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The dedup key on the medication intake surfaces is not only `externalId`. `MedicationIntakeEvent.idempotency_key` is a `@unique` column persisted with the dose row forever, with no TTL and no sweep, matched by plain equality on the per-medication POST, the bulk drain and the external ingest bridge. That makes it an identity, not a replay token, and it carries the same failure mode: a key that rotates per client launch never matches its own earlier post, so every retry logs the dose again. The blank case is sharper still — the column is unique table-wide, so an empty key resolves to whichever unrelated row stored it first. Refuse both shapes at the schema on the single-entry paths and per entry on the bulk drain. The MCP write path hashes a host-supplied key into the `externalId` half of its dedup key, so the shape is laundered before anything downstream could see it and the check has to run on the input. That closes a live one: every tool handler falls back to `""` when the host omits the argument, and `""` digests to a constant, so each keyless write after the first reported `already_logged` and was silently dropped. The HTTP `Idempotency-Key` header stays out, and now says why in the guard: `IdempotencyKey.expiresAt` bounds it and the cleanup job sweeps it, so it is a windowed replay token and rotation is its design. Extend the structural guard with a provenance rule for identities that never pass a Zod request schema — a spreadsheet column, an MCP tool argument. Inside the import and MCP trees, a module handling an identity must apply the floor itself or import a module that does. That is a real chain rather than a list of known offenders: a new importer that mints an `externalId` from file input and imports nothing checked fails it, with no allowlist to escape into.