DocChart
Population Health
Patient panel
Loading the selected patient panel and chart summaries.
Switching panel
Preparing patient rows, flags, problems, medications, and last visit summaries.
Panel size
...
Loading patient records
With open flags
...
Loading review signals
With recent visit
...
Loading visit dates
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: Flag: copd copd_recurrent_exacerbation high in_review Recurrent COPD exacerbation pattern Multiple COPD-related visits/exacerbation language identified within the...
membership needs review
No review task has been created from this cohort for this patient yet.
Open review tasks
6
New, in review, or accepted tasks
Last visit
2026-04-01
Appointment or derived chart contact
Latest A1c
6.8 %
2026-05-09
Latest BP
133 mmHg / 74 mmHg
2026-05-16
Extracted signals
0
Optional text signals
Chart volume
61
8 notes, 3 reports
A compact view of what needs attention before opening the full imported record.
Review priority
1
active signal
6
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
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.
47, 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: POLYPHARMACY_REVIEW
status=needs_review | imported | outreach=phone 2026-05-10 10:50 | next review=2026-06-16 | Review evidence for Polypharmacy medication review; confirm appropriateness before contacting patient.
PHM saved action
PHM action: AGE_ELIGIBLE_SCREENING_MISSING
status=new | imported | next review=2026-06-16 | Review evidence for Age-eligible screening missing; confirm appropriateness before contacting patient.
PHM saved action
PHM action: EYE_EXAM_OVERDUE
status=needs_review | imported | next review=2026-06-16 | Review evidence for Eye exam evidence missing or overdue; confirm appropriateness before contacting patient.
PHM saved action
PHM action: CKD_LOW_EGFR_REVIEW
status=new | imported | next review=2026-08-01 | Review evidence for Reduced eGFR requires review; confirm appropriateness before contacting patient.
PHM saved action
PHM action: COPD_RECURRENT_EXACERBATION
status=in_review | imported | next review=2026-07-02 | Review evidence for Recurrent COPD exacerbation pattern; confirm appropriateness before contacting patient.
PHM saved action
PHM action: DIABETES_ACR_OVERDUE
status=new | imported | next review=2026-07-17 | Review evidence for Urine ACR overdue; confirm appropriateness before contacting patient.
cohort_run
Cohort: Smoking / Lung Screening review cohort
completed | Chart evidence: Flag: copd copd_recurrent_exacerbation high in_review Recurrent COPD exacerbation pattern Multiple COPD-related visits/exacerbation language identified within the recent synthetic chart period. clinical_note | Care element: smoking_status former smoker form | probable
phm_workflow
PHM action: POLYPHARMACY_REVIEW
status=needs_review | imported | outreach=phone 2026-05-10 10:50 | next review=2026-06-16 | Review evidence for Polypharmacy medication review; confirm appropriateness before contacting patient.
phm_workflow
PHM action: AGE_ELIGIBLE_SCREENING_MISSING
status=new | imported | next review=2026-06-16 | Review evidence for Age-eligible screening missing; confirm appropriateness before contacting patient.
phm_workflow
PHM action: EYE_EXAM_OVERDUE
status=needs_review | imported | next review=2026-06-16 | Review evidence for Eye exam evidence missing or overdue; confirm appropriateness before contacting patient.
phm_workflow
PHM action: CKD_LOW_EGFR_REVIEW
status=new | imported | next review=2026-08-01 | Review evidence for Reduced eGFR requires review; confirm appropriateness before contacting patient.
phm_workflow
PHM action: COPD_RECURRENT_EXACERBATION
status=in_review | imported | next review=2026-07-02 | Review evidence for Recurrent COPD exacerbation pattern; confirm appropriateness before contacting patient.
phm_workflow
PHM action: DIABETES_ACR_OVERDUE
status=new | imported | next review=2026-07-17 | Review evidence for Urine ACR overdue; confirm appropriateness before contacting patient.
clinical_flag
Polypharmacy medication review
new | medium | structured_fact | 9 active medications identified; medication reconciliation and deprescribing opportunities should be reviewed.
clinical_flag
Influenza immunization recall
dismissed | low | structured_fact | No recent influenza immunization evidence within the synthetic seasonal window.
