From 883db194f8dc5f8efae88d44456fd11f28419145 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 11 Oct 2024 14:23:57 -0700
Subject: [PATCH 01/30] wip: script to submit example files with snapshots to
 local RS

---
 scripts/hurl/rs/update_examples.sh | 18 ++++++++++++++++++
 1 file changed, 18 insertions(+)
 create mode 100755 scripts/hurl/rs/update_examples.sh

diff --git a/scripts/hurl/rs/update_examples.sh b/scripts/hurl/rs/update_examples.sh
new file mode 100755
index 000000000..15f0af2e3
--- /dev/null
+++ b/scripts/hurl/rs/update_examples.sh
@@ -0,0 +1,18 @@
+#!/bin/bash
+
+find "$CDCTI_HOME/examples" -type f -name '*0_initial_message.hl7' | while read -r file; do
+    echo "Submitting file: $file"
+
+    temp_file=$(mktemp)
+    awk -F'|' '/^MSH/ { $6 = "^simulated-lab-id^" } 1' OFS='|' "$file" >"$temp_file"
+    echo "$temp_file"
+
+    temp_dir_path=$(dirname "$temp_file")
+    temp_file_name=$(basename "$temp_file")
+    ./hrl waters.hurl -f $temp_file_name -r $temp_dir_path
+
+    rm "$temp_file"
+
+    echo "Waiting 5 seconds before the next submission..."
+    sleep 5
+done

From ffb987cfcd9312c4a38c8de92f5ea53d7d0eeef8 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Tue, 15 Oct 2024 16:52:37 -0700
Subject: [PATCH 02/30] Added retry loop to make sure the message is delivered

---
 scripts/hurl/rs/update_examples.sh | 55 +++++++++++++++++++++++++++---
 1 file changed, 50 insertions(+), 5 deletions(-)

diff --git a/scripts/hurl/rs/update_examples.sh b/scripts/hurl/rs/update_examples.sh
index 15f0af2e3..83203c70d 100755
--- a/scripts/hurl/rs/update_examples.sh
+++ b/scripts/hurl/rs/update_examples.sh
@@ -1,15 +1,60 @@
 #!/bin/bash
 
-find "$CDCTI_HOME/examples" -type f -name '*0_initial_message.hl7' | while read -r file; do
+# Ensure jq is installed
+if ! command -v jq &>/dev/null; then
+    echo "jq could not be found. Please install jq to proceed."
+    exit
+fi
+
+# Maximum time to wait for the overallStatus to be "Delivered" (in seconds)
+TIMEOUT=300       # 5 minutes
+RETRY_INTERVAL=10 # Retry every 10 seconds
+
+find "$CDCTI_HOME/examples/MN" -type f -name '*0_initial_message.hl7' | while read -r file; do
     echo "Submitting file: $file"
 
     temp_file=$(mktemp)
-    awk -F'|' '/^MSH/ { $6 = "^simulated-lab-id^" } 1' OFS='|' "$file" >"$temp_file"
-    echo "$temp_file"
-
     temp_dir_path=$(dirname "$temp_file")
     temp_file_name=$(basename "$temp_file")
-    ./hrl waters.hurl -f $temp_file_name -r $temp_dir_path
+
+    # Read the file content, update MSH-6, and write the result to a temporary file
+    awk -F'|' '/^MSH/ { $6 = "^simulated-hospital-id^" } 1' OFS='|' "$file" >"$temp_file"
+    echo "$temp_file"
+
+    # Submit the updated file, capture the JSON response and extract the submission ID
+    waters_response=$(./hrl waters.hurl -f "$temp_file_name" -r "$temp_dir_path")
+    submission_id=$(echo "$waters_response" | jq -r '.id')
+
+    if [ -n "$submission_id" ]; then
+        echo "Submission ID: $submission_id"
+        history_response=$(./hrl history.hurl -i $submission_id)
+        status=$(echo "$history_response" | jq '.overallStatus')
+    else
+        echo "Failed to extract submission ID."
+    fi
+
+    start_time=$(date +%s)
+    while true; do
+        history_response=$(./hrl history.hurl -i "$submission_id")
+        overall_status=$(echo "$history_response" | jq -r '.overallStatus')
+
+        if [ "$overall_status" == "Delivered" ]; then
+            echo "Submission $submission_id is Delivered."
+            break
+        else
+            echo "Status: $overall_status. Retrying in $RETRY_INTERVAL seconds..."
+        fi
+
+        # Check if the timeout has been reached
+        current_time=$(date +%s)
+        elapsed_time=$((current_time - start_time))
+        if [ "$elapsed_time" -ge "$TIMEOUT" ]; then
+            echo "Timeout reached after $elapsed_time seconds. Status is still: $overall_status."
+            break
+        fi
+
+        sleep $RETRY_INTERVAL
+    done
 
     rm "$temp_file"
 

From aec5cef241b7e87f65de05a859f1368042d4e337 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Wed, 16 Oct 2024 16:41:40 -0700
Subject: [PATCH 03/30] Added a way to get the outboud submission id, and then
 check that the second leg of the message is delivered

---
 scripts/hurl/rs/update_examples.sh | 75 +++++++++++++++++++-----------
 1 file changed, 48 insertions(+), 27 deletions(-)

diff --git a/scripts/hurl/rs/update_examples.sh b/scripts/hurl/rs/update_examples.sh
index 83203c70d..9e2f051f0 100755
--- a/scripts/hurl/rs/update_examples.sh
+++ b/scripts/hurl/rs/update_examples.sh
@@ -9,40 +9,22 @@ fi
 # Maximum time to wait for the overallStatus to be "Delivered" (in seconds)
 TIMEOUT=300       # 5 minutes
 RETRY_INTERVAL=10 # Retry every 10 seconds
+CURRENT_DIR=$(pwd)
 
-find "$CDCTI_HOME/examples/MN" -type f -name '*0_initial_message.hl7' | while read -r file; do
-    echo "Submitting file: $file"
-
-    temp_file=$(mktemp)
-    temp_dir_path=$(dirname "$temp_file")
-    temp_file_name=$(basename "$temp_file")
-
-    # Read the file content, update MSH-6, and write the result to a temporary file
-    awk -F'|' '/^MSH/ { $6 = "^simulated-hospital-id^" } 1' OFS='|' "$file" >"$temp_file"
-    echo "$temp_file"
-
-    # Submit the updated file, capture the JSON response and extract the submission ID
-    waters_response=$(./hrl waters.hurl -f "$temp_file_name" -r "$temp_dir_path")
-    submission_id=$(echo "$waters_response" | jq -r '.id')
-
-    if [ -n "$submission_id" ]; then
-        echo "Submission ID: $submission_id"
-        history_response=$(./hrl history.hurl -i $submission_id)
-        status=$(echo "$history_response" | jq '.overallStatus')
-    else
-        echo "Failed to extract submission ID."
-    fi
-
+check_submission_status() {
+    local submission_id=$1
     start_time=$(date +%s)
+
     while true; do
         history_response=$(./hrl history.hurl -i "$submission_id")
         overall_status=$(echo "$history_response" | jq -r '.overallStatus')
 
+        echo -n "Status: $overall_status"
         if [ "$overall_status" == "Delivered" ]; then
-            echo "Submission $submission_id is Delivered."
-            break
+            echo "!"
+            return 0 # Success
         else
-            echo "Status: $overall_status. Retrying in $RETRY_INTERVAL seconds..."
+            echo ". Retrying in $RETRY_INTERVAL seconds..."
         fi
 
