$re = '/(\/)(?:[A-Z2-7]{8})*(?:[A-Z2-7]{2}={6}|[A-Z2-7]{4}={4}|[A-Z2-7]{5}={3}|[A-Z2-7]{7}=)?(\/|$)|(\/)(\d*?)(\/|$)/';
$str = '/emrc/patient/123';
$subst = "/";
$result = preg_replace($re, $subst, $str, 1);
echo "The result of the substitution is ".$result;
Please keep in mind that these code samples are automatically generated and are not guaranteed to work. If you find any syntax errors, feel free to submit a bug report. For a full regex reference for PHP, please visit: http://php.net/manual/en/ref.pcre.php