR ~45 mL/min/1.73 m\u00b2; and serum glucose 280 mg/dL. Urinalysis revealed positive nitrites and leukocyte esterase with >50 WBC/hpf; urine culture was pending initially. Noncontrast CT of the abdomen/pelvis demonstrated a striated right nephrogram consistent with acute pyelonephritis, without hydronephrosis or nephrolithiasis. Initial management included 2 liters of isotonic crystalloid, IV ceftriaxone 1 g every 24 hours, and subcutaneous insulin. He defervesced within 48 hours with improvement in flank pain and urinary symptoms. Two sets of blood cultures yielded Escherichia coli susceptible to third-generation cephalosporins and fluoroquinolones, and resistant to TMP-SMX. He was stepped down to oral ciprofloxacin and discharged to complete a 10-day total antibiotic course; serum creatinine improved to 1.2 mg/dL on follow-up.",
    "subclaim": "Serum creatinine was higher than his baseline.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes presented with 30 minutes of resting chest pressure. The ECG showed 1\u20132 mm ST-segment depressions in the inferior leads. High-sensitivity troponin levels were elevated and rising. The diagnosis was non\u2013ST elevation myocardial infarction (NSTEMI). Urgent coronary angiography revealed a critical proximal right coronary artery lesion. Percutaneous coronary intervention was performed with placement of a drug-eluting stent, restoring flow. He was started on aspirin, clopidogrel, high-intensity atorvastatin, and a beta-blocker. He was discharged with a plan for 12 months of dual antiplatelet therapy and early cardiology follow-up.",
    "subclaim": "The ECG showed ST-segment elevation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes presents with a right plantar foot ulcer that began after a blister three weeks ago. He reports redness and warmth around the wound but denies fever or chills. Exam shows a superficial ulcer with less than 2 cm surrounding cellulitis and intact distal pulses. White blood cell count is normal and C-reactive protein is mildly elevated. Plain radiograph of the foot shows no osteomyelitis or gas. After sharp debridement, a sample is sent for culture, which grows methicillin-susceptible Staphylococcus aureus and Streptococcus species. He is started on oral amoxicillin-clavulanate 875/125 mg twice daily for seven days. Offloading is provided with a special shoe, and he receives a tetanus booster. He is advised on glucose control and scheduled to return in one week.",
    "subclaim": "He was admitted to the hospital for inpatient care.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old male with T2DM and HTN presented with 3 days of productive cough, fevers to 38.5\u00b0C, and exertional dyspnea. Vitals: HR 102, BP 128/76, RR 22, SpO2 89% on room air; oxygen was initiated at 2 L/min via nasal cannula with SpO2 rising to 95%. Exam revealed right basilar crackles without signs of respiratory distress. Laboratory data: WBC 15.4 \u00d710^9/L (neutrophil predominant), CRP 12 mg/dL, creatinine 0.9 mg/dL. Respiratory viral PCR panel including influenza and SARS-CoV-2 was negative. CXR showed a dense right lower lobe lobar consolidation without effusion, consistent with community-acquired pneumonia. Empiric ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily were administered after two sets of blood cultures were obtained; cultures showed no growth at 48 h. Urinary Streptococcus pneumoniae antigen was positive, supporting pneumococcal etiology. The patient was admitted to a general medicine ward, showed clinical improvement by hospital day 2, and was weaned off supplemental oxygen with plan for oral amoxicillin-clavulanate to complete a 5-day total course.",
    "subclaim": "He required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with HTN, T2DM, and active smoking presented with 45 minutes of exertional, pressure-like chest pain radiating to the left arm, associated with diaphoresis and nausea; no prior CAD. Triage: BP 160/92, HR 98, RR 18, afebrile, SpO2 98% RA; supplemental O2 was withheld given normal saturation. ECG showed 1\u20132 mm horizontal ST depressions in V4\u2013V6 with T-wave inversions; initial hs-cTnI 180 ng/L rising to 520 ng/L. CXR was clear without infiltrate or edema. He was treated per NSTEMI protocol: aspirin 325 mg chewed, ticagrelor 180 mg loading dose, IV unfractionated heparin infusion, atorvastatin 80 mg, and metoprolol tartrate 25 mg; sublingual nitroglycerin gave partial relief. No fibrinolytics were given. TTE showed mild anterior hypokinesis with LVEF ~50%. Urgent coronary angiography via right radial access revealed a 90% proximal LAD stenosis; PCI with a 3.0 \u00d7 18 mm drug-eluting stent achieved TIMI 3 flow. Creatinine was 1.4 mg/dL; HbA1c 8.2%. Discharge medications included aspirin 81 mg daily, ticagrelor 90 mg BID, atorvastatin 80 mg nightly, metoprolol, and lisinopril; smoking cessation counseling provided.",
    "subclaim": "Supplemental oxygen was not given.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes presented with 30 minutes of resting chest pressure. The ECG showed 1\u20132 mm ST-segment depressions in the inferior leads. High-sensitivity troponin levels were elevated and rising. The diagnosis was non\u2013ST elevation myocardial infarction (NSTEMI). Urgent coronary angiography revealed a critical proximal right coronary artery lesion. Percutaneous coronary intervention was performed with placement of a drug-eluting stent, restoring flow. He was started on aspirin, clopidogrel, high-intensity atorvastatin, and a beta-blocker. He was discharged with a plan for 12 months of dual antiplatelet therapy and early cardiology follow-up.",
    "subclaim": "The patient received thrombolytic therapy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male presented with 45 minutes of substernal chest pressure radiating to the left arm with diaphoresis and nausea. Past history included hypertension, type 2 diabetes, and active tobacco use; no drug allergies were reported. Initial vitals showed BP 160/92 mmHg, HR 98 bpm, and oxygen saturation 98% on room air; supplemental oxygen was not administered. ECG demonstrated 1\u20132 mm ST-segment depressions in lateral leads. High-sensitivity troponin was elevated and rising. Chest radiograph showed no acute process. He received chewable aspirin, IV unfractionated heparin, high-intensity atorvastatin, and metoprolol; nitroglycerin provided partial relief. Transthoracic echocardiogram revealed mild anterior wall hypokinesis with preserved ejection fraction. Same-day coronary angiography found a 90% proximal LAD lesion, which was treated with percutaneous coronary intervention using a drug-eluting stent. He was discharged on dual antiplatelet therapy, a statin, a beta-blocker, and an ACE inhibitor with smoking cessation counseling.",
    "subclaim": "The patient presented with chest pain.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with 3 days of fever, productive cough, and exertional dyspnea presented to the emergency department. Vitals: T 38.5 C, HR 102, BP 128/74, RR 22, SpO2 90% on room air; supplemental O2 via nasal cannula at 2 L/min increased saturation to 95%. Pulmonary exam revealed crackles at the right base without wheeze. Chest radiograph showed focal right lower lobe air-space consolidation without effusion or pneumothorax. Laboratory data: WBC 14.2 x10^3/\u00b5L with neutrophil predominance; CRP 145 mg/L; procalcitonin 0.6 ng/mL. SARS-CoV-2 PCR was negative; urine pneumococcal antigen was not obtained; two sets of blood cultures remained negative at 48 hours. He had no history of beta-lactam allergy. The patient was treated for community-acquired pneumonia with IV ceftriaxone plus azithromycin, then transitioned on hospital day 2 to oral amoxicillin-clavulanate to complete a 7-day total course. He defervesced within 36 hours, was weaned to room air, and was discharged home on hospital day 3 with outpatient follow-up arranged.",
    "subclaim": "He has a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 56-year-old male presented to the emergency department with 3 days of cough, fever, and dyspnea. He reported right-sided pleuritic chest pain. On arrival he was febrile at 38.6 C, heart rate 108, respiratory rate 24, and oxygen saturation 91% on room air. Chest radiograph demonstrated right lower lobe consolidation. Exam revealed crackles over the right base. Laboratory testing showed leukocytosis (WBC 15.4 x10^9/L, neutrophil-predominant) and elevated CRP. Viral PCR for influenza and SARS-CoV-2 was negative; two sets of blood cultures later showed no growth. Because of an immediate penicillin allergy, he was treated as an outpatient with azithromycin 500 mg on day 1 then 250 mg daily on days 2\u20135. He received low-flow oxygen by nasal cannula with improvement of saturation to 95%, and was discharged with 48-hour follow-up.",
    "subclaim": "The patient has a penicillin allergy.",
    "label": "supported"
  },
  {
    "medical_text": "A 65-year-old man with COPD presented with three days of fever, productive cough, and dyspnea. On arrival, his temperature was 38.5\u00b0C, heart rate 102, respiratory rate 24, and oxygen saturation 89% on room air. Chest exam revealed crackles over the right lower lung. Chest radiograph showed right lower lobe consolidation. White blood cell count was 15,000/\u00b5L and C-reactive protein was 120 mg/L. Influenza A/B and SARS-CoV-2 PCR tests were negative, and blood cultures remained negative. He was started on oxygen via nasal cannula to maintain saturation above 92% and empiric IV ceftriaxone plus azithromycin. He improved clinically within 48 hours and was transitioned to oral antibiotics to complete a five-day course. He was discharged on hospital day 3 with his inhaler regimen unchanged and no drug allergies reported.",
    "subclaim": "He had a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "An adult woman presented with two days of cough, fever, and dyspnea. Past history included asthma and a penicillin allergy. On arrival, SpO2 was 90% on room air, improving to 94% with 2 L/min nasal cannula. Temperature was 38.4 C and heart rate 108 bpm. Chest radiograph demonstrated a right lower lobe consolidation. SARS-CoV-2 PCR and rapid influenza tests were negative. Labs showed leukocytosis with elevated inflammatory markers. She was diagnosed with community-acquired pneumonia and treated with intravenous azithromycin, inhaled albuterol, and IV fluids. She improved clinically within 24 hours without need for ICU care.",
    "subclaim": "Blood cultures identified Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 65-year-old man came to the hospital with cough and fever. His oxygen level was low at 89% on room air. A chest x-ray showed a lung infection in the right lower lung. He is allergic to penicillin; he got a rash in the past. Doctors gave him oxygen through a nose tube and IV levofloxacin. A flu and COVID test were negative. Blood cultures showed no germs after two days. He did not go to the ICU. After two days, his fever went away and he breathed better. He went home on day three with pills to finish five days of antibiotics.",
    "subclaim": "He required mechanical ventilation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with poorly controlled T2DM (HbA1c 9.2%) presented with a 7-day right plantar hallux ulcer and subjective fevers. Examination revealed a 2 cm ulcer with purulent drainage and surrounding cellulitis; pedal pulses were intact and the ulcer did not probe to bone. Vitals were T 38.5 C, HR 102; WBC 14.2 K/\u00b5L, CRP 12 mg/dL; creatinine 0.9 mg/dL. Foot radiographs showed no bony erosion or periosteal reaction, and osteomyelitis was considered unlikely. Bedside sharp debridement was performed, an offloading boot was applied, and a tetanus booster was administered. Empiric IV cefazolin was initiated and transitioned to oral cephalexin after 48 hours as erythema receded. Superficial wound culture grew methicillin-susceptible Staphylococcus aureus; MRSA nasal swab was negative; no anaerobes were isolated. Two sets of peripheral blood cultures remained negative at 48 hours, with no evidence of bacteremia. His insulin regimen was adjusted to basal-bolus with correction scale, maintaining inpatient glucoses between 110 and 180 mg/dL. He was discharged home on day 3 with wound care follow-up.",
    "subclaim": "He was treated with vancomycin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man with COPD presented with two days of fever and productive cough. On arrival, his oxygen saturation was 90% on room air with tachypnea. Chest X-ray demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. He was started on ceftriaxone and azithromycin intravenously. Supplemental oxygen was provided via nasal cannula at 2 L/min. Initial labs showed leukocytosis with neutrophilia, and lactate was normal. Blood cultures were obtained and later reported no growth. Within 48 hours he became afebrile, was breathing easier, and maintained 95% saturation on room air. The plan was to transition to oral antibiotics and discharge if stability continued.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man with GOLD II COPD and a 40-pack-year smoking history presented with 72 hours of productive cough, pleuritic right-sided chest pain, dyspnea, and fever/chills. Vitals: T 38.4\u00b0C, HR 108 bpm, BP 128/74 mmHg, RR 24/min, SpO2 89% on ambient air, improving to 95% on 2 L/min nasal cannula. Exam: increased work of breathing with bronchial breath sounds and crackles over the right infrascapular region; no peripheral edema. CXR shows focal right lower lobe air-space consolidation without pleural effusion; no pneumothorax. Labs: WBC 14.5 \u00d710^9/L (neutrophils 85%), CRP 110 mg/L, procalcitonin 0.42 ng/mL, creatinine 0.9 mg/dL, lactate 1.2 mmol/L. Two sets of blood cultures and a sputum culture were obtained prior to antimicrobials; cultures were negative at 48 hours; urinary antigens for Streptococcus pneumoniae and Legionella were negative. Empiric therapy was initiated with IV ceftriaxone (1 g q24h) plus azithromycin (500 mg daily) and supplemental oxygen; home bronchodilators were continued. The patient denied prior antibiotic reactions; no MRSA risk factors or aspiration features were identified. Within 48 hours he defervesced, oxygenation improved, and respiratory rate decreased to 18/min without hypotension; no ICU-level support was required. He was transitioned to oral amoxicillin-clavulanate to complete a seven-day total antibiotic course and discharged home with follow-up.",
    "subclaim": "He has a documented penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man with COPD and hypertension presented with 3 days of fever, productive green sputum, and dyspnea. On arrival, vital signs were: T 38.6 C, HR 104, RR 24, BP 138/78, and SpO2 91% on room air. Lung exam revealed left basilar crackles and rhonchi. CBC showed leukocytosis to 15.2 K/\u00b5L with neutrophil predominance. Chest radiograph demonstrated left lower lobe consolidation consistent with community-acquired pneumonia. Influenza PCR and SARS-CoV-2 antigen tests were negative. He was started on 2 L/min nasal cannula oxygen and IV ceftriaxone plus azithromycin; blood cultures were obtained before antibiotics. Over 48 hours, his fever resolved and oxygen was weaned to room air with SpO2 95%. Blood cultures showed no growth, and he was transitioned to oral antibiotics and discharged with primary care follow-up.",
    "subclaim": "He was treated with intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with T2DM, HTN, and active cigarette use presented with 2 hours of exertional, pressure-like chest pain. Vitals were stable; initial ECG demonstrated 1\u20132 mm ST depressions in leads V5\u2013V6 without ST elevation. High-sensitivity troponin I rose from 78 ng/L to 1,240 ng/L, consistent with NSTEMI. He received 325 mg aspirin load, ticagrelor 180 mg load, and weight-based enoxaparin, along with sublingual nitroglycerin. Coronary angiography identified a critical 90% proximal LAD lesion; a drug-eluting stent was deployed with TIMI-3 flow and no complications. Transthoracic echocardiography showed normal wall motion and LVEF ~55%. Serum creatinine was 0.9 mg/dL; LDL-C was 152 mg/dL; no known drug allergies. He was discharged on aspirin plus ticagrelor for 12 months, atorvastatin 80 mg nightly, and lisinopril, with smoking-cessation counseling and diabetes follow-up.",
    "subclaim": "The patient had a non\u2013ST elevation myocardial infarction.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male presented with 3 days of fever, productive cough, and dyspnea. Vitals: temperature 38.6 C, respiratory rate 24/min, SpO2 90% on ambient air. Lung exam revealed right lower lobe crackles. Chest X-ray showed right lower lobe consolidation consistent with community-acquired pneumonia. WBC was 14,000/uL; influenza PCR was negative; urine pneumococcal antigen was positive. He was started on IV ceftriaxone plus azithromycin, supplemental oxygen via nasal cannula at 2 L/min, and IV fluids. Blood cultures remained negative at 48 hours. Clinical status improved; oxygen was discontinued and antibiotics were switched to oral amoxicillin-clavulanate to complete a 5-day total course. Discharge was planned within 24 hours with outpatient follow-up.",
    "subclaim": "The patient received IV ceftriaxone plus azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with COPD and a long smoking history presents with three days of productive cough, pleuritic chest pain, and fever. On arrival his vital signs are T 38.4\u00b0C, HR 108, BP 128/74, RR 24, and SpO2 89% on room air. Lung exam shows rales at the right base and increased work of breathing. Chest radiograph demonstrates a right lower lobe consolidation. Labs reveal WBC 14.5 K/\u00b5L with neutrophil predominance and elevated CRP. He is started on IV ceftriaxone plus azithromycin and 2 L/min oxygen via nasal cannula. He has no history of beta-lactam allergy, and renal function is normal. Two sets of blood cultures remain negative at 48 hours, and the sputum Gram stain shows mixed flora without a dominant pathogen. He improves clinically with defervescence and better oxygenation within 48 hours. He is discharged on oral amoxicillin-clavulanate to complete a seven-day course.",
    "subclaim": "Sputum culture identified Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "An elderly female (72 years) presented with a 3-day history of febrile illness, productive cough, and pleuritic right-sided chest pain. Vital signs: T 38.5\u00b0C, HR 108 bpm, RR 24/min, BP 126/74 mmHg, SpO2 90% on ambient air. Pulmonary exam demonstrated right basilar crackles; chest radiograph confirmed a right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Arterial oxygenation improved to 94% with 2 L/min oxygen via nasal cannula. Empiric therapy with ceftriaxone 1 g IV daily plus azithromycin 500 mg IV was initiated after obtaining two sets of peripheral blood cultures. Laboratory evaluation showed leukocytosis (WBC 15 x10^9/L) with normal renal function (creatinine 0.9 mg/dL) and normal lactate. Urinary Streptococcus pneumoniae antigen was positive; sputum Gram stain showed gram-positive diplococci. No systemic corticosteroids were administered, and the patient remained hemodynamically stable on the ward. Clinical status improved within 24 hours, with decreasing work of breathing and reduced cough.",
    "subclaim": "She required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A woman came to the clinic with fever and cough. She had sharp pain on the right side when she breathed. Her oxygen level was 90% on room air, and a small tube in the nose raised it to 95%. A chest x-ray showed pneumonia in the right lower lung. Blood was taken for culture before any antibiotics. She is allergic to penicillin. She started azithromycin and used an inhaler for wheeze. Her COVID test was negative, and she is not pregnant. She did not need the ICU. She will take pills for 5 days and follow up.",
    "subclaim": "The chest X-ray was normal.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old male with GOLD II COPD and hypertension presented with 48 hours of fever, pleuritic cough, and dyspnea. On arrival: T 38.6\u00b0C, RR 24, BP 132/78 mmHg, SpO2 89% on ambient air. Chest radiograph demonstrated dense right lower-lobe lobar consolidation, consistent with community-acquired pneumonia. Labs: WBC 15.2 \u00d710^3/\u00b5L with neutrophilia, BUN 28 mg/dL, creatinine 1.0 mg/dL. CURB-65 was 2 (age \u226565, urea >7 mmol/L), and he was admitted to the general medical ward. Empiric therapy was initiated with ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV q24h; supplemental oxygen via nasal cannula at 2 L/min and prn bronchodilators were provided. Sputum culture yielded Streptococcus pneumoniae susceptible to beta-lactams and macrolides; multiplex respiratory PCR was negative for influenza and SARS-CoV-2. At 48 hours he was afebrile with SpO2 94% on room air; therapy was de-escalated to amoxicillin 1 g PO TID to complete a 5-day total course. He received PCV20 prior to discharge.",
    "subclaim": "The sputum culture identified Streptococcus pneumoniae.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man came to the emergency room with chest pressure for 45 minutes. He has diabetes and high blood pressure. He does not smoke. The heart tracing showed changes that worried the team. A blood test for heart damage (troponin) was high. The doctors said he was having a heart attack. He got aspirin and shots of blood thinner. He then had a stent put in to open a very tight heart artery. It was a drug-eluting stent in the front artery of the heart (LAD). He went home two days later on two blood thinners, a beta blocker, a strong statin, and a blood pressure pill.",
    "subclaim": "A drug-eluting stent was placed in the LAD.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital. He had fever, a cough with yellow mucus, and felt short of breath for 3 days. His oxygen level on room air was 91%. A chest X-ray showed an infection in the right lower lung. A urine test found a germ called Streptococcus pneumoniae. Tests for flu and COVID were negative. He got oxygen by a small tube and two IV antibiotics. After 2 days he felt better and the fever was gone. His oxygen level rose to 95% on room air, and blood cultures stayed negative. He had no drug allergies and went home on antibiotic pills.",
    "subclaim": "He had a documented penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman came to the emergency room with fever and cough. She felt short of breath. She has COPD and high blood pressure. Her temperature was 101.3\u00b0F. Her oxygen level was 90% on room air. A chest X-ray showed a right lower lung infection. Her white blood cell count was high. The team gave oxygen by a small nose tube and IV antibiotics. Blood and sputum tests were sent before the first dose. After a day, she was breathing easier and had no fever.",
    "subclaim": "Blood cultures were drawn before antibiotics.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the ER with trouble breathing and ankle swelling. His heartbeat was fast and uneven; the doctor called it AFib. A chest X-ray showed fluid in his lungs. The team told him he has heart failure and too much fluid. He got an IV water pill to pee out the fluid and a heart rate medicine. They also started a blood thinner called apixaban. His oxygen was 2 liters by nose at first, then he did not need it. By the next day, his heart rate was about 80, he felt better, and he went home with follow-up.",
    "subclaim": "He received intravenous furosemide.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman presented with three days of fever, productive cough, and pleuritic chest pain. On arrival her temperature was 38.5\u00b0C, heart rate 108, respiratory rate 24, and oxygen saturation 90% on room air. Lung exam revealed crackles at the right base. Chest radiograph showed a right lower lobe consolidation consistent with community-acquired pneumonia. She was started on supplemental oxygen via nasal cannula, which raised her saturation to 94%. Empiric IV ceftriaxone and azithromycin were given after drawing two sets of blood cultures. Initial labs showed leukocytosis with a WBC of 15,000 and a creatinine of 0.9 mg/dL. Urinary pneumococcal antigen later returned positive. Her breathing and cough improved over the next day on therapy.",
    "subclaim": "The pneumonia involved the left upper lobe.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with hypertension and type 2 diabetes presented with 45 minutes of substernal chest pressure radiating to the left arm and diaphoresis. EMS administered sublingual nitroglycerin with partial relief. On arrival, blood pressure was 146/88 mmHg, heart rate 102 bpm, and oxygen saturation 97% on room air. The ECG showed 1 mm ST-segment depression in leads V4\u2013V6 without ST elevation. High-sensitivity troponin I was 420 ng/L (reference <20). The working diagnosis was non\u2013ST-elevation myocardial infarction. He received chewable aspirin, an intravenous unfractionated heparin infusion, high-intensity atorvastatin, and metoprolol. Coronary angiography was scheduled for the following morning, and he was kept NPO after midnight. Serum creatinine was 0.9 mg/dL, and a penicillin allergy was documented.",
    "subclaim": "Troponin I was elevated above the normal range.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman presented with a 3-day history of fever, purulent cough, and exertional dyspnea. Triage vitals: 38.5\u00b0C, HR 104 bpm, RR 24/min, BP 128/76 mmHg, SpO2 90% on ambient air. Pulmonary exam revealed right basilar crackles without wheeze. Chest radiograph showed a focal right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Laboratory data demonstrated leukocytosis (WBC 15.0 x10^3/\u00b5L) with neutrophil predominance and CRP 120 mg/L. Two sets of blood cultures were obtained prior to antibiotics; she received supplemental oxygen via nasal cannula and empiric IV ceftriaxone plus azithromycin. She was managed on the general medical ward; no ICU-level support was required. Within 48 hours she defervesced, oxygenation normalized to SpO2 95% on room air, and inflammatory markers down-trended. She was transitioned to oral azithromycin to complete an additional 5 days of therapy and discharged with follow-up in one week.",
    "subclaim": "The chest radiograph showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old man with GOLD stage II COPD and hypertension presented with 48 hours of fever (38.3\u00b0C), purulent sputum, and progressive dyspnea. Initial vitals: HR 102 bpm, BP 138/76 mmHg, RR 24/min; SpO2 88% on ambient air, rising to 94% on 2 L/min nasal cannula. Auscultation revealed right basal crackles and diffuse expiratory wheeze. Chest radiography demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. Leukocytosis was present (WBC 15.0 \u00d7 10^3/\u00b5L) with elevated CRP; lactate 1.2 mmol/L and high-sensitivity troponin were within reference ranges. Empiric therapy comprised IV ceftriaxone plus azithromycin, scheduled nebulized albuterol/ipratropium, and systemic corticosteroids (prednisone 40 mg daily for five days). Blood cultures remained negative; sputum culture later yielded Streptococcus pneumoniae susceptible to beta-lactams. Over 72 hours, work of breathing decreased and supplemental oxygen was weaned. He was discharged on amoxicillin\u2013clavulanate and maintenance inhalers with outpatient follow-up.",
    "subclaim": "The patient tested positive for COVID-19.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old female with GOLD II COPD (tiotropium daily, albuterol PRN), hypertension on lisinopril, and 30 pack-year remote tobacco history presented with 72 hours of fever, purulent cough, and dyspnea. Vitals: T 38.4\u00b0C, HR 102, RR 24, BP 132/78, SpO2 89% on ambient air. Labs: WBC 14.8\u00d710^9/L (85% neutrophils), creatinine 0.9 mg/dL, CRP 112 mg/L, procalcitonin 0.62 ng/mL. Chest radiograph demonstrated right lower lobe lobar consolidation without effusion. Impression: community-acquired pneumonia with concomitant COPD exacerbation; PSI class III. Empiric therapy: ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV q24h, prednisone 40 mg PO daily, ipratropium\u2013albuterol nebulizers q4h, supplemental O2 titrated to SpO2 92\u201396%. Microbiology: two sets of blood cultures no growth at 48 hours; sputum Gram stain mixed upper airway flora; SARS-CoV-2 PCR negative; urine antigens for Legionella and S. pneumoniae negative. By hospital day 3 she was afebrile with SpO2 95% on room air and improved respiratory effort. Ceftriaxone was discontinued; she was transitioned to oral azithromycin to complete 5 days, discharged with a prednisone taper, inhaler education, and 1-week outpatient follow-up.",
    "subclaim": "The chest radiograph showed a right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with diabetes has a sore on his right foot for two weeks. The skin around it is red and warm. He has a fever. The team cleans the wound and removes dead tissue. His blood sugar is high. A lab test shows MRSA germs in the wound. He gets IV vancomycin in the hospital. Because his kidneys are not strong, the doctors change the dose. An MRI shows the bone is not infected. After five days, he feels better and goes home with pills and a plan to lower his sugar.",
    "subclaim": "He required amputation of a toe.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man presents with three days of productive cough, fever, pleuritic chest pain, and dyspnea. Vitals: T 38.5 C, HR 104, RR 24, BP 138/78, SpO2 92% on room air. He has hypertension and a 40 pack-year smoking history; he reports no drug allergies. On exam there are crackles at the right lung base. Labs show leukocytosis to 15,000 with neutrophilia and elevated C-reactive protein. Chest radiograph demonstrates right lower lobe consolidation without pleural effusion. Nasopharyngeal PCR for SARS-CoV-2 is negative. He is diagnosed with community-acquired pneumonia and managed as an outpatient with oral amoxicillin-clavulanate plus azithromycin. After 48 hours he reports defervescence and improved oxygen saturation to 95% with decreased cough.",
    "subclaim": "He received amoxicillin-clavulanate plus azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man with COPD and type 2 diabetes presented with two days of fever, productive cough, and pleuritic chest pain. He was tachycardic and mildly hypoxic on arrival. A chest radiograph showed consolidation in the right lower lobe. His white blood cell count and C-reactive protein were elevated. Empiric IV ceftriaxone plus azithromycin was started, along with oxygen by nasal cannula. Sputum culture later grew Streptococcus pneumoniae that was susceptible to beta-lactams, while blood cultures stayed negative. After 48 hours he defervesced and was switched to oral amoxicillin-clavulanate. He was counseled about vaccines before discharge.",
    "subclaim": "Blood cultures were negative.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman with chronic obstructive pulmonary disease presented with three days of worsening dyspnea, cough, and increased sputum. On arrival, oxygen saturation was 89% on room air, improving to 94% on 2 L nasal cannula. She continued her home tiotropium inhaler. Chest radiograph showed no focal consolidation to suggest pneumonia. Respiratory viral PCR detected rhinovirus. She received nebulized albuterol/ipratropium, systemic corticosteroids (prednisone 40 mg daily), and oral azithromycin. She was admitted to the general medical ward and did not require intubation or ICU care. Her symptoms improved with treatment, and she was discharged after clinical stabilization.",
    "subclaim": "She did not require intubation.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with hypertension and type 2 diabetes, without prior coronary disease, presented with 45 minutes of rest angina radiating to the left arm accompanied by diaphoresis. Initial vitals: HR 102 bpm, BP 146/88 mmHg, RR 18, SpO2 97% on room air. The ECG demonstrated 1\u20131.5 mm horizontal ST-segment depression in V4\u2013V6 with T-wave inversion and no ST elevation. High-sensitivity cardiac troponin I measured 420 ng/L on arrival and rose to 680 ng/L at 3 hours. The diagnosis was non\u2013ST-elevation myocardial infarction. Management included chewable aspirin 325 mg, an IV unfractionated heparin bolus followed by infusion titrated to aPTT, atorvastatin 80 mg, metoprolol tartrate, and sublingual nitroglycerin with partial symptom relief. Diagnostic coronary angiography was planned for the next morning; the patient was kept NPO after midnight. Fibrinolytic therapy was not administered. Renal function was preserved (creatinine 0.9 mg/dL, estimated GFR >60), and a penicillin allergy (rash) was recorded.",
    "subclaim": "The patient received thrombolytic therapy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 66-year-old male presented with exertional chest pressure lasting 45 minutes, not relieved by rest. History includes hypertension, type 2 diabetes, active smoking, and high LDL. ECG showed lateral ST depressions without ST elevation. High-sensitivity troponin rose from 120 to 460 ng/L. He was diagnosed with an NSTEMI. Treatment included chewable aspirin, ticagrelor loading, IV unfractionated heparin, metoprolol, and high-intensity atorvastatin. Transthoracic echocardiogram showed LVEF 55% with no regional wall-motion abnormalities. Next-morning coronary angiography revealed an 80% proximal LAD stenosis; a drug-eluting stent was placed with good flow. He was discharged on dual antiplatelet therapy, a beta-blocker, a statin, and medications for diabetes and blood pressure.",
    "subclaim": "Left ventricular ejection fraction was about 55%.",
    "label": "supported"
  },
  {
    "medical_text": "A middle-aged female presented with 48 hours of productive cough, fever, and exertional dyspnea. Past medical history included asthma; she had an immediate-type penicillin allergy. Vitals: T 38.4 C, HR 108, BP 128/76, RR 22, SpO2 90% on ambient air, increasing to 94% on 2 L/min nasal cannula. Chest radiograph revealed a focal right lower lobe air-space opacity consistent with lobar consolidation. Laboratory results showed WBC 14.2 x10^9/L with neutrophil predominance, elevated CRP, and normal creatinine. SARS-CoV-2 nucleic acid amplification testing and rapid influenza antigen were negative. The assessment was community-acquired pneumonia without sepsis; no ICU criteria were met. Management consisted of intravenous azithromycin transitioned to oral therapy, inhaled albuterol for wheeze, and 1 liter of isotonic crystalloid. Over 24 hours, oxygen requirements decreased and symptoms improved.",
    "subclaim": "The chest X-ray showed a right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old female with HTN and intermittent reactive airway disease presented with 72 hours of febrile cough and exertional dyspnea. On arrival: T 38.6\u00b0C, BP 126/72 mmHg, HR 108 bpm, RR 22/min, SpO2 90% RA, rising to 95% on 2 L/min nasal cannula. CXR revealed a focal right lower lobe air-space consolidation without effusion. CBC showed leukocytosis (WBC 14.2 K/\u00b5L, ANC 11.6 K/\u00b5L); CRP 112 mg/L. Multiplex respiratory PCR was negative for SARS-CoV-2 and influenza A/B. Empiric therapy with IV ceftriaxone 1 g q24h plus azithromycin 500 mg daily was initiated for nonsevere community-acquired pneumonia. Urinary Streptococcus pneumoniae antigen returned positive; two sets of blood cultures remained negative at 48 hours. Oxygen was weaned as symptoms improved; by hospital day 2 she maintained SpO2 96% on room air and was afebrile. There were no known drug allergies or recent antibiotic exposures. She was transitioned to oral amoxicillin-clavulanate to complete a total 5-day antibiotic course and discharged home on hospital day 3.",
    "subclaim": "She required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man with hypertension and COPD presented with three days of fever, productive cough, and dyspnea. On arrival, temperature 38.3 C, heart rate 102, respiratory rate 24, blood pressure 128/76, and oxygen saturation 89% on room air were recorded. Chest radiograph showed a right lower lobe infiltrate consistent with community-acquired pneumonia. He was started on supplemental oxygen via nasal cannula at 2 L per minute. Empiric IV ceftriaxone plus azithromycin were administered. Sputum culture later grew Streptococcus pneumoniae susceptible to ceftriaxone; blood cultures were negative. SARS-CoV-2 PCR was negative. He improved over 72 hours and was discharged on oral amoxicillin-clavulanate.",
    "subclaim": "He tested positive for COVID-19.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman with a history of COPD and hypertension presented with 48 hours of fever, productive cough, and exertional dyspnea. On arrival: BP 138/76 mmHg, HR 106 bpm, RR 24/min, T 38.5\u00b0C, SpO2 90% on ambient air. Pulmonary exam revealed bronchial breath sounds over the right lower lung field. Chest radiograph showed a focal right lower lobe lobar consolidation. Laboratory studies demonstrated leukocytosis to 15.2 \u00d710^3/\u00b5L with neutrophilic predominance; serum lactate and creatinine were within normal limits. Blood cultures were drawn and sputum sent for Gram stain and culture prior to antibiotic administration. Empiric therapy with ceftriaxone 1 g IV daily plus azithromycin 500 mg IV daily was initiated for community-acquired pneumonia. Supplemental oxygen via nasal cannula at 2 L/min improved oxygen saturation to 95%. She had no known drug allergies, including no penicillin allergy. By hospital day 2 she had defervesced and was de-escalated to high-dose amoxicillin to complete a 5-day total course with anticipated discharge.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old male with COPD and active tobacco use presented with fever, purulent sputum, and acute hypoxemia. Vitals: T 38.3\u00b0C, HR 102, RR 24, BP 132/78, SpO2 90% on room air. Chest radiograph demonstrated a right lower lobe lobar consolidation without pleural effusion or pneumothorax. WBC was 15.0 \u00d7 10^9/L with neutrophil predominance; basic metabolic panel was unremarkable. SARS-CoV-2 NAAT was negative; influenza A/B antigen tests were negative. Two sets of blood cultures and a sputum Gram stain were obtained prior to the first antibiotic dose. He received ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily, methylprednisolone 40 mg IV then prednisone 40 mg PO daily, and scheduled ipratropium\u2013albuterol nebulizers. Oxygen via nasal cannula at 2 L/min was titrated to maintain SpO2 92\u201394%; he remained hemodynamically stable without vasopressors and was admitted to the general medicine ward. He improved within 48 hours and was discharged on day three with amoxicillin\u2013clavulanate and azithromycin to complete a five-day course, along with inhaler education; he has no known drug allergies.",
    "subclaim": "He required vasopressors for shock.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man came to the ER with chest pain at rest for 30 minutes. The pain went to his left arm. He felt sweaty and short of breath. He has high blood pressure and diabetes. The heart tracing did not show a big heart attack. A blood test for heart damage was high, and it went higher later. He got aspirin and a blood thinner shot. He also started a statin and a beta-blocker. His chest x-ray looked normal. His kidneys are a little weak, so the team will watch them. He is set for a heart artery test tomorrow.",
    "subclaim": "The ECG did not show ST-segment elevation.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old man with GOLD stage II COPD and hypertension presented with 48 hours of fever (38.3\u00b0C), purulent sputum, and progressive dyspnea. Initial vitals: HR 102 bpm, BP 138/76 mmHg, RR 24/min; SpO2 88% on ambient air, rising to 94% on 2 L/min nasal cannula. Auscultation revealed right basal crackles and diffuse expiratory wheeze. Chest radiography demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. Leukocytosis was present (WBC 15.0 \u00d7 10^3/\u00b5L) with elevated CRP; lactate 1.2 mmol/L and high-sensitivity troponin were within reference ranges. Empiric therapy comprised IV ceftriaxone plus azithromycin, scheduled nebulized albuterol/ipratropium, and systemic corticosteroids (prednisone 40 mg daily for five days). Blood cultures remained negative; sputum culture later yielded Streptococcus pneumoniae susceptible to beta-lactams. Over 72 hours, work of breathing decreased and supplemental oxygen was weaned. He was discharged on amoxicillin\u2013clavulanate and maintenance inhalers with outpatient follow-up.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 56-year-old man came to the emergency room with cough for three days. He had fever and felt short of breath. He had pain on the right side when he took a deep breath. His oxygen level was 91% on room air. A chest x-ray showed an infection in the right lower lung. He is allergic to penicillin. He got azithromycin pills for five days. He also got oxygen through small tubes in his nose, and his level went up to 95%. He went home the same day with a plan to check in two days. The doctor told him to rest and drink plenty of fluids.",
    "subclaim": "He is a current smoker.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man came to the hospital. He had fever, cough with yellow mucus, and trouble breathing. He has diabetes and high blood pressure. His oxygen level was low, so he got oxygen by small tubes. A chest X-ray showed pneumonia in the right lower lung. Blood tests looked like an infection. The COVID test was negative. He got IV antibiotics and started to feel better in two days. He went home on antibiotic pills to finish five days total. He had not gotten a pneumonia shot before.",
    "subclaim": "He was admitted to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the ER with chest pain for two hours. He has high blood pressure and type 2 diabetes. His ECG showed small changes, not the big ST bumps. His blood test called troponin was high. The team said he had a mild heart attack called NSTEMI. He got aspirin, another blood thinner, and a heparin drip. They took him to the cath lab the same day. The doctor opened a tight artery and put in one drug stent. His kidney tests were normal. He went home the next day on two anti-platelet pills.",
    "subclaim": "He went home the next day.",
    "label": "supported"
  },
  {
    "medical_text": "A middle-aged female presented with 48 hours of productive cough, fever, and exertional dyspnea. Past medical history included asthma; she had an immediate-type penicillin allergy. Vitals: T 38.4 C, HR 108, BP 128/76, RR 22, SpO2 90% on ambient air, increasing to 94% on 2 L/min nasal cannula. Chest radiograph revealed a focal right lower lobe air-space opacity consistent with lobar consolidation. Laboratory results showed WBC 14.2 x10^9/L with neutrophil predominance, elevated CRP, and normal creatinine. SARS-CoV-2 nucleic acid amplification testing and rapid influenza antigen were negative. The assessment was community-acquired pneumonia without sepsis; no ICU criteria were met. Management consisted of intravenous azithromycin transitioned to oral therapy, inhaled albuterol for wheeze, and 1 liter of isotonic crystalloid. Over 24 hours, oxygen requirements decreased and symptoms improved.",
    "subclaim": "SARS-CoV-2 testing was negative.",
    "label": "supported"
  },
  {
    "medical_text": "An older man came to the emergency room with fever and cough. He had chest pain when he breathed and felt short of breath. He has COPD and diabetes. A chest x-ray showed a pneumonia in the right lower lung. His blood work showed signs of infection. He got IV antibiotics and oxygen through a small tube in his nose. The sputum test grew a common germ called pneumococcus. Blood cultures did not grow any germs. After two days, his fever went away and he switched to pills. He went home on day four with more pills and a pneumonia shot.",
    "subclaim": "The patient required mechanical ventilation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man presented with acute shortness of breath and leg swelling. On arrival, his pulse was 130 and irregular, and oxygen saturation was 89% on room air. ECG confirmed atrial fibrillation with rapid ventricular response. Chest X-ray demonstrated pulmonary edema. He received supplemental oxygen by nasal cannula. Intravenous furosemide was given for diuresis. Diltiazem was used for rate control. Apixaban was started for stroke prevention. His breathing improved after initial therapy.",
    "subclaim": "A blood thinner was started for stroke prevention.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man came to the ER with chest pain at rest for 30 minutes. The pain went to his left arm. He felt sweaty and short of breath. He has high blood pressure and diabetes. The heart tracing did not show a big heart attack. A blood test for heart damage was high, and it went higher later. He got aspirin and a blood thinner shot. He also started a statin and a beta-blocker. His chest x-ray looked normal. His kidneys are a little weak, so the team will watch them. He is set for a heart artery test tomorrow.",
    "subclaim": "The ECG showed an anterior STEMI.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with type 2 diabetes mellitus and moderate COPD presented with a 72-hour febrile illness characterized by purulent productive cough, pleuritic chest pain, and exertional dyspnea. Vitals: T 38.6\u00b0C, HR 108 bpm, BP 128/74 mmHg, SpO2 89% on room air indicating hypoxemia. Pulmonary exam revealed right lower-lobe bronchial breath sounds with crackles. Labs showed leukocytosis to 15.2 x10^9/L with neutrophilia, CRP 120 mg/L, serum glucose 260 mg/dL, and creatinine 0.9 mg/dL. Chest radiography demonstrated focal consolidation of the right lower lobe; multiplex respiratory PCR was negative for influenza, and urinary pneumococcal antigen was not performed. Empiric therapy included IV ceftriaxone plus azithromycin; supplemental oxygen was delivered via nasal cannula at 2 L/min, and metformin was held in favor of basal-bolus insulin. Microbiology from expectorated sputum grew Streptococcus pneumoniae susceptible to ceftriaxone and amoxicillin-clavulanate; blood cultures remained negative at 48 hours. By hospital day two he met clinical stability criteria, oxygen was discontinued, and therapy was de-escalated to oral amoxicillin-clavulanate to complete a 5-day total course at discharge.",
    "subclaim": "He was discharged on oral amoxicillin-clavulanate.",
    "label": "supported"
  },
  {
    "medical_text": "An older man came to the hospital with cough and fever for three days. He was short of breath and coughed up green mucus. The nurse checked him: his temperature was 101.5 F, he was breathing fast, and his oxygen level was 91% on room air. The doctor heard crackles on the left side of his chest. A chest x-ray showed a lung infection in the lower left lung. He got oxygen by a small tube in his nose and IV antibiotics, ceftriaxone and azithromycin. Tests for flu and COVID were negative. After two days, he felt better and could breathe without extra oxygen, with levels at 95%. Blood cultures did not grow any germs. He went home with pills to finish the antibiotics and a follow-up visit.",
    "subclaim": "On arrival, his oxygen saturation was 91% on room air.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male presented with three days of fever, productive cough, and dyspnea. On arrival, his SpO2 was 90% on room air and he had crackles at the right base. Chest radiography showed a right lower lobe consolidation without effusion. The working diagnosis was community-acquired pneumonia. Empiric therapy with ceftriaxone and azithromycin was started in the emergency department. SARS-CoV-2 and influenza PCR tests were negative. Blood cultures remained negative at 48 hours. He improved clinically, was weaned to room air, and became afebrile by hospital day two. He was discharged on oral azithromycin to complete a five-day total course with outpatient follow-up.",
