# SCRIMED Persistent Agent Workspace Proof Packet

## Workspace
- Tenant: Synthetic Enterprise Preview
- Workspace: Atlas Governed Workflow Evaluation
- Workspace slug: atlas-synthetic-evaluation
- Workspace status: synthetic-pilot
- Product route: /agent-workspace

## Preview Work Order
- Name: RCM denial appeal generation
- Type: rcm-denial-appeal-generation
- Status: v1-ready
- Agent owner: PayerIQ + RCM Agent
- Objective: Draft a reviewable denial appeal outline from synthetic claim context, payer policy evidence, missing documentation, and reviewer disposition.
- Resumable state: Resume from missing-evidence review, appeal-draft revision, or governance disposition.
- Deliverable: Appeal draft outline, policy rationale, missing-evidence list, and proof packet.

## State Machine
- drafted
- planned
- routed
- sandboxed
- trustqa-held
- human-review
- proof-ready

## Model Router Policy
metadata-only payer workflow; deny if live claim identifiers, member IDs, or PHI appear.

## Trust Card Requirement
Policy source, confidence, missing evidence, reviewer status, and no-reimbursement-guarantee boundary.

## Reviewer Checkpoints
- Payer or RCM review
- Governance review

## Audit Timeline
- work-order-created (v1-ready) by Planner Agent: work-order type, tenant workspace, objective, state, owner agent, denied actions
- agent-route-selected (v1-ready) by Router Agent: agent owner, tool scopes, memory scopes, model-router decision, fallback policy
- trustqa-verification-held (active-control) by TrustQA: Trust Card requirement, source attribution, confidence, uncertainty, safety boundary
- human-review-requested (active-control) by Governance Agent: checkpoint, reviewer role, disposition options, escalation state
- proof-packet-exported (active-control) by Tenant reviewer: synthetic-only proof packet, audit timeline, blocked actions, limitation-resolution register

## Blocked Actions
- final coding
- payer submission
- reimbursement guarantee
- coverage determination

## Known Limitations Resolution
- Live PHI ingestion is not enabled. Status: quality-process-replacement. Replacement: Use synthetic fixtures, no-PHI buyer intake, protected pilot sessions, TrustOS decisions, and metadata-only evidence packets. Remaining gate: BAA/DPA, privacy notice, consent, retention, security review, and customer authorization.
- Autonomous clinical decisions remain prohibited. Status: active-control. Replacement: Every clinical-adjacent work order is held behind TrustQA, Clinical Guardian, reviewer checkpoints, blocked actions, and proof packet boundaries. Remaining gate: Licensed clinician validation and regulatory intended-use review before clinical decision-support claims.
- Clinical correctness and safety scores are not externally validated. Status: external-approval-required. Replacement: Expose completeness, source attribution, evidence trail, confidence, reviewer status, and audit fields while marking clinical scoring as clinician-validation required. Remaining gate: Clinician rubric, validation study, data-quality review, and governance sign-off.
- Dedicated long-running work-order persistence requires per-environment migration verification. Status: active-control. Replacement: Use dedicated agent workspace work-order tables, append-only work-order events, explicit authenticated grants, and RPC-only mutations with route-level AAL2 and rate-limit checks. Remaining gate: Apply migration, verify RLS with an authenticated tenant, run database advisors, and approve customer-specific retention/legal-hold policy.
- Production model routing across vendors is not active. Status: quality-process-replacement. Replacement: Attach provider-class, fallback, PHI sensitivity, denial conditions, and human escalation to every work-order template. Remaining gate: Vendor contracts, BAA/DPA path, regional rules, telemetry, cost limits, and rollback tests.
- Live EHR, payer, imaging, and device connectors remain blocked. Status: active-control. Replacement: Use interoperability standards registry, synthetic conformance kits, fixture validation, and connector-readiness gates. Remaining gate: Customer connector approval, security review, consent, audit, monitoring, and partner acceptance.
- Sovereign deployment is not implemented. Status: external-approval-required. Replacement: Define managed cloud, private cloud, hospital-controlled, government/sovereign, and edge/on-prem profiles with required controls. Remaining gate: Customer architecture review, regional compliance mapping, private networking, and local audit design.
- Legal, HIPAA, SOC 2, regulatory, and reimbursement claims require external review. Status: external-approval-required. Replacement: Keep claims register, Trust Center, diligence brief, prohibited-claims controls, and buyer-facing boundary language active. Remaining gate: Qualified counsel, security assessor, privacy owner, regulatory reviewer, and payer/reimbursement expert review.

## Product Boundary
Persistent Agent Workspace v1 coordinates tenant-scoped synthetic work orders, saved state contracts, Trust Cards, audit timelines, reviewer checkpoints, and proof packets. It does not authorize live PHI ingestion, autonomous clinical decisions, payer submission, patient outreach, medical-record mutation, or production connector execution.

This proof packet is a deterministic synthetic workspace packet. It is not clinical advice, a legal opinion, a compliance certification, a reimbursement guarantee, or production authorization.