diff --git a/app/Controllers/AbdmGateway.php b/app/Controllers/AbdmGateway.php
index e15834e..86a585a 100644
--- a/app/Controllers/AbdmGateway.php
+++ b/app/Controllers/AbdmGateway.php
@@ -3466,8 +3466,20 @@ class AbdmGateway extends BaseController
             }
         }
 
-        // Add comorbidities from NABH
+        // Add comorbidities from NABH, with fallback to latest opd_prescription / history
         $coMorbRaw = trim((string) ($nabhMeta['co_morbidities'] ?? ''));
+        if ($coMorbRaw === '' && $patientId > 0 && $this->db && $this->db->tableExists('opd_prescription')) {
+            $latestPresc = $this->db->table('opd_prescription')
+                ->select('Prescriber_Remarks')
+                ->where('p_id', $patientId)
+                ->orderBy('id', 'DESC')
+                ->get(1)->getRowArray();
+            if (! empty($latestPresc['Prescriber_Remarks'])) {
+                if (preg_match('/^\s*Co-Morbidities\s*:\s*(.+)$/im', (string) $latestPresc['Prescriber_Remarks'], $m)) {
+                    $coMorbRaw = trim($m[1]);
+                }
+            }
+        }
         if ($coMorbRaw !== '') {
             $coMorbParts = preg_split('/[,;\n]+/', $coMorbRaw);
             foreach ($coMorbParts as $cPart) {
diff --git a/app/Controllers/Billing/Ipd.php b/app/Controllers/Billing/Ipd.php
index bb3f13d..0ebd3eb 100644
--- a/app/Controllers/Billing/Ipd.php
+++ b/app/Controllers/Billing/Ipd.php
@@ -1074,6 +1074,16 @@ class Ipd extends BaseController
                     ->where('id', $caseId)
                     ->update(['status' => 1]);
             }
+
+            // Trigger complete, final FHIR Discharge Summary generation & ABDM sync
+            try {
+                $patientId = (int) ($currentIpd['p_id'] ?? 0);
+                $dischargeCtrl = new \App\Controllers\Ipd_discharge();
+                $dischargeCtrl->initController($this->request, $this->response, service('logger'));
+                $dischargeCtrl->enqueueIpdDischargeSync($ipdId, $patientId, 'final_discharge');
+            } catch (\Throwable $e) {
+                log_message('warning', '[updateDischargeStatus] ABDM discharge sync trigger failed: ' . $e->getMessage());
+            }
         }
 
         return $this->buildDischargeProcessResponse($ipdId, 'Discharge status updated.');
diff --git a/app/Controllers/Ipd_discharge.php b/app/Controllers/Ipd_discharge.php
index 09850fe..d4c17b2 100644
--- a/app/Controllers/Ipd_discharge.php
+++ b/app/Controllers/Ipd_discharge.php
@@ -9361,7 +9361,17 @@ class Ipd_discharge extends BaseController
             // Do not block discharge workflows if queue service is unavailable.
         }
 
-        // Also persist ABDM-compatible FHIR bundle in sync tables/outbox for M2 push.
+        // Only persist ABDM-compatible FHIR bundle if the patient is officially discharged
+        // (discarge_patient_status > 0 and valid discharge_date) or explicitly finalized.
+        // Intermediate draft saves while patient is still admitted must not create incomplete bundles.
+        $dischargeStatus = (int) ($ipdRow['discarge_patient_status'] ?? 0);
+        $dischargeDate = trim((string) ($ipdRow['discharge_date'] ?? ''));
+        $isDischarged = $dischargeStatus > 0 && $dischargeDate !== '' && $dischargeDate !== '0000-00-00';
+
+        if (! $isDischarged && ! in_array($action, ['final_discharge', 'force', 'auto_push'], true)) {
+            return;
+        }
+
         // Fail-open: discharge save flow must never fail due to ABDM sync issues.
         try {
             $this->enqueueIpdDischargeFhirSync($ipdId, $patientId, $ipdRow, $patientRow);
@@ -9478,8 +9488,19 @@ class Ipd_discharge extends BaseController
             }
         }
 