    "subclaim": "Systemic corticosteroids were given for pneumonia.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with type 2 diabetes and no prior coronary disease presented with 30 minutes of rest angina. The ECG demonstrated 1 mm horizontal ST-segment depressions in leads II, III, and aVF without ST elevation. High-sensitivity troponin I measured 120 ng/L (reference <20) with a rising delta. The working diagnosis was type 1 NSTEMI. Coronary angiography showed a 90% proximal right coronary artery stenosis; other vessels had only mild disease. PCI was performed with placement of a 3.0 \u00d7 18 mm everolimus-eluting stent, achieving TIMI 3 flow without complications. Transthoracic echocardiography showed a left ventricular ejection fraction of 55% with no regional wall motion abnormalities. He received aspirin loading then 81 mg daily, clopidogrel 75 mg daily, a high-intensity statin, metoprolol, and inpatient heparin. The discharge plan included 12 months of dual antiplatelet therapy, cardiac rehabilitation, and follow-up in two weeks.",
    "subclaim": "He was discharged with a 12-month plan for dual antiplatelet therapy.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman with COPD and hypertension presented with two days of fever, productive cough, and dyspnea. Vitals showed T 38.5\u00b0C, HR 106, RR 24, and SpO2 90% on room air. Chest X-ray demonstrated right lower lobe consolidation. Her WBC count was 15,200/\u00b5L. Blood cultures and a sputum sample were obtained prior to antibiotics. She was started on IV ceftriaxone and azithromycin for community-acquired pneumonia. Oxygen at 2 L/min via nasal cannula increased her saturation to 95%. She denied any drug allergies. After 48 hours, she was afebrile and no longer tachypneic. The plan was to transition to oral amoxicillin to complete a five-day course.",
    "subclaim": "The patient is allergic to penicillin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man presented with three days of cough, fever (38.5\u00b0C), and shortness of breath. On room air his oxygen saturation was 90% with a respiratory rate of 24, and exam found right lower-lobe crackles. Chest X-ray showed a right lower-lobe consolidation. Rapid tests for influenza and SARS-CoV-2 were negative, and blood cultures were obtained prior to antibiotics. He was started on IV ceftriaxone plus azithromycin, given 2 L/min oxygen by nasal cannula, and received IV fluids. WBC was 14,000 with neutrophilia and procalcitonin was elevated. Sputum culture later grew Streptococcus pneumoniae susceptible to beta-lactams. After 48 hours he improved, was weaned to room air, and became afebrile. He was discharged on hospital day three with oral amoxicillin-clavulanate to complete a five-day course.",
    "subclaim": "Influenza testing was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old woman with type 2 diabetes, hypertension, and a penicillin allergy (rash) presented with three days of fever, productive cough, and dyspnea. She denied chest pain or leg swelling. Vitals in the ED were T 38.5\u00b0C, HR 110, RR 24, BP 128/76, and SpO2 90% on room air. Lung exam revealed crackles at the right lower lung field. Chest radiograph demonstrated right lower lobe consolidation consistent with community-acquired pneumonia. A rapid respiratory viral panel, including influenza and SARS-CoV-2 PCR, was negative. She was started on oxygen via nasal cannula at 2 L/min, with SpO2 improving to 95%. Empiric antibiotics were initiated with ceftriaxone and doxycycline, and she was admitted for hypoxemia and IV therapy.",
    "subclaim": "She was discharged home from the emergency department.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with fever and cough. He felt short of breath. He cannot take penicillin because it gives him a bad rash. A chest X-ray showed a spot in the lower right lung that looked like pneumonia. A spit test found a common pneumonia germ, and blood cultures were negative. A flu test was negative. The doctor started a strong antibiotic pill called levofloxacin. He also got oxygen through small tubes in his nose. He does not smoke. He improved and went home after three days with more pills.",
    "subclaim": "Influenza testing was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 65-year-old male presented after 48 hours of fever, productive cough, and right-sided pleuritic chest pain. Vitals: T 38.6\u00b0C, HR 104, BP 132/78, RR 24, SpO2 89% on room air. Exam: crackles and bronchial breath sounds at the right lower lung field without percussion dullness. Labs showed WBC 14.8 \u00d710^9/L (85% neutrophils), CRP 115 mg/L, procalcitonin 0.6 ng/mL, and creatinine 0.9 mg/dL. Chest radiograph demonstrated focal right lower lobe airspace consolidation without pleural effusion. Impression: community-acquired bacterial pneumonia with a reported non-anaphylactic beta-lactam allergy (maculopapular rash to amoxicillin). Management included supplemental oxygen via nasal cannula at 2 L/min and IV levofloxacin started after two sets of blood cultures were obtained. Respiratory viral PCR (influenza A/B, SARS-CoV-2) was negative; blood cultures remained negative at 48 hours. At 48 hours he was afebrile with SpO2 94% on ambient air and improved respiratory symptoms. He was discharged on hospital day three with oral levofloxacin to complete a five-day total antibiotic course.",
    "subclaim": "He was treated with amoxicillin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man came to the hospital with fever and cough for three days. He also felt short of breath and had chills at home. On exam, his oxygen level was low, so he got a small tube in his nose for oxygen. A chest X-ray showed a spot in the lower right lung. The team said he had pneumonia that he caught in the community. He got two antibiotics through a vein to treat the lung infection. Virus tests for flu and COVID were negative. Blood tests did not show bacteria growing in his blood. After two days, he felt better and needed less oxygen, so they planned to switch him to pills to finish five days of treatment.",
    "subclaim": "He required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 46-year-old woman went to the emergency room with fever and right back pain. She also had burning when she peed and felt sick. A urine test showed signs of infection. The doctor said she had a kidney infection. She got a dose of IV antibiotic in the ER. Then she started pills at home for 10 days. Her urine culture later showed E. coli, and the pills matched the result. She felt better after two days, and no kidney stone was found on the scan.",
    "subclaim": "She was admitted to the hospital.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old male with moderate COPD (baseline FEV1 ~60% predicted) presented with 48 hours of fever, dyspnea, and purulent sputum. Vitals in the ED: T 38.5 C, HR 102, BP 132/74, RR 24, SpO2 90% on ambient air. Exam noted crackles at the right lung base without wheeze. CXR showed focal right lower lobe consolidation consistent with CAP; no effusion. Labs: WBC 15.2 x10^3/\u00b5L with 86% neutrophils; creatinine 0.9 mg/dL; lactate 1.5 mmol/L. Management included ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily, 2 L/min oxygen via nasal cannula, and 1 L normal saline bolus. Blood cultures x2 were drawn prior to antibiotics and had no growth to date; sputum culture pending. Over 48 hours, he defervesced, his cough improved, and he maintained SpO2 95% on room air. No known drug allergies were documented; plan to transition to oral therapy and discharge if stable.",
    "subclaim": "Oxygen was delivered by nasal cannula.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman presented with a 3-day history of fever, purulent cough, and exertional dyspnea. Triage vitals: 38.5\u00b0C, HR 104 bpm, RR 24/min, BP 128/76 mmHg, SpO2 90% on ambient air. Pulmonary exam revealed right basilar crackles without wheeze. Chest radiograph showed a focal right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Laboratory data demonstrated leukocytosis (WBC 15.0 x10^3/\u00b5L) with neutrophil predominance and CRP 120 mg/L. Two sets of blood cultures were obtained prior to antibiotics; she received supplemental oxygen via nasal cannula and empiric IV ceftriaxone plus azithromycin. She was managed on the general medical ward; no ICU-level support was required. Within 48 hours she defervesced, oxygenation normalized to SpO2 95% on room air, and inflammatory markers down-trended. She was transitioned to oral azithromycin to complete an additional 5 days of therapy and discharged with follow-up in one week.",
    "subclaim": "Her oxygen saturation was 90% on room air at presentation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with 3 days of fever, productive cough, and exertional dyspnea presented to the emergency department. Vitals: T 38.5 C, HR 102, BP 128/74, RR 22, SpO2 90% on room air; supplemental O2 via nasal cannula at 2 L/min increased saturation to 95%. Pulmonary exam revealed crackles at the right base without wheeze. Chest radiograph showed focal right lower lobe air-space consolidation without effusion or pneumothorax. Laboratory data: WBC 14.2 x10^3/\u00b5L with neutrophil predominance; CRP 145 mg/L; procalcitonin 0.6 ng/mL. SARS-CoV-2 PCR was negative; urine pneumococcal antigen was not obtained; two sets of blood cultures remained negative at 48 hours. He had no history of beta-lactam allergy. The patient was treated for community-acquired pneumonia with IV ceftriaxone plus azithromycin, then transitioned on hospital day 2 to oral amoxicillin-clavulanate to complete a 7-day total course. He defervesced within 36 hours, was weaned to room air, and was discharged home on hospital day 3 with outpatient follow-up arranged.",
    "subclaim": "He received oxygen by nasal cannula.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male presented with three days of cough, fever, and dyspnea. Past history included type 2 diabetes and hypertension; he reported no medication allergies. On arrival, SpO2 was 90% on room air, HR 102, RR 24, and BP 128/76. Exam revealed crackles at the right lung base. Labs showed WBC 15,000/\u00b5L with neutrophilia, CRP 120 mg/L, sodium 132 mmol/L, creatinine 0.9 mg/dL, and glucose 178 mg/dL. Chest X-ray demonstrated right lower lobe consolidation without effusion. SARS-CoV-2 and influenza PCR were negative; sputum gram stain showed gram-positive cocci, and blood cultures had no growth at 48 hours. He was treated with supplemental oxygen by nasal cannula at 2 L/min and IV ceftriaxone plus azithromycin; he also received IV fluids. He remained on the general ward without ICU care, improved clinically within 48 hours, and was transitioned to oral amoxicillin-clavulanate to complete a five-day total antibiotic course.",
    "subclaim": "The patient has type 2 diabetes.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman with type 2 diabetes and hypertension presented with three days of fever, productive cough, and dyspnea. Vitals: T 38.3\u00b0C, HR 105, RR 24, SpO2 89% on room air, improving to 95% on 2 L nasal cannula. Lung exam revealed crackles at the right base. Chest radiograph demonstrated right lower lobe consolidation. Labs showed leukocytosis (WBC 14.2 K/\u00b5L) with normal lactate. SARS-CoV-2 PCR was negative; blood cultures had no growth at 48 hours; sputum culture pending. She was started on intravenous ceftriaxone plus azithromycin for community-acquired pneumonia. Oxygen was weaned off by hospital day 3 as her symptoms improved. She was transitioned to oral amoxicillin-clavulanate to complete a 5-day total course and discharged home.",
    "subclaim": "She was treated with intravenous ceftriaxone plus azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with fever and cough. He felt short of breath for three days. His oxygen level was 90% on room air. A chest X-ray showed infection in the right lower lung. The doctors said he had pneumonia that started outside the hospital. He got antibiotics through a vein: ceftriaxone and azithromycin. Tests for COVID and flu were negative. After two days, he felt better and breathed well without oxygen. He went home with azithromycin pills to finish five days of treatment.",
    "subclaim": "Blood cultures grew Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old male with T2DM and hypertension presented with 48 hours of febrile productive cough and exertional dyspnea. Vitals: T 38.6\u00b0C, HR 102, RR 24, BP 132/76, SpO2 89% on ambient air. Pulmonary exam showed right basilar crackles without accessory muscle use. Chest radiograph revealed focal consolidation in the right lower lobe; no pleural effusion or pneumothorax was seen. Labs: WBC 15.2\u00d710^3/\u00b5L (neutrophil predominant) with elevated CRP; serum lactate was normal. Rapid NAAT for influenza A/B and SARS-CoV-2 returned negative. Two sets of peripheral blood cultures were drawn before initiation of antimicrobials. Impression: community-acquired pneumonia requiring inpatient ward-level care. Empiric therapy with IV ceftriaxone plus azithromycin was started; metformin was held and DVT prophylaxis initiated. Supplemental oxygen via nasal cannula at 2 L/min increased SpO2 to 94%, and invasive ventilation was not required.",
    "subclaim": "A chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 66-year-old man with COPD and hypertension presented from home with three days of fever, productive cough, and shortness of breath. On arrival his oxygen saturation was 89% on room air and his heart rate was 105. Chest X-ray showed a right lower lobe consolidation consistent with community-acquired pneumonia. He had leukocytosis, while creatinine was at baseline. Rapid viral testing was negative, and initial blood cultures showed no growth. He was started on intravenous ceftriaxone plus azithromycin. Oxygen at 2 liters via nasal cannula and bronchodilator treatments were given. He was managed on the general medical ward and did not require intensive care. After 48 hours, his symptoms and oxygenation improved. He has no known drug allergies, and plans were made to transition to oral antibiotics.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old male with HTN and former tobacco use presented with 72 hours of fever, productive cough, and dyspnea. He was hypoxemic (SpO2 90% on room air) and febrile to 38.5 C; HR 102, BP 138/76. Chest radiograph demonstrated a right lower lobe air-space consolidation without pleural effusion. CBC revealed neutrophilic leukocytosis (WBC 14.2 x10^9/L); serum lactate was normal and BMP unremarkable. Diagnosis: community-acquired pneumonia with acute hypoxic respiratory failure. He received supplemental oxygen via nasal cannula and empiric ceftriaxone plus azithromycin intravenously. Viral PCR for influenza A/B and SARS-CoV-2 was negative; blood cultures showed no growth at 48 hours. Sputum culture yielded Streptococcus pneumoniae, and therapy was de-escalated to oral amoxicillin-clavulanate. Oxygen was weaned off by hospital day 2 with clinical improvement and SpO2 95% on room air. He was discharged on day 3 to complete a five-day antibiotic course.",
    "subclaim": "He received oxygen via a nasal cannula.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man has had cough and fever for three days. He feels short of breath and has chest pain when he breathes. His temperature is 38.5 C and he breathes fast. His oxygen level is 92% on room air. He has high blood pressure and no drug allergies. A chest x-ray shows a new spot in the right lower lung, with no fluid. A nose swab test for COVID is negative. The doctor says he has community pneumonia and treats him at home. He gets mouth pills: amoxicillin-clavulanate and azithromycin. After two days, his fever goes down and oxygen is 95%.",
    "subclaim": "A pleural effusion was present on imaging.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the ER with chest pain. The pain started at rest and lasted 30 minutes. The doctors said it was a type of heart attack without ST elevation. His blood test for troponin was high. The heart tracing showed small ST drops. They opened a blocked heart artery and put in a stent. He started aspirin, clopidogrel, and a strong cholesterol medicine. He went home and will take both blood thinners for one year.",
    "subclaim": "Troponin levels were elevated.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old male with 3 days of productive cough, pleuritic right-sided chest pain, fever/chills, and exertional dyspnea presented to the emergency department. On arrival: temperature 38.5 C, heart rate 96, respiratory rate 22, blood pressure 132/76, oxygen saturation 90% on ambient air. Pulmonary exam noted inspiratory crackles at the right base; chest radiograph demonstrated right lower lobe airspace consolidation with air bronchograms. Laboratory data: WBC 15.2 x10^9/L (85% neutrophils), elevated CRP, procalcitonin 0.8 ng/mL; creatinine within normal limits. Microbiology: rapid influenza antigen negative; SARS-CoV-2 PCR negative; urine pneumococcal antigen positive; two sets of blood cultures remained sterile at 48 hours. Assessment: community-acquired pneumonia causing acute hypoxemic respiratory failure, hemodynamically stable. Management: ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily; supplemental oxygen via nasal cannula (2 L/min) targeting SpO2 92\u201396%. Care was delivered on a general medical ward; no ICU-level interventions were required. By 48 hours he showed clinical improvement; oxygen was discontinued, and therapy was de-escalated to oral amoxicillin-clavulanate to complete a 5-day total antibiotic course; azithromycin was stopped after 3 days. He was discharged with outpatient follow-up within one week.",
    "subclaim": "He has no known drug allergies.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man presented with 72 hours of fever, productive cough, pleuritic chest pain, and exertional dyspnea. On arrival: temperature 38.6 C, heart rate 102, blood pressure 128/76, respiratory rate 24, SpO2 90% on room air. Auscultation revealed focal crackles over the right lower lung field. Chest radiograph demonstrated right lower lobe air-space consolidation consistent with community-acquired pneumonia; CURB-65 score was 1. Laboratories showed WBC 14.0 x10^9/L with neutrophil predominance; influenza A/B PCR was negative; urine pneumococcal antigen was positive. Initial management included IV ceftriaxone plus azithromycin, 2 L/min oxygen via nasal cannula, and isotonic IV crystalloids. Two sets of blood cultures showed no growth at 48 hours. By hospital day 2, hypoxemia and symptoms improved; supplemental oxygen was discontinued. On day 3, therapy was de-escalated to oral amoxicillin-clavulanate to complete a 5-day total antibiotic course, with anticipated discharge the following day.",
    "subclaim": "A chest CT scan was performed in the emergency department.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman came with three days of fever, cough with green sputum, and shortness of breath. On room air her oxygen saturation was 90%, rising to 95% with 2 liters via nasal cannula. Chest X-ray showed a right lower lobe infiltrate, consistent with pneumonia. She reports an allergy to azithromycin that caused a rash in the past. Past history includes type 2 diabetes and mild chronic kidney disease. Viral PCR for COVID-19 and influenza was negative. She was admitted and treated with IV ceftriaxone plus doxycycline. She improved over two days, and the team planned a switch to oral antibiotics and discharge soon.",
    "subclaim": "The chest X-ray showed a right lower lobe infiltrate.",
    "label": "supported"
  },
  {
    "medical_text": "A 39-year-old woman presented with 2 days of fever, left flank pain, dysuria, and nausea. Vitals showed tachycardia and borderline hypotension. UA was positive for nitrites and leukocyte esterase; CBC revealed leukocytosis. Serum creatinine was elevated from baseline. Renal ultrasound demonstrated a 7 mm obstructing calculus in the proximal left ureter with mild hydronephrosis. She was treated with IV fluids and empiric ceftriaxone. Urology performed urgent decompression with placement of a left ureteral stent. Over 48 hours, fever and pain resolved, and creatinine trended down. Urine culture grew Escherichia coli. She was transitioned to oral antibiotics to complete a 10-day course and scheduled for outpatient stone management.",
    "subclaim": "She was treated only with oral antibiotics.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 66-year-old man with hypertension, type 2 diabetes, active tobacco use, and hyperlipidemia presented with 45 minutes of exertional retrosternal pressure unresponsive to rest. Vitals were stable, with no signs of heart failure or shock. ECG demonstrated 1\u20132 mm ST depressions in V4\u2013V6 without ST elevation. High-sensitivity troponin I increased from 120 to 460 ng/L over 3 hours. He met criteria for non\u2013ST elevation myocardial infarction per the Fourth Universal Definition. Management included aspirin 325 mg, ticagrelor 180 mg loading then 90 mg twice daily, intravenous unfractionated heparin infusion, metoprolol tartrate, and high-intensity atorvastatin 80 mg nightly. Transthoracic echocardiography showed LVEF 55% with no regional wall-motion abnormalities or significant valvular disease. An early invasive strategy was pursued: angiography at 18 hours revealed an 80% proximal LAD lesion, and a drug-eluting stent was deployed with TIMI 3 flow. He was discharged on dual antiplatelet therapy, a beta-blocker, a statin, an ACE inhibitor, and was counseled on smoking cessation and cardiac rehabilitation.",
    "subclaim": "He was febrile at presentation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man with COPD and hypertension presented with two days of fever, productive cough, and shortness of breath. On arrival, his SpO2 was 89% on room air. Chest X-ray revealed right lower lobe consolidation consistent with community-acquired pneumonia. Initial labs showed WBC 15.2 K/\u00b5L with neutrophil predominance and BUN 28 mg/dL. CURB-65 was 2 (age \u226565 and elevated urea), so he was admitted to the medical ward. Empiric ceftriaxone 1 g IV daily plus azithromycin 500 mg IV daily were started, along with 2 L/min nasal cannula oxygen and bronchodilators as needed. Sputum culture grew Streptococcus pneumoniae susceptible to ceftriaxone and amoxicillin; influenza and SARS-CoV-2 tests were negative. After 48 hours he became afebrile and his oxygen saturation improved to 94% on room air; antibiotics were narrowed to oral amoxicillin to complete five days total. He received a pneumococcal vaccine prior to discharge.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 42-year-old woman with type 2 diabetes presented with two days of fever, dysuria, and right flank pain. She was febrile to 38.6\u00b0C and her heart rate was 108. Urinalysis showed leukocyte esterase and nitrites with pyuria. Urine culture later grew E. coli sensitive to ceftriaxone and ciprofloxacin; blood cultures showed no growth. She was diagnosed with acute pyelonephritis and started on IV ceftriaxone and IV fluids. Renal ultrasound demonstrated no hydronephrosis or renal calculi. After 48 hours of improvement, she was transitioned to oral ciprofloxacin to complete a 10-day course. She was discharged on hospital day 3 in good condition.",
    "subclaim": "She was switched to oral ciprofloxacin.",
    "label": "supported"
  },
  {
    "medical_text": "A 45-year-old woman came to the ER with fever and pain in her right back. She also had burning when she peed. She had no known drug allergies. Her temperature was 39 C and her heart was beating fast. A urine test showed infection. An ultrasound of her kidneys looked normal with no blockage. She got one IV dose of an antibiotic and went home with ciprofloxacin pills for 7 days. Two days later she felt better, and the urine culture grew E. coli that was sensitive to ciprofloxacin. Blood cultures did not grow any germs.",
    "subclaim": "Imaging showed a kidney stone causing obstruction.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the ER with chest pain for two hours. He has high blood pressure and type 2 diabetes. His ECG showed small changes, not the big ST bumps. His blood test called troponin was high. The team said he had a mild heart attack called NSTEMI. He got aspirin, another blood thinner, and a heparin drip. They took him to the cath lab the same day. The doctor opened a tight artery and put in one drug stent. His kidney tests were normal. He went home the next day on two anti-platelet pills.",
    "subclaim": "A drug-eluting stent was placed in the proximal LAD.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes presents with a right plantar foot ulcer that began after a blister three weeks ago. He reports redness and warmth around the wound but denies fever or chills. Exam shows a superficial ulcer with less than 2 cm surrounding cellulitis and intact distal pulses. White blood cell count is normal and C-reactive protein is mildly elevated. Plain radiograph of the foot shows no osteomyelitis or gas. After sharp debridement, a sample is sent for culture, which grows methicillin-susceptible Staphylococcus aureus and Streptococcus species. He is started on oral amoxicillin-clavulanate 875/125 mg twice daily for seven days. Offloading is provided with a special shoe, and he receives a tetanus booster. He is advised on glucose control and scheduled to return in one week.",
    "subclaim": "An MRI of the foot was performed the same day.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman with GOLD II COPD presented with 2 days of dyspnea and wheezing. On arrival, SpO2 was 88% on room air with a respiratory rate of 24/min and she was afebrile. Exam demonstrated diffuse expiratory wheezes without focal crackles. Chest radiograph showed no focal consolidation or pleural effusion. Nasopharyngeal PCR detected rhinovirus; WBC was 8.2 \u00d7 10^9/L and procalcitonin was 0.05 ng/mL. Venous blood gas revealed pH 7.36 and pCO2 52 mmHg, consistent with chronic hypercapnia during an acute COPD exacerbation. She received supplemental oxygen via nasal cannula, nebulized albuterol/ipratropium, and oral prednisone 40 mg daily. In the setting of a viral etiology and no radiographic pneumonia, antibiotics were withheld. Oxygenation improved to 94% on 2 L/min with symptomatic relief. She was discharged on a LABA/LAMA inhaler and a 5-day prednisone taper with outpatient pulmonology follow-up.",
    "subclaim": "Bacterial pneumonia was diagnosed.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 66-year-old man with COPD and hypertension presented from home with three days of fever, productive cough, and shortness of breath. On arrival his oxygen saturation was 89% on room air and his heart rate was 105. Chest X-ray showed a right lower lobe consolidation consistent with community-acquired pneumonia. He had leukocytosis, while creatinine was at baseline. Rapid viral testing was negative, and initial blood cultures showed no growth. He was started on intravenous ceftriaxone plus azithromycin. Oxygen at 2 liters via nasal cannula and bronchodilator treatments were given. He was managed on the general medical ward and did not require intensive care. After 48 hours, his symptoms and oxygenation improved. He has no known drug allergies, and plans were made to transition to oral antibiotics.",
    "subclaim": "The patient lives alone.",
    "label": "supported"
  },
  {
    "medical_text": "A 38-year-old otherwise healthy adult presented with 4 days of productive cough, fever, and exertional dyspnea. On exam: T 38.5\u00b0C, HR 104, RR 22, BP 120/76 mmHg, SpO2 93% on ambient air; scattered rhonchi at the right base. Laboratory testing showed WBC 13.2 \u00d710^9/L with neutrophil predominance; procalcitonin 0.34 ng/mL. Chest radiograph revealed a focal right lower lobe consolidation consistent with community-acquired pneumonia. SARS-CoV-2 and influenza A/B PCR were negative. Given a history of immediate penicillin hypersensitivity and CURB-65 score 0, outpatient management was selected. Doxycycline 100 mg PO BID was prescribed for 7 days; acetaminophen and albuterol MDI PRN were provided. Discharge instructions included return precautions and telephonic follow-up at 48 hours. At 48 hours the patient reported symptomatic improvement, was afebrile, and home pulse oximetry read 96%.",
    "subclaim": "The chest X-ray showed a right lower lobe infiltrate.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man has fever and right back pain for three days. Peeing burns, and he goes often. He has diabetes and high blood pressure. The doctor checks his urine. It shows bacteria and white blood cells. A scan shows a kidney infection on the right side. His blood sugar is high, and his kidney blood test is a bit worse than usual. He gets IV fluids and IV antibiotics in the hospital. After two days he feels better and the fever goes down. The lab grows E. coli from his blood. It can be treated with the medicine he got. He goes home on pills for ten more days.",
    "subclaim": "He required ICU admission.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with fever, cough, and trouble breathing. His oxygen level was 89% on room air. A chest X-ray showed a pneumonia in the right lower lung. He has COPD and high blood pressure. He started oxygen by a nasal tube and IV fluids. The team gave him two IV antibiotics: ceftriaxone and azithromycin. A test of his sputum later showed Streptococcus pneumoniae. He felt better after two days, and his oxygen level rose to 94% without extra oxygen. Before he went home, he got a pneumonia vaccine.",
    "subclaim": "He had a history of penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man presented with 3 days of fever, productive cough, and dyspnea. On arrival, temperature was 38.5\u00b0C and oxygen saturation was 90% on room air. Lung exam revealed crackles at the right base. Chest radiograph showed right lower lobe consolidation, consistent with community-acquired pneumonia. Nasal cannula oxygen was started, and saturations improved. Empiric IV ceftriaxone plus azithromycin were administered after obtaining blood tests and blood cultures. SARS-CoV-2 PCR was negative. After 48 hours, he was clinically improved and maintained 95% saturation on room air. He was transitioned to oral antibiotics to complete a 5-day total course and was offered pneumococcal vaccination prior to discharge.",
    "subclaim": "A 5-day total antibiotic course was planned.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man presented with two days of fever, productive cough, and shortness of breath. On arrival, his temperature was 38.5\u00b0C, respiratory rate 24, and oxygen saturation 89% on room air. Chest radiograph showed right lower lobe consolidation. His white blood cell count was elevated and C-reactive protein was high. He was diagnosed with community-acquired pneumonia and admitted. Treatment included IV ceftriaxone plus azithromycin and supplemental oxygen via nasal cannula. Blood cultures showed no growth at 48 hours, and sputum later grew Streptococcus pneumoniae susceptible to ceftriaxone. He improved, was weaned off oxygen, and was discharged on oral antibiotics.",
    "subclaim": "He has a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman came to the hospital with fever and cough. She felt short of breath. Her oxygen level was low at first. The doctor heard crackles on the right side of her chest. A chest x-ray showed a spot in the lower right lung. A blood test showed a high white cell count. She got oxygen through a small tube in her nose. She received IV antibiotics for a lung infection. The COVID test was negative. She went home after she could breathe well and take pills to finish treatment.",
    "subclaim": "The chest x-ray showed a left upper lobe infiltrate.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes presented with 2 hours of substernal chest pressure and diaphoresis. ECG showed no ST-segment elevation. High-sensitivity troponin was elevated. He was diagnosed with a non\u2013ST-elevation myocardial infarction. He received aspirin, intravenous heparin, and a beta-blocker in the ED. Coronary angiography revealed a 90% proximal lesion in the left anterior descending artery. A drug-eluting stent was deployed with good result. He was discharged on aspirin, ticagrelor, high-intensity atorvastatin, and continued metformin.",
    "subclaim": "The ECG showed no ST-segment elevation.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male with type 2 diabetes and no prior coronary disease presented with 30 minutes of rest angina. The ECG demonstrated 1 mm horizontal ST-segment depressions in leads II, III, and aVF without ST elevation. High-sensitivity troponin I measured 120 ng/L (reference <20) with a rising delta. The working diagnosis was type 1 NSTEMI. Coronary angiography showed a 90% proximal right coronary artery stenosis; other vessels had only mild disease. PCI was performed with placement of a 3.0 \u00d7 18 mm everolimus-eluting stent, achieving TIMI 3 flow without complications. Transthoracic echocardiography showed a left ventricular ejection fraction of 55% with no regional wall motion abnormalities. He received aspirin loading then 81 mg daily, clopidogrel 75 mg daily, a high-intensity statin, metoprolol, and inpatient heparin. The discharge plan included 12 months of dual antiplatelet therapy, cardiac rehabilitation, and follow-up in two weeks.",
    "subclaim": "Troponin levels were elevated.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man with type 2 diabetes presented with three days of cough, dyspnea, and fever. On arrival, oxygen saturation was 89% on room air, improving to 95% on 2 L nasal cannula. Chest radiograph showed a right lower lobe consolidation. He was diagnosed with community-acquired pneumonia. Empiric intravenous ceftriaxone plus azithromycin were started in the emergency department. He was admitted to the medical ward and did not require intensive care. Initial labs showed leukocytosis and elevated C-reactive protein. Two sets of blood cultures remained negative at 48 hours; influenza testing was negative. He improved clinically over 48 hours and was transitioned to oral antibiotics to complete a five-day course.",
    "subclaim": "He is allergic to penicillin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A woman came to the hospital with cough and fever. She felt short of breath. She has asthma and is allergic to penicillin. Her oxygen level was low at first but got better with a small tube giving oxygen. A chest X-ray showed infection in the right lower lung. Tests for COVID and flu were negative. The team said she had pneumonia from the community. She got azithromycin and breathing treatments. She also got fluids and felt better after a day.",
    "subclaim": "She was treated with azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old male with a history of COPD and hypertension presented with two days of fever, productive cough, and dyspnea. On arrival, SpO2 was 88% on room air, improving to 94% on 2 L/min nasal cannula. Chest radiograph showed right lower lobe consolidation. WBC count was 15,000/\u00b5L and CRP was elevated. He was diagnosed with community-acquired pneumonia with COPD exacerbation. Treatment included IV ceftriaxone and azithromycin, nebulized albuterol/ipratropium every four hours, and prednisone 40 mg daily for five days. Blood cultures remained negative; sputum later grew Streptococcus pneumoniae susceptible to beta-lactams. Over 72 hours, respiratory symptoms improved and oxygen was weaned. He was discharged on oral amoxicillin-clavulanate and maintenance inhalers.",
    "subclaim": "The patient has COPD.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman presented with febrile illness, productive cough, and pleuritic right-sided chest pain, found hypoxemic with SpO2 89% on ambient air and tachycardic to 110 bpm. Pulmonary exam revealed coarse crackles at the right base. Chest radiograph demonstrated a right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Laboratory studies showed leukocytosis to 15 x10^9/L with left shift, normal creatinine (0.9 mg/dL) and lactate. She was placed on 2 L/min nasal cannula, with SpO2 improving to 95%. Antimicrobial therapy with ceftriaxone and azithromycin was initiated intravenously. Respiratory viral testing (influenza A/B, SARS-CoV-2) was negative, while the pneumococcal urine antigen returned positive. Blood cultures remained without growth at 48 hours; no history of penicillin allergy was reported. She was managed on the general ward, transitioned to oral amoxicillin-clavulanate to complete a 7-day course, and received pneumococcal vaccination prior to discharge. Clinical status improved, allowing discharge home on hospital day 4 with outpatient follow-up arranged.",
    "subclaim": "She was admitted to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old male with COPD and active tobacco use presented with fever, purulent sputum, and acute hypoxemia. Vitals: T 38.3\u00b0C, HR 102, RR 24, BP 132/78, SpO2 90% on room air. Chest radiograph demonstrated a right lower lobe lobar consolidation without pleural effusion or pneumothorax. WBC was 15.0 \u00d7 10^9/L with neutrophil predominance; basic metabolic panel was unremarkable. SARS-CoV-2 NAAT was negative; influenza A/B antigen tests were negative. Two sets of blood cultures and a sputum Gram stain were obtained prior to the first antibiotic dose. He received ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily, methylprednisolone 40 mg IV then prednisone 40 mg PO daily, and scheduled ipratropium\u2013albuterol nebulizers. Oxygen via nasal cannula at 2 L/min was titrated to maintain SpO2 92\u201394%; he remained hemodynamically stable without vasopressors and was admitted to the general medicine ward. He improved within 48 hours and was discharged on day three with amoxicillin\u2013clavulanate and azithromycin to complete a five-day course, along with inhaler education; he has no known drug allergies.",
    "subclaim": "He tested positive for influenza A.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male presented with 45 minutes of substernal chest pressure radiating to the left arm with diaphoresis and nausea. Past history included hypertension, type 2 diabetes, and active tobacco use; no drug allergies were reported. Initial vitals showed BP 160/92 mmHg, HR 98 bpm, and oxygen saturation 98% on room air; supplemental oxygen was not administered. ECG demonstrated 1\u20132 mm ST-segment depressions in lateral leads. High-sensitivity troponin was elevated and rising. Chest radiograph showed no acute process. He received chewable aspirin, IV unfractionated heparin, high-intensity atorvastatin, and metoprolol; nitroglycerin provided partial relief. Transthoracic echocardiogram revealed mild anterior wall hypokinesis with preserved ejection fraction. Same-day coronary angiography found a 90% proximal LAD lesion, which was treated with percutaneous coronary intervention using a drug-eluting stent. He was discharged on dual antiplatelet therapy, a statin, a beta-blocker, and an ACE inhibitor with smoking cessation counseling.",
    "subclaim": "The patient had a fever on arrival.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old woman came to the hospital with cough, fever, and trouble breathing. Her oxygen level was low at 90% in room air. A chest x-ray showed a spot in the right lower lung. Tests for COVID-19 and flu were negative. The team started IV antibiotics, ceftriaxone and azithromycin. Her fever and breathing got better after two days. She did not have any drug allergies. She no longer needed oxygen and kept 96% on room air. Blood cultures did not grow germs. She went home on amoxicillin-clavulanate to finish five days of treatment.",
    "subclaim": "A pleural effusion was present on imaging.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male presented with 2 hours of substernal chest pressure. History included type 2 diabetes, hypertension, and active tobacco use. ECG showed lateral ST depressions without ST elevation. High-sensitivity troponin was elevated. He was treated with chewable aspirin, subcutaneous enoxaparin, and nitroglycerin for pain. Coronary angiography revealed a 90% proximal LAD stenosis. A drug-eluting stent was placed with good flow. Echocardiogram showed preserved left ventricular ejection fraction around 55%. He was discharged on dual antiplatelet therapy, high-intensity statin, and an ACE inhibitor, with counseling to stop smoking.",
    "subclaim": "He received thrombolytic therapy for reperfusion.",
    "label": "not_supported"
  },
  {
    "medical_text": "A woman came to the hospital with cough and fever. She felt short of breath. She has asthma and is allergic to penicillin. Her oxygen level was low at first but got better with a small tube giving oxygen. A chest X-ray showed infection in the right lower lung. Tests for COVID and flu were negative. The team said she had pneumonia from the community. She got azithromycin and breathing treatments. She also got fluids and felt better after a day.",
    "subclaim": "The chest X-ray showed a right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 54-year-old woman came to the hospital with fever, cough with phlegm, and shortness of breath for three days. She has asthma and high blood pressure. She is allergic to penicillin; it caused a rash before. Her temperature was high and her heart rate was fast. Her oxygen level on room air was 92%. A chest x-ray showed a spot in the right lower lung that looked like infection. Tests for flu and COVID were negative. The team gave her oxygen through a small tube in her nose. She started an antibiotic called levofloxacin. After two days she felt better, her oxygen level was 96% while on oxygen, and she went home with pills to finish five days and a plan to see her doctor.",
    "subclaim": "Her oxygen saturation on room air was 92%.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman came to the hospital with fever and cough for three days. She had green mucus and was short of breath. Her temperature was 38.5\u00b0C, and her breathing was fast. A chest x-ray showed an infection in the right lower lung. Her blood test showed many white blood cells. Her oxygen level was low at 90% on room air. The team gave her oxygen and antibiotics through a vein. After two days, she felt better and no longer had a fever. She could breathe well with oxygen at 95% on room air. She went home with antibiotic pills for five more days and a clinic visit next week.",
    "subclaim": "She has a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "An elderly female (72 years) presented with a 3-day history of febrile illness, productive cough, and pleuritic right-sided chest pain. Vital signs: T 38.5\u00b0C, HR 108 bpm, RR 24/min, BP 126/74 mmHg, SpO2 90% on ambient air. Pulmonary exam demonstrated right basilar crackles; chest radiograph confirmed a right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Arterial oxygenation improved to 94% with 2 L/min oxygen via nasal cannula. Empiric therapy with ceftriaxone 1 g IV daily plus azithromycin 500 mg IV was initiated after obtaining two sets of peripheral blood cultures. Laboratory evaluation showed leukocytosis (WBC 15 x10^9/L) with normal renal function (creatinine 0.9 mg/dL) and normal lactate. Urinary Streptococcus pneumoniae antigen was positive; sputum Gram stain showed gram-positive diplococci. No systemic corticosteroids were administered, and the patient remained hemodynamically stable on the ward. Clinical status improved within 24 hours, with decreasing work of breathing and reduced cough.",
    "subclaim": "She has no known drug allergies.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old male with no significant comorbidities presented after 3 days of fever, productive cough, and exertional dyspnea. Vitals in the ED: T 38.3\u00b0C, HR 102 bpm, RR 24/min, BP 128/76 mmHg, SpO2 90% on ambient air. Laboratory studies showed leukocytosis to 14.2 \u00d710^9/L with neutrophil predominance and CRP 120 mg/L. Chest radiography revealed a focal right lower lobe air-space consolidation, compatible with community-acquired pneumonia. Two sets of peripheral blood cultures were drawn before antimicrobial therapy. The patient received supplemental oxygen by nasal cannula and empiric intravenous ceftriaxone plus azithromycin. Nasopharyngeal SARS-CoV-2 RT-PCR returned negative. Clinical status improved within 48 hours with defervescence and SpO2 95% on 2 L/min oxygen. He was discharged on day 2 with oral azithromycin to complete a 5-day total antibiotic course and outpatient follow-up in 1 week.",
    "subclaim": "Chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 70-year-old male with a 3-day history of febrile productive cough and pleuritic chest discomfort presented with dyspnea. Vitals: T 38.5\u00b0C, HR 104, RR 24, BP 132/76, SpO2 89% on ambient air. Labs showed leukocytosis with neutrophilia and elevated CRP. Chest radiograph demonstrated right lower-lobe lobar consolidation. He was diagnosed with moderate-severity community-acquired pneumonia and admitted to the general ward (no ICU criteria). Supplemental oxygen was provided via nasal cannula at 2 L/min. Empiric IV ceftriaxone plus azithromycin was initiated; 1 liter of isotonic fluids was administered. Blood cultures remained negative; sputum culture yielded Streptococcus pneumoniae. By 48 hours he was afebrile, weaned to room air, and transitioned to oral amoxicillin-clavulanate to complete a 5-day total course; he was discharged on hospital day 3 with outpatient follow-up.",
    "subclaim": "He was treated with vancomycin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old female with type 2 diabetes mellitus presented to the ED with 72 hours of fever, productive cough, and exertional dyspnea. Vitals on arrival: T 38.5 C, HR 110 bpm, RR 24/min, BP 118/72 mmHg, SpO2 90% on room air. Pulmonary exam noted crackles localizing to the right lower lung field. Chest radiography showed focal air-space consolidation in the right lower lobe, consistent with community-acquired pneumonia. Two peripheral blood-culture sets were drawn prior to antimicrobial administration. Low-flow supplemental oxygen via nasal cannula at 2 L/min increased SpO2 to 96%. Empiric intravenous ceftriaxone plus azithromycin was initiated with plan to transition to oral therapy if stable. Initial labs included WBC 15,200/\u00b5L and serum lactate 1.8 mmol/L. She had no indications for ICU-level care and was managed on a general medical ward.",
    "subclaim": "Chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman came to the hospital with fever and a wet cough. Her oxygen level was 89% on room air. The doctor heard crackles on the right lower lung. A chest X-ray showed pneumonia in the right lower lobe. She got oxygen by a small tube, and her level went up to 95%. She was given IV antibiotics, ceftriaxone and azithromycin. Tests for flu and COVID were negative. A urine test showed a pneumococcal germ that causes bacterial pneumonia. She has no known drug allergies. She felt better after three days and went home on day four with pills to finish treatment.",
    "subclaim": "She was admitted to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with poorly controlled T2DM (HbA1c 9.1%) presented with a plantar forefoot ulcer (approximately 2 cm) exhibiting surrounding erythema, warmth, and purulent exudate. Vitals: T 38.2\u00b0C, HR 96, BP 138/82; labs notable for WBC 13.2 \u00d710^9/L, CRP 68 mg/L, creatinine 0.9 mg/dL (eGFR ~90 mL/min/1.73 m^2). Physical exam showed diminished protective sensation to monofilament but intact distal pulses; probe-to-bone test was negative. Plain radiography demonstrated soft tissue swelling without cortical erosion or periosteal reaction, arguing against osteomyelitis. The ulcer underwent sharp debridement and copious irrigation; he was initiated on cefazolin 2 g IV every 8 hours. Once afebrile with improving erythema at 48 hours, he was transitioned to oral cephalexin 500 mg four times daily to complete a 10-day course. Aerobic wound culture yielded methicillin-susceptible Staphylococcus aureus; anaerobic cultures were negative. He was discharged with instructions for offloading, daily dressing changes, and outpatient podiatry follow-up.",
