SELECT Patient_ID, First_Name_M0040, Last_Name_M0040, Current_Residence_M0300, Lives_With_M0340, Assisting_Persons_M0350, Current_Payment_Sources_M0150 FROM #Request.prefix_db_agency#.patient WHERE Patient_ID = '#session.cs.patientid#' AND Agency_Id = '#session.AgencyId#' SELECT PatientRecordLock_ID FROM #Request.prefix_db_agency#.PatientRecordLock WHERE Patient_ID = #session.cs.patientid# AND UnlockedBy_ID = 0

#getP.Last_Name_M0040#, #getP.First_Name_M0040# - New Residence

#getP.Last_Name_M0040#, #getP.First_Name_M0040# - Update Residence

Bold fields required.
This Patient is locked. Updates are not allowed.

Current Residence (M0300)
Patient Lives With (M0340)	checked > 1 - Lives alone checked > 2 - With spouse or significant other checked > 3 - With other family member checked > 4 - With a friend checked > 5 - Wtih paid help (other than home care agency staff) checked > 6 - With other than above checked > Other...
Assisting Person(s) (M0350)	checked > 1 - Relatives, friends, or neighbors living outside the home checked > 2 - Person residing in the home (Excluding paid help) checked > 3 - Paid help checked > 4 - None of the above checked > UK - Unknown
Current Payment Sources (M0150) (Mark all that apply.)	checked > 0 - None; no charge for current services checked > 1 - Medicare (traditional fee-for-service) checked > 2 - Medicare (HMO/managed care) checked > 3 - Medicaid (traditional fee-for-service) checked > 4 - Medicaid (HMO/managed care) checked > 5 - Workers' compensation checked > 6 - Title programs (e.g., Title III, V, or XX) checked > 7 - Other goverment (e.g., CHAMPUS, VA, etc.) checked > 8 - Private insurance checked > 9 - Private HMO/managed care checked > 10 - Self-pay checked > 11 - Other checked > UK - Unknown