P22 KE-P22 · 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-00022 · library_default_set@1.0 · library-engine 1.0 · replay 1996f5ba5c7affd9… · 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-P22 · haemoglobin
Title: Clarification request: haemoglobin results
Encounter: KE-P22   Patient: P22   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-00022

Clinical indicators from the health record:
- Haemoglobin 104 g/L (2026-11-10 09:05) [measurement LM-P22-01]

Question:
Based on your independent clinical judgement, how would you describe the clinical significance of the haemoglobin results listed above?

Response options (select one or write your own):
( ) Anemia (please specify the type and cause)
( ) Not clinically significant for this encounter
( ) Other (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 Moderate anaemia haemoglobin 104 g/L 2026-11-10 09:05 · LM-P22-01 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).	Not stated	None entered	The record supports it; neither stated in the note nor entered 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).
Hypertension measured	`nhlbi_bp_categories@1.0` Draft · pending review Not assessable: no reading with all of bp_systolic_office, bp_diastolic_office recorded at the same time; no usable bp_diastolic_office measurement; no usable bp_systolic_office measurement Window: 365 days before the check. Another published definition (`esc2024_office_bp@1.0`) gives: not assessable. Citation Adult blood pressure categories: normal, elevated, stage 1, stage 2 (NHLBI, as in the 2017/2025 ACC/AHA guidelines) nhlbi_bp_categories@1.0 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 National Heart, Lung, and Blood Institute (U.S. National Institutes of Health), High Blood Pressure — Diagnosis (2025) · Blood pressure categories table · source Contested: European guidelines define hypertension at 140/90 (ESC 2024, encoded separately as esc2024_office_bp) while AHA/ACC use 130/80. Not encoded: Measurement technique (seated, rested, correct cuff), averaging of several readings per visit, out-of-office (home, ambulatory) thresholds, white-coat and masked hypertension are not encoded. The 2025 AHA/ACC guideline's own table was not opened; the categories are taken from the NHLBI page. Children and adolescents are not covered (population limited to 18 and older as an interpretation).	Hypertension	None entered	Cannot be assessed no_value
Code-family reference: Hypertension Coders only reference for coders — the clinician's documented statement governs; the software does not assign codes `I10` Essential (primary) hypertension: distinguishes essential (primary) hypertension (one code); hypertension with heart or kidney disease uses I11-I13 (1 codes in the category). `I10` Essential (primary) hypertension `R03` Abnormal blood-pressure reading, without diagnosis: distinguishes R03.0 elevated blood-pressure reading without diagnosis of hypertension; R03.1 nonspecific low reading (2 codes in the category). `R03.0` Elevated blood-pressure reading, without diagnosis of hypertension `R03.1` Nonspecific low blood-pressure reading Source: official ICD-10-CM FY2027 code descriptions (extract in library/data/code_reference_fy2027.json).