    "subclaim": "The wound culture grew methicillin-susceptible Staphylococcus aureus.",
    "label": "supported"
  },
  {
    "medical_text": "A 27-year-old man came to the emergency room with pain in the lower right belly. The pain started about 12 hours earlier. He felt sick to his stomach and threw up once. He had a small fever. The doctor pressed on his belly and it hurt in that spot. A blood test showed high white blood cells. A CT scan showed appendicitis. He got IV antibiotics and then had keyhole surgery to remove the appendix. He went home the next day and felt better. He has no known drug allergies.",
    "subclaim": "The patient had no known drug allergies.",
    "label": "supported"
  },
  {
    "medical_text": "An adult woman presented with two days of cough, fever, and dyspnea. Past history included asthma and a penicillin allergy. On arrival, SpO2 was 90% on room air, improving to 94% with 2 L/min nasal cannula. Temperature was 38.4 C and heart rate 108 bpm. Chest radiograph demonstrated a right lower lobe consolidation. SARS-CoV-2 PCR and rapid influenza tests were negative. Labs showed leukocytosis with elevated inflammatory markers. She was diagnosed with community-acquired pneumonia and treated with intravenous azithromycin, inhaled albuterol, and IV fluids. She improved clinically within 24 hours without need for ICU care.",
    "subclaim": "She was treated with azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man came to the hospital with fever, cough with yellow mucus, and shortness of breath. His temperature was 38.6 C. His oxygen level was low at 90% on room air. The doctor heard crackles on the right side of his chest. A chest X-ray showed pneumonia in the right lower lung. A urine test showed the germ Streptococcus pneumoniae. The flu test was negative. He was given IV ceftriaxone and azithromycin, oxygen by a nose tube, and IV fluids. He is not allergic to penicillin. After two days, he felt better, came off oxygen, and was changed to oral amoxicillin-clavulanate to finish 5 days.",
    "subclaim": "The influenza test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old male with T2DM and HTN presented with 3 days of productive cough, fevers to 38.5\u00b0C, and exertional dyspnea. Vitals: HR 102, BP 128/76, RR 22, SpO2 89% on room air; oxygen was initiated at 2 L/min via nasal cannula with SpO2 rising to 95%. Exam revealed right basilar crackles without signs of respiratory distress. Laboratory data: WBC 15.4 \u00d710^9/L (neutrophil predominant), CRP 12 mg/dL, creatinine 0.9 mg/dL. Respiratory viral PCR panel including influenza and SARS-CoV-2 was negative. CXR showed a dense right lower lobe lobar consolidation without effusion, consistent with community-acquired pneumonia. Empiric ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily were administered after two sets of blood cultures were obtained; cultures showed no growth at 48 h. Urinary Streptococcus pneumoniae antigen was positive, supporting pneumococcal etiology. The patient was admitted to a general medicine ward, showed clinical improvement by hospital day 2, and was weaned off supplemental oxygen with plan for oral amoxicillin-clavulanate to complete a 5-day total course.",
    "subclaim": "He had chills before coming to the hospital.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman with a history of type 2 diabetes mellitus presented with 72 hours of fever, productive cough, pleuritic chest pain, and dyspnea. Initial vitals: T 38.6\u00b0C, HR 110 bpm, RR 28/min, BP 128/74 mmHg, SpO2 90% on ambient air. Examination revealed tachypnea with crackles over the right lung base. Laboratory studies showed leukocytosis (WBC 15.0 \u00d710^3/\u00b5L, neutrophil predominant), CRP elevated, and procalcitonin mildly elevated. Posteroanterior chest radiograph demonstrated a focal right lower lobe air-space consolidation consistent with acute pneumonia. Working diagnosis was community-acquired pneumococcal pneumonia. She received supplemental oxygen via nasal cannula and empiric intravenous ceftriaxone plus azithromycin following pre-antibiotic blood cultures. Sputum Streptococcus pneumoniae antigen was positive; blood cultures showed no growth at 48 hours. With clinical improvement, she was transitioned to oral amoxicillin\u2013clavulanate and discharged home on hospital day two.",
    "subclaim": "The patient is 67 years old.",
    "label": "supported"
  },
  {
    "medical_text": "An older man came to the hospital with cough and fever for three days. He was short of breath and coughed up green mucus. The nurse checked him: his temperature was 101.5 F, he was breathing fast, and his oxygen level was 91% on room air. The doctor heard crackles on the left side of his chest. A chest x-ray showed a lung infection in the lower left lung. He got oxygen by a small tube in his nose and IV antibiotics, ceftriaxone and azithromycin. Tests for flu and COVID were negative. After two days, he felt better and could breathe without extra oxygen, with levels at 95%. Blood cultures did not grow any germs. He went home with pills to finish the antibiotics and a follow-up visit.",
    "subclaim": "He was treated with intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the emergency room with cough and fever. He was bringing up yellow mucus and felt short of breath. His temperature was 38.5\u00b0C and his oxygen level was 89% on room air. A chest X-ray showed a patch in the right lower lung. The team said he had pneumonia. He got IV antibiotics in the hospital and oxygen through a small tube in his nose. After two days, his breathing was better and his oxygen level was normal. He went home with antibiotic pills.",
    "subclaim": "He received intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old female with COPD and type 2 diabetes mellitus presented with three days of fever, purulent cough, and progressive dyspnea. She was febrile to 38.6 C, tachycardic at 102 bpm, tachypneic at 24/min, and hypoxemic with SpO2 88% on ambient air. Chest radiography revealed right lower lobe air-space consolidation, and exam noted crackles over the RLL. She was diagnosed with community-acquired pneumonia complicated by acute hypoxemic respiratory failure. Supplemental oxygen via nasal cannula at 2 L/min increased SpO2 to 94%. Empiric antimicrobial therapy with IV ceftriaxone plus azithromycin was started after obtaining blood and sputum cultures. Respiratory viral panel was negative for influenza A/B and SARS-CoV-2, and initial labs showed leukocytosis. Blood cultures to date show no growth at 24 hours. She has no known drug allergies and is managed on a general medical ward with bronchodilators as needed and plan for step-down to oral agents upon clinical stabilization.",
    "subclaim": "She received intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male presented with 48 hours of fever, purulent yellow sputum, and dyspnea. Initial vitals: T 38.5\u00b0C, RR 24/min, SpO2 89% on ambient air. Laboratory testing revealed WBC 14.2\u00d710^9/L and CRP 120 mg/L. Chest radiography demonstrated right lower lobe air-space consolidation consistent with lobar pneumonia. He was admitted with community-acquired pneumonia (PSI class III). Empiric therapy was ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily, with supplemental oxygen via nasal cannula. Blood cultures remained negative at 48 hours, while sputum culture yielded Streptococcus pneumoniae susceptible to beta-lactams. Within 48 hours, hypoxemia resolved and respiratory symptoms improved. He was discharged on an oral antibiotic regimen.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old male without chronic lung disease presents with a 3-day history of productive cough, pleuritic chest pain, and fever. On arrival: T 38.9 C, HR 108, BP 132/76, RR 24, SpO2 89% on ambient air. Chest radiograph demonstrates right lower lobe air-space opacity consistent with lobar consolidation. Impression: community-acquired pneumonia, likely pneumococcal given a positive urine Streptococcus pneumoniae antigen. Initial management includes nasal cannula oxygen at 2 L/min to maintain SpO2 >= 92% and IV ceftriaxone 1 g q24h plus azithromycin (500 mg day 1, then 250 mg daily). Baseline labs show leukocytosis (WBC 14.2 x10^9/L), CRP 120 mg/L, and procalcitonin 0.6 ng/mL; serum lactate is normal. Two sets of blood cultures remain negative at 48 hours; sputum culture is not obtained due to poor sample quality. By hospital day 2, he is afebrile with improved oxygenation and supplemental oxygen is discontinued. Therapy is de-escalated to oral amoxicillin-clavulanate to complete a 5-day total antibiotic course. Discharge planning includes return precautions and outpatient follow-up in one week.",
    "subclaim": "The patient had chronic obstructive pulmonary disease.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with T2DM, HTN, and active cigarette use presented with 2 hours of exertional, pressure-like chest pain. Vitals were stable; initial ECG demonstrated 1\u20132 mm ST depressions in leads V5\u2013V6 without ST elevation. High-sensitivity troponin I rose from 78 ng/L to 1,240 ng/L, consistent with NSTEMI. He received 325 mg aspirin load, ticagrelor 180 mg load, and weight-based enoxaparin, along with sublingual nitroglycerin. Coronary angiography identified a critical 90% proximal LAD lesion; a drug-eluting stent was deployed with TIMI-3 flow and no complications. Transthoracic echocardiography showed normal wall motion and LVEF ~55%. Serum creatinine was 0.9 mg/dL; LDL-C was 152 mg/dL; no known drug allergies. He was discharged on aspirin plus ticagrelor for 12 months, atorvastatin 80 mg nightly, and lisinopril, with smoking-cessation counseling and diabetes follow-up.",
    "subclaim": "He had a documented aspirin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with diabetes and high blood pressure came to the clinic. He had a sore on the bottom of his left foot for two weeks. The skin around it was red, warm, and smelled bad. He had a fever of 38.3 C and his heart was fast. Blood tests showed high white cells and high sugar. An X-ray did not show damage to the bone. An MRI suggested an early bone infection near the sore. A swab grew staph bacteria that can be treated with common drugs. He got IV antibiotics and had the dead tissue cleaned out. The plan was to switch to pills after two days if he kept getting better.",
    "subclaim": "MRI showed a drainable abscess.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man with type 2 diabetes and hypertension presented with 3 days of fever, cough, and dyspnea. On arrival, SpO2 was 89% on room air and improved to 95% on 2 L nasal cannula. Chest X-ray demonstrated right lower lobe consolidation, consistent with community-acquired pneumonia. He was started on ceftriaxone and azithromycin intravenously after blood cultures were drawn. Influenza and SARS-CoV-2 PCR tests were negative. Urinary pneumococcal antigen was positive, while blood cultures showed no growth at 48 hours. He was admitted to the general medical ward and remained hemodynamically stable. By 48 hours he reported improvement in breathing, and the plan was to transition to oral amoxicillin-clavulanate to complete a 5-day total antibiotic course.",
    "subclaim": "Renal function was normal.",
    "label": "supported"
  },
  {
    "medical_text": "A 39-year-old female with a history of nephrolithiasis presented with 48 hours of febrile left flank pain, dysuria, and nausea. On arrival: T 39.1 C, HR 108, BP 102/64; she was ill-appearing but not toxic. Labs: WBC 16.2 x10^9/L, creatinine 1.8 mg/dL (baseline 1.0), lactate 1.8 mmol/L; UA positive for nitrites and leukocyte esterase. Renal ultrasound showed mild left hydronephrosis secondary to a 7 mm proximal left ureteral obstructing calculus. Diagnosis: acute obstructive pyelonephritis with AKI. Management: IV crystalloid resuscitation and empiric ceftriaxone. Urology achieved source control via urgent left ureteral stent placement. Defervescence occurred within 48 hours, flank pain abated, and creatinine improved toward baseline. Urine culture grew pan-sensitive Escherichia coli; blood cultures remained negative. She was discharged on oral antibiotics to complete a 10-day course with plan for interval stone definitive therapy.",
    "subclaim": "Imaging showed a 7 mm obstructing stone in the left ureter.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman presented with three days of fever, productive cough, and pleuritic chest pain. On arrival her temperature was 38.5\u00b0C, heart rate 108, respiratory rate 24, and oxygen saturation 90% on room air. Lung exam revealed crackles at the right base. Chest radiograph showed a right lower lobe consolidation consistent with community-acquired pneumonia. She was started on supplemental oxygen via nasal cannula, which raised her saturation to 94%. Empiric IV ceftriaxone and azithromycin were given after drawing two sets of blood cultures. Initial labs showed leukocytosis with a WBC of 15,000 and a creatinine of 0.9 mg/dL. Urinary pneumococcal antigen later returned positive. Her breathing and cough improved over the next day on therapy.",
    "subclaim": "Her oxygen saturation improved after oxygen was given.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with COPD and hypertension met criteria for inpatient community-acquired pneumonia after 3 days of fever, productive cough, and exertional dyspnea. Vitals: T 38.6 C, RR 24, SpO2 89% on ambient air; exam notable for right basal crackles without pleuritic chest pain. Chest radiography demonstrated focal consolidation in the right lower lobe. Leukocytosis was present (WBC 14,000/\u03bcL). Microbiologic evaluation: sputum Gram stain/culture and PCR were positive for Streptococcus pneumoniae; Legionella urinary antigen was negative; influenza PCR was negative. No risk factors for MRSA or Pseudomonas were identified, and he had no beta-lactam allergy. Empiric therapy with IV ceftriaxone plus azithromycin was initiated, along with 2 L/min nasal cannula oxygen. By 48 hours, he was afebrile with SpO2 95% on room air, and therapy was de-escalated to oral agents to complete a 7-day total antibiotic course prior to discharge.",
    "subclaim": "Chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man presented with a 3-day history of productive cough, fever, and dyspnea. On exam he was febrile to 38.5 C, tachypneic at 24 breaths per minute, and his oxygen saturation was 90% on room air. Auscultation revealed crackles over the right lower lung field. Chest radiograph demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. Laboratory testing showed leukocytosis with a white blood cell count of 15,000/\u00b5L. He was started on intravenous ceftriaxone and azithromycin and given supplemental oxygen via nasal cannula at 2 L/min. Rapid influenza testing and a Legionella urine antigen were negative; blood cultures showed no growth at 48 hours. By hospital day 2, he had improved clinically, oxygen was weaned off, and the team planned transition to oral amoxicillin-clavulanate to complete a 5-day total antibiotic course.",
    "subclaim": "The white blood cell count was elevated.",
    "label": "supported"
  },
  {
    "medical_text": "A 66-year-old male with COPD and hypertension presented from home with 3 days of fever, purulent cough, and pleuritic dyspnea. Vitals: T 38.6 C, HR 105, RR 24, BP 138/82, SpO2 89% on room air. Chest radiograph demonstrated a right lower lobe lobar consolidation, consistent with community-acquired pneumonia; CURB-65 score was 1. Labs showed WBC 14.8 \u00d7 10^9/L and CRP 120 mg/L; creatinine remained at baseline. Rapid respiratory viral PCR was negative; urinary pneumococcal antigen was positive; initial blood cultures were negative. Empiric therapy with ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily was initiated. Supplemental oxygen was provided via nasal cannula at 2\u20133 L/min, along with scheduled bronchodilators. He was admitted to the general medicine ward; no ICU-level support was required. Within 48 hours the patient showed clinical improvement with reduced oxygen requirement. Plans were made to transition to oral amoxicillin\u2013clavulanate to complete a 5-day total antibiotic course; no beta-lactam allergy was reported.",
    "subclaim": "The patient received ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man has fever and right back pain for three days. Peeing burns, and he goes often. He has diabetes and high blood pressure. The doctor checks his urine. It shows bacteria and white blood cells. A scan shows a kidney infection on the right side. His blood sugar is high, and his kidney blood test is a bit worse than usual. He gets IV fluids and IV antibiotics in the hospital. After two days he feels better and the fever goes down. The lab grows E. coli from his blood. It can be treated with the medicine he got. He goes home on pills for ten more days.",
    "subclaim": "Blood cultures grew Escherichia coli.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male with T2DM (A1c 8.2%) presented with 2 hours of exertional substernal pressure and diaphoresis. Initial ECG demonstrated sinus rhythm without ST-segment elevation or new Q waves. High-sensitivity troponin I rose from 36 ng/L to 412 ng/L over 3 hours. NSTEMI was diagnosed; guideline-directed medical therapy was initiated with chewable aspirin 325 mg, IV unfractionated heparin infusion, metoprolol tartrate, and atorvastatin 80 mg. Creatinine was 1.1 mg/dL (eGFR 72 mL/min/1.73 m\u00b2). Coronary angiography showed a critical 90% proximal LAD stenosis with TIMI 2 flow. PCI with a drug-eluting stent restored TIMI 3 flow without complications. At discharge, medications included aspirin 81 mg daily, ticagrelor 90 mg twice daily, atorvastatin 80 mg nightly, and continuation of metformin.",
    "subclaim": "The patient had a heart attack.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman presented with three days of fever, productive cough, and pleuritic chest pain. On arrival her temperature was 38.5\u00b0C, heart rate 108, respiratory rate 24, and oxygen saturation 90% on room air. Lung exam revealed crackles at the right base. Chest radiograph showed a right lower lobe consolidation consistent with community-acquired pneumonia. She was started on supplemental oxygen via nasal cannula, which raised her saturation to 94%. Empiric IV ceftriaxone and azithromycin were given after drawing two sets of blood cultures. Initial labs showed leukocytosis with a WBC of 15,000 and a creatinine of 0.9 mg/dL. Urinary pneumococcal antigen later returned positive. Her breathing and cough improved over the next day on therapy.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man with type 2 diabetes and hypertension presented with 3 days of fever, cough, and dyspnea. On arrival, SpO2 was 89% on room air and improved to 95% on 2 L nasal cannula. Chest X-ray demonstrated right lower lobe consolidation, consistent with community-acquired pneumonia. He was started on ceftriaxone and azithromycin intravenously after blood cultures were drawn. Influenza and SARS-CoV-2 PCR tests were negative. Urinary pneumococcal antigen was positive, while blood cultures showed no growth at 48 hours. He was admitted to the general medical ward and remained hemodynamically stable. By 48 hours he reported improvement in breathing, and the plan was to transition to oral amoxicillin-clavulanate to complete a 5-day total antibiotic course.",
    "subclaim": "He required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old male with hypertension and type 2 diabetes presents with acute dyspnea and bilateral lower-extremity edema. Vitals: HR 132 irregularly irregular, BP 118/72, RR 24, SpO2 89% on room air. ECG shows atrial fibrillation with rapid ventricular response and no ST-segment elevation. Chest radiograph reveals interstitial and alveolar edema with mild cardiomegaly. Labs: BNP 1200 pg/mL; creatinine 1.5 mg/dL (baseline 1.2); troponin I 0.03 ng/mL without dynamic rise. He received oxygen via nasal cannula and IV furosemide 40 mg with brisk diuresis. Intravenous diltiazem was administered for rate control. Apixaban was initiated for stroke prophylaxis in atrial fibrillation. Working diagnosis: acute decompensated heart failure precipitated by AF with RVR.",
    "subclaim": "He received intravenous furosemide.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with COPD and hypertension met criteria for inpatient community-acquired pneumonia after 3 days of fever, productive cough, and exertional dyspnea. Vitals: T 38.6 C, RR 24, SpO2 89% on ambient air; exam notable for right basal crackles without pleuritic chest pain. Chest radiography demonstrated focal consolidation in the right lower lobe. Leukocytosis was present (WBC 14,000/\u03bcL). Microbiologic evaluation: sputum Gram stain/culture and PCR were positive for Streptococcus pneumoniae; Legionella urinary antigen was negative; influenza PCR was negative. No risk factors for MRSA or Pseudomonas were identified, and he had no beta-lactam allergy. Empiric therapy with IV ceftriaxone plus azithromycin was initiated, along with 2 L/min nasal cannula oxygen. By 48 hours, he was afebrile with SpO2 95% on room air, and therapy was de-escalated to oral agents to complete a 7-day total antibiotic course prior to discharge.",
    "subclaim": "He required intensive care unit admission.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old male with GOLD 2 COPD and hypertension presented with 72 hours of fever, purulent sputum, and exertional dyspnea. Initial vitals: T 38.6 C, HR 104 bpm, RR 24/min, BP 138/78 mmHg, SpO2 91% on ambient air. Pulmonary exam showed left basilar crackles and bronchial breath sounds. CBC revealed leukocytosis to 15,200/\u00b5L with 86% neutrophils; C-reactive protein was 12 mg/dL. PA and lateral chest radiographs demonstrated focal left lower lobe air-space consolidation consistent with community-acquired pneumonia; no pleural effusion was seen. Influenza A/B NAAT and SARS-CoV-2 antigen tests were negative. Empiric therapy included IV ceftriaxone (1 g every 24 hours) plus azithromycin (500 mg day 1 then 250 mg daily); 2 L/min nasal cannula oxygen was used to maintain SpO2 at least 94%, and blood cultures were drawn prior to antibiotics. Over 48 hours, he defervesced and hypoxemia resolved; oxygen was discontinued with SpO2 95% on room air. Blood cultures had no growth at 48 hours, and he was transitioned to oral agents to complete therapy and discharged with clinic follow-up within one week.",
    "subclaim": "He was treated with intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man with COPD presented with two days of fever and productive cough. On arrival, his oxygen saturation was 90% on room air with tachypnea. Chest X-ray demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. He was started on ceftriaxone and azithromycin intravenously. Supplemental oxygen was provided via nasal cannula at 2 L/min. Initial labs showed leukocytosis with neutrophilia, and lactate was normal. Blood cultures were obtained and later reported no growth. Within 48 hours he became afebrile, was breathing easier, and maintained 95% saturation on room air. The plan was to transition to oral antibiotics and discharge if stability continued.",
    "subclaim": "He required mechanical ventilation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old man came to the hospital with fever, cough, and trouble breathing. He used to smoke and has long-term lung disease (COPD). His oxygen level was 88% in room air, and it went up to 94% with a small tube of oxygen. A chest X-ray showed an infection in the right lower lung. Blood tests showed signs of infection. Doctors started IV antibiotics and breathing treatments. He also took steroid pills for a few days. He felt better after three days and went home with antibiotics and inhalers.",
    "subclaim": "Oxygen saturation improved after nasal cannula oxygen was given.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man came to the hospital with a hot, red left lower leg. He had a small cut there two days earlier. He had fever to 38.5\u00b0C and felt tired. He has type 2 diabetes that is not well controlled. Blood tests showed high white cells. An ultrasound looked for a pocket of pus but found none. He got IV antibiotics called cefazolin. After two days his leg looked better and the fever went down. He went home on pill antibiotics to finish a 5-day course and was taught how to care for the wound.",
    "subclaim": "Blood cultures grew Staphylococcus aureus.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 39-year-old woman presented with 2 days of fever, left flank pain, dysuria, and nausea. Vitals showed tachycardia and borderline hypotension. UA was positive for nitrites and leukocyte esterase; CBC revealed leukocytosis. Serum creatinine was elevated from baseline. Renal ultrasound demonstrated a 7 mm obstructing calculus in the proximal left ureter with mild hydronephrosis. She was treated with IV fluids and empiric ceftriaxone. Urology performed urgent decompression with placement of a left ureteral stent. Over 48 hours, fever and pain resolved, and creatinine trended down. Urine culture grew Escherichia coli. She was transitioned to oral antibiotics to complete a 10-day course and scheduled for outpatient stone management.",
    "subclaim": "The infection involved the right kidney.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the hospital with fever and cough. He had thick green mucus and sharp chest pain when he breathed. He has diabetes and lung disease (COPD). His oxygen level was low. A chest X-ray showed an infection in the right lower lung. A flu test was negative. He got IV antibiotics, ceftriaxone and azithromycin, and oxygen through a small tube in his nose at 2 liters per minute. Blood tests showed high white cells and high blood sugar. The sputum test later grew Streptococcus pneumoniae that should respond to ceftriaxone. After two days he felt better, the oxygen was stopped, and he went home on amoxicillin-clavulanate pills to finish five days total.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man presented with fever, productive cough, and dyspnea. History included COPD and type 2 diabetes; he reported a penicillin allergy. Temperature was 38.6\u00b0C, heart rate 104, respiratory rate 24, blood pressure 118/70, and oxygen saturation 90% on room air. Saturation improved to 95% on 2 L/min nasal cannula. Chest x-ray showed a right lower lobe consolidation consistent with community-acquired pneumonia. Labs demonstrated leukocytosis and elevated inflammatory markers. He received IV ceftriaxone plus azithromycin, supplemental oxygen by nasal cannula, and fluids. Blood cultures remained negative at 48 hours. He improved clinically within two days and did not require intubation or ICU care.",
    "subclaim": "The patient required endotracheal intubation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with poorly controlled type 2 diabetes (HbA1c 9.2%) presented with two days of painful, erythematous swelling of the left lower leg after a minor cut. He was febrile to 38.5\u00b0C and tachycardic at 102 bpm. Labs showed leukocytosis (WBC 14.8 \u00d710^9/L) and elevated CRP; renal function was normal. Bedside soft-tissue ultrasound showed cellulitis without a drainable abscess. Blood cultures were obtained and remained negative at 48 hours. Empiric IV cefazolin (2 g every 8 hours) was started for nonpurulent cellulitis. A MRSA nasal PCR screen was negative. After 48 hours he improved clinically, so therapy was stepped down to oral cephalexin to complete a 5-day total course. He was discharged with wound care instructions and a tetanus booster.",
    "subclaim": "He required surgical drainage of the infection.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 65-year-old male presented after 48 hours of fever, productive cough, and right-sided pleuritic chest pain. Vitals: T 38.6\u00b0C, HR 104, BP 132/78, RR 24, SpO2 89% on room air. Exam: crackles and bronchial breath sounds at the right lower lung field without percussion dullness. Labs showed WBC 14.8 \u00d710^9/L (85% neutrophils), CRP 115 mg/L, procalcitonin 0.6 ng/mL, and creatinine 0.9 mg/dL. Chest radiograph demonstrated focal right lower lobe airspace consolidation without pleural effusion. Impression: community-acquired bacterial pneumonia with a reported non-anaphylactic beta-lactam allergy (maculopapular rash to amoxicillin). Management included supplemental oxygen via nasal cannula at 2 L/min and IV levofloxacin started after two sets of blood cultures were obtained. Respiratory viral PCR (influenza A/B, SARS-CoV-2) was negative; blood cultures remained negative at 48 hours. At 48 hours he was afebrile with SpO2 94% on ambient air and improved respiratory symptoms. He was discharged on hospital day three with oral levofloxacin to complete a five-day total antibiotic course.",
    "subclaim": "He received oxygen by nasal cannula.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with 3 days of fever, productive cough, and exertional dyspnea presented to the emergency department. Vitals: T 38.5 C, HR 102, BP 128/74, RR 22, SpO2 90% on room air; supplemental O2 via nasal cannula at 2 L/min increased saturation to 95%. Pulmonary exam revealed crackles at the right base without wheeze. Chest radiograph showed focal right lower lobe air-space consolidation without effusion or pneumothorax. Laboratory data: WBC 14.2 x10^3/\u00b5L with neutrophil predominance; CRP 145 mg/L; procalcitonin 0.6 ng/mL. SARS-CoV-2 PCR was negative; urine pneumococcal antigen was not obtained; two sets of blood cultures remained negative at 48 hours. He had no history of beta-lactam allergy. The patient was treated for community-acquired pneumonia with IV ceftriaxone plus azithromycin, then transitioned on hospital day 2 to oral amoxicillin-clavulanate to complete a 7-day total course. He defervesced within 36 hours, was weaned to room air, and was discharged home on hospital day 3 with outpatient follow-up arranged.",
    "subclaim": "He tested positive for COVID-19.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 66-year-old male presented with exertional chest pressure lasting 45 minutes, not relieved by rest. History includes hypertension, type 2 diabetes, active smoking, and high LDL. ECG showed lateral ST depressions without ST elevation. High-sensitivity troponin rose from 120 to 460 ng/L. He was diagnosed with an NSTEMI. Treatment included chewable aspirin, ticagrelor loading, IV unfractionated heparin, metoprolol, and high-intensity atorvastatin. Transthoracic echocardiogram showed LVEF 55% with no regional wall-motion abnormalities. Next-morning coronary angiography revealed an 80% proximal LAD stenosis; a drug-eluting stent was placed with good flow. He was discharged on dual antiplatelet therapy, a beta-blocker, a statin, and medications for diabetes and blood pressure.",
    "subclaim": "Troponin levels were elevated.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with T2DM, HTN, and active cigarette use presented with 2 hours of exertional, pressure-like chest pain. Vitals were stable; initial ECG demonstrated 1\u20132 mm ST depressions in leads V5\u2013V6 without ST elevation. High-sensitivity troponin I rose from 78 ng/L to 1,240 ng/L, consistent with NSTEMI. He received 325 mg aspirin load, ticagrelor 180 mg load, and weight-based enoxaparin, along with sublingual nitroglycerin. Coronary angiography identified a critical 90% proximal LAD lesion; a drug-eluting stent was deployed with TIMI-3 flow and no complications. Transthoracic echocardiography showed normal wall motion and LVEF ~55%. Serum creatinine was 0.9 mg/dL; LDL-C was 152 mg/dL; no known drug allergies. He was discharged on aspirin plus ticagrelor for 12 months, atorvastatin 80 mg nightly, and lisinopril, with smoking-cessation counseling and diabetes follow-up.",
    "subclaim": "The ECG showed ST segment elevation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 65-year-old male presented after 48 hours of fever, productive cough, and right-sided pleuritic chest pain. Vitals: T 38.6\u00b0C, HR 104, BP 132/78, RR 24, SpO2 89% on room air. Exam: crackles and bronchial breath sounds at the right lower lung field without percussion dullness. Labs showed WBC 14.8 \u00d710^9/L (85% neutrophils), CRP 115 mg/L, procalcitonin 0.6 ng/mL, and creatinine 0.9 mg/dL. Chest radiograph demonstrated focal right lower lobe airspace consolidation without pleural effusion. Impression: community-acquired bacterial pneumonia with a reported non-anaphylactic beta-lactam allergy (maculopapular rash to amoxicillin). Management included supplemental oxygen via nasal cannula at 2 L/min and IV levofloxacin started after two sets of blood cultures were obtained. Respiratory viral PCR (influenza A/B, SARS-CoV-2) was negative; blood cultures remained negative at 48 hours. At 48 hours he was afebrile with SpO2 94% on ambient air and improved respiratory symptoms. He was discharged on hospital day three with oral levofloxacin to complete a five-day total antibiotic course.",
    "subclaim": "He required mechanical ventilation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman came to the hospital with fever and cough for three days. She had green mucus and was short of breath. Her temperature was 38.5\u00b0C, and her breathing was fast. A chest x-ray showed an infection in the right lower lung. Her blood test showed many white blood cells. Her oxygen level was low at 90% on room air. The team gave her oxygen and antibiotics through a vein. After two days, she felt better and no longer had a fever. She could breathe well with oxygen at 95% on room air. She went home with antibiotic pills for five more days and a clinic visit next week.",
    "subclaim": "Blood cultures were drawn before antibiotics were started.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with longstanding T2DM and distal symmetric neuropathy presented with a right plantar forefoot ulcer and overlying cellulitis. Glycemic control was poor (HbA1c 9.2%). He was febrile to 38.2 C with WBC 12.1 \u00d710^9/L and CRP 110 mg/L. Ankle-brachial index was 1.06 with palpable pedal pulses, indicating adequate perfusion. Plain radiographs showed no cortical destruction, periosteal reaction, or subcutaneous gas. After obtaining wound and blood cultures, empiric IV vancomycin plus piperacillin\u2013tazobactam were initiated. The wound culture grew methicillin-susceptible Staphylococcus aureus; blood cultures remained negative. Therapy was de-escalated to IV cefazolin, and bedside sharp debridement was performed. The cellulitis improved clinically without signs of osteomyelitis. He was transitioned to oral cephalexin at discharge to complete 7 days of total antibiotics.",
    "subclaim": "His HbA1c was 9.2%.",
    "label": "supported"
  },
  {
    "medical_text": "A 55-year-old woman with type 2 diabetes presented with two days of fever, dysuria, urinary frequency, and right flank pain. On arrival her temperature was 38.7\u00b0C, heart rate 104, and blood pressure 118/72. Urinalysis was positive for nitrites and leukocyte esterase with marked pyuria. The urine culture grew more than 100,000 CFU/mL of Escherichia coli. Her white blood cell count was 15,200/\u00b5L, and creatinine was 1.0 mg/dL. Non-contrast CT of the abdomen and pelvis showed no kidney stones or perinephric abscess. The working diagnosis was acute pyelonephritis. She received intravenous ceftriaxone and fluids, then was transitioned to oral ciprofloxacin to complete a 10-day course. She defervesced within 24 hours, blood cultures were negative at 48 hours, and she was discharged home after two days with clinic follow-up.",
    "subclaim": "She required ICU admission for hypotension.",
    "label": "not_supported"
  },
  {
    "medical_text": "Mr. Lee is 68 years old. He has had cough, fever, and shortness of breath for three days. His fever is 38.9 C and his heart is beating fast. A chest x-ray shows a spot in the right lower lung. The doctor says it is pneumonia from the community. He gets oxygen through his nose at 2 liters per minute to keep his oxygen above 92%. They start IV antibiotics: ceftriaxone and azithromycin. A urine test is positive for the pneumococcus germ. Blood tests show high white cells and a high CRP. After 48 hours he breathes easier and the fever goes down. He is switched to pills, and the oxygen is stopped.",
    "subclaim": "The patient required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 54-year-old man came to the hospital with cough and fever for three days. He was short of breath and had chest pain when he breathed. The doctor heard crackles on the right. His oxygen level was 92% on room air. A chest X-ray showed an infection in the lower right lung. He has type 2 diabetes and no drug allergies, and he does not smoke. He got IV antibiotics and oxygen on a regular hospital floor. His white blood cell count was high. After two days, he felt better and his oxygen was 95% without extra oxygen. He went home with antibiotic pills for five more days and got a flu shot before leaving. Blood cultures were negative, and his mucus test showed a pneumonia germ that the antibiotics could kill.",
    "subclaim": "The chest radiograph showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman came to the hospital because she was short of breath. She has lung disease called COPD. For three days she had more cough and thick mucus. Her oxygen was low, but it got better with a small tube in her nose. She uses a daily inhaler at home and kept using it. The chest x-ray looked clear and did not show pneumonia. A virus test showed a common cold virus. She got breathing treatments, steroid pills, and an antibiotic pill. She felt better and went home the next day.",
    "subclaim": "She has type 1 diabetes.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with longstanding T2DM and distal symmetric neuropathy presented with a right plantar forefoot ulcer and overlying cellulitis. Glycemic control was poor (HbA1c 9.2%). He was febrile to 38.2 C with WBC 12.1 \u00d710^9/L and CRP 110 mg/L. Ankle-brachial index was 1.06 with palpable pedal pulses, indicating adequate perfusion. Plain radiographs showed no cortical destruction, periosteal reaction, or subcutaneous gas. After obtaining wound and blood cultures, empiric IV vancomycin plus piperacillin\u2013tazobactam were initiated. The wound culture grew methicillin-susceptible Staphylococcus aureus; blood cultures remained negative. Therapy was de-escalated to IV cefazolin, and bedside sharp debridement was performed. The cellulitis improved clinically without signs of osteomyelitis. He was transitioned to oral cephalexin at discharge to complete 7 days of total antibiotics.",
    "subclaim": "Imaging did not show osteomyelitis.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with COPD and a long smoking history presents with three days of productive cough, pleuritic chest pain, and fever. On arrival his vital signs are T 38.4\u00b0C, HR 108, BP 128/74, RR 24, and SpO2 89% on room air. Lung exam shows rales at the right base and increased work of breathing. Chest radiograph demonstrates a right lower lobe consolidation. Labs reveal WBC 14.5 K/\u00b5L with neutrophil predominance and elevated CRP. He is started on IV ceftriaxone plus azithromycin and 2 L/min oxygen via nasal cannula. He has no history of beta-lactam allergy, and renal function is normal. Two sets of blood cultures remain negative at 48 hours, and the sputum Gram stain shows mixed flora without a dominant pathogen. He improves clinically with defervescence and better oxygenation within 48 hours. He is discharged on oral amoxicillin-clavulanate to complete a seven-day course.",
    "subclaim": "The patient required ICU admission for respiratory failure.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 42-year-old woman came to the hospital with fever, chills, and pain in her right lower back. She had burning when she peed. The team said she had a kidney infection. Her urine test showed germs, and later the lab found E. coli. She got fluids in a vein and IV antibiotics. She also got pain medicine. An ultrasound of her kidneys showed no block or stones. She felt better after two days, switched to pills, and went home on day three with 10 days of antibiotics.",
    "subclaim": "She required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old female with T2DM, hypertension, and a non\u2013IgE-mediated penicillin allergy (rash) presented after 3 days of fever, productive cough, and exertional dyspnea; she denied chest pain. On arrival: T 38.5\u00b0C, HR 110 bpm, RR 24/min, BP 128/76 mmHg, SpO2 90% on ambient air. Exam: inspiratory crackles over the right lower posterior lung field without wheezes; no peripheral edema. Labs: WBC 15.2 \u00d7 10^9/L (86% neutrophils), glucose 228 mg/dL, lactate 1.2 mmol/L, procalcitonin 0.8 ng/mL; BMP otherwise unremarkable. CXR showed dense right lower lobe lobar consolidation with air bronchograms. Respiratory viral PCR panel (influenza A/B, RSV, SARS-CoV-2) was negative; urine Streptococcus pneumoniae antigen was positive; blood cultures pending. She received supplemental O2 via nasal cannula at 2 L/min, increasing SpO2 to 95%. Empiric therapy with ceftriaxone 1 g IV q24h plus doxycycline 100 mg q12h was initiated. She was admitted for inpatient management due to hypoxemic community-acquired pneumonia.",
    "subclaim": "Oxygen saturation improved after oxygen therapy.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man with COPD presented with two days of fever and productive cough. On arrival, his oxygen saturation was 90% on room air with tachypnea. Chest X-ray demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. He was started on ceftriaxone and azithromycin intravenously. Supplemental oxygen was provided via nasal cannula at 2 L/min. Initial labs showed leukocytosis with neutrophilia, and lactate was normal. Blood cultures were obtained and later reported no growth. Within 48 hours he became afebrile, was breathing easier, and maintained 95% saturation on room air. The plan was to transition to oral antibiotics and discharge if stability continued.",
    "subclaim": "Ceftriaxone and azithromycin were given intravenously.",
    "label": "supported"
  },
  {
    "medical_text": "A 65-year-old man came to the hospital with cough and fever. He has COPD and uses an inhaler at home. He felt short of breath for three days. A chest x-ray showed pneumonia in the right lower lung. His white blood cells were high. Tests for flu and COVID were negative. He has no medicine allergies. He got oxygen through a small tube in his nose. He was given IV ceftriaxone and azithromycin. He felt better after two days and went home the next day on pills to finish five days total.",
    "subclaim": "He had a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man came to the ER with chest pain at rest for 30 minutes. The pain went to his left arm. He felt sweaty and short of breath. He has high blood pressure and diabetes. The heart tracing did not show a big heart attack. A blood test for heart damage was high, and it went higher later. He got aspirin and a blood thinner shot. He also started a statin and a beta-blocker. His chest x-ray looked normal. His kidneys are a little weak, so the team will watch them. He is set for a heart artery test tomorrow.",
    "subclaim": "The patient received aspirin.",
    "label": "supported"
  },
  {
    "medical_text": "A 38-year-old otherwise healthy adult presented with 4 days of productive cough, fever, and exertional dyspnea. On exam: T 38.5\u00b0C, HR 104, RR 22, BP 120/76 mmHg, SpO2 93% on ambient air; scattered rhonchi at the right base. Laboratory testing showed WBC 13.2 \u00d710^9/L with neutrophil predominance; procalcitonin 0.34 ng/mL. Chest radiograph revealed a focal right lower lobe consolidation consistent with community-acquired pneumonia. SARS-CoV-2 and influenza A/B PCR were negative. Given a history of immediate penicillin hypersensitivity and CURB-65 score 0, outpatient management was selected. Doxycycline 100 mg PO BID was prescribed for 7 days; acetaminophen and albuterol MDI PRN were provided. Discharge instructions included return precautions and telephonic follow-up at 48 hours. At 48 hours the patient reported symptomatic improvement, was afebrile, and home pulse oximetry read 96%.",
    "subclaim": "Oxygen saturation at presentation was 93%.",
    "label": "supported"
  },
  {
    "medical_text": "A 66-year-old man came to the hospital from home. He had fever, cough with yellow mucus, and trouble breathing for three days. He has COPD and high blood pressure. His oxygen level was low when he arrived. A chest X-ray showed pneumonia in the right lower lung. The team started IV ceftriaxone and azithromycin. He was given oxygen by a small tube in the nose and inhaler treatments for his COPD. Quick virus tests were negative, and his kidneys were okay. He began to feel better after two days, and the oxygen was turned down. He has no drug allergies and lives alone.",
    "subclaim": "Blood cultures grew Staphylococcus aureus.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman came to the hospital because she was short of breath. She has lung disease called COPD. For three days she had more cough and thick mucus. Her oxygen was low, but it got better with a small tube in her nose. She uses a daily inhaler at home and kept using it. The chest x-ray looked clear and did not show pneumonia. A virus test showed a common cold virus. She got breathing treatments, steroid pills, and an antibiotic pill. She felt better and went home the next day.",
    "subclaim": "Chest x-ray showed no pneumonia.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes presents with a right plantar foot ulcer that began after a blister three weeks ago. He reports redness and warmth around the wound but denies fever or chills. Exam shows a superficial ulcer with less than 2 cm surrounding cellulitis and intact distal pulses. White blood cell count is normal and C-reactive protein is mildly elevated. Plain radiograph of the foot shows no osteomyelitis or gas. After sharp debridement, a sample is sent for culture, which grows methicillin-susceptible Staphylococcus aureus and Streptococcus species. He is started on oral amoxicillin-clavulanate 875/125 mg twice daily for seven days. Offloading is provided with a special shoe, and he receives a tetanus booster. He is advised on glucose control and scheduled to return in one week.",
    "subclaim": "The patient has type 2 diabetes.",
    "label": "supported"
  },
  {
    "medical_text": "A man came to the hospital with shortness of breath and swollen legs. He has diabetes and high blood pressure. The doctor heard crackles in his lungs and saw neck veins were full. A chest X-ray showed an enlarged heart and fluid in the lungs. A blood test for heart strain was high. His heart ultrasound showed a weak pump with low ejection fraction. The team said he had heart failure that got worse. They gave IV water pills to remove fluid and limited his fluids and salt. They paused his metformin for safety because his kidneys were stressed. He breathed easier and lost weight from urine, and he went home with follow-up.",
    "subclaim": "The ejection fraction was reduced.",
    "label": "supported"
  },
  {
    "medical_text": "A 70-year-old man presented after three days of fever, cough with yellow sputum, and pleuritic chest pain. On arrival he was febrile and short of breath; his oxygen saturation was 89% on room air. A chest X-ray showed consolidation in the right lower lobe, consistent with community-acquired pneumonia. He was admitted to the medical ward and placed on oxygen by nasal cannula. Empiric therapy with intravenous ceftriaxone and azithromycin was started. Sputum culture later grew Streptococcus pneumoniae; blood cultures remained negative. He improved over 48 hours and was weaned to low-flow oxygen. On hospital day three he was discharged home on oral antibiotics with outpatient follow-up.",
