Every sheet Mosaic produces, at the 39 real examples it is built on.
Mosaic does not design a new document for every question. There are 20 canonical types, and every answer that produces something produces one of them. A lab review looks the same in general practice and in gynaecology, because the thing it does is the same: every value against its range, against the last report, with one sentence on what it means.
These are shown as you read them. 27 of the 39 also exist in a second reading, the one the patient sees: the same object, with what it means for her and what she does about it instead of the ranges and the reasoning. Not a second document, which is why the two can never drift apart. You switch between them on the sheet itself.
Before the visit19
What Mosaic reads and prepares before the patient sits down.
Patient snapshot1Who this patient is, in one screen: diagnoses, current therapy, values that matter, what is open.
Anna Keller, 47
Patient snapshot
Anna Keller, 47
Anna Keller, 47 · 16 September 2026 · Signed, in the chart
Diagnoses
Arterial hypertension since September 2023. Prediabetes, HbA1c 5.9 % in May 2026. Mild hepatic steatosis on ultrasound. Generalised anxiety since 2025.
Current therapy
Ramipril 5 mg in the morning, sertraline 50 mg. Simvastatin 20 mg stopped in March 2024 for muscle aches with a CK of 210 U/l; no lipid-lowering therapy since.
Values that matter
LDL 162 mg/dl, non-HDL 186 mg/dl, home blood pressure 136/86 mmHg, BMI 27.4, eGFR 92 ml/min. SCORE2 about 3 %.
Family history
Father: myocardial infarction at 58. Mother: type 2 diabetes and hypertension.
Open
Lipoprotein(a) never measuredDiscussed in May, not ordered.
HbA1c 5.6 → 5.9 % across three reportsAbove the threshold for the first time in May. No control ordered since.
FIB-4 never calculatedAge, AST, ALT and platelets are all in the chart.
Tetanus-diphtheria booster, due since August 2025Last dose in August 2015.
Anna Keller, 47 · 14 September 2026 · Shared with the patient, 12 September 2026, opened
Dropped, because the chart answers them
Eleven answered and unchanged: current medication, allergies, previous operations, smoking status, family historyAll documented since the last visit. Shown to her as a list to confirm, not as questions to answer.
Four answered but out of date: weight, blood pressure, alcohol, occupationKept as a confirmation with the value from the chart beside it, so a correction takes one tap.
Added, because the chart raises them
The home blood pressure readings of the past weekHer plan asked for them; the chart has none yet.
The muscle aches on simvastatin in 2024A statin is being considered again, so the detail matters.
Anything new since the last visitOpen question, for what no template can anticipate.
How it reaches her
One link by e-mail or SMS, no account, no app storeIt opens in her browser and takes about four minutes.
The answers land in the chart, dated, marked as answered by the patientNothing is written into the practice software without your signature.
Built from the practice's own check-up template and her chart. The template stays yours; Mosaic only decides which of its questions are still worth asking.
Markus Vogel, 44 · 10 September 2026 · Signed, in the chart
What he answered
What brings you to us?
A prevention check
What do you want to know at the end of this?
Where I stand. My colleagues did one of those big blood panels and I want the same, but with someone who explains it. — shapes the panel
Height and weight
181 cm, 94 kg
Waist
101
Do you smoke, or did you?
Never
Alcohol in a normal week
Two glasses of wine most evenings, more at the weekend — shapes the panel
How many days a week do you move for at least twenty minutes?
1
Sleep: hours, and anything you noticed
About six hours. My wife says I snore. — shapes the panel
Diagnoses in your parents, grandparents, siblings
Father type 2 diabetes at 55. Mother high blood pressure. Grandfather stroke at 70. — shapes the panel
Medication you take regularly
None. Ibuprofen a few times a month for headaches. Magnesium.
Any diagnosis you have been given
None
Anything you noticed about yourself in the last year
Tired most afternoons since spring. Headaches after long days. — shapes the panel
Your last blood test
Longer ago
The sheet as he filled it in
What brings you to us?
A prevention checkA new problemA second opinionSomething else
What do you want to know at the end of this?New
Where I stand. My colleagues did one of those big blood panels and I want the same, but with someone who explains it.
Height and weight181 cm, 94 kg
Waist101 cm
Measured at the navel, standing, after breathing out. It goes into the risk estimate together with the weight.
Do you smoke, or did you?
NeverStoppedYes
Alcohol in a normal weekNew
Two glasses of wine most evenings, more at the weekend
How many days a week do you move for at least twenty minutes?
012345678910
Sleep: hours, and anything you noticedNewAbout six hours. My wife says I snore.
Diagnoses in your parents, grandparents, siblingsNew
Father type 2 diabetes at 55. Mother high blood pressure. Grandfather stroke at 70.
Heart attack or stroke before 55 in a man or 65 in a woman changes the risk estimate.
Medication you take regularlyOptional
None. Ibuprofen a few times a month for headaches. Magnesium.
Any diagnosis you have been givenOptionalNone
Anything you noticed about yourself in the last yearOptionalNew
Tired most afternoons since spring. Headaches after long days.
