The Patient Chart

When you open a patient record you see three areas: the header (patient demographics and summary cards), the sidebar navigation (section links), and the main content panel (the selected section’s data).

To review a patient’s prior authorization status, open the Overview tab. Its Workflow Timeline surfaces the current PA state, data-request prompts, and action items at the top of the section. Overview represents active, current work — a prior authorization that has already been closed out (approved, renewed, canceled, and so on) is not shown here; you’ll find those completed histories on the Tasks tab.

When you arrive from the task queue with an open task selected, Overview opens focused on that task and a Complete Task button appears near the top of Overview (labeled Mark Reviewed for document-review tasks). Select it to mark that task complete and refresh the timeline. The button does not appear when you open Overview without a focused task. When you select a closed task in the queue instead, you land on the Tasks tab with that task’s history expanded — closed work is never shown on the Overview.

The Patient Header

The header at the top of the chart is arranged in three columns: the patient summary on the left, and the Notes and Alerts and Care Team cards to its right.

The patient summary always shows:

• Patient name — the patient’s full name, with a pencil icon to edit demographics.
• Cardholder ID — the active insurance member/cardholder ID (if present).
• DOB — date of birth.
• Groups — a chip for each business unit this patient belongs to. If no business unit is assigned, an Assign Business Unit button appears instead.

Below the summary is a Show contact details toggle. Select it to expand the patient’s contact information; the button changes to Hide contact details so you can collapse it again. When expanded, it reveals:

• Address — street, city, state, and ZIP.
• Phone — the preferred phone number and type. The number is a clickable link that opens your device’s dialer, and an SMS OK badge appears if the patient can receive text messages.
• Email — the contact email as a clickable link that opens a new message in your mail app, with an Email OK badge if email communications are enabled.

The header also contains two summary cards beside the patient summary:

Notes and Alerts Card

Displays active alert chips (color-coded by severity) and recent notes attached to this patient. Select the pencil icon to add or edit notes and alerts.

Care Team Card

Lists the patient’s assigned prescribers and providers, including their specialty and location. Select the pencil icon on the patient name to update care team members through the edit panel.

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Sidebar Navigation: Patient Chart

The left sidebar under Patient Chart links to the core clinical data sections:

Overview

The default landing section. Shows the patient’s active clinical workflows at a glance — in-progress prior authorization timelines, therapy interchange conversions, drugs with rejected claims awaiting evaluation, and recent guideline evaluation results. Use this section to see what actions are pending without digging through individual task records. Completed prior authorization histories are not shown here — they live on the Tasks tab (see below).

When a patient has both prior authorization and therapy interchange workflows, a Prior Authorization | Therapy Interchange pill group appears at the top of the Overview. Select the relevant pill to switch between the two workflow timelines. When only one type of workflow exists, the pill switcher is hidden and that workflow’s section shows automatically.

Prior Authorization section: presents a single Medication chip selector that lists every medication needing attention — each drug with an active prior authorization workflow, plus each drug with a rejected claim that has no prior authorization yet. Selecting a medication shows that drug’s surface below the selector: for an active PA drug, its workflow timeline (current state, missing data requests, determination letters, and links to communications, listed newest first with the current action surfaced at the top); for a rejected-claim drug, its rejected claim, any completed guideline evaluations, and a Next Step: Start Evaluation action. When only one medication needs attention, the selector is hidden and that medication’s surface shows automatically. This unified selector replaces the older behavior where a rejected-claim timeline and a PA timeline could stack on top of each other. When a PA was started from a GoldCard schedule, a GoldCard chip appears in the timeline header alongside the medication and state chips.

