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GOLD-STR-06

Straightforward · gold-v0.1

Case inputs

As of
2026-06-05
Patient
33 years, MI
Request
Immunara for rheumatoid arthritis
Insurance
CivicCare, CivicCare Plus · CCP-224871
Policy
immunara-v0.1
Inputs
sha256:84385b4ac3d7…

Documents 2

Physician note

clinic_note
SYNTHETIC RECORD - Example Bayview Outside Clinic - Visit Summary - 2026-06-01
Patient reference SYN-8842. This visit summary accompanies a transfer of care to a rheumatology practice near her new home. She is a 33-year-old woman; this clinic diagnosed her rheumatoid arthritis in 2022 after a positive rheumatoid factor and six weeks of symmetric joint swelling.

She was started on subcutaneous methotrexate on 2025-09-15 and continued it until 2026-02-16, when she developed painful mouth ulcers that did not resolve with a folic acid adjustment, so the medication was stopped for intolerance. Her joints remain swollen intermittently, and she works as a school administrator, which she says has become harder with the stiffness. She has no known drug allergies. These records, along with a note about her methotrexate intolerance, are being sent ahead for consideration of Immunara.

Fax cover

fax_cover
SYNTHETIC RECORD - Example Bayview Outside Clinic - Fax Cover Sheet - 2026-06-01
To: CivicCare Plus Pharmacy Benefits Reviewer
Re: Prior authorization request for Immunara
Patient reference SYN-8842. Member ID: CCP-224871. Pages: 1 of 1.

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
0.940
Step therapy met
0.970
Documentation complete
0.930
Material contradiction
0.080
Missing evidence
NONE 0.840
others: DOSAGE 0.08 · TREATMENT_HISTORY 0.05 · DIAGNOSIS 0.02
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=33, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.080, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.930, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.840), request info at >= 0.7

  6. auto_processFIRED → AUTO_PROCESS

    min(required p_yes)=0.930, auto at >= 0.89; p_yes(material_contradiction)=0.080, 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)