Your last blood test
Within a yearOne to three years agoLonger agoNever
You can upload it here; a photo is enough.
Answered by the patient on his phone on 10 September 2026, six days before the first visit. Stored in the chart, dated, marked as answered by the patient. The 2019 report was uploaded as a photo and read.
Read from the laboratory report of 8 May 2026 and compared with the reports of September 2023 and March 2024. Reference ranges from the laboratory, targets from the ESC prevention guideline.
Petra S., 51 · 12 September 2026 · Signed, in the chart
What the decision needs
6 values · 2 to look at
TSH2.1mU/l
In range0.4 to 4.0
Ferritin18ng/ml
In range15 to 150falling
Vitamin D19ng/ml
Below range30 to 50falling
Low; matters for bone under the menopause.
LDL cholesterol134mg/dl
Above rangeaim below 116rising
Rising since the periods became irregular; transdermal estradiol does not raise it.
Fasting glucose96mg/dl
In rangebelow 100
FSHnot needed
In rangenot required for the diagnosis
Read from the laboratory report and compared with the reports of January 2025 and January 2026. The guideline diagnoses the menopause from the symptoms and the age, so no hormone level was ordered.
Read from the laboratory report of 15 September 2026 and compared with the occupational check of March 2019. Reference ranges from the laboratory; targets from the ESC/EAS, ADA, EASL and Endocrine Society guidelines named at each value. FIB-4 and HOMA-IR computed from the report.
Open findings1What the chart already shows more than once, and what follows from it that never happened.
Open in this chartAnna Keller, 47
Open findings
Open in this chart
Anna Keller, 47 · 16 September 2026 · Signed, in the chart
Never measured
Lipoprotein(a), once in a lifetimeLDL 162 with a father who had a myocardial infarction at 58. The ESC prevention guideline lists it as a risk modifier; the chart holds no result.
Documented twice, no step taken
HbA1c 5.6 → 5.9 % across three reportsAbove the threshold for the first time in May. No control ordered since.
ALT and GGT raised alongside hepatic steatosis on ultrasoundAge, AST, ALT and platelets are all in the chart. FIB-4 was never calculated.
Recommended and not done
Tetanus-diphtheria booster, due since August 2025Noted at the check-up of May 2026, no appointment in the chart.
Assembled from 14 documents in the chart. Every line names the documents it rests on. Mosaic states which criterion is met; whether it applies to this patient is the physician's call.
Lab order1The panel read from the intake and the chart, grouped by what each marker decides, with what the insurer covers and what the patient pays; sent to the laboratory as an order.
Prevention panel, 34 markersMarkus Vogel, 44
Lab order
Prevention panel, 34 markers
Markus Vogel, 44 · 11 September 2026 · Signed, in the chart
Grouped by what each marker decides. Covered means billed to the statutory insurer through the check-up; the rest goes on the private form.
Not ordered, and why
Testosterone, cortisol, omega-3 index, zinc, magnesiumOn the commercial panels he mentioned; no guideline asks for them in a 44-year-old without symptoms, and none changes a decision here.
PSANot recommended at 44 without a family history.
“Biological age”Not a laboratory value.
How it reaches the laboratory
Order
Sent through the laboratory's order-entry portal from the practice software; labels and the private form print with it. Where a practice has no order entry, the same sheet prints as the order.
Material
Serum, EDTA, NaF blood, spot urine. Fasting from 22:00 the evening before; water is fine.
Result
Returns as an LDT report into the chart, usually within two working days. Mosaic reads it the moment it lands and drafts the review.
Drafted from the intake of 10 September and the 2019 report. Signed by Dr. med. Sarah Weber on 11 September and sent to the laboratory; the private form was signed by the patient in his app the same day.
Anna Keller, 47 · 16 September 2026 · Shared with the patient, 16 September 2026
Why this one is not covered
Lipoprotein(a) is measured once in a lifetime and changes how your risk is calculated, which matters because your father had a heart attack at 58. The statutory catalogue does not list it for people without known cardiovascular disease, so it cannot be billed to your insurer.
Everything else from today, the visit, the blood pressure, the other blood values, the vaccination and the two prescriptions, is covered. Your app, the plan and the explanations cost you nothing: the practice pays for them.
You decide. Declining changes nothing about your treatment today.
You sign before the blood is drawnGerman law requires a written agreement on a private service before it happens.
You get an invoice from the practice, not from your insurerSome private supplementary policies reimburse it; ask yours.
Prices from the German scale of fees for physicians (GOÄ), at the factor the practice applies. Required before a service outside the statutory catalogue, §18 of the federal agreement between physicians and statutory insurers.
Markus Vogel, 44 · 11 September 2026 · Shared with the patient, 11 September 2026, opened
Why most of it is not covered
Your insurance pays for the check-up that every insured person can have from 35: cholesterol, triglycerides, blood sugar and a urine test, plus the visit. Everything beyond that is paid by the insurer only when there is a diagnosis to investigate. You came without one, which is the point of a prevention check, so the rest is a private service.
