P21 KE-P21 · outpatient visit

One row per condition family: what the record supports under the published definition, what the note states, the visit's diagnosis entries, and an assessment. Codes are coded from the signed documentation; the software never assigns one.

Library check LRUN-00021 · library_default_set@1.0 · library-engine 1.0 · replay d3b77c1742ff3199… · Data (JSON)

Draft query: Anaemia

Blocked by the query linter

A non-leading clarification request: clinical indicators with their sources, an open question, several options plus "other" and "unable to determine". No code and no payment word; the same indicators cannot be queried twice.

DOCUMENTATION QUERY (draft) for KE-P21 · haemoglobin
Title: Clarification request: haemoglobin results
Encounter: KE-P21   Patient: P21   To: author of the draft note
From: (no named sender: sign in to send)
Date: 2026-11-13   Rule versions: who2024_anaemia@1.0, library_default_set@1.0   Check run: LRUN-00021

Clinical indicators from the health record:
- Documented in the record: "Anemia" [draft note KN-P21-1, characters 197-203]
- Visit diagnosis list entry: "Anemia, unspecified" [visit diagnosis list LD-P21-1]
- Haemoglobin 134 g/L (2026-10-22 09:00) [measurement LM-P21-01]
- Haemoglobin 136 g/L (2026-11-11 09:05) [measurement LM-P21-02]

Question:
Based on your independent clinical judgement, can the documentation of this condition be clarified in light of the haemoglobin results listed above?

Response options (select one or write your own):
( ) Anemia: confirmed (please document the supporting clinical information)
( ) Anemia: ruled out
( ) Other explanation of the clinical findings (please specify): ____________
( ) Unable to determine

Please respond based on your independent clinical judgement. Any response, including "unable to determine", is acceptable. This query and your response are kept as part of the health record.

error · no_sender: A query needs a named human sender (sign in).

Condition families for this encounter (2)
Condition family	What the record supports	What the note states	Visit diagnosis entries	Assessment
Anaemia measured	`who2024_anaemia@1.0` Draft · pending review Criteria not met: No anaemia haemoglobin 136 g/L 2026-11-11 09:05 · LM-P21-02 Window: 30 days before the check. Citation Anaemia and its severity by haemoglobin (WHO 2024) who2024_anaemia@1.0 Table 3: Adults, 15–65 years, nonpregnant women: No anaemia ≥120; Mild 110–119; Moderate 80–109; Severe <80. Adults, 15–65, years men: ≥130; 110–129; 80–109; <80 (g/L) World Health Organization, Guideline on haemoglobin cutoffs to define anaemia in individuals and populations (2024) · Executive summary: Table 2 (PDF page 12), Table 3 (PDF page 13), Table 4 (PDF page 14), Table 5 (PDF page 15) · source Contested: Cut-offs are 5th percentiles of mostly higher-income populations (WHO's own remark); the men's 130 g/L cut-off and severity percentages were debated by the guideline group; CTCAE and laboratory reference ranges use other limits; older adults (>65) are not covered. Not encoded: The elevation formula (0.0056384 x elevation + 0.0000003 x elevation²) is not used; the 500 m table rows are. The remark that tailored adjustments may be warranted above 2500 m is not encoded. Adjustment for inflammation/infection (malaria) and for genetic ancestry: WHO recommends none (normative statements 2.b and 2.c); nothing is applied. Type and cause of anaemia (iron deficiency, blood loss, haemolysis) are not assessed. Persons older than 65 years and infants under 6 months: Table 2 gives no cut-off, so they are not assessable. Exactly 20 cigarettes per day: Table 5 lists '10–19' and '>20', so 20 per day is outside the table and not assessable (source gap).	Anemia	`D64.9` Anemia, unspecified (visit diagnosis list (synthetic))	Entered or stated without support in the record Draft a query
Code-family reference: Anaemia Coders only reference for coders — the clinician's documented statement governs; the software does not assign codes `D64` Other anemias: distinguishes type of anaemia (sideroblastic, congenital dyserythropoietic, due to antineoplastic chemotherapy, other specified, unspecified) (8 codes in the category). `D64.0` Hereditary sideroblastic anemia `D64.1` Secondary sideroblastic anemia due to disease `D64.2` Secondary sideroblastic anemia due to drugs and toxins `D64.3` Other sideroblastic anemias `D64.4` Congenital dyserythropoietic anemia `D64.81` Anemia due to antineoplastic chemotherapy `D64.89` Other specified anemias `D64.9` Anemia, unspecified `D50` Iron deficiency anemia: distinguishes iron deficiency anaemia: secondary to chronic blood loss, sideropenic dysphagia, other, unspecified (4 codes in the category). `D50.0` Iron deficiency anemia secondary to blood loss (chronic) `D50.1` Sideropenic dysphagia `D50.8` Other iron deficiency anemias `D50.9` Iron deficiency anemia, unspecified `D62` Acute posthemorrhagic anemia: distinguishes acute posthaemorrhagic anaemia (single code) (1 codes in the category). `D62` Acute posthemorrhagic anemia Source: official ICD-10-CM FY2027 code descriptions (extract in library/data/code_reference_fy2027.json).
Hyperkalaemia measured	`ukka2026_hyperkalaemia@1.0` Draft · pending review Criteria not met: Below 5.5 mmol/L potassium serum 5 mmol/L 2026-11-11 09:05 · LM-P21-03 Window: 14 days before the check. Citation Hyperkalaemia and its severity (UK Kidney Association, July 2026 update) ukka2026_hyperkalaemia@1.0 It is further classified by severity into mild (5.5-5.9 mmol/l), moderate (6.0-6.4 mmol/l) or severe (≥ 6.5 mmol/l). UK Kidney Association, Clinical Practice Guidelines: Treatment of Acute Hyperkalaemia in Adults (2026) · Introduction, document page 9 (PDF page 10) · source Contested: The guideline itself says 'There is no universally accepted definition of hyperkalaemia'; it adopts the ERC threshold of 5.5 mmol/L. CTCAE grades differ (see ctcae6_hyperkalaemia). Not encoded: Pseudohyperkalaemia (guideline 15.3: haemolysis, delayed analysis, sampling technique) is not detected; a haemolysed sample is graded like any other unless the sender withholds it. Acute versus chronic (persistent) hyperkalaemia and the guideline's repeat-testing intervals (guidelines 1.2.1-1.2.3) are not encoded. ECG changes and clinical context are not assessed.	Not stated	None entered	Nothing to act on
Code-family reference: Hyperkalaemia Coders only reference for coders — the clinician's documented statement governs; the software does not assign codes `E87` Other disorders of fluid, electrolyte and acid-base balance: distinguishes E87.5 hyperkalemia (one code; no severity axis) (14 codes in the category). `E87.0` Hyperosmolality and hypernatremia `E87.1` Hypo-osmolality and hyponatremia `E87.20` Acidosis, unspecified `E87.21` Acute metabolic acidosis `E87.22` Chronic metabolic acidosis `E87.29` Other acidosis `E87.3` Alkalosis `E87.4` Mixed disorder of acid-base balance `E87.5` Hyperkalemia `E87.6` Hypokalemia `E87.70` Fluid overload, unspecified `E87.71` Transfusion associated circulatory overload `E87.79` Other fluid overload `E87.8` Other disorders of electrolyte and fluid balance, not elsewhere classified Source: official ICD-10-CM FY2027 code descriptions (extract in library/data/code_reference_fy2027.json).