DocChart

Population Health

PHM worklist

Loading action queue

Loading matching patients, saved rows, and evidence layers.

Building the scoped worklist view

PHM worklist

Possible diabetes signals

Import: synthetic-100-longitudinal.xml | Diabetes | showing the first 20 patients for fast loading.
Queue mode: Last saved list.

PHM

Cohort

Ask

Patient scope

Import: synthetic-100-longitudinal.xml

Counts are unique patients. Import scopes can overlap when several uploaded files contain the same patient.

All patients

70 unique / 403

docchart_synthetic_population_300.json

48 here / 300

docchart_synthetic_population_300.json

48 here / 300

synthetic-100-longitudinal.xml

20 here / 100

sample-omd.xml

None here / 0

What This List Is

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

medium

NLP evidence

Needs review

20, active workflow rows

Queued for:

Possible diabetes signals

How selected:

Deterministic rule + NLP-extracted chart facts + clinician review

Where saved:

PHM workflow rows; escalations become Flags & Tasks.

When updated:

Create queue adds new matches; existing decisions stay saved.

Priority & AI-CDS Evidence

Priority score from the configured PHM rule: base priority plus modifiers such as open flags, age, linked care gaps, or follow-up gaps. Scores are capped at 100.

It is a sorting signal, not a diagnosis. The score combines the rule base priority with modifiers such as open flags, age, overdue visits, or linked care gaps.

Quality Standards:

CEP resources:

Workflow

Save a work queue, then use each patient card to record what happened next.

Build cohort

Ask AI

1. Match

DocChart finds patients who match this rule.

2. Queue

patients are waiting for action.

3. Act

Record call, recall, flag, book, snooze, or close.

4. AI-CDS

Use AI/CDS or cohorts when you need more context.

Current view: Patients from the most recent saved queue run.

Most staff work from Active saved rows after saving today's list.

Prediabetes and Type 2 DiabetesQuality Standard linked through AI-CDS guidance retrieval Type 2 diabetes: non-insulin pharmacotherapyCEP Resource linked through AI-CDS guidance retrieval

Patients

Showing 20 of 20 visible rows from 20 matched patients.

20, shown

Maya Singh 013

78y | F | English

Priority ,57

needs review

2, flag,s

Care team: Maya Singh
Last touch: 2026-01-28

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

2 open clinical flags

Chart care elements

BP 143/91 mmHg on 2026-12-24

BP 143/91 mmHg on 2026-12-24 · HbA1c 6.2% on 2026-12-24 · eGFR 47 mL/min/1.73m2 on 2026-12-24 · ACR 9.9 mg/mmol on 2026-12-24 · Smoking never on 2026-12-24

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-28

Chart

More actions

Maya Singh 033

68y | X | Mandarin

Priority ,57

needs review

2, flag,s

Care team: Maya Singh
Last touch: 2026-01-25

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

2 open clinical flags

Chart care elements

BP 137/83 mmHg on 2026-08-20

BP 137/83 mmHg on 2026-08-20 · HbA1c 5.8% on 2026-08-20 · eGFR 49 mL/min/1.73m2 on 2026-08-20 · ACR 5.9 mg/mmol on 2026-08-20 · Smoking current on 2026-08-20

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-25

Chart

More actions

Maya Singh 053

59y | F | English

Priority ,57

needs review

2, flag,s

Care team: Maya Singh
Last touch: 2026-01-22

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

2 open clinical flags

Chart care elements

BP 157/89 mmHg on 2026-04-16

BP 157/89 mmHg on 2026-04-16 · HbA1c 5.4% on 2026-04-16 · eGFR 51 mL/min/1.73m2 on 2026-04-16 · ACR 7.9 mg/mmol on 2026-04-16 · Smoking never on 2026-04-16