Two invoices come out of that. The practice bills its own part: the counselling and the blood draw. The laboratory bills the analyses it performs to you directly; the practice is not allowed to bill those and does not earn on them.
What the practice bills
GOÄ 1Counselling on the panel and the resultsFactor 2.310.72 €
GOÄ factor 1.15, the rate laboratories apply to self-paid analyses. Example: lipoprotein(a) 18.63 €.
Quote
The laboratory names the total on the order confirmation, before the draw, and invoices you after the analysis. Some private supplementary policies reimburse it.
What this means
You decide. Declining changes nothing about your care in the practice.
You sign before the blood is drawnGerman law requires a written agreement on a private service before it happens, with the price named.
Two invoices, one from the practice, one from the laboratoryNeither goes to your insurer.
Sources
G-BA check-upGOÄ chapter M
Practice fees from the German scale of fees for physicians (GOÄ) at the factors the practice applies; laboratory analyses of chapters M III and M IV are invoiced by the laboratory (medas, Kapitel M GOÄ). Required before a service outside the statutory catalogue, §18 of the federal agreement between physicians and statutory insurers. Signed in the app on 11 September 2026.
Questionnaire5What the practice sent to the patient's phone, and what came back: the same sheet, before and after she filled it in.
Check-up questionnaire, sent 12 SeptemberAnna Keller, 47
Questionnaire
Check-up questionnaire, sent 12 September
Anna Keller, 47 · 12 September 2026 · Shared with the patient, 12 September 2026, opened
As it reached her phone
What would you like to talk about?
Routine checkA new problemSomething from the last visitMedication
Your home blood pressure last weekNew
Mean 136/86, highest 148/92, mornings and evenings
The mean of the week, and the highest single reading. Both are in your plan of 16 March.
Weight84 kg
WaistOptional94 cm
Measured at the navel, standing, after breathing out. Together with the weight this is what the risk calculation uses.
Has anything about your medication changed since May?
Nothing has changedA dose changedSomething was stoppedSomething new was added
You stopped a cholesterol tablet in 2024. What happened then?New
Muscle aches in both thighs after six weeks. Gone two weeks after stopping.
Asked because the chart records simvastatin stopped in March 2024 without a reason.
How many days a week do you move for at least twenty minutes?
012345678910
Anything new since the last visit?OptionalNew
Headaches in the afternoon, two or three times a week
Answers are stored in the chart under your name and marked as entered by the patient. Nothing is shared with anyone else.
Sources
Practice template, 23 questionsChart of Anna Keller, 14 documentsPlan 16.03.2026
Written from the practice's own check-up template and the chart: questions the record already answers were dropped, questions the record raises were added. Sent as one link, no app to install, answers back in the chart.
Petra S., 51 · 20 September 2026 · Shared with the patient, 20 September 2026, opened
The sheet she gets three times a week
Hot flushes in the last 24 hours
None1 to 34 to 78 or more
How much did they disturb you?
012345678910
0 means not at all, 10 means they dominated the day.
How did you sleep?
Slept throughWoke onceWoke two or three timesBarely slept
Anything new you want to report?Optional
Not answered
Bleeding, breast tenderness, headache, mood. Leave it empty if there is nothing.
Nothing here changes your treatment on its own. If an answer needs a look before your next visit, Dr. Weber sees it the same day.
Sources
Plan 18.09.2026S3-Leitlinie Peri- und Postmenopause
Set up by the physician when she signed the plan: which questions, how often, for how long. The schedule stops on its own after six weeks; nothing keeps asking forever.
Anna Keller, 47 · 19 September 2026 · Shared with the patient, 19 September 2026, opened
Day 3 after the first tablet
Have you taken the tablet every evening?
Every eveningMissed oneMissed severalNot started yet
Any muscle pain since starting?New
NoneMild, does not bother meNoticeableSevere
Asked first because simvastatin caused muscle aches in both thighs in 2024.
Anything else you noticed?Optional
Not answered
Severe muscle pain with dark urine, or any chest pain or breathlessness, is not a questionnaire. Call the practice, or 112 outside opening hours.
Sources
Plan 16.09.2026Visit note 14.03.2024
The questions come from the medication that was started and from this chart: the 2024 muscle aches are the reason the second question is asked first. Schedule set by the physician at signing.
Anna Keller, 47 · 9 September 2026 · Shared with the patient, 9 September 2026, opened
What she enters, twice a day
Systolic, first reading142 mmHg
Diastolic, first reading88 mmHg
Systolic, second reading139 mmHg
Diastolic, second reading86 mmHg
Weight this morningOptional84 kg
Once a week is enough, before breakfast.
Did anything unusual happen before the reading?Optional
NothingCoffee within the hourExercise within the hourStress or a bad night
Sit for five minutes first, feet on the floor, back supported, cuff on bare skin at heart height. Two readings a minute apart, both entered.
Sources
Plan 16.09.2026ESC 2023 hypertension guideline
Sent when the physician asked for a week of home readings. The method sits inside the sheet, so it is read at the moment of measuring rather than once at the desk.
