CREATE UNIQUE CLUSTERED INDEX [CI_Patient_PracticeID_PatientID] ON [dbo].[Patient] 
(
	[PracticeID] ASC,
	[PatientID] ASC
)WITH (PAD_INDEX  = OFF, STATISTICS_NORECOMPUTE  = OFF, SORT_IN_TEMPDB = OFF, IGNORE_DUP_KEY = OFF, DROP_EXISTING = OFF, ONLINE = OFF, ALLOW_ROW_LOCKS  = ON, ALLOW_PAGE_LOCKS  = ON) ON [PRIMARY]
GO

CREATE TABLE [dbo].[Patient]...
...
CONSTRAINT [PK_Patient] PRIMARY KEY NONCLUSTERED 
(
	[PatientID] ASC
)WITH (PAD_INDEX  = OFF, STATISTICS_NORECOMPUTE  = OFF, IGNORE_DUP_KEY = OFF, ALLOW_ROW_LOCKS  = ON, ALLOW_PAGE_LOCKS  = ON) ON [PRIMARY]
) ON [PRIMARY]

CREATE PROCEDURE dbo.PatientDataProvider_UpdatePatient
	@patient_id INT,
	@prefix VARCHAR(16),
	@first_name VARCHAR(32),
	@middle_name VARCHAR(32),
	@last_name VARCHAR(32),
	@suffix VARCHAR(16),
	@address_1 VARCHAR(128) = NULL,
	@address_2 VARCHAR(128) = NULL,
	@city VARCHAR(32) = NULL,
	@state VARCHAR(2) = NULL,
	@country VARCHAR(32) = NULL,
	@zip VARCHAR(9) = NULL,
	@gender VARCHAR(1) = 'U',
	@marital_status VARCHAR(1) = 'U',
	@home_phone VARCHAR(10) = NULL,
	@home_phone_x VARCHAR(10) = NULL,
	@work_phone VARCHAR(10) = NULL,
	@work_phone_x VARCHAR(10) = NULL,
	@dob DATETIME = NULL,
	@ssn CHAR(9) = NULL,
	@email VARCHAR(128) = NULL,
	@sendEmailCorrespondence BIT = 1,
	@guarantor_different BIT = 0,
	@employment_status CHAR(1) = NULL,
	@referrer_id INT = NULL,
	@primary_provider_id INT = NULL,
	@patient_referral_source_id INT = NULL,
	@patient_default_location_id INT = NULL,
	@employer_id INT = NULL,
	@medical_record_number VARCHAR(128) = NULL,
	@mobile_phone VARCHAR(10) = NULL,
	@mobile_phone_x VARCHAR(10) = NULL,
	@primary_care_physician_id INT = NULL,
	@modified_user_id INT = 0,
	@active BIT,
	@PhonecallRemindersEnabled BIT = 0,
	@EmergencyName VARCHAR(128) = NULL,
	@EmergencyPhone VARCHAR(10) = NULL,
	@EmergencyPhoneExt VARCHAR(10) = NULL
AS
BEGIN
	
	IF @email IS NULL OR LTRIM(@email) = ''
	BEGIN
		SET @sendEmailCorrespondence = 0 ;
	END
	
	UPDATE	dbo.Patient
	SET	Prefix = @prefix,
		FirstName = @first_name,
		MiddleName = @middle_name,
		LastName = @last_name,
		Suffix = @suffix,
		AddressLine1 = @address_1,
		AddressLine2 = @address_2,
		City = @city,
		State = @state,
		Country = @country,
		ZipCode = @zip,
		Gender = @gender,
		MaritalStatus = @marital_status,
		HomePhone = @home_phone,
		HomePhoneExt = @home_phone_x,
		WorkPhone = @work_phone,
		WorkPhoneExt = @work_phone_x,
		DOB = @dob,
		SSN = @ssn,
		EmailAddress = RTRIM(LTRIM(@email)),
		SendEmailCorrespondence = @sendEmailCorrespondence,
		ResponsibleDifferentThanPatient = @guarantor_different,
		EmploymentStatus = @employment_status,
		ReferringPhysicianID = @referrer_id,
		PrimaryProviderID = @primary_provider_id,
		PatientReferralSourceID = @patient_referral_source_id,
		DefaultServiceLocationID = @patient_default_location_id,
		EmployerID = @employer_id,
		MedicalRecordNumber = @medical_record_number,
		MobilePhone = @mobile_phone,
		MobilePhoneExt = @mobile_phone_x,
		PrimaryCarePhysicianID = @primary_care_physician_id, 
		ModifiedDate = GETDATE(),
		ModifiedUserID = @modified_user_id,
		Active = @Active,
		PhonecallRemindersEnabled = @PhonecallRemindersEnabled,
		EmergencyName = @EmergencyName,
		EmergencyPhone = @EmergencyPhone,
		EmergencyPhoneExt = @EmergencyPhoneExt
	WHERE	PatientID = @patient_id ;
END

SET @var = CONTEXT_INFO();
IF @var != 0x1256698456
BEGIN
    -- do update as usual
END