- Shipped
- August 25, 2026 at 10:01 PM UTC
- Author
- Kamo
- Commit
- 6f5d148
Starting a visit is what grants the clinician the chart, and that is the design rather than a side effect. A clinician about to see a patient has no relationship with them until the visit begins, and requiring an administrator to grant one by hand would make the system unusable. So rooming a patient writes a time-bounded CareRelationship, and the record of WHY somebody could open a chart is the visit itself — a far better answer at audit than "an administrator granted it" with no date attached. Whoever rooms the patient gets it too: a medical assistant taking vitals is doing clinical work and has exactly as much business in the record, for exactly as long. And it EXPIRES, because the point of a relationship is that it ends — a clinician who saw someone once in 2019 is not still in their chart. Starting is idempotent. Two people clicking "start visit" is ordinary, and two encounters for one visit splits the note from the charge. Ending a visit and closing a chart are separate acts, usually days apart: the patient leaving is clinical, the chart being complete is administrative, and a practice with a week of open encounters has a workflow problem that nothing else surfaces. Closing REFUSES while a note is unsigned — a closed chart with an unsigned note is a visit that looks documented and is not, and it cannot be billed either, because the note is what substantiates the claim. Letting it close hides both behind a green tick. Notes are never edited. Every change writes a new version and the previous one stays renderable, including for unsigned drafts: "what did this say before the ambient scribe rewrote it" is a question people ask, and the cost of the answer is one row. Signing writes a new version rather than stamping the current one, because the version table's @PreUpdate throws. Three refusals encode who may do what. Only the author signs — signing somebody else's note attributes their clinical judgement to them under your credentials. Only the named supervisor countersigns. And an author cannot countersign their own note: that is not supervision, and under incident-to billing the supervision is what makes the claim valid, so a self-cosign is a false statement about who oversaw the care. Amendment kinds are not interchangeable and the API refuses a wrong one. An ADDENDUM adds and the note stands; an AMENDMENT corrects and needs a reason, with the original retained and pointed at; a PATIENT_AMENDMENT records a §164.526 disagreement. A record that cannot show what it used to say is not corrected, it is altered. 1269 tests green.