Skip to content

GOLD-CON-02

Conflicting evidence · gold-v0.1

Case inputs

As of
2026-06-15
Patient
39 years, TX
Request
Immunara for rheumatoid arthritis
Insurance
Northstar, Northstar Choice · NSC-118820
Policy
immunara-v0.1
Inputs
sha256:c7fc9403bbfe…

Documents 2

Physician note

referral_letter
SYNTHETIC RECORD - Example Coastal Family Medicine - Referral Letter - 2026-05-01
Patient reference SYN-2277.

Dear Colleague,

I am referring my patient, a 39-year-old man with seropositive rheumatoid arthritis confirmed in 2021, for evaluation for Immunara. He has been under my care for his joint disease while awaiting a rheumatology appointment.

He completed a twenty-five week course of oral methotrexate, from November 3, 2025 to April 27, 2026, which was discontinued for inadequate response despite dose escalation to 20 mg weekly. His hand and wrist swelling has persisted throughout, and he continues to describe stiffness that limits his work as an electrician. He has no other significant medical history apart from mild, diet-controlled reflux.

I appreciate your evaluation and your consideration of Immunara given his disease course.

Sincerely,
The referring primary care physician

Medication history

medication_history
SYNTHETIC RECORD - Example Summit Arthritis Center - Medication History - 2026-05-10
Patient reference SYN-2277.
METHOTREXATE 20 MG PO WEEKLY - status: inactive - start 2026-03-02 - end 2026-04-27 - reason: inadequate response
FOLIC ACID 1 MG PO DAILY - status: inactive - start 2026-03-02
OMEPRAZOLE 20 MG PO DAILY - status: active

Decisions by provider

HUMAN_REVIEWcorrect

Decided by: default_review gate · auto_process 0.89

Judgments

p_yes for yes/no questions; ticks are the thresholds a gate compares each one with.

Diagnosis supported
0.970
Step therapy met
0.796
Documentation complete
0.970
Material contradiction
0.300
Missing evidence
NONE 0.960
others: DOSAGE 0.04
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=39, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.300, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.970, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.960), request info at >= 0.7

  6. auto_processpassed

    min(required p_yes)=0.796, auto at >= 0.89; p_yes(material_contradiction)=0.300, blocks at >= 0.2

  7. default_reviewFIRED → HUMAN_REVIEW

    case does not meet the autonomous-action bar

passed = the gate checked and did not fire; not reached = an earlier gate decided.

  • step_therapy p_yes=0.796 is below the 0.89 autonomous-action bar
  • contradiction risk p=0.300 blocks autonomous processing (>= 0.2)
Run details· q-v0.2

run_20260925T170857Z_b95be9 · q-v0.2 · immunara-v0.1 (v0.1)

auto_process 0.89, chosen on gen-v0.2-dev.

questions: q-v0.2 →

Show expected answer (evaluation only)