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"difficulty": "easy",
"description": "Straightforward clinical cases with direct ICD-10/CPT mapping, single diagnoses, and clear compliance decisions.",
"cases": [
{
"id": "easy_001",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with acute pharyngitis. Throat is erythematous with no exudate. Rapid strep test negative. Diagnosed with viral pharyngitis. Advised rest, fluids, and OTC analgesics.",
"symptoms": ["sore throat", "mild fever", "difficulty swallowing"],
"treatments": ["rest", "fluids", "acetaminophen"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 28,
"patient_sex": "F",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": "Rapid strep test: Negative",
"medications": ["acetaminophen 500mg PRN"]
},
"ground_truth": {
"diagnosis_codes": ["J02.9"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_002",
"difficulty": "easy",
"input": {
"clinical_note": "42-year-old male presents for annual wellness exam. No complaints. Vitals normal. BMI 24.3. Routine labs ordered. Patient counseled on diet and exercise.",
"symptoms": [],
"treatments": ["routine labs", "health counseling"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 42,
"patient_sex": "M",
"provider_specialty": "Internal Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": []
},
"ground_truth": {
"diagnosis_codes": ["Z00.00"],
"procedure_codes": ["99395"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_003",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with uncomplicated urinary tract infection. Dysuria and frequency for 2 days. UA positive for nitrites and leukocyte esterase. Prescribed trimethoprim-sulfamethoxazole.",
"symptoms": ["dysuria", "urinary frequency", "suprapubic discomfort"],
"treatments": ["trimethoprim-sulfamethoxazole"],
"insurance_type": "Medicare",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 65,
"patient_sex": "F",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": "UA: Nitrites positive, Leukocyte esterase positive, WBC >10/hpf",
"medications": ["trimethoprim-sulfamethoxazole 160/800mg BID"]
},
"ground_truth": {
"diagnosis_codes": ["N39.0"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_004",
"difficulty": "easy",
"input": {
"clinical_note": "Child brought in by mother for ear pain x2 days. Otoscopic exam reveals bulging, erythematous right tympanic membrane. Diagnosed with acute otitis media. Prescribed amoxicillin.",
"symptoms": ["right ear pain", "fussiness", "mild fever"],
"treatments": ["amoxicillin"],
"insurance_type": "Medicaid",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 4,
"patient_sex": "M",
"provider_specialty": "Pediatrics",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["amoxicillin 250mg/5mL TID"]
},
"ground_truth": {
"diagnosis_codes": ["H66.91"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_005",
"difficulty": "easy",
"input": {
"clinical_note": "Patient with known type 2 diabetes presents for routine follow-up. A1C obtained is 7.1%. Current medications reviewed. No complications. Continue metformin. Follow up in 3 months.",
"symptoms": [],
"treatments": ["metformin continuation", "A1C monitoring"],
"insurance_type": "Medicare",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 58,
"patient_sex": "M",
"provider_specialty": "Internal Medicine",
"visit_type": "outpatient",
"comorbidities": ["type 2 diabetes"],
"lab_results": "HbA1c: 7.1%",
"medications": ["metformin 1000mg BID"]
},
"ground_truth": {
"diagnosis_codes": ["E11.65"],
"procedure_codes": ["99214"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_006",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with acute bronchitis. Cough productive of clear sputum for 5 days. Lungs clear to auscultation. No fever. Chest x-ray not indicated. Supportive care recommended.",
"symptoms": ["productive cough", "mild chest discomfort", "fatigue"],
"treatments": ["rest", "fluids", "cough suppressant"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 35,
"patient_sex": "F",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["dextromethorphan PRN"]
},
"ground_truth": {
"diagnosis_codes": ["J20.9"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_007",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents for removal of a benign skin lesion on the back. Lesion is 0.8cm, non-suspicious. Shave removal performed without complications. Specimen sent to pathology.",
"symptoms": ["skin lesion on back"],
"treatments": ["shave removal of lesion"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 45,
"patient_sex": "M",
"provider_specialty": "Dermatology",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": []
},
"ground_truth": {
"diagnosis_codes": ["D23.5"],
"procedure_codes": ["11305"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_008",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with allergic rhinitis. Sneezing, nasal congestion, and watery eyes for 3 weeks. Symptoms seasonal. No fever. Started on cetirizine and fluticasone nasal spray.",
