Replay FRUN-00047 specificity check (heart failure type, kidney stage, nutrition)

{
  "as_of": "2026-11-13T16:55:00-05:00",
  "encounter": {
    "admit_dt": "2026-11-12T11:00:00-05:00",
    "encounter_id": "KE-P35",
    "setting": "outpatient"
  },
  "items": [
    {
      "data": {
        "kg": 73.5
      },
      "item_id": "WT-P35-1",
      "kind": "weight",
      "time": "2025-11-12T09:00:00-05:00"
    },
    {
      "data": {
        "kg": 72.0
      },
      "item_id": "WT-P35-2",
      "kind": "weight",
      "time": "2026-05-16T09:00:00-04:00"
    },
    {
      "data": {
        "kg": 68.5
      },
      "item_id": "WT-P35-3",
      "kind": "weight",
      "time": "2026-08-14T09:00:00-04:00"
    },
    {
      "data": {
        "kg": 65.0
      },
      "item_id": "WT-P35-4",
      "kind": "weight",
      "time": "2026-10-13T09:00:00-04:00"
    },
    {
      "data": {
        "analyte": "albumin",
        "low": 3.5,
        "name": "Albumin",
        "unit": "g/dL",
        "value": 2.9
      },
      "item_id": "LO-P35-1",
      "kind": "lab_other",
      "time": "2026-11-09T08:00:00-05:00"
    },
    {
      "data": {
        "analyte": "prealbumin",
        "low": 18,
        "name": "Prealbumin",
        "unit": "mg/dL",
        "value": 12
      },
      "item_id": "LO-P35-2",
      "kind": "lab_other",
      "time": "2026-11-09T08:00:00-05:00"
    },
    {
      "data": {
        "kg": 63.6
      },
      "item_id": "WT-P35-5",
      "kind": "weight",
      "time": "2026-11-09T13:30:00-05:00"
    },
    {
      "data": {
        "author": "Wren Halden, RD",
        "context": "chronic",
        "context_quote": "chronic illness (pancreatic adenocarcinoma on chemotherapy)",
        "fat_loss": {
          "grade": "mild",
          "quote": "mild orbital fat loss"
        },
        "fluid": {
          "grade": "none",
          "quote": "no edema"
        },
        "grip": {
          "quote": "grip strength measurably reduced by hand dynamometer",
          "result": "reduced"
        },
        "intake": {
          "days": 42,
          "pct": 50,
          "quote": "about 50% of estimated energy needs for 6 weeks"
        },
        "muscle_loss": {
          "grade": "moderate",
          "quote": "moderate temporal and clavicular muscle wasting"
        },
        "note_id": "CN-P35-RD"
      },
      "item_id": "NA-P35-1",
      "kind": "nutrition_assessment",
      "time": "2026-11-09T14:00:00-05:00"
    },
    {
      "data": {
        "kg": 63.2
      },
      "item_id": "WT-P35-6",
      "kind": "weight",
      "time": "2026-11-12T09:00:00-05:00"
    }
  ],
  "kidney": {
    "acr": [],
    "acute_change": {
      "flag": false,
      "latest": "L-0083",
      "latest_value": 0.85,
      "lookback_days": 365,
      "lowest": "L-0082",
      "lowest_value": 0.85,
      "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-0083",
        "value": 71.8
      },
      "met": false,
      "normal_pair": [
        "L-0082",
        "L-0083"
      ],
      "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": 71.8,
        "g_2021": "G2",
        "lab_id": "L-0082"
      },
      {
        "date": "2026-11-12",
        "egfr_2021": 71.8,
        "g_2021": "G2",
        "lab_id": "L-0083"
      }
    ],
    "stated_stage": null
  },
  "note": {
    "note_id": "KN-P35-1",
    "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": "297423d60f48b172c800a7531354064cddaf8238e234ce93fdb0881093912703",
        "status": "ok",
        "task": "exactdx.front_statements@1"
      },
      "mentions": [],
      "reader": "front-lexicon 1.0",
      "text_sha256": "297423d60f48b172c800a7531354064cddaf8238e234ce93fdb0881093912703"
    }
  },
  "patient": {
    "birth_date": "1951-11-18",
    "patient_id": "P35",
    "sex": "F"
  }
}

{
  "engine": "front-engine 1.2",
  "families": {
    "kidney": {
      "definition": "front_kidney_stage_wording@1.0",
      "direction": "NONE",
      "measurement": {
        "acr": [],
        "acute_change": {
          "flag": false,
          "latest": "L-0083",
          "latest_value": 0.85,
          "lookback_days": 365,
          "lowest": "L-0082",
          "lowest_value": 0.85,
          "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)"
        }
      ]
    },
    "malnutrition": {
      "definition": "front_malnutrition_us_consensus@1.0",
      "direction": "UNDER",
      "measurement": {
        "assessment": {
          "author": "Wren Halden, RD",
          "context": "chronic",
          "context_label": "chronic illness",
          "context_quote": "chronic illness (pancreatic adenocarcinoma on chemotherapy)",
          "date": "2026-11-09",
          "id": "NA-P35-1",
          "note_id": "CN-P35-RD"
        },
        "characteristics": [
          {
            "id": "intake",
