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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
9
New, in review, or accepted tasks
Last visit
2026-04-26
Appointment or derived chart contact
Latest A1c
6.7 %
2025-05-08
Latest BP
159 mmHg / 105 mmHg
2026-03-06
Extracted signals
0
Optional text signals
Chart volume
59
7 notes, 1 reports
A compact view of what needs attention before opening the full imported record.
Review priority
2
active signal
s
9
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.
45, 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: a1c-overdue
status=new | Created from PHM workbench for clinician review.
PHM saved action
PHM action: PNEUMOCOCCAL_REVIEW_DUE
status=new | imported | next review=2026-08-01 | Review evidence for Pneumococcal immunization review; confirm appropriateness before contacting patient.
PHM saved action
PHM action: INFLUENZA_RECALL_DUE
status=needs_review | imported | outreach=email 2026-04-05 13:20 | next review=2026-06-23 | Review evidence for Influenza immunization recall; 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: NARRATIVE_OA_WITHOUT_PROBLEM
status=new | imported | next review=2026-06-23 | Review evidence for Narrative OA evidence missing from problem list; confirm appropriateness before contacting patient.
PHM saved action
PHM action: OPIOID_MONITORING_DUE
status=outreach_planned | imported | outreach=sms 2026-04-01 10:50 | next review=2026-08-01 | Review evidence for Opioid monitoring review due; 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: a1c-overdue
status=new | Created from PHM workbench for clinician review.
phm_workflow
PHM action: PNEUMOCOCCAL_REVIEW_DUE
status=new | imported | next review=2026-08-01 | Review evidence for Pneumococcal immunization review; confirm appropriateness before contacting patient.
phm_workflow
PHM action: INFLUENZA_RECALL_DUE
status=needs_review | imported | outreach=email 2026-04-05 13:20 | next review=2026-06-23 | Review evidence for Influenza immunization recall; 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: NARRATIVE_OA_WITHOUT_PROBLEM
status=new | imported | next review=2026-06-23 | Review evidence for Narrative OA evidence missing from problem list; confirm appropriateness before contacting patient.
phm_workflow
PHM action: OPIOID_MONITORING_DUE
status=outreach_planned | imported | outreach=sms 2026-04-01 10:50 | next review=2026-08-01 | Review evidence for Opioid monitoring review due; confirm appropriateness before contacting patient.
phm_workflow
PHM action: REPEATED_BP_ABOVE_TARGET
status=new | imported | next review=2026-06-23 | Review evidence for Repeated BP above target; confirm appropriateness before contacting patient.
phm_workflow
PHM action: DIABETES_ACR_OVERDUE
status=new | imported | next review=2026-06-16 | Review evidence for Urine ACR overdue; confirm appropriateness before contacting patient.
clinical_flag
Polypharmacy medication review
completed | medium | structured_fact | 9 active medications identified; medication reconciliation and deprescribing opportunities should be reviewed.
clinical_flag
Pneumococcal immunization review
accepted | medium | active_cohort_automation | Older adult with no pneumococcal immunization evidence in the synthetic chart.
clinical_flag
Influenza immunization recall
new | low | structured_fact | No recent influenza immunization evidence within the synthetic seasonal window.
clinical_flag
Age-eligible screening missing
accepted | 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
accepted | medium | active_cohort_automation | Diabetic retinopathy is documented but no recent eye exam report is present in the synthetic chart.
SOAP note
BP reviewed. Home readings variable. Reviewed sodium, adherence, and medication tolerance.
preventive care
Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records.
SOAP note
Pain follow-up for chronic neuropathic pain. Function, sleep, mood, non-pharmacologic options, and medication risks reviewed. Pain score 5/10.
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.
Laboratory
HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up.
Possible diabetes monitoring care gap
Confirmed diabetes evidence found, but no recent A1c/HbA1c care element was imported.
Polypharmacy medication review
9 active medications identified; medication reconciliation and deprescribing opportunities should be reviewed.
Pneumococcal immunization review
Older adult with no pneumococcal immunization evidence in the synthetic chart.
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 retinopathy is documented but no recent eye exam report is present in the synthetic chart.
Narrative OA evidence missing from problem list
Clinical note describes osteoarthritis-like knee symptoms but there is no structured OA problem-list entry.
Opioid monitoring review due
Active opioid medication identified; verify treatment agreement, functional goals, dispense review, and urine drug screen documentation.
Asthma controller therapy review
Asthma symptoms or reliever pattern suggest controller therapy/adherence should be reviewed.
Repeated BP above target
Two recent BP readings are above target: 145/92 and 159/105 mmHg.
Urine ACR overdue
Patient has diabetes and no recent urine ACR evidence within the synthetic monitoring window.
Review needed
9 open flags
Open clinical review items need status, assignment, or closure.
BP above target
Latest BP is 159 mmHg / 105 mmHg on 2026-03-06.
