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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 never smoker form
membership needs review
No review task has been created from this cohort for this patient yet.
Open review tasks
2
New, in review, or accepted tasks
Last visit
2024-08-05
Appointment or derived chart contact
Latest A1c
9 %
2026-02-08
Latest BP
108 mmHg / 77 mmHg
2025-03-23
Extracted signals
0
Optional text signals
Chart volume
42
4 notes, 3 reports
A compact view of what needs attention before opening the full imported record.
Review priority
2
active signal
s
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.
A1c above review threshold
Latest HbA1c is 9 % on 2026-02-08.
Active problems
3
Diabetic eye screening risk
active
Prostate cancer survivor
active
Type 2 diabetes mellitus
E11
active
Active medications
3
Empagliflozin
10 mg daily
Metformin XR
1000 mg daily
Metformin
500 mg BID
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.
Optional text-derived evidence extracted beside the imported chart. Each signal stays traceable to source text.
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28, more source rows below
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PHM saved action
PHM action: SURVIVORSHIP_PLAN_DUE
status=in_review | imported | outreach=portal 2026-03-12 11:10 | next review=2026-07-17 | Review evidence for Survivorship plan review due; confirm appropriateness before contacting patient.
PHM saved action
PHM action: UNCONTROLLED_HBA1C
status=new | imported | outreach=phone 2026-05-08 08:00 | next review=2026-06-09 | 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: SURVIVORSHIP_PLAN_DUE
status=in_review | imported | outreach=portal 2026-03-12 11:10 | next review=2026-07-17 | Review evidence for Survivorship plan review due; confirm appropriateness before contacting patient.
phm_workflow
PHM action: UNCONTROLLED_HBA1C
status=new | imported | outreach=phone 2026-05-08 08:00 | next review=2026-06-09 | Review evidence for HbA1c above target; confirm appropriateness before contacting patient.
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
Survivorship plan review due
new | medium | report | Cancer history is active/imported; survivorship plan or surveillance schedule should be confirmed.
clinical_flag
HbA1c above target
in_review | high | structured_fact | Latest HbA1c 9.0% suggests above-target glycemic control and needs clinician review.
alert
Diabetes control flag: HbA1c above target
Generated from longitudinal lab trend.
note
SOAP note
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
consult
Survivorship care reviewed for history of prostate cancer survivor. Patient asks about surveillance schedule and late effects.
note
preventive care
Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records.
report
Consult
Oncology follow-up for prostate cancer survivor. No active recurrence noted in this synthetic report. Ongoing surveillance, late effects, and primary care coordination discussed.
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.
report
Laboratory
HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up.
report
Consult
Eye care report: diabetic eye screening risk reviewed. Follow-up interval documented; no urgent ocular change in this synthetic report.
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.
consult
Survivorship care reviewed for history of prostate cancer survivor. Patient asks about surveillance schedule and late effects.
preventive care
Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records.
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.
Consult
Oncology follow-up for prostate cancer survivor. No active recurrence noted in this synthetic report. Ongoing surveillance, late effects, and primary care coordination discussed.
Laboratory
HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up.
Consult
Eye care report: diabetic eye screening risk reviewed. Follow-up interval documented; no urgent ocular change in this synthetic report.
Age-eligible screening missing
Patient appears age-eligible for preventive screening, but no recent screening completion evidence is present.
Survivorship plan review due
Cancer history is active/imported; survivorship plan or surveillance schedule should be confirmed.
HbA1c above target
Latest HbA1c 9.0% suggests above-target glycemic control and needs clinician review.
Smoking Status
never smoker
2026-05-23Fasting Glucose
10.6 mmol/L
2026-05-19Egfr
77 mL/min/1.73m2
2026-05-04Ldl Cholesterol
2.3 mmol/L
2026-05-02Albumin Creatinine Ratio
35.5 mg/mmol
2026-03-10Date | 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: SURVIVORSHIP_PLAN_DUE | status=in_review | imported | outreach=portal 2026-03-12 11:10 | next review=2026-07-17 | Review evidence for Survivorship plan review due; confirm appropriateness before contacting patient. | |
phm_workflow | PHM action: UNCONTROLLED_HBA1C | status=new | imported | outreach=phone 2026-05-08 08:00 | next review=2026-06-09 | Review evidence for HbA1c above target; confirm appropriateness before contacting patient. | |
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 | Survivorship plan review due | new | medium | report | Cancer history is active/imported; survivorship plan or surveillance schedule should be confirmed. | |
clinical_flag | HbA1c above target | in_review | high | structured_fact | Latest HbA1c 9.0% suggests above-target glycemic control and needs clinician review. | |
alert | Diabetes control flag: HbA1c above target | Generated from longitudinal lab trend. | |
care_element | smoking_status | never smoker | |
care_element | fasting_glucose | ||
care_element | egfr | ||
care_element | ldl_cholesterol | ||
care_element | albumin_creatinine_ratio | ||
care_element | hba1c | ||
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. | |
care_element | immunization | Influenza vaccine documented | |
note | consult | Survivorship care reviewed for history of prostate cancer survivor. Patient asks about surveillance schedule and late effects. | |
note | preventive care | Preventive care review: age-eligible cancer screening discussed. No completed screening result found in imported records. | |
report | Consult | Oncology follow-up for prostate cancer survivor. No active recurrence noted in this synthetic report. Ongoing surveillance, late effects, and primary care coordination discussed. | |
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 | systolic_bp | ||
care_element | diastolic_bp | ||
care_element | diastolic_bp | ||
care_element | systolic_bp | ||
care_element | hba1c | ||
care_element | bmi | ||
report | Laboratory | HbA1c, fasting glucose, lipid panel, creatinine/eGFR, and urine ACR reviewed for diabetes follow-up. | |
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 | same-day concern | no_show | |
care_element | hba1c | ||
care_element | ldl_cholesterol | ||
appointment | chronic disease review | completed | |
care_element | ldl_cholesterol | ||
care_element | hba1c | ||
care_element | fasting_glucose | ||
appointment | same-day concern | cancelled | |
care_element | ldl_cholesterol | ||
care_element | fasting_glucose | ||
care_element | immunization | Pneumococcal vaccine documented | |
care_element | hba1c | ||
appointment | medication renewal | completed |
Hba1c
9 %
2026-02-08Immunization
Influenza vaccine documented
2025-08-06Diastolic Bp
77 mmHg
2025-03-23Systolic Bp
108 mmHg
2025-03-23Diastolic Bp
87 mmHg
2025-03-20Systolic Bp
134 mmHg
2025-03-20Hba1c
9.4 %
2025-03-12Bmi
30.3 kg/m2
2025-03-06Diastolic Bp
82 mmHg
2025-01-02Systolic Bp
118 mmHg
2025-01-02Hba1c
9.2 %
2024-07-18Ldl Cholesterol
1.5 mmol/L
2024-04-01Ldl Cholesterol
3.6 mmol/L
2023-05-17Hba1c
8.7 %
2023-05-05Fasting Glucose
8 mmol/L
2023-04-28Ldl Cholesterol
2.8 mmol/L
2022-10-19Fasting Glucose
7.1 mmol/L
2022-02-10Immunization
Pneumococcal vaccine documented
2021-07-13Hba1c
8.7 %
2021-05-25