    "subclaim": "He was given oxygen via a nasal cannula.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came in with cough and fever for three days. He felt short of breath and very tired. He has diabetes and high blood pressure, and no drug allergies. In the ER, his oxygen level was 90% on room air and his heart was fast. A chest X-ray showed a lung spot in the right lower part. The team said he had community pneumonia from bacteria. He got oxygen through a small tube in his nose at 2 liters per minute and IV antibiotics. Tests for flu and COVID were negative, and his blood cultures showed no growth after two days. He did not need the ICU or a breathing machine, and after two days he felt better and could go home on pills to finish five days of antibiotics.",
    "subclaim": "Oxygen was given at 2 L/min via nasal cannula.",
    "label": "supported"
  },
  {
    "medical_text": "A 54-year-old man came to the hospital with cough and fever for three days. He was short of breath and had chest pain when he breathed. The doctor heard crackles on the right. His oxygen level was 92% on room air. A chest X-ray showed an infection in the lower right lung. He has type 2 diabetes and no drug allergies, and he does not smoke. He got IV antibiotics and oxygen on a regular hospital floor. His white blood cell count was high. After two days, he felt better and his oxygen was 95% without extra oxygen. He went home with antibiotic pills for five more days and got a flu shot before leaving. Blood cultures were negative, and his mucus test showed a pneumonia germ that the antibiotics could kill.",
    "subclaim": "Initial therapy included IV ceftriaxone plus azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman came in with leg swelling and shortness of breath. She had gained weight this week but no chest pain or fever. Her exam showed ankle edema, and her oxygen level was okay. A chest X-ray showed fluid in the lungs. A heart ultrasound showed an ejection fraction of about 30%. She got IV water pill medicine (furosemide) and passed a lot of urine. She started sacubitril/valsartan and a beta blocker. Spironolactone was not started because her potassium was 5.2. She was told to eat less salt and to check her weight, with a follow-up in one week.",
    "subclaim": "She was treated with antibiotics.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman with COPD and hypertension presented after three days of fever, productive cough, and dyspnea. On arrival her SpO2 was 89% on room air with mild tachycardia. WBC was 14.8 K/\u00b5L with neutrophilia. Chest radiograph showed a right lower lobe consolidation. She was diagnosed with community-acquired pneumonia and a COPD exacerbation. Treatment included IV ceftriaxone plus azithromycin, prednisone 40 mg daily, nebulized albuterol/ipratropium, and 2 L nasal cannula oxygen. Blood cultures had no growth, and SARS-CoV-2 PCR was negative. By hospital day 3 she was afebrile and maintained 95% oxygen saturation on room air. She was discharged to complete a 5-day azithromycin course with a prednisone taper and follow-up in one week.",
    "subclaim": "She had a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man came to the hospital with cough and fever. He felt short of breath. He does not have any drug allergies. His oxygen level was 89% on room air. A chest X-ray showed pneumonia in the lower right lung. The team gave him oxygen through a small tube under the nose. He got IV antibiotics, ceftriaxone and azithromycin. A spit test grew strep pneumonia bacteria. The COVID test was negative. After three days he felt better and went home on amoxicillin-clavulanate pills.",
    "subclaim": "The chest X-ray showed a right lower lobe pneumonia.",
    "label": "supported"
  },
  {
    "medical_text": "A 70-year-old man presented after three days of fever, cough with yellow sputum, and pleuritic chest pain. On arrival he was febrile and short of breath; his oxygen saturation was 89% on room air. A chest X-ray showed consolidation in the right lower lobe, consistent with community-acquired pneumonia. He was admitted to the medical ward and placed on oxygen by nasal cannula. Empiric therapy with intravenous ceftriaxone and azithromycin was started. Sputum culture later grew Streptococcus pneumoniae; blood cultures remained negative. He improved over 48 hours and was weaned to low-flow oxygen. On hospital day three he was discharged home on oral antibiotics with outpatient follow-up.",
    "subclaim": "His COVID-19 test was negative.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with COPD and hypertension met criteria for inpatient community-acquired pneumonia after 3 days of fever, productive cough, and exertional dyspnea. Vitals: T 38.6 C, RR 24, SpO2 89% on ambient air; exam notable for right basal crackles without pleuritic chest pain. Chest radiography demonstrated focal consolidation in the right lower lobe. Leukocytosis was present (WBC 14,000/\u03bcL). Microbiologic evaluation: sputum Gram stain/culture and PCR were positive for Streptococcus pneumoniae; Legionella urinary antigen was negative; influenza PCR was negative. No risk factors for MRSA or Pseudomonas were identified, and he had no beta-lactam allergy. Empiric therapy with IV ceftriaxone plus azithromycin was initiated, along with 2 L/min nasal cannula oxygen. By 48 hours, he was afebrile with SpO2 95% on room air, and therapy was de-escalated to oral agents to complete a 7-day total antibiotic course prior to discharge.",
    "subclaim": "Legionella urine antigen was negative.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman with COPD and hypertension presented with two days of fever, productive cough, and dyspnea. Vitals showed T 38.5\u00b0C, HR 106, RR 24, and SpO2 90% on room air. Chest X-ray demonstrated right lower lobe consolidation. Her WBC count was 15,200/\u00b5L. Blood cultures and a sputum sample were obtained prior to antibiotics. She was started on IV ceftriaxone and azithromycin for community-acquired pneumonia. Oxygen at 2 L/min via nasal cannula increased her saturation to 95%. She denied any drug allergies. After 48 hours, she was afebrile and no longer tachypneic. The plan was to transition to oral amoxicillin to complete a five-day course.",
    "subclaim": "A rapid influenza test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman with COPD and type 2 diabetes presented with three days of fever, productive green sputum, and dyspnea. On arrival, temperature was 38.6 C, respiratory rate 24, heart rate 102, and SpO2 88% on room air. After starting 2 liters of oxygen by nasal cannula, her saturation improved to 94%. Chest radiograph demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. Laboratory testing showed leukocytosis, and blood and sputum cultures were obtained before antibiotics. Empiric IV ceftriaxone plus azithromycin were initiated, and scheduled bronchodilator nebulizers were given for COPD. A multiplex viral PCR was negative for influenza and SARS-CoV-2. Blood cultures show no growth at 24 hours. She has no known drug allergies and remains on the general medical floor with plans to transition to oral therapy if stable.",
    "subclaim": "Blood cultures grew Streptococcus pneumoniae within 24 hours.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes presented with 2 hours of substernal chest pressure and diaphoresis. ECG showed no ST-segment elevation. High-sensitivity troponin was elevated. He was diagnosed with a non\u2013ST-elevation myocardial infarction. He received aspirin, intravenous heparin, and a beta-blocker in the ED. Coronary angiography revealed a 90% proximal lesion in the left anterior descending artery. A drug-eluting stent was deployed with good result. He was discharged on aspirin, ticagrelor, high-intensity atorvastatin, and continued metformin.",
    "subclaim": "Thrombolytic therapy was administered.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old male with HTN and T2DM presented with 30 minutes of rest angina radiating to the left arm, associated with diaphoresis and dyspnea. ECG demonstrated no STE, with nonspecific ST-T abnormalities. High-sensitivity troponin I was elevated at presentation and increased on repeat sampling at 3 hours, consistent with a rising delta. Clinical picture favored NSTE-ACS (probable NSTEMI). He received 325 mg chewable aspirin and therapeutic-dose enoxaparin; high-intensity atorvastatin and a beta-blocker were initiated. Chest X-ray was clear. Serum creatinine was mildly elevated, warranting renal monitoring prior to contrast exposure. Vitals remained stable, and chest pain improved after medical therapy. Plan is early invasive strategy with coronary angiography the following day. There was no fever, cough, or focal lung findings.",
    "subclaim": "Troponin levels increased on repeat testing.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with COPD and T2DM presented with 48 hours of fever, productive cough, and pleuritic chest pain. Initial vitals: temperature 38.6\u00b0C, heart rate 112 bpm, SpO2 89% on room air; improved to 94% on 2 L nasal cannula. Chest radiograph demonstrated right lower lobe lobar consolidation without pleural effusion. Laboratory studies showed leukocytosis (WBC 15.2 \u00d7 10^9/L) and elevated CRP; serum lactate was normal. Empiric therapy consisted of IV ceftriaxone plus azithromycin, with supplemental oxygen via nasal cannula. Microbiology revealed expectorated sputum culture positive for Streptococcus pneumoniae, penicillin-susceptible. Two sets of blood cultures had no growth. By 48 hours the patient defervesced and therapy was de-escalated to oral amoxicillin-clavulanate. He was discharged home on a short oral course, and pneumococcal vaccination was addressed at discharge.",
    "subclaim": "The patient required mechanical ventilation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman with type 2 diabetes and hypertension presented with three days of fever, productive cough, and dyspnea. Vitals: temperature 38.5\u00b0C, respiratory rate 24, oxygen saturation 90% on room air. Lung exam revealed right basilar crackles with pleuritic chest discomfort. Chest radiograph showed right lower lobe consolidation consistent with community-acquired pneumonia. White blood cell count was 14,000/\u00b5L. Two sets of blood cultures were obtained prior to antibiotics. She was started in the emergency department on supplemental oxygen, ceftriaxone, and azithromycin. Rapid influenza testing was negative. She was admitted for intravenous therapy and monitoring. By 48 hours, her oxygen requirement decreased and symptoms improved.",
    "subclaim": "The chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with GOLD II COPD and hypertension presented with 48 hours of fever, pleuritic cough, and dyspnea. On arrival: T 38.6\u00b0C, RR 24, BP 132/78 mmHg, SpO2 89% on ambient air. Chest radiograph demonstrated dense right lower-lobe lobar consolidation, consistent with community-acquired pneumonia. Labs: WBC 15.2 \u00d710^3/\u00b5L with neutrophilia, BUN 28 mg/dL, creatinine 1.0 mg/dL. CURB-65 was 2 (age \u226565, urea >7 mmol/L), and he was admitted to the general medical ward. Empiric therapy was initiated with ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV q24h; supplemental oxygen via nasal cannula at 2 L/min and prn bronchodilators were provided. Sputum culture yielded Streptococcus pneumoniae susceptible to beta-lactams and macrolides; multiplex respiratory PCR was negative for influenza and SARS-CoV-2. At 48 hours he was afebrile with SpO2 94% on room air; therapy was de-escalated to amoxicillin 1 g PO TID to complete a 5-day total course. He received PCV20 prior to discharge.",
    "subclaim": "Initial antibiotics were intravenous ceftriaxone plus azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman with type 2 diabetes and hypertension presented with three days of fever, productive cough, and dyspnea. Vitals: T 38.3\u00b0C, HR 105, RR 24, SpO2 89% on room air, improving to 95% on 2 L nasal cannula. Lung exam revealed crackles at the right base. Chest radiograph demonstrated right lower lobe consolidation. Labs showed leukocytosis (WBC 14.2 K/\u00b5L) with normal lactate. SARS-CoV-2 PCR was negative; blood cultures had no growth at 48 hours; sputum culture pending. She was started on intravenous ceftriaxone plus azithromycin for community-acquired pneumonia. Oxygen was weaned off by hospital day 3 as her symptoms improved. She was transitioned to oral amoxicillin-clavulanate to complete a 5-day total course and discharged home.",
    "subclaim": "She required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old female with T2DM, hypertension, and a non\u2013IgE-mediated penicillin allergy (rash) presented after 3 days of fever, productive cough, and exertional dyspnea; she denied chest pain. On arrival: T 38.5\u00b0C, HR 110 bpm, RR 24/min, BP 128/76 mmHg, SpO2 90% on ambient air. Exam: inspiratory crackles over the right lower posterior lung field without wheezes; no peripheral edema. Labs: WBC 15.2 \u00d7 10^9/L (86% neutrophils), glucose 228 mg/dL, lactate 1.2 mmol/L, procalcitonin 0.8 ng/mL; BMP otherwise unremarkable. CXR showed dense right lower lobe lobar consolidation with air bronchograms. Respiratory viral PCR panel (influenza A/B, RSV, SARS-CoV-2) was negative; urine Streptococcus pneumoniae antigen was positive; blood cultures pending. She received supplemental O2 via nasal cannula at 2 L/min, increasing SpO2 to 95%. Empiric therapy with ceftriaxone 1 g IV q24h plus doxycycline 100 mg q12h was initiated. She was admitted for inpatient management due to hypoxemic community-acquired pneumonia.",
    "subclaim": "She was treated with azithromycin alone.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old female presented with three days of fever, productive cough, and dyspnea. Past medical history includes type 2 diabetes mellitus and CKD stage 3a; medication allergy: azithromycin (urticarial rash). On arrival: T 38.6\u00b0C, HR 104 bpm, BP 128/76 mmHg, RR 22/min, SpO2 90% on room air, improving to 95% on 2 L/min nasal cannula. Chest radiograph demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. Nasopharyngeal PCR for SARS-CoV-2 and influenza A/B was negative. Initial WBC was 14.2\u00d710^9/L and CRP 120 mg/L. She was admitted to the medical ward and started on IV ceftriaxone plus doxycycline. After 36\u201348 hours she defervesced and her oxygen requirement decreased; the plan was to transition to oral amoxicillin\u2013clavulanate and discharge within 24\u201348 hours.",
    "subclaim": "She was discharged from the emergency department the same day.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 65-year-old man had two days of fever, productive cough, pleuritic chest pain, and shortness of breath. On arrival, his temperature was 38.6\u00b0C and his oxygen saturation was 89% on room air. Chest examination revealed crackles at the right base. A chest X-ray showed right lower lobe consolidation consistent with community-acquired pneumonia. He reported a rash with amoxicillin in the past. He was started on intravenous levofloxacin and 2 L/min oxygen by nasal cannula. Nasopharyngeal PCR for influenza and SARS-CoV-2 was negative. Two sets of blood cultures drawn before antibiotics had no growth at 48 hours. By 48 hours, he was afebrile and maintaining 94% on room air. He was discharged on hospital day three with oral levofloxacin to complete a five-day total course.",
    "subclaim": "Sputum culture identified Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 55-year-old woman with longstanding type 2 diabetes presented with 48 hours of fever, dysuria, urinary frequency, and right costovertebral angle tenderness. Vitals: T 38.7\u00b0C, HR 104 bpm, BP 118/72 mmHg, SpO2 99% on room air. Labs showed leukocytosis to 15.2\u00d710^3/\u00b5L with neutrophil predominance and a normal basic metabolic panel (creatinine 1.0 mg/dL). Urinalysis demonstrated positive nitrites and leukocyte esterase with >50 WBC/HPF. Urine culture yielded >100,000 CFU/mL Escherichia coli susceptible to ceftriaxone and ciprofloxacin. Non-contrast CT abdomen/pelvis revealed no urolithiasis, no hydronephrosis, and no perinephric abscess. She was diagnosed with acute uncomplicated pyelonephritis and started on ceftriaxone 1 g IV q24h with intravenous fluids and antipyretics. After clinical improvement and defervescence within 24 hours, therapy was de-escalated to oral ciprofloxacin to complete a 10-day total course. Blood cultures showed no growth at 48 hours, and she was discharged on hospital day 2 with outpatient follow-up.",
    "subclaim": "She had a fever of 38.7\u00b0C on arrival.",
    "label": "supported"
  },
  {
    "medical_text": "A 54-year-old man came to the hospital with cough and fever for three days. He was short of breath and had chest pain when he breathed. The doctor heard crackles on the right. His oxygen level was 92% on room air. A chest X-ray showed an infection in the lower right lung. He has type 2 diabetes and no drug allergies, and he does not smoke. He got IV antibiotics and oxygen on a regular hospital floor. His white blood cell count was high. After two days, he felt better and his oxygen was 95% without extra oxygen. He went home with antibiotic pills for five more days and got a flu shot before leaving. Blood cultures were negative, and his mucus test showed a pneumonia germ that the antibiotics could kill.",
    "subclaim": "He was admitted to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "Mr. Lee is 68 years old and has lung disease (COPD). He had fever and a bad cough for two days. At the hospital, his oxygen was low at 90% on room air. A chest picture showed an infection in the right lower part of his lung. The team gave him oxygen through a small tube under his nose. He got antibiotics through a vein to treat the pneumonia. They said he has no drug allergies. After two days, he felt better and his oxygen was 95% without extra oxygen. Blood cultures from his arm showed no germs. He may go home soon on pills.",
    "subclaim": "He has a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 66-year-old male presented with exertional chest pressure lasting 45 minutes, not relieved by rest. History includes hypertension, type 2 diabetes, active smoking, and high LDL. ECG showed lateral ST depressions without ST elevation. High-sensitivity troponin rose from 120 to 460 ng/L. He was diagnosed with an NSTEMI. Treatment included chewable aspirin, ticagrelor loading, IV unfractionated heparin, metoprolol, and high-intensity atorvastatin. Transthoracic echocardiogram showed LVEF 55% with no regional wall-motion abnormalities. Next-morning coronary angiography revealed an 80% proximal LAD stenosis; a drug-eluting stent was placed with good flow. He was discharged on dual antiplatelet therapy, a beta-blocker, a statin, and medications for diabetes and blood pressure.",
    "subclaim": "He had an allergy to aspirin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes presented with 30 minutes of resting chest pressure. The ECG showed 1\u20132 mm ST-segment depressions in the inferior leads. High-sensitivity troponin levels were elevated and rising. The diagnosis was non\u2013ST elevation myocardial infarction (NSTEMI). Urgent coronary angiography revealed a critical proximal right coronary artery lesion. Percutaneous coronary intervention was performed with placement of a drug-eluting stent, restoring flow. He was started on aspirin, clopidogrel, high-intensity atorvastatin, and a beta-blocker. He was discharged with a plan for 12 months of dual antiplatelet therapy and early cardiology follow-up.",
    "subclaim": "The echocardiogram showed reduced ejection fraction.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with longstanding type 2 diabetes presented with a one-week right hallux plantar ulcer and fever. The ulcer was erythematous, warm, and purulent. Vital signs showed a temperature of 38.5 C. Labs revealed WBC 14,000/\u00b5L and elevated CRP, with HbA1c 9.2%. Foot radiograph showed no osteomyelitis. The wound was bedside debrided and offloaded, and his tetanus shot was updated. He was started on IV cefazolin and later transitioned to oral cephalexin. The wound swab grew methicillin-susceptible Staphylococcus aureus; MRSA screen was negative. Two sets of blood cultures had no growth at 48 hours. Glycemic control was optimized with basal-bolus insulin, and he was discharged on hospital day 3.",
    "subclaim": "A foot X-ray did not show bone infection.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man presented with 3 days of fever, productive cough, and dyspnea. On arrival, temperature was 38.5\u00b0C and oxygen saturation was 90% on room air. Lung exam revealed crackles at the right base. Chest radiograph showed right lower lobe consolidation, consistent with community-acquired pneumonia. Nasal cannula oxygen was started, and saturations improved. Empiric IV ceftriaxone plus azithromycin were administered after obtaining blood tests and blood cultures. SARS-CoV-2 PCR was negative. After 48 hours, he was clinically improved and maintained 95% saturation on room air. He was transitioned to oral antibiotics to complete a 5-day total course and was offered pneumococcal vaccination prior to discharge.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the emergency room with cough and fever. He was bringing up yellow mucus and felt short of breath. His temperature was 38.5\u00b0C and his oxygen level was 89% on room air. A chest X-ray showed a patch in the right lower lung. The team said he had pneumonia. He got IV antibiotics in the hospital and oxygen through a small tube in his nose. After two days, his breathing was better and his oxygen level was normal. He went home with antibiotic pills.",
    "subclaim": "He was admitted to the hospital.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old female with T2DM and HTN presented with 72 hours of fever, productive cough, pleuritic right-sided chest pain, and exertional dyspnea. On arrival: T 38.5\u00b0C, HR 96, BP 138/76, RR 24, SpO2 90% on room air. Pulmonary exam demonstrated decreased air entry with inspiratory crackles at the right base. Chest radiograph showed focal right lower lobe air-space consolidation without effusion. Laboratory data: WBC 14.2 \u00d7 10^3/\u00b5L with neutrophil predominance; serum lactate normal. Two peripheral blood culture sets were obtained prior to the first antibiotic dose; sputum was sent for Gram stain and culture. Empiric CAP therapy was initiated with IV ceftriaxone plus azithromycin; supplemental oxygen via nasal cannula was titrated to maintain SpO2 > 94%. Rapid influenza A/B NAAT was negative. She was admitted for IV therapy and observation. At 48 hours, she showed clinical improvement with reduced oxygen requirement and plans for transition to oral antibiotics.",
    "subclaim": "Two sets of blood cultures were drawn before antibiotics.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with no chronic lung disease presented with 72 hours of fever, productive purulent sputum, and exertional dyspnea. Vitals: T 38.5 C, HR 110 bpm, RR 24/min, BP 128/76 mmHg, SpO2 91% on ambient air. Pulmonary exam demonstrated focal crackles over the right lower lung field. Chest radiograph revealed lobar consolidation of the right lower lobe, establishing community-acquired pneumonia. He reported a non-anaphylactic penicillin allergy (rash). Oxygen via nasal cannula at 2 L/min raised SpO2 to 96%; levofloxacin 750 mg daily was initiated. Labs showed leukocytosis (WBC 14.2 x10^3/uL, neutrophil predominant) and elevated CRP. Legionella urinary antigen was negative; blood cultures showed no growth at 48 hours. With clinical improvement by hospital day 2, discharge was arranged on day 3 to complete a 5-day antibiotic course.",
    "subclaim": "Imaging showed bilateral infiltrates.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with poorly controlled type 2 DM and hypertension presented with a 2-week plantar ulcer beneath the left first metatarsal head. Exam showed a 2.5 cm ulcer probing to soft tissue with surrounding erythema (~2 cm), warmth, malodor, and purulent drainage; T 38.3 C, HR 102, BP 138/82. Laboratory evaluation revealed WBC 14.2 \u00d710^3/\u00b5L (neutrophil-predominant), CRP 120 mg/L, ESR 68 mm/h, glucose 220 mg/dL, creatinine 1.0 mg/dL. Plain radiography showed no gas, periosteal reaction, or cortical destruction. MRI with contrast demonstrated marrow edema and enhancement of the first metatarsal head contiguous with the ulcer tract, consistent with early osteomyelitis; no abscess was seen. Superficial wound culture grew MSSA; paired blood cultures were negative at 48 hours. Management included IV cefazolin 2 g q8h, bedside sharp debridement, offloading with a CAM boot, and optimization of glycemic control; tetanus immunization was current. No revascularization or amputation was indicated. Plan was to transition to oral cephalexin to complete a 6-week course if afebrile with improving inflammatory markers after 48 hours. By hospital day 2, fever resolved and local symptoms improved.",
    "subclaim": "MRI showed a drainable abscess.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old male presented with acute dyspnea and peripheral edema. Initial rhythm was new-onset atrial fibrillation with rapid ventricular response (~120 bpm). CXR demonstrated interstitial/alveolar edema; BNP was markedly elevated. Transthoracic echocardiography revealed HFrEF with LVEF 35% and a dilated left ventricle. Management included IV furosemide for diuresis and metoprolol tartrate for rate control. Systemic anticoagulation with apixaban 5 mg twice daily was started. Supplemental O2 at 2 L/min via nasal cannula was provided and discontinued as saturations normalized. Serum creatinine increased to 1.8 mg/dL (baseline 1.2); hypokalemia (K+ 3.2 mmol/L) was corrected. Following diuresis (net negative 1.5 L, 2 kg weight reduction), ventricular rate stabilized near 80 bpm with symptomatic improvement; ACE inhibitor deferred pending renal recovery.",
    "subclaim": "He went home the next day.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male with poorly controlled T2DM (HbA1c 9.2%) and CKD stage 3a presents with a two-week plantar ulcer beneath the right first metatarsal head, with erythema, warmth, and purulent drainage, and Tmax 38.3\u00b0C. Examination notes diminished dorsalis pedis pulses but intact capillary refill, and no crepitus. Initial labs: WBC 13.2\u00d710^9/L, CRP elevated, creatinine 1.8 mg/dL (eGFR ~42 mL/min/1.73 m^2). The wound undergoes sharp debridement and saline dressings with offloading. Empiric IV vancomycin is initiated; culture subsequently grows MRSA susceptible to doxycycline. Vancomycin is renally dose-adjusted and guided by trough targets of 10\u201315 mg/L. Plain films show no gas; MRI demonstrates no evidence of osteomyelitis. By hospital day 5, erythema and pain improve, afebrile. He is discharged on oral doxycycline to complete a 10-day total course, started on basal insulin glargine, and arranged podiatry follow-up.",
    "subclaim": "He required amputation of a toe.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 27-year-old male presented with 12 hours of right lower quadrant abdominal pain. He reported nausea with one episode of emesis and low-grade fever. Examination showed focal RLQ tenderness with mild guarding. Laboratory testing demonstrated leukocytosis (WBC 14,000/\u00b5L). CT of the abdomen and pelvis confirmed uncomplicated acute appendicitis. He received preoperative intravenous ceftriaxone and metronidazole. Laparoscopic appendectomy was performed without complications. He recovered well and was discharged on postoperative day 1.",
    "subclaim": "The patient reported a family history of appendicitis.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old female with type 2 diabetes presented with three days of productive cough, fever, and pleuritic chest pain. She reported shortness of breath. On arrival, vitals were T 38.6\u00b0C, HR 110, RR 28, BP 128/74, and SpO2 90% on room air. Chest radiograph demonstrated right lower lobe consolidation. Labs showed leukocytosis to 15,000/\u00b5L with neutrophil predominance and elevated C-reactive protein. She was diagnosed with community-acquired pneumonia. Treatment included supplemental oxygen via nasal cannula and intravenous ceftriaxone plus azithromycin after blood cultures were obtained. Sputum pneumococcal antigen was positive, while blood cultures remained negative at 48 hours. Her symptoms improved, and she was discharged after two days on oral amoxicillin\u2013clavulanate to complete therapy.",
    "subclaim": "She was treated with vancomycin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman with GOLD II COPD presented with 2 days of dyspnea and wheezing. On arrival, SpO2 was 88% on room air with a respiratory rate of 24/min and she was afebrile. Exam demonstrated diffuse expiratory wheezes without focal crackles. Chest radiograph showed no focal consolidation or pleural effusion. Nasopharyngeal PCR detected rhinovirus; WBC was 8.2 \u00d7 10^9/L and procalcitonin was 0.05 ng/mL. Venous blood gas revealed pH 7.36 and pCO2 52 mmHg, consistent with chronic hypercapnia during an acute COPD exacerbation. She received supplemental oxygen via nasal cannula, nebulized albuterol/ipratropium, and oral prednisone 40 mg daily. In the setting of a viral etiology and no radiographic pneumonia, antibiotics were withheld. Oxygenation improved to 94% on 2 L/min with symptomatic relief. She was discharged on a LABA/LAMA inhaler and a 5-day prednisone taper with outpatient pulmonology follow-up.",
    "subclaim": "Systemic steroids were given.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old female with HTN and CKD stage 3a presented with 7 days of progressive exertional dyspnea, orthopnea, and bilateral lower-extremity edema. She noted a 1 kg weight gain; denied chest pain, cough, fever, or infectious symptoms. BP 136/78 mmHg, HR 92 bpm, SpO2 94% on room air; JVP 10 cm H2O, bibasilar crackles, and 2+ pitting edema to the mid-shins were observed. CXR showed cardiomegaly and interstitial edema without lobar consolidation; ECG revealed sinus rhythm without ischemic changes; troponin was normal. NT-proBNP 2,400 pg/mL; serum creatinine 1.6 mg/dL (baseline 1.4), K+ 5.2 mmol/L, Na+ 138 mmol/L. Transthoracic echocardiography demonstrated LVEF ~30% with global hypokinesis and mild functional MR, consistent with HFrEF decompensation. She was treated with IV furosemide 40 mg twice with net negative 2 L and symptomatic improvement; transitioned to guideline-directed medical therapy including sacubitril/valsartan and carvedilol. Mineralocorticoid receptor antagonist therapy was withheld given hyperkalemia and CKD; she was counseled on 2 g sodium diet, daily weights, and cardiology follow-up within 1 week.",
    "subclaim": "Spironolactone was not started.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man came to the hospital with fever and cough. He had thick green mucus and sharp chest pain when he breathed. He has diabetes and lung disease (COPD). His oxygen level was low. A chest X-ray showed an infection in the right lower lung. A flu test was negative. He got IV antibiotics, ceftriaxone and azithromycin, and oxygen through a small tube in his nose at 2 liters per minute. Blood tests showed high white cells and high blood sugar. The sputum test later grew Streptococcus pneumoniae that should respond to ceftriaxone. After two days he felt better, the oxygen was stopped, and he went home on amoxicillin-clavulanate pills to finish five days total.",
    "subclaim": "Sputum culture identified Streptococcus pneumoniae.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old female with T2DM, hypertension, and a non\u2013IgE-mediated penicillin allergy (rash) presented after 3 days of fever, productive cough, and exertional dyspnea; she denied chest pain. On arrival: T 38.5\u00b0C, HR 110 bpm, RR 24/min, BP 128/76 mmHg, SpO2 90% on ambient air. Exam: inspiratory crackles over the right lower posterior lung field without wheezes; no peripheral edema. Labs: WBC 15.2 \u00d7 10^9/L (86% neutrophils), glucose 228 mg/dL, lactate 1.2 mmol/L, procalcitonin 0.8 ng/mL; BMP otherwise unremarkable. CXR showed dense right lower lobe lobar consolidation with air bronchograms. Respiratory viral PCR panel (influenza A/B, RSV, SARS-CoV-2) was negative; urine Streptococcus pneumoniae antigen was positive; blood cultures pending. She received supplemental O2 via nasal cannula at 2 L/min, increasing SpO2 to 95%. Empiric therapy with ceftriaxone 1 g IV q24h plus doxycycline 100 mg q12h was initiated. She was admitted for inpatient management due to hypoxemic community-acquired pneumonia.",
    "subclaim": "She had chest pain on arrival.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old female presented with 3 days of productive cough, fever, and dyspnea. She reported pleuritic chest discomfort with coughing. Chest radiograph showed right lower lobe consolidation. WBC was 14.2k with neutrophil predominance; serum creatinine was normal; glucose was 220 mg/dL in the setting of known type 2 diabetes. Oxygen via nasal cannula at 2 L/min maintained SpO2 above 92%. Empiric IV ceftriaxone plus azithromycin were started for community-acquired pneumonia. Sputum culture was pending; two sets of blood cultures had no growth at 48 hours. She reported no drug allergies. By hospital day 3 she was afebrile with improving oxygenation and transitioned to oral therapy. Discharge home with follow-up was planned.",
    "subclaim": "Vancomycin was part of her initial antibiotic regimen.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with poorly controlled T2DM (HbA1c 9.2%) presented with a 7-day right plantar hallux ulcer and subjective fevers. Examination revealed a 2 cm ulcer with purulent drainage and surrounding cellulitis; pedal pulses were intact and the ulcer did not probe to bone. Vitals were T 38.5 C, HR 102; WBC 14.2 K/\u00b5L, CRP 12 mg/dL; creatinine 0.9 mg/dL. Foot radiographs showed no bony erosion or periosteal reaction, and osteomyelitis was considered unlikely. Bedside sharp debridement was performed, an offloading boot was applied, and a tetanus booster was administered. Empiric IV cefazolin was initiated and transitioned to oral cephalexin after 48 hours as erythema receded. Superficial wound culture grew methicillin-susceptible Staphylococcus aureus; MRSA nasal swab was negative; no anaerobes were isolated. Two sets of peripheral blood cultures remained negative at 48 hours, with no evidence of bacteremia. His insulin regimen was adjusted to basal-bolus with correction scale, maintaining inpatient glucoses between 110 and 180 mg/dL. He was discharged home on day 3 with wound care follow-up.",
    "subclaim": "The ulcer was on the left heel.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man came to the emergency room with cough and fever. He was bringing up yellow mucus and felt short of breath. His temperature was 38.5\u00b0C and his oxygen level was 89% on room air. A chest X-ray showed a patch in the right lower lung. The team said he had pneumonia. He got IV antibiotics in the hospital and oxygen through a small tube in his nose. After two days, his breathing was better and his oxygen level was normal. He went home with antibiotic pills.",
    "subclaim": "He is a current smoker.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 42-year-old woman came to the hospital with fever, chills, and pain in her right lower back. She had burning when she peed. The team said she had a kidney infection. Her urine test showed germs, and later the lab found E. coli. She got fluids in a vein and IV antibiotics. She also got pain medicine. An ultrasound of her kidneys showed no block or stones. She felt better after two days, switched to pills, and went home on day three with 10 days of antibiotics.",
    "subclaim": "The urine culture grew E. coli.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man with COPD and hypertension presented after three days of fever, productive cough, and dyspnea. He denied chest pain and hemoptysis. On arrival, temperature was 38.6 C, respiratory rate 24, and oxygen saturation 89% on room air. Lung exam revealed crackles at the right base. Chest radiograph showed right lower lobe consolidation consistent with community-acquired pneumonia. Sputum testing identified Streptococcus pneumoniae; Legionella urine antigen was negative. He received supplemental oxygen by nasal cannula and intravenous ceftriaxone plus azithromycin. Over 48 hours he became afebrile and maintained 95% oxygen saturation on room air. He was transitioned to oral antibiotics to complete a 7-day total course and discharged.",
    "subclaim": "He required intensive care unit admission.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old man came to the hospital with cough and fever. He also felt short of breath. His oxygen level was low at 89% on room air. A chest x-ray showed a spot in the right lower lung. The doctor said he had a lung infection from the community. He got oxygen through a small tube in his nose. He started IV antibiotics: ceftriaxone and azithromycin. Tests for flu and COVID were negative. Blood cultures were taken before the medicines. He was admitted to a regular ward, not the ICU.",
    "subclaim": "A pleural effusion was present on the chest x-ray.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man presented with three days of fever, productive cough, and dyspnea. On arrival, oxygen saturation was 90% on room air, temperature 38.3\u00b0C, heart rate 102, and respiratory rate 24. Chest radiograph demonstrated right lower lobe consolidation consistent with community-acquired pneumonia. Blood cultures were obtained prior to starting antibiotics. He was started on supplemental oxygen via nasal cannula and given intravenous ceftriaxone plus azithromycin. A nasopharyngeal PCR for SARS-CoV-2 was negative. Over 48 hours, his oxygenation and fevers improved. He was discharged on oral azithromycin to complete a 5-day course, with follow-up arranged in one week.",
    "subclaim": "The patient has a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the ER with chest pain at rest. It lasted about 45 minutes and he felt sick and sweaty. The heart tracing showed small ST drops, and his troponin blood test was high. The team said he had a heart attack called NSTEMI. He got aspirin, another platelet blocker, heparin, pain medicine, and a strong statin. He had a dye test of his heart arteries. They found a very tight blockage in the main front artery (LAD) and put in a drug-coated stent. His kidney function was a bit low, so metformin was stopped for 2 days after the dye. An ultrasound showed the heart pump was about 45% and he stayed stable with no fever. He went home on aspirin and ticagrelor, a statin, a beta blocker, and an ACE inhibitor, and was sent to cardiac rehab.",
    "subclaim": "A drug-eluting stent was placed in the proximal LAD.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came in with cough and fever. He felt short of breath and had pain on the right when he breathed. His oxygen level was low at 91 percent. An x-ray showed a patch in the right lower lung. The doctor said he had a lung infection from the community. He got oxygen by a small tube in his nose. He was given two antibiotics in a vein: ceftriaxone and azithromycin. Blood cultures were taken before the drugs. He had no drug allergies, and was told to drink more water and use a breathing tool. After one day he felt better, went home on pills to finish five days, and would see his doctor in two days.",
    "subclaim": "He was told to drink more water.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman has long-term lung disease called COPD. She came to the hospital with short breath and cough for two days. She had wheezing and chest tightness. Her oxygen level was 88% on room air. A nose swab found a cold virus called rhinovirus. The chest X-ray did not show pneumonia. She got oxygen by a small tube in her nose. She also got breathing treatments and steroid pills. No antibiotics were given. Her breathing improved to 94% oxygen, and she went home with inhalers and a short steroid taper.",
    "subclaim": "The chest X-ray showed no pneumonia.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman presented with a 3-day history of fever, purulent cough, and exertional dyspnea. Triage vitals: 38.5\u00b0C, HR 104 bpm, RR 24/min, BP 128/76 mmHg, SpO2 90% on ambient air. Pulmonary exam revealed right basilar crackles without wheeze. Chest radiograph showed a focal right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Laboratory data demonstrated leukocytosis (WBC 15.0 x10^3/\u00b5L) with neutrophil predominance and CRP 120 mg/L. Two sets of blood cultures were obtained prior to antibiotics; she received supplemental oxygen via nasal cannula and empiric IV ceftriaxone plus azithromycin. She was managed on the general medical ward; no ICU-level support was required. Within 48 hours she defervesced, oxygenation normalized to SpO2 95% on room air, and inflammatory markers down-trended. She was transitioned to oral azithromycin to complete an additional 5 days of therapy and discharged with follow-up in one week.",
    "subclaim": "She received intravenous ceftriaxone plus azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male with poorly controlled T2DM (HbA1c 9.2%) and CKD stage 3a presents with a two-week plantar ulcer beneath the right first metatarsal head, with erythema, warmth, and purulent drainage, and Tmax 38.3\u00b0C. Examination notes diminished dorsalis pedis pulses but intact capillary refill, and no crepitus. Initial labs: WBC 13.2\u00d710^9/L, CRP elevated, creatinine 1.8 mg/dL (eGFR ~42 mL/min/1.73 m^2). The wound undergoes sharp debridement and saline dressings with offloading. Empiric IV vancomycin is initiated; culture subsequently grows MRSA susceptible to doxycycline. Vancomycin is renally dose-adjusted and guided by trough targets of 10\u201315 mg/L. Plain films show no gas; MRI demonstrates no evidence of osteomyelitis. By hospital day 5, erythema and pain improve, afebrile. He is discharged on oral doxycycline to complete a 10-day total course, started on basal insulin glargine, and arranged podiatry follow-up.",
    "subclaim": "The ulcer was on the left foot.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old woman presented with two days of fever, dysuria, and right flank pain. Vitals showed temperature 38.5 C, heart rate 110, blood pressure 118/72. She had right costovertebral angle tenderness on exam. Urinalysis was positive for leukocyte esterase and nitrites with pyuria. CBC showed leukocytosis to 14,000; creatinine was 1.0 mg/dL. She received IV fluids and empiric ceftriaxone for presumed acute pyelonephritis. Renal ultrasound showed no hydronephrosis or renal calculi. Urine culture grew Escherichia coli susceptible to ceftriaxone and ciprofloxacin; blood cultures remained negative. After 48 hours she defervesced and symptoms improved. She was transitioned to oral ciprofloxacin to complete a 7-day total antibiotic course.",
    "subclaim": "Kidney ultrasound showed no stones.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital from home with fever, cough with yellow mucus, and trouble breathing. He had been sick for three days. His oxygen level was low at 88%, but it went up to 95% after 2 liters of oxygen by a small nose tube. A chest x-ray showed pneumonia in the right lower lung. Doctors started IV antibiotics: ceftriaxone and azithromycin. He has no allergy to penicillin drugs. His white blood cell count was high, and blood cultures did not grow germs after two days. He felt better by day two and changed to antibiotic pills to finish treatment. He got a flu shot last season, but he has not had a pneumonia shot.",
    "subclaim": "He is a current smoker.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old male with hypertension and type 2 diabetes presented with 3 days of fever, productive cough, and exertional dyspnea. He was febrile (38.6\u00b0C), tachycardic (110 bpm), tachypneic (24/min), and hypoxemic with SpO2 91% on ambient air. Chest radiography demonstrated a focal right lower lobe air-space consolidation consistent with community-acquired pneumonia. Laboratory evaluation showed neutrophilic leukocytosis (WBC 15.5 \u00d710^3/\u00b5L) and elevated CRP. Microbiologic testing revealed a positive urine Streptococcus pneumoniae antigen; multiplex respiratory viral PCR for influenza A/B and SARS-CoV-2 was negative. Empiric therapy with ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily was initiated along with 2 L/min nasal cannula oxygen; there were no known drug allergies. Two sets of blood cultures had no growth at 48 hours, and the patient defervesced with improving oxygenation, allowing weaning to room air with SpO2 95%. He was stepped down to oral amoxicillin\u2013clavulanate to complete a 7-day course and discharged in stable condition.",
    "subclaim": "He required intensive care unit admission.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old male with COPD and a long smoking history presents with three days of productive cough, pleuritic chest pain, and fever. On arrival his vital signs are T 38.4\u00b0C, HR 108, BP 128/74, RR 24, and SpO2 89% on room air. Lung exam shows rales at the right base and increased work of breathing. Chest radiograph demonstrates a right lower lobe consolidation. Labs reveal WBC 14.5 K/\u00b5L with neutrophil predominance and elevated CRP. He is started on IV ceftriaxone plus azithromycin and 2 L/min oxygen via nasal cannula. He has no history of beta-lactam allergy, and renal function is normal. Two sets of blood cultures remain negative at 48 hours, and the sputum Gram stain shows mixed flora without a dominant pathogen. He improves clinically with defervescence and better oxygenation within 48 hours. He is discharged on oral amoxicillin-clavulanate to complete a seven-day course.",
    "subclaim": "The chest X-ray showed a left upper lobe infiltrate.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old female with T2DM and essential hypertension presented with 24 hours of right lower extremity erythema, warmth, and tenderness with Tmax 38.5 C and chills. The involved area extended from the ankle to mid-calf with indistinct borders; no fluctuance, crepitus, bullae, or purulent drainage were noted. Leukocytosis was 14.2 x10^9/L, CRP 98 mg/L; lactate was normal and creatinine 0.9 mg/dL. Compression venous duplex demonstrated compressible veins without intraluminal thrombus, effectively excluding DVT. Clinical impression was nonpurulent cellulitis, likely beta-hemolytic streptococcus; necrotizing infection was deemed unlikely. Empiric IV cefazolin 2 g q8h was initiated; vancomycin was deferred given low MRSA risk and a documented sulfonamide allergy. Within 24 hours, erythema demarcated and pain improved; no hemodynamic instability occurred. Two sets of blood cultures remained negative at 48 hours. On hospital day 2, therapy was de-escalated to oral cephalexin 500 mg q6h for 5 additional days, and the patient was discharged with return precautions.",
    "subclaim": "An abscess was drained.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the ER with heavy chest pressure that went to his left arm. He felt sick to his stomach and was sweaty. He has high blood pressure, diabetes, and he smokes. His blood pressure was high and his pulse was fast, but his oxygen level was 98%, so he did not get oxygen. A heart tracing showed changes that worried the doctors. A blood test for heart damage was high. He was given chewable aspirin, a blood thinner shot, a strong cholesterol pill, and a pill to slow his heart. An X-ray of his chest looked normal. Doctors found a blocked heart artery and opened it with a stent. He went home on two anti-clot pills, a statin, and blood pressure medicine.",
