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GOLD-CON-09

Conflicting evidence · gold-v0.1

Case inputs

As of
2026-06-10
Patient
41 years, IL
Request
Immunara for rheumatoid arthritis
Insurance
CivicCare, CivicCare Plus · CCP-772140
Policy
immunara-v0.1
Inputs
sha256:d8a48461edb5…

Documents 2

Physician note

physician_note
SYNTHETIC RECORD - Example Meadowlark Rheumatology - Office Visit - 2026-05-04
Patient reference SYN-9915. This 41-year-old woman carries an established diagnosis of rheumatoid arthritis, made at this practice in 2023 after months of symmetric wrist and finger swelling with a positive rheumatoid factor.

Methotrexate has not yet been tried; she has managed her symptoms with over-the-counter ibuprofen alone. Her joint pain has worsened over the past several months, now affecting her ability to type at her office job. Plan is to discuss starting a DMARD trial versus proceeding directly to biologic therapy given the severity of her symptoms.

Physician note

consult_note
SYNTHETIC RECORD - Example Stonebridge Medical Consultants - Consultation Letter - 2026-05-20

Dear Colleague,

I evaluated this 41-year-old woman for recurrent joint pain and swelling. Her presentation, with episodic first-toe and ankle involvement and an elevated uric acid level, is most consistent with gout; she does not have rheumatoid arthritis. She has not taken methotrexate or any other DMARD, which is appropriate given this assessment.

I have recommended urate-lowering therapy and dietary counseling. Please let me know if you would like further workup.

Best regards,
The consulting internist

Decisions by provider

HUMAN_REVIEWcorrect

Decided by: contradiction gate · auto_process 0.89

Judgments

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

Diagnosis supported
0.680
Step therapy met
0.000
Documentation complete
0.930
Material contradiction
0.940
Missing evidence
TREATMENT_HISTORY 0.550
others: DIAGNOSIS 0.27 · NONE 0.16 · DOSAGE 0.01
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=41, policy min_age=18

  3. contradictionFIRED → HUMAN_REVIEW

    p_yes(material_contradiction)=0.940, review at >= 0.8

  4. documentationnot reached
  5. missing_evidencenot reached
  6. auto_processnot reached
  7. default_reviewnot reached

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

  • a material contradiction is likely (p=0.940)
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)