Uploading a prior report to an existing exam creates a duplicate prior card in the comparison exam list. 

This results in the same exam appearing across multiple prior cards with report data split between them. 

Exam data may appear split across cards – i.e. one card for images and one for the report. There is no workaround available at this time. This issue does not affect image integrity or patient safety, but it may cause some disruption during report review workflows and prior exam navigation. 

Users without save permissions can view and configure the Presentation State save option in the Hanging Protocol modal, but no save occurs. 

If a user's Create/Update ACL for Save GSPS/Annotations is disabled, the "Save Image Edits" toggle in the Hanging Protocol modal may still appear visible and configurable in some configurations. The toggle is non-functional in this state — no Presentation State is created or updated — but the UI does not currently reflect the disabled permission. 

Users without save permissions may attempt to configure and save Presentation States via the Hanging Protocol modal without receiving an error. The save action will silently fail. No image data or Presentation State is affected. Users who need to save Presentation States should confirm with their administrator that the appropriate permission is assigned to their role. This will be corrected in a future release. 

Attempting to create a new exam using an ACC number that is already associated with the same MRN and Facility combination results in a database constraint error. 

The system enforces uniqueness on the combination of ACC + MRN + Facility for each order, as this combination is relied upon by the HL7 to DICOM matching mechanism. If a user attempts to submit or save an exam where this combination already exists in the system, the save is rejected and an error message is displayed rather than allowing the duplicate entry to be created. 

Users attempting to reuse an ACC number for a patient who already has an exam under that same ACC and Facility will be unable to proceed until a new, unique ACC number is assigned to the exam. This does not affect existing exam data or patient safety, but it may require coordination with the ordering system or HIS/RIS to issue a corrected accession number before the exam can be created. There is no workaround that allows duplicate ACC + MRN + Facility combinations, as this would compromise the reliability of HL7 to DICOM matching.