SYNTHETIC RECORD - Example Kettle Falls Rheumatology - Progress Note - 2026-06-16
Patient reference SYN-2246.
Subjective: This 46-year-old man returns for follow-up of wrist and knuckle swelling that has persisted despite completing a methotrexate trial. He also mentioned, in passing, that his father had briefly tried methotrexate for two weeks in 2015 before stopping after starting a new job -- unrelated to this patient's own treatment.
Objective: Synovitis remains present at the wrists and MCPs bilaterally. Vitals stable, blood pressure 122/78.
Assessment: Seropositive rheumatoid arthritis, diagnosed 2022. Methotrexate 20 mg weekly, taken 2025-11-17 to 2026-03-23, discontinued for inadequate response given persistent synovitis.
Plan: Start Immunara. Continue folic acid supplementation. Follow up in two months.
Medication history
medication_history
SYNTHETIC RECORD - Example Kettle Falls Rheumatology - Medication History - 2026-06-15
Patient reference SYN-2246. Methotrexate 20 mg weekly, oral, 2025-11-17 through 2026-03-23. Discontinued: inadequate response, persistent synovitis. Current medications: folic acid 1 mg daily, lisinopril 10 mg daily for hypertension.
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 0.980
others: DOSAGE 0.02
Gate path· 7 gates, in engine order
providerpassed
all five decisions present and well-formed
agepassed
patient.age=46, 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=0.980), request info at >= 0.7
auto_processFIRED → AUTO_PROCESS
min(required p_yes)=0.970, auto at >= 0.89; p_yes(material_contradiction)=0.050, 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