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-22

Chart

More actions

Maya Singh 073

49y | F | English

Priority ,57

needs review

2, flag,s

Care team: Maya Singh
Last touch: 2026-01-19

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

2 open clinical flags

Chart care elements

BP 151/95 mmHg on 2026-12-12

BP 151/95 mmHg on 2026-12-12 · HbA1c 6.2% on 2026-12-12 · eGFR 53 mL/min/1.73m2 on 2026-12-12 · ACR 9.9 mg/mmol on 2026-12-12 · Smoking never on 2026-12-12

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-19

Chart

More actions

Maya Singh 093

40y | X | English

Priority ,57

needs review

2, flag,s

Care team: Maya Singh
Last touch: 2026-01-16

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

2 open clinical flags

Chart care elements

BP 145/87 mmHg on 2026-08-08

BP 145/87 mmHg on 2026-08-08 · HbA1c 5.8% on 2026-08-08 · eGFR 55 mL/min/1.73m2 on 2026-08-08 · ACR 5.9 mg/mmol on 2026-08-08 · Smoking never on 2026-08-08

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-16

Chart

More actions

Mei Chen 003

83y | X | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-01-18

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic CKD surveillance review | high | new | synthetic_longitudinal_data

Chart care elements

BP 125/69 mmHg on 2026-02-14

BP 125/69 mmHg on 2026-02-14 · HbA1c 5.2% on 2026-02-14 · eGFR 55 mL/min/1.73m2 on 2026-02-14 · ACR 8.9 mg/mmol on 2026-02-14 · Smoking never on 2026-02-14

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-18

Chart

More actions

Mei Chen 023

73y | F | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-01-15

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic CKD surveillance review | high | new | synthetic_longitudinal_data

Chart care elements

BP 121/76 mmHg on 2026-10-10

BP 121/76 mmHg on 2026-10-10 · HbA1c 6.0% on 2026-10-10 · eGFR 57 mL/min/1.73m2 on 2026-10-10 · ACR 4.9 mg/mmol on 2026-10-10 · Smoking never on 2026-10-10

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-15

Chart

More actions

Mei Chen 043

64y | F | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-02-04

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic CKD surveillance review | high | new | synthetic_longitudinal_data

Chart care elements

BP 117/70 mmHg on 2026-06-06

BP 117/70 mmHg on 2026-06-06 · HbA1c 5.6% on 2026-06-06 · eGFR 59 mL/min/1.73m2 on 2026-06-06 · ACR 6.9 mg/mmol on 2026-06-06 · Smoking never on 2026-06-06

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-02-04

Chart

More actions

Mei Chen 063

54y | X | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-02-01

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic CKD surveillance review | high | new | synthetic_longitudinal_data

Chart care elements

BP 113/77 mmHg on 2026-02-02

BP 113/77 mmHg on 2026-02-02 · HbA1c 5.2% on 2026-02-02 · eGFR 43 mL/min/1.73m2 on 2026-02-02 · ACR 8.9 mg/mmol on 2026-02-02 · Smoking never on 2026-02-02

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-02-01

Chart

More actions

Mei Chen 083

45y | F | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2025-07-29

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic CKD surveillance review | high | new | synthetic_longitudinal_data

Chart care elements

BP 133/71 mmHg on 2026-10-22

BP 133/71 mmHg on 2026-10-22 · HbA1c 6.0% on 2026-10-22 · eGFR 45 mL/min/1.73m2 on 2026-10-22 · ACR 4.9 mg/mmol on 2026-10-22 · Smoking never on 2026-10-22

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2025-07-29

Chart

More actions

Omar Haddad 008

80y | M | French

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-01-23

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic BP follow-up review | medium | new | synthetic_longitudinal_data

Chart care elements

BP 138/86 mmHg on 2026-07-19

BP 138/86 mmHg on 2026-07-19 · HbA1c 5.7% on 2026-07-19 · eGFR 87 mL/min/1.73m2 on 2026-07-19 · ACR 0.9 mg/mmol on 2026-07-19 · Smoking never on 2026-07-19

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-23

Chart

More actions

Omar Haddad 028

71y | M | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-01-20

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic BP follow-up review | medium | new | synthetic_longitudinal_data

