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Accepted chart labels
Human-confirmed labels that stay on the chart after a cohort membership is accepted.
0, active
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Cohort memberships
Patient-list membership from saved cohort runs. These are source lists, not task status or accepted chart labels.
1, current
Smoking / Lung Screening review cohort
Chart evidence: Care element: smoking_status never smoker form
membership needs review
No review task has been created from this cohort for this patient yet.
Open review tasks
3
New, in review, or accepted tasks
Last visit
2026-02-10
Appointment or derived chart contact
Latest A1c
7.8 %
2026-03-10
Latest BP
135 mmHg / 75 mmHg
2026-04-01
Extracted signals
0
Optional text signals
Chart volume
48
6 notes, 4 reports
A compact view of what needs attention before opening the full imported record.
Review priority
1
active signal
3
0
0
Review these before relying on the imported record clinically.
AI-CDS actions selected from Flags & Tasks. These stay visible on the chart for follow-up.
0, selected
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Saved population-health queue work for this patient: calls, recalls, flags, snoozes, exclusions, and completions.
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34, more source rows below
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Audit view for imported records. Kept collapsed so the working chart remains usable.
PHM saved action
PHM action: POLYPHARMACY_REVIEW
status=needs_review | imported | next review=2026-07-02 | Review evidence for Polypharmacy medication review; confirm appropriateness before contacting patient.
PHM saved action
PHM action: SURVIVORSHIP_PLAN_DUE
status=new | imported | outreach=portal 2026-05-27 17:15 | next review=2026-07-02 | Review evidence for Survivorship plan review due; confirm appropriateness before contacting patient.
cohort_run
Cohort: Smoking / Lung Screening review cohort
completed | Chart evidence: Care element: smoking_status never smoker form | probable
phm_workflow
PHM action: POLYPHARMACY_REVIEW
status=needs_review | imported | next review=2026-07-02 | Review evidence for Polypharmacy medication review; confirm appropriateness before contacting patient.
phm_workflow
PHM action: SURVIVORSHIP_PLAN_DUE
status=new | imported | outreach=portal 2026-05-27 17:15 | next review=2026-07-02 | Review evidence for Survivorship plan review due; confirm appropriateness before contacting patient.
clinical_flag
Polypharmacy medication review
in_review | medium | structured_fact | 8 active medications identified; medication reconciliation and deprescribing opportunities should be reviewed.
clinical_flag
Survivorship plan review due
new | medium | report | Cancer history is active/imported; survivorship plan or surveillance schedule should be confirmed.
clinical_flag
Vascular disease without active statin
dismissed | medium | report | Peripheral arterial disease documented but no active statin medication found in the synthetic medication list.
clinical_flag
Urine ACR overdue
new | medium | active_cohort_automation | Patient has diabetes and no recent urine ACR evidence within the synthetic monitoring window.
note
SOAP note
BP reviewed. Home readings not available. Reviewed sodium, adherence, and medication tolerance.
note
consult
Peripheral arterial disease follow-up. Patient reports intermittent exertional dyspnea. Plan: continue guideline-oriented risk management and monitor labs.
appointment
same-day concern
completed
note
SOAP note
Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports improving symptoms. Plan: update labs/vitals and arrange follow-up as clinically indicated.
report
Laboratory
HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up.
note
SOAP note
T2DM review. Home glucose pattern mostly at target. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk.
note
SOAP note
Asthma review. Symptoms: exercise-triggered wheeze. Trigger avoidance and inhaler technique reviewed.
SOAP note
BP reviewed. Home readings not available. Reviewed sodium, adherence, and medication tolerance.
consult
Peripheral arterial disease follow-up. Patient reports intermittent exertional dyspnea. Plan: continue guideline-oriented risk management and monitor labs.
SOAP note
Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports improving symptoms. Plan: update labs/vitals and arrange follow-up as clinically indicated.
SOAP note
T2DM review. Home glucose pattern mostly at target. 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
colonoscopy complete
Consult
Consult follow-up for Peripheral arterial disease. Risk factor optimization, medication adherence, symptom surveillance, and return precautions reviewed.
Consult
Oncology follow-up for prostate cancer survivor. No active recurrence noted in this synthetic report. Ongoing surveillance, late effects, and primary care coordination discussed.
Polypharmacy medication review
8 active medications identified; medication reconciliation and deprescribing opportunities should be reviewed.
Survivorship plan review due
Cancer history is active/imported; survivorship plan or surveillance schedule should be confirmed.
Vascular disease without active statin
Peripheral arterial disease documented but no active statin medication found in the synthetic medication list.
Urine ACR overdue
Patient has diabetes and no recent urine ACR evidence within the synthetic monitoring window.
Review needed
3 open flags
Open clinical review items need status, assignment, or closure.
