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GOLD-CON-06

Conflicting evidence · gold-v0.1

Case inputs

As of
2026-09-01
Patient
58 years, MI
Request
Immunara for rheumatoid arthritis
Insurance
CivicCare, CivicCare Plus · CCP-337712
Policy
immunara-v0.1
Inputs
sha256:8353ccd2f30f…

Documents 2

Physician note

physician_note
SYNTHETIC RECORD - Example Brookhaven Medical Center - Office Visit - 2026-09-01

Subjective: 58-year-old man with seropositive rheumatoid arthritis, diagnosed at this practice in 2021, reports his hand and wrist swelling has not improved.
Objective: Synovitis present at bilateral wrists and MCP joints. Grip strength reduced bilaterally. Vitals stable.
Assessment: Rheumatoid arthritis remains active despite oral methotrexate 20 mg weekly, continuing since 2026-02-01, an inadequate response.
Plan: Discuss Immunara. Continue folic acid. Recheck in one month.

Medication history

medication_history
SYNTHETIC RECORD - Example Brookhaven Medical Center - Medication History - 2026-09-01
METHOTREXATE 20 MG PO WEEKLY - status: inactive - start 2026-02-01 - end 2026-03-10 - reason: inadequate response
FOLIC ACID 1 MG PO DAILY - status: inactive - start 2026-02-01
METOPROLOL 25 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
0.980
Step therapy met
0.067
Documentation complete
0.970
Material contradiction
0.340
Missing evidence
NONE 0.910
others: TREATMENT_HISTORY 0.05 · DOSAGE 0.03 · LAB_RESULT 0.01
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=58, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.340, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.970, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.910), request info at >= 0.7

  6. auto_processpassed

    min(required p_yes)=0.067, auto at >= 0.89; p_yes(material_contradiction)=0.340, 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=0.067 is below the 0.89 autonomous-action bar
  • contradiction risk p=0.340 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)