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GOLD-CON-18

Conflicting evidence · gold-v0.1

Case inputs

As of
2026-08-10
Patient
44 years, UT
Request
Immunara for rheumatoid arthritis
Insurance
CivicCare, CivicCare Plus · CCP-336610
Policy
immunara-v0.1
Inputs
sha256:26bb42697a8d…

Documents 2

Physician note

referral_letter
SYNTHETIC RECORD - Example Ashford Family Medicine - Referral Letter - 2026-08-01

Dear Colleague,

I am referring this 44-year-old man, who has an established diagnosis of seropositive rheumatoid arthritis confirmed in 2021, for evaluation for Immunara. His hand and wrist swelling has persisted despite treatment.

He completed oral methotrexate 20 mg weekly from 2026-02-02 to 2026-07-20, which was discontinued for inadequate response; his synovitis had not meaningfully improved over the course. He has no other chronic medical conditions.

Thank you for your review.

Sincerely,
The referring primary care physician

Medication history

medication_history
SYNTHETIC RECORD - Example Ashford Rheumatology - Medication History - 2026-07-25
Patient reference SYN-9901.
METHOTREXATE 20 MG PO WEEKLY - status: inactive - start 2026-02-02 - end 2026-07-20 - reason: nausea and vomiting
FOLIC ACID 1 MG PO DAILY - status: inactive - start 2026-02-02
IBUPROFEN 400 MG PO AS NEEDED - status: active

Decisions by provider

HUMAN_REVIEWwrong, safe

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
0.910
Documentation complete
0.960
Material contradiction
0.870
Missing evidence
NONE 0.910
others: DOSAGE 0.04 · TREATMENT_HISTORY 0.04 · LAB_RESULT 0.01
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=44, policy min_age=18

  3. contradictionFIRED → HUMAN_REVIEW

    p_yes(material_contradiction)=0.870, 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=0.870)
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)