SELECT patient.Patient_Id, patient.First_Name_M0040, patient.Last_Name_M0040, patient.HI_Claim_Number, patient.DOB_M0066, patient.Gender_M0069, Agency.Agency_Name, Agency.Agency_Medicare_Id, patient.Primary_ReferringPhys_Id_M0072 FROM #Request.prefix_db_agency#.patient, #Request.prefix_db_lookup#.Agency WHERE patient.Patient_Id = #form.txtPatientId# AND Agency.Agency_Id = patient.Agency_Id SELECT Employee.Last_Name, Employee.First_Name FROM #Request.prefix_db_lookup#.Physician, #Request.prefix_db_lookup#.Employee WHERE Physician.Physician_Id='#PhysicianId#' AND Employee.Employee_Id = Physician.Employee_Id INSERT INTO #Request.prefix_db_agency#.Assessment_Forms ( Patient_Id, Agency_Id, Name_Item_6, DOB_Item_8, Gender_Item_9, Form_Type, HI_Claim_Item_1, SOC_Item_2, Provider_Num_Item_5, Provider_name_Item_7, Record_Creation_Date, DME_Supplies_Item_14, Safety_Measures_Item_15, Nutritional_Item_16, Func_Limits_item_18a, Func_Limits_Item_18a_other, Activities_Permitted_Item_18b, Activities_Permitted_Item_18b_Other, Mental_Status_Item_19, Mental_Status_Item_19_Other, Prognosis_Item_20, Physician_ID ) Values (#form.txtPatientId#, '#Session.AgencyLogin#', '#Session.PatientName#', #CreateODBCDate(GetP.DOB_M0066)#, '#GetP.Gender_M0069#', 'Form 485', '#GetP.HI_Claim_Number#', #CreateODBCDate(form.dtSOC)#, null '#GetP.Agency_Medicare_Id#', '#GetP.Agency_Name#', #now()#, '#form.txtDME#', '#form.txtSafety#', '#form.txtNutritionalReq#', '#form.hdchklimitationValue#', '#form.txtFunctionalother#', '#form.Chkpermitted#', '#form.txtOtheractivitiesPermitted#', '#form.ChkStatus#', '#form.txtothermental#', '#form.hdrdPrognosisValue#', '#PhysicianId#' )