         # Check if the timeout has been reached
@@ -50,11 +32,50 @@ find "$CDCTI_HOME/examples/MN" -type f -name '*0_initial_message.hl7' | while re
         elapsed_time=$((current_time - start_time))
         if [ "$elapsed_time" -ge "$TIMEOUT" ]; then
             echo "Timeout reached after $elapsed_time seconds. Status is still: $overall_status."
-            break
+            return 1 # Timeout
         fi
 
         sleep $RETRY_INTERVAL
     done
+}
+
+find "$CDCTI_HOME/examples/MN" -type f -name '*0_initial_message.hl7' | while read -r file; do
+    echo "Submitting file: $file"
+
+    temp_file=$(mktemp)
+    temp_dir_path=$(dirname "$temp_file")
+    temp_file_name=$(basename "$temp_file")
+
+    # Read the file content, update MSH-6, and write the result to a temporary file
+    awk -F'|' '/^MSH/ { $6 = "^simulated-hospital-id^" } 1' OFS='|' "$file" >"$temp_file"
+    # echo "$temp_file"
+
+    # Submit the updated file, capture the JSON response and extract the submission ID
+    waters_response=$(./hrl waters.hurl -f "$temp_file_name" -r "$temp_dir_path")
+    submission_id=$(echo "$waters_response" | jq -r '.id')
+
+    echo "[First leg] Checking submission status for ID: $submission_id"
+    if ! check_submission_status "$submission_id"; then
+        echo "Failed to deliver the first leg of the message. Skipping the next steps."
+        rm "$temp_file"
+        continue
+    fi
+
+    cd ../ti || exit 1
+    inbound_submission_id=$(echo $history_response | jq '.destinations[0].sentReports[0].externalName' | sed 's/^[^-]*-\(.*\)-[^-]*$/\1/')
+    metadata_response=$(./hrl metadata.hurl -i "$inbound_submission_id")
+    outbound_submission_id=$(echo "$metadata_response" | jq -r '.issue[] | select(.details.text == "outbound submission id") | .diagnostics')
+    cd "$CURRENT_DIR"
+
+    echo "[Second leg] Checking submission status for ID: $outbound_submission_id"
+    if ! check_submission_status "$outbound_submission_id"; then
+        echo "Failed to deliver the second leg of the message. Skipping the next steps."
+        rm "$temp_file"
+        continue
+    fi
+
+    final_file_name=$(echo $history_response | jq '.destinations[0].sentReports[0].externalName')
+    echo "Final file name: $final_file_name"
 
     rm "$temp_file"
 

From 5ed64085169a65906e2fc29a5eb9d6f24b84c224 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Thu, 17 Oct 2024 11:30:23 -0700
Subject: [PATCH 04/30] Added functionality to download snapshots from azurite
 + some refactoring

---
 scripts/hurl/rs/update_examples.sh | 54 ++++++++++++++++++++++++------
 1 file changed, 44 insertions(+), 10 deletions(-)

diff --git a/scripts/hurl/rs/update_examples.sh b/scripts/hurl/rs/update_examples.sh
index 9e2f051f0..0cbcb6244 100755
--- a/scripts/hurl/rs/update_examples.sh
+++ b/scripts/hurl/rs/update_examples.sh
@@ -6,10 +6,17 @@ if ! command -v jq &>/dev/null; then
     exit
 fi
 
-# Maximum time to wait for the overallStatus to be "Delivered" (in seconds)
-TIMEOUT=300       # 5 minutes
-RETRY_INTERVAL=10 # Retry every 10 seconds
+# Check if az (Azure CLI) is installed
+if ! command -v az &>/dev/null; then
+    echo "Azure CLI (az) could not be found. Please install Azure CLI to proceed."
+    exit
+fi
+
+TIMEOUT=300
+RETRY_INTERVAL=10
 CURRENT_DIR=$(pwd)
+ROOT="$CDCTI_HOME/examples/Temp"
+AZURITE_CONNECTION_STRING="DefaultEndpointsProtocol=http;AccountName=devstoreaccount1;AccountKey=Eby8vdM02xNOcqFlqUwJPLlmEtlCDXJ1OUzFT50uSRZ6IFsuFq2UVErCz4I6tq/K1SZFPTOtr/KBHBeksoGMGw==;BlobEndpoint=http://localhost:10000/devstoreaccount1;" # pragma: allowlist secret
 
 check_submission_status() {
     local submission_id=$1
@@ -19,7 +26,7 @@ check_submission_status() {
         history_response=$(./hrl history.hurl -i "$submission_id")
         overall_status=$(echo "$history_response" | jq -r '.overallStatus')
 
-        echo -n "Status: $overall_status"
+        echo -n "  Status: $overall_status"
         if [ "$overall_status" == "Delivered" ]; then
             echo "!"
             return 0 # Success
@@ -31,7 +38,7 @@ check_submission_status() {
         current_time=$(date +%s)
         elapsed_time=$((current_time - start_time))
         if [ "$elapsed_time" -ge "$TIMEOUT" ]; then
-            echo "Timeout reached after $elapsed_time seconds. Status is still: $overall_status."
+            echo "  Timeout reached after $elapsed_time seconds. Status is still: $overall_status."
             return 1 # Timeout
         fi
 
@@ -39,7 +46,25 @@ check_submission_status() {
     done
 }
 
-find "$CDCTI_HOME/examples/MN" -type f -name '*0_initial_message.hl7' | while read -r file; do
+get_sent_report_id_from_history_response() {
+    local history_response=$1
+    echo $history_response | jq '.destinations[0].sentReports[0].externalName' | sed 's/.*-\([0-9a-f]\{8\}-[0-9a-f]\{4\}-[0-9a-f]\{4\}-[0-9a-f]\{4\}-[0-9a-f]\{12\}\)-.*/\1/'
+}
+
+download_from_azurite() {
+    local blob_name=$1
+    local file_path=$2
+
+    echo "  Downloading from blob storage '$translated_blob_name' to '$translated_file_path'"
+    az storage blob download \
+        --container-name "reports" \
+        --name $blob_name \
+        --file $file_path \
+        --connection-string $AZURITE_CONNECTION_STRING \
+        --output none
+}
+
+find $ROOT -type f -name '*0_initial_message.hl7' | while read -r file; do
     echo "Submitting file: $file"
 
     temp_file=$(mktemp)
@@ -48,7 +73,6 @@ find "$CDCTI_HOME/examples/MN" -type f -name '*0_initial_message.hl7' | while re
 
     # Read the file content, update MSH-6, and write the result to a temporary file
     awk -F'|' '/^MSH/ { $6 = "^simulated-hospital-id^" } 1' OFS='|' "$file" >"$temp_file"
-    # echo "$temp_file"
 
     # Submit the updated file, capture the JSON response and extract the submission ID
     waters_response=$(./hrl waters.hurl -f "$temp_file_name" -r "$temp_dir_path")
@@ -61,12 +85,20 @@ find "$CDCTI_HOME/examples/MN" -type f -name '*0_initial_message.hl7' | while re
         continue
     fi
 
+    inbound_submission_id=$(get_sent_report_id_from_history_response "$history_response")
+    translated_blob_name="ready/flexion.etor-service-receiver-results/$inbound_submission_id.fhir"
+    translated_file_path="$ROOT/translated.fhir"
+    download_from_azurite "$translated_blob_name" "$translated_file_path"
+
     cd ../ti || exit 1
-    inbound_submission_id=$(echo $history_response | jq '.destinations[0].sentReports[0].externalName' | sed 's/^[^-]*-\(.*\)-[^-]*$/\1/')
     metadata_response=$(./hrl metadata.hurl -i "$inbound_submission_id")
     outbound_submission_id=$(echo "$metadata_response" | jq -r '.issue[] | select(.details.text == "outbound submission id") | .diagnostics')
     cd "$CURRENT_DIR"
 
+    transformed_blob_name="receive/flexion.etor-service-sender/$outbound_submission_id.fhir"
+    transformed_file_path="$ROOT/transformed.fhir"
+    download_from_azurite "$transformed_blob_name" "$transformed_file_path"
+
     echo "[Second leg] Checking submission status for ID: $outbound_submission_id"
     if ! check_submission_status "$outbound_submission_id"; then
         echo "Failed to deliver the second leg of the message. Skipping the next steps."
@@ -74,8 +106,10 @@ find "$CDCTI_HOME/examples/MN" -type f -name '*0_initial_message.hl7' | while re
         continue
     fi
 
