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GOLD-CON-19

Conflicting evidence · gold-v0.1

Case inputs

As of
2026-06-15
Patient
68 years, MO
Request
Immunara for rheumatoid arthritis
Insurance
ExampleHealth, ExampleHealth Gold · EXH-445210
Policy
immunara-v0.1
Inputs
sha256:bfe2a5d65f32…

Documents 2

Medication history

medication_history
SYNTHETIC RECORD - Example Delta Rheumatology - Medication History - 2026-06-05
Patient reference SYN-1056.
TREXALL 15 MG PO WEEKLY - status: inactive - start 2026-04-06 - end 2026-06-01 - reason: nausea
FOLIC ACID 1 MG PO DAILY - status: inactive - start 2026-04-06
FUROSEMIDE 20 MG PO DAILY - status: active

Physician note

problem_list
SYNTHETIC RECORD - Example Delta Rheumatology - Problem List Update - 2026-06-10
Patient reference SYN-1056. 68-year-old woman.

- Seropositive rheumatoid arthritis, diagnosed 2014, followed at this practice since.
- Methotrexate (MTX) 2026-04-06 to 2026-06-01, stopped for nausea that did not resolve with dose adjustment.
- Mild chronic kidney disease, stage 2, monitored.
- Plan: discuss next steps given the brief methotrexate trial; consider Immunara.

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
0.000
Documentation complete
0.950
Material contradiction
0.140
Missing evidence
NONE 0.850
others: DOSAGE 0.08 · TREATMENT_HISTORY 0.05 · DIAGNOSIS 0.01
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=68, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.140, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.950, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.850), request info at >= 0.7

  6. auto_processpassed

    min(required p_yes)=0.000, auto at >= 0.89; p_yes(material_contradiction)=0.140, 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=0.000 is below the 0.89 autonomous-action bar
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)