# Manage patients
URL: https://docs.awellhealth.com/api-reference/guides/manage-patients

> For the complete documentation index, see [llms.txt](https://docs.awellhealth.com/llms.txt).



Field-level reference is in [Patients](/api-reference/reference/patients). This page covers the behavior
worth knowing first.

## Search before you create [#search-before-you-create]

Creating a patient who already exists produces two records for one person. The API can merge them with
[`mergePatients`](/api-reference/reference/patients), though Awell Care offers no way to do it. Always
**search** by your own identifier before creating.

## Updating identifiers replaces them [#updating-identifiers-replaces-them]

> **Passing a patient identifier object to the update mutation REPLACES any existing identifiers.**

If you want to *add* one, use the dedicated add-identifier mutation instead.

An update that includes one identifier, intended as a no-op for the others, removes the others, and
anything looking a patient up by a removed identifier stops finding them. See
[Patient identifiers](/docs/connect-systems/patient-identifiers).

## Validation [#validation]

Certain fields expect particular formats: dates as ISO 8601, phone numbers as E.164. The create mutation's
validation section is the authoritative list, and the update mutation follows the same rules.
[E.164 phone numbers](/api-reference/guides/e164-phone-numbers) gives the phone rules in full.

## Patient language [#patient-language]

A patient's preferred language can be set through the API, and it affects what they see on
[Hosted Pages](/docs/embed-and-host/overview-hosted-pages). Set it when you create the patient if you know
it; changing it later doesn't retranslate anything already sent.

## Anonymous patients [#anonymous-patients]

Awell supports patients with no PHI, which suits an intake flow where you don't yet know who the person
is. See [Before you trigger a care flow](/docs/automate-with-events/before-you-trigger-a-care-flow).

## Next steps [#next-steps]

**Next:** [Versions and releases](/api-reference/guides/versions-and-releases).