How can I use Indexed Temp tables to optimize performance?

Question

Instead of joining two CTEs together, I am now going to attempt to join two indexed temp tables. 
The first temp table is a number of encounters that returns 147 rows in 2 seconds. The second temp table
is progress notes for all those encounters returning 136 rows in 18 seconds. Joining the indexed views comes back at 3 1/2 minutes.
What can I do to optimize performance?
Code is below. Thanks in advance!
if object_id('tempdb..#arpb') is not null begin drop table #arpb end;
if object_id('tempdb..#progress_notes') is not null begin drop table #progress_notes end;
SELECT DISTINCT
ARPB.PAT_ENC_CSN_ID, ARPB.SERVICE_DATE, ARPB.BILLING_PROV_ID, ARPB.DEPARTMENT_ID,
SER.PROV_NAME, DEP.DEPARTMENT_NAME, E.APPT_TIME, ZC_APPT.NAME AS APPT_STATUS
INTO #arpb
FROM ARPB_TRANSACTIONS ARPB
LEFT OUTER JOIN CLARITY_SER AS SER ON SER.PROV_ID = ARPB.BILLING_PROV_ID
LEFT OUTER JOIN CLARITY_DEP AS DEP ON DEP.DEPARTMENT_ID = ARPB.DEPARTMENT_ID
LEFT OUTER JOIN PAT_ENC AS E ON E.PAT_ENC_CSN_ID = ARPB.PAT_ENC_CSN_ID
LEFT OUTER JOIN ZC_APPT_STATUS AS ZC_APPT ON ZC_APPT.APPT_STATUS_C = E.APPT_STATUS_C
WHERE ARPB.DEPARTMENT_ID = xxxx
AND ARPB.TX_TYPE_C = 1
AND ARPB.VOID_DATE IS NULL
AND ARPB.BILLING_PROV_ID = xxxx
AND ARPB.SERVICE_DATE BETWEEN
'xxxx' AND 'xxxxx'
create clustered index idx_temp_arpb on #arpb(PAT_ENC_CSN_ID)
SELECT DISTINCT
ARPB.PAT_ENC_CSN_ID,
ZCNT.NAME AS NOTE_TYPE, PR.NAME AS PURPOSE, HNO_INFO.NOTE_ID,
EMP.NAME AS EMP_NAME, STS.NAME AS NOTE_STATUS
INTO #progress_notes
FROM ARPB_TRANSACTIONS ARPB
LEFT OUTER JOIN ENC_NOTE_INFO AS ENC_NOTE_INFO ON ARPB.PAT_ENC_CSN_ID = ENC_NOTE_INFO.PAT_ENC_CSN_ID
LEFT OUTER JOIN HNO_INFO AS HNO_INFO ON ENC_NOTE_INFO.ENCOUNTER_NOTE_ID = HNO_INFO.NOTE_ID
LEFT OUTER JOIN ZC_NOTE_TYPE AS ZCNT ON ZCNT.NOTE_TYPE_C = ENC_NOTE_INFO.NOTE_TYPE_C
LEFT OUTER JOIN ZC_NOTE_PURPOSE AS PR ON PR.NOTE_PURPOSE_C = HNO_INFO.NOTE_PURPOSE_C
LEFT OUTER JOIN CLARITY_EMP AS EMP ON EMP.EPIC_EMP_ID = HNO_INFO.CURRENT_AUTHOR_ID
LEFT OUTER JOIN ZC_NOTE_STATUS AS STS ON STS.NOTE_STATUS_C = ENC_NOTE_INFO.NOTE_STATUS_C
WHERE ARPB.DEPARTMENT_ID = xxxx
AND ARPB.TX_TYPE_C = 1
AND ARPB.VOID_DATE IS NULL
AND ARPB.BILLING_PROV_ID = xxxx
AND ZCNT.NAME = 'xxxx'
AND ARPB.SERVICE_DATE BETWEEN
'xxxx' AND 'xxxx'
AND PR.NAME = 'xxxxx'
create index idx_temp_pn on #progress_notes(PAT_ENC_CSN_ID)
SELECT
#arpb.PAT_ENC_CSN_ID,
#arpb.APPT_TIME,
#arpb.SERVICE_DATE,
#arpb.BILLING_PROV_ID,
#arpb.PROV_NAME,
#arpb.DEPARTMENT_ID,
#arpb.DEPARTMENT_NAME,
#progress_notes.EMP_NAME as NoteEmp,
CASE #progress_notes.NOTE_ID
WHEN null THEN 'No Progress Note'
ELSE #progress_notes.NOTE_ID
END as NoteId,
#progress_notes.NOTE_STATUS,
#progress_notes.NOTE_TYPE,
#progress_notes.PURPOSE
FROM #ARPB
LEFT JOIN #PROGRESS_NOTES ON #ARPB.PAT_ENC_CSN_ID = #PROGRESS_NOTES.PAT_ENC_CSN_ID
To err is human, to REALLY foul things up requires a computer

Answer 1

Something is not right here. What is the type of that column in both temp tables?
I would assume that joining 147 and 136 rows should be done in less than 1 sec. even without indexes.
How did you measure the time?
BTW, I suggest to use aliases in your last query - it will be easier to read. Also use COALESCE function instead of CASE for the Note_ID (BTW, is Note_ID a character column - otherwise you supposed to get an error).
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