SELECT pCMS4857.Order_ID, pCMS4857.Assmt_ID, pCMS4857.Agy_Name, pCMS4857.Agy_CCN, pCMS4857.Agy_Street, pCMS4857.Agy_City, pCMS4857.Agy_State, pCMS4857.Agy_Zip, pCMS4857.Agy_Phone, pCMS4857.Pt_Last, pCMS4857.Pt_First, pCMS4857.Pt_Agy_ID, pCMS4857.Pt_DOB, pCMS4857.Pt_Street, pCMS4857.Pt_City, pCMS4857.Pt_State, pCMS4857.Pt_Zip, pCMS4857.Pt_Phone, pCMS4857.Date_Create AS Record_Creation_Date, pCMS4857.Certification_From, pCMS4857.Certification_To, pCMS4857.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, pCMS4857.Render_Phys_ID, pCMS4857.MD_Homebound, pCMS4857.MD_Clinical_Condition, pPhysicians.Phys_Last AS LastName, pPhysicians.Phys_First AS FirstName, pPhysicians.Phys_Credentials, pPhysicians.Phys_Street AS Address1, pPhysicians.Phys_City AS City, pPhysicians.Phys_State AS State, pPhysicians.Phys_Zip AS Zip, pPhysicians.Phys_Phone AS Telephone1, 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 = GROUP BY pCMS4857.Order_ID SELECT pAdmit.Admit_ID, pAdmit.clinical_authorization, pAdmit.case_authorization, pAdmit.Clinical_Manager, pAdmit.Case_Manager, pAdmit.Date_F2F, pAdmit.MD_Homebound AS Admit_MD_Homebound, pAdmit.MD_Clinical_Condition AS Admit_MD_Clinical_Condition FROM #Request.prefix_db_agency#.pAdmit WHERE Admit_ID IN ( SELECT Admit_ID FROM #Request.prefix_db_agency#.pAssessments WHERE Assmt_ID = AND status = 0 ) AND status = 0 SELECT Emp_ID, Emp_First, Emp_Last, Skill_1 FROM #Request.prefix_db_lookup#.pEmployee WHERE Emp_ID = Emp_ID = Emp_ID = function stripMarkupToText(raw) { var s = Trim(ToString(raw)); if (!Len(s)) { return ""; } s = REReplaceNoCase(s, "]*>[\s\S]*?", " ", "all"); s = REReplaceNoCase(s, "]*>[\s\S]*?", " ", "all"); s = REReplaceNoCase(s, "]*>[\s\S]*?", " ", "all"); s = REReplaceNoCase(s, "", " ", "all"); s = REReplaceNoCase(s, "", " ", "all"); s = REReplaceNoCase(s, "", " ", "all"); s = REReplaceNoCase(s, "<[^>]*>", "", "all"); s = ReplaceNoCase(s, " ", " ", "all"); s = ReplaceNoCase(s, "&##160;", " ", "all"); s = ReplaceNoCase(s, "&", "&", "all"); s = ReplaceNoCase(s, """, '"', "all"); s = ReplaceNoCase(s, "&##39;", "'", "all"); s = ReplaceNoCase(s, "'", "'", "all"); s = ReplaceNoCase(s, "<", "<", "all"); s = ReplaceNoCase(s, ">", ">", "all"); s = Replace(s, Chr(160), " ", "all"); s = REReplaceNoCase(s, "<[^>]*>", "", "all"); s = REReplace(s, "[\r\n\t]+", " ", "all"); s = REReplace(s, " +", " ", "all"); return Trim(s); } ", "ALL") /> ", "
", "ALL") /> ", "
", "ALL") /> ", "
", "ALL") /> ", false, true) />

#HTMLEditFormat(Trim(Get487.Agy_Name))# #HTMLEditFormat(Trim(Get487.Agy_CCN))#
#HTMLEditFormat(Trim(Get487.Agy_Street))#
#HTMLEditFormat(Trim(Get487.Agy_City))#, #HTMLEditFormat(Trim(Get487.Agy_State))# #HTMLEditFormat(Trim(Get487.Agy_Zip))#
Phone: #HTMLEditFormat(Trim(Get487.Agy_Phone))#   Fax: #HTMLEditFormat(Trim(agencyFax))#
PHYSICIAN VERBAL
ORDER (487)
DATE ORDER CREATED: #DateFormat(Get487.Record_Creation_Date, "mm/dd/yyyy")#
ORDER ID: #session.agencyid#/#Get487.Order_ID#
AGENCY ASSIGNED ID: #HTMLEditFormat(Get487.Pt_Agy_ID)#
CERTIFICATION PERIOD: #DateFormat(Get487.Certification_From, "mm/dd/yyyy")# to #DateFormat(Get487.Certification_To, "mm/dd/yyyy")#
PHYSICIAN FACE-TO-FACE DATE: #f2fDate# 
PATIENT INFORMATION
PATIENT NAME: #HTMLEditFormat(Get487.Pt_First)# #HTMLEditFormat(Get487.Pt_Last)# DOB: #DateFormat(Get487.Pt_DOB, "mm/dd/yyyy")#
ADDRESS: #HTMLEditFormat(ptAddress)#
PHONE: #HTMLEditFormat(Get487.Pt_Phone)#
ORDERS
CLINICAL CONDITION REQUIRING HOME CARE PER CERTIFYING PHYSICIAN: #HTMLEditFormat(clinicalCondition)#
HOMEBOUND STATUS PER CERTIFYING PHYSICIAN: #HTMLEditFormat(homeboundStatus)#
ORDER DETAILS
## ORDER / INSTRUCTIONS
#ri#  #HTMLEditFormat(orderRows[ri])# 
PHYSICIAN INFORMATION
PHYSICIAN NAME: #HTMLEditFormat(Get487.FirstName)# #HTMLEditFormat(Get487.LastName)#, #HTMLEditFormat(Get487.Phys_Credentials)#
ADDRESS: #HTMLEditFormat(physAddress)#
PHONE: #HTMLEditFormat(Get487.Telephone1)# FAX: #HTMLEditFormat(Get487.FAX)#
VERBAL ORDER AUTHORIZATION
By signing below, I acknowledge the verbal order(s) above and agree to follow this plan of care.
PHYSICIAN SIGNATURE
Signature: Digitally Signed by #HTMLEditFormat(physicianSignatureText)# _________________________________
Date: ________________________
STAFF SIGNATURE (RECEIVED BY)
Signature: #HTMLEditFormat(Get487.Clinician_Signature)# Electronically Signed by #HTMLEditFormat(GetEmps.Emp_Last)#, #HTMLEditFormat(GetEmps.Skill_1)#, #HTMLEditFormat(GetEmps.Emp_First)# Electronically Signed
Date: #DateFormat(staffSignDate, "mm/dd/yyyy")#
IMPORTANT: This verbal order must be authenticated by the physician and maintained in the patient's medical record.
#pdf487Body# #pdf487Body# #pdf487Body#