Carmen Calloway

Follow-up visit note

Unsigned draft

Type: Clinic visit
Date: 2026-11-12 11:00
Author: Rhea Castellan, NP
Status: Unsigned draft
Drafted by: Clinician-typed

Visit diagnoses (as entered by the clinician)

None entered yet for this visit.

“Draft · pending review” means the definition awaits approval by your clinical and coding reviewers.

Needs a look Heart pumping fraction (ejection fraction, EF) Draft · pending review

The note says Heart failure with preserved ejection fraction; the latest ejection fraction is 35% on 2026-08-14, which does not fit the type written (needs 50% or higher).

Note read by: Stand-in AI reader and rule reader agree · AI reader quoted Heart failure with preserved ejection fraction, HFpEF

Evidence from the record (2)

Ejection fraction 35% · echocardiogram 2026-08-14 (transthoracic, biplane): Left ventricular ejection fraction 35% by biplane method. (Dr. Leopold Nairn (cardiology))
Ejection fraction 55% · echocardiogram 2024-11-12 (transthoracic, visual estimate): Left ventricular ejection fraction estimated at 55%. (Dr. Leopold Nairn (cardiology))

Acuity indicators in the record (1): evidence only, acuity is your judgement

Acuity words in the note: chronic

Show in the note Reports

Options

Choose wording yourself, or none. Nothing is pre-selected; the list and its order are the same for every patient.

Met / not met only says whether the recorded value falls inside that definition's range. It is not a recommendation; the diagnosis is your judgement.

Needs: latest ejection fraction 40% or lower Record: latest 35% on 2026-08-14 · ✓ met
Needs: latest ejection fraction 41% to 49% Record: latest 35% on 2026-08-14 · ✗ not met
Needs: latest ejection fraction 50% or higher Record: latest 35% on 2026-08-14 · ✗ not met
Needs: an earlier ejection fraction of 40% or lower, the latest above 40%, and a rise of at least 10 points Record: no earlier value of 40% or lower; latest 35% on 2026-08-14 · ✗ not met

One click places the wording you choose in the unsigned draft at your cursor, highlighted, for you to edit or undo before signing. Your choice and the evidence shown are recorded.

Provenance

This check is stored and can be re-run to the same result.
Inputs: 2 record items, listed under Evidence above.
Readers: Stand-in AI reader and rule reader agree
What happened so far: No response yet
Offer OF-000026 in the provenance record

Reference ids (for audit)

Definition version front_hf_ef_type@1.0 · run FRUN-00030 · replay 1dc331474d2f…
Input ids: ECHO-P30-2, ECHO-P30-1

Who read the note

Rule reader: a fixed word list, always on.
AI reader: stand-in (offline demonstration, not a language model). It may only quote the note; its quotes are checked character by character and must agree with the rule reader.
The results side (values, dates, definition) never depends on either reader.

Reference ids (for audit)

Rule reader word list: front-lexicon 1.0
AI reader: stand-in (offline demonstration, not a language model), version mock-1/exactdx.front_statements@1; task exactdx.front_statements@1

Published definition and source

Clinical implications of the universal definition for the prevention and treatment of heart failure

definition version 1.0

Chandramouli C, Stewart S, Almahmeed W, Lam CSP (Clinical Cardiology) · 2022 · Section 1.3 'New universal definition' (classification by left ventricular ejection fraction) · source

Licence: open licence (Creative Commons Attribution 4.0), attribution: Chandramouli C, Stewart S, Almahmeed W, Lam CSP. Clinical implications of the universal definition for the prevention and treatment of heart failure. Clin Cardiol 2022;45(Suppl 1):S2-S12. doi:10.1002/clc.23842. Licensed under CC BY 4.0.. Source checked: opened (2026-11-14).

Categories by ejection fraction: 40% or lower; 41% to 49%; 50% or higher; improved (earlier 40% or lower, now above 40%, a rise of at least 10 points). Acuity is a clinical judgement: indicators are shown, nothing is concluded.

Edition note: The 2021 categories are shown as the 2021 edition. A 2026 second universal definition reportedly drops fixed cut-offs between reduced and preserved ejection fraction while keeping the improved category (summary of an openly licensed editorial; the consensus document itself was not opened). Clinical decision needed before release.

Edition note: A federal cross-check (NHLBI, 2022) describes reduced ejection fraction as below 40%, not 40% or lower: the boundary at exactly 40% differs between sources.

See also: Universal definition and classification of heart failure (2021); Second universal definition of heart failure (2026); Accelerating heart failure research (2022); ICD-10-CM FY2027 tabular list and index (2026).

Draft definition: pending clinical and coding review. No endorsement by the cited bodies is implied.

Reference ids (for audit)

Definition key front_hf_ef_type@1.0

Relevant history

Type at least three letters of the reason for visit to list related items from the whole chart.

Other checks 1

Other measurements checked against published definitions (the extended set).

Agrees: nothing to do Kidney filtering rate (eGFR) over time

Kidney results 200 days apart are 60 or above (filtering rate 69.6 on 2026-04-26 and 69.6 on 2026-11-12) and the note doesn't mention kidney function.

Show the results

Details

Thresholds

Heart pumping fraction (ejection fraction, EF): Categories by ejection fraction: 40% or lower; 41% to 49%; 50% or higher; improved (earlier 40% or lower, now above 40%, a rise of at least 10 points). Acuity is a clinical judgement: indicators are shown, nothing is concluded.

Rules and published sources

ckd_epi_2009@1.0 Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check) · source
ckd_epi_2021@1.0 Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation) · source
kdigo_aki_2012@1.1 KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2) · source
kdigo_ckd_2024@1.1 KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months) · source
kidney_compare@1.1 this tool's comparison rules (both directions) · source
kidney_exclusions@1.0 KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list · source
lab_units@1.1 KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g) · source
front_hf_ef_type@1.0 draft, pending review

Record

Check RUN-00030 · kidney-engine 2.0 · replay 67761018a1d1…. Data for this panel (JSON).

Specificity check FRUN-00030 · front-engine 1.2 · replay 1dc331474d2f….

Library check LRUN-00030 · library_default_set@1.1 · library-engine 1.1 · replay 041d9ac7c403….

Decision support only: you decide and you write the note. Nothing is inserted unless you click it. DataCrafters 1.0.0 · data as of Fri Nov 13, 2026 04:55 PM

Allergies

Latest vitals

Active problems 3

Reminders

Follow-up visit note

Visit diagnoses (as entered by the clinician)

Clinical implications of the universal definition for the prevention and treatment of heart failure