-    final_file_name=$(echo $history_response | jq '.destinations[0].sentReports[0].externalName')
-    echo "Final file name: $final_file_name"
+    final_submission_id=$(get_sent_report_id_from_history_response "$history_response")
+    final_blob_name="ready/flexion.simulated-hospital/$final_submission_id.hl7"
+    final_file_path="$ROOT/final.hl7"
+    download_from_azurite "$final_blob_name" "$final_file_path"
 
     rm "$temp_file"
 

From 256960a61dc18ab8171734186155f83bb34ff761 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Thu, 17 Oct 2024 16:55:01 -0700
Subject: [PATCH 05/30] Renamed output files to overwrite existing snapshots
 and added json formatting in fhir files. Script is now fully functional but
 still needs some cleaning and handling of some cases

---
 scripts/hurl/rs/update_examples.sh | 31 +++++++++++++++++++++---------
 1 file changed, 22 insertions(+), 9 deletions(-)

diff --git a/scripts/hurl/rs/update_examples.sh b/scripts/hurl/rs/update_examples.sh
index 0cbcb6244..9d918b9fc 100755
--- a/scripts/hurl/rs/update_examples.sh
+++ b/scripts/hurl/rs/update_examples.sh
@@ -12,11 +12,15 @@ if ! command -v az &>/dev/null; then
     exit
 fi
 
-TIMEOUT=300
-RETRY_INTERVAL=10
+TIMEOUT=180       # seconds
+RETRY_INTERVAL=10 # seconds
 CURRENT_DIR=$(pwd)
-ROOT="$CDCTI_HOME/examples/Temp"
+ROOT="$CDCTI_HOME/examples"
 AZURITE_CONNECTION_STRING="DefaultEndpointsProtocol=http;AccountName=devstoreaccount1;AccountKey=Eby8vdM02xNOcqFlqUwJPLlmEtlCDXJ1OUzFT50uSRZ6IFsuFq2UVErCz4I6tq/K1SZFPTOtr/KBHBeksoGMGw==;BlobEndpoint=http://localhost:10000/devstoreaccount1;" # pragma: allowlist secret
+FILE_NAME_SUFFIX_STEP_0="_0_initial_message.hl7"
+FILE_NAME_SUFFIX_STEP_1="_1_hl7_translation.fhir"
+FILE_NAME_SUFFIX_STEP_2="_2_fhir_transformation.fhir"
+FILE_NAME_SUFFIX_STEP_3="_3_hl7_translation_final.hl7"
 
 check_submission_status() {
     local submission_id=$1
@@ -55,21 +59,30 @@ download_from_azurite() {
     local blob_name=$1
     local file_path=$2
 
-    echo "  Downloading from blob storage '$translated_blob_name' to '$translated_file_path'"
+    echo "  Downloading from blob storage '$blob_name' to '$file_path'"
     az storage blob download \
         --container-name "reports" \
         --name $blob_name \
         --file $file_path \
         --connection-string $AZURITE_CONNECTION_STRING \
         --output none
+
+    if [[ "$file_path" == *.fhir ]]; then
+        echo "  Formatting the content for: $file_path"
+        formatted_content=$(jq '.' "$file_path")
+        echo "$formatted_content" >"$file_path"
+    fi
 }
 
-find $ROOT -type f -name '*0_initial_message.hl7' | while read -r file; do
-    echo "Submitting file: $file"
+find $ROOT -type f -name "*$FILE_NAME_SUFFIX_STEP_0" | while read -r file; do
+    echo "Submitting message: $file"
 
     temp_file=$(mktemp)
     temp_dir_path=$(dirname "$temp_file")
     temp_file_name=$(basename "$temp_file")
+    message_file_path=$(dirname "$file")
+    message_file_name=$(basename "$file")
+    message_base_name="${message_file_name%$FILE_NAME_SUFFIX_STEP_0}"
 
     # Read the file content, update MSH-6, and write the result to a temporary file
     awk -F'|' '/^MSH/ { $6 = "^simulated-hospital-id^" } 1' OFS='|' "$file" >"$temp_file"
@@ -87,7 +100,7 @@ find $ROOT -type f -name '*0_initial_message.hl7' | while read -r file; do
 
     inbound_submission_id=$(get_sent_report_id_from_history_response "$history_response")
     translated_blob_name="ready/flexion.etor-service-receiver-results/$inbound_submission_id.fhir"
-    translated_file_path="$ROOT/translated.fhir"
+    translated_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_1"
     download_from_azurite "$translated_blob_name" "$translated_file_path"
 
     cd ../ti || exit 1
@@ -96,7 +109,7 @@ find $ROOT -type f -name '*0_initial_message.hl7' | while read -r file; do
     cd "$CURRENT_DIR"
 
     transformed_blob_name="receive/flexion.etor-service-sender/$outbound_submission_id.fhir"
-    transformed_file_path="$ROOT/transformed.fhir"
+    transformed_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_2"
     download_from_azurite "$transformed_blob_name" "$transformed_file_path"
 
     echo "[Second leg] Checking submission status for ID: $outbound_submission_id"
@@ -108,7 +121,7 @@ find $ROOT -type f -name '*0_initial_message.hl7' | while read -r file; do
 
     final_submission_id=$(get_sent_report_id_from_history_response "$history_response")
     final_blob_name="ready/flexion.simulated-hospital/$final_submission_id.hl7"
-    final_file_path="$ROOT/final.hl7"
+    final_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_3"
     download_from_azurite "$final_blob_name" "$final_file_path"
 
     rm "$temp_file"

From f292a0bf2d025f64785faaa05a67125a7d523694 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 07:44:24 -0700
Subject: [PATCH 06/30] Avoid replacing MSH-6.2, now detecting receiver with
 MSH-9 + refactoring

---
 scripts/hurl/rs/update_examples.sh | 45 ++++++++++++++++--------------
 1 file changed, 24 insertions(+), 21 deletions(-)

diff --git a/scripts/hurl/rs/update_examples.sh b/scripts/hurl/rs/update_examples.sh
index 9d918b9fc..c0222fc4a 100755
--- a/scripts/hurl/rs/update_examples.sh
+++ b/scripts/hurl/rs/update_examples.sh
@@ -74,28 +74,32 @@ download_from_azurite() {
     fi
 }
 
-find $ROOT -type f -name "*$FILE_NAME_SUFFIX_STEP_0" | while read -r file; do
-    echo "Submitting message: $file"
-
-    temp_file=$(mktemp)
-    temp_dir_path=$(dirname "$temp_file")
-    temp_file_name=$(basename "$temp_file")
-    message_file_path=$(dirname "$file")
-    message_file_name=$(basename "$file")
-    message_base_name="${message_file_name%$FILE_NAME_SUFFIX_STEP_0}"
+submit_message() {
+    local file=$1
+    local message_file_path=$(dirname "$file")
+    local message_file_name=$(basename "$file")
+    local message_base_name="${message_file_name%$FILE_NAME_SUFFIX_STEP_0}"
+
+    msh9=$(awk -F'|' '/^MSH/ { print $9 }' "$file")
+    if [[ "$msh9" == "ORU^R01^ORU_R01" ]]; then
+        receiver="flexion.simulated-hospital"
+    elif [[ "$msh9" == "OML^O21^OML_O21" || "$msh9" == "ORM^O01^ORM_O01" ]]; then
+        receiver="flexion.simulated-lab"
+    else
+        echo "Unknown receiver for MSH-9 value '$msh9'. Skipping the message"
+        return
+    fi
 
-    # Read the file content, update MSH-6, and write the result to a temporary file
-    awk -F'|' '/^MSH/ { $6 = "^simulated-hospital-id^" } 1' OFS='|' "$file" >"$temp_file"
+    echo "Assuming receiver is '$receiver' because of MSH-9 value '$msh9'"
 
