SYNTHETIC RECORD - Example Overlook Rheumatology - June 18, 2026
Dear Benefits Reviewer,
Patient reference SYN-2210. This patient turned 18 in April and carries an established diagnosis of seropositive rheumatoid arthritis, first diagnosed at age 16.
She took oral methotrexate 15 mg weekly from 2026-01-12 to 2026-06-01, when it was discontinued because of recurrent mouth ulcers, an intolerance that made continuing the medication impractical. Her joint disease remains active and I am requesting Immunara as the next step.
Kind regards,
The adult rheumatology consultant
Medication history
medication_history
SYNTHETIC RECORD - Example Overlook Rheumatology - Medication History - 2026-06-17
Patient reference SYN-2210. Age 18. Methotrexate 15 mg weekly, oral, 2026-01-12 through 2026-06-01. Discontinued: intolerance, recurrent mouth ulcers. Current medications: folic acid 1 mg daily.
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
0.960
Documentation complete
auto 0.89request info 0.60
0.970
Material contradiction
review 0.80block 0.20
0.060
Missing evidence
NONE 0.960
others: DOSAGE 0.03 · LAB_RESULT 0.01
Gate path· 7 gates, in engine order
providerpassed
all five decisions present and well-formed
agepassed
patient.age=18, policy min_age=18
contradictionpassed
p_yes(material_contradiction)=0.060, review at >= 0.8
documentationpassed
p_yes(documentation_complete)=0.970, request info below 0.6
missing_evidencepassed
missing_evidence=NONE (p=0.960), request info at >= 0.7
auto_processFIRED → AUTO_PROCESS
min(required p_yes)=0.960, auto at >= 0.89; p_yes(material_contradiction)=0.060, 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