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Population Health
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Accepted chart labels
Human-confirmed labels that stay on the chart after a cohort membership is accepted.
0, active
No accepted chart labels yet. Cohort memberships and review tasks still appear below before anything is accepted.
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 former 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
2025-10-18
Appointment or derived chart contact
Latest A1c
8.9 %
2026-04-07
Latest BP
128 mmHg / 83 mmHg
2025-02-15
Extracted signals
0
Optional text signals
Chart volume
43
4 notes, 3 reports
A compact view of what needs attention before opening the full imported record.
Review priority
2
active signal
s
3
0
0
Review these before relying on the imported record clinically.
Review needed
3 open flags
Open clinical review items need status, assignment, or closure.
A1c above review threshold
Latest HbA1c is 8.9 % on 2026-04-07.
Active problems
4
Glaucoma suspect
active
Chronic obstructive pulmonary disease
J44.9
active
Essential hypertension
I10
active
Type 2 diabetes mellitus
E11
active
Active medications
6
Tiotropium inhaler
18 mcg daily
Salbutamol inhaler
100 mcg 1-2 puffs q4h PRN
Hydrochlorothiazide
12.5 mg daily
Candesartan
8 mg daily
Semaglutide
0.5 mg weekly
AI-CDS actions selected from Flags & Tasks. These stay visible on the chart for follow-up.
0, selected
No selected follow-up actions
Select AI-CDS actions from Flags & Tasks to keep them visible on this chart.
Saved population-health queue work for this patient: calls, recalls, flags, snoozes, exclusions, and completions.
Optional text-derived evidence extracted beside the imported chart. Each signal stays traceable to source text.
No extracted signals for this patient
Reprocess an import with text enrichment to attach suggested evidence to this patient record.
Most recent values are summarized here so the timeline can stay readable.
Recent chart, workflow, AI, cohort, and audit events shown in the user's local time.
29, more source rows below
Latest narrative evidence, clipped for scanning.
Recent report headers and excerpts.
Audit view for imported records. Kept collapsed so the working chart remains usable.
PHM saved action
PHM action: INFLUENZA_RECALL_DUE
status=snoozed | imported | next review=2026-07-17 | Review evidence for Influenza immunization recall; confirm appropriateness before contacting patient.
PHM saved action
PHM action: COPD_SPIROMETRY_REVIEW
status=in_review | imported | next review=2026-07-17 | Review evidence for COPD spirometry evidence missing or old; confirm appropriateness before contacting patient.
PHM saved action
PHM action: UNCONTROLLED_HBA1C
status=booked | imported | next review=2026-08-01 | Review evidence for HbA1c above target; confirm appropriateness before contacting patient.
cohort_run
Cohort: Smoking / Lung Screening review cohort
completed | Chart evidence: Care element: smoking_status former smoker form | probable
phm_workflow
PHM action: INFLUENZA_RECALL_DUE
status=snoozed | imported | next review=2026-07-17 | Review evidence for Influenza immunization recall; confirm appropriateness before contacting patient.
phm_workflow
PHM action: COPD_SPIROMETRY_REVIEW
status=in_review | imported | next review=2026-07-17 | Review evidence for COPD spirometry evidence missing or old; confirm appropriateness before contacting patient.
phm_workflow
PHM action: UNCONTROLLED_HBA1C
status=booked | imported | next review=2026-08-01 | Review evidence for HbA1c above target; confirm appropriateness before contacting patient.
clinical_flag
Influenza immunization recall
accepted | low | structured_fact | No recent influenza immunization evidence within the synthetic seasonal window.
clinical_flag
COPD spirometry evidence missing or old
new | medium | active_cohort_automation | COPD problem is active but there is no recent spirometry report in this synthetic chart.
clinical_flag
HbA1c above target
new | high | structured_fact | Latest HbA1c 8.9% suggests above-target glycemic control and needs clinician review.
alert
Diabetes control flag: HbA1c above target
Generated from longitudinal lab trend.
note
SOAP note
BP reviewed. Home readings variable. Reviewed sodium, adherence, and medication tolerance.
note
SOAP note
COPD review. Symptoms include shortness of breath on stairs. Inhaler technique reviewed. Exacerbation risk discussed.
appointment
lab follow-up
no_show
report
Laboratory
HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up.
report
Screening
PSA discussed - shared decision
note
SOAP note
T2DM review. Home glucose pattern limited due to missed checks. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk.
SOAP note
BP reviewed. Home readings variable. Reviewed sodium, adherence, and medication tolerance.
SOAP note
COPD review. Symptoms include shortness of breath on stairs. Inhaler technique reviewed. Exacerbation risk discussed.
SOAP note
T2DM review. Home glucose pattern limited due to missed checks. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk.