Chart care elements

BP 132/92 mmHg on 2026-03-15

BP 132/92 mmHg on 2026-03-15 · HbA1c 5.3% on 2026-03-15 · eGFR 76 mL/min/1.73m2 on 2026-03-15 · ACR 1.3 mg/mmol on 2026-03-15 · Smoking never on 2026-03-15

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-20

Chart

More actions

Omar Haddad 048

61y | X | French

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-01-17

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic BP follow-up review | medium | new | synthetic_longitudinal_data

Chart care elements

BP 152/84 mmHg on 2026-11-11

BP 152/84 mmHg on 2026-11-11 · HbA1c 6.1% on 2026-11-11 · eGFR 96 mL/min/1.73m2 on 2026-11-11 · ACR 1.7 mg/mmol on 2026-11-11 · Smoking former on 2026-11-11

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-17

Chart

More actions

Omar Haddad 068

52y | M | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-02-06

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic BP follow-up review | medium | new | synthetic_longitudinal_data

Chart care elements

BP 146/90 mmHg on 2026-07-07

BP 146/90 mmHg on 2026-07-07 · HbA1c 5.7% on 2026-07-07 · eGFR 85 mL/min/1.73m2 on 2026-07-07 · ACR 2.1 mg/mmol on 2026-07-07 · Smoking never on 2026-07-07

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-02-06

Chart

More actions

Omar Haddad 088

42y | M | French

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-02-03

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic BP follow-up review | medium | new | synthetic_longitudinal_data

Chart care elements

BP 140/82 mmHg on 2026-03-03

BP 140/82 mmHg on 2026-03-03 · HbA1c 5.3% on 2026-03-03 · eGFR 74 mL/min/1.73m2 on 2026-03-03 · ACR 0.9 mg/mmol on 2026-03-03 · Smoking current on 2026-03-03

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-02-03

Chart

More actions

Liam Nguyen 018

75y | X | English

Priority ,45

needs review

Care team: Maya Singh
Last touch: 2026-02-02

5 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

Chart care elements

BP 116/71 mmHg on 2026-05-05

BP 116/71 mmHg on 2026-05-05 · HbA1c 5.5% on 2026-05-05 · eGFR 97 mL/min/1.73m2 on 2026-05-05 · ACR 1.9 mg/mmol on 2026-05-05 · Smoking former on 2026-05-05

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

Evidence details (3)

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-02-02

Chart

More actions

Liam Nguyen 038

66y | M | English

Priority ,45

needs review

Care team: Maya Singh
Last touch: 2026-01-30

5 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

Chart care elements

BP 112/78 mmHg on 2026-01-01

BP 112/78 mmHg on 2026-01-01 · HbA1c 5.1% on 2026-01-01 · eGFR 86 mL/min/1.73m2 on 2026-01-01 · ACR 0.7 mg/mmol on 2026-01-01 · Smoking never on 2026-01-01

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

Evidence details (3)

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-30

Chart

More actions

Liam Nguyen 058

56y | M | English

Priority ,45

needs review

Care team: Maya Singh
Last touch: 2026-01-27

5 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

Chart care elements

BP 132/72 mmHg on 2026-09-21

BP 132/72 mmHg on 2026-09-21 · HbA1c 5.9% on 2026-09-21 · eGFR 75 mL/min/1.73m2 on 2026-09-21 · ACR 1.1 mg/mmol on 2026-09-21 · Smoking never on 2026-09-21

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

Evidence details (3)

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-27

Chart

More actions

Liam Nguyen 078

47y | X | English

Priority ,45

needs review

Care team: Maya Singh
Last touch: 2026-01-24

5 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

Chart care elements

BP 128/79 mmHg on 2026-05-17

BP 128/79 mmHg on 2026-05-17 · HbA1c 5.5% on 2026-05-17 · eGFR 95 mL/min/1.73m2 on 2026-05-17 · ACR 1.5 mg/mmol on 2026-05-17 · Smoking former on 2026-05-17

