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GOLD-TMP-20

Temporal reasoning · gold-v0.1

Case inputs

As of
2026-06-02
Patient
40 years, NY
Request
Immunara for rheumatoid arthritis
Insurance
ExampleHealth, ExampleHealth Gold · EXH-733561
Policy
immunara-v0.1
Inputs
sha256:c86162fc7ac5…

Documents 1

Physician note

referral_letter
SYNTHETIC RECORD - Example Aspen Grove Rheumatology - May 26, 2026

Dear Care Coordinator,

Patient reference SYN-6020. This patient, a 40-year-old man, was referred for consideration of Immunara after his methotrexate trial ended. He carries a seropositive rheumatoid arthritis diagnosis from 2021.

He took oral methotrexate 20 mg weekly for fourteen weeks, with his last dose on 2026-05-20, before it was stopped because of persistent nausea and low white blood cell counts on routine labs. He tolerated the medication poorly throughout the trial and asked to discontinue it once his labs came back abnormal.

Given his intolerance to methotrexate, we recommend proceeding with Immunara instead.

Sincerely,
The referring physician

Decisions by provider

HUMAN_REVIEWwrong, safe

Decided by: default_review gate · auto_process 0.89

Judgments

p_yes for yes/no questions; ticks are the thresholds a gate compares each one with.

Diagnosis supported
0.970
Step therapy met
0.006
Documentation complete
0.930
Material contradiction
0.060
Missing evidence
NONE 0.940
others: TREATMENT_HISTORY 0.03 · LAB_RESULT 0.02 · DOSAGE 0.01
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=40, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.060, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.930, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.940), request info at >= 0.7

  6. auto_processpassed

    min(required p_yes)=0.006, auto at >= 0.89; p_yes(material_contradiction)=0.060, blocks at >= 0.2

  7. default_reviewFIRED → HUMAN_REVIEW

    case does not meet the autonomous-action bar

passed = the gate checked and did not fire; not reached = an earlier gate decided.

  • step_therapy p_yes=0.006 is below the 0.89 autonomous-action bar
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)