diff --git a/app/Controllers/AbdmGateway.php b/app/Controllers/AbdmGateway.php
index 369948e..58de7a2 100644
--- a/app/Controllers/AbdmGateway.php
+++ b/app/Controllers/AbdmGateway.php
@@ -6215,8 +6215,9 @@ class AbdmGateway extends BaseController
         $careContextsV3 = [];
         $careContextsFull = [];
         $seenRefs = [];
+        $seenOpdSessions = [];
 
-        $addContext = function (array $item) use (&$careContextsV3, &$careContextsFull, &$seenRefs, $readyOnly) {
+        $addContext = function (array $item) use (&$careContextsV3, &$careContextsFull, &$seenRefs, &$seenOpdSessions, $readyOnly) {
             $ref = trim((string) ($item['referenceNumber'] ?? $item['careContextId'] ?? ''));
             if ($ref === '' || isset($seenRefs[$ref])) {
                 return;
@@ -6225,6 +6226,9 @@ class AbdmGateway extends BaseController
                 return;
             }
             $seenRefs[$ref] = true;
+            if (! empty($item['alias_reference'])) {
+                $seenRefs[trim((string) $item['alias_reference'])] = true;
+            }
             $recType = trim((string) ($item['record_type'] ?? ''));
             $hiType = $this->mapRecordTypeToAbdmHiType($recType);
 
@@ -6669,6 +6673,15 @@ class AbdmGateway extends BaseController
                     'is_primary'      => false,
                 ]);
                 $seenRefs[$aliasRef] = true;
+                $seenRefs['OPD-' . $opdId . '-S' . $sessionId . '-' . $visitDate] = true;
+                $seenRefs['OPD-' . $opdId . '-S' . $sessionId . '-' . $cleanDate] = true;
+                $seenRefs['OPD-' . $patientId . '-S' . $sessionId . '-' . $visitDate] = true;
+                if ($sessionId > 0) {
+                    $seenOpdSessions[$sessionId] = true;
+                }
+                if ($opdId > 0) {
+                    $seenOpdSessions[$opdId] = true;
+                }
             }
         }
 
@@ -6930,6 +6943,21 @@ class AbdmGateway extends BaseController
                 if (str_starts_with($ccRef, 'PRESC-') || str_starts_with($ccRef, 'WELLNESS-')) {
                     continue;
                 }
+                // Skip if this OPD session or OPD ID has already been included in step 4
+                if (str_starts_with($ccRef, 'OPD-')) {
+                    if (preg_match('/-S(\d+)-/i', $ccRef, $sm)) {
+                        $sId = (int) $sm[1];
+                        if ($sId > 0 && isset($seenOpdSessions[$sId])) {
+                            continue;
+                        }
+                    }
+                    if (preg_match('/^OPD-(\d+)-/i', $ccRef, $om)) {
+                        $oId = (int) $om[1];
+                        if ($oId > 0 && isset($seenOpdSessions[$oId])) {
+                            continue;
+                        }
+                    }
+                }
                 $hiType = trim((string) ($row['hi_type'] ?? 'HealthDocumentRecord'));
                 if (str_starts_with($ccRef, 'INVOICE-')) {
                     $hiType = 'InvoiceRecord';
diff --git a/app/Controllers/Opd_prescription.php b/app/Controllers/Opd_prescription.php
index 525bb25..f858e5a 100644
--- a/app/Controllers/Opd_prescription.php
+++ b/app/Controllers/Opd_prescription.php
@@ -5892,8 +5892,7 @@ class Opd_prescription extends BaseController
         };
 
         if ($sessionId > 0 && in_array('care_context_reference', $fields, true)) {
-            $careContextPrefix = 'OPD-' . $opdId . '-S' . $sessionId . '-';
-            $candidate = $findCandidate($careContextPrefix);
+            $candidate = $findCandidate('-S' . $sessionId . '-');
             if ($candidate !== null) {
                 return $candidate;
             }
@@ -11923,6 +11922,16 @@ class Opd_prescription extends BaseController
             ]);
         }
 
+        // Clean up redundant standalone bundles in opd_fhir_documents so only unified OPConsultRecord is kept
+        try {
+            $this->db->table('opd_fhir_documents')
+                ->where('opd_id', $opdId)
+                ->where('opd_session_id', $sessionId)
+                ->whereIn('bundle_type', ['PrescriptionRecord', 'MedicationRequestBundle', 'WellnessRecord'])
+                ->delete();
+        } catch (\Throwable) {
+        }
+
         if (! $inserted) {
             return false;
         }
@@ -11961,10 +11970,15 @@ class Opd_prescription extends BaseController
                     $this->db->table('health_records')->insert($hrPayload);
                 }
 