     # Submit the updated file, capture the JSON response and extract the submission ID
-    waters_response=$(./hrl waters.hurl -f "$temp_file_name" -r "$temp_dir_path")
+    waters_response=$(./hrl waters.hurl -f "$message_file_name" -r "$message_file_path")
     submission_id=$(echo "$waters_response" | jq -r '.id')
 
     echo "[First leg] Checking submission status for ID: $submission_id"
     if ! check_submission_status "$submission_id"; then
         echo "Failed to deliver the first leg of the message. Skipping the next steps."
-        rm "$temp_file"
-        continue
+        return
     fi
 
     inbound_submission_id=$(get_sent_report_id_from_history_response "$history_response")
@@ -115,17 +119,16 @@ find $ROOT -type f -name "*$FILE_NAME_SUFFIX_STEP_0" | while read -r file; do
     echo "[Second leg] Checking submission status for ID: $outbound_submission_id"
     if ! check_submission_status "$outbound_submission_id"; then
         echo "Failed to deliver the second leg of the message. Skipping the next steps."
-        rm "$temp_file"
-        continue
+        return
     fi
 
     final_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    final_blob_name="ready/flexion.simulated-hospital/$final_submission_id.hl7"
+    final_blob_name="ready/$receiver/$final_submission_id.hl7"
     final_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_3"
     download_from_azurite "$final_blob_name" "$final_file_path"
+}
 
-    rm "$temp_file"
-
-    echo "Waiting 5 seconds before the next submission..."
-    sleep 5
+find $ROOT -type f -name "*$FILE_NAME_SUFFIX_STEP_0" | while read -r file; do
+    echo "Submitting message: $file"
+    submit_message "$file"
 done

From 0f8146c0afee7eb2a25eda777b79cbeec696ba52 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 09:15:39 -0700
Subject: [PATCH 07/30] Increased timeout

---
 scripts/hurl/rs/update_examples.sh | 5 +++--
 1 file changed, 3 insertions(+), 2 deletions(-)

diff --git a/scripts/hurl/rs/update_examples.sh b/scripts/hurl/rs/update_examples.sh
index c0222fc4a..3d988438a 100755
--- a/scripts/hurl/rs/update_examples.sh
+++ b/scripts/hurl/rs/update_examples.sh
@@ -12,8 +12,8 @@ if ! command -v az &>/dev/null; then
     exit
 fi
 
-TIMEOUT=180       # seconds
-RETRY_INTERVAL=10 # seconds
+TIMEOUT=180       # 3 minutes
+RETRY_INTERVAL=10 # Retry every 10 seconds
 CURRENT_DIR=$(pwd)
 ROOT="$CDCTI_HOME/examples"
 AZURITE_CONNECTION_STRING="DefaultEndpointsProtocol=http;AccountName=devstoreaccount1;AccountKey=Eby8vdM02xNOcqFlqUwJPLlmEtlCDXJ1OUzFT50uSRZ6IFsuFq2UVErCz4I6tq/K1SZFPTOtr/KBHBeksoGMGw==;BlobEndpoint=http://localhost:10000/devstoreaccount1;" # pragma: allowlist secret
@@ -129,6 +129,7 @@ submit_message() {
 }
 
 find $ROOT -type f -name "*$FILE_NAME_SUFFIX_STEP_0" | while read -r file; do
+    echo "-----------------------------------------------------------------------------------------------------------"
     echo "Submitting message: $file"
     submit_message "$file"
 done

From 534399bcc261f728bc7870bfec4671c0cc4a13a9 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 09:28:06 -0700
Subject: [PATCH 08/30] Changing relative paths to absoulte to make sure we can
 move this script to a different location

---
 scripts/hurl/rs/update_examples.sh | 22 +++++++++++++++-------
 1 file changed, 15 insertions(+), 7 deletions(-)

diff --git a/scripts/hurl/rs/update_examples.sh b/scripts/hurl/rs/update_examples.sh
index 3d988438a..f50f5a52c 100755
--- a/scripts/hurl/rs/update_examples.sh
+++ b/scripts/hurl/rs/update_examples.sh
@@ -15,7 +15,8 @@ fi
 TIMEOUT=180       # 3 minutes
 RETRY_INTERVAL=10 # Retry every 10 seconds
 CURRENT_DIR=$(pwd)
-ROOT="$CDCTI_HOME/examples"
+RS_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/rs"
+TI_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/ti"
 AZURITE_CONNECTION_STRING="DefaultEndpointsProtocol=http;AccountName=devstoreaccount1;AccountKey=Eby8vdM02xNOcqFlqUwJPLlmEtlCDXJ1OUzFT50uSRZ6IFsuFq2UVErCz4I6tq/K1SZFPTOtr/KBHBeksoGMGw==;BlobEndpoint=http://localhost:10000/devstoreaccount1;" # pragma: allowlist secret
 FILE_NAME_SUFFIX_STEP_0="_0_initial_message.hl7"
 FILE_NAME_SUFFIX_STEP_1="_1_hl7_translation.fhir"
@@ -27,7 +28,10 @@ check_submission_status() {
     start_time=$(date +%s)
 
     while true; do
-        history_response=$(./hrl history.hurl -i "$submission_id")
+        history_response=$(
+            cd "$RS_HRL_SCRIPT_PATH" || exit 1
+            ./hrl history.hurl -i "$submission_id"
+        )
         overall_status=$(echo "$history_response" | jq -r '.overallStatus')
 
         echo -n "  Status: $overall_status"
@@ -93,7 +97,10 @@ submit_message() {
     echo "Assuming receiver is '$receiver' because of MSH-9 value '$msh9'"
 
     # Submit the updated file, capture the JSON response and extract the submission ID
-    waters_response=$(./hrl waters.hurl -f "$message_file_name" -r "$message_file_path")
+    waters_response=$(
+        cd "$RS_HRL_SCRIPT_PATH" || exit 1
+        ./hrl waters.hurl -f "$message_file_name" -r "$message_file_path"
+    )
     submission_id=$(echo "$waters_response" | jq -r '.id')
 
     echo "[First leg] Checking submission status for ID: $submission_id"
@@ -107,10 +114,11 @@ submit_message() {
     translated_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_1"
     download_from_azurite "$translated_blob_name" "$translated_file_path"
 
-    cd ../ti || exit 1
-    metadata_response=$(./hrl metadata.hurl -i "$inbound_submission_id")
+    metadata_response=$(
+        cd "$TI_HRL_SCRIPT_PATH" || exit 1
+        ./hrl metadata.hurl -i "$inbound_submission_id"
+    )
     outbound_submission_id=$(echo "$metadata_response" | jq -r '.issue[] | select(.details.text == "outbound submission id") | .diagnostics')
-    cd "$CURRENT_DIR"
 
     transformed_blob_name="receive/flexion.etor-service-sender/$outbound_submission_id.fhir"
     transformed_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_2"
@@ -128,7 +136,7 @@ submit_message() {
     download_from_azurite "$final_blob_name" "$final_file_path"
 }
 
-find $ROOT -type f -name "*$FILE_NAME_SUFFIX_STEP_0" | while read -r file; do
+find "$CDCTI_HOME/examples" -type f -name "*$FILE_NAME_SUFFIX_STEP_0" | while read -r file; do
     echo "-----------------------------------------------------------------------------------------------------------"
     echo "Submitting message: $file"
     submit_message "$file"

From 8409faa301a8c595c98110e5db95f40b8701215e Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 09:32:10 -0700
Subject: [PATCH 09/30] Moved script to parent dir

---
 scripts/hurl/{rs => }/update_examples.sh | 0
 1 file changed, 0 insertions(+), 0 deletions(-)
 rename scripts/hurl/{rs => }/update_examples.sh (100%)

diff --git a/scripts/hurl/rs/update_examples.sh b/scripts/hurl/update_examples.sh
similarity index 100%
rename from scripts/hurl/rs/update_examples.sh
rename to scripts/hurl/update_examples.sh

From 8dd00d476be4f3ccceae03a98cca61f9a39c3111 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 09:42:36 -0700
Subject: [PATCH 10/30] Refactored to extract functions and added script to
 submit a message given the file path