When a determination is available, the timeline shows Determination Review with a Review button that expands the review panel. If your tenant has Determination LLM summary turned on, a plain-language summary banner also appears above those controls; when the summary is off, you still use the same review experience without that text. There you can read the clinical criteria tree (each requirement marked with a green check and Criteria met or a red X and Criteria not met; when a guideline uses an ontology rule, its name appears as a heading above the expanded diagnosis, drug, or procedure list beneath it), preview the patient’s documents inline — including a Search document… box in the PDF preview toolbar to jump between text matches — upload a new document via the + next to Documents, and use Enter Missing Clinical Data under Chart Updates to open the failed-criteria entry form. Each failed requirement shows Current versus Required, and supported updates save directly to the patient chart without re-evaluating. Select Pause or Complete to collapse the panel. After you complete a review, if the chart is updated or a new evaluation runs, Review again appears so you can reopen the panel. This is the same Determination Review experience available on the PA task detail page.

When a determination is rejected, the timeline’s Next Steps: Determination Rejected card lets you Enter Missing Clinical Data without leaving the workflow. Re-evaluation stays a separate, explicit Re-evaluate Against Guidelines step — including when a banner notes that chart data has changed since the determination.

When a PA is awaiting data, the timeline shows a Next Steps: Resolve Data Request card. Once the requested clinical data is present on the chart, the data request is fulfilled and the PA is re-evaluated automatically. Select Re-evaluate now in that card to trigger re-evaluation immediately.

Therapy Interchange section: shows the full interchange workflow timeline for each drug, in the same chronological format as the PA timeline. Events appear in order:

1. Workflow Created — when the therapy interchange task was initiated.
2. Guideline Evaluation — the evaluation run (and its result: Conversion, Not Met, or Missing Data).
3. Conversion Letters — a grouped card showing the send status of every conversion letter (prescriber, member, pharmacy) with View and Download links for each recipient.

When multiple interchange medications exist, a drug chip selector appears above the timeline so you can switch between them. A View Full Task Details button opens the interchange task record.

Selecting View Evaluation from within the timeline switches you directly to this patient’s Evaluations section with the relevant evaluation detail panel open — you stay within the patient chart rather than navigating to the population-level evaluations list.

When a patient has no PA workflows, no interchange workflows, and no rejected claims, the Overview shows an All Clear indicator confirming no workflow action is needed.

Medications

Lists the patient’s current and historical medications from claims and confirmations.

Brand products appear as Brand (generic) — for example, Zepbound (tirzepatide) — while true generics show only the generic ingredient name. Each card shows status and type chips, fill timeline, brands, and therapeutic class codes when available.

Expand Show Claims on a card to review claim rows that mirror the Claims display (submission date, fill date, ingredients, brand, NDC, source, status, and rejection codes), plus days supply, times refilled, and strength. Click a claim row to open the medication claim details panel.

On each active medication card you see a Medication Possession Ratio (MPR) percentage. MPR shows how consistently the patient has kept that medication filled over the past 12 months, or since therapy began if that is shorter. Reversed or cancelled fills do not count toward the ratio. The value can exceed 100% when refill coverage periods overlap.

Diagnoses

Lists diagnosis codes (ICD codes) on file for this patient, along with dates and source information.

Procedures

Lists procedure codes (CPT/HCPCS) associated with this patient.

Observations

Displays clinical observations recorded for this patient. Results are grouped by LOINC category — Laboratory, Clinical, Surveys & Questionnaires, and Claims Attachments. Those groups appear as tabs at the top of the section, each with a count, so you can switch between them without scrolling a stacked list. Empty tabs stay visible and appear quieter than ones with data. When results first appear, the first tab that has data is selected unless you have already chosen a different tab. Use Filter tests at the top of the section to narrow the list by test name or LOINC code. Within the Laboratory tab, results are further divided by panel type when more than one panel is present: Chemistry, Hematology, Microbiology, Serology, and Toxicology. If every lab result belongs to a single panel, that extra heading is omitted so you do not see the same count twice. Each individual test also starts closed; open it to see its result table. Dates are collection dates — a time of day appears only when one was recorded. Lab values relevant to prior authorization criteria appear here alongside other recorded clinical data.