Anna Keller, 47 · 16 September 2026 · Shared with the patient, 16 September 2026, opened
Sunday morning, before breakfast
Weight this morning82.4 kg
How did the week go with the movement in your plan?
Five days or moreThree or four daysOne or two daysNone this week
Your plan asks for 30 minutes on five days.
Anything that made this week different?OptionalHoliday week, ate out four times
Weight moves by a kilo or more from day to day with fluid alone. That is why this asks once a week, always on the same day, and why the line matters rather than any single number.
Sources
Plan 16.09.2026
Set up with the plan of 16 September: weekday, rhythm and end date chosen by the physician. The schedule ends on its own after twelve weeks.
What it answers while you decide, with the guideline and the studies under it.
Evidence answer1The answer to a clinical question, with the studies and the guidelines it rests on.
A second statin after muscle aches on the firstAnna Keller, 47
Evidence answer
A second statin after muscle aches on the first
Anna Keller, 47 · 16 September 2026 · Signed, in the chart
The evidence
The Cholesterol Treatment Trialists' meta-analysis of 27 trials found that each 1 mmol/l (39 mg/dl) reduction in LDL cholesterol lowered major vascular events by about a fifth. The proportional benefit was at least as large in people whose five-year risk was below 10 %.
The same collaboration pooled 19 double-blind trials for muscle symptoms. Muscle pain or weakness was reported by 27.1 % on a statin and 26.6 % on placebo; more than 90 % of the reports in the statin groups were not caused by the statin.
In SAMSON, 60 people who had stopped a statin for side effects took a statin, a placebo and no tablet in random months. The placebo months produced 90 % of the symptom burden of the statin months, and half of the participants were back on a statin six months later.
What this means for her
A different statin, at a moderate dose, in the eveningAfter symptoms of this kind the EAS consensus advises a rechallenge rather than permanent avoidance.
Her CK before the start is in the chart: 96 U/l in MayNew aches can be measured against her own baseline.
If a second statin also fails, the options without a statin come nextEzetimibe, then bempedoic acid. Both stand in the therapy options with their evidence.
Sources
Lancet 2012, CTTLancet 2022, CTT muscle symptomsN Engl J Med 2020, SAMSONEur Heart J 2015, EAS consensus
Written from two meta-analyses, one blinded trial and one consensus statement, read against this chart. Every number links to the publication it comes from.
Guideline comparison2The society's sentence, then the options for this patient: what applies, with a caveat, or is ruled out.
ESC, applied to herAnna Keller, 47
Guideline comparison
ESC, applied to her
Anna Keller, 47 · 16 September 2026 · Signed, in the chart
For patients at high cardiovascular risk the ESC recommends an LDL target below 100 mg/dl and a blood pressure target of 120 to 129 mmHg systolic where tolerated.
AppliesStart a statin, low dose, different moleculeLDL 162 with a premature family history; atorvastatin 20 mg, CK and ALT after six weeks, given the myalgia on simvastatin
AppliesRamipril to 10 mgHome mean 136/86, above target; one step up before adding a second drug
CaveatLipoprotein(a), onceNever measured; changes the risk estimate with the family history
Ruled outMetforminHbA1c 5.9 %: prediabetes, lifestyle first, control in three months
The society's sentence is quoted, not paraphrased. What follows is this chart checked against it, value by value.
Petra S., 51 · 18 September 2026 · Signed, in the chart
Hormone therapy is the most effective treatment of vasomotor symptoms; the route and the preparation are chosen by the patient's risk profile, and the decision is shared with her.
S3-Leitlinie Peri- und Postmenopause, DGGG, AWMF 015-062, 2020
AppliesTransdermal estradiolMigraine with aura and a rising LDL favor the transdermal route; no increase in venous thrombosis risk at standard doses
AppliesMicronized progesteroneUterus in place; oral progesterone in the evening, also helps sleep
CaveatA hip fracture in the familyMother at 68; not a contraindication, and a reason to repeat the bone density (DXA) of January 2025 in the usual interval
Ruled outOral combined preparationsMigraine with aura in the history
The society's sentence is quoted, not paraphrased. What follows is this chart checked against it.
Therapy options1The options that apply, ranked, each with the guideline, the study behind it, the benefit in numbers and what this patient's own record says against it.
Lowering her LDL, the options in orderAnna Keller, 47
Therapy options
Lowering her LDL, the options in order
Anna Keller, 47 · 16 September 2026 · Signed, in the chart
In order, with the evidence under each
1Atorvastatin 20 mg in the eveningAppliesApproved for this use
A different statin from the simvastatin she stopped, at a moderate dose. Her aches of 2024 fit statin-associated muscle symptoms with a CK below four times the upper limit, the pattern in which the consensus advises a second attempt.
CTT meta-analysis, 27 randomised trials, 174,149 participantsversus placebo or a less intensive statin
Major vascular events per 1 mmol/l of LDL
RR 0.79 (0.77–0.81)
Muscle pain or weakness, statin versus placebo
27.1 % versus 26.6 %
Population studied
Adults with and without vascular disease. The analysis reports people with a five-year risk below 10 % separately.
