{"patient_id":"P07","encounter_id":"KE-P07","note_id":"KN-P07-1","signed":false,"origin":"clinician","origin_label":"Clinician-typed","origin_note":"as declared by the source system","needs_look":1,"needs_look_kidney":1,"surfaced":[{"source":"kidney","family":"kidney"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00007","replay_hash":"42508c0c3a9b5ca250e1a520ff0bfb3b26802c369d802987b1397627d5984e81","measurement_replay_hash":"2a1570191b34227399b66a35ba23883a8f2e609e47f04c44568e3238e1748f5b","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-00007","encounter_id":"KE-P07","note_id":"KN-P07-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"7e6a5c327d655f67cae18db3201bb6cbad79f2833fd4a97b5bebf59141b476f1","measurement_replay_hash":"5e2f3de03361dff98039794a44291dc78aa9dab4946c884423a3ea75f1267d37","surfaced":[],"more":[{"family":"copd_airflow","topic":"Lung function after bronchodilator","direction":"JUDGEMENT","status":"neutral","label":"Needs your clinical judgement","icon":"◆","lead":"The note says ","quote":"COPD","text":". FEV1/FVC 0.58 on 2026-09-11 10:00; FEV1 % predicted 62 % on 2026-09-11 10:00: the record shows these values; this needs your clinical judgement (gold2026_copd_airflow@1.0 uses them as one part of a wider clinical picture, category “FEV1/FVC below 0.7 with FEV1 50 to below 80% predicted (grade 2)”).","sentence":"The note says “COPD”. FEV1/FVC 0.58 on 2026-09-11 10:00; FEV1 % predicted 62 % on 2026-09-11 10:00: the record shows these values; this needs your clinical judgement (gold2026_copd_airflow@1.0 uses them as one part of a wider clinical picture, category “FEV1/FVC below 0.7 with FEV1 50 to below 80% predicted (grade 2)”).","threshold":"Threshold for this category (gold2026_copd_airflow@1.0): FEV1/FVC < 0.7 and FEV1 % predicted ≥ 50 % and FEV1 % predicted < 80 %.","span":[0,4],"note_mentions":true,"lab_ids":["LM-P07-01","LM-P07-02"],"definition":"gold2026_copd_airflow@1.0","version":"1.0","tier":"judgement","values":"FEV1/FVC 0.58 on 2026-09-11 10:00; FEV1 % predicted 62 % on 2026-09-11 10:00","alternatives":[],"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://goldcopd.org/wp-content/uploads/2026/01/GOLD-Pocket-Guide-2026-v1.1-20Nov2025_WMV2.pdf","optional_set":null,"cite":{"id":"gold2026_copd_airflow@1.0","title":"Global Strategy for Prevention, Diagnosis and Management of COPD: 2026 Report — Pocket Guide","body":"Global Initiative for Chronic Obstructive Lung Disease (GOLD)","edition":"2026 (pocket guide v1.1, 20 Nov 2025)","year":2026,"url":"https://goldcopd.org/wp-content/uploads/2026/01/GOLD-Pocket-Guide-2026-v1.1-20Nov2025_WMV2.pdf","locator":"Figure 2.10 (PDF page 20); key points (PDF page 11)","quote":"In patients with COPD (FEV1/FVC < 0.7): GOLD 1: Mild FEV1 ≥ 80% predicted; GOLD 2: Moderate 50% ≤ FEV1 < 80% predicted; GOLD 3: Severe 30% ≤ FEV1 < 50% predicted; GOLD 4: Very Severe FEV1 < 30% predicted","accessed":"2026-11-14"}}],"n_needs":0,"limit":2,"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":"needs_look","label":"Needs a look","sentence":"Two kidney results 180 days apart are in the G4 range (filtering rate 25.6 on 2026-05-14 and 23.4 on 2026-11-10); the note doesn't mention kidney function.","quote":null,"threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":null,"note_mentions":false,"lab_ids":["L-0014","L-0015"]}]}