diff --git a/database/migrations/2026_07_18_100000_create_care_queue_engine_tables.php b/database/migrations/2026_07_18_100000_create_care_queue_engine_tables.php
index d9584e7..b342fa5 100644
--- a/database/migrations/2026_07_18_100000_create_care_queue_engine_tables.php
+++ b/database/migrations/2026_07_18_100000_create_care_queue_engine_tables.php
@@ -8,69 +8,75 @@ return new class extends Migration
 {
     public function up(): void
     {
-        Schema::create('care_service_queues', function (Blueprint $table) {
-            $table->id();
-            $table->uuid('uuid')->unique();
-            $table->string('owner_ref', 64)->index();
-            $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
-            $table->foreignId('branch_id')->constrained('care_branches')->cascadeOnDelete();
-            $table->string('context', 64);
-            $table->string('name');
-            $table->string('prefix', 8);
-            $table->string('routing_mode', 32)->default('shared_pool');
-            $table->string('external_key')->nullable()->index();
-            $table->unsignedInteger('next_number')->default(1);
-            $table->boolean('is_active')->default(true);
-            $table->timestamps();
+        if (! Schema::hasTable('care_service_queues')) {
+            Schema::create('care_service_queues', function (Blueprint $table) {
+                $table->id();
+                $table->uuid('uuid')->unique();
+                $table->string('owner_ref', 64)->index();
+                $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
+                $table->foreignId('branch_id')->constrained('care_branches')->cascadeOnDelete();
+                $table->string('context', 64);
+                $table->string('name');
+                $table->string('prefix', 8);
+                $table->string('routing_mode', 32)->default('shared_pool');
+                $table->string('external_key')->nullable()->index();
+                $table->unsignedInteger('next_number')->default(1);
+                $table->boolean('is_active')->default(true);
+                $table->timestamps();
 
-            $table->unique(['organization_id', 'branch_id', 'context']);
-        });
+                $table->unique(['organization_id', 'branch_id', 'context']);
+            });
+        }
 
-        Schema::create('care_service_points', function (Blueprint $table) {
-            $table->id();
-            $table->uuid('uuid')->unique();
-            $table->string('owner_ref', 64)->index();
-            $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
-            $table->foreignId('service_queue_id')->constrained('care_service_queues')->cascadeOnDelete();
-            $table->string('name');
-            $table->string('destination')->nullable();
-            $table->string('kind', 32)->default('default');
-            $table->unsignedBigInteger('ref_id')->nullable();
-            $table->string('staff_ref')->nullable();
-            $table->string('staff_display_name')->nullable();
-            $table->string('external_key')->nullable()->index();
-            $table->boolean('is_active')->default(true);
-            $table->timestamps();
+        if (! Schema::hasTable('care_service_points')) {
+            Schema::create('care_service_points', function (Blueprint $table) {
+                $table->id();
+                $table->uuid('uuid')->unique();
+                $table->string('owner_ref', 64)->index();
+                $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
+                $table->foreignId('service_queue_id')->constrained('care_service_queues')->cascadeOnDelete();
+                $table->string('name');
+                $table->string('destination')->nullable();
+                $table->string('kind', 32)->default('default');
+                $table->unsignedBigInteger('ref_id')->nullable();
+                $table->string('staff_ref')->nullable();
+                $table->string('staff_display_name')->nullable();
+                $table->string('external_key')->nullable()->index();
+                $table->boolean('is_active')->default(true);
+                $table->timestamps();
 
-            $table->unique(['service_queue_id', 'external_key']);
-        });
+                $table->unique(['service_queue_id', 'external_key']);
+            });
+        }
 
-        Schema::create('care_queue_tickets', function (Blueprint $table) {
-            $table->id();
-            $table->uuid('uuid')->unique();
-            $table->string('owner_ref', 64)->index();
-            $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
-            $table->foreignId('service_queue_id')->constrained('care_service_queues')->cascadeOnDelete();
-            $table->foreignId('service_point_id')->nullable()->constrained('care_service_points')->nullOnDelete();
-            $table->string('ticket_number', 32);
-            $table->string('status', 32)->default('waiting')->index();
-            $table->string('priority', 32)->default('walk_in');
-            $table->string('source', 32)->default('api');
-            $table->string('customer_name')->nullable();
-            $table->string('customer_phone')->nullable();
-            $table->string('care_entity', 32)->nullable();
-            $table->string('care_entity_uuid', 36)->nullable()->index();
-            $table->unsignedBigInteger('care_entity_id')->nullable();
-            $table->unsignedBigInteger('visit_id')->nullable();
-            $table->json('metadata')->nullable();
-            $table->timestamp('called_at')->nullable();
-            $table->timestamp('serving_at')->nullable();
-            $table->timestamp('completed_at')->nullable();
-            $table->timestamps();
+        if (! Schema::hasTable('care_queue_tickets')) {
+            Schema::create('care_queue_tickets', function (Blueprint $table) {
+                $table->id();
+                $table->uuid('uuid')->unique();
+                $table->string('owner_ref', 64)->index();
+                $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
+                $table->foreignId('service_queue_id')->constrained('care_service_queues')->cascadeOnDelete();
+                $table->foreignId('service_point_id')->nullable()->constrained('care_service_points')->nullOnDelete();
+                $table->string('ticket_number', 32);
+                $table->string('status', 32)->default('waiting')->index();
+                $table->string('priority', 32)->default('walk_in');
+                $table->string('source', 32)->default('api');
+                $table->string('customer_name')->nullable();
+                $table->string('customer_phone')->nullable();
+                $table->string('care_entity', 32)->nullable();
+                $table->string('care_entity_uuid', 36)->nullable()->index();
+                $table->unsignedBigInteger('care_entity_id')->nullable();
+                $table->unsignedBigInteger('visit_id')->nullable();
+                $table->json('metadata')->nullable();
+                $table->timestamp('called_at')->nullable();
+                $table->timestamp('serving_at')->nullable();
+                $table->timestamp('completed_at')->nullable();
+                $table->timestamps();
 
