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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
5
New, in review, or accepted tasks
Last visit
2026-03-28
Appointment or derived chart contact
Latest A1c
8 %
2026-03-15
Latest BP
131 mmHg / 87 mmHg
2026-04-16
Extracted signals
0
Optional text signals
Chart volume
55
6 notes, 3 reports
A compact view of what needs attention before opening the full imported record.
Review priority
2
active signal
s
5
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.
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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.
Recent chart, workflow, AI, cohort, and audit events shown in the user's local time.
41, 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 2026-05-06 09:50 | next review=2026-07-02 | Review evidence for Polypharmacy medication review; confirm appropriateness before contacting patient.
PHM saved action
PHM action: ASTHMA_CONTROLLER_REVIEW
status=new | imported | outreach=phone 2026-03-07 08:15 | next review=2026-07-02 | Review evidence for Asthma controller therapy review; confirm appropriateness before contacting patient.
PHM saved action
PHM action: HEART_FAILURE_MONITORING_DUE
status=new | imported | outreach=portal 2026-02-28 14:50 | next review=2026-06-16 | Review evidence for Heart failure monitoring due; confirm appropriateness before contacting patient.
PHM saved action
PHM action: DIABETES_ACR_OVERDUE
status=new | imported | outreach=email 2026-04-03 10:30 | next review=2026-06-16 | Review evidence for Urine ACR overdue; confirm appropriateness before contacting patient.
PHM saved action
PHM action: UNCONTROLLED_HBA1C
status=in_review | imported | next review=2026-06-16 | 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 never smoker form | probable
phm_workflow
PHM action: POLYPHARMACY_REVIEW
status=needs_review | imported | outreach=phone 2026-05-06 09:50 | next review=2026-07-02 | Review evidence for Polypharmacy medication review; confirm appropriateness before contacting patient.
phm_workflow
PHM action: ASTHMA_CONTROLLER_REVIEW
status=new | imported | outreach=phone 2026-03-07 08:15 | next review=2026-07-02 | Review evidence for Asthma controller therapy review; confirm appropriateness before contacting patient.
phm_workflow
PHM action: HEART_FAILURE_MONITORING_DUE
status=new | imported | outreach=portal 2026-02-28 14:50 | next review=2026-06-16 | Review evidence for Heart failure monitoring due; confirm appropriateness before contacting patient.
phm_workflow
PHM action: DIABETES_ACR_OVERDUE
status=new | imported | outreach=email 2026-04-03 10:30 | next review=2026-06-16 | Review evidence for Urine ACR overdue; confirm appropriateness before contacting patient.
phm_workflow
PHM action: UNCONTROLLED_HBA1C
status=in_review | imported | next review=2026-06-16 | Review evidence for HbA1c above target; 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
Age-eligible screening missing
completed | medium | clinical_note | Patient appears age-eligible for preventive screening, but no recent screening completion evidence is present.
clinical_flag
Asthma controller therapy review
new | medium | clinical_note | Asthma symptoms or reliever pattern suggest controller therapy/adherence 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.
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.
clinical_flag
HbA1c above target
accepted | high | structured_fact | Latest HbA1c 8.0% suggests above-target glycemic control and needs clinician review.
alert
Diabetes control flag: HbA1c above target
Generated from longitudinal lab trend.
note
SOAP note
Asthma review. Symptoms: uses reliever most days. Trigger avoidance and inhaler technique reviewed.
SOAP note
Asthma review. Symptoms: uses reliever most days. Trigger avoidance and inhaler technique reviewed.
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 above target several mornings. Reviewed sodium, adherence, and medication tolerance.
preventive care
Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records.
Consult
Eye care report: diabetic eye screening risk reviewed. Follow-up interval documented; no urgent ocular change in this synthetic report.
Laboratory
HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up.
Consult
Consult follow-up for Heart failure. Risk factor optimization, medication adherence, symptom surveillance, and return precautions reviewed.
Polypharmacy medication review
8 active medications identified; medication reconciliation and deprescribing opportunities should be reviewed.
Age-eligible screening missing
Patient appears age-eligible for preventive screening, but no recent screening completion evidence is present.
Asthma controller therapy review
Asthma symptoms or reliever pattern suggest controller therapy/adherence should be reviewed.
Heart failure monitoring due
Heart failure diagnosis present; verify recent symptoms, weight trend, renal function, potassium, and medication tolerance.
Urine ACR overdue
Patient has diabetes and no recent urine ACR evidence within the synthetic monitoring window.
HbA1c above target
Latest HbA1c 8.0% suggests above-target glycemic control and needs clinician review.
Review needed
5 open flags
Open clinical review items need status, assignment, or closure.
A1c above review threshold
Latest HbA1c is 8 % on 2026-03-15.
