{"patient_id":"P01","encounter_id":"KE-P01","note_id":"KN-P01-1","signed":false,"origin":"clinician","origin_label":"Clinician-typed","origin_note":"as declared by the source system","needs_look":1,"needs_look_kidney":0,"surfaced":[{"source":"kidney","family":"kidney"},{"source":"library","family":"blood_pressure"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00001","replay_hash":"3d4f2d2ebcc56b011349776ca4dc259fae72911e113750940954a43510232a04","measurement_replay_hash":"62d2a372d6e6be7bfcbeb55e8a5aa6a3c9125316163b7d802b43c5beaa845fc2","engine":"kidney-engine 2.0","rules":[{"rule":"ckd_epi_2009@1.0","source":"Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check)","url":"https://www.acpjournals.org/doi/10.7326/0003-4819-150-9-200905050-00006"},{"rule":"ckd_epi_2021@1.0","source":"Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation)","url":"https://www.kidney.org/ckd-epi-creatinine-equation-2021"},{"rule":"kdigo_aki_2012@1.1","source":"KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2)","url":"https://kdigo.org/guidelines/acute-kidney-injury/"},{"rule":"kdigo_ckd_2024@1.1","source":"KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"kidney_compare@1.1","source":"Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update","url":"https://www.cms.gov/medicare/coding-billing/icd-10-codes"},{"rule":"kidney_exclusions@1.0","source":"KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"lab_units@1.1","source":"KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"}],"last_replay":null,"library":{"run_id":"LRUN-00001","encounter_id":"KE-P01","note_id":"KN-P01-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"7e1a90ec93ece1491d3d1d8bc4c7262d58f458eec2ccadfaa8b9982968d0d78f","measurement_replay_hash":"289116ca1d48dc264375a5362ca30519aab2b439a5528ec720d85dc0f6beb907","surfaced":[{"family":"blood_pressure","topic":"Blood pressure readings","direction":"UNDER","status":"needs_look","label":"Needs a look","icon":"●","lead":"","quote":null,"text":"Blood pressure 132/78 mmHg on 2026-11-12 10:05 meets the published definition's criteria for the category “stage 1 range (130 to 139 systolic, or 80 to 89 diastolic)” (nhlbi_bp_categories@1.0). The note doesn't mention this.","sentence":"Blood pressure 132/78 mmHg on 2026-11-12 10:05 meets the published definition's criteria for the category “stage 1 range (130 to 139 systolic, or 80 to 89 diastolic)” (nhlbi_bp_categories@1.0). The note doesn't mention this.","threshold":"Threshold for this category (nhlbi_bp_categories@1.0): systolic ≥ 130 mmHg and systolic < 140 mmHg or diastolic ≥ 80 mmHg and diastolic < 90 mmHg.","span":null,"note_mentions":false,"lab_ids":["LM-P01-04","LM-P01-03"],"definition":"nhlbi_bp_categories@1.0","version":"1.0","tier":"measured","values":"blood pressure 132/78 mmHg on 2026-11-12 10:05","alternatives":["Another published definition (esc2024_office_bp@1.0) gives the category “office 120 to 139 systolic or 70 to 89 diastolic”."],"contested":true,"contested_text":"Published bodies disagree on these thresholds; another definition may give a different answer.","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://www.nhlbi.nih.gov/health/high-blood-pressure/diagnosis","optional_set":null,"cite":{"id":"nhlbi_bp_categories@1.0","title":"High Blood Pressure — Diagnosis","body":"National Heart, Lung, and Blood Institute (U.S. National Institutes of Health)","edition":"page last updated June 26, 2025","year":2025,"url":"https://www.nhlbi.nih.gov/health/high-blood-pressure/diagnosis","locator":"Blood pressure categories table","quote":"Normal: Less than 120 systolic AND Less than 80 diastolic; Elevated: 120 to 129 AND Less than 80; Stage 1: 130 to 139 OR 80 to 89; Stage 2: 140 or higher OR 90 or higher; Hypertensive Crisis: Higher than 180 OR Higher than 120","accessed":"2026-11-14"}}],"more":[{"family":"ldl","topic":"LDL cholesterol","direction":"NOT_ASSESSABLE","status":"not_assessable","label":"Not assessable","icon":"∅","lead":"The note says ","quote":"Hyperlipidemia","text":"; it could not be checked against aha2018_severe_hypercholesterolaemia@1.0: there is no LDL cholesterol result in the last 730 days.","sentence":"The note says “Hyperlipidemia”; it could not be checked against aha2018_severe_hypercholesterolaemia@1.0: there is no LDL cholesterol result in the last 730 days.","threshold":"Categories that count (aha2018_severe_hypercholesterolaemia@1.0): LDL 190 mg/dL or more (LDL ≥ 190 mg/dL).","span":[202,216],"note_mentions":true,"lab_ids":[],"definition":"aha2018_severe_hypercholesterolaemia@1.0","version":"1.0","tier":"measured","values":"","alternatives":["Another published definition (atp3_ldl@1.0) cannot decide: there is no usable LDL cholesterol result."],"contested":false,"contested_text":"","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC7403606/","optional_set":null,"cite":{"id":"aha2018_severe_hypercholesterolaemia@1.0","title":"2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol","body":"American Heart Association / American College of Cardiology and partner societies","edition":"2018 (Circulation 2019;139:e1082-e1143, author manuscript PMC7403606)","year":2018,"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC7403606/","locator":"Section 4.2 heading; Top 10 Take-Home Message 4","quote":"Severe Hypercholesterolemia (LDL-C ≥190 mg/dL [≥4.9 mmol/L])","accessed":"2026-11-14"}}],"n_needs":1,"limit":3,"dismissed":0,"ctcae_on":false,"draft_label":"Draft definition: pending clinical and coding review","dismiss_reasons":{"addressed_elsewhere":"Already addressed elsewhere in the record","not_representative":"Values not representative (for example acute illness or a lab error)","not_relevant":"Not relevant to this visit","definition_not_applicable":"The definition does not apply to this patient","other":"Other (explain)"}},"findings":[{"family":"kidney","topic":"Kidney function over time","status":"agrees","label":"Agrees","sentence":"The note says “CKD stage 3b” and two results 200 days apart agree (G3b range, filtering rate 37.0 on 2026-04-26 and 34.8 on 2026-11-12).","quote":"CKD stage 3b","threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":[138,150],"note_mentions":true,"lab_ids":["L-0001","L-0002"]}]}