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The current entity relationship diagram is at dbdocs.io/hosteddb_support/hosted_database_snowflake.

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Advance Notices

Changes that have been announced but have not yet reached General Availability (GA). Each entry names the change category under Change Management, the table affected, and the GA date. Where a change can be queried ahead of that date, the entry links to its Early Release notes.
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Early Release
lab_order_tests, breaking change, GA 2026-09-13. uq_lab_order_tests becomes a stable key identifying the pairing of an order and a test, so editing an order updates the row already there rather than adding another, and a test removed from an order is retained and marked with a new is_deleted column. Anything that stores or joins on uq_lab_order_tests must be updated, because the values change. Row counts against this table will shift too.Available now as lab_order_tests_early_release. Change notes
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Early Release
user, breaking change, GA 2026-09-13. direct_message_address becomes the Direct address Elation has provisioned for a provider, rather than the address the most recent inbound Direct message was sent to. Far more rows are populated, a small number change to a different address, and a small number lose their value.Available now as user_early_release. Change notes

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GA Releases

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GA
Six new Elation Billing tables. elation_billing_user names the billers, administrators, and practice staff who work claims, and makes the user references on the other new tables resolve to a person. claim_queue records which biller sent each claim out to the clearinghouse and when. charge_dx holds the diagnosis codes on each charge line, and payer_address the addresses paper claims are mailed to. claim_note and payment_note are the notes billers leave on claims and on payments, each with the note text, the author, and the timestamp.Full release notes
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GA
patient_history is now documented: the entries recorded in the History section of a patient’s chart, covering past medical and surgical history, social history, habits, family history, smoking status, and health maintenance notes. The table was already in your Hosted Database; it now has full column descriptions and an article explaining the type column, including how health maintenance notes differ from the health_maintenance table.Full release notes
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GA
New Elation Billing table: clearinghouse_message - the individual messages the ClaimMD clearinghouse returns against a claim submission, including validation and scrubbing errors, acknowledgments, and payment detail lines from an ERA. Documented together with its parent table in the Clearinghouse transactions and messages article.Full release notes
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GA
health_maintenance table added: preventive care item completions with measure name, completion date, clinician note, quality measure code, and result flags. New Elation Billing table: payer - the payers a practice bills, combined with the Claim.MD payer directory, including which transaction types Claim.MD supports for each payer.Full release notes
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GA
patient_problem_code: use the single is_deleted boolean to filter deleted rows. deletion_time and deleted_by_user_id are deprecated — they remain on the table but are now always null and will be fully removed at a future date. Also fixes duplicate-code and deleted-problem inconsistencies so deletion state matches the Elation application.Full release notes
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GA
Three Elation Billing tables: insurance_eligibility_check, patient_insurance_eligibility, clearinghouse_transaction. Also renames patient_guarantor.guarantor to the boolean is_guarantor.Full release notes
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GA
Six Elation Billing tables: patient_guarantor, patient_statement_tracking, user_practice, elation_sso_user, payment, financial_transaction.Full release notes
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GA
Detailed billing status on each bill, plus the rendering, supervising, billing, and referring providers.Full release notes
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GA
Five Elation Billing lookup tables (legal_entity, worklist, worklist_reason, tag_system, tag); claim.legal_entity_id documented as a foreign key.Full release notes
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GA
Consistent visit-note deletion across bill, bill_item, bill_item_dx; unified is_deleted flag.Full release notes
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GA
New elation_billing schema: era_matched_adjustment, user_role, claim, authorization.Full release notes
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GA
recurring_event_group and recurring_event_schedule promoted to GA.Full release notes
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GA
office_messages report_id; med_order prescription lifecycle; Elation Note beta tables.Full release notes
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GA
physician_license expansion; ethnicity fields overhaul; loinc_code replaces loinc_id.Full release notes
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GA
Timestamp standardization to TIMESTAMPNTZ(9); Event Streaming migration.Full release notes
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GA
medication_rxnorm.is_deleted; appointment in_person_or_virtual and instructions.Full release notes
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GA
med_order.days_supply; patient full_name, consented, gender_identity update.Full release notes
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GA
New physician_license and provider_availability tables; visit_note time columns.Full release notes
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GA
patient primary_care_provider_id, primary_care_provider_npi, pronouns.Full release notes
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GA
patient.deceased_date; visit_note_bullet.is_deleted; user.direct_message_address.Full release notes
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GA
patient_employer.is_deleted.Full release notes
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GA
referral_order lifecycle columns; misc_orders.is_deleted and resolution_state.Full release notes
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GA
Audit columns for patient_tag and document_tag; patient.patient_status.Full release notes
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GA
appointment.service_location_id; service_location.name.Full release notes

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Beta Releases

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Beta
bill_item_dx schema overhaul; visit_note_bullet.replaced_by_visit_note_bullet_id.
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Beta
clinical_form_collection.is_deleted; visit_note_bullet audit columns.
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Beta
is_deleted added to 10 tables; unique key rebuild required.
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Beta
uq_{tablename} and hdb_last_sync added to all tables.
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Beta
Views replaced by tables (report, report_addendum, report_document_tag).