-            $table->index(['service_queue_id', 'status']);
-            $table->index(['service_point_id', 'status']);
-        });
+                $table->index(['service_queue_id', 'status']);
+                $table->index(['service_point_id', 'status']);
+            });
+        }
     }
 
     public function down(): void
diff --git a/database/migrations/2026_07_18_120000_create_care_specialty_clinical_records_table.php b/database/migrations/2026_07_18_120000_create_care_specialty_clinical_records_table.php
index c5ce494..7d2c76c 100644
--- a/database/migrations/2026_07_18_120000_create_care_specialty_clinical_records_table.php
+++ b/database/migrations/2026_07_18_120000_create_care_specialty_clinical_records_table.php
@@ -8,6 +8,10 @@ return new class extends Migration
 {
     public function up(): void
     {
+        if (Schema::hasTable('care_specialty_clinical_records')) {
+            return;
+        }
+
         Schema::create('care_specialty_clinical_records', function (Blueprint $table) {
             $table->id();
             $table->uuid('uuid')->unique();
diff --git a/database/migrations/2026_07_18_140000_create_care_display_and_voice_tables.php b/database/migrations/2026_07_18_140000_create_care_display_and_voice_tables.php
index df3b5b8..e56b746 100644
--- a/database/migrations/2026_07_18_140000_create_care_display_and_voice_tables.php
+++ b/database/migrations/2026_07_18_140000_create_care_display_and_voice_tables.php
@@ -8,40 +8,44 @@ return new class extends Migration
 {
     public function up(): void
     {
-        Schema::create('care_display_screens', function (Blueprint $table) {
-            $table->id();
-            $table->uuid('uuid')->unique();
-            $table->string('owner_ref')->index();
-            $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
-            $table->foreignId('branch_id')->constrained('care_branches')->cascadeOnDelete();
-            $table->string('name');
-            $table->string('layout')->default('standard');
-            $table->string('access_token')->unique();
-            $table->json('service_queue_ids')->nullable();
-            $table->json('settings')->nullable();
-            $table->boolean('is_active')->default(true);
-            $table->timestamp('last_seen_at')->nullable();
-            $table->timestamps();
-            $table->softDeletes();
-        });
+        if (! Schema::hasTable('care_display_screens')) {
+            Schema::create('care_display_screens', function (Blueprint $table) {
+                $table->id();
+                $table->uuid('uuid')->unique();
+                $table->string('owner_ref')->index();
+                $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
+                $table->foreignId('branch_id')->constrained('care_branches')->cascadeOnDelete();
+                $table->string('name');
+                $table->string('layout')->default('standard');
+                $table->string('access_token')->unique();
+                $table->json('service_queue_ids')->nullable();
+                $table->json('settings')->nullable();
+                $table->boolean('is_active')->default(true);
+                $table->timestamp('last_seen_at')->nullable();
+                $table->timestamps();
+                $table->softDeletes();
+            });
+        }
 
-        Schema::create('care_voice_announcements', function (Blueprint $table) {
-            $table->id();
-            $table->string('owner_ref')->index();
-            $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
-            $table->foreignId('branch_id')->constrained('care_branches')->cascadeOnDelete();
-            $table->foreignId('ticket_id')->nullable()->constrained('care_queue_tickets')->nullOnDelete();
-            $table->string('locale', 10)->default('en');
-            $table->text('message');
-            $table->string('voice')->default('female');
-            $table->unsignedTinyInteger('volume')->default(80);
-            $table->unsignedTinyInteger('repeat_count')->default(1);
-            $table->string('status')->default('pending');
-            $table->timestamp('played_at')->nullable();
-            $table->timestamps();
+        if (! Schema::hasTable('care_voice_announcements')) {
+            Schema::create('care_voice_announcements', function (Blueprint $table) {
+                $table->id();
+                $table->string('owner_ref')->index();
+                $table->foreignId('organization_id')->constrained('care_organizations')->cascadeOnDelete();
+                $table->foreignId('branch_id')->constrained('care_branches')->cascadeOnDelete();
+                $table->foreignId('ticket_id')->nullable()->constrained('care_queue_tickets')->nullOnDelete();
+                $table->string('locale', 10)->default('en');
+                $table->text('message');
+                $table->string('voice')->default('female');
+                $table->unsignedTinyInteger('volume')->default(80);
+                $table->unsignedTinyInteger('repeat_count')->default(1);
+                $table->string('status')->default('pending');
+                $table->timestamp('played_at')->nullable();
+                $table->timestamps();
 
-            $table->index(['branch_id', 'status']);
-        });
+                $table->index(['branch_id', 'status']);
+            });
+        }
     }
 
     public function down(): void