QuestLab
JC Virus Antibody Panel
Jordan signed in once with her lab account; results arrived as structured FHIR data.
1CollectJordan acts
Jordan collects her records
No data left behind: three source systems, three different acquisition paths, every format accepted into a pod she owns. The friction is real and shown honestly; patient mediation relocates the chart chase, it does not magic it away.
Instant
Cascade Imaging Center
MRI Brain w/wo Contrast
The MRI report was not in the API feed; Jordan downloaded the radiology report from the imaging center portal.
Prior Neurology Note
Neurology Consultation Note
Her previous neurologist has no portal; Jordan requested her records and they arrived as a clinical document.
- InstantQuestLab
- 4 minutesCascade Imaging Center
- 6 daysPrior Neurology Note
- All records in Jordan's pod
No data left behind. Collected once, reusable for every future authorization.
2ConnectCascade acts
Cascade connects them into one health knowledge graph
Collected data becomes usable data: every fact is a linked, provenance-tagged statement anchored to the codes care teams already use (ICD-10, LOINC), whether it arrived structured or was extracted from narrative. Click any source badge to follow a fact back to its exact origin.
Source records
3 documentsCascade Imaging Center
MRI Brain w/wo Contrast
Imaging reportC-CDA
MRI BRAIN W/WO CONTRAST. CLINICAL HISTORY: Relapsing-remitting MS, surveillance. FINDINGS: Multiple T2/FLAIR hyperintense lesions in periventricular and juxtacortical white matter. Compared to the prior exam dated 14 months ago, there are two new T2 lesions in the right frontal white matter and one enlarging lesion in the left centrum semiovale. One lesion demonstrates gadolinium enhancement, compatible with active demyelination. No infratentorial lesion. IMPRESSION: Interval radiologic disease activity.
QuestLab
JC Virus Antibody Panel
Lab resultFHIR R4
{
"resourceType": "Bundle",
"id": "0a5f1e00-0000-4000-8000-000000000000",
"type": "collection",
"timestamp": "2026-05-21T14:32:00Z",
"entry": [
{
"fullUrl": "urn:uuid:0a5f1e00-0000-4000-8000-000000000001",
"resource": {
"resourceType": "Patient",
"id": "0a5f1e00-0000-4000-8000-000000000001",
"identifier": [
{
"system": "urn:oid:2.16.840.1.113883.19.5.99999.2",
"value": "QL-PT-4471"
}
],
"name": [
{
"use": "official",
"family": "Rivera",
"given": [
"Jordan"
]
}
],
"gender": "female",
"birthDate": "1992-03-15"
}
},
{
"fullUrl": "urn:uuid:0a5f1e00-0000-4000-8000-000000000002",
"resource": {
"resourceType": "Condition",
"id": "0a5f1e00-0000-4000-8000-000000000002",
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active",
"display": "Active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed",
"display": "Confirmed"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "problem-list-item",
"display": "Problem List Item"
}
]
}
],
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/icd-10-cm",
"code": "G35.A",
"display": "Relapsing-remitting multiple sclerosis"
}
],
"text": "Relapsing-remitting multiple sclerosis"
},
"subject": {
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000001",
"display": "Jordan Rivera"
},
"onsetDateTime": "2024-09-12",
"recordedDate": "2024-09-12"
}
},
{
"fullUrl": "urn:uuid:0a5f1e00-0000-4000-8000-000000000003",
"resource": {
"resourceType": "DiagnosticReport",
"id": "0a5f1e00-0000-4000-8000-000000000003",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "SR",
"display": "Serology"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "70173-0",
"display": "JC virus Ab [Presence] in Serum or Plasma by Immunoassay"
}
],
"text": "JC Virus Antibody with Index, Serum"
},
"subject": {
