


<cfquery name="GetP" datasource="#Application.DataSrc#">
	SELECT Patient_ID, Agency_Assigned_ID, First_Name_M0040, Last_Name_M0040, Middle_Initial_M0040, 
		Suffix_M0040, Street_Address, Mailing_Address, City, State_M0050, Zip_M0060, 
		Telephone, MSA_Code, DOB_M0066, Gender_M0069, SSN_M0064, SSN_M0064_NA, HI_Claim_Number,
		Current_Payment_Sources_M0150, Race_M0140, Primary_ReferringPhys_ID_M0072,
		Home_Directions, Specific_Concerns, AD_on_File, AD_Content, AD_Eff_Date, 
		Code_Status, Code_Status_Eff_Date, Status, Payer_ID, Employee_ID, 
		Medicare_Number_M0063, Medicare_Number_NA_M0063, Medicaid_Number_M0065, 
		Medicaid_Number_NA_M0065, Allergies, Admission_Status, Referral_ID, Priority, M1100_Living_Situation,
		Latitude,Longitude
	FROM #Request.prefix_db_agency#.patient
	WHERE Patient_ID =<cfif isdefined('URL.pid')>#session.cs.patientid#<cfelse>#URL.pid#</cfif>
	AND patient.Agency_ID = #session.AgencyID#
</cfquery>

<!--- Get Physician--->
<cfquery name="GetPhy" datasource="#Application.DataSrc#">
<!---SELECT Physician.Physician_ID,Physician.Fax, Employee.Last_Name, Employee.First_Name,Employee.Address1,Employee.Address2,Employee.City,Employee.State,Employee.Cell_Phone,Employee.Zip, Employee.Home_Phone as Telephone1,Physician.Fax,Physician.Natl_Provider_ID
	FROM Employee
	left outer join Physician on Employee.Employee_ID = Physician.Employee_ID
    WHERE Physician.Physician_ID = '#GetP.Primary_ReferringPhys_ID_M0072#' AND Employee.EmployeeType = 'Physician'--->
	
		select e.employee_id,first_name,last_name,e.Address1,e.Address2,e.City,e.State,e.Zip,e.Cell_Phone,Email,Status,p.Natl_Provider_ID,p.Fax,pp.Physician_ID from #Request.prefix_db_lookup#.Employee e
inner join patientphysician pp on pp.patient_Id=<cfif isdefined('URL.pid')>#session.cs.patientid#<cfelse>#URL.pid#</cfif>
inner join Physician p on p.employee_id=e.employee_id and p.Physician_ID=pp.Physician_ID
where e.EmployeeType='Physician'
</cfquery>
<cfquery name="GetR" datasource="#Application.DataSrc#">
	SELECT Patient_ID,ContactName,ContactType,NPI,Referral_ID,Telephone1,ContactStreet,ContactCity,ContactState,ContactZip
	FROM   #Request.prefix_db_agency#.PatientContact
	WHERE  Patient_ID = <cfif isdefined('URL.pid')>#session.cs.patientid#<cfelse>#URL.pid#</cfif>
</cfquery>
<cfquery name="GetRefSource" datasource="#Application.DataSrc#">
	SELECT Patient_ID,Referral_ID
	FROM   #Request.prefix_db_agency#.patient
	WHERE  Patient_ID = <cfif isdefined('URL.pid')>#session.cs.patientid#<cfelse>#URL.pid#</cfif>
</cfquery>
<cfquery name="GetRefcontact" datasource="#Application.DataSrc#">
	SELECT Referral_ID,R_Contact_Name,R_Address_1,R_City,R_State,R_Zip,R_Phone,R_NPI
	FROM  #Request.prefix_db_agency#.Referral
	WHERE  Referral_ID = #GetRefSource.Referral_ID#
</cfquery>
<!---<cfquery name="GetPhys" datasource="#Application.DataSrc#">
	SELECT Physician.Physician_ID,Physician.Fax, Employee.Last_Name, Employee.First_Name,Employee.Address1,Employee.Address2,Employee.City,Employee.State,Employee.Cell_Phone,Employee.Zip
	FROM   Employee
	Left Outer Join Physician on Employee.Employee_ID = Physician.Employee_ID
	WHERE Employee.Agency_ID = #session.AgencyID#
	AND   Employee.status = 'active' 
	AND   Employee.EmployeeType = 'Physician'
	

