New Patient: You should open a new eConsult if you are starting a consult for a new patient.
New Symptoms: You should also open a new eConsult for the same patient when he/she presents new symptoms that would require another specialty to review the case. However, if you would like the same specialist to respond (this is most preferred method), then you can reopen an old consult.
Please also consider opening a new consult for a follow-up question if a substantial amount of time, e.g. 3 months, has passed since you asked the previous question.