---
 scripts/hurl/local_test_utils.sh | 137 +++++++++++++++++++++++++++++++
 scripts/hurl/submit_message.sh   |  10 +++
 scripts/hurl/update_examples.sh  | 136 +-----------------------------
 3 files changed, 148 insertions(+), 135 deletions(-)
 create mode 100755 scripts/hurl/local_test_utils.sh
 create mode 100755 scripts/hurl/submit_message.sh

diff --git a/scripts/hurl/local_test_utils.sh b/scripts/hurl/local_test_utils.sh
new file mode 100755
index 000000000..ad64d9e44
--- /dev/null
+++ b/scripts/hurl/local_test_utils.sh
@@ -0,0 +1,137 @@
+#!/bin/bash
+
+# Ensure jq is installed
+if ! command -v jq &>/dev/null; then
+    echo "jq could not be found. Please install jq to proceed."
+    exit
+fi
+
+# Check if az (Azure CLI) is installed
+if ! command -v az &>/dev/null; then
+    echo "Azure CLI (az) could not be found. Please install Azure CLI to proceed."
+    exit
+fi
+
+TIMEOUT=180       # 3 minutes
+RETRY_INTERVAL=10 # Retry every 10 seconds
+CURRENT_DIR=$(pwd)
+RS_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/rs"
+TI_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/ti"
+AZURITE_CONNECTION_STRING="DefaultEndpointsProtocol=http;AccountName=devstoreaccount1;AccountKey=Eby8vdM02xNOcqFlqUwJPLlmEtlCDXJ1OUzFT50uSRZ6IFsuFq2UVErCz4I6tq/K1SZFPTOtr/KBHBeksoGMGw==;BlobEndpoint=http://localhost:10000/devstoreaccount1;" # pragma: allowlist secret
+FILE_NAME_SUFFIX_STEP_0="_0_initial_message.hl7"
+FILE_NAME_SUFFIX_STEP_1="_1_hl7_translation.fhir"
+FILE_NAME_SUFFIX_STEP_2="_2_fhir_transformation.fhir"
+FILE_NAME_SUFFIX_STEP_3="_3_hl7_translation_final.hl7"
+
+check_submission_status() {
+    local submission_id=$1
+    start_time=$(date +%s)
+
+    while true; do
+        history_response=$(
+            cd "$RS_HRL_SCRIPT_PATH" || exit 1
+            ./hrl history.hurl -i "$submission_id"
+        )
+        overall_status=$(echo "$history_response" | jq -r '.overallStatus')
+
+        echo -n "  Status: $overall_status"
+        if [ "$overall_status" == "Delivered" ]; then
+            echo "!"
+            return 0 # Success
+        else
+            echo ". Retrying in $RETRY_INTERVAL seconds..."
+        fi
+
+        # Check if the timeout has been reached
+        current_time=$(date +%s)
+        elapsed_time=$((current_time - start_time))
+        if [ "$elapsed_time" -ge "$TIMEOUT" ]; then
+            echo "  Timeout reached after $elapsed_time seconds. Status is still: $overall_status."
+            return 1 # Timeout
+        fi
+
+        sleep $RETRY_INTERVAL
+    done
+}
+
+get_sent_report_id_from_history_response() {
+    local history_response=$1
+    echo $history_response | jq '.destinations[0].sentReports[0].externalName' | sed 's/.*-\([0-9a-f]\{8\}-[0-9a-f]\{4\}-[0-9a-f]\{4\}-[0-9a-f]\{4\}-[0-9a-f]\{12\}\)-.*/\1/'
+}
+
+download_from_azurite() {
+    local blob_name=$1
+    local file_path=$2
+
+    echo "  Downloading from blob storage '$blob_name' to '$file_path'"
+    az storage blob download \
+        --container-name "reports" \
+        --name $blob_name \
+        --file $file_path \
+        --connection-string $AZURITE_CONNECTION_STRING \
+        --output none
+
+    if [[ "$file_path" == *.fhir ]]; then
+        echo "  Formatting the content for: $file_path"
+        formatted_content=$(jq '.' "$file_path")
+        echo "$formatted_content" >"$file_path"
+    fi
+}
+
+submit_message() {
+    local file=$1
+    local message_file_path=$(dirname "$file")
+    local message_file_name=$(basename "$file")
+    local message_base_name="${message_file_name%$FILE_NAME_SUFFIX_STEP_0}"
+
+    msh9=$(awk -F'|' '/^MSH/ { print $9 }' "$file")
+    if [[ "$msh9" == "ORU^R01^ORU_R01" ]]; then
+        receiver="flexion.simulated-hospital"
+    elif [[ "$msh9" == "OML^O21^OML_O21" || "$msh9" == "ORM^O01^ORM_O01" ]]; then
+        receiver="flexion.simulated-lab"
+    else
+        echo "Unknown receiver for MSH-9 value '$msh9'. Skipping the message"
+        return
+    fi
+
+    echo "Assuming receiver is '$receiver' because of MSH-9 value '$msh9'"
+
+    # Submit the updated file, capture the JSON response and extract the submission ID
+    waters_response=$(
+        cd "$RS_HRL_SCRIPT_PATH" || exit 1
+        ./hrl waters.hurl -f "$message_file_name" -r "$message_file_path"
+    )
+    submission_id=$(echo "$waters_response" | jq -r '.id')
+
+    echo "[First leg] Checking submission status for ID: $submission_id"
+    if ! check_submission_status "$submission_id"; then
+        echo "Failed to deliver the first leg of the message. Skipping the next steps."
+        return
+    fi
+
+    inbound_submission_id=$(get_sent_report_id_from_history_response "$history_response")
+    translated_blob_name="ready/flexion.etor-service-receiver-results/$inbound_submission_id.fhir"
+    translated_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_1"
+    download_from_azurite "$translated_blob_name" "$translated_file_path"
+
+    metadata_response=$(
+        cd "$TI_HRL_SCRIPT_PATH" || exit 1
+        ./hrl metadata.hurl -i "$inbound_submission_id"
+    )
+    outbound_submission_id=$(echo "$metadata_response" | jq -r '.issue[] | select(.details.text == "outbound submission id") | .diagnostics')
+
+    transformed_blob_name="receive/flexion.etor-service-sender/$outbound_submission_id.fhir"
+    transformed_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_2"
+    download_from_azurite "$transformed_blob_name" "$transformed_file_path"
+
+    echo "[Second leg] Checking submission status for ID: $outbound_submission_id"
+    if ! check_submission_status "$outbound_submission_id"; then
+        echo "Failed to deliver the second leg of the message. Skipping the next steps."
+        return
+    fi
+
+    final_submission_id=$(get_sent_report_id_from_history_response "$history_response")
+    final_blob_name="ready/$receiver/$final_submission_id.hl7"
+    final_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_3"
+    download_from_azurite "$final_blob_name" "$final_file_path"
+}
diff --git a/scripts/hurl/submit_message.sh b/scripts/hurl/submit_message.sh
new file mode 100755
index 000000000..ad75f86f4
--- /dev/null
+++ b/scripts/hurl/submit_message.sh
@@ -0,0 +1,10 @@
+#!/bin/bash
+
+source ./local_test_utils.sh
+
+if [ $# -eq 0 ]; then
+    echo "Usage: $0 /path/to/file.hl7"
+    exit 1
+fi
+
+submit_message "$1"
diff --git a/scripts/hurl/update_examples.sh b/scripts/hurl/update_examples.sh
index f50f5a52c..cc61f2302 100755
--- a/scripts/hurl/update_examples.sh
+++ b/scripts/hurl/update_examples.sh
@@ -1,140 +1,6 @@
 #!/bin/bash
 
