Replay FRUN-00033 specificity check (heart failure type, kidney stage, nutrition)

{
  "as_of": "2026-11-13T16:55:00-05:00",
  "encounter": {
    "admit_dt": "2026-11-12T14:00:00-05:00",
    "encounter_id": "KE-P33",
    "setting": "outpatient"
  },
  "items": [
    {
      "data": {
        "author": "Dr. Leopold Nairn (cardiology)",
        "ef": 30,
        "method": "transthoracic, biplane",
        "text": "Transthoracic echocardiogram. Dilated left ventricle with global hypokinesis. Left ventricular ejection fraction 30% by biplane method."
      },
      "item_id": "ECHO-P33-1",
      "kind": "echo",
      "time": "2025-05-21T09:30:00-04:00"
    },
    {
      "data": {
        "author": "Dr. Leopold Nairn (cardiology)",
        "ef": 48,
        "method": "transthoracic, biplane",
        "text": "Transthoracic echocardiogram. Left ventricular size now normal; mild global hypokinesis. Left ventricular ejection fraction 48% by biplane method."
      },
      "item_id": "ECHO-P33-2",
      "kind": "echo",
      "time": "2026-10-13T14:00:00-04:00"
    },
    {
      "data": {
        "kg": 84.0
      },
      "item_id": "WT-P33-1",
      "kind": "weight",
      "time": "2026-11-12T09:00:00-05:00"
    }
  ],
  "kidney": {
    "acr": [],
    "acute_change": {
      "flag": false,
      "latest": "L-0076",
      "latest_value": 1.07,
      "lookback_days": 365,
      "lowest": "L-0075",
      "lowest_value": 1.07,
      "ratio": 1.0
    },
    "albuminuria": {
      "met": false
    },
    "direction": "NONE",
    "e21": {
      "direction": "NONE",
      "direction_why": "",
      "latest": {
        "confirmed": true,
        "date": "2026-11-12",
        "g": "G2",
        "lab_id": "L-0076",
        "value": 80.4
      },
      "met": false,
      "normal_pair": [
        "L-0075",
        "L-0076"
      ],
      "persistence": {
        "days_apart": null,
        "latest": null,
        "met": false,
        "pair": null,
        "pair_values": null,
        "persistent_value": null,
        "reason": "no qualifying value"
      },
      "reason": "two values of 60 or more 200 days apart, none below 60 after them",
      "reason_code": "persistent_normal",
      "route": null,
      "stage": null,
      "status": "not_met"
    },
    "egfr": [
      {
        "date": "2026-04-26",
        "egfr_2021": 80.4,
        "g_2021": "G2",
        "lab_id": "L-0075"
      },
      {
        "date": "2026-11-12",
        "egfr_2021": 80.4,
        "g_2021": "G2",
        "lab_id": "L-0076"
      }
    ],
    "stated_stage": null
  },
  "note": {
    "note_id": "KN-P33-1",
    "reading": {
      "ai": {
        "families": {
          "heart_failure": {
            "faults": [],
            "spans": [
              [
                244,
                288
              ],
              [
                290,
                295
              ]
            ],
            "status": "agree"
          },
          "malnutrition": {
            "faults": [],
            "spans": [],
            "status": "agree"
          }
        },
        "faults": [],
        "model": "clockworks-mock",
        "model_version": "mock-1/exactdx.front_statements@1",
        "provider": "mock",
        "sent_sha256": "703f9a0a7bd5313be453ac051a6d969c87e560e41bfd1bf9f3dc46cd320711f4",
        "status": "ok",
        "task": "exactdx.front_statements@1"
      },
      "mentions": [
        {
          "assertion": "affirmed",
          "category": "reduced",
          "context": null,
          "end": 288,
          "family": "heart_failure",
          "quote": "Heart failure with reduced ejection fraction",
          "start": 244,
          "words": []
        },
        {
          "assertion": "affirmed",
          "category": "reduced",
          "context": null,
          "end": 295,
          "family": "heart_failure",
          "quote": "HFrEF",
          "start": 290,
          "words": []
        }
      ],
      "reader": "front-lexicon 1.0",
      "text_sha256": "703f9a0a7bd5313be453ac051a6d969c87e560e41bfd1bf9f3dc46cd320711f4"
    }
  },
  "patient": {
    "birth_date": "1967-11-18",
    "patient_id": "P33",
    "sex": "M"
  }
}

{
  "engine": "front-engine 1.2",
  "families": {
    "heart_failure": {
      "acuity_words": [],
      "definition": "front_hf_ef_type@1.0",
      "direction": "UNSUPPORTED",
      "measurement": {
        "acuity": {
          "admissions": [],
          "iv_diuretic": [],
          "natriuretic": null,
          "symptoms": [],
          "weight": {
            "latest": {
              "date": "2026-11-12",
              "id": "WT-P33-1",
              "kg": 84.0
            },
            "reference": null
          }
        },
        "baseline": {
          "author": "Dr. Leopold Nairn (cardiology)",
          "date": "2025-05-21",
          "ef": 30,
          "id": "ECHO-P33-1",
          "method": "transthoracic, biplane",
          "text": "Transthoracic echocardiogram. Dilated left ventricle with global hypokinesis. Left ventricular ejection fraction 30% by biplane method.",
          "time": "2025-05-21T09:30:00-04:00"
        },
        "category": "mildly_reduced",
        "efs": [
          {
            "author": "Dr. Leopold Nairn (cardiology)",
            "date": "2025-05-21",
            "ef": 30,
            "id": "ECHO-P33-1",
            "method": "transthoracic, biplane",
            "text": "Transthoracic echocardiogram. Dilated left ventricle with global hypokinesis. Left ventricular ejection fraction 30% by biplane method.",
            "time": "2025-05-21T09:30:00-04:00"
          },
          {
            "author": "Dr. Leopold Nairn (cardiology)",
            "date": "2026-10-13",
            "ef": 48,
            "id": "ECHO-P33-2",
            "method": "transthoracic, biplane",
            "text": "Transthoracic echocardiogram. Left ventricular size now normal; mild global hypokinesis. Left ventricular ejection fraction 48% by biplane method.",
            "time": "2026-10-13T14:00:00-04:00"
          }
        ],
        "improved": true,