-        // Comorbidities from NABH metadata
+        // Comorbidities from NABH metadata with fallback to latest opd_prescription / history
         $coMorbRaw = trim((string) ($nabhMeta['co_morbidities'] ?? ''));
+        if ($coMorbRaw === '' && $patientId > 0 && $this->db->tableExists('opd_prescription')) {
+            $latestOpdRow = $this->db->table('opd_prescription')
+                ->where('p_id', $patientId)
+                ->orderBy('id', 'DESC')
+                ->get(1)
+                ->getRowArray();
+            if (! empty($latestOpdRow)) {
+                $hydratedNabh = $this->hydrateNabhFieldsFromOpdRow($latestOpdRow);
+                $coMorbRaw = trim((string) ($hydratedNabh['co_morbidities'] ?? ''));
+            }
+        }
         if ($coMorbRaw !== '') {
             $coMorbParts = preg_split('/[,;\n]+/', $coMorbRaw);
             foreach ($coMorbParts as $cPart) {
diff --git a/app/Libraries/Abdm/Fhir/Generators/DischargeFhirGenerator.php b/app/Libraries/Abdm/Fhir/Generators/DischargeFhirGenerator.php
index 218e02e..59b4498 100644
--- a/app/Libraries/Abdm/Fhir/Generators/DischargeFhirGenerator.php
+++ b/app/Libraries/Abdm/Fhir/Generators/DischargeFhirGenerator.php
@@ -326,6 +326,114 @@ class DischargeFhirGenerator extends \App\Libraries\Abdm\Fhir\Generators\Abstrac
             $builder->addMedicationRequest($medResource);
         }
 
+        // ── Physical Examination & Vital Signs ──────────────────────────────
+        $rawObservations = (array) ($source['ui_physical_exam'] ?? $source['observations'] ?? []);
+        $validObservations = [];
+        foreach ($rawObservations as $idx => $obs) {
+            if (! is_array($obs)) {
+                continue;
+            }
+            $obsText = trim((string) ($obs['text'] ?? $obs['name'] ?? ''));
+            $obsValue = trim((string) ($obs['value'] ?? ''));
+            if ($obsText === '' || ! $this->isMeaningfulValue($obsText)) {
+                continue;
+            }
+            if ($obsValue === '' || ! $this->isMeaningfulValue($obsValue)) {
+                continue;
+            }
+            $validObservations[$idx] = $obs;
+        }
+
+        foreach ($validObservations as $idx => $obs) {
+            $obsText = trim((string) ($obs['text'] ?? $obs['name'] ?? ''));
+            $obsValue = trim((string) ($obs['value'] ?? ''));
+            $obsCategoryText = trim((string) ($obs['category'] ?? 'Physical Examination'));
+            $obsCategoryCode = trim((string) ($obs['category_code'] ?? ''));
+            $effectiveAt = (string) ($obs['effective_at'] ?? $obs['effective_date_time'] ?? $timestamp);
+
+            $isVital = in_array(strtolower($obsCategoryCode), ['vital-signs', 'vitals'], true)
+                || preg_match('/^(pulse|heart rate|bp|blood pressure|respiration|respiratory rate|temperature|temp|spo2|oxygen)/i', $obsText);
+
+            $catCode = $isVital ? 'vital-signs' : 'exam';
+            $catDisplay = $isVital ? 'Vital Signs' : 'Exam';
+
+            $observationId = 'discharge-observation-' . $recordId . '-' . $idx;
+
+            $coding = [];
+            $lowerText = strtolower($obsText);
+            if (str_contains($lowerText, 'pulse') || str_contains($lowerText, 'heart rate')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '8499008', 'display' => 'Pulse rate'];
+            } elseif (str_contains($lowerText, 'respiration') || str_contains($lowerText, 'respiratory')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '86290005', 'display' => 'Respiratory rate'];
+            } elseif (str_contains($lowerText, 'pallor')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '271782001', 'display' => 'Pallor'];
+            } elseif (str_contains($lowerText, 'jaundice') || str_contains($lowerText, 'icterus')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '18165001', 'display' => 'Jaundice'];
+            } elseif (str_contains($lowerText, 'cyanosis')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '3415004', 'display' => 'Cyanosis'];
+            } elseif (str_contains($lowerText, 'clubbing')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '30760006', 'display' => 'Clubbing'];
+            } elseif (str_contains($lowerText, 'edema') || str_contains($lowerText, 'oedema')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '267038008', 'display' => 'Edema'];
+            } elseif (str_contains($lowerText, 'jvp') || str_contains($lowerText, 'jugular')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '271649006', 'display' => 'Jugular venous pressure'];
+            } elseif (str_contains($lowerText, 'bp') || str_contains($lowerText, 'blood pressure')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '75367002', 'display' => 'Blood pressure'];
+            } elseif (str_contains($lowerText, 'temp')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '386725007', 'display' => 'Body temperature'];
+            } elseif (str_contains($lowerText, 'spo2') || str_contains($lowerText, 'oxygen saturation')) {
+                $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '431314004', 'display' => 'Oxygen saturation'];
+            } else {
+                $resolved = $this->codingResolver->resolveSnomedForDiagnosisOrFinding((string) ($obs['code'] ?? ''), $obsText);
+                $coding = $this->withoutPlaceholderCoding((array) ($resolved['coding'] ?? []));
+                if ($coding === []) {
+                    $coding[] = ['system' => 'http://snomed.info/sct', 'code' => '404684003', 'display' => 'Clinical finding'];
+                }
+            }
+
+            $obsResource = [
+                'resourceType' => 'Observation',
+                'id' => $observationId,
+                'meta' => ['profile' => ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Observation']],
+                'text' => [
+                    'status' => 'generated',
+                    'div' => '<div xmlns="http://www.w3.org/1999/xhtml"><p><b>' . htmlspecialchars($obsText) . ' (' . htmlspecialchars($obsCategoryText) . '):</b> ' . htmlspecialchars($obsValue) . '</p></div>',
+                ],
+                'status' => 'final',
+                'category' => [[
+                    'coding' => [[
+                        'system' => 'http://terminology.hl7.org/CodeSystem/observation-category',
+                        'code' => $catCode,
+                        'display' => $catDisplay,
+                    ]],
+                    'text' => $obsCategoryText !== '' ? $obsCategoryText : $catDisplay,
+                ]],
+                'code' => [
+                    'coding' => $coding,
+                    'text' => $obsText,
+                ],
+                'subject' => ['reference' => $patientRef, 'display' => (string) ($source['patient']['name'] ?? $source['patient_name'] ?? 'Patient')],
+                'effectiveDateTime' => $effectiveAt,
+            ];
+
+            $unit = trim((string) ($obs['unit'] ?? ''));
+            if ($unit === '' && preg_match('/^([\d\.]+)\s*(\/min|bpm|mmHg|°c|°f|%)$/i', $obsValue, $uParts)) {
+                $obsResource['valueQuantity'] = [
+                    'value' => (float) $uParts[1],
+                    'unit' => $uParts[2],
+                ];
+            } elseif (is_numeric($obsValue)) {
+                $obsResource['valueQuantity'] = [
+                    'value' => (float) $obsValue,
+                    'unit' => $unit,
+                ];
+            } else {
+                $obsResource['valueString'] = $obsValue;
+            }
+
+            $builder->addObservation($obsResource);
+        }
+
         // ── Investigations ─────────────────────────────────────────────────────
         foreach ((array) ($source['ui_investigations'] ?? $source['investigations'] ?? []) as $idx => $inv) {
             $text = trim((string) ($inv['text'] ?? ''));
@@ -670,6 +778,18 @@ class DischargeFhirGenerator extends \App\Libraries\Abdm\Fhir\Generators\Abstrac
             ];
         }
 
