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1, current
Smoking / Lung Screening review cohort
Chart evidence: Care element: smoking_status former synthetic-demo | Clinical note: SOAP note Hypertension follow-up S: Patient seen for longitudinal primary care follow-up. Repor...
membership needs review
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1
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Last visit
2026-01-30
Appointment or derived chart contact
Latest A1c
6.1 %
2026-11-23
Latest BP
136 mmHg / 92 mmHg
2026-11-23
Extracted signals
0
Optional text signals
Chart volume
93
7 notes, 7 reports
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Review priority
3
active signal
s
1
11
0
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Review needed
1 open flag
Open clinical review items need status, assignment, or closure.
BP above target
Latest BP is 136 mmHg / 92 mmHg on 2026-11-23.
Future-dated imported records
Some source dates are after today's date and should be validated before clinical use.
Active problems
2
Essential hypertension
I10
active
Asthma
J45
active
Active medications
2
Ramipril
5mg daily
Salbutamol inhaler
100mcg PRN
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0, selected
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79, more source rows below
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11
imported record
s
appear future-dated relative to today. Keep them visible for audit, but review source dates before using them clinically.
note
SOAP note
S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 138/76, BMI 33.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Pre
report
Laboratory
Lab panel: HbA1c 6.1%, LDL 2.5 mmol/L, eGFR 70, ACR 2.1. Interpret in clinical context.
cohort_run
Cohort: Smoking / Lung Screening review cohort
completed | Chart evidence: Care element: smoking_status former synthetic-demo | Clinical note: SOAP note Hypertension follow-up S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 138/76, BMI 33.4, cardiopulmonary... | Clinical note: SOAP note Hypertension follow-up S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 137/75, BMI 32.4, cardiopulmonary... | Care element: smoking_status former synthetic-demo | probable
alert
Preventive care review due
Synthetic alert for testing active cohort and review workflows.
clinical_flag
Synthetic BP follow-up review
new | medium | synthetic_longitudinal_data | Several synthetic BP readings are above target and need clinician review.
appointment
Annual preventive visit
completed
note
SOAP note
S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 137/75, BMI 32.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Pre
report
Laboratory
Lab panel: HbA1c 6.0%, LDL 2.4 mmol/L, eGFR 69, ACR 2.0. Interpret in clinical context.
appointment
Annual preventive visit
cancelled
appointment
Annual preventive visit
completed
note
SOAP note
S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 136/74, BMI 31.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Pre
report
Laboratory
Lab panel: HbA1c 5.9%, LDL 2.3 mmol/L, eGFR 68, ACR 1.9. Interpret in clinical context.
appointment
Annual preventive visit
completed
appointment
Annual preventive visit
completed
SOAP note
S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 138/76, BMI 33.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Preventive care review; hypertension monitoring; risk factors reviewed. P: Review labs, reinforce lifestyle plan, reconcile medications, update immunizations, and arrange follow-up. Clinician review required for any care gap.
SOAP note
S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 137/75, BMI 32.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Preventive care review; hypertension monitoring; risk factors reviewed. P: Review labs, reinforce lifestyle plan, reconcile medications, update immunizations, and arrange follow-up. Clinician review required for any care gap.
SOAP note
S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 136/74, BMI 31.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Preventive care review; hypertension monitoring; risk factors reviewed. P: Review labs, reinforce lifestyle plan, reconcile medications, update immunizations, and arrange follow-up. Clinician review required for any care gap.
SOAP note
S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 135/73, BMI 30.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Preventive care review; hypertension monitoring; risk factors reviewed. P: Review labs, reinforce lifestyle plan, reconcile medications, update immunizations, and arrange follow-up. Clinician review required for any care gap.
Synthetic BP follow-up review
Several synthetic BP readings are above target and need clinician review.
Laboratory
Lab panel: HbA1c 6.1%, LDL 2.5 mmol/L, eGFR 70, ACR 2.1. Interpret in clinical context.
Laboratory
Lab panel: HbA1c 6.0%, LDL 2.4 mmol/L, eGFR 69, ACR 2.0. Interpret in clinical context.
Laboratory
Lab panel: HbA1c 5.9%, LDL 2.3 mmol/L, eGFR 68, ACR 1.9. Interpret in clinical context.
Laboratory
Lab panel: HbA1c 5.8%, LDL 2.2 mmol/L, eGFR 98, ACR 1.8. Interpret in clinical context.
