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GOLD-TRK-19

Tricky or ambiguous · gold-v0.1

Case inputs

As of
2026-06-22
Patient
39 years, OR
Request
Immunara for rheumatoid arthritis
Insurance
Northstar, Northstar Choice · NSC-905183
Policy
immunara-v0.1
Inputs
sha256:e7fa1bb5c577…

Documents 2

Physician note

problem_list
SYNTHETIC RECORD - Example Millpond Rheumatology - Problem List Update - 2026-06-22
Patient reference SYN-2201. 39-year-old woman, new to this practice after a recent move.
- Rheumatoid arthritis, seropositive, diagnosed 2021 per records reviewed from her prior clinic.
- Her own prior treatment records, including any methotrexate history, remain unavailable despite a records request to her previous clinic.
- Active synovitis at the wrists and MCPs bilaterally on today's exam.
- Plan: Continue pursuing her prior records. Discuss Immunara pending a complete treatment history.

Medication history

medication_history
SYNTHETIC RECORD - Example Millpond Rheumatology - Medication History - 2026-06-21
Patient reference SYN-9988. Methotrexate 15 mg weekly, oral, 2025-08-04 through 2026-01-26. Discontinued: inadequate response. Current medications: folic acid 1 mg daily.

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
0.750
Step therapy met
0.657
Documentation complete
0.830
Material contradiction
0.550
Missing evidence
TREATMENT_HISTORY 0.430
others: NONE 0.42 · DIAGNOSIS 0.13 · DOSAGE 0.02
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=39, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.550, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.830, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=TREATMENT_HISTORY (p=0.430), request info at >= 0.7

  6. auto_processpassed

    min(required p_yes)=0.657, auto at >= 0.89; p_yes(material_contradiction)=0.550, 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.

  • diagnosis_support p_yes=0.750 is below the 0.89 autonomous-action bar
  • step_therapy p_yes=0.657 is below the 0.89 autonomous-action bar
  • documentation_complete p_yes=0.830 is below the 0.89 autonomous-action bar
  • contradiction risk p=0.550 blocks autonomous processing (>= 0.2)
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)