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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
2026-05-28
Appointment or derived chart contact
Latest A1c
5.5 %
2024-07-27
Latest BP
112 mmHg / 74 mmHg
2026-01-17
Extracted signals
0
Optional text signals
Chart volume
29
5 notes, 1 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.
Review needed
3 open flags
Open clinical review items need status, assignment, or closure.
Active problems
3
Osteoarthritis of knee
M19.90
active
Mixed anxiety and depressive disorder
active
Heart failure
I50
active
Active medications
2
Metoprolol
25 mg BID
Rosuvastatin
20 mg daily
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.
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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.
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15, 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: AGE_ELIGIBLE_SCREENING_MISSING
status=needs_review | imported | next review=2026-06-16 | Review evidence for Age-eligible screening missing; confirm appropriateness before contacting patient.
PHM saved action
PHM action: MODERATE_SEVERE_SYMPTOM_SCORE
status=needs_review | imported | next review=2026-07-17 | Review evidence for Elevated mental health symptom score; 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: AGE_ELIGIBLE_SCREENING_MISSING
status=needs_review | imported | next review=2026-06-16 | Review evidence for Age-eligible screening missing; confirm appropriateness before contacting patient.
phm_workflow
PHM action: MODERATE_SEVERE_SYMPTOM_SCORE
status=needs_review | imported | next review=2026-07-17 | Review evidence for Elevated mental health symptom score; confirm appropriateness before contacting patient.
clinical_flag
Age-eligible screening missing
new | medium | clinical_note | Patient appears age-eligible for preventive screening, but no recent screening completion evidence is present.
clinical_flag
Elevated mental health symptom score
new | high | clinical_note | Recent note documents PHQ-9 19 and GAD-7 12; follow-up priority should be reviewed.
clinical_flag
Heart failure monitoring due
in_review | medium | clinical_note | Heart failure diagnosis present; verify recent symptoms, weight trend, renal function, potassium, and medication tolerance.
appointment
lab follow-up
completed
note
SOAP note
Mental health review. PHQ-9 19, GAD-7 12. Sleep improving. No acute safety concern documented. Plan includes counselling resources, medication review, and follow-up interval based on symptoms.
note
SOAP note
MSK review: chronic knee pain with morning stiffness and crepitus, consistent with osteoarthritis pattern. Discussed activity modification, strengthening, topical/oral analgesia risks, imaging only if red flags or surgical planning.
note
consult
Heart failure follow-up. Patient reports intermittent exertional dyspnea. Plan: continue guideline-oriented risk management and monitor labs.
report
Consult
Consult follow-up for Heart failure. Risk factor optimization, medication adherence, symptom surveillance, and return precautions reviewed.
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.
note
preventive care
Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records.
appointment
periodic health review
completed
SOAP note
Mental health review. PHQ-9 19, GAD-7 12. Sleep improving. No acute safety concern documented. Plan includes counselling resources, medication review, and follow-up interval based on symptoms.
SOAP note
MSK review: chronic knee pain with morning stiffness and crepitus, consistent with osteoarthritis pattern. Discussed activity modification, strengthening, topical/oral analgesia risks, imaging only if red flags or surgical planning.
consult
Heart failure 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 recent family stress. Plan: update labs/vitals and arrange follow-up as clinically indicated.
Consult
Consult follow-up for Heart failure. Risk factor optimization, medication adherence, symptom surveillance, and return precautions reviewed.
Age-eligible screening missing
Patient appears age-eligible for preventive screening, but no recent screening completion evidence is present.
Elevated mental health symptom score
Recent note documents PHQ-9 19 and GAD-7 12; follow-up priority should be reviewed.
Heart failure monitoring due
Heart failure diagnosis present; verify recent symptoms, weight trend, renal function, potassium, and medication tolerance.
Diastolic Bp
74 mmHg
2026-01-17Systolic Bp
112 mmHg
2026-01-17Immunization
COVID-19 vaccine documented
2025-10-05Immunization
Influenza vaccine documented
2025-10-05Smoking Status
former smoker
2025-08-10Date | 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: AGE_ELIGIBLE_SCREENING_MISSING | status=needs_review | imported | next review=2026-06-16 | Review evidence for Age-eligible screening missing; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: MODERATE_SEVERE_SYMPTOM_SCORE | status=needs_review | imported | next review=2026-07-17 | Review evidence for Elevated mental health symptom score; confirm appropriateness before contacting patient. | |
clinical_flag | Age-eligible screening missing | new | medium | clinical_note | Patient appears age-eligible for preventive screening, but no recent screening completion evidence is present. | |
clinical_flag | Elevated mental health symptom score | new | high | clinical_note | Recent note documents PHQ-9 19 and GAD-7 12; follow-up priority should be reviewed. | |
clinical_flag | Heart failure monitoring due | in_review | medium | clinical_note | Heart failure diagnosis present; verify recent symptoms, weight trend, renal function, potassium, and medication tolerance. | |
appointment | lab follow-up | completed | |
note | SOAP note | Mental health review. PHQ-9 19, GAD-7 12. Sleep improving. No acute safety concern documented. Plan includes counselling resources, medication review, and follow-up interval based on symptoms. | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
note | SOAP note | MSK review: chronic knee pain with morning stiffness and crepitus, consistent with osteoarthritis pattern. Discussed activity modification, strengthening, topical/oral analgesia risks, imaging only if red flags or surgical planning. | |
care_element | immunization | Influenza vaccine documented | |
care_element | immunization | COVID-19 vaccine documented | |
note | consult | Heart failure follow-up. Patient reports intermittent exertional dyspnea. Plan: continue guideline-oriented risk management and monitor labs. | |
care_element | smoking_status | former smoker | |
report | Consult | Consult follow-up for Heart failure. Risk factor optimization, medication adherence, symptom surveillance, and return precautions reviewed. | |
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 | bmi | ||
note | preventive care | Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records. | |
appointment | periodic health review | completed | |
care_element | hba1c | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
appointment | same-day concern | completed | |
appointment | periodic health review | completed | |
appointment | lab follow-up | completed | |
appointment | medication renewal | completed |
Bmi
27.1 kg/m2
2025-04-10Hba1c
5.5 %
2024-07-27Diastolic Bp
85 mmHg
2024-01-11Systolic Bp
114 mmHg
2024-01-11Diastolic Bp
84 mmHg
2023-11-03Systolic Bp
125 mmHg
2023-11-03