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GOLD-CON-10

Conflicting evidence · gold-v0.1

Case inputs

As of
2026-06-10
Patient
55 years, GA
Request
Immunara for rheumatoid arthritis
Insurance
ExampleHealth, ExampleHealth Gold · EXH-882201
Policy
immunara-v0.1
Inputs
sha256:ff16d7c473b2…

Documents 2

Physician note

physician_note
SYNTHETIC RECORD - Example Trailhead Rheumatology - Office Visit - 2026-06-05

Subjective: 55-year-old man with seropositive rheumatoid arthritis, diagnosed at this clinic in 2018, reports continued hand and knee swelling. He was hospitalized for pneumonia on February 14, 2021, unrelated to his joint disease.
Objective: Synovitis at bilateral MCPs and the right knee. Mild pitting edema at the ankles. Vitals stable.
Assessment: Rheumatoid arthritis remains active. Methotrexate has not been tried for this patient; leflunomide 20 mg daily was started instead six months ago and has not controlled his disease.
Plan: Discuss Immunara given the inadequate response to leflunomide. Continue routine labs.

Medication history

medication_history
SYNTHETIC RECORD - Example Trailhead Rheumatology - Medication History - 2026-06-01
Patient reference SYN-1123.
METHOTREXATE 15 MG PO WEEKLY - status: inactive - start 2026-01-06 - end 2026-05-26 - reason: nausea
FOLIC ACID 1 MG PO DAILY - status: inactive - start 2026-01-06
LISINOPRIL 10 MG PO DAILY - status: active

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
0.970
Step therapy met
0.728
Documentation complete
0.950
Material contradiction
0.940
Missing evidence
NONE 0.760
others: TREATMENT_HISTORY 0.14 · DOSAGE 0.07 · DIAGNOSIS 0.02
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=55, 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)