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000001",
"display": "Jordan Rivera"
},
"effectiveDateTime": "2026-05-21T08:15:00Z",
"issued": "2026-05-22T16:40:00Z",
"performer": [
{
"display": "QuestLab"
}
],
"result": [
{
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000004"
},
{
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000005"
}
]
}
},
{
"fullUrl": "urn:uuid:0a5f1e00-0000-4000-8000-000000000004",
"resource": {
"resourceType": "Observation",
"id": "0a5f1e00-0000-4000-8000-000000000004",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "70173-0",
"display": "JC virus Ab [Presence] in Serum or Plasma by Immunoassay"
}
],
"text": "JC Virus Antibody, Serum"
},
"subject": {
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000001",
"display": "Jordan Rivera"
},
"effectiveDateTime": "2026-05-21T08:15:00Z",
"issued": "2026-05-22T16:40:00Z",
"performer": [
{
"display": "QuestLab"
}
],
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "10828004",
"display": "Positive"
}
],
"text": "Positive"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "POS",
"display": "Positive"
}
]
}
]
}
},
{
"fullUrl": "urn:uuid:0a5f1e00-0000-4000-8000-000000000005",
"resource": {
"resourceType": "Observation",
"id": "0a5f1e00-0000-4000-8000-000000000005",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "100977-8",
"display": "JC virus Ab Index in Serum or Plasma by Immunoassay"
}
],
"text": "JC Virus Antibody Index, Serum"
},
"subject": {
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000001",
"display": "Jordan Rivera"
},
"effectiveDateTime": "2026-05-21T08:15:00Z",
"issued": "2026-05-22T16:40:00Z",
"performer": [
{
"display": "QuestLab"
}
],
"valueQuantity": {
"value": 0.42,
"unit": "index",
"system": "http://unitsofmeasure.org",
"code": "{Index_val}"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "POS",
"display": "Positive"
}
]
}
],
"referenceRange": [
{
"text": "Index less than 0.20 negative; 0.20 to 0.40 indeterminate; greater than 0.40 positive"
}
],
"note": [
{
"text": "Anti-JCV antibody positive. Per natalizumab REMS, index value is used for PML risk stratification."
}
]
}
},
{
"fullUrl": "urn:uuid:0a5f1e00-0000-4000-8000-000000000006",
"resource": {
"resourceType": "DiagnosticReport",
"id": "0a5f1e00-0000-4000-8000-000000000006",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "HM",
"display": "Hematology"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "57021-8",
"display": "CBC W Auto Differential panel - Blood"
}
],
"text": "CBC with Automated Differential"
},
"subject": {
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000001",
"display": "Jordan Rivera"
},
"effectiveDateTime": "2026-05-21T08:15:00Z",
"issued": "2026-05-21T11:05:00Z",
"performer": [
{
"display": "QuestLab"
}
],
"result": [
{
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000007"
},
{
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000008"
}
]
}
},
{
"fullUrl": "urn:uuid:0a5f1e00-0000-4000-8000-000000000007",
"resource": {
"resourceType": "Observation",
"id": "0a5f1e00-0000-4000-8000-000000000007",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "6690-2",
"display": "Leukocytes [#/volume] in Blood by Automated count"
}
],
"text": "WBC"
},
"subject": {
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000001",
"display": "Jordan Rivera"
},
"effectiveDateTime": "2026-05-21T08:15:00Z",
"issued": "2026-05-21T11:05:00Z",
"performer": [
{
"display": "QuestLab"
}
],
"valueQuantity": {
"value": 6.1,
"unit": "10*9/L",
"system": "http://unitsofmeasure.org",
"code": "10*9/L"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "N",
"display": "Normal"
}
]
}
],
"referenceRange": [
{
"low": {
"value": 4.5,
"unit": "10*9/L",
"system": "http://unitsofmeasure.org",
