SELECT patient.Last_Name_M0040 AS Last_Name, patient.First_Name_M0040 AS First_Name, patient.Middle_Initial_M0040 AS Middle, Assessment_Completed_M0090, Date_Most_Recent_M0903, Date_Discharge_M0906, Discharged_From_M0175, Medical_or_Treatment_Change_M0200, Conditions_Prior_M0220, Therapies_Home_M0250, Assessment_New.Record_Created_By FROM #Request.prefix_db_agency#.Assessment_New INNER JOIN #Request.prefix_db_agency#.patient ON (Assessment_New.Patient_ID=patient.Patient_ID) WHERE Assessment_New.Assessment_ID='#session.cs.AssessmentId#' select Last_Name, First_Name from #Request.prefix_db_lookup#.Employee where Employee_ID = '#Form.Record_Created_By#' select Diagnosis_ID,Diagnosis,Short_Diagnosis,Text_ICD,Severity,CONVERT(Diagnosis.Dx_Order, CHAR(10)) as Dx_Order,Primary_Diagnosis,Secondary_Diagnosis,DG_Type from #Request.prefix_db_agency#.Diagnosis where Assessment_ID='#session.cs.AssessmentId#' and M0230_Link like '%M0230%' and M0230_Link is not null order by Dx_Order asc

#session.agencyname#	Date Completed #DateFormat(Form.Assessment_Completed_M0090,"mm/dd/yyyy")#
Discharge Non-OASIS Evaluation	By #GetE.Last_Name# #GetE.First_Name#
#Form.First_Name# #Form.Last_Name#

Date of Last (Most Recent) Home

#dateformat( Form.Date_Most_Recent_M0903,'mm/dd/yyyy')#

Discharge/Transfer/Death Date

#dateformat(Form.Date_Discharge_M0906,'mm/dd/yyyy')#

Reason For Discharge

#replace('#Form.Discharged_From_M0175#',',',' ',"ALL")# #replace('#Form.Discharged_From_M0175#','!',' ',"ALL")#

Discharge Disposition:Where is the patient after discharge from your agency?

#replace('#Form.Medical_or_Treatment_Change_M0200#',',',' ',"ALL")# #replace('#Form.Medical_or_Treatment_Change_M0200#','!',' ',"ALL")#

Who's caring for patient

#Form.Conditions_Prior_M0220#

Discharge Instructions

#Form.Therapies_Home_M0250#

Physician Signature: ____________________________________________________

Page #cfdocument.currentpagenumber# Discharge Non-OASIS Evaluation Evaluation for #Form.First_Name# #Form.Last_Name#