Laboratory
Hba1c
6.1 %
2026-11-23Fasting Glucose
6.2 mmol/L
2026-11-23Ldl Cholesterol
2.5 mmol/L
2026-11-23Egfr
70 mL/min/1.73m2
2026-11-23Albumin Creatinine Ratio
2.1 mg/mmol
2026-11-23Systolic Bp
Date | Type | Title | Detail |
|---|---|---|---|
note | SOAP note | S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 138/76, BMI 33.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Pre | |
report | Laboratory | Lab panel: HbA1c 6.1%, LDL 2.5 mmol/L, eGFR 70, ACR 2.1. Interpret in clinical context. | |
care_element | diastolic_bp | 92 | |
care_element | fasting_glucose | 6.2 | |
care_element | hba1c | 6.1 | |
care_element | ldl_cholesterol | 2.5 | |
care_element | egfr | 70 | |
care_element | albumin_creatinine_ratio | 2.1 | |
care_element | smoking_status | former | |
care_element | bmi | 23.0 | |
care_element | systolic_bp | 136 | |
cohort_run | Cohort: Smoking / Lung Screening review cohort | completed | Chart evidence: Care element: smoking_status former synthetic-demo | Clinical note: SOAP note Hypertension follow-up S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 138/76, BMI 33.4, cardiopulmonary... | Clinical note: SOAP note Hypertension follow-up S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 137/75, BMI 32.4, cardiopulmonary... | Care element: smoking_status former synthetic-demo | probable | |
alert | Preventive care review due | Synthetic alert for testing active cohort and review workflows. | |
clinical_flag | Synthetic BP follow-up review | new | medium | synthetic_longitudinal_data | Several synthetic BP readings are above target and need clinician review. | |
appointment | Annual preventive visit | completed | |
note | SOAP note | S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 137/75, BMI 32.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Pre | |
report | Laboratory | Lab panel: HbA1c 6.0%, LDL 2.4 mmol/L, eGFR 69, ACR 2.0. Interpret in clinical context. | |
care_element | hba1c | 6.0 | |
care_element | albumin_creatinine_ratio | 2.0 | |
care_element | egfr | 69 | |
care_element | fasting_glucose | 6.1 | |
care_element | systolic_bp | 135 | |
care_element | diastolic_bp | 91 | |
care_element | ldl_cholesterol | 2.4 | |
care_element | smoking_status | former | |
care_element | bmi | 22.0 | |
appointment | Annual preventive visit | cancelled | |
appointment | Annual preventive visit | completed | |
note | SOAP note | S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 136/74, BMI 31.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Pre | |
report | Laboratory | Lab panel: HbA1c 5.9%, LDL 2.3 mmol/L, eGFR 68, ACR 1.9. Interpret in clinical context. | |
care_element | smoking_status | former | |
care_element | systolic_bp | 134 | |
care_element | albumin_creatinine_ratio | 1.9 | |
care_element | ldl_cholesterol | 2.3 | |
care_element | bmi | 38.0 | |
care_element | hba1c | 5.9 | |
care_element | diastolic_bp | 90 | |
care_element | fasting_glucose | 6.0 | |
care_element | egfr | 68 | |
appointment | Annual preventive visit | completed | |
appointment | Annual preventive visit | completed | |
note | SOAP note | S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 135/73, BMI 30.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Pre | |
report | Laboratory | Lab panel: HbA1c 5.8%, LDL 2.2 mmol/L, eGFR 98, ACR 1.8. Interpret in clinical context. | |
care_element | diastolic_bp | 89 | |
care_element | systolic_bp | 133 | |
care_element | bmi | 37.0 | |
care_element | fasting_glucose | 5.9 | |
care_element | egfr | 98 | |
care_element | hba1c | 5.8 | |
care_element | albumin_creatinine_ratio | 1.8 | |
care_element | smoking_status | former | |
care_element | ldl_cholesterol | 2.2 | |
appointment | Annual preventive visit | completed | |
appointment | Annual preventive visit | completed | |
appointment | Annual preventive visit | completed | |
note | SOAP note | S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 134/72, BMI 29.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Pre | |