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
Eye exam evidence missing or overdue
in_review | medium | active_cohort_automation | Diabetic eye screening risk is documented but no recent eye exam report is present in the synthetic chart.
clinical_flag
Reduced eGFR requires review
in_review | medium | structured_fact | Latest eGFR 35.0 mL/min/1.73m2 requires medication and renal-risk review.
clinical_flag
COPD spirometry evidence missing or old
completed | medium | active_cohort_automation | COPD problem is active but there is no recent spirometry report in this synthetic chart.
clinical_flag
Recurrent COPD exacerbation pattern
in_review | high | clinical_note | Multiple COPD-related visits/exacerbation language identified within the recent synthetic chart period.
preventive care
Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records.
SOAP note
Asthma review. Symptoms: well controlled. Trigger avoidance and inhaler technique reviewed.
SOAP note
BP reviewed. Home readings variable. Reviewed sodium, adherence, and medication tolerance.
SOAP note
COPD review. Symptoms include wheeze during viral illness. Inhaler technique reviewed. Exacerbation risk discussed.
Laboratory
HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up.
Consult
Consult follow-up for Coronary artery disease. Risk factor optimization, medication adherence, symptom surveillance, and return precautions reviewed.
Laboratory
Creatinine/eGFR and urine albumin-creatinine ratio reviewed for chronic kidney disease monitoring.
Polypharmacy medication review
9 active medications identified; medication reconciliation and deprescribing opportunities should be reviewed.
Influenza immunization recall
No recent influenza immunization evidence within the synthetic seasonal window.
Age-eligible screening missing
Patient appears age-eligible for preventive screening, but no recent screening completion evidence is present.
Eye exam evidence missing or overdue
Diabetic eye screening risk is documented but no recent eye exam report is present in the synthetic chart.
Reduced eGFR requires review
Latest eGFR 35.0 mL/min/1.73m2 requires medication and renal-risk review.
COPD spirometry evidence missing or old
COPD problem is active but there is no recent spirometry report in this synthetic chart.
Recurrent COPD exacerbation pattern
Multiple COPD-related visits/exacerbation language identified within the recent synthetic chart period.
Urine ACR overdue
Patient has diabetes and no recent urine ACR evidence within the synthetic monitoring window.
Review needed
6 open flags
Open clinical review items need status, assignment, or closure.
Active problems
7
Diabetic eye screening risk
active
Chronic kidney disease stage 3b
N18
active
Asthma
J45.909
active
Chronic obstructive pulmonary disease
J44.9
active
Coronary artery disease
I25.10
active
Active medications
9
Budesonide/formoterol inhaler
200/6 mcg 2 puffs BID
Salbutamol inhaler
100 mcg 1-2 puffs q4h PRN
Salbutamol inhaler
100 mcg 1-2 puffs q4h PRN
Atorvastatin
40 mg daily
Ramipril
Diastolic Bp
74 mmHg
2026-05-16Systolic Bp
133 mmHg
2026-05-16Hba1c
6.8 %
2026-05-09Bmi
28.4 kg/m2
2026-05-06Egfr
35 mL/min/1.73m2
2026-05-04Fasting Glucose
Date | Type | Title | Detail |
|---|---|---|---|
cohort_run | Cohort: Smoking / Lung Screening review cohort | completed | Chart evidence: Flag: copd copd_recurrent_exacerbation high in_review Recurrent COPD exacerbation pattern Multiple COPD-related visits/exacerbation language identified within the recent synthetic chart period. clinical_note | Care element: smoking_status former smoker form | probable | |
phm_workflow | PHM action: POLYPHARMACY_REVIEW | status=needs_review | imported | outreach=phone 2026-05-10 10:50 | next review=2026-06-16 | Review evidence for Polypharmacy medication review; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: AGE_ELIGIBLE_SCREENING_MISSING | status=new | imported | next review=2026-06-16 | Review evidence for Age-eligible screening missing; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: EYE_EXAM_OVERDUE | status=needs_review | imported | next review=2026-06-16 | Review evidence for Eye exam evidence missing or overdue; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: CKD_LOW_EGFR_REVIEW | status=new | imported | next review=2026-08-01 | Review evidence for Reduced eGFR requires review; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: COPD_RECURRENT_EXACERBATION | status=in_review | imported | next review=2026-07-02 | Review evidence for Recurrent COPD exacerbation pattern; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: DIABETES_ACR_OVERDUE | status=new | imported | next review=2026-07-17 | Review evidence for Urine ACR overdue; confirm appropriateness before contacting patient. | |