"code": "10*9/L"
},
"high": {
"value": 11,
"unit": "10*9/L",
"system": "http://unitsofmeasure.org",
"code": "10*9/L"
}
}
]
}
},
{
"fullUrl": "urn:uuid:0a5f1e00-0000-4000-8000-000000000008",
"resource": {
"resourceType": "Observation",
"id": "0a5f1e00-0000-4000-8000-000000000008",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "laboratory",
"display": "Laboratory"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "731-0",
"display": "Lymphocytes [#/volume] in Blood by Automated count"
}
],
"text": "Lymphocytes (absolute)"
},
"subject": {
"reference": "urn:uuid:0a5f1e00-0000-4000-8000-000000000001",
"display": "Jordan Rivera"
},
"effectiveDateTime": "2026-05-21T08:15:00Z",
"issued": "2026-05-21T11:05:00Z",
"performer": [
{
"display": "QuestLab"
}
],
"valueQuantity": {
"value": 1.8,
"unit": "10*9/L",
"system": "http://unitsofmeasure.org",
"code": "10*9/L"
},
"interpretation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
"code": "N",
"display": "Normal"
}
]
}
],
"referenceRange": [
{
"low": {
"value": 1,
"unit": "10*9/L",
"system": "http://unitsofmeasure.org",
"code": "10*9/L"
},
"high": {
"value": 4,
"unit": "10*9/L",
"system": "http://unitsofmeasure.org",
"code": "10*9/L"
}
}
]
}
}
]
}
Prior Neurology Note
Neurology Consultation Note
Clinical noteC-CDA
History: Started interferon beta-1a 18 months ago. Discontinued after 11 months due to breakthrough relapse (acute optic neuritis, treated with IV methylprednisolone) and patient-reported intolerance. Currently off DMT for 6 weeks.
CascadeConnecting 3 sources into one knowledge graph
CascadeConnecting 3 sources into one knowledge graph
Structured data
5 coded · 9 extractedDiagnosis2
Diagnosis: Relapsing-remitting multiple sclerosis
Relapsing-remitting multiple sclerosis, status: active, ICD-10-CM G35.A
ICD-10-CM G35.A
Diagnosis: Relapsing-remitting MS
Relapsing-remitting MS
Narrative extracted, uncodedExtracted from narrativeAI extracted · 1.00
MRI disease activity4
New T2 lesions
two new T2 lesions in the right frontal white matter
Narrative extracted, uncodedExtracted from narrativeAI extracted · 1.00
Enlarging T2 lesion
one enlarging lesion in the left centrum semiovale
Narrative extracted, uncodedExtracted from narrativeAI extracted · 1.00
Gadolinium-enhancing lesion
One lesion demonstrates gadolinium enhancement
Narrative extracted, uncodedExtracted from narrativeAI extracted · 1.00
Interval radiologic disease activity
Interval radiologic disease activity
Narrative extracted, uncodedExtracted from narrativeAI extracted · 1.00
Relapse history1
Breakthrough relapse: acute optic neuritis
acute optic neuritis, treated with IV methylprednisolone
Narrative extracted, uncodedExtracted from narrativeAI extracted · 0.95
DMT history3
Prior DMT trial: interferon beta-1a
Started interferon beta-1a 18 months ago. Discontinued after 11 months
Narrative extracted, uncodedExtracted from narrativeAI extracted · 0.95
DMT intolerance reported
patient-reported intolerance
Narrative extracted, uncodedExtracted from narrativeAI extracted · 0.90
Currently off DMT
Currently off DMT for 6 weeks
Narrative extracted, uncodedExtracted from narrativeAI extracted · 0.95
Laboratory4
JC Virus Antibody, Serum
Positive
LOINC 70173-0
JC Virus Antibody Index, Serum
0.42 index
LOINC 100977-8
WBC
6.1 10*9/L
LOINC 6690-2
Lymphocytes (absolute)
1.8 10*9/L
LOINC 731-0
3ControlCascade reports
Readiness is known before anything is submitted
Reasoning Jordan can trust: the payer's criteria, checked against the knowledge graph up front, every met criterion citing its evidence. The decisive criterion lives as prose in a radiology report; a discrete-field tool would drop it to manual review.
