diff --git a/apps/Backend/src/services/typeAgentRunner.ts b/apps/Backend/src/services/typeAgentRunner.ts
index 3c2e1a1a..8b6755f8 100644
--- a/apps/Backend/src/services/typeAgentRunner.ts
+++ b/apps/Backend/src/services/typeAgentRunner.ts
@@ -134,8 +134,10 @@ async function detectAndTrackNewWindow(ctx: RunContext, label: string): Promise<
 //      outside it (the main window's title bar, side panels) can ever be matched by mistake.
 //   3. Click the Last Name field (found by vision, now unambiguous since the window is small
 //      and cropped) and type the first three letters — no first name is typed.
-//   4. Find the topmost actual patient row in the now-filtered results grid and double-click
-//      it (opens Edit Appointment).
+//   4. Locate the target patient's first and last name text directly in the now-filtered results
+//      grid (the 3-letter filter can return more than one patient) and pair up whichever
+//      occurrences share a row to find the target row's real position, then double-click it
+//      (opens Edit Appointment).
 //   5. Diff again to find the Edit Appointment window's bounds, then click Exam and Save
 //      within it.
 const OPEN_DENTAL_EXISTING_PATIENT: RunStep[] = [
@@ -189,7 +191,7 @@ const OPEN_DENTAL_EXISTING_PATIENT: RunStep[] = [
     delayAfterMs: 200,
   },
   {
-    label: "Find and double-click the first patient row",
+    label: "Find and double-click the matching patient row",
     execute: async (ctx) => {
       const { region } = await captureWindowScreenshot(ctx);
       backupTypeAgentScreenshot(ctx.runId, "patient_row_locate", region);
@@ -199,25 +201,49 @@ const OPEN_DENTAL_EXISTING_PATIENT: RunStep[] = [
       if (headerMatches.length === 0) throw new Error('Could not find the "PatNum" column header');
       const header = headerMatches.reduce((a, b) => (a.y < b.y ? a : b));
 
-      // A separate "find the first data row, not the header" locate call kept landing too close
-      // to (or on) the header — the two rows are visually similar and only ~15px apart. Since
-      // "PatNum" is an unambiguous anchor and the row height is measurable, the first row's
-      // position is computed directly (headerY + one row height) instead of asking the AI to
-      // visually tell two adjacent, similarly-styled rows apart a second time — nothing left to
-      // confuse once it's arithmetic on two already-known values.
+      // Locate the target patient's first and last name directly, rather than computing the row's
+      // y arithmetically (headerY + rowHeight * rowIndex) — a previous version did that and the
+      // click drifted further off-row the more rows down the target was, since any small error in
+      // the estimated row height got multiplied by the row index. Two real, independently-detected
+      // text positions and a same-row pairing between them is grounded in what's actually on
+      // screen instead of compounding an estimate.
+      const lastNameMatches = await locateAllOnScreenshot(ctx.userId, region, ctx.patientLastName);
+      const firstNameMatches = await locateAllOnScreenshot(ctx.userId, region, ctx.patientFirstName);
+      logTypeAgentStep(ctx.runId, { event: "locate_all", label: "last name", matches: toScreenPoints(ctx, lastNameMatches) });
+      logTypeAgentStep(ctx.runId, { event: "locate_all", label: "first name", matches: toScreenPoints(ctx, firstNameMatches) });
+      if (lastNameMatches.length === 0) throw new Error(`Could not find "${ctx.patientLastName}" in the patient list`);
+      if (firstNameMatches.length === 0) throw new Error(`Could not find "${ctx.patientFirstName}" in the patient list`);
+
+      // Row height is only used here as a "same row" tolerance for the pairing below, not
+      // multiplied by anything — so any imprecision in it no longer compounds with row distance.
       const rowHeightRatio = await detectRowHeightRatio(ctx.userId, region);
       const rowHeightPx = Math.round(rowHeightRatio * (ctx.windowBounds?.height ?? 0));
       if (rowHeightPx <= 0) throw new Error(`AI reported an invalid row height ratio: ${rowHeightRatio}`);
-      const finalY = header.y + rowHeightPx;
 
