SELECT p.ClientID, p.StartOfCare, PhyContact.CombinedName AS PhyName, p.Address, p.City, p.State, p.Zip, 
PhyContact.TaxonomyCode AS PhyTaxID, PhyContact.NPI AS PhyNPI, contact.CompanyName AS InsuranceName, PIns.InsuranceNumber, 
pl.Locationid AS Facility, p.County AS PatientCounty, p.DOB, p.Sex AS Gender, p.eightyoneA, Client.ClientName, 
Client.Address AS ClientAddress, Client.City AS ClientCity, Client.State AS ClientState, Client.Zip AS ClientZip, 
Client.PhoneNumber AS ClientPhone, Client.FaxNumber AS ClientFax, Client.NPI AS ClientNPI, Client.FEIN AS ClientTaxID, 
Client.CCN AS PTAN, p.ID, p.MRNum, p.Compined, p.PrimDiag, pl.Location4, pl.NPI AS FacilityNPI, LocContact.CompanyName 
FROM (Patient p
	 LEFT OUTER JOIN (PatientLocation pl
		 LEFT OUTER JOIN contact LocContact
			 ON  pl.ContactID = LocContact.id )
		 ON  pl.Patientid4 = p.ID 
	 LEFT OUTER JOIN (PatientPhysician Pphy
		 LEFT OUTER JOIN contact PhyContact
			 ON  Pphy.PhysicianID = PhyContact.id )
		 ON  Pphy.PatientID = p.ID  AND  Pphy.Role = 'Attending' 
	 LEFT OUTER JOIN Client Client
		 ON  p.ClientID = Client.ID 
	 LEFT OUTER JOIN (PatientInsurance PIns
		 LEFT OUTER JOIN contact contact
			 ON  PIns.InsuranceID = contact.id )
		 ON  pIns.PatientID = p.ID  AND  pIns.PrimaryOrSecondary = 'Primary' )

SELECT TOP(1) pl.Patientid4, pl.ContactID, pl.ID4, pl.Locationid, pl.Location4, pl.NPI, LocContact.CompanyName
FROM PatientLocation pl LEFT OUTER JOIN
           contact LocContact ON pl.ContactID = LocContact.id
ORDER BY pl.ID4 DESC

	JOIN
	(
		SELECT	[T_RowNumber] = ROW_NUMBER()
				OVER
				(
					PARTITION BY PKey1, PKey2, ...
					ORDER BY PKey1, PKey2, ..., ID4
				),
			PKey1,
			PKey2,
			...
		FROM	PatientLocation
	) AS X
		 ON X.T_RowNumber = 1	-- FIRST row for each patient only
		AND X.PKey1 = P.PKey1
		AND X.PKey2 = P.PKey2
		AND ...