    "subclaim": "Supplemental oxygen was not given.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old female with T2DM and HTN presented after three days of fever, productive cough, and exertional dyspnea consistent with community-acquired pneumonia. On arrival: T 38.3\u00b0C, HR 105 bpm, RR 24/min, SpO2 89% on room air, increasing to 95% on 2 L/min nasal cannula. Pulmonary exam noted right basilar crackles; no wheeze; hemodynamically stable; lactate 1.4 mmol/L. Chest radiograph demonstrated focal consolidation in the right lower lobe without effusion. Laboratory studies showed WBC 14.2 \u00d7 10^9/L with neutrophil predominance and normal creatinine; procalcitonin was 0.6 ng/mL. SARS-CoV-2 nucleic-acid testing was negative; two sets of blood cultures remained negative at 48 hours; sputum culture pending. Empiric therapy was initiated with intravenous ceftriaxone plus azithromycin; venous thromboembolism prophylaxis was provided; no reported beta-lactam allergy. Clinical status improved; supplemental oxygen was discontinued by hospital day 3. She was transitioned to oral amoxicillin\u2013clavulanate to complete a 5-day course and discharged with outpatient follow-up.",
    "subclaim": "Blood cultures showed no growth at 48 hours.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man presented from the community with 72 hours of fever, purulent sputum, and exertional dyspnea. Vitals: T 38.3\u00b0C, HR 102 bpm, BP 132/76 mmHg, RR 22/min; SpO2 88% on room air, rising to 95% on 2 L/min via nasal cannula. Chest radiography demonstrated a focal right lower lobe air-space opacity consistent with lobar consolidation. Impression: community-acquired pneumonia with mild hypoxemic respiratory failure; CURB-65 = 1 (age criterion). Laboratory data: WBC 15.2 \u00d710^9/L with neutrophilia; lactate 1.6 mmol/L; procalcitonin 0.4 ng/mL. No history of beta-lactam hypersensitivity; empiric IV ceftriaxone plus azithromycin were administered after obtaining two peripheral blood culture sets. Blood cultures showed no growth at 48 hours. Clinical status improved by hospital day 2; therapy was de-escalated to oral amoxicillin\u2013clavulanate to complete a 5-day total course. Immunizations: influenza vaccine documented last season; pneumococcal vaccination not previously administered.",
    "subclaim": "The chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman came to the hospital with cough, fever, and trouble breathing for two days. Her oxygen level was 90% on room air. The doctor heard crackles on the right side of her chest. A chest X-ray showed an infection in the right lower lung. The flu test was negative. Her white blood cell count was high. She has COPD and high blood pressure, and no allergies to medicines. She was given oxygen by a small tube in her nose. She got IV ceftriaxone and azithromycin for pneumonia caught in the community. After two days she felt better, and on day three she kept 95% on room air and went home with antibiotic pills.",
    "subclaim": "She required mechanical ventilation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man came to the hospital with cough, fever, and trouble breathing for three days. His temperature was 38.5 C, and his oxygen level was 90% on room air. The doctor heard crackles on the right side. A chest X-ray showed an infection in the right lower lung. A nose swab for flu was negative. His white blood cell count was high. He got two antibiotics through a vein. He also got oxygen through a small tube in his nose. He felt better after two days and went home with pills to finish a 5-day course. He has no drug allergies.",
    "subclaim": "The SARS-CoV-2 PCR test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old woman came to the hospital with cough, fever, and trouble breathing. Her oxygen level was low at 90% in room air. A chest x-ray showed a spot in the right lower lung. Tests for COVID-19 and flu were negative. The team started IV antibiotics, ceftriaxone and azithromycin. Her fever and breathing got better after two days. She did not have any drug allergies. She no longer needed oxygen and kept 96% on room air. Blood cultures did not grow germs. She went home on amoxicillin-clavulanate to finish five days of treatment.",
    "subclaim": "She required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman with type 2 diabetes and hypertension presented with three days of fever, productive cough, and dyspnea. Vitals: T 38.3\u00b0C, HR 105, RR 24, SpO2 89% on room air, improving to 95% on 2 L nasal cannula. Lung exam revealed crackles at the right base. Chest radiograph demonstrated right lower lobe consolidation. Labs showed leukocytosis (WBC 14.2 K/\u00b5L) with normal lactate. SARS-CoV-2 PCR was negative; blood cultures had no growth at 48 hours; sputum culture pending. She was started on intravenous ceftriaxone plus azithromycin for community-acquired pneumonia. Oxygen was weaned off by hospital day 3 as her symptoms improved. She was transitioned to oral amoxicillin-clavulanate to complete a 5-day total course and discharged home.",
    "subclaim": "She was treated with oseltamivir.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man presented with three days of fever, productive cough, and dyspnea. On arrival, oxygen saturation was 90% on room air, temperature 38.3\u00b0C, heart rate 102, and respiratory rate 24. Chest radiograph demonstrated right lower lobe consolidation consistent with community-acquired pneumonia. Blood cultures were obtained prior to starting antibiotics. He was started on supplemental oxygen via nasal cannula and given intravenous ceftriaxone plus azithromycin. A nasopharyngeal PCR for SARS-CoV-2 was negative. Over 48 hours, his oxygenation and fevers improved. He was discharged on oral azithromycin to complete a 5-day course, with follow-up arranged in one week.",
    "subclaim": "He was treated with systemic corticosteroids.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with type 2 diabetes and hypertension presented with a two-week plantar left foot ulcer. Surrounding erythema, warmth, and malodor were noted, and he was febrile to 38.3 C with tachycardia. Labs showed leukocytosis (WBC 14K/\u00b5L), elevated CRP (120 mg/L), hyperglycemia (glucose 220 mg/dL), and normal creatinine. Plain radiograph showed no subcutaneous gas or bony erosions. MRI demonstrated marrow edema of the first metatarsal head consistent with early osteomyelitis contiguous with the ulcer. Wound swab culture grew methicillin-sensitive Staphylococcus aureus; blood cultures remained negative. He received IV cefazolin and bedside debridement by podiatry, along with offloading in a boot. The team planned transition to oral cephalexin after 48 hours of clinical improvement and ongoing wound care. Glycemic control was intensified; no surgical amputation was required. After two days, his fever resolved and pain decreased.",
    "subclaim": "He received intravenous cefazolin.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man presented with three days of fever, productive cough, and dyspnea. On arrival, oxygen saturation was 90% on room air, temperature 38.3\u00b0C, heart rate 102, and respiratory rate 24. Chest radiograph demonstrated right lower lobe consolidation consistent with community-acquired pneumonia. Blood cultures were obtained prior to starting antibiotics. He was started on supplemental oxygen via nasal cannula and given intravenous ceftriaxone plus azithromycin. A nasopharyngeal PCR for SARS-CoV-2 was negative. Over 48 hours, his oxygenation and fevers improved. He was discharged on oral azithromycin to complete a 5-day course, with follow-up arranged in one week.",
    "subclaim": "Chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman with COPD presented after two days of worsening shortness of breath and cough. She denied fever. Vitals showed an oxygen saturation of 88% on room air and mild tachypnea. On exam, there were diffuse wheezes without focal crackles. Chest X-ray showed no focal consolidation to suggest pneumonia. A respiratory viral panel was positive for rhinovirus, and her white blood cell count was within normal limits. She was started on supplemental oxygen, nebulized albuterol/ipratropium, and oral prednisone. Because the findings suggested a viral exacerbation, antibiotics were not started. Her oxygen improved to 94% on low-flow oxygen, and her symptoms eased. She was discharged with a long-acting bronchodilator inhaler and a short steroid taper.",
    "subclaim": "Systemic steroids were given.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came in with cough and fever for three days. He felt short of breath and had chest pain when he breathed. He had chills at night. His oxygen level was 90% on room air. The doctor heard crackles on the right side of his chest. A chest x-ray showed a lung infection in the right lower lobe. Flu and COVID tests were negative. He was given oxygen by a small tube in the nose and started on IV antibiotics, ceftriaxone and azithromycin. He has no drug allergies and takes medicine for high blood pressure. After two days he felt better, and his oxygen was 95% without extra oxygen.",
    "subclaim": "He was discharged the same day he arrived.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man with type 2 diabetes, hypertension, and stage 3 chronic kidney disease presented with progressive dyspnea on exertion and bilateral leg edema. On exam he had bibasilar crackles, elevated jugular venous pressure, and 2+ pitting edema. Chest X-ray showed cardiomegaly with interstitial pulmonary edema. Labs revealed BNP 1800 pg/mL and creatinine 1.8 mg/dL (baseline 1.5); troponin was negative. ECG demonstrated sinus tachycardia without ischemic changes. Transthoracic echocardiogram showed a left ventricular ejection fraction around 35% with global hypokinesis. The impression was acute decompensated heart failure with reduced ejection fraction and volume overload. He was treated with IV furosemide and a 1.5 L/day fluid restriction. His ACE inhibitor and beta-blocker were continued, and metformin was held. He improved with diuresis and was discharged on a low-sodium diet with cardiology follow-up.",
    "subclaim": "He was treated with antibiotics.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man came to the ER with cough and fever. He felt short of breath for three days. He has COPD and high blood pressure. He has no penicillin allergy. His oxygen level was 90% on room air. A chest X-ray showed pneumonia in the right lower lung. He got oxygen by nasal prongs, and his level rose to 95%. He was given IV ceftriaxone and azithromycin. Flu and COVID tests were negative. The doctor planned a total five-day course of antibiotics.",
    "subclaim": "His oxygen saturation was 90% on room air at presentation.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the hospital with cough and fever. He felt short of breath. He does not have any drug allergies. His oxygen level was 89% on room air. A chest X-ray showed pneumonia in the lower right lung. The team gave him oxygen through a small tube under the nose. He got IV antibiotics, ceftriaxone and azithromycin. A spit test grew strep pneumonia bacteria. The COVID test was negative. After three days he felt better and went home on amoxicillin-clavulanate pills.",
    "subclaim": "He has a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 70-year-old man came to the hospital. He had fever and a wet cough. He felt short of breath. His oxygen level was 89% in room air. A chest x-ray showed a spot in the right lower lung. The team said he had pneumonia. He got oxygen by a small nose tube. He was given two antibiotics, ceftriaxone and azithromycin. His COVID-19 test was negative. After two days he felt better and went home on day three with pills.",
    "subclaim": "He was given oxygen via a nasal cannula.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old male with no known immunosuppression presented with 3 days of productive cough, fever, and exertional dyspnea. Vitals: T 38.5 C, HR 102, RR 24, BP 128/76, SpO2 90% on room air. Pulmonary exam revealed right basilar crackles; no wheezes. Chest radiograph showed a focal right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Labs: WBC 15.0 x10^3/\u00b5L with neutrophil predominance; basic metabolic panel unremarkable. Empiric therapy initiated with ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily; supplemental oxygen via nasal cannula at 2 L/min for hypoxemia. Diagnostics: rapid influenza A/B negative, Legionella urine antigen negative; paired blood cultures remained without growth at 48 hours. By hospital day 2, the patient demonstrated clinical improvement with resolution of hypoxemia, oxygen discontinued; plan made to transition to oral amoxicillin-clavulanate to complete a 5-day total antimicrobial course.",
    "subclaim": "The patient was admitted to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman came to the emergency room with fever and cough. She felt short of breath. She has COPD and high blood pressure. Her temperature was 101.3\u00b0F. Her oxygen level was 90% on room air. A chest X-ray showed a right lower lung infection. Her white blood cell count was high. The team gave oxygen by a small nose tube and IV antibiotics. Blood and sputum tests were sent before the first dose. After a day, she was breathing easier and had no fever.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old woman with hypertension and mild asthma presented with 3 days of productive cough, dyspnea, and fever. Vitals showed T 38.6\u00b0C, HR 108, SpO2 90% on room air, improving to 95% on 2 L nasal cannula. Chest radiograph demonstrated a right lower lobe consolidation. SARS-CoV-2 and influenza A/B PCR were negative. WBC was 14,200/\u00b5L with neutrophil predominance; CRP elevated. She received IV ceftriaxone plus azithromycin for community-acquired pneumonia. Pneumococcal urine antigen was positive; blood cultures had no growth. Over 48 hours, fevers resolved and oxygen was weaned off with SpO2 96% on room air. She had no known drug allergies. She was discharged on oral amoxicillin-clavulanate to complete a 5-day course.",
    "subclaim": "A pleural effusion was present on imaging.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman with type 2 diabetes and hypertension presented with one day of painful erythema and edema of the right calf and a fever to 38.5 C. Exam showed warm, tender skin without fluctuance or purulence. WBC was 14,200/\u00b5L and CRP was elevated. Venous duplex of the right leg showed no evidence of deep vein thrombosis. The diagnosis was nonpurulent cellulitis, likely streptococcal. She received IV cefazolin and had improvement in erythema after 24 hours. She has a sulfonamide allergy, so trimethoprim-sulfamethoxazole was avoided. Blood cultures remained negative at 48 hours. She was transitioned to oral cephalexin and discharged on hospital day 2.",
    "subclaim": "An ultrasound found no blood clot in the leg.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old male with hypertension and type 2 diabetes presents with acute dyspnea and bilateral lower-extremity edema. Vitals: HR 132 irregularly irregular, BP 118/72, RR 24, SpO2 89% on room air. ECG shows atrial fibrillation with rapid ventricular response and no ST-segment elevation. Chest radiograph reveals interstitial and alveolar edema with mild cardiomegaly. Labs: BNP 1200 pg/mL; creatinine 1.5 mg/dL (baseline 1.2); troponin I 0.03 ng/mL without dynamic rise. He received oxygen via nasal cannula and IV furosemide 40 mg with brisk diuresis. Intravenous diltiazem was administered for rate control. Apixaban was initiated for stroke prophylaxis in atrial fibrillation. Working diagnosis: acute decompensated heart failure precipitated by AF with RVR.",
    "subclaim": "He has a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old male with 3 days of productive cough, pleuritic right-sided chest pain, fever/chills, and exertional dyspnea presented to the emergency department. On arrival: temperature 38.5 C, heart rate 96, respiratory rate 22, blood pressure 132/76, oxygen saturation 90% on ambient air. Pulmonary exam noted inspiratory crackles at the right base; chest radiograph demonstrated right lower lobe airspace consolidation with air bronchograms. Laboratory data: WBC 15.2 x10^9/L (85% neutrophils), elevated CRP, procalcitonin 0.8 ng/mL; creatinine within normal limits. Microbiology: rapid influenza antigen negative; SARS-CoV-2 PCR negative; urine pneumococcal antigen positive; two sets of blood cultures remained sterile at 48 hours. Assessment: community-acquired pneumonia causing acute hypoxemic respiratory failure, hemodynamically stable. Management: ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily; supplemental oxygen via nasal cannula (2 L/min) targeting SpO2 92\u201396%. Care was delivered on a general medical ward; no ICU-level interventions were required. By 48 hours he showed clinical improvement; oxygen was discontinued, and therapy was de-escalated to oral amoxicillin-clavulanate to complete a 5-day total antibiotic course; azithromycin was stopped after 3 days. He was discharged with outpatient follow-up within one week.",
    "subclaim": "The SARS-CoV-2 PCR test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man with type 2 diabetes and hypertension presented with 3 days of fever, productive cough, and shortness of breath. On arrival, his oxygen saturation was 90% on room air and improved with 2 L/min via nasal cannula. Chest radiograph demonstrated a right lower lobe consolidation. Laboratory studies showed leukocytosis and elevated C-reactive protein. SARS-CoV-2 PCR was negative. He received intravenous ceftriaxone plus azithromycin and clinical status improved over 48 hours. Sputum Gram stain suggested pneumococcus; blood cultures remained negative at 48 hours. He was transitioned to oral amoxicillin-clavulanate to complete a 5-day total antibacterial course and discharged home. There was no record of prior pneumococcal vaccination.",
    "subclaim": "He was admitted to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old male presented with 48 hours of fever, purulent yellow sputum, and dyspnea. Initial vitals: T 38.5\u00b0C, RR 24/min, SpO2 89% on ambient air. Laboratory testing revealed WBC 14.2\u00d710^9/L and CRP 120 mg/L. Chest radiography demonstrated right lower lobe air-space consolidation consistent with lobar pneumonia. He was admitted with community-acquired pneumonia (PSI class III). Empiric therapy was ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily, with supplemental oxygen via nasal cannula. Blood cultures remained negative at 48 hours, while sputum culture yielded Streptococcus pneumoniae susceptible to beta-lactams. Within 48 hours, hypoxemia resolved and respiratory symptoms improved. He was discharged on an oral antibiotic regimen.",
    "subclaim": "He received intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with poorly controlled type 2 diabetes presented with a right forefoot ulcer and surrounding cellulitis. He reported decreased sensation in the toes, consistent with peripheral neuropathy. Vitals showed fever to 38.2 C, and labs included an A1c of 9.2%. Empiric IV vancomycin plus piperacillin-tazobactam were started after obtaining a wound swab and blood cultures. Foot radiographs showed no gas and no osteomyelitis. The wound culture later grew methicillin-susceptible Staphylococcus aureus (MSSA), while blood cultures remained negative. Antibiotics were narrowed to IV cefazolin. Vascular assessment showed adequate perfusion. With improvement, he was discharged on oral cephalexin to complete a 7-day course.",
    "subclaim": "He was discharged on oral cephalexin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman with a history of type 2 diabetes mellitus presented with 72 hours of fever, productive cough, pleuritic chest pain, and dyspnea. Initial vitals: T 38.6\u00b0C, HR 110 bpm, RR 28/min, BP 128/74 mmHg, SpO2 90% on ambient air. Examination revealed tachypnea with crackles over the right lung base. Laboratory studies showed leukocytosis (WBC 15.0 \u00d710^3/\u00b5L, neutrophil predominant), CRP elevated, and procalcitonin mildly elevated. Posteroanterior chest radiograph demonstrated a focal right lower lobe air-space consolidation consistent with acute pneumonia. Working diagnosis was community-acquired pneumococcal pneumonia. She received supplemental oxygen via nasal cannula and empiric intravenous ceftriaxone plus azithromycin following pre-antibiotic blood cultures. Sputum Streptococcus pneumoniae antigen was positive; blood cultures showed no growth at 48 hours. With clinical improvement, she was transitioned to oral amoxicillin\u2013clavulanate and discharged home on hospital day two.",
    "subclaim": "She received oxygen via a nasal cannula.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with fever and cough. He had trouble breathing and thick green mucus. His oxygen level was low at 91% on room air. A chest X-ray showed a spot in the right lower lung. The doctor said he had pneumonia from the community. He is allergic to penicillin; it causes a rash. He got oxygen through a small nose tube and it went up to 96%. He started the antibiotic levofloxacin. After two days, his fever fell and blood cultures showed no growth. He was getting ready to go home with pills to finish five days.",
    "subclaim": "Imaging showed bilateral infiltrates.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 42-year-old woman with poorly controlled type 2 diabetes mellitus presented with 48 hours of fever, dysuria, and right costovertebral angle tenderness. On exam she was febrile to 38.6\u00b0C and tachycardic at 108 bpm; blood pressure was 112/70. Initial labs revealed leukocytosis and a urinalysis with pyuria, positive nitrites, and bacteriuria. Urine culture grew >10^5 CFU/mL of pan-sensitive Escherichia coli; paired blood cultures had no growth at 48 hours. The working diagnosis was acute uncomplicated pyelonephritis. She was treated with intravenous ceftriaxone 1 g every 24 hours and isotonic IV fluids. Renal ultrasonography showed no hydronephrosis or nephrolithiasis. With clinical improvement by 48 hours, she was stepped down to oral ciprofloxacin 500 mg twice daily to complete a 10-day total course and was discharged on hospital day 3.",
    "subclaim": "She was treated with systemic corticosteroids.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 39-year-old female with a history of nephrolithiasis presented with 48 hours of febrile left flank pain, dysuria, and nausea. On arrival: T 39.1 C, HR 108, BP 102/64; she was ill-appearing but not toxic. Labs: WBC 16.2 x10^9/L, creatinine 1.8 mg/dL (baseline 1.0), lactate 1.8 mmol/L; UA positive for nitrites and leukocyte esterase. Renal ultrasound showed mild left hydronephrosis secondary to a 7 mm proximal left ureteral obstructing calculus. Diagnosis: acute obstructive pyelonephritis with AKI. Management: IV crystalloid resuscitation and empiric ceftriaxone. Urology achieved source control via urgent left ureteral stent placement. Defervescence occurred within 48 hours, flank pain abated, and creatinine improved toward baseline. Urine culture grew pan-sensitive Escherichia coli; blood cultures remained negative. She was discharged on oral antibiotics to complete a 10-day course with plan for interval stone definitive therapy.",
    "subclaim": "A ureteral stent was placed to decompress the kidney.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male with poorly controlled type 2 diabetes mellitus (HbA1c 9.2%) presented with 48 hours of progressive left lower extremity erythema, warmth, and tenderness following a superficial laceration. On arrival he was febrile to 38.5\u00b0C and tachycardic at 102 bpm, with stable blood pressure and no organ dysfunction. Laboratory evaluation revealed leukocytosis (WBC 14.8 \u00d710^9/L) and elevated C-reactive protein; serum creatinine was 0.9 mg/dL. Point-of-care soft-tissue ultrasound demonstrated subcutaneous cobblestoning consistent with cellulitis without a drainable collection. Two sets of peripheral blood cultures were drawn and showed no growth at 48 hours. He was initiated on intravenous cefazolin 2 g every 8 hours for nonpurulent cellulitis, given absence of beta-lactam allergy and low MRSA risk. MRSA nares PCR screening returned negative. With clinical improvement and defervescence within 48 hours, therapy was de-escalated to oral cephalexin 500 mg every 6 hours to complete a 5-day total antibiotic course. He was discharged with wound care instructions and received a tetanus-diphtheria booster prior to discharge.",
    "subclaim": "Blood cultures grew Staphylococcus aureus.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man has had cough and fever for three days. He feels short of breath and has chest pain when he breathes. His temperature is 38.5 C and he breathes fast. His oxygen level is 92% on room air. He has high blood pressure and no drug allergies. A chest x-ray shows a new spot in the right lower lung, with no fluid. A nose swab test for COVID is negative. The doctor says he has community pneumonia and treats him at home. He gets mouth pills: amoxicillin-clavulanate and azithromycin. After two days, his fever goes down and oxygen is 95%.",
    "subclaim": "He received amoxicillin-clavulanate plus azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man presented with 3 days of productive cough, fever, and dyspnea. Vitals: temperature 38.5 C, respiratory rate 22, oxygen saturation 90% on room air, blood pressure 132/76. Exam revealed crackles at the right base; chest radiograph showed right lower lobe consolidation. Labs: white blood cell count 15,000 with neutrophilia; creatinine normal; procalcitonin elevated. Rapid influenza test was negative; urine Streptococcus pneumoniae antigen was positive. He was diagnosed with community-acquired pneumonia and hypoxemia. Treatment was ceftriaxone plus azithromycin given intravenously and oxygen via nasal cannula at 2 L/min. Blood cultures showed no growth at 48 hours. He improved by hospital day 2, was weaned to room air, and was transitioned to oral amoxicillin-clavulanate to complete a 5-day total course. He was managed on a general medical ward and discharged with follow-up.",
    "subclaim": "The SARS-CoV-2 PCR test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman came with three days of fever, cough with green sputum, and shortness of breath. On room air her oxygen saturation was 90%, rising to 95% with 2 liters via nasal cannula. Chest X-ray showed a right lower lobe infiltrate, consistent with pneumonia. She reports an allergy to azithromycin that caused a rash in the past. Past history includes type 2 diabetes and mild chronic kidney disease. Viral PCR for COVID-19 and influenza was negative. She was admitted and treated with IV ceftriaxone plus doxycycline. She improved over two days, and the team planned a switch to oral antibiotics and discharge soon.",
    "subclaim": "Her blood pressure on arrival was 80/50 mmHg.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with type 2 diabetes mellitus and moderate COPD presented with a 72-hour febrile illness characterized by purulent productive cough, pleuritic chest pain, and exertional dyspnea. Vitals: T 38.6\u00b0C, HR 108 bpm, BP 128/74 mmHg, SpO2 89% on room air indicating hypoxemia. Pulmonary exam revealed right lower-lobe bronchial breath sounds with crackles. Labs showed leukocytosis to 15.2 x10^9/L with neutrophilia, CRP 120 mg/L, serum glucose 260 mg/dL, and creatinine 0.9 mg/dL. Chest radiography demonstrated focal consolidation of the right lower lobe; multiplex respiratory PCR was negative for influenza, and urinary pneumococcal antigen was not performed. Empiric therapy included IV ceftriaxone plus azithromycin; supplemental oxygen was delivered via nasal cannula at 2 L/min, and metformin was held in favor of basal-bolus insulin. Microbiology from expectorated sputum grew Streptococcus pneumoniae susceptible to ceftriaxone and amoxicillin-clavulanate; blood cultures remained negative at 48 hours. By hospital day two he met clinical stability criteria, oxygen was discontinued, and therapy was de-escalated to oral amoxicillin-clavulanate to complete a 5-day total course at discharge.",
    "subclaim": "A chest CT scan was performed to confirm the diagnosis.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with hypertension and type 2 diabetes, without prior coronary disease, presented with 45 minutes of rest angina radiating to the left arm accompanied by diaphoresis. Initial vitals: HR 102 bpm, BP 146/88 mmHg, RR 18, SpO2 97% on room air. The ECG demonstrated 1\u20131.5 mm horizontal ST-segment depression in V4\u2013V6 with T-wave inversion and no ST elevation. High-sensitivity cardiac troponin I measured 420 ng/L on arrival and rose to 680 ng/L at 3 hours. The diagnosis was non\u2013ST-elevation myocardial infarction. Management included chewable aspirin 325 mg, an IV unfractionated heparin bolus followed by infusion titrated to aPTT, atorvastatin 80 mg, metoprolol tartrate, and sublingual nitroglycerin with partial symptom relief. Diagnostic coronary angiography was planned for the next morning; the patient was kept NPO after midnight. Fibrinolytic therapy was not administered. Renal function was preserved (creatinine 0.9 mg/dL, estimated GFR >60), and a penicillin allergy (rash) was recorded.",
    "subclaim": "The ECG showed ST-segment depression without ST elevation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old female with COPD and hypertension presented with 48 hours of fever, productive cough, and dyspnea. Vitals: T 38.5 C, RR 24, SpO2 90% on room air, hemodynamically stable. Pulmonary exam revealed right basilar crackles. Laboratory studies showed WBC 14.2 \u00d710^3/\u00b5L with neutrophilia, creatinine 0.9 mg/dL, and procalcitonin 0.8 ng/mL. Chest radiograph demonstrated right lower lobe lobar consolidation without pleural effusion. Influenza A/B PCR was negative; blood cultures had no growth at 48 hours. The working diagnosis was hypoxemic community-acquired pneumonia. She was treated with supplemental oxygen via nasal cannula and intravenous ceftriaxone 1 g daily plus azithromycin 500 mg daily. Over 48 hours she exhibited clinical improvement and was weaned to room air with SpO2 95%. She was transitioned to oral antibiotics and discharged on hospital day 3.",
    "subclaim": "She received intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old female with COPD and hypertension presented with 48 hours of fever, productive cough, and dyspnea. Vitals: T 38.5 C, RR 24, SpO2 90% on room air, hemodynamically stable. Pulmonary exam revealed right basilar crackles. Laboratory studies showed WBC 14.2 \u00d710^3/\u00b5L with neutrophilia, creatinine 0.9 mg/dL, and procalcitonin 0.8 ng/mL. Chest radiograph demonstrated right lower lobe lobar consolidation without pleural effusion. Influenza A/B PCR was negative; blood cultures had no growth at 48 hours. The working diagnosis was hypoxemic community-acquired pneumonia. She was treated with supplemental oxygen via nasal cannula and intravenous ceftriaxone 1 g daily plus azithromycin 500 mg daily. Over 48 hours she exhibited clinical improvement and was weaned to room air with SpO2 95%. She was transitioned to oral antibiotics and discharged on hospital day 3.",
    "subclaim": "Sputum culture grew Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 54-year-old male with type 2 diabetes presented with three days of fever, productive cough, and pleuritic chest pain. Vitals: T 38.6 C, HR 104, RR 24, SpO2 92% on room air, BP 130/78. Lung exam revealed crackles over the right base. Chest radiograph showed right lower lobe consolidation, consistent with community-acquired pneumonia. Initial labs showed leukocytosis with neutrophil predominance. He was started on IV ceftriaxone plus azithromycin and 2 L/min oxygen by nasal cannula on the general ward. Blood cultures remained negative at 48 hours; sputum culture grew Streptococcus pneumoniae susceptible to beta-lactams. He improved clinically, was weaned to room air with SpO2 95%, and transitioned to oral amoxicillin-clavulanate to complete a 5-day course. He received the seasonal influenza vaccine prior to discharge and had a follow-up arranged in one week.",
    "subclaim": "The rapid influenza test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 54-year-old woman came to the hospital with fever, cough with phlegm, and shortness of breath for three days. She has asthma and high blood pressure. She is allergic to penicillin; it caused a rash before. Her temperature was high and her heart rate was fast. Her oxygen level on room air was 92%. A chest x-ray showed a spot in the right lower lung that looked like infection. Tests for flu and COVID were negative. The team gave her oxygen through a small tube in her nose. She started an antibiotic called levofloxacin. After two days she felt better, her oxygen level was 96% while on oxygen, and she went home with pills to finish five days and a plan to see her doctor.",
    "subclaim": "The chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the hospital with fever and cough. He felt short of breath for three days. His oxygen level on room air was about 90%. A chest x-ray showed a spot of infection in the right lower lung. The team gave him oxygen through a small tube in his nose. He got antibiotics through a vein. A swab test for COVID was negative. After two days, he felt better and went home with antibiotic pills and a plan to see his doctor in one week.",
    "subclaim": "He was treated with systemic corticosteroids.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the hospital with a hot, red left lower leg. He had a small cut there two days earlier. He had fever to 38.5\u00b0C and felt tired. He has type 2 diabetes that is not well controlled. Blood tests showed high white cells. An ultrasound looked for a pocket of pus but found none. He got IV antibiotics called cefazolin. After two days his leg looked better and the fever went down. He went home on pill antibiotics to finish a 5-day course and was taught how to care for the wound.",
    "subclaim": "He was treated initially with IV cefazolin.",
    "label": "supported"
  },
  {
    "medical_text": "An older man came to the emergency room with fever and cough. He had chest pain when he breathed and felt short of breath. He has COPD and diabetes. A chest x-ray showed a pneumonia in the right lower lung. His blood work showed signs of infection. He got IV antibiotics and oxygen through a small tube in his nose. The sputum test grew a common germ called pneumococcus. Blood cultures did not grow any germs. After two days, his fever went away and he switched to pills. He went home on day four with more pills and a pneumonia shot.",
    "subclaim": "The pneumonia was located in the left lower lobe.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with T2DM (A1c 8.2%) presented with 2 hours of exertional substernal pressure and diaphoresis. Initial ECG demonstrated sinus rhythm without ST-segment elevation or new Q waves. High-sensitivity troponin I rose from 36 ng/L to 412 ng/L over 3 hours. NSTEMI was diagnosed; guideline-directed medical therapy was initiated with chewable aspirin 325 mg, IV unfractionated heparin infusion, metoprolol tartrate, and atorvastatin 80 mg. Creatinine was 1.1 mg/dL (eGFR 72 mL/min/1.73 m\u00b2). Coronary angiography showed a critical 90% proximal LAD stenosis with TIMI 2 flow. PCI with a drug-eluting stent restored TIMI 3 flow without complications. At discharge, medications included aspirin 81 mg daily, ticagrelor 90 mg twice daily, atorvastatin 80 mg nightly, and continuation of metformin.",
    "subclaim": "A drug-eluting stent was placed in the LAD.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital. He had fever, a cough with yellow mucus, and felt short of breath for 3 days. His oxygen level on room air was 91%. A chest X-ray showed an infection in the right lower lung. A urine test found a germ called Streptococcus pneumoniae. Tests for flu and COVID were negative. He got oxygen by a small tube and two IV antibiotics. After 2 days he felt better and the fever was gone. His oxygen level rose to 95% on room air, and blood cultures stayed negative. He had no drug allergies and went home on antibiotic pills.",
    "subclaim": "His oxygen saturation improved to 95% on room air before discharge.",
    "label": "supported"
  },
  {
    "medical_text": "A 38-year-old otherwise healthy adult presented with 4 days of productive cough, fever, and exertional dyspnea. On exam: T 38.5\u00b0C, HR 104, RR 22, BP 120/76 mmHg, SpO2 93% on ambient air; scattered rhonchi at the right base. Laboratory testing showed WBC 13.2 \u00d710^9/L with neutrophil predominance; procalcitonin 0.34 ng/mL. Chest radiograph revealed a focal right lower lobe consolidation consistent with community-acquired pneumonia. SARS-CoV-2 and influenza A/B PCR were negative. Given a history of immediate penicillin hypersensitivity and CURB-65 score 0, outpatient management was selected. Doxycycline 100 mg PO BID was prescribed for 7 days; acetaminophen and albuterol MDI PRN were provided. Discharge instructions included return precautions and telephonic follow-up at 48 hours. At 48 hours the patient reported symptomatic improvement, was afebrile, and home pulse oximetry read 96%.",
    "subclaim": "The patient has a history of asthma.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old male with no known immunosuppression presented with 3 days of productive cough, fever, and exertional dyspnea. Vitals: T 38.5 C, HR 102, RR 24, BP 128/76, SpO2 90% on room air. Pulmonary exam revealed right basilar crackles; no wheezes. Chest radiograph showed a focal right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Labs: WBC 15.0 x10^3/\u00b5L with neutrophil predominance; basic metabolic panel unremarkable. Empiric therapy initiated with ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily; supplemental oxygen via nasal cannula at 2 L/min for hypoxemia. Diagnostics: rapid influenza A/B negative, Legionella urine antigen negative; paired blood cultures remained without growth at 48 hours. By hospital day 2, the patient demonstrated clinical improvement with resolution of hypoxemia, oxygen discontinued; plan made to transition to oral amoxicillin-clavulanate to complete a 5-day total antimicrobial course.",
    "subclaim": "Rapid influenza testing was negative.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old woman comes to the ER with cough and fever for three days. She is short of breath and tired. She has type 2 diabetes. Her temperature is 38.5 C, and her breathing is fast. The oxygen level on room air is 90%. A chest x-ray shows a spot of infection in the right lower lung. Doctors give oxygen by a small tube in her nose at 2 liters per minute; it raises her oxygen to 96%. Blood for germ tests is taken before starting antibiotics. She starts IV ceftriaxone and azithromycin and feels a little better the next day.",
    "subclaim": "Her oxygen saturation rose to 96% on 2 L nasal cannula.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man presented with three days of cough, fever (38.5\u00b0C), and shortness of breath. On room air his oxygen saturation was 90% with a respiratory rate of 24, and exam found right lower-lobe crackles. Chest X-ray showed a right lower-lobe consolidation. Rapid tests for influenza and SARS-CoV-2 were negative, and blood cultures were obtained prior to antibiotics. He was started on IV ceftriaxone plus azithromycin, given 2 L/min oxygen by nasal cannula, and received IV fluids. WBC was 14,000 with neutrophilia and procalcitonin was elevated. Sputum culture later grew Streptococcus pneumoniae susceptible to beta-lactams. After 48 hours he improved, was weaned to room air, and became afebrile. He was discharged on hospital day three with oral amoxicillin-clavulanate to complete a five-day course.",
    "subclaim": "Sputum culture grew Streptococcus pneumoniae.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with fever and cough. He felt short of breath for three days. His oxygen level was 90% on room air. A chest X-ray showed infection in the right lower lung. The doctors said he had pneumonia that started outside the hospital. He got antibiotics through a vein: ceftriaxone and azithromycin. Tests for COVID and flu were negative. After two days, he felt better and breathed well without oxygen. He went home with azithromycin pills to finish five days of treatment.",
    "subclaim": "The patient required intensive care unit admission.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman with COPD and type 2 diabetes presented with three days of fever, productive green sputum, and dyspnea. On arrival, temperature was 38.6 C, respiratory rate 24, heart rate 102, and SpO2 88% on room air. After starting 2 liters of oxygen by nasal cannula, her saturation improved to 94%. Chest radiograph demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. Laboratory testing showed leukocytosis, and blood and sputum cultures were obtained before antibiotics. Empiric IV ceftriaxone plus azithromycin were initiated, and scheduled bronchodilator nebulizers were given for COPD. A multiplex viral PCR was negative for influenza and SARS-CoV-2. Blood cultures show no growth at 24 hours. She has no known drug allergies and remains on the general medical floor with plans to transition to oral therapy if stable.",
    "subclaim": "She had a documented penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with long-standing type 2 diabetes presented with a painful plantar foot ulcer with purulent drainage. He had a low-grade fever and his capillary glucose was elevated on arrival. Laboratory tests showed leukocytosis and a high HbA1c, consistent with poor glycemic control. The wound was debrided and irrigated, and an X-ray of the foot did not show osteomyelitis. Empiric intravenous cefazolin was started, with plans to transition to oral cephalexin once improving. The wound culture later grew methicillin-susceptible Staphylococcus aureus. He clinically improved and was switched to oral therapy before discharge. He was advised to offload the foot and follow up with podiatry.",
    "subclaim": "A follow-up visit was planned in one week.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old male with HTN and T2DM presented with 30 minutes of rest angina radiating to the left arm, associated with diaphoresis and dyspnea. ECG demonstrated no STE, with nonspecific ST-T abnormalities. High-sensitivity troponin I was elevated at presentation and increased on repeat sampling at 3 hours, consistent with a rising delta. Clinical picture favored NSTE-ACS (probable NSTEMI). He received 325 mg chewable aspirin and therapeutic-dose enoxaparin; high-intensity atorvastatin and a beta-blocker were initiated. Chest X-ray was clear. Serum creatinine was mildly elevated, warranting renal monitoring prior to contrast exposure. Vitals remained stable, and chest pain improved after medical therapy. Plan is early invasive strategy with coronary angiography the following day. There was no fever, cough, or focal lung findings.",
    "subclaim": "The patient is allergic to aspirin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 42-year-old woman with type 2 diabetes presented with two days of fever, dysuria, and right flank pain. She was febrile to 38.6\u00b0C and her heart rate was 108. Urinalysis showed leukocyte esterase and nitrites with pyuria. Urine culture later grew E. coli sensitive to ceftriaxone and ciprofloxacin; blood cultures showed no growth. She was diagnosed with acute pyelonephritis and started on IV ceftriaxone and IV fluids. Renal ultrasound demonstrated no hydronephrosis or renal calculi. After 48 hours of improvement, she was transitioned to oral ciprofloxacin to complete a 10-day course. She was discharged on hospital day 3 in good condition.",
    "subclaim": "The urine culture grew E. coli.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman with chronic obstructive pulmonary disease presented with three days of worsening dyspnea, cough, and increased sputum. On arrival, oxygen saturation was 89% on room air, improving to 94% on 2 L nasal cannula. She continued her home tiotropium inhaler. Chest radiograph showed no focal consolidation to suggest pneumonia. Respiratory viral PCR detected rhinovirus. She received nebulized albuterol/ipratropium, systemic corticosteroids (prednisone 40 mg daily), and oral azithromycin. She was admitted to the general medical ward and did not require intubation or ICU care. Her symptoms improved with treatment, and she was discharged after clinical stabilization.",
    "subclaim": "She has type 1 diabetes.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old woman came to the hospital with fever and burning when she peed. She also had pain in her right lower back. Her temperature was high and her heart was fast, but her blood pressure was okay. Her urine test showed signs of infection. Later, the urine grew E. coli, a common germ. She got IV fluids and an antibiotic called ceftriaxone. After two days she felt better and had no fever. An ultrasound of her kidneys showed no stones or blockages. Her blood tests were okay and her blood cultures did not grow germs. She went home on pills called ciprofloxacin to finish 7 days of treatment.",
    "subclaim": "The patient is male.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old man came to the hospital with fever, cough, and trouble breathing. He used to smoke and has long-term lung disease (COPD). His oxygen level was 88% in room air, and it went up to 94% with a small tube of oxygen. A chest X-ray showed an infection in the right lower lung. Blood tests showed signs of infection. Doctors started IV antibiotics and breathing treatments. He also took steroid pills for a few days. He felt better after three days and went home with antibiotics and inhalers.",
    "subclaim": "The patient has COPD.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man with type 2 diabetes and hypertension presented with 3 days of fever, productive cough, and shortness of breath. On arrival, his oxygen saturation was 90% on room air and improved with 2 L/min via nasal cannula. Chest radiograph demonstrated a right lower lobe consolidation. Laboratory studies showed leukocytosis and elevated C-reactive protein. SARS-CoV-2 PCR was negative. He received intravenous ceftriaxone plus azithromycin and clinical status improved over 48 hours. Sputum Gram stain suggested pneumococcus; blood cultures remained negative at 48 hours. He was transitioned to oral amoxicillin-clavulanate to complete a 5-day total antibacterial course and discharged home. There was no record of prior pneumococcal vaccination.",
    "subclaim": "He has chronic kidney disease.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the ER with chest pain at rest. It lasted about 45 minutes and he felt sick and sweaty. The heart tracing showed small ST drops, and his troponin blood test was high. The team said he had a heart attack called NSTEMI. He got aspirin, another platelet blocker, heparin, pain medicine, and a strong statin. He had a dye test of his heart arteries. They found a very tight blockage in the main front artery (LAD) and put in a drug-coated stent. His kidney function was a bit low, so metformin was stopped for 2 days after the dye. An ultrasound showed the heart pump was about 45% and he stayed stable with no fever. He went home on aspirin and ticagrelor, a statin, a beta blocker, and an ACE inhibitor, and was sent to cardiac rehab.",
    "subclaim": "Metformin was held for 48 hours after contrast exposure.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with COPD and T2DM presented with 48 hours of fever, productive cough, and pleuritic chest pain. Initial vitals: temperature 38.6\u00b0C, heart rate 112 bpm, SpO2 89% on room air; improved to 94% on 2 L nasal cannula. Chest radiograph demonstrated right lower lobe lobar consolidation without pleural effusion. Laboratory studies showed leukocytosis (WBC 15.2 \u00d7 10^9/L) and elevated CRP; serum lactate was normal. Empiric therapy consisted of IV ceftriaxone plus azithromycin, with supplemental oxygen via nasal cannula. Microbiology revealed expectorated sputum culture positive for Streptococcus pneumoniae, penicillin-susceptible. Two sets of blood cultures had no growth. By 48 hours the patient defervesced and therapy was de-escalated to oral amoxicillin-clavulanate. He was discharged home on a short oral course, and pneumococcal vaccination was addressed at discharge.",
    "subclaim": "Sputum culture grew Streptococcus pneumoniae.",
    "label": "supported"
  },
  {
