The takings
Disease registers
Everyone with each long-term condition — and what each of them is overdue for.
Open Reports → Disease registers. There are seven: diabetes, hypertension, kidney disease, heart disease, thyroid, asthma and COPD, and epilepsy. A patient joins one when the condition — or its short form, DM, HTN, CKD — is written in the diagnosis or the history of any visit.
Beside each patient: the last prescription, the last BP, the HbA1c and the kidney figures (eGFR, or creatinine where there is none), and TSH on the thyroid register — each with its date. The most overdue come first, and a name opens the file.
What counts as overdue
- Not seen for three months (red at six)
- In diabetes, an HbA1c every six months and a kidney test every year; an HbA1c of 8% or more is said too
- A last BP of 140/90 or more (red at 160/100), or no BP on file in hypertension
- In kidney disease, a creatinine every six months; an eGFR below 30 in red
- On the thyroid register, a TSH every year, and a TSH outside the usual range
Tick Only those needing attention to hide everyone who is up to date. Search by name, ID or phone, and print the page if you want it on paper.
If this page did not get you there, write to support — tell us where it stopped making sense and we will fix the page too.