Where she differs
The trials did not select people with earlier muscle symptoms. For that question, the blinded trials stand in the evidence answer.
Data maturity
Individual participant data with about five years of follow-up. The pooled analysis of muscle symptoms followed in 2022.
Guideline
ESC/EAS 2019: at moderate risk an LDL goal below 100 mg/dl, with a statin as the first step. EAS consensus 2015: after muscle symptoms, a rechallenge with a different statin. ESC/EAS 2019
If the aches come back, check the CK and pause the tablet. Do not raise the dose into the symptoms.
Before it could startCK before the start96 U/l on 8 May 2026Liver values before the startALT 41 U/l on 8 May 2026. It fits the steatosis and is no reason to wait.Her medication checkedRamipril and sertraline, no interaction
2Rosuvastatin 5 mgAppliesApproved for this use
The second statin if atorvastatin brings the aches back. It lowers LDL at a small dose, which keeps the dose low for a patient who has reacted once.
3Ezetimibe, then bempedoic acidIf a second statin also failsApproved, bempedoic acid for people who cannot take a statin
Neither is a statin. Ezetimibe lowers the uptake of cholesterol from the gut. Bempedoic acid acts one step before the statins and is activated only in the liver, which is why it was studied in people who could not take a statin.
Bempedoic acid raises uric acid. One value before the start is worth it in anyone with gout in the history.
Checked against everything she takes
Her medication list of 16 September, read against the product information of the option ranked first.
No actionAtorvastatin × ramiprilNo shared metabolic route.Continue both unchanged.
No actionAtorvastatin × sertralineNo clinically relevant interaction.Continue both unchanged.
WatchAtorvastatin × clarithromycinA strong CYP3A4 inhibitor. Not on her list today.If a macrolide is ever prescribed for an infection, pause atorvastatin for the course.
Read from her own record, not from the guideline
Simvastatin 20 mg, March 2024: muscle aches in both thighs, CK 210 U/lBelow four times the upper limit and gone within two weeks of stopping. That is what puts a second statin first.
LDL 162 mg/dl, father with a myocardial infarction at 58From 162 to below 100 mg/dl is a reduction of about 40 %, the range of a moderate statin dose. The blood test after eight weeks shows whether it closes the distance.
Lipoprotein(a) not yet measuredA high value would move her risk category, and with it the goal.
Sources
ESC/EAS 2019Lancet 2012, CTTN Engl J Med 2008, JUPITERN Engl J Med 2023, CLEAR OutcomesVisit 14.03.2024Lab 08.05.2026
Built from the studies behind each option and from this chart: the muscle aches of 2024, the LDL, the family history and the medication list. Where a study population differs from her, that sentence stands above the numbers. The order is a proposal with its reasons visible; the decision is the physician's.
Candidate list1The patients of the practice who could qualify, with what is met and what is still open.
Criteria met, step not takenYour practice
Candidate list
Criteria met, step not taken
Your practice · 16 September 2026 · Signed, in the chart
What the rules found
9patientsTwo eGFR values between 30 and 59, more than 90 days apart, no chronic kidney disease in the chartThe criterion for stage 3 is two qualifying values, not one.Confirm the second value and the interval before coding
6patientsThree or more antihypertensives and repeated hypokalaemia, no aldosterone-to-renin ratioGuidelines name this constellation as an indication to screen for primary aldosteronism.
4patientsLDL above 190 mg/dl on two reports, no assessment for familial hypercholesterolaemiaThe Dutch Lipid Clinic Network score needs the LDL course, the medication, the age and the family history, all of which are in the chart.
12patientsAge, AST, ALT and platelets all present, FIB-4 never calculatedThe score needs no new test.
What this list is not
It is not a diagnosisEvery line says which criterion the record meets, not what the patient has.
It is not a predictionNo model is guessing. The rules are the ones the guidelines state.
Nothing left the practiceThe charts were read where they are.
Every chart the practice has connected was checked against four documented criteria. A patient appears here only when the data behind the criterion is already in her record.
Markus Vogel, 44 · 16 September 2026 · Shared with the patient, 16 September 2026, opened
Medication
Vitamin D3 2,000 IUOne tablet daily, with a meal · Vitamin D was 17 ng/mlNew
What you do
Move 150 minutes a weekModerate: brisk walking, cycling, swimming. Five times thirty minutes, or three times fifty. Something you will still do in March.
Alcohol below 100 g a weekThat is about one bottle of wine over the whole week, not two glasses an evening. The liver values and the triglycerides answer within weeks.
Weight 89 kg by MarchFive percent. Slower is fine; the direction is what December measures.
Measure your blood pressure for seven days before the December visitMorning and evening, seated, after five minutes of rest, two readings each time.
The decision in December
LDL below 100 and ApoB below 100: continue without a tabletNext check in September.
LDL 100 or above, or ApoB above 100: a statin conversationThe guideline says “should be considered” at your risk; your lipoprotein(a) argues for starting rather than waiting. If it is close, a coronary calcium score settles it.
When to call us
Chest pain, or breathlessness that is new when you climb stairsThe same day. Not because we expect it; because the rule applies to everyone.
