SYNTHETIC RECORD - Example Ridge Rheumatology - Follow-up Visit - 2026-07-06
Patient reference SYN-4471. 44-year-old woman with seropositive rheumatoid arthritis, diagnosed in 2023 by rheumatology after persistently elevated anti-CCP and rheumatoid factor.
Subjective: She reports ongoing pain and stiffness in both wrists and the small joints of her hands, worse in the morning, and has been asking about additional treatment options.
Objective: Synovitis is present at the bilateral wrists, MCPs, and PIPs. Grip strength is reduced. Vitals are stable, blood pressure 118/76.
Assessment: Seropositive rheumatoid arthritis with persistent synovitis despite an adequate trial of oral methotrexate 15 mg weekly from 2026-01-12 to 2026-06-29, which was discontinued for inadequate response.
Plan: Start Immunara. Continue folic acid supplementation. Recheck in eight weeks.
Decisions by provider
AUTO_PROCESS·correct
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
auto 0.89
0.980
Step therapy met
auto 0.89
0.980
Documentation complete
auto 0.89request info 0.60
0.920
Material contradiction
review 0.80block 0.20
0.060
Missing evidence
NONE 0.850
others: TREATMENT_HISTORY 0.13 · DOSAGE 0.02
Gate path· 7 gates, in engine order
providerpassed
all five decisions present and well-formed
agepassed
patient.age=44, policy min_age=18
contradictionpassed
p_yes(material_contradiction)=0.060, review at >= 0.8
documentationpassed
p_yes(documentation_complete)=0.920, request info below 0.6
missing_evidencepassed
missing_evidence=NONE (p=0.850), request info at >= 0.7
auto_processFIRED → AUTO_PROCESS
min(required p_yes)=0.920, auto at >= 0.89; p_yes(material_contradiction)=0.060, blocks at >= 0.2
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