diff --git a/etor/src/main/java/gov/hhs/cdc/trustedintermediary/etor/ruleengine/transformation/custom/RemovePatientNameTypeCode.java b/etor/src/main/java/gov/hhs/cdc/trustedintermediary/etor/ruleengine/transformation/custom/RemovePatientNameTypeCode.java
index 22aa2e109..eaf44962d 100644
--- a/etor/src/main/java/gov/hhs/cdc/trustedintermediary/etor/ruleengine/transformation/custom/RemovePatientNameTypeCode.java
+++ b/etor/src/main/java/gov/hhs/cdc/trustedintermediary/etor/ruleengine/transformation/custom/RemovePatientNameTypeCode.java
@@ -12,6 +12,8 @@ public class RemovePatientNameTypeCode implements CustomFhirTransformation {
     @Override
     public void transform(final FhirResource<?> resource, final Map<String, String> args) {
         Bundle bundle = (Bundle) resource.getUnderlyingResource();
-        HapiHelper.removePID5_7Extension(bundle);
+        // Need to set the value for extension to empty instead of removing the extension,
+        // otherwise RS will set its own value in its place
+        HapiHelper.setPID5_7ExtensionValue(bundle, null);
     }
 }
diff --git a/shared/src/main/java/gov/hhs/cdc/trustedintermediary/external/hapi/HapiHelper.java b/shared/src/main/java/gov/hhs/cdc/trustedintermediary/external/hapi/HapiHelper.java
index 746bb72b7..cb113e0a7 100644
--- a/shared/src/main/java/gov/hhs/cdc/trustedintermediary/external/hapi/HapiHelper.java
+++ b/shared/src/main/java/gov/hhs/cdc/trustedintermediary/external/hapi/HapiHelper.java
@@ -272,10 +272,12 @@ public static Extension getPID5Extension(Bundle bundle) {
         return name.getExtensionByUrl(HapiHelper.EXTENSION_XPN_HUMAN_NAME_URL);
     }
 
-    public static void removePID5_7Extension(Bundle bundle) {
+    public static void setPID5_7ExtensionValue(Bundle bundle, String value) {
         Extension extension = getPID5Extension(bundle);
         if (extension != null && extension.hasExtension(HapiHelper.EXTENSION_XPN7_URL)) {
-            extension.removeExtension(HapiHelper.EXTENSION_XPN7_URL);
+            extension
+                    .getExtensionByUrl(HapiHelper.EXTENSION_XPN7_URL)
+                    .setValue(new StringType(value));
         }
     }
 
diff --git a/shared/src/test/groovy/gov/hhs/cdc/trustedintermediary/external/hapi/HapiHelperTest.groovy b/shared/src/test/groovy/gov/hhs/cdc/trustedintermediary/external/hapi/HapiHelperTest.groovy
index 8532a9d18..d8684a5db 100644
--- a/shared/src/test/groovy/gov/hhs/cdc/trustedintermediary/external/hapi/HapiHelperTest.groovy
+++ b/shared/src/test/groovy/gov/hhs/cdc/trustedintermediary/external/hapi/HapiHelperTest.groovy
@@ -457,7 +457,7 @@ class HapiHelperTest extends Specification {
 
         when:
         def bundle = new Bundle()
-        HapiHelper.removePID5_7Extension(bundle)
+        HapiHelper.setPID5_7ExtensionValue(bundle, null)
 
         then:
         HapiHelper.getPID5Extension(bundle) == null
@@ -465,7 +465,7 @@ class HapiHelperTest extends Specification {
         when:
         HapiFhirHelper.createPIDPatient(bundle)
         HapiFhirHelper.setPID5Extension(bundle)
-        HapiHelper.removePID5_7Extension(bundle)
+        HapiHelper.setPID5_7ExtensionValue(bundle, null)
 
         then:
         HapiFhirHelper.getPID5_7Value(bundle) == null
@@ -478,7 +478,7 @@ class HapiHelperTest extends Specification {
         HapiFhirHelper.getPID5_7Value(bundle) == pid5_7
 
         when:
-        HapiHelper.removePID5_7Extension(bundle)
+        HapiHelper.setPID5_7ExtensionValue(bundle, null)
 
         then:
         HapiHelper.getPID5Extension(bundle) != null