Appointments
Please bookUltrasound of the liverIn the practice, twenty minutes, no preparation.
Week of 14 Dec 2026Blood test 2Lipids, apolipoprotein B, ALT, GGT, HbA1c, vitamin D, uric acid. Fasting.
18 Dec 2026, 09:00Visit with Dr. WeberResults, home readings, the decision on lipid-lowering treatment.
March 2027Check-in, videoWeight, activity, how the weeks went. No blood test.
Week of 13 Sep 2027Blood test 3The full panel again, without lipoprotein(a).
20 Sep 2027Annual review with Dr. WeberWhere you stand after a year.
Drafted from the results of 15 September, the intake and the visit of 16 September. Targets from the ESC 2021 prevention guideline, the ESC 2024 blood pressure guideline, the ADA 2026 standards and the Endocrine Society. Signed by Dr. med. Sarah Weber; every statement can be traced to the note.
Take-home3What the patient takes home: why, what to do, what to watch for, in plain language.
Why taking your statin mattersAnna Keller, 47
Take-home
Why taking your statin matters
Anna Keller, 47 · 16 September 2026 · Shared with the patient, 16 September 2026, opened
Why this medicine matters
Your LDL cholesterol is 162 mg/dl. Together with your blood pressure and your father's heart attack at 58, this raises your risk of a heart attack or stroke in the coming years.
LDL builds up in the walls of your blood vessels over time. Lowering it is one of the best-proven ways to protect your heart, and the benefit grows the longer you take the tablet.
The plan
You start atorvastatin 20 mg in the evening. This is a different molecule from the simvastatin you tried in 2024, and we expect your LDL to fall by about a third within eight weeks.
The target we are aiming for is below 100 mg/dl. If you are there and tolerating the tablet, nothing changes. If not, we can raise the dose or add a second medicine.
What to watch for
Muscle pain that is new or unusualIn 2024 you had aches on simvastatin. Note when it started and where, and tell us. We check a blood value and adjust. Do not stop on your own unless the pain is severe.
Grapefruit in large amountsIt raises the level of atorvastatin in your blood. A glass now and then is fine.
Next
Week of 9 Nov 2026Blood test: cholesterol, liver and muscle values
16 Nov 2026, 10:30Follow-up with Dr. Weber
Sources
Eur Heart J 2020Lancet 2016
Written from the visit, the chart and two guideline sources, in plain language, with the physician's own instruction about the muscle symptoms of 2024. Shared under her name.
Petra S., 51 · 18 September 2026 · Shared with the patient, 18 September 2026, opened
Why through the skin
Because of your migraine with aura we chose the gel instead of tablets. Oestrogen taken as a tablet passes through the liver and can raise the risk of a clot; through the skin it does not.
How to use it
One pump on the inner arm every morning, spread it and let it dry before you dress. Progesterone every evening; it also helps your sleep.
What to expect
Flushes ease within two to four weeks
Tender breasts or spotting in the first weeks are commonThey usually settle. Tell us if they do not.
Call us if your migraine with aura returns
Next
25 Sep 2026Gynaecological check-up
18 Dec 2026Follow-up
Sources
S3 guideline, AWMF 015-062
Written from the consultation and the S3 guideline, in plain language, shared under the physician's name.
Markus Vogel, 44 · 16 September 2026 · Shared with the patient, 16 September 2026, opened
What is fine
Your kidneys, your thyroid, your blood count, your iron and your B vitamins are all where they should be. The scarring test for the liver (FIB-4) says your liver is not damaged. Your blood pressure is at the upper edge of normal, not high.
What we work on, and why
Your cholesterol (LDL 158, apolipoprotein B 118) is above the goal for someone with your risk. Your risk of a heart attack or stroke in the next ten years is around 3 %, which is moderate at 44, and a value you inherited, lipoprotein(a), is in the middle band. Together they mean: take the cholesterol seriously now, not at 55.
Your blood sugar (HbA1c 5.8 %) is just above the line for prediabetes, for the first time. Your father got diabetes at 55. This is the value with the most to gain: people in your situation who lost a little weight and moved regularly cut their chance of diabetes by more than half in the largest study on it.
Your liver values (ALT 52, GGT 78) most likely come from fat in the liver, which fits the waist, the wine and the triglycerides. It is reversible. Your vitamin D is low, which a tablet fixes.
What you do
Move 150 minutes a weekBrisk enough that talking is still possible, singing is not.
Wine: one bottle a week, not two glasses a nightThis is the change your liver answers fastest.
Five kilos by March94 to 89. The direction matters more than the date.
One vitamin D tablet a day2,000 units, with a meal.
What happens next
In December we measure the cholesterol, the liver and the sugar again. If the cholesterol is below the goal, we continue without a tablet. If it is not, we talk about a statin, and your lipoprotein(a) is a reason to say yes rather than to wait. In September we repeat the whole panel and see the year.