</cfquery>--->
<cfquery name="GetPay" datasource="#Application.DataSrc#">
<!---	SELECT Payer_ID, PayName,Address1,Address2,City,State,Zip,Contact,Contact_Phone
	FROM   Payer
	WHERE  Agency_ID = #session.AgencyID#
	AND    PayerStatus = 'active'
	ORDER BY PayName--->
	
	select pr.Payer_ID,pr.PayName,Address1,pr.Address2,pr.City,pr.State,pr.Zip,pr.Contact,pr.Contact_Phone,pp.InsuredName,
 pp.RelationShip_to_Insured,pp.Insured_PolicyNumber,pp.InsuredIDNumber
	FROM  #Request.prefix_db_agency#.patientpayer pp
left outer join #Request.prefix_db_agency#.patient p on p.Patient_ID=pp.Patient_ID
left outer join #Request.prefix_db_agency#.Payer pr on pr.Payer_ID=pp.Payer_ID where p.Patient_ID=<cfif isdefined('URL.pid')>#session.cs.patientid#<cfelse>#URL.pid#</cfif>
</cfquery>

<cfdocument   format = "PDF"   orientation = "portrait" marginbottom=".5"  overwrite = "yes" margintop=".8" marginleft=".5" marginright=".5">
<cfdocumentitem type="header" >
	<table border="0" cellpadding="0" cellspacing="0" style='margin-top:none;padding-top:none;' width="100%">
		<tr>
			<td  align="left">
			Patient Information
			</td>
			<td align="right">
			<cfoutput>#getP.Last_Name_M0040#, #getP.First_Name_M0040#</cfoutput>
			</td>
		</tr>
		<tr>
			<td style="height:2px"> 
			
			</td>
		</tr>
		<tr>			 
			<td style="border-top:1px solid 666666;width:100%;" colspan="2">
			</td>
		</tr>
	
	</table>
</cfdocumentitem>
<table border="0" cellpadding="0" cellspacing="0" width="100%" style='margin-top:none;padding-top:none;' align="center">
<tr>
	<td align="left">
		<table style="font-family:Courier New;font-size:12px" width="100%">
			<tr>
				<td style="padding-top:3px">
				<cfoutput>
				#getP.Last_Name_M0040#, #getP.First_Name_M0040# #getP.Middle_Initial_M0040#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				<cfoutput>#GetP.Street_Address#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				<cfoutput>#GetP.Mailing_Address#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				<cfoutput>#GetP.City#,#GetP.State_M0050#  #GetP.Zip_M0060#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				Telephone <cfoutput>#GetP.Telephone#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				Advance directive 
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px;width:50%">
				Home Direction  <cfoutput>#GetP.Home_Directions#</cfoutput>
				</td>
			</tr>
		</table>
	</td>
	<td align="right">
		<table style="font-family:Courier New;font-size:12px" align="right">
			<tr>
				<td style="padding-top:3px">
					DOB <cfoutput>#DateFormat(GetP.DOB_M0066,"yyyy-mm-dd")#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				<cfoutput>#GetP.Gender_M0069#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				SSN <cfoutput>#GetP.SSN_M0064#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				 <cfoutput>#GetP.Race_M0140#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				Allergies <cfoutput>#GetP.Allergies#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				Code status <cfoutput>#GetP.Code_Status#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				Emergency
				</td>
			</tr>
		</table>
	</td>
</tr>

<tr style="font-family:Arial;font-size:14px;font-style:bold">
<td>
Contacts
</td>
</tr>
<tr>
						 
<td style="border: solid 1px black; width:100%" colspan="2">
</td>
</tr>
<cfset count=0 />
<cfloop query="GetR">
<tr>
<cfset count=count+1 />
	<td align="left">
		<table style="font-family:Courier New;font-size:12px">
			<tr>
			<td style="padding-top:3px">
				<cfoutput>#count#.</cfoutput>
			</td>
				<td style="padding-top:3px">
				
				<cfoutput>#GetR.ContactName#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				</td>
				<td style="padding-top:3px">
				<cfoutput>#GetR.ContactStreet#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				</td>
				<td style="padding-top:3px">
				<cfoutput>#GetR.ContactCity# #GetR.ContactState# #GetR.ContactZip#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				</td>
				<td style="padding-top:3px">
				<cfoutput>#GetR.Telephone1#</cfoutput>
				</td>
			</tr>
			
		</table>
	</td>
	<td align="right">
		<table style="font-family:Courier New;font-size:12px">
			<tr>
				<td style="padding-top:3px">
					
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
					Fax
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				NPI<cfoutput>#GetR.NPI#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				
				</td>
			</tr>
		
		</table>
	</td>
</tr>
</cfloop>


	<tr style="font-family:Arial;font-size:14px;font-style:bold">
		<td>
			Referral Sources
		</td>
	</tr>
<tr>
						 
<td style="border: solid 1px black; width:100%" colspan="2">
</td>
</tr>
	
	<cfset counting=0 />
<cfloop query="GetRefcontact">
<tr>
<cfset counting=counting+1 />
	<td align="left">
		<table style="font-family:Courier New;font-size:12px">
			<tr>
			<td style="padding-top:3px">
				<cfoutput>#counting#.</cfoutput>
			</td>
				<td style="padding-top:3px">				
				<cfoutput>#GetRefcontact.R_Contact_Name#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				</td>
				<td style="padding-top:3px">
				<cfoutput>#GetRefcontact.R_Address_1#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				</td>
				<td style="padding-top:3px">
				<cfoutput>#GetRefcontact.R_City# #GetRefcontact.R_State# #GetRefcontact.R_Zip#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				</td>
				<td style="padding-top:3px">
				<cfoutput>#GetRefcontact.R_Phone#</cfoutput>
				</td>
			</tr>
			