-                // Delete redundant standalone PRESC / WELLNESS records so only the single unified bundle is kept
+                // Delete redundant standalone PRESC / WELLNESS / alias OPD records so only the single unified bundle is kept
                 $redundantRefs = [
                     'PRESC-' . $patientId . '-S' . $sessionId . '-' . $cleanDate,
                     'WELLNESS-' . $sessionId . '-' . $cleanDate,
+                    'OPD-' . $opdId . '-S' . $sessionId . '-' . $visitDate,
+                    'OPD-' . $opdId . '-S' . $sessionId . '-' . $cleanDate,
+                    'OPD-' . $patientId . '-S' . $sessionId . '-' . $visitDate,
+                    'PRESC-' . $opdId . '-S' . $sessionId . '-' . $visitDate,
+                    'WELLNESS-' . $opdId . '-S' . $sessionId . '-' . $visitDate,
                 ];
                 $this->db->table('health_records')
                     ->whereIn('care_context_reference', $redundantRefs)
diff --git a/app/Libraries/Abdm/Sync/AbdmTaskBoardSyncService.php b/app/Libraries/Abdm/Sync/AbdmTaskBoardSyncService.php
index 2c02542..df19268 100644
--- a/app/Libraries/Abdm/Sync/AbdmTaskBoardSyncService.php
+++ b/app/Libraries/Abdm/Sync/AbdmTaskBoardSyncService.php
@@ -112,6 +112,7 @@ class AbdmTaskBoardSyncService
                 ->select('id, opd_id, opd_session_id, bundle_type, bundle_json, generated_at')
                 ->whereIn('opd_id', $opdIds)
                 ->whereIn('bundle_type', ['OPConsultRecord', 'MedicationRequestBundle', 'PrescriptionRecord'])
+                ->orderBy("CASE WHEN bundle_type = 'OPConsultRecord' THEN 1 ELSE 2 END", 'ASC', false)
                 ->orderBy('id', 'DESC')
                 ->get()
                 ->getResultArray();
@@ -203,7 +204,8 @@ class AbdmTaskBoardSyncService
 
             $consultDate = (string) ($row['apointment_date'] ?? '');
             $visitDate = $consultDate !== '' ? date('Y-m-d', strtotime($consultDate)) : date('Y-m-d');
-            $derivedCcRef = 'OPD-' . $opdId . '-S' . ($sessionId > 0 ? $sessionId : 0) . '-' . $visitDate;
+            $cleanDate = str_replace('-', '', $visitDate);
+            $derivedCcRef = 'OPD-' . $patientId . '-S' . ($sessionId > 0 ? $sessionId : 0) . '-' . $cleanDate;
 
             $careContextRef = trim((string) ($hr['care_context_reference'] ?? ''));
             if ($careContextRef === '') {
@@ -411,6 +413,16 @@ class AbdmTaskBoardSyncService
 
         // 1. Upsert into health_records
         $healthRecordId = (int) ($existingHr['id'] ?? 0);
+        if ($healthRecordId <= 0) {
+            $foundHr = $this->db->table('health_records')
+                ->select('id')
+                ->where('care_context_reference', $careContextRef)
+                ->get(1)
+                ->getRowArray();
+            if (! empty($foundHr['id'])) {
+                $healthRecordId = (int) $foundHr['id'];
+            }
+        }
         $hrData = [
             'patient_id'             => $patientId,
             'abha_id'                => $effectiveAbha,
@@ -763,6 +775,7 @@ class AbdmTaskBoardSyncService
             if ($this->db->tableExists('opd_fhir_documents')) {
                 $docRow = $this->db->table('opd_fhir_documents')
                     ->where('opd_id', $entityId)
+                    ->orderBy("CASE WHEN bundle_type = 'OPConsultRecord' THEN 1 ELSE 2 END", 'ASC', false)
                     ->orderBy('id', 'DESC')
                     ->get(1)
                     ->getRowArray();
@@ -778,7 +791,10 @@ class AbdmTaskBoardSyncService
 
             $opdRow['abha_id'] = $abhaId;
             $visitDate = ! empty($opdRow['apointment_date']) ? date('Y-m-d', strtotime((string) $opdRow['apointment_date'])) : date('Y-m-d');
-            $ccRef = 'OPD-' . $entityId . '-S' . ($docRow['opd_session_id'] ?? 0) . '-' . $visitDate;
+            $cleanDate = str_replace('-', '', $visitDate);
+            $targetPatientId = (int) ($opdRow['p_id'] ?? $patientId);
+            $targetSessionId = (int) ($docRow['opd_session_id'] ?? 0);
+            $ccRef = 'OPD-' . $targetPatientId . '-S' . $targetSessionId . '-' . $cleanDate;
 
             return $this->linkAndPushOpdRecord($opdRow, $docRow, $ccRef, $visitDate, null);
         }