SYNTHETIC RECORD - Example Harbor Medical Group - Referral Letter - 2026-06-28
Patient reference SYN-2209.
Dear Colleague,
I am referring my patient, a 39-year-old man, for consideration of Immunara. He carries an established diagnosis of rheumatoid arthritis, confirmed in 2024 with positive rheumatoid factor and erosive changes on hand imaging.
He was treated with oral methotrexate from January 5, 2026 to May 26, 2026 but developed nausea and a rise in his liver enzymes, so the medication was discontinued for intolerance. His joint symptoms have continued to limit his work as a carpenter. He has no other significant medical history apart from well-controlled seasonal allergies.
Please review the enclosed medication history and let me know if you require anything further.
Sincerely,
The referring primary care physician
Medication history
medication_history
SYNTHETIC RECORD - Example Harbor Medical Group - Medication History - 2026-06-28
Patient reference SYN-2209.
METHOTREXATE 15 MG PO WEEKLY - status: inactive - start 2026-01-05 - end 2026-05-26 - reason: nausea and elevated liver enzymes
FOLIC ACID 1 MG PO DAILY - status: inactive - start 2026-01-05
LORATADINE 10 MG PO DAILY - status: active
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
0.970
Material contradiction
review 0.80block 0.20
0.050
Missing evidence
NONE 0.970
others: DOSAGE 0.02 · LAB_RESULT 0.01
Gate path· 7 gates, in engine order
providerpassed
all five decisions present and well-formed
agepassed
patient.age=39, policy min_age=18
contradictionpassed
p_yes(material_contradiction)=0.050, review at >= 0.8
documentationpassed
p_yes(documentation_complete)=0.970, request info below 0.6
missing_evidencepassed
missing_evidence=NONE (p=0.970), request info at >= 0.7
auto_processFIRED → AUTO_PROCESS
min(required p_yes)=0.970, auto at >= 0.89; p_yes(material_contradiction)=0.050, 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