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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.
2, current
Frailty / Falls review cohort
Chart evidence: Flag: diabetes_prediabetes prediabetes_risk medium new Prediabetes range HbA1c Latest HbA1c 6.2% falls in the prediabetes range without a diabetes problem-list dia...
membership needs review
No review task has been created from this cohort for this patient yet.
Smoking / Lung Screening review cohort
Chart evidence: Care element: smoking_status current smoker form
membership needs review
Open review tasks
2
New, in review, or accepted tasks
Last visit
2026-03-18
Appointment or derived chart contact
Latest A1c
6.2 %
2026-03-06
Latest BP
122 mmHg / 85 mmHg
2026-05-12
Extracted signals
0
Optional text signals
Chart volume
32
5 notes, 0 reports
A compact view of what needs attention before opening the full imported record.
Review priority
1
active signal
2
0
0
Review these before relying on the imported record clinically.
Review needed
2 open flags
Open clinical review items need status, assignment, or closure.
Active problems
3
Chronic neck pain
active
Major depressive disorder
active
Essential hypertension
I10
active
Active medications
6
Duloxetine
30 mg daily
Oxycodone/acetaminophen
5/325 mg q6h PRN
Sertraline
50 mg daily
Amlodipine
5 mg daily
Ramipril
5 mg daily
No review task has been created from this cohort for this patient yet.
AI-CDS actions selected from Flags & Tasks. These stay visible on the chart for follow-up.
0, selected
No selected follow-up actions
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Saved population-health queue work for this patient: calls, recalls, flags, snoozes, exclusions, and completions.
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18, more source rows below
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Recent report headers and excerpts.
No reports imported
Audit view for imported records. Kept collapsed so the working chart remains usable.
PHM saved action
PHM action: OPIOID_MONITORING_DUE
status=outreach_planned | imported | outreach=email 2026-02-05 11:10 | next review=2026-07-17 | Review evidence for Opioid monitoring review due; confirm appropriateness before contacting patient.
PHM saved action
PHM action: PREDIABETES_RISK
status=needs_review | imported | next review=2026-07-02 | Review evidence for Prediabetes range HbA1c; confirm appropriateness before contacting patient.
cohort_run
Cohort: Frailty / Falls review cohort
completed | Chart evidence: Flag: diabetes_prediabetes prediabetes_risk medium new Prediabetes range HbA1c Latest HbA1c 6.2% falls in the prediabetes range without a diabetes problem-list diagnosis. structured_fact | Flag: chronic_pain_opioids opioid_monitoring_due high in_review Opioid monitoring review due Active opioid medication identified; verify treatment agreement, functional goals, dispense review, and urine drug screen document... | Clinical note: SOAP note Mental health review. PHQ-9 12, GAD-7 12. Sleep poor. No acute safety concern documented. Plan includes counselling resources, medication review, and follow-up interval based on symptoms. | Clinical note: SOAP note BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance. | probable
cohort_run
Cohort: Smoking / Lung Screening review cohort
completed | Chart evidence: Care element: smoking_status current smoker form | probable
phm_workflow
PHM action: OPIOID_MONITORING_DUE
status=outreach_planned | imported | outreach=email 2026-02-05 11:10 | next review=2026-07-17 | Review evidence for Opioid monitoring review due; confirm appropriateness before contacting patient.
phm_workflow
PHM action: PREDIABETES_RISK
status=needs_review | imported | next review=2026-07-02 | Review evidence for Prediabetes range HbA1c; confirm appropriateness before contacting patient.
clinical_flag
Opioid monitoring review due
in_review | high | structured_fact | Active opioid medication identified; verify treatment agreement, functional goals, dispense review, and urine drug screen documentation.
clinical_flag
Prediabetes range HbA1c
new | medium | structured_fact | Latest HbA1c 6.2% falls in the prediabetes range without a diabetes problem-list diagnosis.
note
SOAP note
Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports no acute concern. Plan: update labs/vitals and arrange follow-up as clinically indicated.
appointment
preventive care recall
cancelled
note
SOAP note
Pain follow-up for chronic neck pain. Function, sleep, mood, non-pharmacologic options, and medication risks reviewed. Pain score 8/10.
note
SOAP note
Mental health review. PHQ-9 12, GAD-7 12. Sleep poor. No acute safety concern documented. Plan includes counselling resources, medication review, and follow-up interval based on symptoms.
note
SOAP note
BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance.
note
preventive care
HbA1c in prediabetes range. Discussed weight, activity, nutrition, sleep, and repeat testing. No confirmed diabetes diagnosis documented.
appointment
chronic disease review
completed
appointment
lab follow-up
cancelled
SOAP note
Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports no acute concern. Plan: update labs/vitals and arrange follow-up as clinically indicated.