+        // Physical Examination & Vital Signs
+        if (! empty($validObservations)) {
+            $sectionDefinitions[] = [
+                'title' => 'Physical Examination',
+                'code' => '425044008',
+                'display' => 'Physical examination section',
+                'prefix' => 'discharge-observation-',
+                'items_indexed' => $validObservations,
+                'entry_display' => 'Observation',
+            ];
+        }
+
         // Surgery / Procedure
         $surgeries = (array) ($source['ui_surgeries'] ?? $source['procedures'] ?? []);
         if (! empty($surgeries)) {
@@ -1078,7 +1198,7 @@ class DischargeFhirGenerator extends \App\Libraries\Abdm\Fhir\Generators\Abstrac
         if (empty($diagnoses) && ! empty($source['conditions'])) {
             $diagnoses = (array) $source['conditions'];
         }
-        $vitals = (array) ($source['observations'] ?? []);
+        $vitals = (array) ($source['ui_physical_exam'] ?? $source['observations'] ?? []);
         $procedures = (array) ($source['procedures'] ?? []);
         $medications = ! empty($source['medications']) ? (array) $source['medications'] : (array) ($source['ui_discharge_medicine'] ?? []);
         $carePlans = ! empty($source['care_plans']) ? (array) $source['care_plans'] : (array) ($source['ui_care_plans'] ?? $source['ui_discharge_summary'] ?? []);
diff --git a/tests/unit/Abdm/FhirGeneratorsTest.php b/tests/unit/Abdm/FhirGeneratorsTest.php
index f8b611a..02e688e 100644
--- a/tests/unit/Abdm/FhirGeneratorsTest.php
+++ b/tests/unit/Abdm/FhirGeneratorsTest.php
@@ -988,6 +988,7 @@ final class FhirGeneratorsTest extends CIUnitTestCase
         $this->assertContains('Patient', $resourceTypes);
         $this->assertContains('Encounter', $resourceTypes);
         $this->assertContains('Condition', $resourceTypes);
+        $this->assertContains('Observation', $resourceTypes);
         $this->assertContains('MedicationRequest', $resourceTypes);
         $this->assertContains('DiagnosticReport', $resourceTypes);
         $this->assertContains('CarePlan', $resourceTypes);
@@ -996,6 +997,7 @@ final class FhirGeneratorsTest extends CIUnitTestCase
         $composition = $bundle['entry'][0]['resource'];
         $sectionTitles = array_column($composition['section'], 'title');
         $this->assertContains('Chief complaints', $sectionTitles);
+        $this->assertContains('Physical Examination', $sectionTitles);
         $this->assertContains('Medications', $sectionTitles);
         $this->assertContains('Care Plan', $sectionTitles);
     }