Try

SELECT *, IDENTITY(int, 1,1) AS sn, 1 AS FirstCaseFlag  
	INTO #temp01
	FROM (
		SELECT convert(varchar(10),dbo.meetings.BeginTime,101) as CaseDate,
		...) 
UPDATE #temp01 
	SET FirstCaseFlag = 0
	FROM #temp01 
	JOIN #temp01 t01 
		ON #temp01.CaseDate = t01.CaseDate
		   AND #temp01.RoomName = t01.RoomName
			AND #temp01.sn > t01.sn
SELECT * FROM #temp01
DROP TABLE #temp01			

>The query belows returns a set of records ordered by date and roomname
>I'd like to create a flag field that shows if that record is the first
>record in the Room for the same date.
>

>Example    Case Date     Room Name   ....other fields   FirstCaseFlag
>Record 1   2004-12-14     ROOM 1                           1
>Record 2   2004-12-14     ROOM 1                           0
>Record 3   2004-12-14     ROOM 1                           0
>Record 4   2004-12-14     ROOM 2                           1
>Record 5   2004-12-14     ROOM 2                           0
>

>
>Anybody know how I can reword the query/stored procedure?
>
>Thanks
>
>
>
>

>select * from
>(
>SELECT
>convert(varchar(10),dbo.meetings.BeginTime,101) as CaseDate,
>dbo.Get_PrimaryProcSurgeonByMeetID(meetings.MeetingNumber) as PrimarySurgeon,
>dbo.Get_ProceduresOnCase(meetings.Meetingnumber) as ProceduresOnCase,
>dbo.Get_ProcsOnCase(meetings.MeetingNumber) as ProcedureCount,
>(Select RoomName from dbo.coRooms where dbo.coRooms.RoomID = dbo.meetings.RoomID) as RoomName,
>convert(varchar(10),dbo.meetings.EnterOR,114) as EnterOR,
>convert(varchar(10),dbo.meetings.ProcStart,114) as ProcStart,
>convert(varchar(10),dbo.meetings.ProcEnd,114) as ProcEnd,
>convert(varchar(10),dbo.meetings.ExitOR,114) as ExitOR,
>convert(varchar(10),dbo.meetings.BeginTime,114) as ScheduledStart,
>dbo.meetings.iscancelled,
>dbo.meetings.CancelDate,
>datediff(mi,dbo.meetings.EnterOr,dbo.meetings.ExitOR) as RoomMinutes,
>datediff(mi,dbo.meetings.ProcStart, dbo.meetings.ProcEnd) as ProcMinutes,
>dbo.meetings.DeptID
>
>FROM    dbo.meetings
>WHERE     (dbo.meetings.iscompleted = 1 )
>and dbo.meetings.begintime between @ttStartDate and @ttEndDate
>AND dbo.meetings.deptid=@tiDeptID
>and dbo.meetings.iscancelled=0
>and dbo.meetings.isblock=0
>and dbo.meetings.RoomClosed=0) det
>order by CaseDate,roomname,enterOR
>