-      const screen = toScreenPoint(ctx, { x: header.x, y: finalY });
+      let best: { last: { x: number; y: number }; first: { x: number; y: number }; dist: number } | null = null;
+      for (const last of lastNameMatches) {
+        for (const first of firstNameMatches) {
+          const dist = Math.abs(last.y - first.y);
+          if (dist <= rowHeightPx / 2 && (!best || dist < best.dist)) {
+            best = { last, first, dist };
+          }
+        }
+      }
+      if (!best) {
+        throw new Error(
+          `Could not find a row where "${ctx.patientFirstName}" and "${ctx.patientLastName}" are on the same line`
+        );
+      }
+
+      const screen = toScreenPoint(ctx, { x: header.x, y: best.last.y });
       logTypeAgentStep(ctx.runId, {
         event: "locate",
-        label: "first patient row",
+        label: "matching patient row",
         pixelX: screen.x,
         finalY: screen.y,
+        lastNameMatch: toScreenPoint(ctx, best.last),
+        firstNameMatch: toScreenPoint(ctx, best.first),
         rowHeightPx,
-        headerY: toScreenPoint(ctx, { x: 0, y: header.y }).y,
       });
 
       ctx.beforeNextWindow = (await captureScreenshot(ctx.ip)).image;
diff --git a/apps/Backend/src/services/visionLocate.ts b/apps/Backend/src/services/visionLocate.ts
index 7cd2154c..6e7027d6 100644
--- a/apps/Backend/src/services/visionLocate.ts
+++ b/apps/Backend/src/services/visionLocate.ts
@@ -4,7 +4,7 @@ import { resolveAiProvider, getLlm } from "../ai/llm-factory";
 
 // Side length (px) of the debug crop saved around a click point — big enough to show
 // surrounding context (e.g. neighboring grid rows) when reviewing what a run actually clicked.
-const DEBUG_CROP_SIZE = 220;
+const DEBUG_CROP_SIZE = 440;
 
 interface ParsedLocation {
   found: boolean;
@@ -148,11 +148,17 @@ export async function cropAroundPoint(imageBase64: string, x: number, y: number)
   return cropped.toString("base64");
 }
 
-// Parses {"matches": [{"xRatio":.., "yRatio":..}, ...]}, tolerating near-miss JSON the same
-// way parseLocationResponse does — falls back to regex-extracting every xRatio/yRatio pair in
-// the response if strict parsing fails, rather than treating a malformed-but-salvageable
+interface RawMatch {
+  xRatio: number;
+  yTopRatio: number;
+  yBottomRatio: number;
+}
+
+// Parses {"matches": [{"xRatio":.., "yTopRatio":.., "yBottomRatio":..}, ...]}, tolerating
+// near-miss JSON the same way parseLocationResponse does — falls back to regex-extracting every
+// triple in the response if strict parsing fails, rather than treating a malformed-but-salvageable
 // response as zero matches.
-function parseMatchesResponse(raw: string): { xRatio: number; yRatio: number }[] | null {
+function parseMatchesResponse(raw: string): RawMatch[] | null {
   const block = raw.match(/\{[\s\S]*\}/)?.[0];
   if (!block) return null;
 
@@ -163,13 +169,14 @@ function parseMatchesResponse(raw: string): { xRatio: number; yRatio: number }[]
     // fall through to lenient repair below
   }
 
-  const pairs: { xRatio: number; yRatio: number }[] = [];
-  const pairRegex = /"xRatio"\s*:\s*(-?\d+(?:\.\d+)?)\s*,\s*"yRatio"\s*:\s*(-?\d+(?:\.\d+)?)/g;
+  const triples: RawMatch[] = [];
+  const tripleRegex =
+    /"xRatio"\s*:\s*(-?\d+(?:\.\d+)?)\s*,\s*"yTopRatio"\s*:\s*(-?\d+(?:\.\d+)?)\s*,\s*"yBottomRatio"\s*:\s*(-?\d+(?:\.\d+)?)/g;
   let match: RegExpExecArray | null;
-  while ((match = pairRegex.exec(block))) {
-    pairs.push({ xRatio: Number(match[1]), yRatio: Number(match[2]) });
+  while ((match = tripleRegex.exec(block))) {
+    triples.push({ xRatio: Number(match[1]), yTopRatio: Number(match[2]), yBottomRatio: Number(match[3]) });
   }
-  return pairs.length > 0 ? pairs : null;
+  return triples.length > 0 ? triples : null;
 }
 
