Replay FRUN-00049 specificity check (heart failure type, kidney stage, nutrition)

{
  "as_of": "2026-11-13T16:55:00-05:00",
  "encounter": {
    "admit_dt": "2026-11-12T10:00:00-05:00",
    "encounter_id": "KE-P41",
    "setting": "outpatient"
  },
  "items": [
    {
      "data": {
        "author": "Dr. Ines Varga (cardiology)",
        "method": "transthoracic, report text only",
        "text": "Transthoracic echocardiogram. Left ventricle mildly dilated with global hypokinesis. Left ventricular ejection fraction is 30% by biplane method. Mild mitral regurgitation. Normal right ventricular size and function."
      },
      "item_id": "ECHO-P41-1",
      "kind": "echo",
      "time": "2026-10-19T10:20:00-04:00"
    },
    {
      "data": {
        "kg": 82.4
      },
      "item_id": "WT-P41-1",
      "kind": "weight",
      "time": "2026-11-12T10:05:00-05:00"
    },
    {
      "data": {
        "ai": {
          "faults": [],
          "model": "openai/gpt-6.1-terra",
          "model_version": "openai/gpt-6.1-terra",
          "provider": "openrouter",
          "status": "agree",
          "task": "exactdx.echo_ef@1",
          "verified_span": [
            85,
            145
          ]
        },
        "author": "Dr. Ines Varga (cardiology)",
        "date": "2026-10-19",
        "end": 145,
        "high": 30.0,
        "label": "read from the report text by the AI reader \u00b7 quote verified \u00b7 rule reader agrees",
        "low": 30.0,
        "method": "transthoracic, report text only",
        "quote": "Left ventricular ejection fraction is 30% by biplane method.",
        "report_sha256": "13bf4d82d62b6b2c132df2e7ff17afd4b0138da752f3e7b25ac32768095fa40c",
        "rule": {
          "end": 145,
          "found": true,
          "high": 30.0,
          "low": 30.0,
          "start": 85
        },
        "source_item": "ECHO-P41-1",
        "start": 85,
        "status": "used",
        "value": 30.0
      },
      "item_id": "ECHO-P41-1.text",
      "kind": "echo_text",
      "time": "2026-10-19T10:20:00-04:00"
    }
  ],
  "kidney": {
    "acr": [],
    "acute_change": {
      "flag": false,
      "latest": "L-0097",
      "latest_value": 0.95,
      "lookback_days": 365,
      "lowest": "L-0096",
      "lowest_value": 0.95,
      "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-0097",
        "value": 86.6
      },
      "met": false,
      "normal_pair": [
        "L-0096",
        "L-0097"
      ],
      "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": 86.6,
        "g_2021": "G2",
        "lab_id": "L-0096"
      },
      {
        "date": "2026-11-12",
        "egfr_2021": 86.6,
        "g_2021": "G2",
        "lab_id": "L-0097"
      }
    ],
    "stated_stage": null
  },
  "note": {
    "note_id": "KN-P41-1",
    "reading": {
      "ai": {
        "families": {
          "heart_failure": {
            "faults": [],
            "spans": [
              [
                128,
                131
              ]
            ],
            "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": "ea76be336eb2445b9d29f3a979b9010fe46d581f9e93b37c7d03971af08f10b4",
        "status": "ok",
        "task": "exactdx.front_statements@1"
      },
      "mentions": [
        {
          "assertion": "affirmed",
          "category": "unspecified",
          "context": null,
          "end": 131,
          "family": "heart_failure",
          "quote": "CHF",
          "start": 128,
          "words": []
        }
      ],
      "reader": "front-lexicon 1.0",
      "text_sha256": "ea76be336eb2445b9d29f3a979b9010fe46d581f9e93b37c7d03971af08f10b4"
    }
  },
  "patient": {
    "birth_date": "1956-11-17",
    "patient_id": "P41",
    "sex": "M"
  }
}

{
  "engine": "front-engine 1.2",
  "families": {
    "heart_failure": {
      "acuity_words": [],
      "definition": "front_hf_ef_type@1.0",
      "direction": "SPECIFICITY_GAP",
      "measurement": {
        "acuity": {
          "admissions": [],
          "iv_diuretic": [],
          "natriuretic": null,
          "symptoms": [],
          "weight": {
            "latest": {
              "date": "2026-11-12",
              "id": "WT-P41-1",
              "kg": 82.4
            },
            "reference": null
          }
        },
        "baseline": null,
        "category": "reduced",
        "efs": [
          {
            "author": "Dr. Ines Varga (cardiology)",
            "date": "2026-10-19",
            "ef": 30.0,
            "high": 30.0,
            "id": "ECHO-P41-1",
            "low": 30.0,
            "method": "transthoracic, report text only",
            "origin": "report_text",
            "quote": "Left ventricular ejection fraction is 30% by biplane method.",
            "text": "Left ventricular ejection fraction is 30% by biplane method.",
            "time": "2026-10-19T10:20:00-04:00"
          }
        ],
        "improved": null,
        "latest": {
          "author": "Dr. Ines Varga (cardiology)",
          "date": "2026-10-19",
          "ef": 30.0,
          "high": 30.0,
          "id": "ECHO-P41-1",
          "low": 30.0,
          "method": "transthoracic, report text only",
          "origin": "report_text",
          "quote": "Left ventricular ejection fraction is 30% by biplane method.",
          "text": "Left ventricular ejection fraction is 30% by biplane method.",
          "time": "2026-10-19T10:20:00-04:00"
        },
        "option_status": {
          "improved": {
            "shows": "only one measurement on file (30% on 2026-10-19)",
            "status": "not_assessable"
          },
          "mildly_reduced": {
            "shows": "latest 30% on 2026-10-19",
            "status": "not_met"
          },
          "preserved": {
            "shows": "latest 30% on 2026-10-19",
            "status": "not_met"
          },
          "reduced": {
            "shows": "latest 30% on 2026-10-19",
            "status": "met"
          }
        }
      },
      "mention": {
        "assertion": "affirmed",
        "category": "unspecified",
        "context": null,
        "end": 131,
        "family": "heart_failure",
        "quote": "CHF",
        "start": 128,
        "words": []
      },
      "options": [
        {
          "key": "reduced",
          "kind": "wording",
          "requires": "latest ejection fraction 40% or lower",
          "shows": "latest 30% on 2026-10-19",
          "status": "met",
          "status_label": "met",
          "wording": "Heart failure with reduced ejection fraction (HFrEF)"
        },
        {
          "key": "mildly_reduced",
          "kind": "wording",
          "requires": "latest ejection fraction 41% to 49%",
          "shows": "latest 30% on 2026-10-19",
          "status": "not_met",
          "status_label": "not met",
          "wording": "Heart failure with mildly reduced ejection fraction (HFmrEF)"
        },
        {
          "key": "preserved",
          "kind": "wording",
          "requires": "latest ejection fraction 50% or higher",
          "shows": "latest 30% on 2026-10-19",
          "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": "only one measurement on file (30% on 2026-10-19)",
          "status": "not_assessable",
          "status_label": "not assessable",
          "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": "unspecified",
      "why": "type_not_stated"
    },
    "kidney": {
      "definition": "front_kidney_stage_wording@1.0",
      "direction": "NONE",
      "measurement": {
        "acr": [],
        "acute_change": {
          "flag": false,
          "latest": "L-0097",
          "latest_value": 0.95,
          "lookback_days": 365,
          "lowest": "L-0096",
          "lowest_value": 0.95,
          "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)"
        }
      ]
    }
  }
}