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R4 APIs (Millennium)

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How are chained patient combines handled?

Workflow or API calls:

Our team is working on different scenarios regarding combined patients. One such scenario that needs to be addressed is if a chain of patient combines occur.
For example:
1. Patient record A is combined with B (B now is inactive with a ‘replaced-by’ link to A)

2. Then, patient record C is combined with A (making C the active record, A becomes inactive)

What is the actual state of these three patient records after this?

Will B's ‘replaced-by’ link now reference C, or will B's ‘replaced-by’ link still reference A, which references C?

Any information and help surrounding this is greatly appreciated, Thanks.

Background Information:

Failure to provide answers will impact our ability to respond in a timely and effective manner
Developer questions:

Are you an OPN Member? Yes
Have you signed up to be in the Healthcare Developer Track? Yes
Are you a registered Code Program member? Yes
Does your App have a presence on the Oracle Healthcare App Marketplace? Not yet

Are you developing on behalf of an Oracle Health client? No
If so, which client:

Application's Client ID and App ID, if relevant:

Expected Result:

We expect that after a chain of patient combines as described, patient record A will resemble this:

References C as it was combined into C

{
"resourceType": "Patient",
"id": "A",
"active": false,
"link": [
{
"other": {
"reference": "Patient/C"
},
"type": "replaced-by"
}
],
// ... rest of patient data

Patient record B will resemble this:

Reference changes from A to C because A got replaced by C.

{
"resourceType": "Patient",
"id": "B",
"active": false,
"link": [
{
"other": {
"reference": "Patient/C"
},
"type": "replaced-by"
}
],
// ... rest of patient data

Patient record C:

C is the surviving patient record that is active

{
"resourceType": "Patient",
"id": "C",
"active": true,
// ... rest of patient data

Actual Result:

X-Request-Id / Cerner-Correlation-Id / opc-request-id:
Date/time of the example:

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Added on Feb 13 2026
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