> ## 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.

# Release Notes

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The current entity relationship diagram is at [dbdocs.io/hosteddb\_support/hosted\_database\_snowflake](https://dbdocs.io/hosteddb_support/hosted_database_snowflake).

## Advance Notices

Changes that have been announced but have not yet reached General Availability (GA). Each entry names the change category under [Change Management](/articles/hdb/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](/articles/hdb/early-release) notes.

<Update label="2026-10-02-1" tags={["Behavior change"]}>
  **`patient_tag`, GA 2026-10-09.** Changing a patient's tag updates the existing row rather than adding a second row with the same `id`, so each patient tag carries only its current `tag_value`. Most Hosted Databases see no change in row count; the most affected loses up to 6.4% of rows. `uq_patient_tag` values change on every row, so incremental loads keyed on it need a full reload.

  Available now as `early_release.patient_tag`. [Change notes](/articles/hdb/early-release#one-row-per-patient-tag)
</Update>

<Update label="2026-10-02-2" tags={["Behavior change"]}>
  **`caregaps`, `caregap_definitions`, `caregaps_engagement`, GA 2026-10-09.** Deleted care gaps and definitions are kept and marked `is_deleted = true` rather than disappearing. Most deleted gaps still read `status = 'open'`, so open-gap counts that do not filter on `is_deleted` rise by about 55% across Hosted Databases with Care Gaps. `caregaps_engagement.hdb_last_sync` becomes the row's refresh time rather than the event time.

  Available now as `early_release.caregaps`, `early_release.caregap_definitions`, and `early_release.caregaps_engagement`. [Change notes](/articles/hdb/early-release#deleted-care-gaps-are-kept-and-flagged)
</Update>

## GA Releases

<Update label="2026-10-02" tags={["GA"]}>
  The two behavior changes announced on 2026-09-24 reach GA. `med_order`: `fulfillment_type` and `fulfillment_state` report the successful electronic send when an order has one, then any completed delivery, then the last attempt, so orders sent electronically and later printed, cancelled, or changed no longer read as paper. `pharmacy_ncpdpid` follows the same fulfillment and is populated on more rows. `referral_order`: `send_to_name` falls back to the consultant name captured on the referral order, so directory-based referrals carry the name shown in the chart. No existing value of `send_to_name` changes.

  [Full release notes](/articles/hdb/2026-10-02)
</Update>

<Update label="2026-09-23" tags={["GA"]}>
  Two new columns on `patient`. `inactive_reason` gives the reason a chart went inactive, using the labels shown in the chart, so you can separate patients who moved away from those the practice discharged. `patient_status_notes` holds the free-text note recorded against a patient's status, and is often where the specific reason appears when the reason itself is `Other` or `Unknown`. It is separate from the chart-level `patient.notes`. Coverage follows how a practice uses the chart.

  [Full release notes](/articles/hdb/2026-09-23)
</Update>

<Update label="2026-09-14" tags={["GA"]}>
  The two changes announced on 2026-08-14 reach GA. `lab_order_tests`: `uq_lab_order_tests` now identifies the pairing of an order and a test and is stable across edits, so the duplicate rows left behind by edited orders are gone, and a test removed from an order is retained and marked with the new `is_deleted` column. The key values change, so anything storing or joining on them must be repointed, and row counts against the table will shift. `user`: `direct_message_address` is now the Direct address Elation has provisioned for the provider rather than one inferred from inbound mail, so far more rows are populated. `lab_order_tests` also gains `lab_order_state`, the tracking state of the parent order.

  [Full release notes](/articles/hdb/2026-09-14)
</Update>

<Update label="2026-08-31" tags={["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](/articles/hdb/2026-08-31)
</Update>

<Update label="2026-08-03" tags={["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](/articles/hdb/2026-08-03)
</Update>

<Update label="2026-07-30" tags={["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](/articles/hdb/2026-07-30)
</Update>

<Update label="2026-07-29" tags={["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](/articles/hdb/2026-07-29)
</Update>

<Update label="2026-07-28" tags={["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](/articles/hdb/2026-07-28)
</Update>

<Update label="2026-07-27" tags={["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](/articles/hdb/2026-07-27)
</Update>

<Update label="2026-07-22" tags={["GA"]}>
  Six Elation Billing tables: `patient_guarantor`, `patient_statement_tracking`, `user_practice`, `elation_sso_user`, `payment`, `financial_transaction`.

  [Full release notes](/articles/hdb/2026-07-22)
</Update>

<Update label="2026-07-13" tags={["GA"]}>
  Detailed billing status on each bill, plus the rendering, supervising, billing, and referring providers.