        "latest": {
          "author": "Dr. Leopold Nairn (cardiology)",
          "date": "2026-10-13",
          "ef": 48,
          "id": "ECHO-P33-2",
          "method": "transthoracic, biplane",
          "text": "Transthoracic echocardiogram. Left ventricular size now normal; mild global hypokinesis. Left ventricular ejection fraction 48% by biplane method.",
          "time": "2026-10-13T14:00:00-04:00"
        },
        "option_status": {
          "improved": {
            "shows": "earlier 30% on 2025-05-21, latest 48% on 2026-10-13 (change +18 points)",
            "status": "met"
          },
          "mildly_reduced": {
            "shows": "latest 48% on 2026-10-13",
            "status": "met"
          },
          "preserved": {
            "shows": "latest 48% on 2026-10-13",
            "status": "not_met"
          },
          "reduced": {
            "shows": "latest 48% on 2026-10-13",
            "status": "not_met"
          }
        }
      },
      "mention": {
        "assertion": "affirmed",
        "category": "reduced",
        "context": null,
        "end": 288,
        "family": "heart_failure",
        "quote": "Heart failure with reduced ejection fraction",
        "start": 244,
        "words": []
      },
      "needs": "needs 40% or lower",
      "options": [
        {
          "key": "reduced",
          "kind": "wording",
          "requires": "latest ejection fraction 40% or lower",
          "shows": "latest 48% on 2026-10-13",
          "status": "not_met",
          "status_label": "not met",
          "wording": "Heart failure with reduced ejection fraction (HFrEF)"
        },
        {
          "key": "mildly_reduced",
          "kind": "wording",
          "requires": "latest ejection fraction 41% to 49%",
          "shows": "latest 48% on 2026-10-13",
          "status": "met",
          "status_label": "met",
          "wording": "Heart failure with mildly reduced ejection fraction (HFmrEF)"
        },
        {
          "key": "preserved",
          "kind": "wording",
          "requires": "latest ejection fraction 50% or higher",
          "shows": "latest 48% on 2026-10-13",
          "status": "not_met",
          "status_label": "not met",
          "wording": "Heart failure with preserved ejection fraction (HFpEF)"
        },
        {
          "key": "improved",
          "kind": "wording",
          "requires": "an earlier ejection fraction of 40% or lower, the latest above 40%, and a rise of at least 10 points",
          "shows": "earlier 30% on 2025-05-21, latest 48% on 2026-10-13 (change +18 points)",
          "status": "met",
          "status_label": "met",
          "wording": "Heart failure with improved ejection fraction (HFimpEF)"
        },
        {
          "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)"
        }
      ],
      "stated": "reduced",
      "why": "type_not_fit"
    },
    "kidney": {
      "definition": "front_kidney_stage_wording@1.0",
      "direction": "NONE",
      "measurement": {
        "acr": [],
        "acute_change": {
          "flag": false,
          "latest": "L-0076",
          "latest_value": 1.07,
          "lookback_days": 365,
          "lowest": "L-0075",
          "lowest_value": 1.07,
          "ratio": 1.0
        },
        "albuminuria_persistent": false,
        "direction": "NONE",
        "option_status": {
          "G1": {
            "shows": "filtering rate 60 or above; needs a kidney damage marker (no persistent albuminuria on file)",
            "status": "not_assessable"
          },
          "G2": {
            "shows": "filtering rate 60 or above; needs a kidney damage marker (no persistent albuminuria on file)",
            "status": "not_assessable"
          },
          "G3a": {
            "shows": "results at least 90 days apart are 60 or above",
            "status": "not_met"
          },
          "G3b": {
            "shows": "results at least 90 days apart are 60 or above",
            "status": "not_met"
          },
          "G4": {
            "shows": "results at least 90 days apart are 60 or above",
            "status": "not_met"
          },
          "G5": {
            "shows": "results at least 90 days apart are 60 or above",
            "status": "not_met"
          }
        },
        "pair": [],
        "route": null,
        "stage": null,
        "stated_stage": null,
        "status": "not_met"
      },
      "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": "filtering rate 60 or above; needs a kidney damage marker (no persistent albuminuria on file)",
          "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": "filtering rate 60 or above; needs a kidney damage marker (no persistent albuminuria on file)",
          "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": "results at least 90 days apart are 60 or above",
          "status": "not_met",
          "status_label": "not met",
          "wording": "Chronic kidney disease stage 3a"
        },
        {
          "key": "G3b",
          "kind": "wording",
          "requires": "filtering rate 30-44 on two results at least 90 days apart",
          "shows": "results at least 90 days apart are 60 or above",
          "status": "not_met",
          "status_label": "not met",
          "wording": "Chronic kidney disease stage 3b"
        },
        {
          "key": "G4",
          "kind": "wording",
          "requires": "filtering rate 15-29 on two results at least 90 days apart",
          "shows": "results at least 90 days apart are 60 or above",
          "status": "not_met",
          "status_label": "not met",
          "wording": "Chronic kidney disease stage 4"
        },
        {
          "key": "G5",
          "kind": "wording",
          "requires": "filtering rate below 15 on two results at least 90 days apart",
          "shows": "results at least 90 days apart are 60 or above",
          "status": "not_met",
          "status_label": "not met",
          "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)"
        }
      ]
    }
  }
}