SELECT pCMS4857.Agy_Name, pCMS4857.Agy_CCN, pCMS4857.Agy_Street, pCMS4857.Agy_City, pCMS4857.Agy_State, pCMS4857.Agy_Zip, pCMS4857.Agy_Phone, "" AS Faxs, "" AS Location, pCMS4857.Pt_Last, pCMS4857.Pt_First, pCMS4857.Render_Phys_ID AS Primary_ReferringPhys_ID_M0072, pCMS4857.Pt_Agy_ID, pCMS4857.Pt_DOB, pPhysicians.Phys_Last AS LastName, pPhysicians.Phys_First AS FirstName, pPhysicians.Phys_Street AS Address1, "" AS Address2, pPhysicians.Phys_City AS City, pPhysicians.Phys_State AS State, pPhysicians.Phys_Zip AS Zip, pPhysicians.Phys_Phone AS Telephone1, pPhysicians.Phys_ID, Order_ID, pCMS4857.Date_Create AS Record_Creation_Date, pCMS4857.Change_by AS Record_Modified_by, "" AS Medical_Num_Item_4, "" AS SOC_Item_2, pCMS4857.Certification_From, pCMS4857.Certification_To, pCMS4857.Assmt_ID, Order_description AS Addendum_Details_21, pCMS4857.MD_Digital_Signature, pCMS4857.Date_Sent, pCMS4857.Date_Received, pCMS4857.Clinician_Signature, pCMS4857.Form_Status, pCMS4857.Created_by, 0 AS contact_id, "" AS ContactName, "" AS ContactType, "" AS ContactStreet, "" AS ContactCity, "" AS ContactState, "" AS ContactZip, pCMS4857.Render_Phys_ID, "" AS ContactTelephone1, "" AS ContactTelephone2, pPhysicians.Phys_Fax AS FAX FROM #Request.prefix_db_agency#.pCMS4857 LEFT OUTER JOIN #Request.prefix_db_lookup#.pPhysicians ON pCMS4857.Render_Phys_ID = pPhysicians.Phys_ID WHERE Order_ID = '#url.afid#' GROUP BY pCMS4857.Order_ID SELECT * FROM #Request.prefix_db_agency#.pAdmit WHERE Admit_ID IN (SELECT Admit_ID FROM #Request.prefix_db_agency#.pAssessments WHERE Assmt_ID = #Get487.Assmt_ID# AND status = 0) AND status = 0 SELECT Emp_ID, Emp_First, Emp_Last FROM #Request.prefix_db_lookup#.pEmployee WHERE Emp_ID = '#GetAdmit.Clinical_Manager#' Emp_ID = '#GetAdmit.Case_Manager#' Emp_ID = '#Get487.Created_by#' UPDATE #Request.prefix_db_agency#.pCMS4857 SET Form_Status = 'Printed Only' WHERE Order_ID =

Medical Update for #Pt_First# #Pt_Last# #Medical_Num_Item_4# DOB: #DateFormat(Pt_DOB, "mm/dd/yyyy")#

Date Order Created: #DateFormat(Record_Creation_Date, "mm/dd/yyyy")#

Agency Assigned Id: #Pt_Agy_ID#

Certification Period: #DateFormat(Certification_From, "mm/dd/yyyy")# to #DateFormat(Certification_To, "mm/dd/yyyy")#

#Agy_Name# #Agy_CCN#
#Agy_Street#
#Agy_City#, #Agy_State# #Agy_Zip#
PHONE #Agy_Phone# FAX #getTimeZone.Agency_Fax# #Agy_Name# #Agy_CCN#
#Agy_Street#
#Agy_City#, #Agy_State# #Agy_Zip#
PHONE #Agy_Phone# FAX #getTimeZone.Agency_Fax#

_______________________________________________________________
Orders:
#Replace(Addendum_Details_21, CrLf, "
", "ALL")#

_______________________________________________________________
#ContactName#
#ContactStreet#
#ContactCity#, #ContactState# #ContactZip# #ContactTelephone1# #ContactTelephone2# #FirstName# #LastName#
#Address1#
#Address2#
#City#, #State# #Zip#
Tele:#Telephone1# FAX: #FAX#

Physician Signature_________________________________________ Date __________

#Get487.Clinician_Signature# Staff Signature: Electronically Signed by #GetEmps.Emp_Last#, #GetEmps.Emp_First# Date #DateFormat(Get487.Date_Sent, "mm/dd/yyyy")#