"symptoms": ["sneezing", "nasal congestion", "watery eyes", "itchy nose"],
"treatments": ["cetirizine", "fluticasone nasal spray"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 32,
"patient_sex": "F",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["cetirizine 10mg daily", "fluticasone nasal spray"]
},
"ground_truth": {
"diagnosis_codes": ["J30.1"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_009",
"difficulty": "easy",
"input": {
"clinical_note": "Patient twisted ankle playing basketball. X-ray negative for fracture. Mild swelling and tenderness over lateral malleolus. Diagnosed with ankle sprain. RICE protocol and ACE wrap applied.",
"symptoms": ["ankle pain", "swelling", "difficulty bearing weight"],
"treatments": ["RICE protocol", "ACE wrap", "ibuprofen"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 22,
"patient_sex": "M",
"provider_specialty": "Emergency Medicine",
"visit_type": "emergency",
"comorbidities": [],
"lab_results": "X-ray right ankle: No fracture identified",
"medications": ["ibuprofen 400mg TID PRN"]
},
"ground_truth": {
"diagnosis_codes": ["S93.401"],
"procedure_codes": ["99283"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_010",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with tension headache. Reports bilateral, non-pulsating headache for 2 days. No visual changes, no nausea or vomiting. Neurological exam normal. Prescribed ibuprofen.",
"symptoms": ["bilateral headache", "neck stiffness", "fatigue"],
"treatments": ["ibuprofen"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 30,
"patient_sex": "F",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["ibuprofen 400mg PRN"]
},
"ground_truth": {
"diagnosis_codes": ["G44.209"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_011",
"difficulty": "easy",
"input": {
"clinical_note": "Infant presents for 6-month well-child visit. Growth and development on track. Immunizations administered per CDC schedule. Anticipatory guidance provided to parents.",
"symptoms": [],
"treatments": ["immunizations", "developmental screening"],
"insurance_type": "Medicaid",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 0,
"patient_sex": "F",
"provider_specialty": "Pediatrics",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": []
},
"ground_truth": {
"diagnosis_codes": ["Z00.129"],
"procedure_codes": ["99391"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_012",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with localized contact dermatitis on both hands. Reports using new cleaning product. Erythematous, pruritic rash on dorsal hands bilaterally. Prescribed topical hydrocortisone.",
"symptoms": ["itchy rash on hands", "erythema", "mild swelling"],
"treatments": ["topical hydrocortisone", "avoidance of irritant"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 38,
"patient_sex": "F",
"provider_specialty": "Dermatology",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["hydrocortisone 1% cream BID"]
},
"ground_truth": {
"diagnosis_codes": ["L25.9"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_013",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with conjunctivitis. Red, watery left eye for 3 days. No vision changes. No discharge. Likely viral etiology. Advised warm compresses and artificial tears.",
"symptoms": ["red eye", "watery discharge", "mild irritation"],
"treatments": ["warm compresses", "artificial tears"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 25,
"patient_sex": "M",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["artificial tears PRN"]
},
"ground_truth": {
"diagnosis_codes": ["H10.9"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_014",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with GERD symptoms. Heartburn and regurgitation for 4 weeks. No alarm symptoms. No dysphagia or weight loss. Started on omeprazole 20mg daily.",
"symptoms": ["heartburn", "acid regurgitation", "epigastric discomfort"],
"treatments": ["omeprazole"],
"insurance_type": "Medicare",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 55,
"patient_sex": "M",
"provider_specialty": "Internal Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["omeprazole 20mg daily"]
},
"ground_truth": {
"diagnosis_codes": ["K21.0"],
"procedure_codes": ["99214"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_015",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with insomnia. Difficulty falling asleep for 6 weeks. No daytime sleepiness while driving. Good sleep hygiene discussed. No medications prescribed; CBT-I referral placed.",
"symptoms": ["difficulty falling asleep", "fatigue", "irritability"],
"treatments": ["sleep hygiene counseling", "CBT-I referral"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 40,
"patient_sex": "F",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": []
},
"ground_truth": {
"diagnosis_codes": ["G47.00"],