 // Like locateOnScreenshot, but finds every occurrence of an exact piece of text rather than
@@ -178,6 +185,11 @@ function parseMatchesResponse(raw: string): { xRatio: number; yRatio: number }[]
 // in the search box and once per matching patient row, so the caller pairs it against another
 // text's occurrences (a first name) that share the same row instead of relying on a single
 // fuzzy vision judgment call.
+//
+// Reports each match's TOP and BOTTOM pixel edge rather than asking the model to self-estimate a
+// "center" — a center is an abstract judgment call, whereas the top/bottom of a glyph is a
+// concrete, visible thing to point at. The vertical midpoint used for x/y below is then computed
+// here in code from those two real edges, not trusted as a direct AI estimate.
 export async function locateAllOnScreenshot(
   userId: number,
   imageBase64: string,
@@ -202,9 +214,12 @@ export async function locateAllOnScreenshot(
         `This is a screenshot of a Windows desktop application. Find EVERY occurrence of the text ` +
         `"${text}" visible anywhere in this screenshot (case-insensitive) — there may be zero, one, ` +
         "or several. Respond with strict JSON only, no prose, no markdown fences: " +
-        '{"matches": [{"xRatio": <0 to 1>, "yRatio": <0 to 1>}, ...]} — one entry per occurrence, ' +
-        "at the center of that occurrence's text, using the same fraction-of-image-width/height " +
-        "convention as before. Use an empty array if there are no occurrences.",
+        '{"matches": [{"xRatio": <0 to 1>, "yTopRatio": <0 to 1>, "yBottomRatio": <0 to 1>}, ...]} — ' +
+        "one entry per occurrence. xRatio is how far across the image the occurrence's horizontal " +
+        "center is, as a fraction of the TOTAL image width. yTopRatio is where the TOP edge of that " +
+        "occurrence's text (the top of its tallest letters) is, and yBottomRatio is where its BOTTOM " +
+        "edge (the bottom of its lowest letters, including descenders) is — both as a fraction of " +
+        "the TOTAL image height. Use an empty array if there are no occurrences.",
     },
     {
       type: "image_url",
@@ -226,7 +241,7 @@ export async function locateAllOnScreenshot(
     }
     return matches.map((m) => ({
       x: Math.round(m.xRatio * width),
-      y: Math.round(m.yRatio * height),
+      y: Math.round(((m.yTopRatio + m.yBottomRatio) / 2) * height),
     }));
   }
 
@@ -253,10 +268,12 @@ export async function detectRowHeightRatio(userId: number, imageBase64: string):
     {
       type: "text",
       text:
-        "This is a screenshot containing a results-grid list of rows (e.g. a patient list), each " +
-        "row the same height. Measure the height of a single row. Respond with strict JSON only, " +
-        'no prose, no markdown fences: {"rowHeightRatio": <0 to 1>} — the height of one row as a ' +
-        "fraction of the TOTAL image height. Use two decimal places of precision.",
+        "This is a screenshot containing a results-grid list of rows (e.g. a patient list) with a " +
+        "header row followed by data rows, all data rows the same height. IGNORE the header row — " +
+        "it is taller than a data row and would skew the measurement. Look at ALL the visible data " +
+        "rows (not just one) and measure their AVERAGE height. Respond with strict JSON only, no " +
+        'prose, no markdown fences: {"rowHeightRatio": <0 to 1>} — the average data row height as ' +
+        "a fraction of the TOTAL image height. Use three decimal places of precision.",
     },
     {
       type: "image_url",