  [Full release notes](/articles/hdb/2026-07-13)
</Update>

<Update label="2026-07-10" tags={["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](/articles/hdb/2026-07-10)
</Update>

<Update label="Version 1.9.5" tags={["GA"]}>
  Consistent visit-note deletion across `bill`, `bill_item`, `bill_item_dx`; unified `is_deleted` flag.

  [Full release notes](/articles/hdb/2026-06-30-ver-195)
</Update>

<Update label="Version 1.9.4" tags={["GA"]}>
  New `elation_billing` schema: `era_matched_adjustment`, `user_role`, `claim`, `authorization`.

  [Full release notes](/articles/hdb/2026-06-29-ver-194)
</Update>

<Update label="Version 1.9.2" tags={["GA"]}>
  `recurring_event_group` and `recurring_event_schedule` promoted to GA.

  [Full release notes](/articles/hdb/2026-06-17-ver-192)
</Update>

<Update label="Version 1.9" tags={["GA"]}>
  `office_messages` `report_id`; `med_order` prescription lifecycle; Elation Note beta tables.

  [Full release notes](/articles/hdb/2025-12-16-ver-19)
</Update>

<Update label="Version 1.8" tags={["GA"]}>
  `physician_license` expansion; ethnicity fields overhaul; `loinc_code` replaces `loinc_id`.

  [Full release notes](/articles/hdb/2025-01-15-ver-18)
</Update>

<Update label="Version 1.7" tags={["GA"]}>
  Timestamp standardization to `TIMESTAMPNTZ(9)`; Event Streaming migration.

  [Full release notes](/articles/hdb/2024-07-29-ver-17)
</Update>

<Update label="Version 1.6" tags={["GA"]}>
  `medication_rxnorm.is_deleted`; `appointment` `in_person_or_virtual` and `instructions`.

  [Full release notes](/articles/hdb/2024-02-13-ver-16)
</Update>

<Update label="Version 1.5" tags={["GA"]}>
  `med_order.days_supply`; `patient` `full_name`, `consented`, `gender_identity` update.

  [Full release notes](/articles/hdb/2023-11-06-ver-15)
</Update>

<Update label="Version 1.4" tags={["GA"]}>
  New `physician_license` and `provider_availability` tables; `visit_note` time columns.

  [Full release notes](/articles/hdb/2023-10-05-ver-14)
</Update>

<Update label="Version 1.3" tags={["GA"]}>
  `patient` `primary_care_provider_id`, `primary_care_provider_npi`, `pronouns`.

  [Full release notes](/articles/hdb/2023-09-06-ver-13)
</Update>

<Update label="Version 1.2" tags={["GA"]}>
  `patient.deceased_date`; `visit_note_bullet.is_deleted`; `user.direct_message_address`.

  [Full release notes](/articles/hdb/2023-08-01-ver-12)
</Update>

<Update label="Hot Fix" tags={["GA"]}>
  `patient_employer.is_deleted`.

  [Full release notes](/articles/hdb/2023-06-07-hotfix)
</Update>

<Update label="Version 1.1.1" tags={["GA"]}>
  `referral_order` lifecycle columns; `misc_orders.is_deleted` and `resolution_state`.

  [Full release notes](/articles/hdb/2023-05-12-ver-111)
</Update>

<Update label="Version 1.1" tags={["GA"]}>
  Audit columns for `patient_tag` and `document_tag`; `patient.patient_status`.

  [Full release notes](/articles/hdb/2023-04-14-ver-11)
</Update>

<Update label="Version 1.0.1" tags={["GA"]}>
  `appointment.service_location_id`; `service_location.name`.

  [Full release notes](/articles/hdb/2023-04-07-ver-101)
</Update>

## Beta Releases

<Update label="Version 1.4beta / 1.0" tags={["Beta"]}>
  `bill_item_dx` schema overhaul; `visit_note_bullet.replaced_by_visit_note_bullet_id`.
</Update>

<Update label="Version 1.3beta" tags={["Beta"]}>
  `clinical_form_collection.is_deleted`; `visit_note_bullet` audit columns.
</Update>

<Update label="Version 1.2beta" tags={["Beta"]}>
  `is_deleted` added to 10 tables; unique key rebuild required.
</Update>

<Update label="Version 1.1beta" tags={["Beta"]}>
  `uq_{tablename}` and `hdb_last_sync` added to all tables.
</Update>

<Update label="Version 1.0beta" tags={["Beta"]}>
  Views replaced by tables (`report`, `report_addendum`, `report_document_tag`).
</Update>