SYNTHETIC RECORD - Synthetic River Primary Care - Office Visit Note - 2026-06-03
Patient reference SYN-3345. Returning today for a treatment update on his rheumatoid arthritis. Rheumatology diagnosed him in 2019 after years of symmetric hand and wrist pain and positive serologic testing; he is 66 years old.
He took oral methotrexate from 2025-08-04 through 2026-01-26, when it was stopped because his joint swelling and pain persisted despite the medication. He is a retired postal worker and enjoys woodworking, though he says his grip has weakened over the past year. His pharmacy fill history confirms the course. He has no known allergies to medications.
Given the inadequate response, Immunara is being requested.
Other document
pharmacy_fills
SYNTHETIC RECORD - Synthetic River Primary Care - Pharmacy Fill History - 2026-06-03
Patient reference SYN-3345.
Methotrexate 2.5 mg tablets, take 6 weekly - filled monthly 2025-08-04, 2025-09-03, 2025-10-02, 2025-11-01, 2025-12-01, 2026-01-02.
Folic acid 1 mg tablets - filled monthly on the same dates.
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
0.960
Step therapy met
auto 0.89
0.970
Documentation complete
auto 0.89request info 0.60
0.960
Material contradiction
review 0.80block 0.20
0.070
Missing evidence
NONE 0.950
others: DOSAGE 0.04 · TREATMENT_HISTORY 0.01
Gate path· 7 gates, in engine order
providerpassed
all five decisions present and well-formed
agepassed
patient.age=66, policy min_age=18
contradictionpassed
p_yes(material_contradiction)=0.070, review at >= 0.8
documentationpassed
p_yes(documentation_complete)=0.960, request info below 0.6
missing_evidencepassed
missing_evidence=NONE (p=0.950), request info at >= 0.7
auto_processFIRED → AUTO_PROCESS
min(required p_yes)=0.960, auto at >= 0.89; p_yes(material_contradiction)=0.070, 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