-# Ensure jq is installed
-if ! command -v jq &>/dev/null; then
-    echo "jq could not be found. Please install jq to proceed."
-    exit
-fi
-
-# Check if az (Azure CLI) is installed
-if ! command -v az &>/dev/null; then
-    echo "Azure CLI (az) could not be found. Please install Azure CLI to proceed."
-    exit
-fi
-
-TIMEOUT=180       # 3 minutes
-RETRY_INTERVAL=10 # Retry every 10 seconds
-CURRENT_DIR=$(pwd)
-RS_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/rs"
-TI_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/ti"
-AZURITE_CONNECTION_STRING="DefaultEndpointsProtocol=http;AccountName=devstoreaccount1;AccountKey=Eby8vdM02xNOcqFlqUwJPLlmEtlCDXJ1OUzFT50uSRZ6IFsuFq2UVErCz4I6tq/K1SZFPTOtr/KBHBeksoGMGw==;BlobEndpoint=http://localhost:10000/devstoreaccount1;" # pragma: allowlist secret
-FILE_NAME_SUFFIX_STEP_0="_0_initial_message.hl7"
-FILE_NAME_SUFFIX_STEP_1="_1_hl7_translation.fhir"
-FILE_NAME_SUFFIX_STEP_2="_2_fhir_transformation.fhir"
-FILE_NAME_SUFFIX_STEP_3="_3_hl7_translation_final.hl7"
-
-check_submission_status() {
-    local submission_id=$1
-    start_time=$(date +%s)
-
-    while true; do
-        history_response=$(
-            cd "$RS_HRL_SCRIPT_PATH" || exit 1
-            ./hrl history.hurl -i "$submission_id"
-        )
-        overall_status=$(echo "$history_response" | jq -r '.overallStatus')
-
-        echo -n "  Status: $overall_status"
-        if [ "$overall_status" == "Delivered" ]; then
-            echo "!"
-            return 0 # Success
-        else
-            echo ". Retrying in $RETRY_INTERVAL seconds..."
-        fi
-
-        # Check if the timeout has been reached
-        current_time=$(date +%s)
-        elapsed_time=$((current_time - start_time))
-        if [ "$elapsed_time" -ge "$TIMEOUT" ]; then
-            echo "  Timeout reached after $elapsed_time seconds. Status is still: $overall_status."
-            return 1 # Timeout
-        fi
-
-        sleep $RETRY_INTERVAL
-    done
-}
-
-get_sent_report_id_from_history_response() {
-    local history_response=$1
-    echo $history_response | jq '.destinations[0].sentReports[0].externalName' | sed 's/.*-\([0-9a-f]\{8\}-[0-9a-f]\{4\}-[0-9a-f]\{4\}-[0-9a-f]\{4\}-[0-9a-f]\{12\}\)-.*/\1/'
-}
-
-download_from_azurite() {
-    local blob_name=$1
-    local file_path=$2
-
-    echo "  Downloading from blob storage '$blob_name' to '$file_path'"
-    az storage blob download \
-        --container-name "reports" \
-        --name $blob_name \
-        --file $file_path \
-        --connection-string $AZURITE_CONNECTION_STRING \
-        --output none
-
-    if [[ "$file_path" == *.fhir ]]; then
-        echo "  Formatting the content for: $file_path"
-        formatted_content=$(jq '.' "$file_path")
-        echo "$formatted_content" >"$file_path"
-    fi
-}
-
-submit_message() {
-    local file=$1
-    local message_file_path=$(dirname "$file")
-    local message_file_name=$(basename "$file")
-    local message_base_name="${message_file_name%$FILE_NAME_SUFFIX_STEP_0}"
-
-    msh9=$(awk -F'|' '/^MSH/ { print $9 }' "$file")
-    if [[ "$msh9" == "ORU^R01^ORU_R01" ]]; then
-        receiver="flexion.simulated-hospital"
-    elif [[ "$msh9" == "OML^O21^OML_O21" || "$msh9" == "ORM^O01^ORM_O01" ]]; then
-        receiver="flexion.simulated-lab"
-    else
-        echo "Unknown receiver for MSH-9 value '$msh9'. Skipping the message"
-        return
-    fi
-
-    echo "Assuming receiver is '$receiver' because of MSH-9 value '$msh9'"
-
-    # Submit the updated file, capture the JSON response and extract the submission ID
-    waters_response=$(
-        cd "$RS_HRL_SCRIPT_PATH" || exit 1
-        ./hrl waters.hurl -f "$message_file_name" -r "$message_file_path"
-    )
-    submission_id=$(echo "$waters_response" | jq -r '.id')
-
-    echo "[First leg] Checking submission status for ID: $submission_id"
-    if ! check_submission_status "$submission_id"; then
-        echo "Failed to deliver the first leg of the message. Skipping the next steps."
-        return
-    fi
-
-    inbound_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    translated_blob_name="ready/flexion.etor-service-receiver-results/$inbound_submission_id.fhir"
-    translated_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_1"
-    download_from_azurite "$translated_blob_name" "$translated_file_path"
-
-    metadata_response=$(
-        cd "$TI_HRL_SCRIPT_PATH" || exit 1
-        ./hrl metadata.hurl -i "$inbound_submission_id"
-    )
-    outbound_submission_id=$(echo "$metadata_response" | jq -r '.issue[] | select(.details.text == "outbound submission id") | .diagnostics')
-
-    transformed_blob_name="receive/flexion.etor-service-sender/$outbound_submission_id.fhir"
-    transformed_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_2"
-    download_from_azurite "$transformed_blob_name" "$transformed_file_path"
-
-    echo "[Second leg] Checking submission status for ID: $outbound_submission_id"
-    if ! check_submission_status "$outbound_submission_id"; then
-        echo "Failed to deliver the second leg of the message. Skipping the next steps."
-        return
-    fi
-
-    final_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    final_blob_name="ready/$receiver/$final_submission_id.hl7"
-    final_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_3"
-    download_from_azurite "$final_blob_name" "$final_file_path"
-}
+source ./local_test_utils.sh
 
 find "$CDCTI_HOME/examples" -type f -name "*$FILE_NAME_SUFFIX_STEP_0" | while read -r file; do
     echo "-----------------------------------------------------------------------------------------------------------"

From 4c9030020fa44c5ace0faa6c78265515264bad4d Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 13:08:17 -0700
Subject: [PATCH 11/30] Added pre-condition check to make sure the TI and RS
 local APIs are reachable

---
 scripts/hurl/local_test_utils.sh | 48 +++++++++++++++++++++-----------
 1 file changed, 31 insertions(+), 17 deletions(-)

diff --git a/scripts/hurl/local_test_utils.sh b/scripts/hurl/local_test_utils.sh
index ad64d9e44..2cef00664 100755
--- a/scripts/hurl/local_test_utils.sh
+++ b/scripts/hurl/local_test_utils.sh
@@ -1,28 +1,42 @@
 #!/bin/bash
 
-# Ensure jq is installed
-if ! command -v jq &>/dev/null; then
-    echo "jq could not be found. Please install jq to proceed."
-    exit
-fi
-
-# Check if az (Azure CLI) is installed
-if ! command -v az &>/dev/null; then
-    echo "Azure CLI (az) could not be found. Please install Azure CLI to proceed."
-    exit
-fi
-
-TIMEOUT=180       # 3 minutes
-RETRY_INTERVAL=10 # Retry every 10 seconds
 CURRENT_DIR=$(pwd)
 RS_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/rs"
 TI_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/ti"
-AZURITE_CONNECTION_STRING="DefaultEndpointsProtocol=http;AccountName=devstoreaccount1;AccountKey=Eby8vdM02xNOcqFlqUwJPLlmEtlCDXJ1OUzFT50uSRZ6IFsuFq2UVErCz4I6tq/K1SZFPTOtr/KBHBeksoGMGw==;BlobEndpoint=http://localhost:10000/devstoreaccount1;" # pragma: allowlist secret
 FILE_NAME_SUFFIX_STEP_0="_0_initial_message.hl7"
 FILE_NAME_SUFFIX_STEP_1="_1_hl7_translation.fhir"
 FILE_NAME_SUFFIX_STEP_2="_2_fhir_transformation.fhir"
 FILE_NAME_SUFFIX_STEP_3="_3_hl7_translation_final.hl7"
 
