M19 · MCPV · Multi-Condition Patient View
Single-pane patient view
Cross-condition summary · all comorbidities, controls, meds, and interactions in one view. Sourced from EMR + RPM + screeners + claims.
MRN 4419873 · DOB 1958-03-12 · Male · 67y
JM
Jose Marquez
Active conditions
6
HTN · DM2 · CKD3 · DEP · OSA · CMP
Programs
4
CCM · BHI · RPM · APCM L2
ED visits · 12mo
2
last: 47d ago · CHF watch
CMS-HCC · risk
2.84
95th percentile · panel avg 1.32
Conditions
Vitals + RPM
Meds
Care plan
Encounters
Documents
Last sync · 2 min ago
Hypertension · stage 2
I10 · since 2014-06
Borderline
Last BP
142 / 88
device · 2d ago
Avg 30d
138 / 86
target < 130/80
CBP measure
open
CGAE · A1c+CBP rule
Device days · 30d
22
99454 capture ✓
Diabetes mellitus · type 2
E11.9 · since 2017-02
Above goal
Last A1c
8.4%
42d ago · trend ↑
A1c < 8% measure
open
Stars · CDC HbA1c
Avg fasting glu · 7d
154
CGM · Dexcom G7
Foot exam
current
2026-04-12 · normal
CKD · stage 3a
N18.31 · since 2021-09
Stable
eGFR
52
28d ago · was 49
UACR
A2 (118)
moderately elevated
Nephrology consult
current
Dr. Greene · 2026-03-08
SGLT2i candidate
on therapy
empagliflozin 10 mg
Major depressive disorder · recurrent
F33.1 · since 2019-04
Improving
Last PHQ-9
14
4d ago · prev 19
PHQ-9 ↓ from baseline
−7
≥ 5pt improvement ✓
BHI minutes · MTD
8 / 20
99484 not yet billable
Psych consult
scheduled
Dr. Chen · 2026-05-14
Obstructive sleep apnea
G47.33 · since 2020-11
Controlled
CPAP adherence · 30d
88%
≥ 4h on 27/30 nights
AHI · last download
3.2
target < 5
Mask fit
good
F&P Vitera · checked 2026-02
Resupply
due 30d
routed to MDRX
Chronic low back pain
M54.50 · since 2015-01
Recurring
Last pain score
5 / 10
VIDA capture · 5d ago
Opioid days · 90d
0
non-opioid plan
PT visits · 30d
2 / 4
target 4 / month
Function score
68
PROMIS PF · 28d ago
12-month event timeline enrollments · admits · interventions · device starts
Filter: All
May '25
Jul
Sep
Nov
Jan '26
Mar
May '26
Enroll · CCM
BP cuff
ED · CHF watch
+ empa
+ BHI
VIDA · A1c
Inpt · 3d
PHQ-9 ↓5
Active medications · 9
Lisinopril
20 mg PO daily · HTN
94%
MPR 30d
Amlodipine
5 mg PO daily · HTN
91%
MPR 30d
HCTZ
25 mg PO daily · HTN
82%
MPR 30d
Metformin
1000 mg PO BID · DM2
96%
MPR 30d
Semaglutide
1 mg SC weekly · DM2
78%
MPR 30d
Insulin glargine
22 U SC qHS · DM2
64%
MPR 30d
Empagliflozin
10 mg PO daily · DM2 + CKD
88%
MPR 30d
Sertraline
100 mg PO daily · MDD
92%
MPR 30d
Gabapentin
300 mg PO TID · CMP
71%
MPR 30d
Care plan · open goals
●
Reduce A1c to < 7.5% by 2026-Q3
DM2 · titrate semaglutide, reinforce diet
due Q3
●
PHQ-9 < 10 sustained ×3 months
BHI · 14 → goal < 10
due Aug
✓
Start SGLT2 inhibitor for CKD
empagliflozin started 2025-11
complete
●
BP avg < 130/80 over 30d
currently 138/86 · device-confirmed
ongoing
✓
CPAP adherence > 70% / month
88% · sustained ×6 mo
complete
●
Complete annual wellness visit
last AWV 2025-06 · due now
due now
●
Functional status improvement
PROMIS PF 68 → goal 75
2026-Q4
Interactions + alerts
Sertraline ⇄ Gabapentin
Mild additive CNS effect · monitor sedation, dizziness, fall risk in 67y M.
MINOR
Empagliflozin ⇄ HCTZ
Increased volume depletion risk · check eGFR + BP weekly during CKD progression.
MODERATE
Lisinopril ⇄ Empagliflozin
Synergistic renal protection ✓ — preferred combination for DM2 + CKD3.
BENEFICIAL
Insulin glargine adherence
MPR 64% · last 30d. Likely contributor to A1c rise. Recommend pen-vs-vial review.
PRIORITY
Falls risk · age + gabapentin + HCTZ
STEADI fall screen overdue. Add to CGAE outreach.
MODERATE