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

Evidence details (3)

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-24

Chart

More actions

Liam Nguyen 098

38y | M | English

Priority ,45

needs review

Care team: Maya Singh
Last touch: 2026-01-21

5 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

Chart care elements

BP 124/73 mmHg on 2026-01-13

BP 124/73 mmHg on 2026-01-13 · HbA1c 5.1% on 2026-01-13 · eGFR 84 mL/min/1.73m2 on 2026-01-13 · ACR 1.9 mg/mmol on 2026-01-13 · Smoking never on 2026-01-13

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

Evidence details (3)

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-21

Chart

More actions

20, shown

Maya Singh 013

78y | F | English

Priority ,57

needs review

2, flag,s

Care team: Maya Singh
Last touch: 2026-01-28

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

2 open clinical flags

Chart care elements

BP 143/91 mmHg on 2026-12-24

BP 143/91 mmHg on 2026-12-24 · HbA1c 6.2% on 2026-12-24 · eGFR 47 mL/min/1.73m2 on 2026-12-24 · ACR 9.9 mg/mmol on 2026-12-24 · Smoking never on 2026-12-24

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-28

Chart

More actions

Maya Singh 033

68y | X | Mandarin

Priority ,57

needs review

2, flag,s

Care team: Maya Singh
Last touch: 2026-01-25

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

2 open clinical flags

Chart care elements

BP 137/83 mmHg on 2026-08-20

BP 137/83 mmHg on 2026-08-20 · HbA1c 5.8% on 2026-08-20 · eGFR 49 mL/min/1.73m2 on 2026-08-20 · ACR 5.9 mg/mmol on 2026-08-20 · Smoking current on 2026-08-20

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-25

Chart

More actions

Maya Singh 053

59y | F | English

Priority ,57

needs review

2, flag,s

Care team: Maya Singh
Last touch: 2026-01-22

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

2 open clinical flags

Chart care elements

BP 157/89 mmHg on 2026-04-16

BP 157/89 mmHg on 2026-04-16 · HbA1c 5.4% on 2026-04-16 · eGFR 51 mL/min/1.73m2 on 2026-04-16 · ACR 7.9 mg/mmol on 2026-04-16 · Smoking never on 2026-04-16

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-22

Chart

More actions

Maya Singh 073

49y | F | English

Priority ,57

needs review

2, flag,s

Care team: Maya Singh
Last touch: 2026-01-19

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

2 open clinical flags

Chart care elements

BP 151/95 mmHg on 2026-12-12

BP 151/95 mmHg on 2026-12-12 · HbA1c 6.2% on 2026-12-12 · eGFR 53 mL/min/1.73m2 on 2026-12-12 · ACR 9.9 mg/mmol on 2026-12-12 · Smoking never on 2026-12-12

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-19

Chart

More actions

Maya Singh 093

40y | X | English

Priority ,57

needs review

2, flag,s

Care team: Maya Singh
Last touch: 2026-01-16

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

2 open clinical flags

Chart care elements

BP 145/87 mmHg on 2026-08-08

BP 145/87 mmHg on 2026-08-08 · HbA1c 5.8% on 2026-08-08 · eGFR 55 mL/min/1.73m2 on 2026-08-08 · ACR 5.9 mg/mmol on 2026-08-08 · Smoking never on 2026-08-08

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-16

Chart

More actions

Mei Chen 003

83y | X | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-01-18

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic CKD surveillance review | high | new | synthetic_longitudinal_data

Chart care elements

BP 125/69 mmHg on 2026-02-14

BP 125/69 mmHg on 2026-02-14 · HbA1c 5.2% on 2026-02-14 · eGFR 55 mL/min/1.73m2 on 2026-02-14 · ACR 8.9 mg/mmol on 2026-02-14 · Smoking never on 2026-02-14

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-18

Chart

More actions

Mei Chen 023

73y | F | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-01-15

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic CKD surveillance review | high | new | synthetic_longitudinal_data

