{"patient_id":"P10","encounter_id":"KE-P10","note_id":"KN-P10-1","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":"ferritin"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00010","replay_hash":"0da07e1036f172def5bcf7a4ceabc23bf46d393527467cb51e40a35c35cdfa37","measurement_replay_hash":"39d9982529eec98d1266ab9f33133acc9fd60887cb993dc53cb0c1bffa15b217","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-00010","encounter_id":"KE-P10","note_id":"KN-P10-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"2b8d6ad0851fbe9be0a99bc03530b9b0caed731b6ed8a76664fc3b372d0cb4b4","measurement_replay_hash":"24b1070268513766334d2a498c285830615821765d69458e6c86c88c2bef9c4c","surfaced":[{"family":"ferritin","topic":"Ferritin","direction":"UNDER","status":"needs_look","label":"Needs a look","icon":"●","lead":"","quote":null,"text":"Ferritin 11 ug/L on 2026-11-12 09:05 meets the published definition's criteria for the category “band below the ferritin cut-off for this group” (who2020_iron_deficiency_ferritin@1.0). The note doesn't mention this.","sentence":"Ferritin 11 ug/L on 2026-11-12 09:05 meets the published definition's criteria for the category “band below the ferritin cut-off for this group” (who2020_iron_deficiency_ferritin@1.0). The note doesn't mention this.","threshold":"Threshold for this category (who2020_iron_deficiency_ferritin@1.0): ferritin < 15 ug/L.","span":null,"note_mentions":false,"lab_ids":["LM-P10-01"],"definition":"who2020_iron_deficiency_ferritin@1.0","version":"1.0","tier":"measured","values":"ferritin 11 ug/L on 2026-11-12 09:05","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://iris.who.int/server/api/core/bitstreams/ccf25949-dfa7-4409-8b86-ade1a48dbd8f/content","optional_set":null,"cite":{"id":"who2020_iron_deficiency_ferritin@1.0","title":"WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations","body":"World Health Organization","edition":"2020","year":2020,"url":"https://iris.who.int/server/api/core/bitstreams/ccf25949-dfa7-4409-8b86-ade1a48dbd8f/content","locator":"Executive summary, recommendations 1.1-1.2 (PDF page 11) and Table 1 (PDF page 12)","quote":"Table 1, iron deficiency, serum ferritin (µg/L): Children under 5 years <12 (apparently healthy), <30 (infection or inflammation); Adults (20–59 years) <15, <70; Pregnant women <15 (first trimester)","accessed":"2026-11-14"}}],"more":[],"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":"not_assessable","label":"Not assessable","sentence":"Could not check kidney function yet: only one result is below 60 (filtering rate 45.4 on 2026-11-12); a repeat at least 90 days later is needed.","quote":null,"threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":[80,86],"note_mentions":true,"lab_ids":["L-0019","L-0020","L-0021"]}]}