		</table>
	</td>
	<td align="right">
	<table style="font-family:Courier New;font-size:12px">
			
			<tr>
				<td style="padding-top:3px">
					Fax
				</td>
			</tr>
			
			<tr>
				<td style="padding-top:3px">
				NPI<cfoutput>#GetRefcontact.R_NPI#</cfoutput>
				</td>
			</tr>
		<!---	<tr>
				<td>
				
				</td>
			</tr>
			<tr>
				<td>
				
				</td>
			</tr>--->
		
		</table>
	</td>
</tr>
</cfloop>


<cfif GetPhy.Recordcount GT 0>
	
		<tr style="font-family:Arial;font-size:14px;font-style:bold">
		<td>
			Physicians
		</td>
	</tr>
<tr>
						 
<td style="border: solid 1px black; width:100%" colspan="2">
</td>
</tr>
	
	<cfset phycounting=0 />
<cfloop query="GetPhy">
<tr>
<cfset phycounting=phycounting+1 />
	<td align="left">
		<table style="font-family:Courier New;font-size:12px">
			<tr>
			<td style="padding-top:3px">
				<cfoutput>#phycounting#.</cfoutput>
			</td>
				<td style="padding-top:3px">
				
				<cfoutput>#GetPhy.first_name# #GetPhy.last_name#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				</td>
				<td style="padding-top:3px">
				<cfoutput>#GetPhy.Address1#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				</td>
				<td style="padding-top:3px">
				<cfoutput>#GetPhy.City# #GetPhy.State# #GetPhy.Zip#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				</td>
				<td style="padding-top:3px">
				<cfoutput>#GetPhy.Cell_Phone#</cfoutput>
				</td>
			</tr>
			
		</table>
	</td>
	<td align="right">
	<table style="font-family:Courier New;font-size:12px" align="right">
			
			<tr>
				<td align="right" style="padding-top:3px">
					<cfoutput>#GetPhy.Fax#</cfoutput>
				</td>
			</tr>
			
			<tr>
				<td align="right" style="padding-top:3px">
				<cfoutput>#GetPhy.Natl_Provider_ID#</cfoutput>
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				
				</td>
			</tr>
			<tr>
				<td style="padding-top:3px">
				
				</td>
			</tr>
		
		</table>
	</td>
</tr>
</cfloop>
</cfif>

<cfif GetPay.Recordcount GT 0>
<tr style="font-family:Arial;font-size:14px;font-style:bold">
		<td>
			Payers
			
		</td>
	</tr>
	<tr>
						 
<td style="border: solid 1px black; width:100%" colspan="2">
</td>
</tr>
<cfset paycounting=0 />
<cfloop query="GetPay">
<tr>
<cfset paycounting=paycounting+1 />
	<td align="left">
		<table style="font-family:Courier New;font-size:12px">
			<tr>
			<td>
				<cfoutput>#paycounting#.</cfoutput>
			</td>
				<td>
				
				<cfoutput>#GetPay.PayName#</cfoutput>
				</td>
			</tr>
			<tr>
				<td>
				</td>
				<td>
				<cfoutput>#GetPay.Address1# #GetPay.Address2#</cfoutput>
				</td>
			</tr>
			<tr>
				<td>
				</td>
				<td>
				<cfoutput>#GetPay.City# #GetPay.State# #GetPay.Zip#</cfoutput>
				</td>
			</tr>
			<tr>
				<td>
				</td>
				<td>
				<cfoutput>#GetPay.Contact#</cfoutput>
				</td>
			</tr>
				<tr>
				<td>
				</td>
				<td>
				<cfoutput>#GetPay.Contact_Phone#</cfoutput>
				</td>
			</tr>
		</table>
	</td>
	<td align="right">
	<table style="font-family:Courier New;font-size:12px">
			
			<tr>
				<td>
					Insured's Name  <cfoutput>#GetPay.InsuredName#</cfoutput>
				</td>
			</tr>
			
			<tr>
				<td>
				Patient Relationship to Insured  <cfoutput>#GetPay.RelationShip_to_Insured#</cfoutput>
				</td>
			</tr>
			<tr>
				<td>
				Insured's Policy Number  <cfoutput>#GetPay.Insured_PolicyNumber#</cfoutput>
				</td>
			</tr>
			<tr>
				<td>
				Insured's ID Number  <cfoutput>#GetPay.InsuredIDNumber#</cfoutput>
				</td>
			</tr>
		
		</table>
	</td>
</tr>
</cfloop>
</cfif>	
</table>
</cfdocument>