SOAP note
Pain follow-up for chronic neck pain. Function, sleep, mood, non-pharmacologic options, and medication risks reviewed. Pain score 8/10.
SOAP note
Mental health review. PHQ-9 12, GAD-7 12. Sleep poor. No acute safety concern documented. Plan includes counselling resources, medication review, and follow-up interval based on symptoms.
SOAP note
BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance.
Opioid monitoring review due
Active opioid medication identified; verify treatment agreement, functional goals, dispense review, and urine drug screen documentation.
Prediabetes range HbA1c
Latest HbA1c 6.2% falls in the prediabetes range without a diabetes problem-list diagnosis.
Diastolic Bp
85 mmHg
2026-05-12Systolic Bp
122 mmHg
2026-05-12Hba1c
6.2 %
2026-03-06Smoking Status
current smoker
2025-09-05Diastolic Bp
72 mmHg
2025-07-23Systolic Bp
Date | Type | Title | Detail |
|---|---|---|---|
cohort_run | Cohort: Frailty / Falls review cohort | completed | Chart evidence: Flag: diabetes_prediabetes prediabetes_risk medium new Prediabetes range HbA1c Latest HbA1c 6.2% falls in the prediabetes range without a diabetes problem-list diagnosis. structured_fact | Flag: chronic_pain_opioids opioid_monitoring_due high in_review Opioid monitoring review due Active opioid medication identified; verify treatment agreement, functional goals, dispense review, and urine drug screen document... | Clinical note: SOAP note Mental health review. PHQ-9 12, GAD-7 12. Sleep poor. No acute safety concern documented. Plan includes counselling resources, medication review, and follow-up interval based on symptoms. | Clinical note: SOAP note BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance. | probable | |
cohort_run | Cohort: Smoking / Lung Screening review cohort | completed | Chart evidence: Care element: smoking_status current smoker form | probable | |
phm_workflow | PHM action: OPIOID_MONITORING_DUE | status=outreach_planned | imported | outreach=email 2026-02-05 11:10 | next review=2026-07-17 | Review evidence for Opioid monitoring review due; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: PREDIABETES_RISK | status=needs_review | imported | next review=2026-07-02 | Review evidence for Prediabetes range HbA1c; confirm appropriateness before contacting patient. | |
clinical_flag | Opioid monitoring review due | in_review | high | structured_fact | Active opioid medication identified; verify treatment agreement, functional goals, dispense review, and urine drug screen documentation. | |
clinical_flag | Prediabetes range HbA1c | new | medium | structured_fact | Latest HbA1c 6.2% falls in the prediabetes range without a diabetes problem-list diagnosis. | |
note | SOAP note | Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports no acute concern. Plan: update labs/vitals and arrange follow-up as clinically indicated. | |
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
appointment | preventive care recall | cancelled | |
care_element | hba1c | ||
note | SOAP note | Pain follow-up for chronic neck pain. Function, sleep, mood, non-pharmacologic options, and medication risks reviewed. Pain score 8/10. | |
note | SOAP note | Mental health review. PHQ-9 12, GAD-7 12. Sleep poor. No acute safety concern documented. Plan includes counselling resources, medication review, and follow-up interval based on symptoms. | |
note | SOAP note | BP reviewed. Home readings above target several mornings. Reviewed sodium, adherence, and medication tolerance. | |
note | preventive care | HbA1c in prediabetes range. Discussed weight, activity, nutrition, sleep, and repeat testing. No confirmed diabetes diagnosis documented. | |
care_element | smoking_status | current smoker | |
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
appointment | chronic disease review | completed | |
care_element | bmi | ||
care_element | egfr | ||
appointment | lab follow-up | cancelled | |
care_element | hba1c | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
appointment | chronic disease review | cancelled | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
appointment | same-day concern | completed | |
appointment | same-day concern | completed |
127 mmHg
2025-07-23Bmi
25.2 kg/m2
2025-02-01Egfr
83 mL/min/1.73m2
2024-10-14Hba1c
6.2 %
2024-10-04Diastolic Bp
81 mmHg
2024-09-13Systolic Bp
134 mmHg
2024-09-13Diastolic Bp
70 mmHg
2022-07-22Systolic Bp
130 mmHg
2022-07-22Diastolic Bp
69 mmHg
2021-05-02Systolic Bp
135 mmHg
2021-05-02