clinical_flag | Polypharmacy medication review | new | medium | structured_fact | 9 active medications identified; medication reconciliation and deprescribing opportunities should be reviewed. | |
clinical_flag | Influenza immunization recall | dismissed | low | structured_fact | No recent influenza immunization evidence within the synthetic seasonal window. | |
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 | Eye exam evidence missing or overdue | in_review | medium | active_cohort_automation | Diabetic eye screening risk is documented but no recent eye exam report is present in the synthetic chart. | |
clinical_flag | Reduced eGFR requires review | in_review | medium | structured_fact | Latest eGFR 35.0 mL/min/1.73m2 requires medication and renal-risk review. | |
clinical_flag | COPD spirometry evidence missing or old | completed | medium | active_cohort_automation | COPD problem is active but there is no recent spirometry report in this synthetic chart. | |
clinical_flag | Recurrent COPD exacerbation pattern | in_review | high | clinical_note | Multiple COPD-related visits/exacerbation language identified within the recent synthetic chart period. | |
clinical_flag | Urine ACR overdue | in_review | medium | active_cohort_automation | Patient has diabetes and no recent urine ACR evidence within the synthetic monitoring window. | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | hba1c | ||
care_element | bmi | ||
care_element | egfr | ||
note | preventive care | Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records. | |
note | SOAP note | Asthma review. Symptoms: well controlled. Trigger avoidance and inhaler technique reviewed. | |
note | SOAP note | BP reviewed. Home readings variable. Reviewed sodium, adherence, and medication tolerance. | |
appointment | periodic health review | completed | |
note | SOAP note | COPD review. Symptoms include wheeze during viral illness. Inhaler technique reviewed. Exacerbation risk discussed. | |
care_element | fasting_glucose | ||
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. | |
note | SOAP note | COPD review. Symptoms include shortness of breath on stairs. Inhaler technique reviewed. Exacerbation risk discussed. | |
note | consult | Coronary artery disease follow-up. Patient reports no chest pain. Plan: continue guideline-oriented risk management and monitor labs. | |
report | Laboratory | HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up. | |
report | Consult | Consult follow-up for Coronary artery disease. Risk factor optimization, medication adherence, symptom surveillance, and return precautions reviewed. | |
care_element | egfr | ||
care_element | immunization | COVID-19 vaccine documented | |
appointment | lab follow-up | completed | |
care_element | fasting_glucose | ||
report | Laboratory | Creatinine/eGFR and urine albumin-creatinine ratio reviewed for chronic kidney disease monitoring. | |
care_element | hba1c | ||
care_element | albumin_creatinine_ratio | ||
care_element | albumin_creatinine_ratio | ||
care_element | smoking_status | former smoker | |
care_element | fasting_glucose | ||
care_element | ldl_cholesterol | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | egfr | ||
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 | hba1c | ||
care_element | immunization | Influenza vaccine documented | |
care_element | egfr | ||
appointment | same-day concern | completed | |
care_element | fasting_glucose | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | ldl_cholesterol | ||
care_element | egfr | ||
care_element | fasting_glucose | ||
care_element | hba1c | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
care_element | hba1c | ||
appointment | preventive care recall | no_show |
5 mg daily
7.8 mmol/L
2026-03-08Egfr
44 mL/min/1.73m2
2025-10-08Immunization
COVID-19 vaccine documented
2025-10-05Fasting Glucose
6.6 mmol/L
2025-08-23Hba1c
7.2 %
2025-05-12Albumin Creatinine Ratio
69.6 mg/mmol
2025-04-10Albumin Creatinine Ratio
44.6 mg/mmol
2025-02-01Smoking Status
former smoker
2024-10-22Fasting Glucose
9 mmol/L
2024-09-05Ldl Cholesterol
3 mmol/L
2024-07-16Diastolic Bp
85 mmHg
2024-05-21Systolic Bp
119 mmHg
2024-05-21Egfr
43 mL/min/1.73m2
2024-03-23Hba1c
7.1 %
2024-02-17Immunization
Influenza vaccine documented
2023-11-15Egfr
43 mL/min/1.73m2
2023-09-06Fasting Glucose
10.2 mmol/L
2023-01-22Diastolic Bp
74 mmHg
2022-09-09Systolic Bp
136 mmHg
2022-09-09Ldl Cholesterol
2.6 mmol/L
2022-07-26Egfr
42 mL/min/1.73m2
2022-05-26Fasting Glucose
7.7 mmol/L
2022-02-13Hba1c
7.2 %
2022-01-02Diastolic Bp
84 mmHg
2021-08-13Systolic Bp
128 mmHg
2021-08-13Hba1c
7.5 %
2021-08-06