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GOLD-CON-20

Conflicting evidence · gold-v0.1

Case inputs

As of
2026-06-01
Patient
31 years, KY
Request
Immunara for rheumatoid arthritis
Insurance
Northstar, Northstar Choice · NSC-771102
Policy
immunara-v0.1
Inputs
sha256:84913b7f683b…

Documents 2

Physician note

referral_letter
SYNTHETIC RECORD - Example Timberline Family Medicine - Referral Note - 2025-11-10
Patient reference SYN-2267. This 31-year-old man was seen for six weeks of symmetric swelling in both hands and feet, with morning stiffness lasting well over an hour.

Suspected rheumatoid arthritis is noted given the joint distribution, and he is being referred to rheumatology for confirmatory evaluation and further management. He has not started any DMARD therapy at this point. He is otherwise healthy and takes no regular medications.

Physician note

consult_note
SYNTHETIC RECORD - Example Sequoia Rheumatology - Consultation Note - 2025-12-05
Patient reference SYN-2267. This 31-year-old man was evaluated for the hand and foot swelling described in his family medicine referral.

His rheumatoid factor and anti-CCP antibody were both strongly positive, and exam showed synovitis at the wrists, MCPs and MTPs bilaterally, establishing a diagnosis of seropositive rheumatoid arthritis. Oral methotrexate 20 mg weekly was started 2025-12-15 and continued until 2026-05-11, when it was stopped because his synovitis had not improved despite dose escalation, an inadequate response.

Immunara is recommended given his sustained disease activity.

Decisions by provider

AUTO_PROCESScorrect

Decided by: auto_process 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
0.970
Documentation complete
0.950
Material contradiction
0.120
Missing evidence
NONE 0.920
others: DOSAGE 0.03 · TREATMENT_HISTORY 0.03 · DIAGNOSIS 0.01
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=31, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.120, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.950, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.920), request info at >= 0.7

  6. auto_processFIRED → AUTO_PROCESS

    min(required p_yes)=0.950, auto at >= 0.89; p_yes(material_contradiction)=0.120, blocks at >= 0.2

  7. default_reviewnot reached

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

  • all required judgments are at or above 0.89 and contradiction risk is below 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)