Capture and save is rpm/televisit covered in cpc

resources/views/app/patient/create-patient/insurance-coverage-form.blade.php

@@ -34,6 +34,9 @@
 				<label class="control-label">Carrier Memo</label>
 				<input type="text" name="carrierFreeTextMemo" class="form-control input-sm">
 			</div>
+			<div class="col-12">
+				<hr class="mt-0 mb-2">
+			</div>
 			<div class="form-group col-md-6">
 				<label class="control-label">Patient Member Identifier</label>
 				<input type="text" name="commercialMemberIdentifier" class="form-control input-sm">
@@ -47,6 +50,37 @@
 				<input type="text" name="primaryInsurancePhoneNumberForHcps" class="form-control input-sm">
 			</div>
 		</div>
+
+		<div class="row" v-if="planType">
+			<div class="col-12">
+				<hr class="mt-0 mb-2">
+			</div>
+			<div class="form-group col-md-6">
+				<p class="mb-1 font-weight-bold">RPM covered (if medically needed)?</p>
+				<div class="form-check form-check-inline">
+					<label class="form-check-label"><input class="form-check-input" type="radio" name="isRpmCoveredIfMedicallyNeeded" value="YES">Yes</label>
+				</div>
+				<div class="form-check form-check-inline">
+					<label class="form-check-label"><input class="form-check-input" type="radio" name="isRpmCoveredIfMedicallyNeeded" value="NO">No</label>
+				</div>
+				<div class="form-check form-check-inline">
+					<label class="form-check-label"><input class="form-check-input" type="radio" name="isRpmCoveredIfMedicallyNeeded" value="UNKNOWN">Unknown</label>
+				</div>
+			</div>
+			<div class="form-group col-md-6">
+				<p class="mb-1 font-weight-bold">Televisits covered (if medically needed)?</p>
+				<div class="form-check form-check-inline">
+					<label class="form-check-label"><input class="form-check-input" type="radio" name="isTelevisitCoveredIfMedicallyNeeded" value="YES">Yes</label>
+				</div>
+				<div class="form-check form-check-inline">
+					<label class="form-check-label"><input class="form-check-input" type="radio" name="isTelevisitCoveredIfMedicallyNeeded" value="NO">No</label>
+				</div>
+				<div class="form-check form-check-inline">
+					<label class="form-check-label"><input class="form-check-input" type="radio" name="isTelevisitCoveredIfMedicallyNeeded" value="UNKNOWN">Unknown</label>
+				</div>
+			</div>
+		</div>
+
 		<div class="row">
 			<div class="form-group col-md-12" v-if="planType == 'MEDICAID' || planType == 'COMMERCIAL'">
 				<div class="form-check form-check-inline">

resources/views/app/patient/primary-coverage-form.blade.php

@@ -38,6 +38,9 @@
 						<label class="control-label">Carrier Memo</label>
 						<input type="text" name="carrierFreeTextMemo" class="form-control input-sm">
 					</div>
+					<div class="col-12">
+						<hr class="mt-0 mb-2">
+					</div>
 					<div class="form-group col-md-6">
 						<label class="control-label">Patient Member Identifier</label>
 						<input type="text" name="commercialMemberIdentifier" class="form-control input-sm">
@@ -52,6 +55,36 @@
 					</div>
 				</div>
 
+				<div class="row" v-if="insuranceCardType">
+					<div class="col-12">
+						<hr class="mt-0 mb-2">
+					</div>
+					<div class="form-group col-md-6">
+						<p class="mb-1 font-weight-bold">RPM covered (if medically needed)?</p>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" name="isRpmCoveredIfMedicallyNeeded" value="YES">Yes</label>
+						</div>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" name="isRpmCoveredIfMedicallyNeeded" value="NO">No</label>
+						</div>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" name="isRpmCoveredIfMedicallyNeeded" value="UNKNOWN">Unknown</label>
+						</div>
+					</div>
+					<div class="form-group col-md-6">
+						<p class="mb-1 font-weight-bold">Televisits covered (if medically needed)?</p>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" name="isTelevisitCoveredIfMedicallyNeeded" value="YES">Yes</label>
+						</div>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" name="isTelevisitCoveredIfMedicallyNeeded" value="NO">No</label>
+						</div>
+						<div class="form-check form-check-inline">
+							<label class="form-check-label"><input class="form-check-input" type="radio" name="isTelevisitCoveredIfMedicallyNeeded" value="UNKNOWN">Unknown</label>
+						</div>
+					</div>
+				</div>
+
 
 				<div class="row" v-if="insuranceCardType">
 					<div class="col-md-12 bg-light p-3 mb-2">