    "medical_text": "A 65-year-old man had two days of fever, productive cough, pleuritic chest pain, and shortness of breath. On arrival, his temperature was 38.6\u00b0C and his oxygen saturation was 89% on room air. Chest examination revealed crackles at the right base. A chest X-ray showed right lower lobe consolidation consistent with community-acquired pneumonia. He reported a rash with amoxicillin in the past. He was started on intravenous levofloxacin and 2 L/min oxygen by nasal cannula. Nasopharyngeal PCR for influenza and SARS-CoV-2 was negative. Two sets of blood cultures drawn before antibiotics had no growth at 48 hours. By 48 hours, he was afebrile and maintaining 94% on room air. He was discharged on hospital day three with oral levofloxacin to complete a five-day total course.",
    "subclaim": "A CT scan of the chest was performed.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with cough and fever for three days. He felt short of breath and had no chest pain. He coughed up yellow mucus. His temperature was 38.6 C and his oxygen level was 89% on room air. A chest x-ray showed pneumonia in the right lower lung. A test of his mucus found Streptococcus pneumoniae, and a urine test for Legionella was negative. He was given oxygen by nasal tube and IV antibiotics ceftriaxone and azithromycin. After two days, his fever stopped and his oxygen level improved to 95% on room air. He went home with pills to finish seven days of antibiotics.",
    "subclaim": "He received IV ceftriaxone plus azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with HTN, T2DM, and active tobacco use presented with 30 minutes of rest angina radiating to the left arm, onset 120 minutes pre-arrival. On exam: BP 150/92 mmHg, HR 96 bpm, RR 16, SpO2 97% on room air, afebrile; lungs clear, no JVD or edema. ECG demonstrated 1\u20132 mm horizontal ST depression in V5\u2013V6 and leads I/aVL without ST elevation. High-sensitivity troponin I was 82 ng/L at baseline and rose to 214 ng/L at 3 hours. He was managed per ACC/AHA NSTEMI guidance with aspirin 325 mg load then 81 mg daily, atorvastatin 80 mg nightly, metoprolol tartrate 25 mg BID, and enoxaparin 1 mg/kg SC q12h; 0.4 mg SL nitroglycerin relieved symptoms. Basic labs notable for creatinine 0.9 mg/dL (eGFR > 90 mL/min/1.73 m2) and normal electrolytes. Transthoracic echocardiography showed LVEF ~50% with mild lateral wall hypokinesis. The diagnosis was NSTEMI (ACS without ST elevation). An early invasive strategy was selected with diagnostic coronary angiography scheduled for the following morning; the patient was kept NPO after midnight. No fibrinolytic therapy or oxygen supplementation was given.",
    "subclaim": "The ECG showed ST elevation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old woman came to the emergency room with cough and trouble breathing for three days. She also had a fever and felt very tired. Her oxygen level was low at 90% without extra oxygen. The doctor heard crackles on the right side of her chest. A chest X-ray showed pneumonia in the lower right lung. She got oxygen through a small tube in her nose, and her level rose to 94%. She was given two antibiotics, ceftriaxone and azithromycin. Blood cultures were taken before the first dose, and she was admitted to the medical ward.",
    "subclaim": "A rapid influenza A test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old male with COPD and type 2 diabetes mellitus presented with 3 days of fever, productive cough, and dyspnea. Vitals: T 38.6\u00b0C, HR 104 bpm, RR 24/min, BP 118/70 mmHg, SpO2 90% on room air, rising to 95% on 2 L/min nasal cannula. Chest radiograph revealed a right lower lobe air-space opacity consistent with community-acquired pneumonia. Laboratory data showed WBC 15.8\u00d710^9/L with neutrophilia, CRP 120 mg/L, lactate 1.8 mmol/L, sodium 130 mmol/L; high-sensitivity troponin was within reference range. Two sets of blood cultures obtained prior to antibiotics showed no growth at 48 hours. He was treated with IV ceftriaxone 1 g daily and azithromycin 500 mg daily, isotonic fluids, and bronchodilators as needed. No vasopressors were required. The patient was not intubated and remained on low-flow nasal cannula. By 48 hours, fever abated and work of breathing improved.",
    "subclaim": "The patient is a woman.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old female with T2DM and essential hypertension presented with 24 hours of right lower extremity erythema, warmth, and tenderness with Tmax 38.5 C and chills. The involved area extended from the ankle to mid-calf with indistinct borders; no fluctuance, crepitus, bullae, or purulent drainage were noted. Leukocytosis was 14.2 x10^9/L, CRP 98 mg/L; lactate was normal and creatinine 0.9 mg/dL. Compression venous duplex demonstrated compressible veins without intraluminal thrombus, effectively excluding DVT. Clinical impression was nonpurulent cellulitis, likely beta-hemolytic streptococcus; necrotizing infection was deemed unlikely. Empiric IV cefazolin 2 g q8h was initiated; vancomycin was deferred given low MRSA risk and a documented sulfonamide allergy. Within 24 hours, erythema demarcated and pain improved; no hemodynamic instability occurred. Two sets of blood cultures remained negative at 48 hours. On hospital day 2, therapy was de-escalated to oral cephalexin 500 mg q6h for 5 additional days, and the patient was discharged with return precautions.",
    "subclaim": "She was treated with vancomycin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with poorly controlled T2DM (HbA1c 9.2%) presented with a 7-day right plantar hallux ulcer and subjective fevers. Examination revealed a 2 cm ulcer with purulent drainage and surrounding cellulitis; pedal pulses were intact and the ulcer did not probe to bone. Vitals were T 38.5 C, HR 102; WBC 14.2 K/\u00b5L, CRP 12 mg/dL; creatinine 0.9 mg/dL. Foot radiographs showed no bony erosion or periosteal reaction, and osteomyelitis was considered unlikely. Bedside sharp debridement was performed, an offloading boot was applied, and a tetanus booster was administered. Empiric IV cefazolin was initiated and transitioned to oral cephalexin after 48 hours as erythema receded. Superficial wound culture grew methicillin-susceptible Staphylococcus aureus; MRSA nasal swab was negative; no anaerobes were isolated. Two sets of peripheral blood cultures remained negative at 48 hours, with no evidence of bacteremia. His insulin regimen was adjusted to basal-bolus with correction scale, maintaining inpatient glucoses between 110 and 180 mg/dL. He was discharged home on day 3 with wound care follow-up.",
    "subclaim": "Blood cultures were negative for bacteremia.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman came to the hospital with fever and cough. She felt short of breath. She has type 2 diabetes. A chest X-ray showed pneumonia in the right lower lung. Her oxygen level was low, so she got oxygen through a small tube in the nose. She was given two IV antibiotics: ceftriaxone and azithromycin. Blood tests and blood cultures were taken before the antibiotics. She is not allergic to any drugs. She did not need the ICU. By the next day, she was breathing easier.",
    "subclaim": "The pneumonia involved the left upper lobe.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 54-year-old woman came to the hospital with fever, cough with phlegm, and shortness of breath for three days. She has asthma and high blood pressure. She is allergic to penicillin; it caused a rash before. Her temperature was high and her heart rate was fast. Her oxygen level on room air was 92%. A chest x-ray showed a spot in the right lower lung that looked like infection. Tests for flu and COVID were negative. The team gave her oxygen through a small tube in her nose. She started an antibiotic called levofloxacin. After two days she felt better, her oxygen level was 96% while on oxygen, and she went home with pills to finish five days and a plan to see her doctor.",
    "subclaim": "The patient has diabetes mellitus.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man presented with 3 days of fever, productive cough, and dyspnea. On arrival, temperature was 38.5\u00b0C and oxygen saturation was 90% on room air. Lung exam revealed crackles at the right base. Chest radiograph showed right lower lobe consolidation, consistent with community-acquired pneumonia. Nasal cannula oxygen was started, and saturations improved. Empiric IV ceftriaxone plus azithromycin were administered after obtaining blood tests and blood cultures. SARS-CoV-2 PCR was negative. After 48 hours, he was clinically improved and maintained 95% saturation on room air. He was transitioned to oral antibiotics to complete a 5-day total course and was offered pneumococcal vaccination prior to discharge.",
    "subclaim": "The pneumonia involved the left upper lobe.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old male with 3 days of fever, productive cough, and exertional dyspnea presented to the emergency department. Vitals: T 38.5 C, HR 102, BP 128/74, RR 22, SpO2 90% on room air; supplemental O2 via nasal cannula at 2 L/min increased saturation to 95%. Pulmonary exam revealed crackles at the right base without wheeze. Chest radiograph showed focal right lower lobe air-space consolidation without effusion or pneumothorax. Laboratory data: WBC 14.2 x10^3/\u00b5L with neutrophil predominance; CRP 145 mg/L; procalcitonin 0.6 ng/mL. SARS-CoV-2 PCR was negative; urine pneumococcal antigen was not obtained; two sets of blood cultures remained negative at 48 hours. He had no history of beta-lactam allergy. The patient was treated for community-acquired pneumonia with IV ceftriaxone plus azithromycin, then transitioned on hospital day 2 to oral amoxicillin-clavulanate to complete a 7-day total course. He defervesced within 36 hours, was weaned to room air, and was discharged home on hospital day 3 with outpatient follow-up arranged.",
    "subclaim": "He had chest pain when coughing.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman came to the hospital with pain, redness, and swelling in her right lower leg. She had a fever. She has diabetes and high blood pressure. The doctors thought it was a skin infection (cellulitis). An ultrasound looked for a blood clot and did not find one. Her white blood cell count was high. She started IV antibiotics, and the redness began to fade after one day. She is allergic to sulfa drugs, so they did not use those medicines. Blood cultures did not grow bacteria after two days. She went home on pills to finish treatment.",
    "subclaim": "She had a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with diabetes and high blood pressure came to the clinic. He had a sore on the bottom of his left foot for two weeks. The skin around it was red, warm, and smelled bad. He had a fever of 38.3 C and his heart was fast. Blood tests showed high white cells and high sugar. An X-ray did not show damage to the bone. An MRI suggested an early bone infection near the sore. A swab grew staph bacteria that can be treated with common drugs. He got IV antibiotics and had the dead tissue cleaned out. The plan was to switch to pills after two days if he kept getting better.",
    "subclaim": "The ulcer was on the right foot.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man came in with cough and fever for three days. He felt short of breath and very tired. He has diabetes and high blood pressure, and no drug allergies. In the ER, his oxygen level was 90% on room air and his heart was fast. A chest X-ray showed a lung spot in the right lower part. The team said he had community pneumonia from bacteria. He got oxygen through a small tube in his nose at 2 liters per minute and IV antibiotics. Tests for flu and COVID were negative, and his blood cultures showed no growth after two days. He did not need the ICU or a breathing machine, and after two days he felt better and could go home on pills to finish five days of antibiotics.",
    "subclaim": "Influenza A PCR was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 70-year-old man came to the hospital. He had fever and a wet cough. He felt short of breath. His oxygen level was 89% in room air. A chest x-ray showed a spot in the right lower lung. The team said he had pneumonia. He got oxygen by a small nose tube. He was given two antibiotics, ceftriaxone and azithromycin. His COVID-19 test was negative. After two days he felt better and went home on day three with pills.",
    "subclaim": "He received ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the hospital with fever and a bad cough. He has COPD and used to smoke. He felt sharp pain in his chest when he took a deep breath. His oxygen level was 90 percent on room air. A chest x-ray showed pneumonia in the right lower lung. COVID and flu tests were negative. He has no drug allergies. Doctors gave him oxygen, IV ceftriaxone and azithromycin, and breathing treatments. They drew blood cultures before antibiotics, and he went home after three days on pills.",
    "subclaim": "The chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old male with COPD (former 40 pack-year smoker) presented with 3 days of fever, productive cough, and pleuritic chest pain. On arrival he was febrile (38.5 C), tachycardic (HR 104), tachypneic (RR 24), and hypoxemic on room air (SpO2 90%). Chest radiography demonstrated right lower lobe lobar consolidation consistent with community-acquired pneumonia; SARS-CoV-2 and influenza PCR were negative. Labs showed leukocytosis (WBC 14.2 x10^9/L) and CRP 120 mg/L; renal function was normal. He had no known drug allergies. Two sets of peripheral blood cultures were obtained prior to antimicrobial therapy. He was admitted to the general medical ward and started on supplemental oxygen (2 L nasal cannula), ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily, and bronchodilator nebulizations; prednisone 40 mg PO daily was initiated for COPD exacerbation. He exhibited clinical improvement over 72 hours without ICU escalation and was discharged on oral azithromycin to complete a 5-day course with outpatient pneumococcal vaccination planned.",
    "subclaim": "Blood cultures were obtained before antibiotics.",
    "label": "supported"
  },
  {
    "medical_text": "A 56-year-old man came to the emergency room with cough for three days. He had fever and felt short of breath. He had pain on the right side when he took a deep breath. His oxygen level was 91% on room air. A chest x-ray showed an infection in the right lower lung. He is allergic to penicillin. He got azithromycin pills for five days. He also got oxygen through small tubes in his nose, and his level went up to 95%. He went home the same day with a plan to check in two days. The doctor told him to rest and drink plenty of fluids.",
    "subclaim": "He was told to rest and drink fluids.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the hospital with cough, fever, and trouble breathing for three days. His temperature was 38.5 C, and his oxygen level was 90% on room air. The doctor heard crackles on the right side. A chest X-ray showed an infection in the right lower lung. A nose swab for flu was negative. His white blood cell count was high. He got two antibiotics through a vein. He also got oxygen through a small tube in his nose. He felt better after two days and went home with pills to finish a 5-day course. He has no drug allergies.",
    "subclaim": "Blood cultures were negative at 48 hours.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man with type 2 diabetes presented with three days of cough, dyspnea, and fever. On arrival, oxygen saturation was 89% on room air, improving to 95% on 2 L nasal cannula. Chest radiograph showed a right lower lobe consolidation. He was diagnosed with community-acquired pneumonia. Empiric intravenous ceftriaxone plus azithromycin were started in the emergency department. He was admitted to the medical ward and did not require intensive care. Initial labs showed leukocytosis and elevated C-reactive protein. Two sets of blood cultures remained negative at 48 hours; influenza testing was negative. He improved clinically over 48 hours and was transitioned to oral antibiotics to complete a five-day course.",
    "subclaim": "The chest X-ray showed a right lower lobe infiltrate.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old man with COPD and ongoing tobacco use presented with fever, shortness of breath, and productive green sputum. On arrival his temperature was 38.3\u00b0C, heart rate 102, respiratory rate 24, blood pressure 132/78, and oxygen saturation 90% on room air. Chest X-ray showed a right lower lobe consolidation without pleural effusion. Laboratory testing revealed leukocytosis to 15,000 with neutrophilia. SARS-CoV-2 PCR was negative. He was started on supplemental oxygen via nasal cannula, titrated to keep SpO2 above 92%. Empiric therapy included IV ceftriaxone plus azithromycin, systemic steroids, and nebulized bronchodilators. He had no known drug allergies. He improved and was discharged on hospital day three with oral antibiotics and inhaler instructions.",
    "subclaim": "He has a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man came to the hospital with cough and fever for two days. He felt short of breath. His oxygen level was 90% on room air. A chest X-ray showed an infection in the lower right lung. The doctor said he had pneumonia that started in the community. He is allergic to penicillin, so they gave him azithromycin pills. He also got oxygen through a small tube in his nose. After two days, his breathing was better and his oxygen was 95% on room air. Blood cultures did not grow germs, but his sputum grew a common pneumonia germ. He went home on day three to finish five days of azithromycin and he got a pneumonia vaccine before leaving.",
    "subclaim": "The patient received intravenous ceftriaxone.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman came to the hospital with fever and cough. She felt short of breath. She has type 2 diabetes. A chest X-ray showed pneumonia in the right lower lung. Her oxygen level was low, so she got oxygen through a small tube in the nose. She was given two IV antibiotics: ceftriaxone and azithromycin. Blood tests and blood cultures were taken before the antibiotics. She is not allergic to any drugs. She did not need the ICU. By the next day, she was breathing easier.",
    "subclaim": "She required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with fever, cough with yellow mucus, and trouble breathing. His temperature was 38.5\u00b0C and his oxygen level was 90% on room air. A chest X-ray showed a spot in the right lower lung. The doctors said he had a lung infection from the community. They gave him oxygen through small tubes in his nose. He got two IV antibiotics: ceftriaxone and azithromycin. Blood tests and blood cultures were done before the first dose. After two days, he felt better and his oxygen was 95% without extra oxygen. He went home with pills to finish a 5-day total course, and he was offered a pneumonia shot.",
    "subclaim": "The patient required intensive care unit admission.",
    "label": "not_supported"
  },
  {
    "medical_text": "A previously healthy 27-year-old man presented with 12 hours of migratory periumbilical-to-RLQ pain, nausea, and a single emetic episode. Vitals showed low-grade fever; abdominal exam revealed RLQ tenderness with mild guarding and rebound. Laboratory studies demonstrated leukocytosis to 14.2 \u00d710^3/\u00b5L with left shift and elevated CRP. Contrast-enhanced CT of the abdomen/pelvis showed a 9 mm, noncompressible, hyperenhancing appendix with periappendiceal fat stranding and no evidence of perforation or abscess. Preoperative antibiotics were administered (ceftriaxone 2 g IV plus metronidazole 500 mg IV). The patient underwent uneventful laparoscopic appendectomy under general anesthesia. Postoperative course was uncomplicated with rapid diet advancement and adequate analgesia. He was discharged home on postoperative day 1; final pathology confirmed acute suppurative appendicitis without perforation.",
    "subclaim": "A CT scan confirmed appendicitis.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man has fever and right back pain for three days. Peeing burns, and he goes often. He has diabetes and high blood pressure. The doctor checks his urine. It shows bacteria and white blood cells. A scan shows a kidney infection on the right side. His blood sugar is high, and his kidney blood test is a bit worse than usual. He gets IV fluids and IV antibiotics in the hospital. After two days he feels better and the fever goes down. The lab grows E. coli from his blood. It can be treated with the medicine he got. He goes home on pills for ten more days.",
    "subclaim": "He was treated with trimethoprim-sulfamethoxazole.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man came to the hospital with fever and cough for three days. He also felt short of breath and had chills at home. On exam, his oxygen level was low, so he got a small tube in his nose for oxygen. A chest X-ray showed a spot in the lower right lung. The team said he had pneumonia that he caught in the community. He got two antibiotics through a vein to treat the lung infection. Virus tests for flu and COVID were negative. Blood tests did not show bacteria growing in his blood. After two days, he felt better and needed less oxygen, so they planned to switch him to pills to finish five days of treatment.",
    "subclaim": "Blood cultures grew bacteria.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old male with hypertension and type 2 diabetes presents with acute dyspnea and bilateral lower-extremity edema. Vitals: HR 132 irregularly irregular, BP 118/72, RR 24, SpO2 89% on room air. ECG shows atrial fibrillation with rapid ventricular response and no ST-segment elevation. Chest radiograph reveals interstitial and alveolar edema with mild cardiomegaly. Labs: BNP 1200 pg/mL; creatinine 1.5 mg/dL (baseline 1.2); troponin I 0.03 ng/mL without dynamic rise. He received oxygen via nasal cannula and IV furosemide 40 mg with brisk diuresis. Intravenous diltiazem was administered for rate control. Apixaban was initiated for stroke prophylaxis in atrial fibrillation. Working diagnosis: acute decompensated heart failure precipitated by AF with RVR.",
    "subclaim": "A ST-elevation myocardial infarction was diagnosed.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with diabetes has a sore on his right foot for two weeks. The skin around it is red and warm. He has a fever. The team cleans the wound and removes dead tissue. His blood sugar is high. A lab test shows MRSA germs in the wound. He gets IV vancomycin in the hospital. Because his kidneys are not strong, the doctors change the dose. An MRI shows the bone is not infected. After five days, he feels better and goes home with pills and a plan to lower his sugar.",
    "subclaim": "Amoxicillin-clavulanate was the initial antibiotic.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 38-year-old person came to the clinic with a cough for four days. The cough brought up yellow mucus. They had a fever and felt very tired. Breathing was a bit fast and hard. The finger oxygen number was 93%. A chest X-ray showed an infection in the lower right lung. The doctor said this was pneumonia. The person is allergic to penicillin. The doctor gave doxycycline pills to take twice a day for seven days and sent them home with an inhaler and fever medicine. Two days later they had no fever, were coughing less, and their oxygen was 96%.",
    "subclaim": "A pneumococcal vaccine was given at the visit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with poorly controlled type 2 DM and hypertension presented with a 2-week plantar ulcer beneath the left first metatarsal head. Exam showed a 2.5 cm ulcer probing to soft tissue with surrounding erythema (~2 cm), warmth, malodor, and purulent drainage; T 38.3 C, HR 102, BP 138/82. Laboratory evaluation revealed WBC 14.2 \u00d710^3/\u00b5L (neutrophil-predominant), CRP 120 mg/L, ESR 68 mm/h, glucose 220 mg/dL, creatinine 1.0 mg/dL. Plain radiography showed no gas, periosteal reaction, or cortical destruction. MRI with contrast demonstrated marrow edema and enhancement of the first metatarsal head contiguous with the ulcer tract, consistent with early osteomyelitis; no abscess was seen. Superficial wound culture grew MSSA; paired blood cultures were negative at 48 hours. Management included IV cefazolin 2 g q8h, bedside sharp debridement, offloading with a CAM boot, and optimization of glycemic control; tetanus immunization was current. No revascularization or amputation was indicated. Plan was to transition to oral cephalexin to complete a 6-week course if afebrile with improving inflammatory markers after 48 hours. By hospital day 2, fever resolved and local symptoms improved.",
    "subclaim": "The wound culture grew methicillin-sensitive Staphylococcus aureus.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes and hypertension presented with 45 minutes of rest chest pain with nausea and diaphoresis. ECG showed 1-2 mm ST-segment depressions in lateral leads, and troponin I was elevated. He was diagnosed with a non-ST-elevation myocardial infarction. Aspirin and ticagrelor were loaded, and an unfractionated heparin infusion was started along with high-intensity statin therapy. Coronary angiography revealed a 90% proximal LAD stenosis. Percutaneous coronary intervention was performed with placement of a drug-eluting stent. Baseline creatinine was 1.6 mg/dL (eGFR about 48 mL/min/1.73 m^2), so metformin was held for 48 hours after contrast. Transthoracic echocardiogram showed a left ventricular ejection fraction of approximately 45% with mild anterior hypokinesis. He remained afebrile and hemodynamically stable, and was discharged on dual antiplatelet therapy, beta-blocker, ACE inhibitor, and statin with referral to cardiac rehabilitation.",
    "subclaim": "He was discharged without statin therapy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old male with COPD and hypertension presented from home with 3 days of fever, productive cough, and exertional dyspnea. Vitals on admission: T 38.3 C, HR 102 bpm, RR 24/min, BP 128/76 mm Hg, SpO2 89% on ambient air. Auscultation revealed right basilar crackles without accessory muscle use. Chest radiography demonstrated a focal right lower lobe consolidation consistent with community-acquired pneumonia. Low-flow supplemental oxygen via nasal cannula (2 L/min) was initiated to target SpO2 of at least 94%. Empiric intravenous ceftriaxone plus azithromycin were started; lactate was normal and there was no hypotension. Microbiology returned Streptococcus pneumoniae growth from sputum; blood cultures showed no growth, and SARS-CoV-2 PCR was negative. By hospital day 3 he was stable on room air and was transitioned to oral amoxicillin-clavulanate for discharge.",
    "subclaim": "He tested positive for COVID-19.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman has long-term lung disease called COPD. She came to the hospital with short breath and cough for two days. She had wheezing and chest tightness. Her oxygen level was 88% on room air. A nose swab found a cold virus called rhinovirus. The chest X-ray did not show pneumonia. She got oxygen by a small tube in her nose. She also got breathing treatments and steroid pills. No antibiotics were given. Her breathing improved to 94% oxygen, and she went home with inhalers and a short steroid taper.",
    "subclaim": "Rhinovirus was detected on respiratory testing.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man presented with 72 hours of fever, productive cough, pleuritic chest pain, and exertional dyspnea. On arrival: temperature 38.6 C, heart rate 102, blood pressure 128/76, respiratory rate 24, SpO2 90% on room air. Auscultation revealed focal crackles over the right lower lung field. Chest radiograph demonstrated right lower lobe air-space consolidation consistent with community-acquired pneumonia; CURB-65 score was 1. Laboratories showed WBC 14.0 x10^9/L with neutrophil predominance; influenza A/B PCR was negative; urine pneumococcal antigen was positive. Initial management included IV ceftriaxone plus azithromycin, 2 L/min oxygen via nasal cannula, and isotonic IV crystalloids. Two sets of blood cultures showed no growth at 48 hours. By hospital day 2, hypoxemia and symptoms improved; supplemental oxygen was discontinued. On day 3, therapy was de-escalated to oral amoxicillin-clavulanate to complete a 5-day total antibiotic course, with anticipated discharge the following day.",
    "subclaim": "The patient has no penicillin allergy.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes and hypertension presented with three days of fever, dysuria, urinary frequency, and right flank pain. Vitals showed temperature 38.6\u00b0C, heart rate 104, and blood pressure 122/74. Urinalysis was positive for nitrites, leukocyte esterase, and pyuria. Serum creatinine was 1.8 mg/dL (baseline 1.0), glucose 280 mg/dL, and WBC count 15,200/\u00b5L. Noncontrast CT abdomen/pelvis demonstrated right-sided pyelonephritis without hydronephrosis or stones. He received intravenous ceftriaxone and isotonic fluids, and insulin was used for hyperglycemia. After 48 hours, his fever resolved and symptoms improved. Blood cultures grew Escherichia coli susceptible to ceftriaxone and ciprofloxacin but resistant to trimethoprim-sulfamethoxazole. He was transitioned to oral ciprofloxacin to complete a 10-day total course and discharged home.",
    "subclaim": "Blood cultures grew Escherichia coli.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old man came to the hospital with fever, cough with green mucus, and trouble breathing for three days. He has COPD and diabetes. His oxygen level was 89% in room air. A chest X-ray showed a lung infection in the right lower part. The team started oxygen by a small nose tube and gave IV antibiotics, ceftriaxone and azithromycin. His blood tests showed high white cells. Tests for flu and COVID were negative. After two days, he was breathing better and needed less oxygen. His sputum culture grew Streptococcus pneumoniae that antibiotics can kill. They planned to switch him to amoxicillin pills to finish five days of treatment.",
    "subclaim": "The chest imaging showed bilateral infiltrates.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 46-year-old woman went to the emergency room with fever and right back pain. She also had burning when she peed and felt sick. A urine test showed signs of infection. The doctor said she had a kidney infection. She got a dose of IV antibiotic in the ER. Then she started pills at home for 10 days. Her urine culture later showed E. coli, and the pills matched the result. She felt better after two days, and no kidney stone was found on the scan.",
    "subclaim": "She was pregnant.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman with COPD and type 2 diabetes presented with three days of fever, productive green sputum, and dyspnea. On arrival, temperature was 38.6 C, respiratory rate 24, heart rate 102, and SpO2 88% on room air. After starting 2 liters of oxygen by nasal cannula, her saturation improved to 94%. Chest radiograph demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. Laboratory testing showed leukocytosis, and blood and sputum cultures were obtained before antibiotics. Empiric IV ceftriaxone plus azithromycin were initiated, and scheduled bronchodilator nebulizers were given for COPD. A multiplex viral PCR was negative for influenza and SARS-CoV-2. Blood cultures show no growth at 24 hours. She has no known drug allergies and remains on the general medical floor with plans to transition to oral therapy if stable.",
    "subclaim": "She received intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with cough, fever, and short breath for 3 days. He had chest pain when he coughed. He has no drug allergies. His oxygen level was low at first, so the team gave him oxygen by a small tube in his nose. A chest X-ray showed a new spot in the right lower lung, which means pneumonia. A COVID-19 test was negative. He got two antibiotics through a vein, then pills when he felt better. The fever went away by day 2, and his breathing got better. He went home on day 3 with more antibiotic pills to finish 7 days. He was told to return if symptoms got worse.",
    "subclaim": "He tested positive for COVID-19.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old male with 3 days of productive cough, dyspnea, and fever to 38.5\u00b0C presented to the ED. Vitals: BP 128/72 mmHg, HR 102 bpm, RR 24/min, SpO2 90% on room air; T 38.4\u00b0C. Pulmonary exam revealed crackles over the right base. Portable CXR demonstrated right lower lobe air-space consolidation consistent with community-acquired pneumonia. Influenza A/B and SARS-CoV-2 rapid antigen tests were negative. Initial labs: WBC 14.2 \u00d710^9/L with 86% neutrophils; procalcitonin 1.1 ng/mL; creatinine 1.2 mg/dL. Two sets of blood cultures were obtained before antimicrobials. Empiric therapy with IV ceftriaxone plus azithromycin was initiated; 2 L/min supplemental O2 via nasal cannula and IV crystalloids were provided. Sputum culture grew Streptococcus pneumoniae (beta-lactam\u2013susceptible). By 48 hours, the patient was afebrile, saturating >94% on room air; he was transitioned to oral amoxicillin-clavulanate to complete a 5-day total course and discharged on hospital day 3.",
    "subclaim": "Sputum culture grew Streptococcus pneumoniae.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes and hypertension presented with three days of fever, dysuria, urinary frequency, and right flank pain. Vitals showed temperature 38.6\u00b0C, heart rate 104, and blood pressure 122/74. Urinalysis was positive for nitrites, leukocyte esterase, and pyuria. Serum creatinine was 1.8 mg/dL (baseline 1.0), glucose 280 mg/dL, and WBC count 15,200/\u00b5L. Noncontrast CT abdomen/pelvis demonstrated right-sided pyelonephritis without hydronephrosis or stones. He received intravenous ceftriaxone and isotonic fluids, and insulin was used for hyperglycemia. After 48 hours, his fever resolved and symptoms improved. Blood cultures grew Escherichia coli susceptible to ceftriaxone and ciprofloxacin but resistant to trimethoprim-sulfamethoxazole. He was transitioned to oral ciprofloxacin to complete a 10-day total course and discharged home.",
    "subclaim": "He required ICU admission.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man presented with two days of fever, productive cough, and shortness of breath. On arrival, his temperature was 38.5\u00b0C, respiratory rate 24, and oxygen saturation 89% on room air. Chest radiograph showed right lower lobe consolidation. His white blood cell count was elevated and C-reactive protein was high. He was diagnosed with community-acquired pneumonia and admitted. Treatment included IV ceftriaxone plus azithromycin and supplemental oxygen via nasal cannula. Blood cultures showed no growth at 48 hours, and sputum later grew Streptococcus pneumoniae susceptible to ceftriaxone. He improved, was weaned off oxygen, and was discharged on oral antibiotics.",
    "subclaim": "He tested positive for influenza.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man presented from the community with 72 hours of fever, purulent sputum, and exertional dyspnea. Vitals: T 38.3\u00b0C, HR 102 bpm, BP 132/76 mmHg, RR 22/min; SpO2 88% on room air, rising to 95% on 2 L/min via nasal cannula. Chest radiography demonstrated a focal right lower lobe air-space opacity consistent with lobar consolidation. Impression: community-acquired pneumonia with mild hypoxemic respiratory failure; CURB-65 = 1 (age criterion). Laboratory data: WBC 15.2 \u00d710^9/L with neutrophilia; lactate 1.6 mmol/L; procalcitonin 0.4 ng/mL. No history of beta-lactam hypersensitivity; empiric IV ceftriaxone plus azithromycin were administered after obtaining two peripheral blood culture sets. Blood cultures showed no growth at 48 hours. Clinical status improved by hospital day 2; therapy was de-escalated to oral amoxicillin\u2013clavulanate to complete a 5-day total course. Immunizations: influenza vaccine documented last season; pneumococcal vaccination not previously administered.",
    "subclaim": "Blood cultures were negative at 48 hours.",
    "label": "supported"
  },
  {
    "medical_text": "A 66-year-old man came to the hospital from home. He had fever, cough with yellow mucus, and trouble breathing for three days. He has COPD and high blood pressure. His oxygen level was low when he arrived. A chest X-ray showed pneumonia in the right lower lung. The team started IV ceftriaxone and azithromycin. He was given oxygen by a small tube in the nose and inhaler treatments for his COPD. Quick virus tests were negative, and his kidneys were okay. He began to feel better after two days, and the oxygen was turned down. He has no drug allergies and lives alone.",
    "subclaim": "The patient had a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man with type 2 diabetes, hypertension, and stage 3 chronic kidney disease presented with progressive dyspnea on exertion and bilateral leg edema. On exam he had bibasilar crackles, elevated jugular venous pressure, and 2+ pitting edema. Chest X-ray showed cardiomegaly with interstitial pulmonary edema. Labs revealed BNP 1800 pg/mL and creatinine 1.8 mg/dL (baseline 1.5); troponin was negative. ECG demonstrated sinus tachycardia without ischemic changes. Transthoracic echocardiogram showed a left ventricular ejection fraction around 35% with global hypokinesis. The impression was acute decompensated heart failure with reduced ejection fraction and volume overload. He was treated with IV furosemide and a 1.5 L/day fluid restriction. His ACE inhibitor and beta-blocker were continued, and metformin was held. He improved with diuresis and was discharged on a low-sodium diet with cardiology follow-up.",
    "subclaim": "He had leg swelling.",
    "label": "supported"
  },
  {
    "medical_text": "A 45-year-old woman came to the ER with fever and pain in her right back. She also had burning when she peed. She had no known drug allergies. Her temperature was 39 C and her heart was beating fast. A urine test showed infection. An ultrasound of her kidneys looked normal with no blockage. She got one IV dose of an antibiotic and went home with ciprofloxacin pills for 7 days. Two days later she felt better, and the urine culture grew E. coli that was sensitive to ciprofloxacin. Blood cultures did not grow any germs.",
    "subclaim": "She was treated with oral ciprofloxacin for seven days.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman came to the hospital with fever and cough for three days. She had green mucus and was short of breath. Her temperature was 38.5\u00b0C, and her breathing was fast. A chest x-ray showed an infection in the right lower lung. Her blood test showed many white blood cells. Her oxygen level was low at 90% on room air. The team gave her oxygen and antibiotics through a vein. After two days, she felt better and no longer had a fever. She could breathe well with oxygen at 95% on room air. She went home with antibiotic pills for five more days and a clinic visit next week.",
    "subclaim": "Sputum culture grew Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man presented with three days of fever, productive cough, pleuritic chest pain, and dyspnea. On arrival, his vitals were T 38.5 C, HR 105, RR 24, BP 128/76, and SpO2 90% on room air. Lung exam revealed right basilar crackles. Chest radiograph showed right lower lobe consolidation; nasopharyngeal PCR for influenza A/B and SARS-CoV-2 was negative. Past history included hypertension and former tobacco use; he had no known drug allergies. Labs showed leukocytosis of 14,000 with neutrophil predominance and an elevated CRP. He was admitted for hypoxemic community-acquired pneumonia and started on ceftriaxone plus azithromycin intravenously with oxygen via nasal cannula at 2 L/min. By 48 hours he improved, was weaned to room air with SpO2 95%, and was preparing for transition to oral antibiotics and discharge.",
    "subclaim": "The influenza test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the hospital with a hot, red left lower leg. He had a small cut there two days earlier. He had fever to 38.5\u00b0C and felt tired. He has type 2 diabetes that is not well controlled. Blood tests showed high white cells. An ultrasound looked for a pocket of pus but found none. He got IV antibiotics called cefazolin. After two days his leg looked better and the fever went down. He went home on pill antibiotics to finish a 5-day course and was taught how to care for the wound.",
    "subclaim": "Ultrasound showed no drainable abscess.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man with type 2 diabetes presented with two days of fever, productive cough, and right-sided pleuritic chest pain. On arrival, his temperature was 38.5 C, respiratory rate 24, and oxygen saturation 91% on room air. Lung exam revealed crackles over the right lower lobe. Chest radiograph showed right lower lobe consolidation, consistent with community-acquired pneumonia. He was admitted for hypoxemia and comorbidity. Supplemental oxygen via nasal cannula was started, and empiric IV ceftriaxone plus azithromycin were given. Blood cultures were drawn prior to antibiotics; sputum could not be obtained. He reported no known drug allergies. Supportive care and return precautions were reviewed. Within 24 hours his oxygenation improved, and he was discharged on oral therapy to complete a 5-day course with follow-up in two days.",
    "subclaim": "He was told to drink more water.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man with type 2 diabetes presented with three days of cough, dyspnea, and fever. On arrival, oxygen saturation was 89% on room air, improving to 95% on 2 L nasal cannula. Chest radiograph showed a right lower lobe consolidation. He was diagnosed with community-acquired pneumonia. Empiric intravenous ceftriaxone plus azithromycin were started in the emergency department. He was admitted to the medical ward and did not require intensive care. Initial labs showed leukocytosis and elevated C-reactive protein. Two sets of blood cultures remained negative at 48 hours; influenza testing was negative. He improved clinically over 48 hours and was transitioned to oral antibiotics to complete a five-day course.",
    "subclaim": "He received intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "An adult woman came in with two days of fever, painful urination, and right flank pain. Exam showed tenderness over the right costovertebral angle. Urinalysis had leukocyte esterase and nitrites, consistent with a urinary infection. She received a single dose of IV antibiotic in the emergency department, then was switched to oral therapy. The urine culture grew Escherichia coli that was sensitive to ciprofloxacin. A renal ultrasound showed no hydronephrosis or abscess. Blood cultures had no growth. She was prescribed ciprofloxacin pills for a total of 7 days. Her symptoms improved within 48 hours, and she was afebrile by day three.",
    "subclaim": "The urine culture grew E. coli.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male with poorly controlled T2DM and HTN presented with 72 hours of fever, dysuria, urinary urgency, and right costovertebral angle tenderness. On admission: T 38.6\u00b0C, HR 104 bpm, BP 122/74 mmHg, SpO2 98% on room air. Labs showed WBC 15.2 \u00d7 10^3/\u00b5L with neutrophil predominance; serum creatinine 1.8 mg/dL (baseline 1.0), estimated eGFR ~45 mL/min/1.73 m\u00b2; and serum glucose 280 mg/dL. Urinalysis revealed positive nitrites and leukocyte esterase with >50 WBC/hpf; urine culture was pending initially. Noncontrast CT of the abdomen/pelvis demonstrated a striated right nephrogram consistent with acute pyelonephritis, without hydronephrosis or nephrolithiasis. Initial management included 2 liters of isotonic crystalloid, IV ceftriaxone 1 g every 24 hours, and subcutaneous insulin. He defervesced within 48 hours with improvement in flank pain and urinary symptoms. Two sets of blood cultures yielded Escherichia coli susceptible to third-generation cephalosporins and fluoroquinolones, and resistant to TMP-SMX. He was stepped down to oral ciprofloxacin and discharged to complete a 10-day total antibiotic course; serum creatinine improved to 1.2 mg/dL on follow-up.",
    "subclaim": "He was treated with trimethoprim-sulfamethoxazole.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the hospital with fever and cough. He had thick green mucus and sharp chest pain when he breathed. He has diabetes and lung disease (COPD). His oxygen level was low. A chest X-ray showed an infection in the right lower lung. A flu test was negative. He got IV antibiotics, ceftriaxone and azithromycin, and oxygen through a small tube in his nose at 2 liters per minute. Blood tests showed high white cells and high blood sugar. The sputum test later grew Streptococcus pneumoniae that should respond to ceftriaxone. After two days he felt better, the oxygen was stopped, and he went home on amoxicillin-clavulanate pills to finish five days total.",
    "subclaim": "The patient required admission to the ICU.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old male with T2DM and hypertension presented with 48 hours of febrile productive cough and exertional dyspnea. Vitals: T 38.6\u00b0C, HR 102, RR 24, BP 132/76, SpO2 89% on ambient air. Pulmonary exam showed right basilar crackles without accessory muscle use. Chest radiograph revealed focal consolidation in the right lower lobe; no pleural effusion or pneumothorax was seen. Labs: WBC 15.2\u00d710^3/\u00b5L (neutrophil predominant) with elevated CRP; serum lactate was normal. Rapid NAAT for influenza A/B and SARS-CoV-2 returned negative. Two sets of peripheral blood cultures were drawn before initiation of antimicrobials. Impression: community-acquired pneumonia requiring inpatient ward-level care. Empiric therapy with IV ceftriaxone plus azithromycin was started; metformin was held and DVT prophylaxis initiated. Supplemental oxygen via nasal cannula at 2 L/min increased SpO2 to 94%, and invasive ventilation was not required.",
    "subclaim": "The influenza test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old woman with type 2 diabetes, hypertension, and a penicillin allergy (rash) presented with three days of fever, productive cough, and dyspnea. She denied chest pain or leg swelling. Vitals in the ED were T 38.5\u00b0C, HR 110, RR 24, BP 128/76, and SpO2 90% on room air. Lung exam revealed crackles at the right lower lung field. Chest radiograph demonstrated right lower lobe consolidation consistent with community-acquired pneumonia. A rapid respiratory viral panel, including influenza and SARS-CoV-2 PCR, was negative. She was started on oxygen via nasal cannula at 2 L/min, with SpO2 improving to 95%. Empiric antibiotics were initiated with ceftriaxone and doxycycline, and she was admitted for hypoxemia and IV therapy.",
    "subclaim": "Oxygen saturation improved after oxygen therapy.",
    "label": "supported"
  },
  {
    "medical_text": "An older man came to the hospital with cough and fever for three days. He was short of breath and coughed up green mucus. The nurse checked him: his temperature was 101.5 F, he was breathing fast, and his oxygen level was 91% on room air. The doctor heard crackles on the left side of his chest. A chest x-ray showed a lung infection in the lower left lung. He got oxygen by a small tube in his nose and IV antibiotics, ceftriaxone and azithromycin. Tests for flu and COVID were negative. After two days, he felt better and could breathe without extra oxygen, with levels at 95%. Blood cultures did not grow any germs. He went home with pills to finish the antibiotics and a follow-up visit.",
