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GOLD-TRK-09

Tricky or ambiguous · gold-v0.1

Case inputs

As of
2026-06-12
Patient
60 years, PA
Request
Immunara for rheumatoid arthritis
Insurance
CivicCare, CivicCare Plus · CCP-560374
Policy
immunara-v0.1
Inputs
sha256:47b35bb12d8a…

Documents 1

Physician note

physician_note
SYNTHETIC RECORD - Example Granger Rheumatology - Follow-up Visit - 2026-06-12
Patient reference SYN-1873.
Subjective: This 60-year-old man reports persistent hand and shoulder stiffness despite over a year of DMARD therapy.
Objective: Synovitis remains at the wrists and shoulders. Grip strength reduced bilaterally. Vitals stable.
Assessment: Seropositive rheumatoid arthritis, diagnosed 2019. He was treated with hydroxychloroquine 400 mg daily and sulfasalazine 1 g twice daily from January 2025 to January 2026, with an inadequate response despite the combination. Methotrexate has not been taken; he has repeatedly declined it out of concern for the required blood monitoring.
Plan: Discuss Immunara given the inadequate response to hydroxychloroquine and sulfasalazine. Continue current supportive measures.

Decisions by provider

HUMAN_REVIEWcorrect

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
0.000
Documentation complete
0.940
Material contradiction
0.130
Missing evidence
NONE 0.500
others: TREATMENT_HISTORY 0.47 · DOSAGE 0.02 · LAB_RESULT 0.01
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=60, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.130, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.940, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.500), request info at >= 0.7

  6. auto_processpassed

    min(required p_yes)=0.000, auto at >= 0.89; p_yes(material_contradiction)=0.130, 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=0.000 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)