When the same result appears in more than one document — for example, the same lab value reported on multiple faxes — you see one row, not a duplicate for each document. The Source column shows where that result came from and how many documents reported it; when several documents share the same source type, the label includes a count (for example, Fax/Upload ×3). Select a row to open its details panel. If the result came from multiple documents, the panel notes Reported in N documents and lists each document once, with its own Download / View link — a document that reported the same result several times still appears as a single card, noting how many entries it contributed. Edit and Delete on that row apply to all underlying entries behind it — if you remove a merged row, every duplicate stored from those documents is removed together. If a delete only partly succeeds, you are told how many entries were removed and the panel narrows to the entries that are still stored, so selecting Delete again retries just those.

Select Add Observation to record a new result — enter a LOINC code, date, value, and unit. After you save, the matching category tab opens and the new test is expanded so you can see the result. There is no source picker; observations you add from the chart are saved with Chart as the source.

Insurance

Shows the patient’s insurance coverage records — carrier, account, group, member ID, and coverage dates. Both active and historical coverage records appear here.

Prior Authorizations

Lists all prior authorization records for this patient, including PA status, drug, dates, and associated task links.

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Sidebar Navigation: Other Sections

Below the Patient Chart group, the sidebar lists additional sections:

Tasks

A historical list of this patient’s root prior authorization and PA continuation tasks, newest first. Each row shows the task type, status (or workflow stage), created date, and assignee. Select a row to expand it and load that task’s workflow timeline in place — child tasks and events appear inside the expanded timeline, not as separate top-level rows. Select the row again to collapse it. If older history exists beyond the first page, select Load More at the bottom of the list.

When you open a closed task from the task queue, this tab opens with that task’s row already expanded and scrolled into view. If the task lives further down the history, the list loads additional pages automatically until it finds and reveals the matching row.

Therapy interchange and other non-PA task types are not listed here; use Overview for active interchange workflows.

Evaluations

A history of guideline evaluations run against this patient. Each row shows the date, guideline, type, status, current therapy, outcome, and how many tasks were created.

For standard prior-authorization evaluations, Type is Initiation or Continuation, PA Status shows Approved (or a rejection date), Current Therapy is Yes or No, and Outcome uses PA wording such as Prior Auth or Data Request.

For Therapeutic Interchange evaluations, the same columns use conversion wording instead of PA vocabulary: Type shows Conversion, PA Status is blank (an em dash), Current Therapy shows On Source Drug when the member is on the source drug, and Outcome shows Conversion when a conversion task was created (otherwise an em dash). Mixed PA and interchange history can appear in the same table.

Select any row to open the Evaluation Audit panel — a letter-like, read-only record of exactly why that evaluation reached its result:

• Header — the evaluation date, a type badge (Initiation, Continuation, or Conversion), and an outcome chip.
• Guideline — the guideline name and the version of the guideline that was in effect at evaluation time.
• Notices — a banner if the historical patient chart could not be recovered for this evaluation, a footnote if criteria statuses are approximated rather than exact, and an explanatory note for interchange evaluations that have no initiation criteria to display.
• Value Changes Since Last Evaluation — when a value referenced by the guideline (for example a lab result) differs from the same patient’s prior evaluation against this guideline, it’s called out here as a “changed from X to Y” line.
• Criteria — the full requirement tree as it was evaluated, with each requirement or group marked Met (green), Not Met (red), or Data Needed (orange).
• Links — View Evaluation Run Details and View All Patients in Run open the population-level evaluation record.

Documents

Documents uploaded or received for this patient — prior auth letters, clinical notes, and other attachments. You can upload new documents and view or download existing ones from this section.

Correspondence

Outbound letters and fax records associated with this patient — determination letters, denial notices, data-request letters (including Goldcard Data Request when outreach came from a GoldCard schedule), and other communications sent via the system.