Next
Please bookUltrasound of the liver
Week of 14 Dec 2026Blood test, fasting
18 Dec 2026, 09:00Visit with Dr. Weber
Sources
ESC 2021N Engl J Med 2002EASL 2024
Written from the results of 15 September, the intake and the visit, in plain language, with the same numbers as the lab review. Shared under the physician's name after signature.
Visit note1The visit in your structure: reason, findings, assessment, plan.
Visit of 16 September 2026Anna Keller, 47
Visit note
Visit of 16 September 2026
Anna Keller, 47 · 16 September 2026 · Signed, in the chart
Reason
Blood pressure control, lipids, decision on statin therapy.
Findings
BP 142/88, HR 72, BMI 29.1. Lab 12 September: LDL 162 mg/dl, HbA1c 5.9 %, ALT 41 U/l. Father: myocardial infarction at 58. Simvastatin stopped 2024 for myalgia.
Assessment
Hypertension not at target under ramipril 5 mg; primary prevention with high LDL and premature family history; prediabetes; mild steatosis.
Plan
Atorvastatin 20 mg started, CK and ALT after six weeks; lipoprotein(a) once; ramipril to 10 mg; home blood pressure for four weeks; follow-up in three months.
Written from the recording of the visit and what was open on screen, in the practice's structure. Signed by Dr. med. Sarah Weber; every sentence points to its passage in the conversation.
Anna Keller, 47 · 16 September 2026 · Draft, for your signature
Draft. It carries your name after you sign it.
To
Cardiology practice, Hamburg
Subject
Referral of Mrs Anna Keller, born 1979, for coronary artery calcium scoring
Dear colleagues,
I am referring Mrs Keller, 47, for a coronary artery calcium score to refine her cardiovascular risk before committing to long-term lipid-lowering therapy.
Findings: arterial hypertension since 2023 (ramipril, increased to 10 mg today; home mean 136/86 mmHg), LDL cholesterol 162 mg/dl, non-HDL 186 mg/dl, HbA1c 5.9 %, BMI 27.4, former smoker (10 pack-years, stopped 2019), mild hepatic steatosis on ultrasound (May 2026), eGFR 92 ml/min. Family history: father with myocardial infarction at 58. Lipoprotein(a) is ordered with the next blood draw. SCORE2 is about 3 %, low to moderate for her age; the family history and the LDL level are the reasons for the question.
Simvastatin 20 mg was stopped in March 2024 for myalgia with a CK of 210 U/l; atorvastatin 20 mg is started today as a rechallenge. Current medication: ramipril 10 mg, atorvastatin 20 mg, sertraline 50 mg, vitamin D3 1,000 IU.
The 2021 ESC prevention guideline lists coronary artery calcium scoring as a risk modifier that may be considered in people at low-to-moderate risk. I would be grateful for the score and your assessment of whether the result changes the treatment intensity.
With kind regards,
Dr. med. Sarah Weber
Internal medicine and general practice, Hamburg
Drafted from the chart and today's visit. A draft: it carries the physician's name only after signing.
What the patient enters at home, and what comes back as a sheet.
Measured at home2What the patient measured between visits, as a series with its mean, against the target in her plan.
Blood pressure at home, seven daysAnna Keller, 47
Measured at home
Blood pressure at home, seven days
Anna Keller, 47 · 15 September 2026 · Signed, in the chart
Morning readings
1449 Sep
14810 Sep
14111 Sep
13912 Sep
14513 Sep
14214 Sep
14015 Sep
mmHg systolic · target below 130
What the week shows
Morning mean 143/91, evening mean 129/81A morning-dominant pattern under ramipril taken in the morning.
Highest single reading 148/92 on 10 SeptemberNo symptoms reported alongside it.
No reading came with chest pain, breathlessness or neurological symptomsMosaic asks that with every entry and escalates immediately if the answer changes.
What Mosaic did not do
It did not change anythingThe readings sit in the chart for the visit of 16 November. A dose is a decision, not a measurement.
Entered by the patient twice a day for seven days, on the schedule her plan asked for. Nothing was inferred; the mean is the arithmetic mean of the fourteen readings.
Anna Keller, 47 · 9 December 2026 · Signed, in the chart
Sunday mornings
85.821 Sep
85.128 Sep
84.65 Oct
84.912 Oct
84.019 Oct
83.626 Oct
83.42 Nov
83.79 Nov
83.016 Nov
82.823 Nov
82.630 Nov
82.46 Dec
kg · target below 82
What the twelve weeks show
A steady line, not a drop and a returnThe largest weekly change was 0.7 kg. Nothing here looks like a crash diet, which is what makes it likely to hold.
The two weeks that went up carry their reason12 October: holiday week, ate out four times. 9 November: a cold, no movement for six days. Both written by her at the time, not reconstructed afterwards.
Movement and weight move togetherIn the four weeks she reported five days or more of movement, the weight fell every time.
What it means for the next visit
HbA1c is worth repeatingIt was 5.9 % in May at 85.8 kg. Three and a half kilos down is within the range where the value moves.
Blood pressure may followHer mean was 136/86 in September. Weight loss of this size often takes a few mmHg with it, so measure before changing the ramipril dose again.
