SYNTHETIC RECORD - Example Northgate Rheumatology Consultants - Consultation Letter - 2026-06-15
Patient reference SYN-1120.
Dear Referring Physician,
Thank you for sending this 58-year-old man for rheumatology consultation. He has an established diagnosis of seropositive rheumatoid arthritis, made at this practice in 2021 based on positive anti-CCP antibodies and symmetric polyarthritis.
He completed a trial of oral methotrexate from November 3, 2025 to May 4, 2026, which was discontinued because his synovitis and pain did not improve despite dose titration. He works as a long-haul truck driver and reports that prolonged sitting worsens his hand stiffness. He has a remote history of a kidney stone but no other chronic conditions.
Given the inadequate response to methotrexate, I support proceeding with Immunara. The enclosed medication history documents this course.
Kind regards,
The consulting rheumatologist
Medication history
medication_history
SYNTHETIC RECORD - Example Northgate Rheumatology Consultants - Medication History - 2026-06-15
Patient reference SYN-1120.
METHOTREXATE 20 MG PO WEEKLY - status: inactive - start 2025-11-03 - end 2026-05-04 - reason: inadequate response
FOLIC ACID 1 MG PO DAILY - status: inactive - start 2025-11-03
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
0.040
Missing evidence
NONE 0.980
others: DOSAGE 0.02
Gate path· 7 gates, in engine order
providerpassed
all five decisions present and well-formed
agepassed
patient.age=58, policy min_age=18
contradictionpassed
p_yes(material_contradiction)=0.040, review at >= 0.8
documentationpassed
p_yes(documentation_complete)=0.970, request info below 0.6
missing_evidencepassed
missing_evidence=NONE (p=0.980), request info at >= 0.7
auto_processFIRED → AUTO_PROCESS
min(required p_yes)=0.970, auto at >= 0.89; p_yes(material_contradiction)=0.040, 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