When adding text items, templated items or patient tab information, if the browser is refreshed the item will be duplicated in the case.  This occurs because the refresh will resend or resubmit the information to RCMS.  When refreshing, the browser will display a warning message upon refresh and if you continue it will resubmit the information causing the duplication.  To prevent the duplication wait at least 10 minutes before refreshing the browser.