    "subclaim": "The patient required admission to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old male with GOLD II COPD and hypertension presented with 3 days of fever (Tmax 38.5 C), productive cough, and exertional dyspnea. No history of beta-lactam hypersensitivity. Triage vitals: HR 105 bpm, BP 128/76 mmHg, RR 24/min, SpO2 90% on ambient air. Exam: right basilar crackles without wheeze. Labs: WBC 15.2 x10^9/L (85% neutrophils), CRP 120 mg/L, lactate 1.4 mmol/L, creatinine 0.9 mg/dL. Chest radiograph showed lobar consolidation in the right lower lobe consistent with community-acquired pneumonia. Respiratory viral PCR for SARS-CoV-2 and influenza A/B was negative; urine pneumococcal antigen was positive. Management included 2 L/min nasal cannula oxygen (SpO2 improved to 95%) and empiric ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily. Microbiologic cultures were sent with intent to de-escalate and transition to oral agents upon stabilization.",
    "subclaim": "He was treated with vancomycin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 38-year-old person came to the clinic with a cough for four days. The cough brought up yellow mucus. They had a fever and felt very tired. Breathing was a bit fast and hard. The finger oxygen number was 93%. A chest X-ray showed an infection in the lower right lung. The doctor said this was pneumonia. The person is allergic to penicillin. The doctor gave doxycycline pills to take twice a day for seven days and sent them home with an inhaler and fever medicine. Two days later they had no fever, were coughing less, and their oxygen was 96%.",
    "subclaim": "The chest X-ray showed a right lower lobe infiltrate.",
    "label": "supported"
  },
  {
    "medical_text": "A 72-year-old woman with T2DM presented with 72 hours of productive cough, fever, and exertional dyspnea. Vitals: T 38.5\u00b0C, HR 102 bpm, BP 132/76 mmHg, RR 22/min, SpO2 89% on room air; improved to 94\u201395% on 2 L/min nasal cannula. Pulmonary exam revealed right basilar crackles; chest radiograph demonstrated a focal right lower lobe air-space consolidation without pleural effusion. Laboratory data: WBC 14.2\u00d710^9/L (neutrophil-predominant), creatinine 0.9 mg/dL, serum glucose 220 mg/dL. She was admitted to the general medical ward and started on guideline-concordant empiric therapy with IV ceftriaxone and azithromycin. Two sets of peripheral blood cultures remained negative at 48 hours; sputum culture was non-diagnostic. No history of beta-lactam allergy was elicited. By hospital day 3 she was afebrile with improved work of breathing and was stepped down to oral antibiotics with plans for discharge.",
    "subclaim": "She received intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman with COPD and diabetes came to the hospital with fever and cough. She had green mucus and felt short of breath for three days. Her oxygen level was 88% on room air. A chest X-ray showed an infection in the right lower lung. She got oxygen through a nose tube, and her level rose to 94%. The team started IV antibiotics: ceftriaxone and azithromycin. Tests for flu and COVID were negative. Blood cultures were taken and have not grown any germs yet. She has no drug allergies and is being treated on the regular ward.",
    "subclaim": "Blood cultures grew Streptococcus pneumoniae within 24 hours.",
    "label": "not_supported"
  },
  {
    "medical_text": "The patient is a 45-year-old female with acute uncomplicated pyelonephritis, presenting with fever, dysuria, and right-sided flank pain. On arrival, T 39.0 C, HR 110, BP 118/72, SpO2 98% on room air. UA revealed positive nitrites, 3+ leukocyte esterase, and ~50 WBC/hpf; serum WBC 15.2 x10^9/L; lactate 1.2 mmol/L; eGFR ~95 mL/min/1.73 m^2. Point-of-care \u03b2-hCG was negative. Renal ultrasonography showed no hydronephrosis, calculi, or perinephric collection. She received ceftriaxone 1 g IV once, then was transitioned to ciprofloxacin 500 mg PO BID for a total of 7 days. Urine culture grew 10^5 CFU/mL E. coli with susceptibility: S to ciprofloxacin, TMP-SMX, ceftriaxone; R to ampicillin. Two sets of blood cultures remained negative at 48 hours. She improved clinically within 48 hours and was discharged with hydration advice and return precautions.",
    "subclaim": "The patient had right-sided flank pain.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes presented with 2 hours of substernal chest pressure and diaphoresis. ECG showed no ST-segment elevation. High-sensitivity troponin was elevated. He was diagnosed with a non\u2013ST-elevation myocardial infarction. He received aspirin, intravenous heparin, and a beta-blocker in the ED. Coronary angiography revealed a 90% proximal lesion in the left anterior descending artery. A drug-eluting stent was deployed with good result. He was discharged on aspirin, ticagrelor, high-intensity atorvastatin, and continued metformin.",
    "subclaim": "He was discharged on dual antiplatelet therapy.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male with type 2 diabetes and no prior coronary disease presented with 30 minutes of rest angina. The ECG demonstrated 1 mm horizontal ST-segment depressions in leads II, III, and aVF without ST elevation. High-sensitivity troponin I measured 120 ng/L (reference <20) with a rising delta. The working diagnosis was type 1 NSTEMI. Coronary angiography showed a 90% proximal right coronary artery stenosis; other vessels had only mild disease. PCI was performed with placement of a 3.0 \u00d7 18 mm everolimus-eluting stent, achieving TIMI 3 flow without complications. Transthoracic echocardiography showed a left ventricular ejection fraction of 55% with no regional wall motion abnormalities. He received aspirin loading then 81 mg daily, clopidogrel 75 mg daily, a high-intensity statin, metoprolol, and inpatient heparin. The discharge plan included 12 months of dual antiplatelet therapy, cardiac rehabilitation, and follow-up in two weeks.",
    "subclaim": "The echocardiogram showed reduced ejection fraction.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes and hypertension presented with 45 minutes of rest chest pain with nausea and diaphoresis. ECG showed 1-2 mm ST-segment depressions in lateral leads, and troponin I was elevated. He was diagnosed with a non-ST-elevation myocardial infarction. Aspirin and ticagrelor were loaded, and an unfractionated heparin infusion was started along with high-intensity statin therapy. Coronary angiography revealed a 90% proximal LAD stenosis. Percutaneous coronary intervention was performed with placement of a drug-eluting stent. Baseline creatinine was 1.6 mg/dL (eGFR about 48 mL/min/1.73 m^2), so metformin was held for 48 hours after contrast. Transthoracic echocardiogram showed a left ventricular ejection fraction of approximately 45% with mild anterior hypokinesis. He remained afebrile and hemodynamically stable, and was discharged on dual antiplatelet therapy, beta-blocker, ACE inhibitor, and statin with referral to cardiac rehabilitation.",
    "subclaim": "The diagnosis was a non-ST-elevation myocardial infarction.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man has had cough and fever for three days. He feels short of breath and has chest pain when he breathes. His temperature is 38.5 C and he breathes fast. His oxygen level is 92% on room air. He has high blood pressure and no drug allergies. A chest x-ray shows a new spot in the right lower lung, with no fluid. A nose swab test for COVID is negative. The doctor says he has community pneumonia and treats him at home. He gets mouth pills: amoxicillin-clavulanate and azithromycin. After two days, his fever goes down and oxygen is 95%.",
    "subclaim": "The patient was breathing fast.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man with type 2 diabetes mellitus and hypertension presented with 3 days of fever, productive cough, and dyspnea. He has a documented penicillin allergy (delayed maculopapular rash). On arrival: T 38.5\u00b0C, HR 102, BP 136/78 mmHg, RR 22/min, SpO2 89% on room air. Chest radiograph demonstrated a right lower lobe lobar consolidation. WBC 14.8\u00d710^9/L, CRP 120 mg/L, procalcitonin 0.6 ng/mL; lactate and creatinine were normal. Sputum Gram stain showed gram-positive diplococci, and culture yielded Streptococcus pneumoniae; blood cultures had no growth at 48 hours. Respiratory viral PCR, including influenza A/B, was negative. He received levofloxacin 750 mg daily (IV then oral) and supplemental oxygen at 2 L/min via nasal cannula, targeting SpO2 \u2265 92%. No systemic corticosteroids were given, and no ICU-level support was required. He defervesced and improved clinically, and was discharged on hospital day 3 with instructions to complete a 5-day total course of levofloxacin.",
    "subclaim": "He was treated with levofloxacin.",
    "label": "supported"
  },
  {
    "medical_text": "A 66-year-old man with hypertension, type 2 diabetes, active tobacco use, and hyperlipidemia presented with 45 minutes of exertional retrosternal pressure unresponsive to rest. Vitals were stable, with no signs of heart failure or shock. ECG demonstrated 1\u20132 mm ST depressions in V4\u2013V6 without ST elevation. High-sensitivity troponin I increased from 120 to 460 ng/L over 3 hours. He met criteria for non\u2013ST elevation myocardial infarction per the Fourth Universal Definition. Management included aspirin 325 mg, ticagrelor 180 mg loading then 90 mg twice daily, intravenous unfractionated heparin infusion, metoprolol tartrate, and high-intensity atorvastatin 80 mg nightly. Transthoracic echocardiography showed LVEF 55% with no regional wall-motion abnormalities or significant valvular disease. An early invasive strategy was pursued: angiography at 18 hours revealed an 80% proximal LAD lesion, and a drug-eluting stent was deployed with TIMI 3 flow. He was discharged on dual antiplatelet therapy, a beta-blocker, a statin, an ACE inhibitor, and was counseled on smoking cessation and cardiac rehabilitation.",
    "subclaim": "He had an allergy to aspirin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the ER with heavy chest pressure that went to his left arm. He felt sick to his stomach and was sweaty. He has high blood pressure, diabetes, and he smokes. His blood pressure was high and his pulse was fast, but his oxygen level was 98%, so he did not get oxygen. A heart tracing showed changes that worried the doctors. A blood test for heart damage was high. He was given chewable aspirin, a blood thinner shot, a strong cholesterol pill, and a pill to slow his heart. An X-ray of his chest looked normal. Doctors found a blocked heart artery and opened it with a stent. He went home on two anti-clot pills, a statin, and blood pressure medicine.",
    "subclaim": "The patient had a fever on arrival.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 65-year-old male with GOLD II COPD (former 40 pack-year smoker) presented with 72 hours of fever, purulent sputum, pleuritic chest pain, and dyspnea. Vitals: T 38.5\u00b0C, HR 102 bpm, BP 132/78 mmHg, RR 24/min, SpO2 89% on ambient air. Laboratory data: WBC 15.2 \u00d710^9/L with neutrophilia, CRP 120 mg/L, procalcitonin 0.4 ng/mL. Chest radiograph demonstrated right lower lobe lobar consolidation without pleural effusion. Supplemental oxygen was initiated via nasal cannula at 2\u20133 L/min to target SpO2 92\u201396%. Empiric community-acquired pneumonia therapy was started with IV ceftriaxone 1 g daily plus azithromycin 500 mg daily. Microbiology: two sets of blood cultures with no growth at 48 hours; urinary antigens for Streptococcus pneumoniae and Legionella negative; multiplex viral PCR including influenza A/B and SARS-CoV-2 negative. By 48 hours, the patient had clinical improvement and was transitioned to oral therapy to complete a five-day total antibiotic course. He was discharged on hospital day 3; home LAMA/LABA inhalers were continued; no history of beta-lactam allergy.",
    "subclaim": "A pleural effusion was seen on the chest x-ray.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 29-year-old woman presented with 48 hours of fever to 38.9 C, dysuria, frequency, and right flank pain. Vitals: HR 112 bpm, BP 108/68 mmHg; exam revealed right costovertebral angle tenderness. Labs showed WBC 14.8 x10^9/L with neutrophilia; creatinine 0.8 mg/dL. Urinalysis demonstrated positive leukocyte esterase, nitrites, pyuria, and bacteriuria. She received ceftriaxone 1 g IV once in the ED and was transitioned to oral ciprofloxacin 500 mg twice daily for 7 days. Urine culture grew >100,000 CFU/mL E. coli susceptible to ceftriaxone and ciprofloxacin; blood cultures remained negative. Renal ultrasound revealed no hydronephrosis, calculus, or perinephric abscess. She was discharged from the ED, improved within 48 hours, and was afebrile by day 3 with outpatient follow-up.",
    "subclaim": "She increased her fluid intake as advised.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with diabetes has a sore on his right foot for two weeks. The skin around it is red and warm. He has a fever. The team cleans the wound and removes dead tissue. His blood sugar is high. A lab test shows MRSA germs in the wound. He gets IV vancomycin in the hospital. Because his kidneys are not strong, the doctors change the dose. An MRI shows the bone is not infected. After five days, he feels better and goes home with pills and a plan to lower his sugar.",
    "subclaim": "He was discharged on oral doxycycline.",
    "label": "supported"
  },
  {
    "medical_text": "A 54-year-old female, with asthma and hypertension, presented with 3 days of fever, productive cough, and exertional dyspnea. Vitals: T 38.5 C, HR 104, BP 128/76, RR 24, SpO2 92% on room air. Chest radiograph demonstrated a focal right lower lobe alveolar consolidation, compatible with community-acquired pneumonia. WBC 14.2 x 10^9/L and CRP 120 mg/L; metabolic panel unremarkable. SARS-CoV-2 PCR and rapid influenza A/B were negative; two sets of blood cultures remained negative at 48 hours. Documented medication allergy: penicillin (pruritic rash). She was initiated on IV levofloxacin 750 mg daily and supplemental oxygen via nasal cannula, titrated to SpO2 >94%. Over 48 hours she showed clinical improvement, oxygenating at 96% on 2 L/min, and was transitioned to oral levofloxacin to complete a five-day total course with outpatient follow-up.",
    "subclaim": "She was discharged from the emergency department on the same day.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old male with hypertension and type 2 diabetes presents with acute dyspnea and bilateral lower-extremity edema. Vitals: HR 132 irregularly irregular, BP 118/72, RR 24, SpO2 89% on room air. ECG shows atrial fibrillation with rapid ventricular response and no ST-segment elevation. Chest radiograph reveals interstitial and alveolar edema with mild cardiomegaly. Labs: BNP 1200 pg/mL; creatinine 1.5 mg/dL (baseline 1.2); troponin I 0.03 ng/mL without dynamic rise. He received oxygen via nasal cannula and IV furosemide 40 mg with brisk diuresis. Intravenous diltiazem was administered for rate control. Apixaban was initiated for stroke prophylaxis in atrial fibrillation. Working diagnosis: acute decompensated heart failure precipitated by AF with RVR.",
    "subclaim": "The patient had a fever on arrival.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man came to the emergency room with cough and fever. He felt short of breath. His oxygen level was low at 90% on room air. A chest X-ray showed pneumonia in the right lower lung. He got oxygen through small tubes in his nose. Doctors started antibiotics. His temperature was 101.3 F. A spit test later showed strep pneumonia bacteria. After two days, he felt better. He went home on day three with pills.",
    "subclaim": "His temperature was 101.3 F.",
    "label": "supported"
  },
  {
    "medical_text": "A 70-year-old man presented after three days of fever, cough with yellow sputum, and pleuritic chest pain. On arrival he was febrile and short of breath; his oxygen saturation was 89% on room air. A chest X-ray showed consolidation in the right lower lobe, consistent with community-acquired pneumonia. He was admitted to the medical ward and placed on oxygen by nasal cannula. Empiric therapy with intravenous ceftriaxone and azithromycin was started. Sputum culture later grew Streptococcus pneumoniae; blood cultures remained negative. He improved over 48 hours and was weaned to low-flow oxygen. On hospital day three he was discharged home on oral antibiotics with outpatient follow-up.",
    "subclaim": "Influenza testing was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 54-year-old woman with asthma and hypertension presented with three days of fever, productive cough, and dyspnea. She reports a penicillin allergy manifested by rash. On arrival: temperature 38.5 C, heart rate 104, respiratory rate 24, blood pressure 128/76, and oxygen saturation 92% on room air. Chest x-ray showed right lower lobe consolidation consistent with community-acquired pneumonia. Laboratory testing showed leukocytosis and elevated C-reactive protein. SARS-CoV-2 and influenza tests were negative; blood cultures had no growth at 48 hours. She received supplemental oxygen via nasal cannula and was started on intravenous levofloxacin. After 48 hours she improved, was transitioned to oral therapy, and discharged to complete a five-day total antibiotic course with outpatient follow-up.",
    "subclaim": "The chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man with COPD and hypertension presented with two days of fever, productive cough, and shortness of breath. On arrival, his SpO2 was 89% on room air. Chest X-ray revealed right lower lobe consolidation consistent with community-acquired pneumonia. Initial labs showed WBC 15.2 K/\u00b5L with neutrophil predominance and BUN 28 mg/dL. CURB-65 was 2 (age \u226565 and elevated urea), so he was admitted to the medical ward. Empiric ceftriaxone 1 g IV daily plus azithromycin 500 mg IV daily were started, along with 2 L/min nasal cannula oxygen and bronchodilators as needed. Sputum culture grew Streptococcus pneumoniae susceptible to ceftriaxone and amoxicillin; influenza and SARS-CoV-2 tests were negative. After 48 hours he became afebrile and his oxygen saturation improved to 94% on room air; antibiotics were narrowed to oral amoxicillin to complete five days total. He received a pneumococcal vaccine prior to discharge.",
    "subclaim": "The influenza test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 54-year-old man with type 2 diabetes mellitus and no drug allergies presented with 3 days of fever, productive cough, and pleuritic right-sided chest pain. On arrival: T 38.6 C, HR 104 bpm, RR 24/min, BP 130/78 mmHg, SpO2 92% on ambient air; exam showed inspiratory crackles at the right base. CBC revealed leukocytosis (WBC 15.2 x10^9/L, neutrophils 86%), CRP 112 mg/L; procalcitonin 0.48 ng/mL. Chest radiograph demonstrated a right lower lobe air-space consolidation consistent with community-acquired pneumonia; PSI class II. Empiric therapy was initiated with IV ceftriaxone plus azithromycin and supplemental oxygen via nasal cannula at 2 L/min on the general medical ward. Sputum culture later grew Streptococcus pneumoniae (penicillin-susceptible); paired blood cultures showed no growth at 48 hours. By hospital day 2 he was afebrile, saturating 95% on room air, and transitioned to oral amoxicillin-clavulanate to complete 5 additional days. He received the seasonal inactivated influenza vaccine prior to discharge; PPSV23 had been administered 3 years earlier. He was discharged after 2 inpatient nights with outpatient follow-up in one week.",
    "subclaim": "Vancomycin was administered empirically.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old female with HTN and intermittent reactive airway disease presented with 72 hours of febrile cough and exertional dyspnea. On arrival: T 38.6\u00b0C, BP 126/72 mmHg, HR 108 bpm, RR 22/min, SpO2 90% RA, rising to 95% on 2 L/min nasal cannula. CXR revealed a focal right lower lobe air-space consolidation without effusion. CBC showed leukocytosis (WBC 14.2 K/\u00b5L, ANC 11.6 K/\u00b5L); CRP 112 mg/L. Multiplex respiratory PCR was negative for SARS-CoV-2 and influenza A/B. Empiric therapy with IV ceftriaxone 1 g q24h plus azithromycin 500 mg daily was initiated for nonsevere community-acquired pneumonia. Urinary Streptococcus pneumoniae antigen returned positive; two sets of blood cultures remained negative at 48 hours. Oxygen was weaned as symptoms improved; by hospital day 2 she maintained SpO2 96% on room air and was afebrile. There were no known drug allergies or recent antibiotic exposures. She was transitioned to oral amoxicillin-clavulanate to complete a total 5-day antibiotic course and discharged home on hospital day 3.",
    "subclaim": "COVID-19 and influenza PCR tests were negative.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with hypertension and type 2 diabetes presented with 3 days of fever, productive cough, and exertional dyspnea. He was febrile (38.6\u00b0C), tachycardic (110 bpm), tachypneic (24/min), and hypoxemic with SpO2 91% on ambient air. Chest radiography demonstrated a focal right lower lobe air-space consolidation consistent with community-acquired pneumonia. Laboratory evaluation showed neutrophilic leukocytosis (WBC 15.5 \u00d710^3/\u00b5L) and elevated CRP. Microbiologic testing revealed a positive urine Streptococcus pneumoniae antigen; multiplex respiratory viral PCR for influenza A/B and SARS-CoV-2 was negative. Empiric therapy with ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily was initiated along with 2 L/min nasal cannula oxygen; there were no known drug allergies. Two sets of blood cultures had no growth at 48 hours, and the patient defervesced with improving oxygenation, allowing weaning to room air with SpO2 95%. He was stepped down to oral amoxicillin\u2013clavulanate to complete a 7-day course and discharged in stable condition.",
    "subclaim": "Blood cultures were positive for bacteria.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male presented with 45 minutes of substernal chest pressure radiating to the left arm with diaphoresis and nausea. Past history included hypertension, type 2 diabetes, and active tobacco use; no drug allergies were reported. Initial vitals showed BP 160/92 mmHg, HR 98 bpm, and oxygen saturation 98% on room air; supplemental oxygen was not administered. ECG demonstrated 1\u20132 mm ST-segment depressions in lateral leads. High-sensitivity troponin was elevated and rising. Chest radiograph showed no acute process. He received chewable aspirin, IV unfractionated heparin, high-intensity atorvastatin, and metoprolol; nitroglycerin provided partial relief. Transthoracic echocardiogram revealed mild anterior wall hypokinesis with preserved ejection fraction. Same-day coronary angiography found a 90% proximal LAD lesion, which was treated with percutaneous coronary intervention using a drug-eluting stent. He was discharged on dual antiplatelet therapy, a statin, a beta-blocker, and an ACE inhibitor with smoking cessation counseling.",
    "subclaim": "Troponin levels were elevated.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old male presents with a 3-day history of febrile illness, productive cough, pleuritic chest pain, and exertional dyspnea. On arrival: T 38.5 C, HR 104 bpm, RR 24/min, BP 138/78 mmHg, SpO2 92% on ambient air; no confusion. Physical exam reveals bronchial breath sounds and inspiratory crackles over the right lower lung field; no wheeze. Laboratory studies show leukocytosis 15.2 x10^9/L with neutrophil predominance, CRP 12 mg/dL, procalcitonin 0.42 ng/mL, normal lactate and renal function. Posterior\u2013anterior chest radiograph demonstrates a focal right lower lobe consolidation without parapneumonic effusion. SARS-CoV-2 PCR and influenza antigen testing are negative; pneumococcal urine antigen and blood cultures are not obtained. Assessment: community-acquired pneumonia, low severity (PSI class II), appropriate for outpatient management. Treatment is initiated with oral amoxicillin-clavulanate 875/125 mg twice daily plus azithromycin (500 mg day 1, then 250 mg daily days 2\u20135), along with return precautions and smoking-cessation counseling. At 48 hours he shows clinical response with defervescence, improved SpO2 to 95% on room air, and reduced cough; no adverse drug effects are reported.",
    "subclaim": "The patient was admitted to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with T2DM (A1c 8.3%) and HTN presented with 45 minutes of substernal pressure radiating to the left arm. Initial ECG revealed 1\u20132 mm horizontal ST depressions in V4\u2013V6 with T-wave inversions; no ST elevation. hs-cTnT rose from 28 ng/L to 642 ng/L, consistent with NSTEMI. He received aspirin loading, ticagrelor, and unfractionated heparin; beta-blocker initiated. Coronary angiography showed a 90% thrombotic mid-LAD culprit; other coronaries had nonobstructive disease. PCI was performed with placement of a 3.0 \u00d7 24 mm everolimus-eluting stent, post-dilated to 3.5 mm, achieving TIMI 3 flow. Transthoracic echocardiogram demonstrated LVEF 55% without significant wall-motion abnormality. Creatinine was 1.4 mg/dL (eGFR ~55 mL/min/1.73 m2). He was discharged on day 2 with DAPT (aspirin 81 mg daily plus ticagrelor 90 mg bid), atorvastatin 80 mg nightly, metoprolol succinate, and lisinopril, with plan for 12 months of DAPT and cardiology follow-up.",
    "subclaim": "He does not smoke.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man presented from the community with 72 hours of fever, purulent sputum, and exertional dyspnea. Vitals: T 38.3\u00b0C, HR 102 bpm, BP 132/76 mmHg, RR 22/min; SpO2 88% on room air, rising to 95% on 2 L/min via nasal cannula. Chest radiography demonstrated a focal right lower lobe air-space opacity consistent with lobar consolidation. Impression: community-acquired pneumonia with mild hypoxemic respiratory failure; CURB-65 = 1 (age criterion). Laboratory data: WBC 15.2 \u00d710^9/L with neutrophilia; lactate 1.6 mmol/L; procalcitonin 0.4 ng/mL. No history of beta-lactam hypersensitivity; empiric IV ceftriaxone plus azithromycin were administered after obtaining two peripheral blood culture sets. Blood cultures showed no growth at 48 hours. Clinical status improved by hospital day 2; therapy was de-escalated to oral amoxicillin\u2013clavulanate to complete a 5-day total course. Immunizations: influenza vaccine documented last season; pneumococcal vaccination not previously administered.",
    "subclaim": "A urinary antigen test identified Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man came to the ER with cough and fever. He felt short of breath for three days. He has COPD and high blood pressure. He has no penicillin allergy. His oxygen level was 90% on room air. A chest X-ray showed pneumonia in the right lower lung. He got oxygen by nasal prongs, and his level rose to 95%. He was given IV ceftriaxone and azithromycin. Flu and COVID tests were negative. The doctor planned a total five-day course of antibiotics.",
    "subclaim": "He tested positive for COVID-19.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old male with HTN and T2DM presented with 30 minutes of rest angina radiating to the left arm, associated with diaphoresis and dyspnea. ECG demonstrated no STE, with nonspecific ST-T abnormalities. High-sensitivity troponin I was elevated at presentation and increased on repeat sampling at 3 hours, consistent with a rising delta. Clinical picture favored NSTE-ACS (probable NSTEMI). He received 325 mg chewable aspirin and therapeutic-dose enoxaparin; high-intensity atorvastatin and a beta-blocker were initiated. Chest X-ray was clear. Serum creatinine was mildly elevated, warranting renal monitoring prior to contrast exposure. Vitals remained stable, and chest pain improved after medical therapy. Plan is early invasive strategy with coronary angiography the following day. There was no fever, cough, or focal lung findings.",
    "subclaim": "The patient received aspirin.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came in with cough and fever for three days. He felt short of breath and had chest pain when he breathed. He had chills at night. His oxygen level was 90% on room air. The doctor heard crackles on the right side of his chest. A chest x-ray showed a lung infection in the right lower lobe. Flu and COVID tests were negative. He was given oxygen by a small tube in the nose and started on IV antibiotics, ceftriaxone and azithromycin. He has no drug allergies and takes medicine for high blood pressure. After two days he felt better, and his oxygen was 95% without extra oxygen.",
    "subclaim": "His oxygen saturation was 90% on room air at presentation.",
    "label": "supported"
  },
  {
    "medical_text": "A 66-year-old male with COPD and hypertension presented from home with 3 days of fever, purulent cough, and pleuritic dyspnea. Vitals: T 38.6 C, HR 105, RR 24, BP 138/82, SpO2 89% on room air. Chest radiograph demonstrated a right lower lobe lobar consolidation, consistent with community-acquired pneumonia; CURB-65 score was 1. Labs showed WBC 14.8 \u00d7 10^9/L and CRP 120 mg/L; creatinine remained at baseline. Rapid respiratory viral PCR was negative; urinary pneumococcal antigen was positive; initial blood cultures were negative. Empiric therapy with ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily was initiated. Supplemental oxygen was provided via nasal cannula at 2\u20133 L/min, along with scheduled bronchodilators. He was admitted to the general medicine ward; no ICU-level support was required. Within 48 hours the patient showed clinical improvement with reduced oxygen requirement. Plans were made to transition to oral amoxicillin\u2013clavulanate to complete a 5-day total antibiotic course; no beta-lactam allergy was reported.",
    "subclaim": "The patient had a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man presented with shortness of breath and leg edema. He had new atrial fibrillation with a heart rate near 120. Chest radiograph was consistent with pulmonary edema. BNP was elevated, and echocardiogram showed reduced left ventricular ejection fraction at 35%. He received intravenous furosemide and metoprolol for rate control. Anticoagulation with apixaban was initiated. Oxygen via nasal cannula at 2 L/min was given and later weaned. Creatinine rose from 1.2 to 1.8 mg/dL; potassium was 3.2 mmol/L and was repleted. After good urine output and 2 kg weight loss, his rate improved to around 80 bpm and symptoms eased.",
    "subclaim": "Apixaban therapy was initiated.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old male with COPD and hypertension presented from home with 3 days of fever, productive cough, and exertional dyspnea. Vitals on admission: T 38.3 C, HR 102 bpm, RR 24/min, BP 128/76 mm Hg, SpO2 89% on ambient air. Auscultation revealed right basilar crackles without accessory muscle use. Chest radiography demonstrated a focal right lower lobe consolidation consistent with community-acquired pneumonia. Low-flow supplemental oxygen via nasal cannula (2 L/min) was initiated to target SpO2 of at least 94%. Empiric intravenous ceftriaxone plus azithromycin were started; lactate was normal and there was no hypotension. Microbiology returned Streptococcus pneumoniae growth from sputum; blood cultures showed no growth, and SARS-CoV-2 PCR was negative. By hospital day 3 he was stable on room air and was transitioned to oral amoxicillin-clavulanate for discharge.",
    "subclaim": "He required mechanical ventilation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 45-year-old woman presented with fever, dysuria, and right costovertebral angle tenderness. Vitals showed T 39.0 C and pulse 110. Urinalysis was positive for leukocyte esterase and nitrites. CBC showed leukocytosis to 15,200/\u00b5L and creatinine was 0.9 mg/dL. Renal ultrasound demonstrated no hydronephrosis or stones. She received ceftriaxone 1 g IV in the ED and was discharged on ciprofloxacin 500 mg twice daily for 7 days. She reported symptomatic improvement within 48 hours. The urine culture grew >100,000 CFU/mL Escherichia coli susceptible to ciprofloxacin. Paired blood cultures showed no growth at 48 hours.",
    "subclaim": "The patient had right-sided flank pain.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with type 2 diabetes and hypertension presented with 45 minutes of substernal chest pressure. ECG showed lateral ST depressions with T-wave inversions. High-sensitivity troponin was elevated and rising. He was treated with aspirin, a P2Y12 inhibitor, and heparin. Coronary angiography demonstrated a 90% mid left anterior descending lesion felt to be the culprit. A drug-eluting stent was deployed with good result. Echocardiogram showed preserved left ventricular ejection fraction (~55%). He was discharged on hospital day 2 on dual antiplatelet therapy (aspirin plus ticagrelor), high-intensity statin, metoprolol, and an ACE inhibitor. He was counseled on diet and glycemic control.",
    "subclaim": "He had an ST-elevation myocardial infarction.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with type 2 diabetes and no prior coronary disease presented with 30 minutes of rest angina. The ECG demonstrated 1 mm horizontal ST-segment depressions in leads II, III, and aVF without ST elevation. High-sensitivity troponin I measured 120 ng/L (reference <20) with a rising delta. The working diagnosis was type 1 NSTEMI. Coronary angiography showed a 90% proximal right coronary artery stenosis; other vessels had only mild disease. PCI was performed with placement of a 3.0 \u00d7 18 mm everolimus-eluting stent, achieving TIMI 3 flow without complications. Transthoracic echocardiography showed a left ventricular ejection fraction of 55% with no regional wall motion abnormalities. He received aspirin loading then 81 mg daily, clopidogrel 75 mg daily, a high-intensity statin, metoprolol, and inpatient heparin. The discharge plan included 12 months of dual antiplatelet therapy, cardiac rehabilitation, and follow-up in two weeks.",
    "subclaim": "A drug-eluting stent was placed in the right coronary artery.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male with T2DM and HTN presented with 45 minutes of rest angina accompanied by nausea and diaphoresis. Initial ECG demonstrated 1-2 mm horizontal ST depressions in V4-V6; high-sensitivity troponin T rose to 5200 ng/L. He met Fourth Universal Definition criteria for NSTEMI. Management included aspirin 325 mg and ticagrelor 180 mg loading, intravenous unfractionated heparin, and initiation of high-intensity statin therapy. An early invasive strategy was pursued. Coronary angiography showed a focal 90% proximal LAD lesion; PCI was performed with deployment of a 3.0 x 24 mm everolimus-eluting stent. Given baseline creatinine 1.6 mg/dL (eGFR ~48 mL/min/1.73 m^2), metformin was withheld for 48 hours post-contrast to mitigate lactic acidosis risk. Transthoracic echocardiography revealed LVEF ~45% with mild anterior wall hypokinesis. He remained afebrile and hemodynamically stable and was discharged on DAPT (aspirin 81 mg daily plus ticagrelor 90 mg BID), metoprolol succinate, lisinopril, and high-intensity statin with referral to phase II cardiac rehabilitation.",
    "subclaim": "The patient had a fever on admission.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman came to the hospital with cough and fever. She felt short of breath and had chest pain when she coughed. She had chills at home. A chest x-ray showed a spot in the right lower lung. Her white blood cell count was high. She was given oxygen by a small tube in her nose to keep her level above 92%. The team started IV antibiotics, ceftriaxone and azithromycin. Her blood sugar was high because she has type 2 diabetes. Blood cultures did not grow bacteria after two days. She felt better and was switched to pills for discharge.",
    "subclaim": "Vancomycin was part of her initial antibiotic regimen.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with fever, cough with yellow mucus, and trouble breathing. His temperature was 38.5\u00b0C and his oxygen level was 90% on room air. A chest X-ray showed a spot in the right lower lung. The doctors said he had a lung infection from the community. They gave him oxygen through small tubes in his nose. He got two IV antibiotics: ceftriaxone and azithromycin. Blood tests and blood cultures were done before the first dose. After two days, he felt better and his oxygen was 95% without extra oxygen. He went home with pills to finish a 5-day total course, and he was offered a pneumonia shot.",
    "subclaim": "Oxygen was delivered through a nasal cannula.",
    "label": "supported"
  },
  {
    "medical_text": "A 65-year-old man had two days of fever, productive cough, pleuritic chest pain, and shortness of breath. On arrival, his temperature was 38.6\u00b0C and his oxygen saturation was 89% on room air. Chest examination revealed crackles at the right base. A chest X-ray showed right lower lobe consolidation consistent with community-acquired pneumonia. He reported a rash with amoxicillin in the past. He was started on intravenous levofloxacin and 2 L/min oxygen by nasal cannula. Nasopharyngeal PCR for influenza and SARS-CoV-2 was negative. Two sets of blood cultures drawn before antibiotics had no growth at 48 hours. By 48 hours, he was afebrile and maintaining 94% on room air. He was discharged on hospital day three with oral levofloxacin to complete a five-day total course.",
    "subclaim": "He was treated with amoxicillin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old male with poorly controlled T2DM and HTN presented with 72 hours of fever, dysuria, urinary urgency, and right costovertebral angle tenderness. On admission: T 38.6\u00b0C, HR 104 bpm, BP 122/74 mmHg, SpO2 98% on room air. Labs showed WBC 15.2 \u00d7 10^3/\u00b5L with neutrophil predominance; serum creatinine 1.8 mg/dL (baseline 1.0), estimated eGFR ~45 mL/min/1.73 m\u00b2; and serum glucose 280 mg/dL. Urinalysis revealed positive nitrites and leukocyte esterase with >50 WBC/hpf; urine culture was pending initially. Noncontrast CT of the abdomen/pelvis demonstrated a striated right nephrogram consistent with acute pyelonephritis, without hydronephrosis or nephrolithiasis. Initial management included 2 liters of isotonic crystalloid, IV ceftriaxone 1 g every 24 hours, and subcutaneous insulin. He defervesced within 48 hours with improvement in flank pain and urinary symptoms. Two sets of blood cultures yielded Escherichia coli susceptible to third-generation cephalosporins and fluoroquinolones, and resistant to TMP-SMX. He was stepped down to oral ciprofloxacin and discharged to complete a 10-day total antibiotic course; serum creatinine improved to 1.2 mg/dL on follow-up.",
    "subclaim": "He received intravenous ceftriaxone.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with cough, fever, and short breath for 3 days. He had chest pain when he coughed. He has no drug allergies. His oxygen level was low at first, so the team gave him oxygen by a small tube in his nose. A chest X-ray showed a new spot in the right lower lung, which means pneumonia. A COVID-19 test was negative. He got two antibiotics through a vein, then pills when he felt better. The fever went away by day 2, and his breathing got better. He went home on day 3 with more antibiotic pills to finish 7 days. He was told to return if symptoms got worse.",
    "subclaim": "He was discharged home on day 3.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the hospital with cough and fever for two days. He felt short of breath. His oxygen level was 90% on room air. A chest X-ray showed an infection in the lower right lung. The doctor said he had pneumonia that started in the community. He is allergic to penicillin, so they gave him azithromycin pills. He also got oxygen through a small tube in his nose. After two days, his breathing was better and his oxygen was 95% on room air. Blood cultures did not grow germs, but his sputum grew a common pneumonia germ. He went home on day three to finish five days of azithromycin and he got a pneumonia vaccine before leaving.",
    "subclaim": "The admission blood pressure was low.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman with COPD presented after two days of worsening shortness of breath and cough. She denied fever. Vitals showed an oxygen saturation of 88% on room air and mild tachypnea. On exam, there were diffuse wheezes without focal crackles. Chest X-ray showed no focal consolidation to suggest pneumonia. A respiratory viral panel was positive for rhinovirus, and her white blood cell count was within normal limits. She was started on supplemental oxygen, nebulized albuterol/ipratropium, and oral prednisone. Because the findings suggested a viral exacerbation, antibiotics were not started. Her oxygen improved to 94% on low-flow oxygen, and her symptoms eased. She was discharged with a long-acting bronchodilator inhaler and a short steroid taper.",
    "subclaim": "Bacterial pneumonia was diagnosed.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman came to the hospital because she was short of breath. She has lung disease called COPD. For three days she had more cough and thick mucus. Her oxygen was low, but it got better with a small tube in her nose. She uses a daily inhaler at home and kept using it. The chest x-ray looked clear and did not show pneumonia. A virus test showed a common cold virus. She got breathing treatments, steroid pills, and an antibiotic pill. She felt better and went home the next day.",
    "subclaim": "She went home the next day.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the ER with trouble breathing and ankle swelling. His heartbeat was fast and uneven; the doctor called it AFib. A chest X-ray showed fluid in his lungs. The team told him he has heart failure and too much fluid. He got an IV water pill to pee out the fluid and a heart rate medicine. They also started a blood thinner called apixaban. His oxygen was 2 liters by nose at first, then he did not need it. By the next day, his heart rate was about 80, he felt better, and he went home with follow-up.",
    "subclaim": "He has diabetes mellitus.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old woman came to the hospital with cough, fever, and trouble breathing. Her oxygen level was low at 90% in room air. A chest x-ray showed a spot in the right lower lung. Tests for COVID-19 and flu were negative. The team started IV antibiotics, ceftriaxone and azithromycin. Her fever and breathing got better after two days. She did not have any drug allergies. She no longer needed oxygen and kept 96% on room air. Blood cultures did not grow germs. She went home on amoxicillin-clavulanate to finish five days of treatment.",
    "subclaim": "COVID-19 and influenza PCR tests were negative.",
    "label": "supported"
  },
  {
    "medical_text": "A 65-year-old male presented after 48 hours of fever, productive cough, and right-sided pleuritic chest pain. Vitals: T 38.6\u00b0C, HR 104, BP 132/78, RR 24, SpO2 89% on room air. Exam: crackles and bronchial breath sounds at the right lower lung field without percussion dullness. Labs showed WBC 14.8 \u00d710^9/L (85% neutrophils), CRP 115 mg/L, procalcitonin 0.6 ng/mL, and creatinine 0.9 mg/dL. Chest radiograph demonstrated focal right lower lobe airspace consolidation without pleural effusion. Impression: community-acquired bacterial pneumonia with a reported non-anaphylactic beta-lactam allergy (maculopapular rash to amoxicillin). Management included supplemental oxygen via nasal cannula at 2 L/min and IV levofloxacin started after two sets of blood cultures were obtained. Respiratory viral PCR (influenza A/B, SARS-CoV-2) was negative; blood cultures remained negative at 48 hours. At 48 hours he was afebrile with SpO2 94% on ambient air and improved respiratory symptoms. He was discharged on hospital day three with oral levofloxacin to complete a five-day total antibiotic course.",
    "subclaim": "Sputum culture identified Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with cough, fever, and short breath for 3 days. He had chest pain when he coughed. He has no drug allergies. His oxygen level was low at first, so the team gave him oxygen by a small tube in his nose. A chest X-ray showed a new spot in the right lower lung, which means pneumonia. A COVID-19 test was negative. He got two antibiotics through a vein, then pills when he felt better. The fever went away by day 2, and his breathing got better. He went home on day 3 with more antibiotic pills to finish 7 days. He was told to return if symptoms got worse.",
    "subclaim": "He was admitted to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man presented with 3 days of fever, productive cough, and dyspnea. On arrival, his temperature was 38.5 C, blood pressure 128/74, heart rate 102, and oxygen saturation was 90% on room air, improving to 95% on 2 L via nasal cannula. Chest radiograph demonstrated a right lower lobe consolidation consistent with community-acquired pneumonia. SARS-CoV-2 PCR was negative. White blood cell count was 14.2 x10^9/L and C-reactive protein was elevated; procalcitonin measured 0.6 ng/mL. He reported no known drug allergies. He was started on intravenous ceftriaxone and azithromycin; two sets of blood cultures showed no growth at 48 hours. By hospital day 2 he was afebrile with improved oxygenation, and antibiotics were transitioned to oral amoxicillin-clavulanate to complete a 7-day course. He was discharged home on day 3 with instructions to follow up with his primary care physician.",
    "subclaim": "He was admitted to the intensive care unit.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old male with no significant comorbidities presented after 3 days of fever, productive cough, and exertional dyspnea. Vitals in the ED: T 38.3\u00b0C, HR 102 bpm, RR 24/min, BP 128/76 mmHg, SpO2 90% on ambient air. Laboratory studies showed leukocytosis to 14.2 \u00d710^9/L with neutrophil predominance and CRP 120 mg/L. Chest radiography revealed a focal right lower lobe air-space consolidation, compatible with community-acquired pneumonia. Two sets of peripheral blood cultures were drawn before antimicrobial therapy. The patient received supplemental oxygen by nasal cannula and empiric intravenous ceftriaxone plus azithromycin. Nasopharyngeal SARS-CoV-2 RT-PCR returned negative. Clinical status improved within 48 hours with defervescence and SpO2 95% on 2 L/min oxygen. He was discharged on day 2 with oral azithromycin to complete a 5-day total antibiotic course and outpatient follow-up in 1 week.",
    "subclaim": "Blood cultures later grew Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman came to the emergency room. She had a cough and fever for three days. Breathing was hard, and her chest hurt when she took a deep breath. Her temperature was 101.5\u00b0F. Her oxygen level was 90% on room air. A chest X-ray showed a spot in the right lower lung. The doctor said she had pneumonia from the community. She got oxygen through a small tube in her nose and IV antibiotics. She felt better and went home after two days with antibiotic pills. She has type 2 diabetes and no drug allergies.",
    "subclaim": "She tested positive for influenza.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man presented with three days of fever, productive cough, and dyspnea. On arrival, oxygen saturation was 90% on room air, temperature 38.3\u00b0C, heart rate 102, and respiratory rate 24. Chest radiograph demonstrated right lower lobe consolidation consistent with community-acquired pneumonia. Blood cultures were obtained prior to starting antibiotics. He was started on supplemental oxygen via nasal cannula and given intravenous ceftriaxone plus azithromycin. A nasopharyngeal PCR for SARS-CoV-2 was negative. Over 48 hours, his oxygenation and fevers improved. He was discharged on oral azithromycin to complete a 5-day course, with follow-up arranged in one week.",
    "subclaim": "Blood cultures later grew Streptococcus pneumoniae.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman with long-term lung disease is sick. She has cough, fever, and hard breathing for three days. Her blood oxygen is low. A chest picture shows an infection in the right lower lung. A blood test shows high white cells. She gets IV antibiotics, oxygen, and breathing treatments. She also takes steroid pills. Her COVID test is negative. After three days she feels better and can breathe room air. She goes home with pills and a plan to see her doctor in one week.",