"procedure_codes": ["99214"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_016",
"difficulty": "easy",
"input": {
"clinical_note": "Patient with known hypertension presents for medication refill. Blood pressure well controlled at 128/78. No symptoms. Continue lisinopril 10mg daily. Follow up in 6 months.",
"symptoms": [],
"treatments": ["lisinopril continuation"],
"insurance_type": "Medicare",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 62,
"patient_sex": "M",
"provider_specialty": "Internal Medicine",
"visit_type": "outpatient",
"comorbidities": ["essential hypertension"],
"lab_results": "BP: 128/78 mmHg",
"medications": ["lisinopril 10mg daily"]
},
"ground_truth": {
"diagnosis_codes": ["I10"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_017",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with acute sinusitis. Facial pain, nasal congestion, and purulent discharge for 10 days. No improvement with OTC decongestants. Started amoxicillin-clavulanate.",
"symptoms": ["facial pain", "nasal congestion", "purulent nasal discharge", "low-grade fever"],
"treatments": ["amoxicillin-clavulanate"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 34,
"patient_sex": "M",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["amoxicillin-clavulanate 875/125mg BID"]
},
"ground_truth": {
"diagnosis_codes": ["J01.90"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_018",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with impetigo on the face. Honey-colored crusted lesions around the nose and mouth. Diagnosed with non-bullous impetigo. Prescribed mupirocin ointment.",
"symptoms": ["crusted lesions around nose", "mild itching"],
"treatments": ["mupirocin ointment"],
"insurance_type": "Medicaid",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 6,
"patient_sex": "M",
"provider_specialty": "Pediatrics",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["mupirocin 2% ointment TID"]
},
"ground_truth": {
"diagnosis_codes": ["L01.00"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_019",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents for flu vaccination. No acute complaints. Past medical history unremarkable. Influenza vaccine (IIV4) administered intramuscularly in left deltoid.",
"symptoms": [],
"treatments": ["influenza vaccination"],
"insurance_type": "Medicare",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 70,
"patient_sex": "F",
"provider_specialty": "Internal Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": []
},
"ground_truth": {
"diagnosis_codes": ["Z23"],
"procedure_codes": ["90688"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_020",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with lower back pain after lifting heavy box at work. No radiation to legs. No weakness or numbness. Lumbar strain diagnosed. NSAIDs and physical therapy recommended.",
"symptoms": ["lower back pain", "stiffness", "limited range of motion"],
"treatments": ["ibuprofen", "physical therapy referral"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 36,
"patient_sex": "M",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["ibuprofen 600mg TID"]
},
"ground_truth": {
"diagnosis_codes": ["M54.5"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_021",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents for iron deficiency anemia follow-up. Recent labs show hemoglobin 10.8 g/dL, ferritin 12 ng/mL. Iron supplementation continued. Repeat labs in 3 months.",
"symptoms": ["fatigue", "pallor"],
"treatments": ["iron supplementation"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 29,
"patient_sex": "F",
"provider_specialty": "Internal Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": "Hgb: 10.8 g/dL, Ferritin: 12 ng/mL, MCV: 72 fL",
"medications": ["ferrous sulfate 325mg daily"]
},
"ground_truth": {
"diagnosis_codes": ["D50.9"],
"procedure_codes": ["99214"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_022",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with acne vulgaris. Moderate papulopustular acne on face. No scarring. Started on benzoyl peroxide and topical retinoid. Follow up in 8 weeks.",
"symptoms": ["facial acne", "papules", "pustules"],
"treatments": ["benzoyl peroxide", "topical tretinoin"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 16,
"patient_sex": "F",
"provider_specialty": "Dermatology",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["benzoyl peroxide 5% gel", "tretinoin 0.025% cream"]
},
"ground_truth": {
"diagnosis_codes": ["L70.0"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_023",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with gastroenteritis. Nausea, vomiting, and watery diarrhea for 2 days. No blood in stool. Mild dehydration. Oral rehydration recommended. Symptoms improving.",
"symptoms": ["nausea", "vomiting", "watery diarrhea", "abdominal cramps"],
"treatments": ["oral rehydration", "bland diet"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 27,