Prior-Authorization Readiness
natalizumab (Tysabri) · Relapsing-Remitting MS
5 of 6 criteria met. 1 needs clinician confirmation.
Every met criterion expands to the evidence it came from.
Diagnosis: relapsing form of MS
Member has a documented diagnosis of a relapsing form of multiple sclerosis, defined as relapsing-remitting MS, active secondary progressive MS, or clinically isolated syndrome, established by a qualified clinician using accepted diagnostic criteria.
Prescribed by a neurologist
The requested therapy is prescribed by, or in documented consultation with, a neurologist or a physician who specializes in the management of multiple sclerosis.
Needs clinician confirmation. Prescriber specialty is not part of the patient record. The prescribing neurologist confirms this step locally when the request is signed.
Clinical relapse in the last year
Extracted from narrativeMember has experienced at least one clinically documented relapse, defined as an acute neurologic episode lasting 24 hours or longer in the absence of fever or infection, within the 12 months preceding this request.
New or enlarging MRI lesion in the last year
Extracted from narrativeBrain or spinal cord MRI within the preceding 12 months demonstrates ongoing disease activity, defined as one or more new or unequivocally enlarging T2/FLAIR lesions, or one or more gadolinium-enhancing lesions.
New T2 lesions
two new T2 lesions in the right frontal white matter
UncodedExtracted from narrative
“two new T2 lesions in the right frontal white matter”
Extraction: gemini-3-flash-preview · confidence 1.00
Enlarging T2 lesion
one enlarging lesion in the left centrum semiovale
UncodedExtracted from narrative
“one enlarging lesion in the left centrum semiovale”
Extraction: gemini-3-flash-preview · confidence 1.00
Gadolinium-enhancing lesion
One lesion demonstrates gadolinium enhancement
UncodedExtracted from narrative
“One lesion demonstrates gadolinium enhancement”
Extraction: gemini-3-flash-preview · confidence 1.00
Interval radiologic disease activity
Interval radiologic disease activity
UncodedExtracted from narrative
“Interval radiologic disease activity”
Extraction: gemini-3-flash-preview · confidence 1.00
Step therapy: prior DMT trial
Extracted from narrativeMember has demonstrated an inadequate response to, intolerance of, or a documented contraindication to at least one preferred disease-modifying therapy, such as an interferon beta product, glatiramer acetate, or an oral agent.
JC virus antibody status documented
Safety flagAnti-JC virus (JCV) antibody serostatus has been tested and documented prior to initiation, consistent with the natalizumab Risk Evaluation and Mitigation Strategy (the TOUCH Prescribing Program) for progressive multifocal leukoencephalopathy risk stratification. A positive result is a safety consideration that informs monitoring and is not an absolute contraindication.
JCV antibody positive. A safety consideration for natalizumab (PML risk monitoring per the REMS program), not a blocker for readiness.
Share with Riverside Neurology
Scope
- DMT readiness summary for natalizumab
- Supporting clinical facts with source provenance
- Source documents: 3
Scoped to this request. Revocable at any time. Every access is logged to Jordan's pod.
Demo preview of the consent step.
What Riverside Neurology receives
Prior Authorization Readiness · Jordan Rivera · natalizumab (Tysabri)
- ✓Diagnosis: relapsing form of MS
- Prescribed by a neurologist
- ✓Clinical relapse in the last year
- ✓New or enlarging MRI lesion in the last year
- ✓Step therapy: prior DMT trial
- ✓JC virus antibody status documented
ICD-10-CM G35.ALOINC 70173-0LOINC 100977-85 of 6 met
Every fact links to its source. No fax. No re-keying.
What this replaced
- 3 records requests chased by clinic staff
- 2 faxes and a phone tree
- Days of waiting, repeated for every authorization
What Jordan did
- Connected one account
- Downloaded one report
- Made one records request
Once. Her pod keeps the records for the next authorization, the next switch, the next clinician.