Sources
Entered by the patient, 12 of 12 weeksPlan 16.09.2026
Entered by the patient every Sunday on the schedule the physician set. No value was changed afterwards, and the two notes were written in the week they belong to.
Symptom trend2How symptoms moved since treatment started, and which reported event needs a look before the next visit.
Symptoms since starting transdermal estradiolPetra S., 51
Symptom trend
Symptoms since starting transdermal estradiol
Petra S., 51 · 30 October 2026 · Signed, in the chart
Since 18 September
↓Hot flushesMeasured as her own count each evening, asked three times a week.9 → 4 a day
↓Night-time waking3 → 1 a night
–Mood and concentrationHer own rating, no direction yet at six weeks.unchanged
↑Breast tendernessCommon in the first weeks and named in her take-home.from none to mild
•SpottingFirst report. Under an unopposed interval it would matter; she takes progesterone, and the date is what the physician needs.12 October
Hot flushes a day
9wk 1
8wk 2
7wk 3
5wk 4
5wk 5
4wk 6
self-reported count
How the questions were asked
Three times a week, four questions, under a minuteThe schedule stops on its own after twelve weeks unless the physician extends it.
Every entry asks the safety question for this therapyMigraine with aura returning, leg swelling, chest pain. All answered no so far.
Collected in the patient app three times a week since 18 September. Counts are her own; the direction is the change between the first and the last two weeks.
Anna Keller, 47 · 30 September 2026 · Signed, in the chart
What was asked and what came back
–Day 3 · muscle pain, stomach, sleepnone
–Day 7 · the same threenone
•Day 14 · muscle painBoth thighs, since the previous day. The same site as the simvastatin myalgia of 2024.reported
What happened then
Mosaic did not tell her to stopHer plan says to keep taking it unless the pain is severe, and a change would be a decision.
It showed her what the practice would receive and let her decideShe sent it at 13:22.
The physician opened a sheet, not a chatQuestion, plan item, the CK of 210 from 2024, the CK of 96 before this start, and a draft reply.
Asked on the schedule the physician set when she signed the plan: day 3, 7 and 14 after starting, then monthly. Three questions each time, under a minute.
Patient question2A question from the patient app, with the plan it touches, what the patient already heard, and a reply to approve.
Muscle aches on atorvastatin, since yesterdayAnna Keller, 47
Patient question
Muscle aches on atorvastatin, since yesterday
Anna Keller, 47 · 16 September 2026, 13:22 · Draft, for your signature
Draft. It carries your name after you sign it.
How the question was formed
The patient · 13:14
I have had muscle aches since yesterday. Should I stop the atorvastatin?
Mosaic
I cannot answer that one. Your plan asks you to report new muscle pain and to keep taking the tablet unless the pain is severe, so telling us is exactly right. Before I send this to Dr. Weber, is this the question you want to ask?
Mosaic proposed the wording; the patient confirmed it unchanged at 13:22.
The patient · 13:22
Yes. I have had muscle aches in both thighs since yesterday. Should I stop the atorvastatin, or keep taking it?
Confirmed and sent. Nothing else from her record went with it.
What you need to answer it
Her plan
Atorvastatin 20 mg every evening, started 16 September 2026. Signed by you. It asks her to note new or unusual muscle pain and tell the practice, and to keep taking the tablet unless the pain is severe.
From the chart
Simvastatin 20 mg stopped March 2024 for myalgia, CK 210 U/l. CK before this start 96 U/l, 8 May 2026. None since. eGFR 92.
Already said
That reporting it was right, and that the 2024 myalgia is in her chart. Nothing about stopping, halving or switching.
Draft reply, written from her plan and her chart
Your reply
Thank you for telling me straight away, that is exactly right. Please keep taking the tablet for now unless the pain is severe or you feel unwell.
I would like a blood test this week to check the muscle enzyme, so we know whether this is the tablet. Come by the practice for a blood draw, no appointment needed, the laboratory is open from 8 to 11.
If the pain gets worse, or you notice dark urine or weakness, stop the tablet and call us the same day.
Nothing is sent until you approve it. Edit any sentence; the reply goes out under your name, not Mosaic's.
The patient agreed the wording of her question with Mosaic before it was sent. The reply is a draft from her plan and her chart; you are its author once you approve it.
Open the whole sheetWhether her daughter should have her cholesterol checkedAnna Keller, 47
Patient question
Whether her daughter should have her cholesterol checked
Anna Keller, 47 · 15 September 2026, 18:40 · Signed, in the chart
She asked
“My daughter asks whether she should have her cholesterol checked too.”
Why it matters
Her father had a myocardial infarction at 58 and her own LDL is 162 mg/dl. Familial hypercholesterolaemia has not been assessed in this family.
What was sent
Yes, that is a sensible question. With your values and your father's heart attack at a young age, it is worth checking your daughter's cholesterol once.
Her own doctor can do that. I am also adding one test to your November blood draw, lipoprotein(a), which is measured once in a lifetime and tells us more about whether this runs in the family.
Approved and sent on 15 September 2026. Kept with the chart like every other document.