SOAP note
Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports stable function. Plan: update labs/vitals and arrange follow-up as clinically indicated.
Laboratory
HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up.
Screening
PSA discussed - shared decision
Consult
Eye care report: glaucoma suspect reviewed. Follow-up interval documented; no urgent ocular change in this synthetic report.
Influenza immunization recall
No recent influenza immunization evidence within the synthetic seasonal window.
COPD spirometry evidence missing or old
COPD problem is active but there is no recent spirometry report in this synthetic chart.
HbA1c above target
Latest HbA1c 8.9% suggests above-target glycemic control and needs clinician review.
Ldl Cholesterol
3.9 mmol/L
2026-04-18Hba1c
8.9 %
2026-04-07Albumin Creatinine Ratio
27.8 mg/mmol
2025-11-16Hba1c
8.8 %
2025-09-10Cancer Screening
PSA discussed - shared decision
2025-08-23Date | Type | Title | Detail |
|---|---|---|---|
cohort_run | Cohort: Smoking / Lung Screening review cohort | completed | Chart evidence: Care element: smoking_status former smoker form | probable | |
phm_workflow | PHM action: INFLUENZA_RECALL_DUE | status=snoozed | imported | next review=2026-07-17 | Review evidence for Influenza immunization recall; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: COPD_SPIROMETRY_REVIEW | status=in_review | imported | next review=2026-07-17 | Review evidence for COPD spirometry evidence missing or old; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: UNCONTROLLED_HBA1C | status=booked | imported | next review=2026-08-01 | Review evidence for HbA1c above target; confirm appropriateness before contacting patient. | |
clinical_flag | Influenza immunization recall | accepted | low | structured_fact | No recent influenza immunization evidence within the synthetic seasonal window. | |
clinical_flag | COPD spirometry evidence missing or old | new | medium | active_cohort_automation | COPD problem is active but there is no recent spirometry report in this synthetic chart. | |
clinical_flag | HbA1c above target | new | high | structured_fact | Latest HbA1c 8.9% suggests above-target glycemic control and needs clinician review. | |
alert | Diabetes control flag: HbA1c above target | Generated from longitudinal lab trend. | |
care_element | ldl_cholesterol | ||
care_element | hba1c | ||
note | SOAP note | BP reviewed. Home readings variable. Reviewed sodium, adherence, and medication tolerance. | |
note | SOAP note | COPD review. Symptoms include shortness of breath on stairs. Inhaler technique reviewed. Exacerbation risk discussed. | |
care_element | albumin_creatinine_ratio | ||
appointment | lab follow-up | no_show | |
report | Laboratory | HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up. | |
care_element | hba1c | ||
report | Screening | PSA discussed - shared decision | |
care_element | cancer_screening | PSA discussed - shared decision | |
care_element | ldl_cholesterol | ||
note | SOAP note | T2DM review. Home glucose pattern limited due to missed checks. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk. | |
care_element | egfr | ||
care_element | fasting_glucose | ||
care_element | smoking_status | former smoker | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
report | Consult | Eye care report: glaucoma suspect reviewed. Follow-up interval documented; no urgent ocular change in this synthetic report. | |
note | SOAP note | Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports stable function. Plan: update labs/vitals and arrange follow-up as clinically indicated. | |
care_element | bmi | ||
care_element | immunization | Influenza vaccine documented | |
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
care_element | hba1c | ||
care_element | fasting_glucose | ||
care_element | ldl_cholesterol | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | immunization | COVID-19 vaccine documented | |
care_element | hba1c | ||
care_element | hba1c | ||
appointment | same-day concern | no_show | |
care_element | ldl_cholesterol | ||
care_element | hba1c | ||
appointment | periodic health review | booked |
Ldl Cholesterol
3.9 mmol/L
2025-07-10Egfr
59 mL/min/1.73m2
2025-05-13Fasting Glucose
8.7 mmol/L
2025-04-17Smoking Status
former smoker
2025-03-17Diastolic Bp
83 mmHg
2025-02-15Systolic Bp
128 mmHg
2025-02-15Bmi
32.9 kg/m2
2024-12-15Immunization
Influenza vaccine documented
2024-10-10Diastolic Bp
87 mmHg
2024-08-09Systolic Bp
129 mmHg
2024-08-09Hba1c
8.4 %
2024-06-14Fasting Glucose
10.8 mmol/L
2024-01-19Ldl Cholesterol
3 mmol/L
2023-10-02Diastolic Bp
88 mmHg
2023-08-17Systolic Bp
117 mmHg
2023-08-17Immunization
COVID-19 vaccine documented
2023-05-19Hba1c
8.5 %
2023-03-22Hba1c
7.9 %
2022-08-23Ldl Cholesterol
1.9 mmol/L
2022-01-26Hba1c
8.3 %
2021-08-10