            "label": "Energy intake",
            "level": "severe",
            "quote": "about 50% of estimated energy needs for 6 weeks",
            "shows": "50% of estimated needs for 42 days"
          },
          {
            "id": "weight",
            "label": "Weight loss",
            "level": "severe",
            "quote": null,
            "shows": "2.8% over 1 month (65 kg on 2026-10-13 to 63.2 kg on 2026-11-12); 7.7% over 3 months (68.5 kg on 2026-08-14 to 63.2 kg on 2026-11-12); 12.2% over 6 months (72 kg on 2026-05-16 to 63.2 kg on 2026-11-12); 14% over 1 year (73.5 kg on 2025-11-12 to 63.2 kg on 2026-11-12)",
            "windows": [
              {
                "days": 30,
                "latest": {
                  "date": "2026-11-12",
                  "id": "WT-P35-6",
                  "kg": 63.2
                },
                "pct": 2.8,
                "ref": {
                  "date": "2026-10-13",
                  "id": "WT-P35-4",
                  "kg": 65.0
                }
              },
              {
                "days": 90,
                "latest": {
                  "date": "2026-11-12",
                  "id": "WT-P35-6",
                  "kg": 63.2
                },
                "pct": 7.7,
                "ref": {
                  "date": "2026-08-14",
                  "id": "WT-P35-3",
                  "kg": 68.5
                }
              },
              {
                "days": 180,
                "latest": {
                  "date": "2026-11-12",
                  "id": "WT-P35-6",
                  "kg": 63.2
                },
                "pct": 12.2,
                "ref": {
                  "date": "2026-05-16",
                  "id": "WT-P35-2",
                  "kg": 72.0
                }
              },
              {
                "days": 365,
                "latest": {
                  "date": "2026-11-12",
                  "id": "WT-P35-6",
                  "kg": 63.2
                },
                "pct": 14.0,
                "ref": {
                  "date": "2025-11-12",
                  "id": "WT-P35-1",
                  "kg": 73.5
                }
              }
            ]
          },
          {
            "id": "fat_loss",
            "label": "Fat loss",
            "level": "moderate",
            "quote": "mild orbital fat loss",
            "shows": "graded mild"
          },
          {
            "id": "muscle_loss",
            "label": "Muscle loss",
            "level": "moderate",
            "quote": "moderate temporal and clavicular muscle wasting",
            "shows": "graded moderate"
          },
          {
            "id": "fluid",
            "label": "Fluid accumulation",
            "level": "not_met",
            "quote": "no edema",
            "shows": "graded none"
          },
          {
            "id": "grip",
            "label": "Grip strength",
            "level": "severe",
            "quote": "grip strength measurably reduced by hand dynamometer",
            "shows": "reduced"
          }
        ],
        "n_assessable": 6,
        "n_moderate": 5,
        "n_severe": 3,
        "not_criteria_low": [
          {
            "analyte": "albumin",
            "date": "2026-11-09",
            "id": "LO-P35-1",
            "low": 3.5,
            "name": "Albumin",
            "unit": "g/dL",
            "value": 2.9
          },
          {
            "analyte": "prealbumin",
            "date": "2026-11-09",
            "id": "LO-P35-2",
            "low": 18,
            "name": "Prealbumin",
            "unit": "mg/dL",
            "value": 12
          }
        ],
        "option_status": {
          "moderate": {
            "shows": "5 at the moderate level or worse",
            "status": "met"
          },
          "severe": {
            "shows": "3 at the severe level",
            "status": "met"
          }
        },
        "result": "severe"
      },
      "mention": null,
      "options": [
        {
          "key": "moderate",
          "kind": "wording",
          "requires": "two or more characteristics at the moderate level or worse",
          "shows": "5 at the moderate level or worse",
          "status": "met",
          "status_label": "met",
          "wording": "Moderate (non-severe) malnutrition in the context of chronic illness"
        },
        {
          "key": "severe",
          "kind": "wording",
          "requires": "two or more characteristics at the severe level",
          "shows": "3 at the severe level",
          "status": "met",
          "status_label": "met",
          "wording": "Severe malnutrition in the context of chronic illness"
        },
        {
          "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": null,
      "why": "met_not_stated"
    }
  }
}