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GOLD-CON-15

Conflicting evidence · gold-v0.1

Case inputs

As of
2026-06-10
Patient
71 years, WI
Request
Immunara for rheumatoid arthritis
Insurance
CivicCare, CivicCare Plus · CCP-114402
Policy
immunara-v0.1
Inputs
sha256:023abfb1bb8e…

Documents 3

Physician note

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

Subjective: 71-year-old woman with seropositive rheumatoid arthritis, diagnosed at this clinic in 2016, reports ongoing hand and wrist pain.
Objective: Synovitis at bilateral wrists and MCPs. Vitals stable. No new rashes.
Assessment: Rheumatoid arthritis remains active despite oral methotrexate 15 mg weekly, taken from 2026-01-05 to 2026-06-01, discontinued for inadequate response.
Plan: Discuss Immunara. Continue calcium supplementation.

Medication history

medication_history
SYNTHETIC RECORD - Example Harborview Rheumatology - Medication History - 2026-06-01
Patient reference SYN-6678.
METHOTREXATE 20 MG PO WEEKLY - status: inactive - start 2026-01-05 - end 2026-06-01 - reason: inadequate response
FOLIC ACID 1 MG PO DAILY - status: inactive - start 2026-01-05
CALCIUM CARBONATE 500 MG PO DAILY - status: active

Lab report

lab_report
SYNTHETIC RECORD - Example Harborview Rheumatology - Laboratory Report - 2026-05-15
Patient reference SYN-6678.
Rheumatoid factor: positive, 70 IU/mL (reference <14).
Anti-CCP antibody: positive, 95 U/mL (reference <20).
ESR: 40 mm/hr (elevated).

Decisions by provider

HUMAN_REVIEWwrong, safe

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
0.571
Documentation complete
0.970
Material contradiction
0.210
Missing evidence
NONE 0.970
others: DOSAGE 0.03
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=71, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.210, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.970, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.970), request info at >= 0.7

  6. auto_processpassed

    min(required p_yes)=0.571, auto at >= 0.89; p_yes(material_contradiction)=0.210, 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=0.571 is below the 0.89 autonomous-action bar
  • contradiction risk p=0.210 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)