@admin I did one quick test. My assumption was that all of the ON statements would align. That is not what happened.
select
*
FROM dbs.clr_tdl_tran ttr
INNER JOIN dbs.ptr pat ON ttr.int_pat_id = pat.pat_id
and 1 =1
LEFT OUTER JOIN dbs.valid_ptr vpat ON pat.pat_id = vpat.pat_id
INNER JOIN dbs.account a ON ttr.account_id = a.account_id
INNER JOIN dbs.clr_ser ser ON ttr.performing_pr_id = ser.emm_pr_id
or ttr.dog = ser.cat
INNER JOIN dbs.clr_ser bser ON ttr.billing_prider_id = bser.emm_pr_id
INNER JOIN dbs.clr_dep dep ON ttr.dept_id = dep.department_id