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In this technical deep dive, I demonstrate how to architect an enterprise-grade, high-integrity clinical data pipeline using Microsoft Fabric. Drawing on over 20 years of experience as a Senior Data Expert, I show you how to move beyond basic ETL to a "Self-Healing" integration model that handles 45 million patient records (Artifical - created by chatgpt) with absolute precision. We’ll explore the implementation of a T-SQL MERGE strategy powered by Common Table Expressions (CTEs) and window functions to resolve duplicates in-memory, ensuring the "Golden Record" always reaches production. This workflow isn't just about code; it's about governance—aligning with DAMA-DMBOK and N*S Data Governance standards to provide a transparent, idempotent, and fully audited environment. Whether you're looking to enhance your Fabric architecture or preparing for a research in Data Science, this video provides a blueprint for building resilient systems that maintain patient data safety and operational uptime