Dal.fs

    let internal save connection apptId apptPatientId apptPatientInfoId apptProviderScheduledId apptFacilityId apptStartTime apptEndTime apptTypeId apptStatus apptBillingStage apptLoS apptCheckInFlag apptCheckInTime apptCheckOutTime apptForeignEhrId apptAccidentRelated apptAccidentId apptAccidentDate apptAccidentState presentingCondition notesToBiller isChecked apptPrimaryGuarantorType admitStatus (admitFacilityId:int Nullable) referralPcp = 

        let admitStatus = if String.IsNullOrEmpty(admitStatus) then null else admitStatus
        getScalar connection false (fun db -> db.UspAppointmentsInsUpd(apptId, apptPatientId, apptPatientInfoId, apptProviderScheduledId, apptFacilityId, apptStartTime, apptEndTime, apptTypeId, apptStatus, apptBillingStage, apptLoS, apptCheckInFlag, apptCheckInTime, apptCheckOutTime, apptForeignEhrId, apptAccidentRelated, apptAccidentId, apptAccidentDate, apptAccidentState, presentingCondition, notesToBiller, isChecked, apptPrimaryGuarantorType,admitStatus=admitStatus,admitFacilityId=admitFacilityId,referralPcp=referralPcp))

    let SaveConn con apptId apptPatientId apptPatientInfoId apptProviderScheduledId apptFacilityId apptStartTime apptEndTime apptTypeId apptStatus apptBillingStage apptLoS apptCheckInFlag apptCheckInTime apptCheckOutTime apptForeignEhrId apptAccidentRelated apptAccidentId apptAccidentDate apptAccidentState presentingCondition notesToBiller isChecked apptPrimaryGuarantorType admitStatus admitFacilityId referralPcp = 
        save (SqlConn.Conn con) apptId apptPatientId apptPatientInfoId apptProviderScheduledId apptFacilityId apptStartTime apptEndTime apptTypeId apptStatus apptBillingStage apptLoS apptCheckInFlag apptCheckInTime apptCheckOutTime apptForeignEhrId apptAccidentRelated apptAccidentId apptAccidentDate apptAccidentState presentingCondition notesToBiller isChecked apptPrimaryGuarantorType admitStatus admitFacilityId referralPcp
        
    // instead of 
    let SaveConn' con = save (SqlConn.Conn con)
    // this version while vastly shorter gives no information about parameter names in either F# or C# when called

With this many parameters (and this much "metadata" such as parameter names) it can make sense to use a either a static member or an instance member on a context type. Some parameters can be associated with the type, and the remaining parameters with the method. And both can use named/optional arguments.

type Connection(connection) = 
    let conn = SqlConn.Conn connection
    member __.SaveAppointment(referralPcp, id, patientId, patientInfoId, providerScheduledId, facilityId, startTime, endTime, typeId, status, billingStage, los, checkInFlag, checkInTime, checkOutTime, foreignEhrId, accidentRelated, accidentId, accidentDate, accidentState, presentingCondition, notesToBiller, isChecked, primaryGuarantorType, ?admitStatus, ?admitFacilityId:int) =  
        let admitStatus = defaultArg admitStatus null 
        getScalar connection false (fun db -> db.UspAppointmentsInsUpd(id, patientId, patientInfoId, providerScheduledId, facilityId, startTime, endTime, typeId, status, billingStage, los, checkInFlag, checkInTime, checkOutTime, foreignEhrId, accidentRelated, accidentId, accidentDate, accidentState, presentingCondition, notesToBiller, isChecked, primaryGuarantorType, admitStatus, admitFacilityId, referralPcp)) 


let conn = Connection(...)
conn.SaveAppointment(referralPcp, Id, patientId, patientInfoId, providerScheduledId, facilityId, startTime, endTime, typeId, status, billingStage, los, checkInFlag, checkInTime, checkOutTime, foreignEhrId, accidentRelated, accidentId, accidentDate, accidentState, presentingCondition, notesToBiller, isChecked, primaryGuarantorType, admitStatus, admitFacilityId)

This works particularly well if there are multiple operations closing over the same context parameters.

There are other variations on this that can serve just as well. A record doesn't cope well with named/optional arguments, except by adding a static "Create" member which makes things optional, which is also ok.