Active problems
5
Diabetic eye screening risk
active
Asthma
J45.909
active
Heart failure
I50
active
Essential hypertension
I10
active
Type 2 diabetes mellitus
E11
active
Active medications
8
Fluticasone/salmeterol inhaler
250/50 mcg 2 puffs BID
Salbutamol inhaler
100 mcg 1-2 puffs q4h PRN
Apixaban
5 mg BID
Metoprolol
25 mg BID
ASA 81 mg
Fasting Glucose
9.8 mmol/L
2026-05-26Diastolic Bp
87 mmHg
2026-04-16Systolic Bp
131 mmHg
2026-04-16Hba1c
8 %
2026-03-15Ldl Cholesterol
3.9 mmol/L
2026-03-08Immunization
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 | outreach=phone 2026-05-06 09:50 | next review=2026-07-02 | Review evidence for Polypharmacy medication review; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: ASTHMA_CONTROLLER_REVIEW | status=new | imported | outreach=phone 2026-03-07 08:15 | next review=2026-07-02 | Review evidence for Asthma controller therapy review; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: HEART_FAILURE_MONITORING_DUE | status=new | imported | outreach=portal 2026-02-28 14:50 | next review=2026-06-16 | Review evidence for Heart failure monitoring due; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: DIABETES_ACR_OVERDUE | status=new | imported | outreach=email 2026-04-03 10:30 | next review=2026-06-16 | Review evidence for Urine ACR overdue; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: UNCONTROLLED_HBA1C | status=in_review | imported | next review=2026-06-16 | Review evidence for HbA1c above target; 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 | Age-eligible screening missing | completed | medium | clinical_note | Patient appears age-eligible for preventive screening, but no recent screening completion evidence is present. | |
clinical_flag | Asthma controller therapy review | new | medium | clinical_note | Asthma symptoms or reliever pattern suggest controller therapy/adherence 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. | |
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. | |
clinical_flag | HbA1c above target | accepted | high | structured_fact | Latest HbA1c 8.0% suggests above-target glycemic control and needs clinician review. | |
alert | Diabetes control flag: HbA1c above target | Generated from longitudinal lab trend. | |
note | SOAP note | Asthma review. Symptoms: uses reliever most days. Trigger avoidance and inhaler technique reviewed. | |
care_element | fasting_glucose | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
report | Consult | Eye care report: diabetic eye screening risk reviewed. Follow-up interval documented; no urgent ocular change in this synthetic report. | |
appointment | lab follow-up | completed | |
care_element | hba1c | ||
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. | |
note | SOAP note | BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance. | |
note | preventive care | Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records. | |
care_element | immunization | Influenza vaccine documented | |
note | consult | Heart failure follow-up. Patient reports palpitations resolved. Plan: continue guideline-oriented risk management and monitor labs. | |
care_element | hba1c | ||
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 | ||
care_element | ldl_cholesterol | ||
appointment | chronic disease review | cancelled | |
report | Laboratory | HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up. | |
care_element | fasting_glucose | ||
care_element | smoking_status | never smoker | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | fasting_glucose | ||
report | Consult | Consult follow-up for Heart failure. Risk factor optimization, medication adherence, symptom surveillance, and return precautions reviewed. | |
care_element | bmi | ||
appointment | chronic disease review | completed | |
care_element | ldl_cholesterol | ||
care_element | hba1c | ||
care_element | hba1c | ||
care_element | immunization | COVID-19 vaccine documented | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | hba1c | ||
care_element | fasting_glucose | ||
care_element | ldl_cholesterol | ||
appointment | preventive care recall | booked | |
care_element | diastolic_bp | ||
care_element | systolic_bp |
81 mg daily
Influenza vaccine documented
2025-09-05Hba1c
8.5 %
2025-08-10Diastolic Bp
90 mmHg
2025-07-02Systolic Bp
138 mmHg
2025-07-02Ldl Cholesterol
2.9 mmol/L
2025-06-16Fasting Glucose
7.1 mmol/L
2025-03-01Smoking Status
never smoker
2025-01-23Diastolic Bp
88 mmHg
2024-12-11Systolic Bp
143 mmHg
2024-12-11Fasting Glucose
8.6 mmol/L
2024-09-21Bmi
23.9 kg/m2
2024-06-24Ldl Cholesterol
3 mmol/L
2024-04-09Hba1c
7.5 %
2024-03-28Hba1c
7.1 %
2023-07-12Immunization
COVID-19 vaccine documented
2023-05-19Diastolic Bp
83 mmHg
2023-05-03Systolic Bp
144 mmHg
2023-05-03Diastolic Bp
78 mmHg
2022-11-17Systolic Bp
137 mmHg
2022-11-17Hba1c
7.4 %
2022-07-17Fasting Glucose
8.6 mmol/L
2022-04-26Ldl Cholesterol
3.6 mmol/L
2022-02-20Diastolic Bp
77 mmHg
2021-01-01Systolic Bp
133 mmHg
2021-01-01