Active problems
5
Prostate cancer survivor
active
Asthma
J45.909
active
Peripheral arterial disease
I73.9
active
Essential hypertension
I10
active
Type 2 diabetes mellitus
E11
active
Active medications
9
Budesonide/formoterol inhaler
200/6 mcg BID
Salbutamol inhaler
100 mcg 1-2 puffs q4h PRN
ASA 81 mg
81 mg daily
Apixaban
5 mg BID
Rosuvastatin
Ldl Cholesterol
3.9 mmol/L
2026-04-05Diastolic Bp
75 mmHg
2026-04-01Systolic Bp
135 mmHg
2026-04-01Hba1c
7.8 %
2026-03-10Egfr
69 mL/min/1.73m2
2026-02-20Smoking Status
Date | Type | Title | Detail |
|---|---|---|---|
cohort_run | Cohort: Smoking / Lung Screening review cohort | completed | Chart evidence: Care element: smoking_status never smoker form | probable | |
phm_workflow | PHM action: POLYPHARMACY_REVIEW | status=needs_review | imported | next review=2026-07-02 | Review evidence for Polypharmacy medication review; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: SURVIVORSHIP_PLAN_DUE | status=new | imported | outreach=portal 2026-05-27 17:15 | next review=2026-07-02 | Review evidence for Survivorship plan review due; confirm appropriateness before contacting patient. | |
clinical_flag | Polypharmacy medication review | in_review | medium | structured_fact | 8 active medications identified; medication reconciliation and deprescribing opportunities should be reviewed. | |
clinical_flag | Survivorship plan review due | new | medium | report | Cancer history is active/imported; survivorship plan or surveillance schedule should be confirmed. | |
clinical_flag | Vascular disease without active statin | dismissed | medium | report | Peripheral arterial disease documented but no active statin medication found in the synthetic medication list. | |
clinical_flag | Urine ACR overdue | new | medium | active_cohort_automation | Patient has diabetes and no recent urine ACR evidence within the synthetic monitoring window. | |
note | SOAP note | BP reviewed. Home readings not available. Reviewed sodium, adherence, and medication tolerance. | |
care_element | ldl_cholesterol | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
care_element | hba1c | ||
care_element | egfr | ||
note | consult | Peripheral arterial disease follow-up. Patient reports intermittent exertional dyspnea. Plan: continue guideline-oriented risk management and monitor labs. | |
appointment | same-day concern | completed | |
note | SOAP note | Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports improving symptoms. Plan: update labs/vitals and arrange follow-up as clinically indicated. | |
care_element | smoking_status | never smoker | |
report | Laboratory | HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up. | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
note | SOAP note | T2DM review. Home glucose pattern mostly at target. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk. | |
note | SOAP note | Asthma review. Symptoms: exercise-triggered wheeze. Trigger avoidance and inhaler technique reviewed. | |
care_element | ldl_cholesterol | ||
care_element | albumin_creatinine_ratio | ||
appointment | lab follow-up | completed | |
appointment | periodic health review | completed | |
note | consult | Survivorship care reviewed for history of prostate cancer survivor. Patient asks about surveillance schedule and late effects. | |
care_element | bmi | ||
care_element | ldl_cholesterol | ||
report | Screening | colonoscopy complete | |
care_element | cancer_screening | colonoscopy complete | |
report | Consult | Consult follow-up for Peripheral arterial disease. Risk factor optimization, medication adherence, symptom surveillance, and return precautions reviewed. | |
care_element | fasting_glucose | ||
report | Consult | Oncology follow-up for prostate cancer survivor. No active recurrence noted in this synthetic report. Ongoing surveillance, late effects, and primary care coordination discussed. | |
care_element | hba1c | ||
care_element | ldl_cholesterol | ||
care_element | hba1c | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | fasting_glucose | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
care_element | hba1c | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
appointment | chronic disease review | completed | |
care_element | hba1c | ||
appointment | medication renewal | booked |
20 mg daily
never smoker
2026-01-11Diastolic Bp
87 mmHg
2025-09-27Systolic Bp
131 mmHg
2025-09-27Ldl Cholesterol
1.5 mmol/L
2025-01-14Albumin Creatinine Ratio
10.6 mg/mmol
2025-01-06Bmi
28.1 kg/m2
2024-10-30Ldl Cholesterol
3.2 mmol/L
2024-10-05Cancer Screening
colonoscopy complete
2024-09-23Fasting Glucose
10.2 mmol/L
2024-06-02Hba1c
8.2 %
2024-01-21Ldl Cholesterol
2.7 mmol/L
2023-09-27Hba1c
7.8 %
2023-05-16Diastolic Bp
76 mmHg
2023-04-27Systolic Bp
126 mmHg
2023-04-27Fasting Glucose
9.1 mmol/L
2023-02-06Diastolic Bp
79 mmHg
2022-12-08Systolic Bp
138 mmHg
2022-12-08Hba1c
8.8 %
2022-01-26Diastolic Bp
67 mmHg
2021-07-04Systolic Bp
116 mmHg
2021-07-04Hba1c
7.9 %
2021-03-04