Patient presents with clinical findings consistent with hospital-acquired pneumonia (HAP), developing 48 hours after admission for [initial admitting diagnosis].  Symptoms include productive cough with [description of sputum e.g., purulent, greenish sputum], fever of [temperature], chills, pleuritic chest pain, and shortness of breath.  Physical examination reveals [lung sounds e.g., rales, decreased breath sounds] in the [location e.g., right lower lobe].  Patient's respiratory rate is [rate] breaths per minute, oxygen saturation is [percentage] on [oxygen delivery method e.g., room air, 2L nasal cannula].  White blood cell count is elevated at [value] with left shift.  Chest X-ray demonstrates [radiographic findings e.g., infiltrates, consolidation] in the [location e.g., right lower lobe].  Differential diagnosis includes ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HCAP), community-acquired pneumonia (CAP), and aspiration pneumonitis.  Based on the timing of symptom onset post-admission and the clinical picture, HAP is the most likely diagnosis.  Blood cultures drawn and sent for analysis.  Sputum culture and gram stain ordered.  Patient initiated on empiric antibiotic therapy with [antibiotic name and dosage] pending culture results.  Respiratory therapy consulted for optimization of pulmonary toilet.  Plan to monitor oxygenation, respiratory status, and response to therapy.  Patient education provided regarding deep breathing exercises, incentive spirometry, and the importance of completing the full course of antibiotics.  ICD-10 code J18.9 Pneumonia, unspecified organism, will be utilized pending culture results which may necessitate a more specific code assignment.  DRG assignment will be determined based on the overall clinical course and treatment provided.