    "subclaim": "The chest radiograph showed a right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male with no chronic lung disease presented with 72 hours of fever, productive purulent sputum, and exertional dyspnea. Vitals: T 38.5 C, HR 110 bpm, RR 24/min, BP 128/76 mmHg, SpO2 91% on ambient air. Pulmonary exam demonstrated focal crackles over the right lower lung field. Chest radiograph revealed lobar consolidation of the right lower lobe, establishing community-acquired pneumonia. He reported a non-anaphylactic penicillin allergy (rash). Oxygen via nasal cannula at 2 L/min raised SpO2 to 96%; levofloxacin 750 mg daily was initiated. Labs showed leukocytosis (WBC 14.2 x10^3/uL, neutrophil predominant) and elevated CRP. Legionella urinary antigen was negative; blood cultures showed no growth at 48 hours. With clinical improvement by hospital day 2, discharge was arranged on day 3 to complete a 5-day antibiotic course.",
    "subclaim": "The Legionella urine antigen test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man comes to the ER with cough and fever. He has trouble breathing and chest pain when he coughs. He smokes and has COPD. His oxygen level is low. A chest X-ray shows infection in the right lower lung. The team gives IV antibiotics and oxygen by a nasal tube. He does not have a penicillin allergy. His blood cultures do not grow bacteria. After two days, his breathing is better and his fever goes down. He goes home on oral antibiotics.",
    "subclaim": "The chest X-ray showed a left upper lobe infiltrate.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 56-year-old man came to the emergency room with cough for three days. He had fever and felt short of breath. He had pain on the right side when he took a deep breath. His oxygen level was 91% on room air. A chest x-ray showed an infection in the right lower lung. He is allergic to penicillin. He got azithromycin pills for five days. He also got oxygen through small tubes in his nose, and his level went up to 95%. He went home the same day with a plan to check in two days. The doctor told him to rest and drink plenty of fluids.",
    "subclaim": "The chest x-ray showed a right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "Mr. Lee is 68 years old and has lung disease (COPD). He had fever and a bad cough for two days. At the hospital, his oxygen was low at 90% on room air. A chest picture showed an infection in the right lower part of his lung. The team gave him oxygen through a small tube under his nose. He got antibiotics through a vein to treat the pneumonia. They said he has no drug allergies. After two days, he felt better and his oxygen was 95% without extra oxygen. Blood cultures from his arm showed no germs. He may go home soon on pills.",
    "subclaim": "Ceftriaxone and azithromycin were given intravenously.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man came to the hospital. He had a bad cough for three days. He had a fever and felt short of breath. The doctor heard crackles on the right side of his chest. A chest x-ray showed pneumonia in the right lower lung. His blood test showed a high white blood cell count. He got oxygen through a small tube in his nose at 2 liters per minute. He was given IV antibiotics, ceftriaxone and azithromycin. Flu and Legionella tests were negative. After two days, he felt better, was off oxygen, and the team planned to switch him to pills to finish treatment.",
    "subclaim": "The white blood cell count was elevated.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old male with T2DM (A1c 8.2%) and hypertension presented after 72 hours of fever, pleuritic cough, and dyspnea. Vitals: T 38.5\u00b0C, HR 102, RR 24, BP 138/82, SpO2 90% on room air; crackles at the right base. CXR showed focal consolidation in the right lower lobe consistent with community-acquired pneumonia. WBC was 15.2 \u00d7 10^9/L and CRP 112 mg/L; creatinine 0.9 mg/dL. Nasopharyngeal SARS-CoV-2 PCR and influenza testing were negative. Initial management included 2 L/min oxygen by nasal cannula and empiric ceftriaxone plus azithromycin. Sputum Gram stain revealed gram-positive diplococci; blood cultures had no growth at 48 hours. By hospital day 2 he was afebrile, maintaining SpO2 \u226596% on room air, and transitioned to oral amoxicillin\u2013clavulanate to complete a total 5-day course. No documentation of prior pneumococcal vaccination was found.",
    "subclaim": "The chest X-ray showed right lower lobe pneumonia.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman with chronic obstructive pulmonary disease presented with three days of worsening dyspnea, cough, and increased sputum. On arrival, oxygen saturation was 89% on room air, improving to 94% on 2 L nasal cannula. She continued her home tiotropium inhaler. Chest radiograph showed no focal consolidation to suggest pneumonia. Respiratory viral PCR detected rhinovirus. She received nebulized albuterol/ipratropium, systemic corticosteroids (prednisone 40 mg daily), and oral azithromycin. She was admitted to the general medical ward and did not require intubation or ICU care. Her symptoms improved with treatment, and she was discharged after clinical stabilization.",
    "subclaim": "She was given intravenous antibiotics.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man came to the hospital. He had a bad cough for three days. He had a fever and felt short of breath. The doctor heard crackles on the right side of his chest. A chest x-ray showed pneumonia in the right lower lung. His blood test showed a high white blood cell count. He got oxygen through a small tube in his nose at 2 liters per minute. He was given IV antibiotics, ceftriaxone and azithromycin. Flu and Legionella tests were negative. After two days, he felt better, was off oxygen, and the team planned to switch him to pills to finish treatment.",
    "subclaim": "Rapid influenza testing was negative.",
    "label": "supported"
  },
  {
    "medical_text": "A 38-year-old otherwise healthy adult presented with 4 days of productive cough, fever, and exertional dyspnea. On exam: T 38.5\u00b0C, HR 104, RR 22, BP 120/76 mmHg, SpO2 93% on ambient air; scattered rhonchi at the right base. Laboratory testing showed WBC 13.2 \u00d710^9/L with neutrophil predominance; procalcitonin 0.34 ng/mL. Chest radiograph revealed a focal right lower lobe consolidation consistent with community-acquired pneumonia. SARS-CoV-2 and influenza A/B PCR were negative. Given a history of immediate penicillin hypersensitivity and CURB-65 score 0, outpatient management was selected. Doxycycline 100 mg PO BID was prescribed for 7 days; acetaminophen and albuterol MDI PRN were provided. Discharge instructions included return precautions and telephonic follow-up at 48 hours. At 48 hours the patient reported symptomatic improvement, was afebrile, and home pulse oximetry read 96%.",
    "subclaim": "The patient received azithromycin as the only antibiotic.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old man with hypertension and type 2 diabetes, and no smoking history, presented with cough and shortness of breath. On arrival, his oxygen saturation was 90% on room air, improving to 95% on 2 L/min nasal cannula. Chest radiograph demonstrated a right lower lobe consolidation. The working diagnosis was community-acquired pneumonia. He was started on intravenous ceftriaxone plus azithromycin and supplemental oxygen. Initial labs showed leukocytosis and elevated C-reactive protein; renal function and troponin were normal. SARS-CoV-2 PCR was negative; blood cultures remained negative during hospitalization. He was cared for on the general medical ward. By hospital day 2, his dyspnea improved, and antibiotics were transitioned to an oral regimen. He was discharged on hospital day 3 with follow-up arranged.",
    "subclaim": "His serum creatinine was elevated.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman came in with leg swelling and shortness of breath. She had gained weight this week but no chest pain or fever. Her exam showed ankle edema, and her oxygen level was okay. A chest X-ray showed fluid in the lungs. A heart ultrasound showed an ejection fraction of about 30%. She got IV water pill medicine (furosemide) and passed a lot of urine. She started sacubitril/valsartan and a beta blocker. Spironolactone was not started because her potassium was 5.2. She was told to eat less salt and to check her weight, with a follow-up in one week.",
    "subclaim": "The chest X-ray showed pneumonia.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man with long-standing type 2 diabetes presented with a painful plantar foot ulcer with purulent drainage. He had a low-grade fever and his capillary glucose was elevated on arrival. Laboratory tests showed leukocytosis and a high HbA1c, consistent with poor glycemic control. The wound was debrided and irrigated, and an X-ray of the foot did not show osteomyelitis. Empiric intravenous cefazolin was started, with plans to transition to oral cephalexin once improving. The wound culture later grew methicillin-susceptible Staphylococcus aureus. He clinically improved and was switched to oral therapy before discharge. He was advised to offload the foot and follow up with podiatry.",
    "subclaim": "He had a positive MRSA nasal screen.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man with GOLD II COPD and a 40-pack-year smoking history presented with 72 hours of productive cough, pleuritic right-sided chest pain, dyspnea, and fever/chills. Vitals: T 38.4\u00b0C, HR 108 bpm, BP 128/74 mmHg, RR 24/min, SpO2 89% on ambient air, improving to 95% on 2 L/min nasal cannula. Exam: increased work of breathing with bronchial breath sounds and crackles over the right infrascapular region; no peripheral edema. CXR shows focal right lower lobe air-space consolidation without pleural effusion; no pneumothorax. Labs: WBC 14.5 \u00d710^9/L (neutrophils 85%), CRP 110 mg/L, procalcitonin 0.42 ng/mL, creatinine 0.9 mg/dL, lactate 1.2 mmol/L. Two sets of blood cultures and a sputum culture were obtained prior to antimicrobials; cultures were negative at 48 hours; urinary antigens for Streptococcus pneumoniae and Legionella were negative. Empiric therapy was initiated with IV ceftriaxone (1 g q24h) plus azithromycin (500 mg daily) and supplemental oxygen; home bronchodilators were continued. The patient denied prior antibiotic reactions; no MRSA risk factors or aspiration features were identified. Within 48 hours he defervesced, oxygenation improved, and respiratory rate decreased to 18/min without hypotension; no ICU-level support was required. He was transitioned to oral amoxicillin-clavulanate to complete a seven-day total antibiotic course and discharged home with follow-up.",
    "subclaim": "He was started on intravenous ceftriaxone plus azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "Mr. Lee is 68 years old and has lung disease (COPD). He had fever and a bad cough for two days. At the hospital, his oxygen was low at 90% on room air. A chest picture showed an infection in the right lower part of his lung. The team gave him oxygen through a small tube under his nose. He got antibiotics through a vein to treat the pneumonia. They said he has no drug allergies. After two days, he felt better and his oxygen was 95% without extra oxygen. Blood cultures from his arm showed no germs. He may go home soon on pills.",
    "subclaim": "He required mechanical ventilation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man presented with three days of fever, productive cough, pleuritic chest pain, and dyspnea. On arrival, his vitals were T 38.5 C, HR 105, RR 24, BP 128/76, and SpO2 90% on room air. Lung exam revealed right basilar crackles. Chest radiograph showed right lower lobe consolidation; nasopharyngeal PCR for influenza A/B and SARS-CoV-2 was negative. Past history included hypertension and former tobacco use; he had no known drug allergies. Labs showed leukocytosis of 14,000 with neutrophil predominance and an elevated CRP. He was admitted for hypoxemic community-acquired pneumonia and started on ceftriaxone plus azithromycin intravenously with oxygen via nasal cannula at 2 L/min. By 48 hours he improved, was weaned to room air with SpO2 95%, and was preparing for transition to oral antibiotics and discharge.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man with GOLD II COPD and a 40-pack-year smoking history presented with 72 hours of productive cough, pleuritic right-sided chest pain, dyspnea, and fever/chills. Vitals: T 38.4\u00b0C, HR 108 bpm, BP 128/74 mmHg, RR 24/min, SpO2 89% on ambient air, improving to 95% on 2 L/min nasal cannula. Exam: increased work of breathing with bronchial breath sounds and crackles over the right infrascapular region; no peripheral edema. CXR shows focal right lower lobe air-space consolidation without pleural effusion; no pneumothorax. Labs: WBC 14.5 \u00d710^9/L (neutrophils 85%), CRP 110 mg/L, procalcitonin 0.42 ng/mL, creatinine 0.9 mg/dL, lactate 1.2 mmol/L. Two sets of blood cultures and a sputum culture were obtained prior to antimicrobials; cultures were negative at 48 hours; urinary antigens for Streptococcus pneumoniae and Legionella were negative. Empiric therapy was initiated with IV ceftriaxone (1 g q24h) plus azithromycin (500 mg daily) and supplemental oxygen; home bronchodilators were continued. The patient denied prior antibiotic reactions; no MRSA risk factors or aspiration features were identified. Within 48 hours he defervesced, oxygenation improved, and respiratory rate decreased to 18/min without hypotension; no ICU-level support was required. He was transitioned to oral amoxicillin-clavulanate to complete a seven-day total antibiotic course and discharged home with follow-up.",
    "subclaim": "The chest radiograph showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old man came to the hospital with fever, cough with yellow mucus, and trouble breathing. His temperature was 38.5\u00b0C and his oxygen level was 90% on room air. A chest X-ray showed a spot in the right lower lung. The doctors said he had a lung infection from the community. They gave him oxygen through small tubes in his nose. He got two IV antibiotics: ceftriaxone and azithromycin. Blood tests and blood cultures were done before the first dose. After two days, he felt better and his oxygen was 95% without extra oxygen. He went home with pills to finish a 5-day total course, and he was offered a pneumonia shot.",
    "subclaim": "The patient received vancomycin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 42-year-old woman came to the hospital with fever, chills, and pain in her right lower back. She had burning when she peed. The team said she had a kidney infection. Her urine test showed germs, and later the lab found E. coli. She got fluids in a vein and IV antibiotics. She also got pain medicine. An ultrasound of her kidneys showed no block or stones. She felt better after two days, switched to pills, and went home on day three with 10 days of antibiotics.",
    "subclaim": "A CT scan of the abdomen was performed.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old female presented with 3 days of productive cough, fever, and dyspnea. She reported pleuritic chest discomfort with coughing. Chest radiograph showed right lower lobe consolidation. WBC was 14.2k with neutrophil predominance; serum creatinine was normal; glucose was 220 mg/dL in the setting of known type 2 diabetes. Oxygen via nasal cannula at 2 L/min maintained SpO2 above 92%. Empiric IV ceftriaxone plus azithromycin were started for community-acquired pneumonia. Sputum culture was pending; two sets of blood cultures had no growth at 48 hours. She reported no drug allergies. By hospital day 3 she was afebrile with improving oxygenation and transitioned to oral therapy. Discharge home with follow-up was planned.",
    "subclaim": "The chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man came to the emergency room with chest pressure for 45 minutes. He has diabetes and high blood pressure. He does not smoke. The heart tracing showed changes that worried the team. A blood test for heart damage (troponin) was high. The doctors said he was having a heart attack. He got aspirin and shots of blood thinner. He then had a stent put in to open a very tight heart artery. It was a drug-eluting stent in the front artery of the heart (LAD). He went home two days later on two blood thinners, a beta blocker, a strong statin, and a blood pressure pill.",
    "subclaim": "He underwent bypass surgery.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman presented with febrile illness, productive cough, and pleuritic right-sided chest pain, found hypoxemic with SpO2 89% on ambient air and tachycardic to 110 bpm. Pulmonary exam revealed coarse crackles at the right base. Chest radiograph demonstrated a right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Laboratory studies showed leukocytosis to 15 x10^9/L with left shift, normal creatinine (0.9 mg/dL) and lactate. She was placed on 2 L/min nasal cannula, with SpO2 improving to 95%. Antimicrobial therapy with ceftriaxone and azithromycin was initiated intravenously. Respiratory viral testing (influenza A/B, SARS-CoV-2) was negative, while the pneumococcal urine antigen returned positive. Blood cultures remained without growth at 48 hours; no history of penicillin allergy was reported. She was managed on the general ward, transitioned to oral amoxicillin-clavulanate to complete a 7-day course, and received pneumococcal vaccination prior to discharge. Clinical status improved, allowing discharge home on hospital day 4 with outpatient follow-up arranged.",
    "subclaim": "She had a penicillin allergy.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man presented with shortness of breath and leg edema. He had new atrial fibrillation with a heart rate near 120. Chest radiograph was consistent with pulmonary edema. BNP was elevated, and echocardiogram showed reduced left ventricular ejection fraction at 35%. He received intravenous furosemide and metoprolol for rate control. Anticoagulation with apixaban was initiated. Oxygen via nasal cannula at 2 L/min was given and later weaned. Creatinine rose from 1.2 to 1.8 mg/dL; potassium was 3.2 mmol/L and was repleted. After good urine output and 2 kg weight loss, his rate improved to around 80 bpm and symptoms eased.",
    "subclaim": "He was treated with digoxin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old man came in with cough and fever. He felt short of breath and had pain on the right when he breathed. His oxygen level was low at 91 percent. An x-ray showed a patch in the right lower lung. The doctor said he had a lung infection from the community. He got oxygen by a small tube in his nose. He was given two antibiotics in a vein: ceftriaxone and azithromycin. Blood cultures were taken before the drugs. He had no drug allergies, and was told to drink more water and use a breathing tool. After one day he felt better, went home on pills to finish five days, and would see his doctor in two days.",
    "subclaim": "His room-air oxygen saturation was 91 percent at presentation.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old male presented from home with three days of fever, productive cough, and dyspnea. On arrival, SpO2 was 88% on room air, improving to 95% on 2 L/min nasal cannula. Chest radiograph showed right lower lobe consolidation, consistent with community-acquired pneumonia. White blood cell count was 15,200/\u00b5L; serum lactate was normal. He reported no penicillin allergy and received IV ceftriaxone plus azithromycin after cultures were drawn. Two sets of blood cultures remained negative at 48 hours. CURB-65 score was 1 (age), and he was admitted to a medical ward for hypoxemia. By hospital day 2, symptoms and oxygenation improved; he was transitioned to oral amoxicillin-clavulanate. He had an influenza vaccination last season but no prior pneumococcal vaccination.",
    "subclaim": "The chest x-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 55-year-old woman came to the hospital with fever and right side back pain. She has type 2 diabetes. She felt burning when she peed. Her urine culture later grew E. coli. Her temperature was 38.7\u00b0C. A pee test showed bacteria and many white blood cells. A belly scan showed no kidney stones or a pocket of pus. The doctors said she had a kidney infection. She got antibiotics through a vein, then pills at home. Her fever eased in one day, and blood cultures were negative before she went home after two days.",
    "subclaim": "The CT scan showed no kidney stones.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old male with GOLD II COPD and hypertension presented with 3 days of fever (Tmax 38.5 C), productive cough, and exertional dyspnea. No history of beta-lactam hypersensitivity. Triage vitals: HR 105 bpm, BP 128/76 mmHg, RR 24/min, SpO2 90% on ambient air. Exam: right basilar crackles without wheeze. Labs: WBC 15.2 x10^9/L (85% neutrophils), CRP 120 mg/L, lactate 1.4 mmol/L, creatinine 0.9 mg/dL. Chest radiograph showed lobar consolidation in the right lower lobe consistent with community-acquired pneumonia. Respiratory viral PCR for SARS-CoV-2 and influenza A/B was negative; urine pneumococcal antigen was positive. Management included 2 L/min nasal cannula oxygen (SpO2 improved to 95%) and empiric ceftriaxone 1 g IV q24h plus azithromycin 500 mg IV daily. Microbiologic cultures were sent with intent to de-escalate and transition to oral agents upon stabilization.",
    "subclaim": "His oxygen saturation was 90% on room air at presentation.",
    "label": "supported"
  },
  {
    "medical_text": "A young woman had a high fever and burning when she peed. Her right side hurt near her back. A urine test showed an infection. In the ER, she got one dose of medicine through a vein. She then took antibiotic pills at home for 7 days. The urine culture found E. coli. A blood test for germs was negative. An ultrasound of her kidneys showed no blockage or abscess. Her fever was gone by the third day. The nurse told her to drink plenty of water, and she did.",
    "subclaim": "She increased her fluid intake as advised.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man who does not smoke came to the hospital with cough and trouble breathing. He also had a fever. His oxygen level was low at 90% on room air. A chest X-ray showed a spot in the right lower lung. The doctors said it was pneumonia he got in the community. He got oxygen by a small tube in his nose. He was given two IV antibiotics: ceftriaxone and azithromycin. A COVID test was negative. After two days, he felt better and his oxygen level rose. He went home on day 3 with pills for antibiotics.",
    "subclaim": "He was treated with ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with longstanding type 2 diabetes presented with a one-week right hallux plantar ulcer and fever. The ulcer was erythematous, warm, and purulent. Vital signs showed a temperature of 38.5 C. Labs revealed WBC 14,000/\u00b5L and elevated CRP, with HbA1c 9.2%. Foot radiograph showed no osteomyelitis. The wound was bedside debrided and offloaded, and his tetanus shot was updated. He was started on IV cefazolin and later transitioned to oral cephalexin. The wound swab grew methicillin-susceptible Staphylococcus aureus; MRSA screen was negative. Two sets of blood cultures had no growth at 48 hours. Glycemic control was optimized with basal-bolus insulin, and he was discharged on hospital day 3.",
    "subclaim": "The ulcer was on the left heel.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man with COPD and hypertension presented with 3 days of fever, productive green sputum, and dyspnea. On arrival, vital signs were: T 38.6 C, HR 104, RR 24, BP 138/78, and SpO2 91% on room air. Lung exam revealed left basilar crackles and rhonchi. CBC showed leukocytosis to 15.2 K/\u00b5L with neutrophil predominance. Chest radiograph demonstrated left lower lobe consolidation consistent with community-acquired pneumonia. Influenza PCR and SARS-CoV-2 antigen tests were negative. He was started on 2 L/min nasal cannula oxygen and IV ceftriaxone plus azithromycin; blood cultures were obtained before antibiotics. Over 48 hours, his fever resolved and oxygen was weaned to room air with SpO2 95%. Blood cultures showed no growth, and he was transitioned to oral antibiotics and discharged with primary care follow-up.",
    "subclaim": "On arrival, his oxygen saturation was 91% on room air.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman presented with a 3-day history of fever, purulent cough, and exertional dyspnea. Triage vitals: 38.5\u00b0C, HR 104 bpm, RR 24/min, BP 128/76 mmHg, SpO2 90% on ambient air. Pulmonary exam revealed right basilar crackles without wheeze. Chest radiograph showed a focal right lower lobe air-space consolidation, consistent with community-acquired pneumonia. Laboratory data demonstrated leukocytosis (WBC 15.0 x10^3/\u00b5L) with neutrophil predominance and CRP 120 mg/L. Two sets of blood cultures were obtained prior to antibiotics; she received supplemental oxygen via nasal cannula and empiric IV ceftriaxone plus azithromycin. She was managed on the general medical ward; no ICU-level support was required. Within 48 hours she defervesced, oxygenation normalized to SpO2 95% on room air, and inflammatory markers down-trended. She was transitioned to oral azithromycin to complete an additional 5 days of therapy and discharged with follow-up in one week.",
    "subclaim": "The chest x-ray was normal.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 72-year-old woman came with three days of fever, cough with green sputum, and shortness of breath. On room air her oxygen saturation was 90%, rising to 95% with 2 liters via nasal cannula. Chest X-ray showed a right lower lobe infiltrate, consistent with pneumonia. She reports an allergy to azithromycin that caused a rash in the past. Past history includes type 2 diabetes and mild chronic kidney disease. Viral PCR for COVID-19 and influenza was negative. She was admitted and treated with IV ceftriaxone plus doxycycline. She improved over two days, and the team planned a switch to oral antibiotics and discharge soon.",
    "subclaim": "She was discharged from the emergency department the same day.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old male presented from home with three days of fever, productive cough, and dyspnea. On arrival, SpO2 was 88% on room air, improving to 95% on 2 L/min nasal cannula. Chest radiograph showed right lower lobe consolidation, consistent with community-acquired pneumonia. White blood cell count was 15,200/\u00b5L; serum lactate was normal. He reported no penicillin allergy and received IV ceftriaxone plus azithromycin after cultures were drawn. Two sets of blood cultures remained negative at 48 hours. CURB-65 score was 1 (age), and he was admitted to a medical ward for hypoxemia. By hospital day 2, symptoms and oxygenation improved; he was transitioned to oral amoxicillin-clavulanate. He had an influenza vaccination last season but no prior pneumococcal vaccination.",
    "subclaim": "He was treated with vancomycin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman came to the hospital with pain, redness, and swelling in her right lower leg. She had a fever. She has diabetes and high blood pressure. The doctors thought it was a skin infection (cellulitis). An ultrasound looked for a blood clot and did not find one. Her white blood cell count was high. She started IV antibiotics, and the redness began to fade after one day. She is allergic to sulfa drugs, so they did not use those medicines. Blood cultures did not grow bacteria after two days. She went home on pills to finish treatment.",
    "subclaim": "IV cefazolin was started.",
    "label": "supported"
  },
  {
    "medical_text": "A 54-year-old man came to the hospital with cough and fever for three days. He was short of breath and had chest pain when he breathed. The doctor heard crackles on the right. His oxygen level was 92% on room air. A chest X-ray showed an infection in the lower right lung. He has type 2 diabetes and no drug allergies, and he does not smoke. He got IV antibiotics and oxygen on a regular hospital floor. His white blood cell count was high. After two days, he felt better and his oxygen was 95% without extra oxygen. He went home with antibiotic pills for five more days and got a flu shot before leaving. Blood cultures were negative, and his mucus test showed a pneumonia germ that the antibiotics could kill.",
    "subclaim": "The rapid influenza test was positive.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old man came to the ER with trouble breathing and ankle swelling. His heartbeat was fast and uneven; the doctor called it AFib. A chest X-ray showed fluid in his lungs. The team told him he has heart failure and too much fluid. He got an IV water pill to pee out the fluid and a heart rate medicine. They also started a blood thinner called apixaban. His oxygen was 2 liters by nose at first, then he did not need it. By the next day, his heart rate was about 80, he felt better, and he went home with follow-up.",
    "subclaim": "He was treated with digoxin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old male presents with a 3-day history of febrile illness, productive cough, pleuritic chest pain, and exertional dyspnea. On arrival: T 38.5 C, HR 104 bpm, RR 24/min, BP 138/78 mmHg, SpO2 92% on ambient air; no confusion. Physical exam reveals bronchial breath sounds and inspiratory crackles over the right lower lung field; no wheeze. Laboratory studies show leukocytosis 15.2 x10^9/L with neutrophil predominance, CRP 12 mg/dL, procalcitonin 0.42 ng/mL, normal lactate and renal function. Posterior\u2013anterior chest radiograph demonstrates a focal right lower lobe consolidation without parapneumonic effusion. SARS-CoV-2 PCR and influenza antigen testing are negative; pneumococcal urine antigen and blood cultures are not obtained. Assessment: community-acquired pneumonia, low severity (PSI class II), appropriate for outpatient management. Treatment is initiated with oral amoxicillin-clavulanate 875/125 mg twice daily plus azithromycin (500 mg day 1, then 250 mg daily days 2\u20135), along with return precautions and smoking-cessation counseling. At 48 hours he shows clinical response with defervescence, improved SpO2 to 95% on room air, and reduced cough; no adverse drug effects are reported.",
    "subclaim": "He received amoxicillin-clavulanate plus azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old male with T2DM, HTN, and CKD stage 3a presented with two weeks of progressive exertional dyspnea, orthopnea, and bilateral lower-extremity edema. Vitals: BP 152/88 mmHg, HR 108 bpm, SpO2 93% on room air, afebrile. Exam: elevated JVP to the angle of the mandible at 45 degrees, bibasilar rales, S3 gallop, and 2+ pitting edema to the knees. CXR demonstrated cardiomegaly, pulmonary vascular congestion, and perihilar interstitial edema. Labs: NT-proBNP 3200 pg/mL, creatinine 1.8 mg/dL (baseline 1.5), electrolytes within normal limits, and high-sensitivity troponin within reference. ECG showed sinus tachycardia without ST-T ischemic changes. TTE revealed a dilated LV with LVEF 35%, global hypokinesis, and mild functional mitral regurgitation. Working diagnosis: acute decompensated HFrEF due to volume overload. Management included IV furosemide bolus then infusion, 1.5 L/day fluid restriction, continuation of ACE inhibitor and beta-blocker, temporary discontinuation of metformin given renal function, and dietary sodium restriction. Over 48 hours he achieved a net negative fluid balance of 3 liters, had symptomatic improvement, and was planned for discharge with close cardiology follow-up.",
    "subclaim": "Chest X-ray showed an enlarged heart.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the emergency room with cough and fever. He felt short of breath. His oxygen level was low at 90% on room air. A chest X-ray showed pneumonia in the right lower lung. He got oxygen through small tubes in his nose. Doctors started antibiotics. His temperature was 101.3 F. A spit test later showed strep pneumonia bacteria. After two days, he felt better. He went home on day three with pills.",
    "subclaim": "The chest X-ray showed right lower lobe consolidation.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old male with hypertension and type 2 diabetes presented with 45 minutes of substernal chest pressure radiating to the left arm and diaphoresis. EMS administered sublingual nitroglycerin with partial relief. On arrival, blood pressure was 146/88 mmHg, heart rate 102 bpm, and oxygen saturation 97% on room air. The ECG showed 1 mm ST-segment depression in leads V4\u2013V6 without ST elevation. High-sensitivity troponin I was 420 ng/L (reference <20). The working diagnosis was non\u2013ST-elevation myocardial infarction. He received chewable aspirin, an intravenous unfractionated heparin infusion, high-intensity atorvastatin, and metoprolol. Coronary angiography was scheduled for the following morning, and he was kept NPO after midnight. Serum creatinine was 0.9 mg/dL, and a penicillin allergy was documented.",
    "subclaim": "Aspirin and unfractionated heparin were administered.",
    "label": "supported"
  },
  {
    "medical_text": "A 55-year-old woman with longstanding type 2 diabetes presented with 48 hours of fever, dysuria, urinary frequency, and right costovertebral angle tenderness. Vitals: T 38.7\u00b0C, HR 104 bpm, BP 118/72 mmHg, SpO2 99% on room air. Labs showed leukocytosis to 15.2\u00d710^3/\u00b5L with neutrophil predominance and a normal basic metabolic panel (creatinine 1.0 mg/dL). Urinalysis demonstrated positive nitrites and leukocyte esterase with >50 WBC/HPF. Urine culture yielded >100,000 CFU/mL Escherichia coli susceptible to ceftriaxone and ciprofloxacin. Non-contrast CT abdomen/pelvis revealed no urolithiasis, no hydronephrosis, and no perinephric abscess. She was diagnosed with acute uncomplicated pyelonephritis and started on ceftriaxone 1 g IV q24h with intravenous fluids and antipyretics. After clinical improvement and defervescence within 24 hours, therapy was de-escalated to oral ciprofloxacin to complete a 10-day total course. Blood cultures showed no growth at 48 hours, and she was discharged on hospital day 2 with outpatient follow-up.",
    "subclaim": "The urine culture grew E. coli.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with hypertension and type 2 diabetes, without prior coronary disease, presented with 45 minutes of rest angina radiating to the left arm accompanied by diaphoresis. Initial vitals: HR 102 bpm, BP 146/88 mmHg, RR 18, SpO2 97% on room air. The ECG demonstrated 1\u20131.5 mm horizontal ST-segment depression in V4\u2013V6 with T-wave inversion and no ST elevation. High-sensitivity cardiac troponin I measured 420 ng/L on arrival and rose to 680 ng/L at 3 hours. The diagnosis was non\u2013ST-elevation myocardial infarction. Management included chewable aspirin 325 mg, an IV unfractionated heparin bolus followed by infusion titrated to aPTT, atorvastatin 80 mg, metoprolol tartrate, and sublingual nitroglycerin with partial symptom relief. Diagnostic coronary angiography was planned for the next morning; the patient was kept NPO after midnight. Fibrinolytic therapy was not administered. Renal function was preserved (creatinine 0.9 mg/dL, estimated GFR >60), and a penicillin allergy (rash) was recorded.",
    "subclaim": "The patient is allergic to aspirin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old woman presented with two days of fever, dysuria, and right flank pain. Vitals showed temperature 38.5 C, heart rate 110, blood pressure 118/72. She had right costovertebral angle tenderness on exam. Urinalysis was positive for leukocyte esterase and nitrites with pyuria. CBC showed leukocytosis to 14,000; creatinine was 1.0 mg/dL. She received IV fluids and empiric ceftriaxone for presumed acute pyelonephritis. Renal ultrasound showed no hydronephrosis or renal calculi. Urine culture grew Escherichia coli susceptible to ceftriaxone and ciprofloxacin; blood cultures remained negative. After 48 hours she defervesced and symptoms improved. She was transitioned to oral ciprofloxacin to complete a 7-day total antibiotic course.",
    "subclaim": "She was treated with vancomycin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old woman presented with two days of fever, productive cough, and shortness of breath. On arrival, her temperature was 38.5 C and oxygen saturation was 90% on room air. Lung exam revealed crackles at the right base. The chest X-ray showed right lower lobe consolidation, consistent with community-acquired pneumonia. White blood cell count was 14,000/\u00b5L and creatinine was normal. Procalcitonin was elevated, and influenza PCR was negative. She was started on oxygen by nasal cannula plus intravenous ceftriaxone and azithromycin. Blood cultures showed no growth at 48 hours, and her breathing improved. By hospital day 3 she maintained 95% on room air and was discharged with oral antibiotics to complete therapy.",
    "subclaim": "She received intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 68-year-old man came to the ER with trouble breathing and ankle swelling. His heartbeat was fast and uneven; the doctor called it AFib. A chest X-ray showed fluid in his lungs. The team told him he has heart failure and too much fluid. He got an IV water pill to pee out the fluid and a heart rate medicine. They also started a blood thinner called apixaban. His oxygen was 2 liters by nose at first, then he did not need it. By the next day, his heart rate was about 80, he felt better, and he went home with follow-up.",
    "subclaim": "Anticoagulation was given to reduce stroke risk.",
    "label": "supported"
  },
  {
    "medical_text": "A 70-year-old man presented after three days of fever, cough with yellow sputum, and pleuritic chest pain. On arrival he was febrile and short of breath; his oxygen saturation was 89% on room air. A chest X-ray showed consolidation in the right lower lobe, consistent with community-acquired pneumonia. He was admitted to the medical ward and placed on oxygen by nasal cannula. Empiric therapy with intravenous ceftriaxone and azithromycin was started. Sputum culture later grew Streptococcus pneumoniae; blood cultures remained negative. He improved over 48 hours and was weaned to low-flow oxygen. On hospital day three he was discharged home on oral antibiotics with outpatient follow-up.",
    "subclaim": "He had a history of asthma.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 58-year-old man came to the ER with chest pain for two hours. He has high blood pressure and type 2 diabetes. His ECG showed small changes, not the big ST bumps. His blood test called troponin was high. The team said he had a mild heart attack called NSTEMI. He got aspirin, another blood thinner, and a heparin drip. They took him to the cath lab the same day. The doctor opened a tight artery and put in one drug stent. His kidney tests were normal. He went home the next day on two anti-platelet pills.",
    "subclaim": "Troponin levels were elevated.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man with hypertension and type 2 diabetes, and no smoking history, presented with cough and shortness of breath. On arrival, his oxygen saturation was 90% on room air, improving to 95% on 2 L/min nasal cannula. Chest radiograph demonstrated a right lower lobe consolidation. The working diagnosis was community-acquired pneumonia. He was started on intravenous ceftriaxone plus azithromycin and supplemental oxygen. Initial labs showed leukocytosis and elevated C-reactive protein; renal function and troponin were normal. SARS-CoV-2 PCR was negative; blood cultures remained negative during hospitalization. He was cared for on the general medical ward. By hospital day 2, his dyspnea improved, and antibiotics were transitioned to an oral regimen. He was discharged on hospital day 3 with follow-up arranged.",
    "subclaim": "He is a current cigarette smoker.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 68-year-old female without an indwelling urinary catheter presented with 48 hours of fever, dysuria, and right flank pain consistent with acute pyelonephritis. On arrival: T 38.5 C, HR 110, BP 118/72, RR 18, SpO2 98% on room air; exam notable for right costovertebral angle tenderness without peritoneal signs. Labs showed WBC 14.0 x10^9/L with neutrophilia, serum creatinine 1.0 mg/dL (baseline), and lactate 1.6 mmol/L. Urinalysis demonstrated positive leukocyte esterase and nitrites with >50 WBC/HPF; urine culture later yielded E. coli susceptible to ceftriaxone and ciprofloxacin. Two sets of blood cultures remained negative at 48 hours. Renal ultrasound showed no hydronephrosis or nephrolithiasis, arguing against obstructive uropathy. She received IV isotonic fluids and empiric ceftriaxone; no vasopressors were required. The patient reported a remote urticarial reaction to penicillin; no beta-lactam contraindication to ceftriaxone was noted. She defervesced and had clinical improvement within 48 hours. She was transitioned to oral ciprofloxacin at discharge to complete a 7-day total course for nonbacteremic pyelonephritis.",
    "subclaim": "She was treated with vancomycin.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 67-year-old male presented from home with three days of fever, productive cough, and dyspnea. On arrival, SpO2 was 88% on room air, improving to 95% on 2 L/min nasal cannula. Chest radiograph showed right lower lobe consolidation, consistent with community-acquired pneumonia. White blood cell count was 15,200/\u00b5L; serum lactate was normal. He reported no penicillin allergy and received IV ceftriaxone plus azithromycin after cultures were drawn. Two sets of blood cultures remained negative at 48 hours. CURB-65 score was 1 (age), and he was admitted to a medical ward for hypoxemia. By hospital day 2, symptoms and oxygenation improved; he was transitioned to oral amoxicillin-clavulanate. He had an influenza vaccination last season but no prior pneumococcal vaccination.",
    "subclaim": "He received intravenous ceftriaxone and azithromycin.",
    "label": "supported"
  },
  {
    "medical_text": "A 62-year-old man came to the ER with chest pain at rest for 30 minutes. The pain went to his left arm. He felt sweaty and short of breath. He has high blood pressure and diabetes. The heart tracing did not show a big heart attack. A blood test for heart damage was high, and it went higher later. He got aspirin and a blood thinner shot. He also started a statin and a beta-blocker. His chest x-ray looked normal. His kidneys are a little weak, so the team will watch them. He is set for a heart artery test tomorrow.",
    "subclaim": "The patient was treated with thrombolytics.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old male with HTN and T2DM presented with 30 minutes of rest angina radiating to the left arm, associated with diaphoresis and dyspnea. ECG demonstrated no STE, with nonspecific ST-T abnormalities. High-sensitivity troponin I was elevated at presentation and increased on repeat sampling at 3 hours, consistent with a rising delta. Clinical picture favored NSTE-ACS (probable NSTEMI). He received 325 mg chewable aspirin and therapeutic-dose enoxaparin; high-intensity atorvastatin and a beta-blocker were initiated. Chest X-ray was clear. Serum creatinine was mildly elevated, warranting renal monitoring prior to contrast exposure. Vitals remained stable, and chest pain improved after medical therapy. Plan is early invasive strategy with coronary angiography the following day. There was no fever, cough, or focal lung findings.",
    "subclaim": "The ECG did not show ST-segment elevation.",
    "label": "supported"
  },
  {
    "medical_text": "A 58-year-old man with longstanding T2DM and distal symmetric neuropathy presented with a right plantar forefoot ulcer and overlying cellulitis. Glycemic control was poor (HbA1c 9.2%). He was febrile to 38.2 C with WBC 12.1 \u00d710^9/L and CRP 110 mg/L. Ankle-brachial index was 1.06 with palpable pedal pulses, indicating adequate perfusion. Plain radiographs showed no cortical destruction, periosteal reaction, or subcutaneous gas. After obtaining wound and blood cultures, empiric IV vancomycin plus piperacillin\u2013tazobactam were initiated. The wound culture grew methicillin-susceptible Staphylococcus aureus; blood cultures remained negative. Therapy was de-escalated to IV cefazolin, and bedside sharp debridement was performed. The cellulitis improved clinically without signs of osteomyelitis. He was transitioned to oral cephalexin at discharge to complete 7 days of total antibiotics.",
    "subclaim": "He was hypotensive at presentation.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 62-year-old male presents with a 3-day history of febrile illness, productive cough, pleuritic chest pain, and exertional dyspnea. On arrival: T 38.5 C, HR 104 bpm, RR 24/min, BP 138/78 mmHg, SpO2 92% on ambient air; no confusion. Physical exam reveals bronchial breath sounds and inspiratory crackles over the right lower lung field; no wheeze. Laboratory studies show leukocytosis 15.2 x10^9/L with neutrophil predominance, CRP 12 mg/dL, procalcitonin 0.42 ng/mL, normal lactate and renal function. Posterior\u2013anterior chest radiograph demonstrates a focal right lower lobe consolidation without parapneumonic effusion. SARS-CoV-2 PCR and influenza antigen testing are negative; pneumococcal urine antigen and blood cultures are not obtained. Assessment: community-acquired pneumonia, low severity (PSI class II), appropriate for outpatient management. Treatment is initiated with oral amoxicillin-clavulanate 875/125 mg twice daily plus azithromycin (500 mg day 1, then 250 mg daily days 2\u20135), along with return precautions and smoking-cessation counseling. At 48 hours he shows clinical response with defervescence, improved SpO2 to 95% on room air, and reduced cough; no adverse drug effects are reported.",
    "subclaim": "The patient was breathing fast.",
    "label": "supported"
  },
  {
    "medical_text": "A 67-year-old woman came in with leg swelling and shortness of breath. She had gained weight this week but no chest pain or fever. Her exam showed ankle edema, and her oxygen level was okay. A chest X-ray showed fluid in the lungs. A heart ultrasound showed an ejection fraction of about 30%. She got IV water pill medicine (furosemide) and passed a lot of urine. She started sacubitril/valsartan and a beta blocker. Spironolactone was not started because her potassium was 5.2. She was told to eat less salt and to check her weight, with a follow-up in one week.",
    "subclaim": "She was started on spironolactone.",
    "label": "not_supported"
  },
  {
    "medical_text": "A 65-year-old male with GOLD II COPD (former 40 pack-year smoker) presented with 72 hours of fever, purulent sputum, pleuritic chest pain, and dyspnea. Vitals: T 38.5\u00b0C, HR 102 bpm, BP 132/78 mmHg, RR 24/min, SpO2 89% on ambient air. Laboratory data: WBC 15.2 \u00d710^9/L with neutrophilia, CRP 120 mg/L, procalcitonin 0.4 ng/mL. Chest radiograph demonstrated right lower lobe lobar consolidation without pleural effusion. Supplemental oxygen was initiated via nasal cannula at 2\u20133 L/min to target SpO2 92\u201396%. Empiric community-acquired pneumonia therapy was started with IV ceftriaxone 1 g daily plus azithromycin 500 mg daily. Microbiology: two sets of blood cultures with no growth at 48 hours; urinary antigens for Streptococcus pneumoniae and Legionella negative; multiplex viral PCR including influenza A/B and SARS-CoV-2 negative. By 48 hours, the patient had clinical improvement and was transitioned to oral therapy to complete a five-day total antibiotic course. He was discharged on hospital day 3; home LAMA/LABA inhalers were continued; no history of beta-lactam allergy.",
    "subclaim": "He received oxygen via nasal cannula.",
    "label": "supported"
  }
]