"patient_sex": "M",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["ondansetron 4mg PRN"]
},
"ground_truth": {
"diagnosis_codes": ["K52.9"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_024",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with wrist pain after fall on outstretched hand. X-ray shows distal radius fracture, non-displaced. Short arm cast applied. Orthopedic follow-up arranged.",
"symptoms": ["wrist pain", "swelling", "limited wrist motion"],
"treatments": ["short arm cast", "pain management"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "medium",
"patient_age": 11,
"patient_sex": "M",
"provider_specialty": "Emergency Medicine",
"visit_type": "emergency",
"comorbidities": [],
"lab_results": "X-ray left wrist: Non-displaced distal radius fracture",
"medications": ["ibuprofen 200mg TID"]
},
"ground_truth": {
"diagnosis_codes": ["S52.501"],
"procedure_codes": ["99283"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_025",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents for hypothyroidism follow-up. TSH 3.2 mIU/L on levothyroxine 75mcg. Symptoms well controlled. No dose adjustment needed. Continue current therapy.",
"symptoms": [],
"treatments": ["levothyroxine continuation"],
"insurance_type": "Medicare",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 56,
"patient_sex": "F",
"provider_specialty": "Endocrinology",
"visit_type": "outpatient",
"comorbidities": ["hypothyroidism"],
"lab_results": "TSH: 3.2 mIU/L (normal range 0.4-4.0)",
"medications": ["levothyroxine 75mcg daily"]
},
"ground_truth": {
"diagnosis_codes": ["E03.9"],
"procedure_codes": ["99214"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_026",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with mild depression. PHQ-9 score of 8. No suicidal ideation. Started on sertraline 50mg. Counseling referral provided. Follow up in 4 weeks.",
"symptoms": ["depressed mood", "decreased interest", "fatigue", "difficulty concentrating"],
"treatments": ["sertraline", "counseling referral"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 33,
"patient_sex": "F",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": "PHQ-9: 8 (mild depression)",
"medications": ["sertraline 50mg daily"]
},
"ground_truth": {
"diagnosis_codes": ["F32.0"],
"procedure_codes": ["99214"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_027",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with tinea pedis. Itchy, scaly rash between toes bilaterally. Classic interdigital presentation. Prescribed topical clotrimazole cream.",
"symptoms": ["itchy feet", "scaly rash between toes", "mild burning"],
"treatments": ["clotrimazole cream"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 44,
"patient_sex": "M",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["clotrimazole 1% cream BID"]
},
"ground_truth": {
"diagnosis_codes": ["B35.3"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_028",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents requesting a tetanus booster. Last Tdap was over 10 years ago. No acute injuries. Td vaccine administered in right deltoid without complications.",
"symptoms": [],
"treatments": ["Td vaccination"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 50,
"patient_sex": "M",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": []
},
"ground_truth": {
"diagnosis_codes": ["Z23"],
"procedure_codes": ["90714"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_029",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with constipation. No bowel movement for 4 days. Abdomen soft, non-distended. No alarming features. Advised increased fiber and fluids. Prescribed polyethylene glycol.",
"symptoms": ["constipation", "mild abdominal discomfort", "bloating"],
"treatments": ["dietary fiber increase", "polyethylene glycol"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 48,
"patient_sex": "F",
"provider_specialty": "Family Medicine",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["polyethylene glycol 17g daily"]
},
"ground_truth": {
"diagnosis_codes": ["K59.00"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
},
{
"id": "easy_030",
"difficulty": "easy",
"input": {
"clinical_note": "Patient presents with plantar fasciitis. Heel pain worse with first steps in morning. Tenderness at medial calcaneal tubercle. Recommended stretching exercises, ice, and supportive footwear.",
"symptoms": ["heel pain", "pain with first steps", "tenderness at heel"],
"treatments": ["stretching exercises", "ice therapy", "supportive footwear"],
"insurance_type": "Private",
"prior_auth_required": false,
"treatment_cost": "low",
"patient_age": 42,
"patient_sex": "M",
"provider_specialty": "Orthopedics",
"visit_type": "outpatient",
"comorbidities": [],
"lab_results": null,
"medications": ["naproxen 500mg BID PRN"]
},
"ground_truth": {
"diagnosis_codes": ["M72.2"],
"procedure_codes": ["99213"],
"decision": "approve",
"risk_flags": []
}
}
]
}
|