Chart care elements

BP 121/76 mmHg on 2026-10-10

BP 121/76 mmHg on 2026-10-10 · HbA1c 6.0% on 2026-10-10 · eGFR 57 mL/min/1.73m2 on 2026-10-10 · ACR 4.9 mg/mmol on 2026-10-10 · Smoking never on 2026-10-10

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-15

Chart

More actions

Mei Chen 043

64y | F | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-02-04

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic CKD surveillance review | high | new | synthetic_longitudinal_data

Chart care elements

BP 117/70 mmHg on 2026-06-06

BP 117/70 mmHg on 2026-06-06 · HbA1c 5.6% on 2026-06-06 · eGFR 59 mL/min/1.73m2 on 2026-06-06 · ACR 6.9 mg/mmol on 2026-06-06 · Smoking never on 2026-06-06

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-02-04

Chart

More actions

Mei Chen 063

54y | X | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-02-01

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic CKD surveillance review | high | new | synthetic_longitudinal_data

Chart care elements

BP 113/77 mmHg on 2026-02-02

BP 113/77 mmHg on 2026-02-02 · HbA1c 5.2% on 2026-02-02 · eGFR 43 mL/min/1.73m2 on 2026-02-02 · ACR 8.9 mg/mmol on 2026-02-02 · Smoking never on 2026-02-02

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-02-01

Chart

More actions

Mei Chen 083

45y | F | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2025-07-29

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic CKD surveillance review | high | new | synthetic_longitudinal_data

Chart care elements

BP 133/71 mmHg on 2026-10-22

BP 133/71 mmHg on 2026-10-22 · HbA1c 6.0% on 2026-10-22 · eGFR 45 mL/min/1.73m2 on 2026-10-22 · ACR 4.9 mg/mmol on 2026-10-22 · Smoking never on 2026-10-22

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2025-07-29

Chart

More actions

Omar Haddad 008

80y | M | French

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-01-23

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic BP follow-up review | medium | new | synthetic_longitudinal_data

Chart care elements

BP 138/86 mmHg on 2026-07-19

BP 138/86 mmHg on 2026-07-19 · HbA1c 5.7% on 2026-07-19 · eGFR 87 mL/min/1.73m2 on 2026-07-19 · ACR 0.9 mg/mmol on 2026-07-19 · Smoking never on 2026-07-19

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-23

Chart

More actions

Omar Haddad 028

71y | M | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-01-20

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic BP follow-up review | medium | new | synthetic_longitudinal_data

Chart care elements

BP 132/92 mmHg on 2026-03-15

BP 132/92 mmHg on 2026-03-15 · HbA1c 5.3% on 2026-03-15 · eGFR 76 mL/min/1.73m2 on 2026-03-15 · ACR 1.3 mg/mmol on 2026-03-15 · Smoking never on 2026-03-15

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-20

Chart

More actions

Omar Haddad 048

61y | X | French

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-01-17

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic BP follow-up review | medium | new | synthetic_longitudinal_data

Chart care elements

BP 152/84 mmHg on 2026-11-11

BP 152/84 mmHg on 2026-11-11 · HbA1c 6.1% on 2026-11-11 · eGFR 96 mL/min/1.73m2 on 2026-11-11 · ACR 1.7 mg/mmol on 2026-11-11 · Smoking former on 2026-11-11

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-17

Chart

More actions

Omar Haddad 068

52y | M | English

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-02-06

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic BP follow-up review | medium | new | synthetic_longitudinal_data

Chart care elements

BP 146/90 mmHg on 2026-07-07

BP 146/90 mmHg on 2026-07-07 · HbA1c 5.7% on 2026-07-07 · eGFR 85 mL/min/1.73m2 on 2026-07-07 · ACR 2.1 mg/mmol on 2026-07-07 · Smoking never on 2026-07-07

