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2, current
Mental Health review cohort
Chart evidence: Clinical note: SOAP note BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance. | Clinical note: SOAP note...
membership needs review
No review task has been created from this cohort for this patient yet.
Smoking / Lung Screening review cohort
Chart evidence: Care element: smoking_status never smoker form
membership needs review
Open review tasks
0
New, in review, or accepted tasks
Last visit
2026-02-28
Appointment or derived chart contact
Latest A1c
7.7 %
2026-02-26
Latest BP
132 mmHg / 84 mmHg
2026-03-03
Extracted signals
0
Optional text signals
Chart volume
42
3 notes, 2 reports
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0
active signal
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0
0
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Active problems
2
Essential hypertension
I10
active
Type 2 diabetes mellitus
E11
active
Active medications
3
Hydrochlorothiazide
12.5 mg daily
Candesartan
8 mg daily
Metformin XR
1000 mg daily
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cohort_run
Cohort: Mental Health review cohort
completed | Chart evidence: Clinical note: SOAP note BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance. | Clinical note: SOAP note Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports recent family stress. Plan: update labs/vitals and arrange follow-up as clinically indicated. | Clinical note: SOAP note T2DM review. Home glucose pattern often elevated fasting. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk. | Appointment: medication renewal completed | probable
cohort_run
Cohort: Smoking / Lung Screening review cohort
completed | Chart evidence: Care element: smoking_status never smoker form | probable
note
SOAP note
BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance.
report
Laboratory
HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up.
note
SOAP note
Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports recent family stress. Plan: update labs/vitals and arrange follow-up as clinically indicated.
appointment
chronic disease review
completed
note
SOAP note
T2DM review. Home glucose pattern often elevated fasting. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk.
appointment
same-day concern
booked
appointment
chronic disease review
completed
report
Screening
PSA discussed - shared decision
appointment
medication renewal
completed
appointment
periodic health review
completed
appointment
chronic disease review
completed
SOAP note
BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance.
SOAP note
Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports recent family stress. Plan: update labs/vitals and arrange follow-up as clinically indicated.
SOAP note
T2DM review. Home glucose pattern often elevated fasting. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk.
Laboratory
HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up.
Screening
PSA discussed - shared decision
Diastolic Bp
84 mmHg
2026-03-03Systolic Bp
132 mmHg
2026-03-03Hba1c
7.7 %
2026-02-26Fasting Glucose
8.9 mmol/L
2026-01-11Diastolic Bp
66 mmHg
2025-11-27Systolic Bp
Date | Type | Title | Detail |
|---|---|---|---|
cohort_run | Cohort: Mental Health review cohort | completed | Chart evidence: Clinical note: SOAP note BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance. | Clinical note: SOAP note Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports recent family stress. Plan: update labs/vitals and arrange follow-up as clinically indicated. | Clinical note: SOAP note T2DM review. Home glucose pattern often elevated fasting. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk. | Appointment: medication renewal completed | probable | |
cohort_run | Cohort: Smoking / Lung Screening review cohort | completed | Chart evidence: Care element: smoking_status never smoker form | probable | |
note | SOAP note | BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance. | |
report | Laboratory | HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up. | |
note | SOAP note | Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports recent family stress. Plan: update labs/vitals and arrange follow-up as clinically indicated. | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
appointment | chronic disease review | completed | |
care_element | hba1c | ||
care_element | fasting_glucose | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | egfr | ||
care_element | albumin_creatinine_ratio | ||
note | SOAP note | T2DM review. Home glucose pattern often elevated fasting. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk. | |
appointment | same-day concern | booked | |
care_element | fasting_glucose | ||
care_element | bmi | ||
care_element | hba1c | ||
care_element | smoking_status | never smoker | |
care_element | ldl_cholesterol | ||
appointment | chronic disease review | completed | |
care_element | fasting_glucose | ||
care_element | hba1c | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
report | Screening | PSA discussed - shared decision | |
care_element | cancer_screening | PSA discussed - shared decision | |
care_element | hba1c | ||
care_element | fasting_glucose | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
appointment | medication renewal | completed | |
care_element | fasting_glucose | ||
care_element | hba1c | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
appointment | periodic health review | completed | |
care_element | hba1c | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
appointment | chronic disease review | completed |
140 mmHg
2025-11-27Egfr
90 mL/min/1.73m2
2025-10-11Albumin Creatinine Ratio
28.7 mg/mmol
2025-09-08Fasting Glucose
7.9 mmol/L
2025-07-08Bmi
28.2 kg/m2
2025-03-27Hba1c
7.1 %
2025-02-26Smoking Status
never smoker
2025-01-13Ldl Cholesterol
4.1 mmol/L
2024-12-18Fasting Glucose
10.1 mmol/L
2024-05-28Hba1c
7.1 %
2024-05-16Diastolic Bp
78 mmHg
2024-04-02Systolic Bp
123 mmHg
2024-04-02Cancer Screening
PSA discussed - shared decision
2024-03-13Hba1c
7.7 %
2023-12-20Fasting Glucose
8.9 mmol/L
2023-11-14Diastolic Bp
79 mmHg
2023-10-23Systolic Bp
133 mmHg
2023-10-23Fasting Glucose
7.6 mmol/L
2022-12-27Hba1c
6.7 %
2022-12-25Diastolic Bp
85 mmHg
2022-10-23Systolic Bp
139 mmHg
2022-10-23Hba1c
7.7 %
2021-10-19Diastolic Bp
78 mmHg
2021-01-20Systolic Bp
125 mmHg
2021-01-20