Replay FRUN-00046 specificity check (heart failure type, kidney stage, nutrition)

{
  "as_of": "2026-11-13T16:55:00-05:00",
  "encounter": {
    "admit_dt": "2026-11-12T09:00:00-05:00",
    "encounter_id": "KE-P34",
    "setting": "outpatient"
  },
  "items": [],
  "kidney": {
    "acr": [
      {
        "a_cat": "A2",
        "acr": 140.0,
        "date": "2026-07-25",
        "lab_id": "L-0079"
      },
      {
        "a_cat": "A2",
        "acr": 165.0,
        "date": "2026-11-12",
        "lab_id": "L-0081"
      }
    ],
    "acute_change": {
      "flag": false,
      "latest": "L-0080",
      "latest_value": 1.96,
      "lookback_days": 365,
      "lowest": "L-0077",
      "lowest_value": 1.84,
      "ratio": 1.07
    },
    "albuminuria": {
      "met": true
    },
    "direction": "SPECIFICITY_GAP",
    "e21": {
      "direction": "SPECIFICITY_GAP",
      "direction_why": "",
      "latest": {
        "confirmed": true,
        "date": "2026-11-12",
        "g": "G3b",
        "lab_id": "L-0080",
        "value": 37.0
      },
      "met": true,
      "persistence": {
        "days_apart": 110,
        "latest": "L-0080",
        "latest_value": 37.0,
        "met": true,
        "pair": [
          "L-0078",
          "L-0080"
        ],
        "pair_dates": [
          "2026-07-25",
          "2026-11-12"
        ],
        "pair_values": [
          38.4,
          37.0
        ],
        "persistent_value": 38.4,
        "reason": "met"
      },
      "reason": "two values below 60 at least 90 days apart, none of 60 or more between",
      "reason_code": "met",
      "route": "egfr",
      "stage": "G3b",
      "status": "met"
    },
    "egfr": [
      {
        "date": "2026-04-26",
        "egfr_2021": 39.9,
        "g_2021": "G3b",
        "lab_id": "L-0077"
      },
      {
        "date": "2026-07-25",
        "egfr_2021": 38.4,
        "g_2021": "G3b",
        "lab_id": "L-0078"
      },
      {
        "date": "2026-11-12",
        "egfr_2021": 37.0,
        "g_2021": "G3b",
        "lab_id": "L-0080"
      }
    ],
    "stated_stage": null
  },
  "note": {
    "note_id": "KN-P34-1",
    "reading": {
      "ai": {
        "families": {
          "heart_failure": {
            "faults": [],
            "spans": [],
            "status": "agree"
          },
          "malnutrition": {
            "faults": [],
            "spans": [],
            "status": "agree"
          }
        },
        "faults": [],
        "model": "openai/gpt-6.1-terra",
        "model_version": "openai/gpt-6.1-terra",
        "provider": "openrouter",
        "sent_sha256": "0740485dafd583d937e7a8c845967f53ae9f7ea687e638ef97a15b185fca65ac",
        "status": "ok",
        "task": "exactdx.front_statements@1"
      },
      "mentions": [],
      "reader": "front-lexicon 1.0",
      "text_sha256": "0740485dafd583d937e7a8c845967f53ae9f7ea687e638ef97a15b185fca65ac"
    }
  },
  "patient": {
    "birth_date": "1959-11-18",
    "patient_id": "P34",
    "sex": "M"
  }
}

{
  "engine": "front-engine 1.2",
  "families": {
    "kidney": {
      "definition": "front_kidney_stage_wording@1.0",
      "direction": "SPECIFICITY_GAP",
      "measurement": {
        "acr": [
          {
            "category": "A2",
            "date": "2026-07-25",
            "id": "L-0079",
            "value": 140.0
          },
          {
            "category": "A2",
            "date": "2026-11-12",
            "id": "L-0081",
            "value": 165.0
          }
        ],
        "acute_change": {
          "flag": false,
          "latest": "L-0080",
          "latest_value": 1.96,
          "lookback_days": 365,
          "lowest": "L-0077",
          "lowest_value": 1.84,
          "ratio": 1.07
        },
        "albuminuria_persistent": true,
        "direction": "SPECIFICITY_GAP",
        "option_status": {
          "G1": {
            "shows": "filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
            "status": "not_met"
          },
          "G2": {
            "shows": "filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
            "status": "not_met"
          },
          "G3a": {
            "shows": "filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
            "status": "not_met"
          },
          "G3b": {
            "shows": "filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
            "status": "met"
          },
          "G4": {
            "shows": "filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
            "status": "not_met"
          },
          "G5": {
            "shows": "filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
            "status": "not_met"
          }
        },
        "pair": [
          {
            "date": "2026-07-25",
            "egfr_2021": 38.4,
            "g_2021": "G3b",
            "lab_id": "L-0078"
          },
          {
            "date": "2026-11-12",
            "egfr_2021": 37.0,
            "g_2021": "G3b",
            "lab_id": "L-0080"
          }
        ],
        "route": "egfr",
        "stage": "G3b",
        "stated_stage": null,
        "status": "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 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
          "status": "not_met",
          "status_label": "not met",
          "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 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
          "status": "not_met",
          "status_label": "not met",
          "wording": "Chronic kidney disease stage 2"
        },
        {
          "key": "G3a",
          "kind": "wording",
          "requires": "filtering rate 45-59 on two results at least 90 days apart",
          "shows": "filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
          "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": "filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
          "status": "met",
          "status_label": "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": "filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
          "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": "filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)",
          "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)"
        }
      ]
    }
  }
}