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GOLD-MIS-16

Missing information · gold-v0.1

Case inputs

As of
2026-07-22
Patient
35 years, SC
Request
Immunara for rheumatoid arthritis
Insurance
Northstar, Northstar Choice · NSC-663321
Policy
immunara-v0.1
Inputs
sha256:96c1ddee8d55…

Documents 2

Physician note

referral_letter
SYNTHETIC RECORD - Example Timberline Family Clinic - Referral Letter - 2026-07-18

Dear Rheumatology Colleague,

I am referring this 35-year-old man for evaluation of seronegative inflammatory arthritis, with symptoms of symmetric hand and wrist swelling beginning in November 2025. His serology has been negative throughout, and rheumatoid arthritis has not been confirmed at this point; his presentation remains under active investigation.

Given the severity of his symptoms, he was started on oral methotrexate on 2026-01-19 and continued it through 2026-06-08, when it was stopped because his synovitis had not improved despite the trial, an inadequate response. His negative serology results are enclosed.

Best regards,
The referring family physician

Lab report

lab_report
SYNTHETIC RECORD - Example Timberline Family Clinic - Laboratory Report - 2026-07-05
Patient reference SYN-2278.
Rheumatoid factor: negative, 8 IU/mL (reference <14).
Anti-CCP antibody: negative, 6 U/mL (reference <20).
Erythrocyte sedimentation rate: 30 mm/hr (elevated).

Decisions by provider

REQUEST_INFOcorrect

Decided by: documentation gate · auto_process 0.89

Judgments

p_yes for yes/no questions; ticks are the thresholds a gate compares each one with.

Diagnosis supported
0.030
Step therapy met
0.970
Documentation complete
0.370
Material contradiction
0.120
Missing evidence
DIAGNOSIS 1.000
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=35, policy min_age=18

  3. contradictionpassed

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

  4. documentationFIRED → REQUEST_INFO

    p_yes(documentation_complete)=0.370, request info below 0.6

  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.

  • documentation is likely incomplete (p_yes=0.370)
  • most likely missing: diagnosis (p=1.000)
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)