Replay FRUN-00021 specificity check (heart failure type, kidney stage, nutrition)

{
  "as_of": "2026-11-13T16:55:00-05:00",
  "encounter": {
    "admit_dt": "2026-11-11T10:00:00-05:00",
    "encounter_id": "KE-P21",
    "setting": "outpatient"
  },
  "items": [],
  "kidney": {
    "acr": [],
    "acute_change": {
      "flag": false,
      "ratio": null
    },
    "albuminuria": {
      "met": false
    },
    "direction": "NOT_ASSESSABLE",
    "e21": {
      "direction": "NOT_ASSESSABLE",
      "direction_why": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
      "latest": null,
      "met": false,
      "persistence": {
        "days_apart": null,
        "latest": null,
        "met": false,
        "pair": null,
        "pair_values": null,
        "persistent_value": null,
        "reason": "no qualifying value"
      },
      "reason": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
      "reason_code": "exclusion",
      "route": null,
      "stage": null,
      "status": "not_assessable"
    },
    "egfr": [
      {
        "date": "2026-08-13",
        "egfr_2021": 8.4,
        "g_2021": "G5",
        "lab_id": "L-0047"
      },
      {
        "date": "2026-11-11",
        "egfr_2021": 7.9,
        "g_2021": "G5",
        "lab_id": "L-0048"
      }
    ],
    "stated_stage": null
  },
  "note": {
    "note_id": "KN-P21-1",
    "reading": {
      "ai": {
        "families": {
          "heart_failure": {
            "faults": [],
            "spans": [],
            "status": "agree"
          },
          "malnutrition": {
            "faults": [],
            "spans": [],
            "status": "agree"
          }
        },
        "faults": [],
        "model": "clockworks-mock",
        "model_version": "mock-1/exactdx.front_statements@1",
        "provider": "mock",
        "sent_sha256": "7aa826ac8deae0eade2231b97cd0181afd32f2e121539d643b12327048a078e1",
        "status": "ok",
        "task": "exactdx.front_statements@1"
      },
      "mentions": [],
      "reader": "front-lexicon 1.0",
      "text_sha256": "7aa826ac8deae0eade2231b97cd0181afd32f2e121539d643b12327048a078e1"
    }
  },
  "patient": {
    "birth_date": "1961-11-16",
    "patient_id": "P21",
    "sex": "M"
  }
}

{
  "engine": "front-engine 1.2",
  "families": {
    "kidney": {
      "definition": "front_kidney_stage_wording@1.0",
      "direction": "NOT_ASSESSABLE",
      "measurement": {
        "acr": [],
        "acute_change": {
          "flag": false,
          "ratio": null
        },
        "albuminuria_persistent": false,
        "direction": "NOT_ASSESSABLE",
        "option_status": {
          "G1": {
            "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
            "status": "not_assessable"
          },
          "G2": {
            "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
            "status": "not_assessable"
          },
          "G3a": {
            "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
            "status": "not_assessable"
          },
          "G3b": {
            "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
            "status": "not_assessable"
          },
          "G4": {
            "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
            "status": "not_assessable"
          },
          "G5": {
            "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
            "status": "not_assessable"
          }
        },
        "pair": [],
        "route": null,
        "stage": null,
        "stated_stage": null,
        "status": "not_assessable"
      },
      "options": [
        {
          "key": "G1",
          "kind": "wording",
          "requires": "filtering rate 90 or above with a kidney damage marker (for example albuminuria on two tests at least 90 days apart)",
          "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
          "status": "not_assessable",
          "status_label": "not assessable",
          "wording": "Chronic kidney disease stage 1"
        },
        {
          "key": "G2",
          "kind": "wording",
          "requires": "filtering rate 60-89 with a kidney damage marker (for example albuminuria on two tests at least 90 days apart)",
          "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
          "status": "not_assessable",
          "status_label": "not assessable",
          "wording": "Chronic kidney disease stage 2"
        },
        {
          "key": "G3a",
          "kind": "wording",
          "requires": "filtering rate 45-59 on two results at least 90 days apart",
          "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
          "status": "not_assessable",
          "status_label": "not assessable",
          "wording": "Chronic kidney disease stage 3a"
        },
        {
          "key": "G3b",
          "kind": "wording",
          "requires": "filtering rate 30-44 on two results at least 90 days apart",
          "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
          "status": "not_assessable",
          "status_label": "not assessable",
          "wording": "Chronic kidney disease stage 3b"
        },
        {
          "key": "G4",
          "kind": "wording",
          "requires": "filtering rate 15-29 on two results at least 90 days apart",
          "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
          "status": "not_assessable",
          "status_label": "not assessable",
          "wording": "Chronic kidney disease stage 4"
        },
        {
          "key": "G5",
          "kind": "wording",
          "requires": "filtering rate below 15 on two results at least 90 days apart",
          "shows": "maintenance dialysis on record (problem list, since 2024-09-02): creatinine reflects the dialysis schedule, not kidney filtering",
          "status": "not_assessable",
          "status_label": "not assessable",
          "wording": "Chronic kidney disease stage 5"
        },
        {
          "key": "other",
          "kind": "fixed",
          "wording": "Other (I will write it)"
        },
        {
          "key": "unable",
          "kind": "fixed",
          "wording": "Clinically unable to determine"
        },
        {
          "key": "not_supported",
          "kind": "fixed",
          "wording": "Not clinically supported (I will revise the note myself)"
        }
      ]
    }
  }
}