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-02-06

Chart

More actions

Omar Haddad 088

42y | M | French

Priority ,57

needs review

1, flag,

Care team: Maya Singh
Last touch: 2026-02-03

6 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

DocChart flags

1 open clinical flag

Synthetic BP follow-up review | medium | new | synthetic_longitudinal_data

Chart care elements

BP 140/82 mmHg on 2026-03-03

BP 140/82 mmHg on 2026-03-03 · HbA1c 5.3% on 2026-03-03 · eGFR 74 mL/min/1.73m2 on 2026-03-03 · ACR 0.9 mg/mmol on 2026-03-03 · Smoking current on 2026-03-03

Evidence details (4)

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-02-03

Chart

More actions

Liam Nguyen 018

75y | X | English

Priority ,45

needs review

Care team: Maya Singh
Last touch: 2026-02-02

5 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

Chart care elements

BP 116/71 mmHg on 2026-05-05

BP 116/71 mmHg on 2026-05-05 · HbA1c 5.5% on 2026-05-05 · eGFR 97 mL/min/1.73m2 on 2026-05-05 · ACR 1.9 mg/mmol on 2026-05-05 · Smoking former on 2026-05-05

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

Evidence details (3)

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-02-02

Chart

More actions

Liam Nguyen 038

66y | M | English

Priority ,45

needs review

Care team: Maya Singh
Last touch: 2026-01-30

5 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

Chart care elements

BP 112/78 mmHg on 2026-01-01

BP 112/78 mmHg on 2026-01-01 · HbA1c 5.1% on 2026-01-01 · eGFR 86 mL/min/1.73m2 on 2026-01-01 · ACR 0.7 mg/mmol on 2026-01-01 · Smoking never on 2026-01-01

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

Evidence details (3)

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-30

Chart

More actions

Liam Nguyen 058

56y | M | English

Priority ,45

needs review

Care team: Maya Singh
Last touch: 2026-01-27

5 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

Chart care elements

BP 132/72 mmHg on 2026-09-21

BP 132/72 mmHg on 2026-09-21 · HbA1c 5.9% on 2026-09-21 · eGFR 75 mL/min/1.73m2 on 2026-09-21 · ACR 1.1 mg/mmol on 2026-09-21 · Smoking never on 2026-09-21

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

Evidence details (3)

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-27

Chart

More actions

Liam Nguyen 078

47y | X | English

Priority ,45

needs review

Care team: Maya Singh
Last touch: 2026-01-24

5 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

Chart care elements

BP 128/79 mmHg on 2026-05-17

BP 128/79 mmHg on 2026-05-17 · HbA1c 5.5% on 2026-05-17 · eGFR 95 mL/min/1.73m2 on 2026-05-17 · ACR 1.5 mg/mmol on 2026-05-17 · Smoking former on 2026-05-17

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

Evidence details (3)

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-24

Chart

More actions

Liam Nguyen 098

38y | M | English

Priority ,45

needs review

Care team: Maya Singh
Last touch: 2026-01-21

5 evidence layers

NLP evidence

DocChart PHM rule

Possible diabetes signals 2026.05

Prediabetes, note text or medication pattern without confirmed diabetes criteria.

Chart care elements

BP 124/73 mmHg on 2026-01-13

BP 124/73 mmHg on 2026-01-13 · HbA1c 5.1% on 2026-01-13 · eGFR 84 mL/min/1.73m2 on 2026-01-13 · ACR 1.9 mg/mmol on 2026-01-13 · Smoking never on 2026-01-13

NLP evidence layer

NLP extraction enabled for this rule

No extracted fact was required for this row; structured chart data and flags still matched.

Evidence details (3)

AI-CDS guidance

1 Quality Standard / 1 CEP resource

Prediabetes and Type 2 Diabetes · Type 2 diabetes: non-insulin pharmacotherapy

Workflow state

needs review

Not yet acted on in the saved PHM workflow.

Matched by:

structured record

Strengthen with:

fresh labs, recent visit note, or confirmed OpenMed fact.

False positive risk:

stale imported record, resolved condition, duplicate note mention, or missing exclusion.

Evidence freshness:

last touch 2026-01-21

Chart

More actions