+TIMEOUT=180       # 3 minutes
+RETRY_INTERVAL=10 # Retry every 10 seconds
+
+AZURITE_CONNECTION_STRING="DefaultEndpointsProtocol=http;AccountName=devstoreaccount1;AccountKey=Eby8vdM02xNOcqFlqUwJPLlmEtlCDXJ1OUzFT50uSRZ6IFsuFq2UVErCz4I6tq/K1SZFPTOtr/KBHBeksoGMGw==;BlobEndpoint=http://localhost:10000/devstoreaccount1;" # pragma: allowlist secret
+
+RS_LOCAL_API="http://localhost:7071"
+TI_LOCAL_API="http://localhost:8080"
+
+LOCAL_APIS=("$RS_LOCAL_API" "$TI_LOCAL_API")
+# Check if the RS and TO local APIs are reachable
+for service in "${LOCAL_APIS[@]}"; do
+    if ! curl -s --head --fail "$service" | grep "200 OK" >/dev/null; then
+        echo "The service at $service is not reachable"
+        exit 1
+    fi
+done
+
+# Check jq is installed
+if ! command -v jq &>/dev/null; then
+    echo "jq could not be found. Please install jq to proceed."
+    exit 1
+fi
+
+# Check az (Azure CLI) is installed
+if ! command -v az &>/dev/null; then
+    echo "Azure CLI (az) could not be found. Please install Azure CLI to proceed."
+    exit 1
+fi
+
 check_submission_status() {
     local submission_id=$1
     start_time=$(date +%s)
@@ -37,7 +51,7 @@ check_submission_status() {
         echo -n "  Status: $overall_status"
         if [ "$overall_status" == "Delivered" ]; then
             echo "!"
-            return 0 # Success
+            return 0
         else
             echo ". Retrying in $RETRY_INTERVAL seconds..."
         fi
@@ -47,7 +61,7 @@ check_submission_status() {
         elapsed_time=$((current_time - start_time))
         if [ "$elapsed_time" -ge "$TIMEOUT" ]; then
             echo "  Timeout reached after $elapsed_time seconds. Status is still: $overall_status."
-            return 1 # Timeout
+            return 1
         fi
 
         sleep $RETRY_INTERVAL

From 781f7bc6b23521681f38a2b646e698c71b036f46 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 13:26:25 -0700
Subject: [PATCH 12/30] Fixed naming of file + cleanup

---
 scripts/hurl/local_test_utils.sh | 4 ++--
 scripts/hurl/submit_message.sh   | 2 +-
 2 files changed, 3 insertions(+), 3 deletions(-)

diff --git a/scripts/hurl/local_test_utils.sh b/scripts/hurl/local_test_utils.sh
index 2cef00664..2899aeb39 100755
--- a/scripts/hurl/local_test_utils.sh
+++ b/scripts/hurl/local_test_utils.sh
@@ -96,7 +96,8 @@ submit_message() {
     local file=$1
     local message_file_path=$(dirname "$file")
     local message_file_name=$(basename "$file")
-    local message_base_name="${message_file_name%$FILE_NAME_SUFFIX_STEP_0}"
+    local message_base_name="${message_file_name%.hl7}"
+    message_base_name="${message_base_name%FILE_NAME_SUFFIX_STEP_0}"
 
     msh9=$(awk -F'|' '/^MSH/ { print $9 }' "$file")
     if [[ "$msh9" == "ORU^R01^ORU_R01" ]]; then
@@ -110,7 +111,6 @@ submit_message() {
 
     echo "Assuming receiver is '$receiver' because of MSH-9 value '$msh9'"
 
-    # Submit the updated file, capture the JSON response and extract the submission ID
     waters_response=$(
         cd "$RS_HRL_SCRIPT_PATH" || exit 1
         ./hrl waters.hurl -f "$message_file_name" -r "$message_file_path"
diff --git a/scripts/hurl/submit_message.sh b/scripts/hurl/submit_message.sh
index ad75f86f4..2161cda07 100755
--- a/scripts/hurl/submit_message.sh
+++ b/scripts/hurl/submit_message.sh
@@ -3,7 +3,7 @@
 source ./local_test_utils.sh
 
 if [ $# -eq 0 ]; then
-    echo "Usage: $0 /path/to/file.hl7"
+    echo "Usage: $0 /path/to/message.hl7"
     exit 1
 fi
 

From 4fbb1254f2c1e2744f042cc91c8b9bf3ee299c9f Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 14:18:23 -0700
Subject: [PATCH 13/30] Capitalized readme file name for consistency

---
 scripts/hurl/rs/{readme.md => README.md} | 0
 scripts/hurl/ti/{readme.md => README.md} | 0
 2 files changed, 0 insertions(+), 0 deletions(-)
 rename scripts/hurl/rs/{readme.md => README.md} (100%)
 rename scripts/hurl/ti/{readme.md => README.md} (100%)

diff --git a/scripts/hurl/rs/readme.md b/scripts/hurl/rs/README.md
similarity index 100%
rename from scripts/hurl/rs/readme.md
rename to scripts/hurl/rs/README.md
diff --git a/scripts/hurl/ti/readme.md b/scripts/hurl/ti/README.md
similarity index 100%
rename from scripts/hurl/ti/readme.md
rename to scripts/hurl/ti/README.md

From 7697a410bf5aaabc661915b5d106ce0ba77cac08 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 14:19:54 -0700
Subject: [PATCH 14/30] Capitalized readme file name for consistency

---
 scripts/hurl/{readme.md => README.md} | 0
 1 file changed, 0 insertions(+), 0 deletions(-)
 rename scripts/hurl/{readme.md => README.md} (100%)

diff --git a/scripts/hurl/readme.md b/scripts/hurl/README.md
similarity index 100%
rename from scripts/hurl/readme.md
rename to scripts/hurl/README.md

From a3ee014b1ed63305a24b90ad2e0e529dec9f52b5 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 14:21:54 -0700
Subject: [PATCH 15/30] Capitalized readme file name for consistency

---
 scripts/hurl/epic/{readme.md => README.md} | 0
 scripts/rs/{readme.md => README.md}        | 0
 2 files changed, 0 insertions(+), 0 deletions(-)
 rename scripts/hurl/epic/{readme.md => README.md} (100%)
 rename scripts/rs/{readme.md => README.md} (100%)

diff --git a/scripts/hurl/epic/readme.md b/scripts/hurl/epic/README.md
similarity index 100%
rename from scripts/hurl/epic/readme.md
rename to scripts/hurl/epic/README.md
diff --git a/scripts/rs/readme.md b/scripts/rs/README.md
similarity index 100%
rename from scripts/rs/readme.md
rename to scripts/rs/README.md

From 54b8ebaeeccc40590d05ef8d6d572d5d355c8fac Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 14:45:24 -0700
Subject: [PATCH 16/30] Added documentation for new scripts and moved some
 stuff in readme files

---
 scripts/README.md              |  3 +++
 scripts/hurl/README.md         | 16 ++++++++++++++++
 scripts/rs/README.md           |  2 --
 scripts/{rs => }/start-here.sh |  0
 4 files changed, 19 insertions(+), 2 deletions(-)
 create mode 100644 scripts/README.md
 rename scripts/{rs => }/start-here.sh (100%)

diff --git a/scripts/README.md b/scripts/README.md
new file mode 100644
index 000000000..3fa583ac1
--- /dev/null
+++ b/scripts/README.md
@@ -0,0 +1,3 @@
+# Scripts
+
+These scripts rely in a `CDCTI_HOME` environment variable that needs to be set in your environment to your local path to the CDC-TI codebase. You may update and run the `start-here.sh` script to set it. You may also want to add it to your shell's startup file to persist it.
diff --git a/scripts/hurl/README.md b/scripts/hurl/README.md
index 5bdda7016..4fbd4b1cb 100644
--- a/scripts/hurl/README.md
+++ b/scripts/hurl/README.md
@@ -3,9 +3,25 @@
 ## Requirements
 
 - [hurl](https://hurl.dev/)
+- [jq](https://jqlang.github.io/jq/)
+- `CDCTI_HOME` environment variable ([see here](../README.md))
 