Active problems
5
Diabetic retinopathy
active
Chronic neuropathic pain
active
Asthma
J45.909
active
Essential hypertension
I10
active
Type 2 diabetes mellitus
E11
active
Active medications
9
Duloxetine
30 mg daily
Naproxen
500 mg BID PRN
Hydromorphone
1 mg q6h PRN
Salbutamol inhaler
100 mcg 1-2 puffs q4h PRN
Ramipril
Fasting Glucose
6.7 mmol/L
2026-04-09Ldl Cholesterol
2.2 mmol/L
2026-04-06Diastolic Bp
105 mmHg
2026-03-06Systolic Bp
159 mmHg
2026-03-06Smoking Status
former smoker
2025-12-17Diastolic Bp
Date | 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: a1c-overdue | status=new | Created from PHM workbench for clinician review. | |
phm_workflow | PHM action: PNEUMOCOCCAL_REVIEW_DUE | status=new | imported | next review=2026-08-01 | Review evidence for Pneumococcal immunization review; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: INFLUENZA_RECALL_DUE | status=needs_review | imported | outreach=email 2026-04-05 13:20 | next review=2026-06-23 | Review evidence for Influenza immunization recall; 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: NARRATIVE_OA_WITHOUT_PROBLEM | status=new | imported | next review=2026-06-23 | Review evidence for Narrative OA evidence missing from problem list; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: OPIOID_MONITORING_DUE | status=outreach_planned | imported | outreach=sms 2026-04-01 10:50 | next review=2026-08-01 | Review evidence for Opioid monitoring review due; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: REPEATED_BP_ABOVE_TARGET | status=new | imported | next review=2026-06-23 | Review evidence for Repeated BP above target; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: DIABETES_ACR_OVERDUE | status=new | imported | next review=2026-06-16 | Review evidence for Urine ACR overdue; confirm appropriateness before contacting patient. | |
clinical_flag | Polypharmacy medication review | completed | medium | structured_fact | 9 active medications identified; medication reconciliation and deprescribing opportunities should be reviewed. | |
clinical_flag | Pneumococcal immunization review | accepted | medium | active_cohort_automation | Older adult with no pneumococcal immunization evidence in the synthetic chart. | |
clinical_flag | Influenza immunization recall | new | low | structured_fact | No recent influenza immunization evidence within the synthetic seasonal window. | |
clinical_flag | Age-eligible screening missing | accepted | 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 | accepted | medium | active_cohort_automation | Diabetic retinopathy is documented but no recent eye exam report is present in the synthetic chart. | |
clinical_flag | Narrative OA evidence missing from problem list | new | medium | clinical_note | Clinical note describes osteoarthritis-like knee symptoms but there is no structured OA problem-list entry. | |
clinical_flag | Opioid monitoring review due | accepted | high | structured_fact | Active opioid medication identified; verify treatment agreement, functional goals, dispense review, and urine drug screen documentation. | |
clinical_flag | Asthma controller therapy review | dismissed | medium | clinical_note | Asthma symptoms or reliever pattern suggest controller therapy/adherence should be reviewed. | |
clinical_flag | Repeated BP above target | accepted | high | structured_fact | Two recent BP readings are above target: 145/92 and 159/105 mmHg. | |
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 | Possible diabetes monitoring care gap | new | medium | structured | Confirmed diabetes evidence found, but no recent A1c/HbA1c care element was imported. | |
appointment | lab follow-up | completed | |
note | SOAP note | BP reviewed. Home readings variable. Reviewed sodium, adherence, and medication tolerance. | |
care_element | fasting_glucose | ||
care_element | ldl_cholesterol | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
note | preventive care | Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records. | |
care_element | smoking_status | former smoker | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | fasting_glucose | ||
care_element | egfr | ||
note | SOAP note | Pain follow-up for chronic neuropathic pain. Function, sleep, mood, non-pharmacologic options, and medication risks reviewed. Pain score 5/10. | |
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. | |
report | Laboratory | HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up. | |
note | SOAP note | Asthma review. Symptoms: exercise-triggered wheeze. Trigger avoidance and inhaler technique reviewed. | |
note | SOAP note | T2DM review. Home glucose pattern mostly at target. Discussed nutrition, exercise, foot care, and medication adherence. Plan: repeat HbA1c and review cardiovascular/renal risk. | |
care_element | hba1c | ||
note | SOAP note | Follow-up visit. Medication list reviewed, allergies checked, and preventive care status discussed. Patient reports variable energy. Plan: update labs/vitals and arrange follow-up as clinically indicated. | |
care_element | albumin_creatinine_ratio | ||
care_element | ldl_cholesterol | ||
care_element | immunization | Influenza vaccine documented | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | hba1c | ||
care_element | bmi | ||
care_element | fasting_glucose | ||
care_element | immunization | COVID-19 vaccine documented | |
care_element | ldl_cholesterol | ||
appointment | periodic health review | no_show | |
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | hba1c | ||
care_element | hba1c | ||
care_element | ldl_cholesterol | ||
care_element | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | hba1c | ||
appointment | lab follow-up | cancelled |
5 mg daily
92 mmHg
2025-12-12Systolic Bp
145 mmHg
2025-12-12Fasting Glucose
6.6 mmol/L
2025-12-04Egfr
94 mL/min/1.73m2
2025-12-03Hba1c
6.7 %
2025-05-08Albumin Creatinine Ratio
34.4 mg/mmol
2025-03-06Ldl Cholesterol
1.8 mmol/L
2025-01-25Immunization
Influenza vaccine documented
2025-01-08Diastolic Bp
72 mmHg
2024-12-18Systolic Bp
140 mmHg
2024-12-18Hba1c
7.2 %
2024-10-10Bmi
32.7 kg/m2
2024-09-02Fasting Glucose
8.3 mmol/L
2024-08-17Immunization
COVID-19 vaccine documented
2024-06-12Ldl Cholesterol
4.1 mmol/L
2024-06-11Diastolic Bp
72 mmHg
2023-08-24Systolic Bp
135 mmHg
2023-08-24Hba1c
7 %
2023-01-01Hba1c
6.5 %
2022-12-15Ldl Cholesterol
2 mmol/L
2022-11-19Diastolic Bp
78 mmHg
2021-04-17Systolic Bp
117 mmHg
2021-04-17Hba1c
7 %
2021-01-11