The expected result is written down as a labelled oracle and the tests assert the engine matches it on every criterion.
For the demo case, each criterion has an expected verdict and the span or miss that justifies it. 8 proven, 1 gap. Synthetic data.
All other reasonable sources of pain and/or neurological deficit have been ruled out, including but not limited to significant pathology at other spinal level(s) on the advanced imaging radiology report that is/are not part of the surgical request resulting in incomplete surgical planning
Cited span“isolated to the right”
Member has signs or symptoms of neural compression (radiculopathy, neurogenic extremity claudication, myelopathy) associated with the levels being treated
Cited span“positive right straight-leg raise”
Advanced imaging studies (CT or MRI) indicate central/lateral recess or foraminal stenosis (graded as moderate, moderate to severe or severe; not mild or mild to moderate), or nerve root or spinal cord compression, at the level corresponding with the clinical findings
Cited span“moderate-to-severe right lateral recess narrowing”
Member has failed at least 6 weeks of conservative therapy
Cited span“past 10 weeks”
Conservative measures were recent (within the past year)
Cited span“July to September 2026”
Active in-person physical therapy (not home or virtual) for the entire required duration, confirmed by the actual PT notes or by documentation in the member claims history
Named gapRequired: in-person physical therapy. No chart span supports it.
Trial of medications (NSAIDs, acetaminophen, or tricyclic antidepressants)
Cited span“naproxen 500 mg”
Patient education provided
Cited span“written lumbar self-care education”
Member's activities of daily living are limited by symptoms of neural compression
Cited span“unable to work his delivery-driver shifts”
The gap is not an accident of the chart. It is asserted.
A test feeds a chart with the in-person therapy evidence removed and asserts that criterion stays a gap. A green there would fail the suite.
We mutate the engine to green the gap and confirm the test turns red. A check that cannot fail is not a check.