> ## Documentation Index
> Fetch the complete documentation index at: https://help.elationhealth.com/llms.txt
> Use this file to discover all available pages before exploring further.

# 2026-10-23

This release links orders to the note they were placed from, flags confidential notes, reports, and orders, and adds the date a clinical form was administered. All three are non-breaking changes under [Change Management](https://help.elationhealth.com/articles/hdb/change-management.md): columns are added and no existing column changes.

## Schema Changes

| Table | Column | Change |
| - | - | - |
| lab\_order, med\_order, discontinue\_med\_order, referral\_order, misc\_orders | `visit_note_id` | New column: the visit note the order was placed from. Joins to `visit_note.id` |
| lab\_order, med\_order, discontinue\_med\_order, referral\_order, misc\_orders | `non_visit_note_id` | New column: the non-visit note the order was placed from. Joins to `non_visit_note.id` |
| clinical\_form\_collection | `screening_date` | New column: when the form was administered |
| visit\_note, non\_visit\_note, report, lab\_order, referral\_order | `confidential` | New column: whether the document is marked confidential in the chart |
| visit\_note, non\_visit\_note, report, lab\_order, referral\_order | `confidential_marked_by_user_id` | New column: the user who marked the document confidential. Joins to `user.id` |

***

## Release Highlights

**Orders linked to the note they were placed from**

An order placed from inside a visit note or a non-visit note, such as a phone note, now carries that note's id. This connects orders to the visit they came from: the visit type, the diagnoses on the note, and whether the order was placed during a visit or between visits. Both columns are empty for an order created outside a note. See [Ordering medical tests for your patients](https://help.elationhealth.com/articles/Order-Forms-Introduction-Ordering-medical-tests-for-your-patients.md) for how orders are placed in the chart.

**Working with these columns**

* Filter `med_order.origin = 'rx'` to count prescriptions placed outside a note. Rows with `origin = 'surescripts'` are imported medication history and never carry a note.
* Count orders in `misc_orders` with `count(distinct id)`. The table has one row per order for each test and diagnosis code on it.

Example queries are in [Visit Notes](https://help.elationhealth.com/articles/hdb/visit-notes.md#orders-placed-from-a-note).

**Confidential notes, reports, and orders**

`confidential` is `true` when a note, report, or order is marked confidential in the chart, and `confidential_marked_by_user_id` names the user who marked it. `confidential_marked_by_user_id` is empty when the document is not confidential. See [Managing confidential records](https://help.elationhealth.com/articles/confidential-items-in-your-patient-chart.md) for how records are marked.

This counts confidential visit notes by month, leaving out deleted notes:

```sql theme={null}
select date_trunc('month', document_date) as month, count(*) as confidential_visit_notes
from visit_note
where confidential
  and deletion_time is null
group by 1
order by 1
```

**When a clinical form was administered**

`screening_date` is when a form such as a PHQ-9 was administered. `creation_time` is when it was saved in Elation. Use `screening_date` to report when a screening happened, and `creation_time` to audit when it was documented.

`screening_date` defaults to when the clinician opened the form, or when the patient submitted it for a patient form, so it is usually a little earlier than `creation_time`: minutes for forms filled out in the chart, sometimes days for patient forms. That gap on its own does not mean the form was backdated. Clinicians can also change the date, including after the form is saved. See [Structured Questionnaires](https://help.elationhealth.com/articles/structured-questionnaires.md) for the forms in the chart.

`clinical_form_collection` has one row per question on a form, so every row of a form carries the same `screening_date`.

The new columns are described in the [Hosted Database schema](https://help.elationhealth.com/articles/hdb/schema.md).

*If you have any questions about this topic please reach out to [Elation Support Portal](https://help.elationhealth.com/articles/support-portal-introduction.md) with the subject line HDB - \<your\_question>*