report | Laboratory | Lab panel: HbA1c 5.7%, LDL 2.1 mmol/L, eGFR 97, ACR 1.7. Interpret in clinical context. | |
care_element | diastolic_bp | 88 | |
care_element | fasting_glucose | 5.8 | |
care_element | systolic_bp | 132 | |
care_element | egfr | 97 | |
care_element | smoking_status | former | |
care_element | albumin_creatinine_ratio | 1.7 | |
care_element | ldl_cholesterol | 2.1 | |
care_element | bmi | 36.0 | |
care_element | hba1c | 5.7 | |
appointment | Annual preventive visit | completed | |
appointment | Annual preventive visit | completed | |
note | SOAP note | S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 133/89, BMI 28.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Pre | |
report | Laboratory | Lab panel: HbA1c 5.6%, LDL 2.0 mmol/L, eGFR 96, ACR 1.6. Interpret in clinical context. | |
care_element | bmi | 35.0 | |
care_element | diastolic_bp | 87 | |
care_element | hba1c | 5.6 | |
care_element | ldl_cholesterol | 2.0 | |
care_element | albumin_creatinine_ratio | 1.6 | |
care_element | smoking_status | former | |
care_element | egfr | 96 | |
care_element | systolic_bp | 157 | |
care_element | fasting_glucose | 5.7 | |
appointment | Annual preventive visit | completed | |
appointment | Annual preventive visit | completed | |
note | SOAP note | S: Patient seen for longitudinal primary care follow-up. Reports general preventive care concerns, with home BP readings sometimes above target. O: BP 132/88, BMI 27.4, cardiopulmonary exam stable, feet checked when diabetes present. A: Pre | |
report | Laboratory | Lab panel: HbA1c 5.5%, LDL 1.9 mmol/L, eGFR 95, ACR 1.5. Interpret in clinical context. | |
care_element | systolic_bp | 156 | |
care_element | diastolic_bp | 86 | |
care_element | fasting_glucose | 5.6 | |
care_element | bmi | 34.0 | |
care_element | egfr | 95 | |
care_element | albumin_creatinine_ratio | 1.5 | |
care_element | ldl_cholesterol | 1.9 | |
care_element | hba1c | 5.5 | |
care_element | smoking_status | former | |
appointment | Annual preventive visit | completed |
Lab panel: HbA1c 5.7%, LDL 2.1 mmol/L, eGFR 97, ACR 1.7. Interpret in clinical context.
136 mmHg
2026-11-23Diastolic Bp
92 mmHg
2026-11-23Bmi
23 kg/m2
2026-11-23Smoking Status
former
2026-11-23Hba1c
6 %
2025-10-22Fasting Glucose
6.1 mmol/L
2025-10-22Ldl Cholesterol
2.4 mmol/L
2025-10-22Egfr
69 mL/min/1.73m2
2025-10-22Albumin Creatinine Ratio
2 mg/mmol
2025-10-22Systolic Bp
135 mmHg
2025-10-22Diastolic Bp
91 mmHg
2025-10-22Bmi
22 kg/m2
2025-10-22Smoking Status
former
2025-10-22Hba1c
5.9 %
2024-09-21Fasting Glucose
6 mmol/L
2024-09-21Ldl Cholesterol
2.3 mmol/L
2024-09-21Egfr
68 mL/min/1.73m2
2024-09-21Albumin Creatinine Ratio
1.9 mg/mmol
2024-09-21Systolic Bp
134 mmHg
2024-09-21Diastolic Bp
90 mmHg
2024-09-21Bmi
38 kg/m2
2024-09-21Smoking Status
former
2024-09-21Hba1c
5.8 %
2023-08-20Fasting Glucose
5.9 mmol/L
2023-08-20Ldl Cholesterol
2.2 mmol/L
2023-08-20Egfr
98 mL/min/1.73m2
2023-08-20Albumin Creatinine Ratio
1.8 mg/mmol
2023-08-20Systolic Bp
133 mmHg
2023-08-20Diastolic Bp
89 mmHg
2023-08-20Bmi
37 kg/m2
2023-08-20Smoking Status
former
2023-08-20Hba1c
5.7 %
2022-07-19Fasting Glucose
5.8 mmol/L
2022-07-19Ldl Cholesterol
2.1 mmol/L
2022-07-19Egfr
97 mL/min/1.73m2
2022-07-19Albumin Creatinine Ratio
1.7 mg/mmol
2022-07-19Systolic Bp
132 mmHg
2022-07-19Diastolic Bp
88 mmHg
2022-07-19Bmi
36 kg/m2
2022-07-19Smoking Status
former
2022-07-19Hba1c
5.6 %
2021-06-18Fasting Glucose
5.7 mmol/L
2021-06-18Ldl Cholesterol
2 mmol/L
2021-06-18Egfr
96 mL/min/1.73m2
2021-06-18Albumin Creatinine Ratio
1.6 mg/mmol
2021-06-18Systolic Bp
157 mmHg
2021-06-18Diastolic Bp
87 mmHg
2021-06-18Bmi
35 kg/m2
2021-06-18Smoking Status
former
2021-06-18Hba1c
5.5 %
2020-05-17Fasting Glucose
5.6 mmol/L
2020-05-17Ldl Cholesterol
1.9 mmol/L
2020-05-17Egfr
95 mL/min/1.73m2
2020-05-17Albumin Creatinine Ratio
1.5 mg/mmol
2020-05-17Systolic Bp
156 mmHg
2020-05-17Diastolic Bp
86 mmHg
2020-05-17Bmi
34 kg/m2
2020-05-17Smoking Status
former
2020-05-17