 ## Available Hurl Scripts
 
 - [ReportStream](./rs/): scripts to send requests to ReportStream's endpoints
 - [CDC Intermediary](./ti/): scripts to send requests to the CDC Intermediary's endpoints
 - [Epic/UCSD](./epic/): scripts to send requests to Epic endpoints for UCSD
+
+## Local Submission Scripts
+
+- `submit_message.sh`: sends a HL7 message to a locally running RS instance. It also grabs the snapshots of the file in azurite after converting to FHIR, after applying transformations in TI, and after converting back to HL7. It copies these files to the same folder where the submitted file is
+    ```
+    Usage: ./submit_message.sh /path/to/message.hl7
+    ```
+- `update_examples.sh`: sends all the HL7 files with `_0_initial_message.hl7` suffix in the `/examples` folder to a locally running RS instance. As the previous script, it copies the snapshots at each stage
+    ```
+    Usage: ./update_examples.sh
+    ```
+- `local_test_utils.sh`: utility functions for the previous scripts. It has functions to submit requests to RS, check the submission status throughout the whole flow, and downloading snapshots from azurite
+
+**Note**: these scripts require both RS and TI to be running locally
diff --git a/scripts/rs/README.md b/scripts/rs/README.md
index 7e39245b5..ebf318acf 100644
--- a/scripts/rs/README.md
+++ b/scripts/rs/README.md
@@ -1,5 +1,3 @@
 # ReportStream Scripts
 
 The scripts in this folder are meant to be copied and run in the [prime-reportstream](https://github.com/CDCgov/prime-reportstream) codebase inside the `prime-router` folder. You can also create symbolic links instead of copying the files in order to keep them up-to-date.
-
-These scripts rely in a `CDCTI_HOME` environment variable that needs to be set in your environment to your local path to the CDC-TI codebase. You may update and run the `start-here.sh` script to set it. You may also want to add it to your shell's startup file to persist it.
diff --git a/scripts/rs/start-here.sh b/scripts/start-here.sh
similarity index 100%
rename from scripts/rs/start-here.sh
rename to scripts/start-here.sh

From dc94008372b0d2ef19a235deaf48d8a1a2233230 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 14:55:15 -0700
Subject: [PATCH 17/30] Renamed Natus examples without snapshots to remove
 suffix

---
 ...RU_R01_NBS_0_initial_message.hl7 => 002_Natus_ORU_R01_NBS.hl7} | 0
 ...RU_R01_NBS_0_initial_message.hl7 => 003_Natus_ORU_R01_NBS.hl7} | 0
 ...RU_R01_NBS_0_initial_message.hl7 => 004_Natus_ORU_R01_NBS.hl7} | 0
 ...RU_R01_NBS_0_initial_message.hl7 => 005_Natus_ORU_R01_NBS.hl7} | 0
 ...RU_R01_NBS_0_initial_message.hl7 => 006_Natus_ORU_R01_NBS.hl7} | 0
 ...RU_R01_NBS_0_initial_message.hl7 => 007_Natus_ORU_R01_NBS.hl7} | 0
 ...RU_R01_NBS_0_initial_message.hl7 => 008_Natus_ORU_R01_NBS.hl7} | 0
 7 files changed, 0 insertions(+), 0 deletions(-)
 rename examples/Natus/{002_Natus_ORU_R01_NBS_0_initial_message.hl7 => 002_Natus_ORU_R01_NBS.hl7} (100%)
 rename examples/Natus/{003_Natus_ORU_R01_NBS_0_initial_message.hl7 => 003_Natus_ORU_R01_NBS.hl7} (100%)
 rename examples/Natus/{004_Natus_ORU_R01_NBS_0_initial_message.hl7 => 004_Natus_ORU_R01_NBS.hl7} (100%)
 rename examples/Natus/{005_Natus_ORU_R01_NBS_0_initial_message.hl7 => 005_Natus_ORU_R01_NBS.hl7} (100%)
 rename examples/Natus/{006_Natus_ORU_R01_NBS_0_initial_message.hl7 => 006_Natus_ORU_R01_NBS.hl7} (100%)
 rename examples/Natus/{007_Natus_ORU_R01_NBS_0_initial_message.hl7 => 007_Natus_ORU_R01_NBS.hl7} (100%)
 rename examples/Natus/{008_Natus_ORU_R01_NBS_0_initial_message.hl7 => 008_Natus_ORU_R01_NBS.hl7} (100%)

diff --git a/examples/Natus/002_Natus_ORU_R01_NBS_0_initial_message.hl7 b/examples/Natus/002_Natus_ORU_R01_NBS.hl7
similarity index 100%
rename from examples/Natus/002_Natus_ORU_R01_NBS_0_initial_message.hl7
rename to examples/Natus/002_Natus_ORU_R01_NBS.hl7
diff --git a/examples/Natus/003_Natus_ORU_R01_NBS_0_initial_message.hl7 b/examples/Natus/003_Natus_ORU_R01_NBS.hl7
similarity index 100%
rename from examples/Natus/003_Natus_ORU_R01_NBS_0_initial_message.hl7
rename to examples/Natus/003_Natus_ORU_R01_NBS.hl7
diff --git a/examples/Natus/004_Natus_ORU_R01_NBS_0_initial_message.hl7 b/examples/Natus/004_Natus_ORU_R01_NBS.hl7
similarity index 100%
rename from examples/Natus/004_Natus_ORU_R01_NBS_0_initial_message.hl7
rename to examples/Natus/004_Natus_ORU_R01_NBS.hl7
diff --git a/examples/Natus/005_Natus_ORU_R01_NBS_0_initial_message.hl7 b/examples/Natus/005_Natus_ORU_R01_NBS.hl7
similarity index 100%
rename from examples/Natus/005_Natus_ORU_R01_NBS_0_initial_message.hl7
rename to examples/Natus/005_Natus_ORU_R01_NBS.hl7
diff --git a/examples/Natus/006_Natus_ORU_R01_NBS_0_initial_message.hl7 b/examples/Natus/006_Natus_ORU_R01_NBS.hl7
similarity index 100%
rename from examples/Natus/006_Natus_ORU_R01_NBS_0_initial_message.hl7
rename to examples/Natus/006_Natus_ORU_R01_NBS.hl7
diff --git a/examples/Natus/007_Natus_ORU_R01_NBS_0_initial_message.hl7 b/examples/Natus/007_Natus_ORU_R01_NBS.hl7
similarity index 100%
rename from examples/Natus/007_Natus_ORU_R01_NBS_0_initial_message.hl7
rename to examples/Natus/007_Natus_ORU_R01_NBS.hl7
diff --git a/examples/Natus/008_Natus_ORU_R01_NBS_0_initial_message.hl7 b/examples/Natus/008_Natus_ORU_R01_NBS.hl7
similarity index 100%
rename from examples/Natus/008_Natus_ORU_R01_NBS_0_initial_message.hl7
rename to examples/Natus/008_Natus_ORU_R01_NBS.hl7

From 499967d33af1a5ee1cf17cdbafb2314d16db2ae8 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 15:11:11 -0700
Subject: [PATCH 18/30] Added snapshots in MN folder

---
 ...S_0_initial_message_1_hl7_translation.fhir | 33764 +++++++++++++++
 ...initial_message_2_fhir_transformation.fhir | 33769 ++++++++++++++++
 ...nitial_message_3_hl7_translation_final.hl7 |     1 +
 3 files changed, 67534 insertions(+)
 create mode 100644 examples/MN/004_MN_ORU_R01_NBS_0_initial_message_1_hl7_translation.fhir
 create mode 100644 examples/MN/004_MN_ORU_R01_NBS_0_initial_message_2_fhir_transformation.fhir
 create mode 100644 examples/MN/004_MN_ORU_R01_NBS_0_initial_message_3_hl7_translation_final.hl7

diff --git a/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_1_hl7_translation.fhir b/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_1_hl7_translation.fhir
new file mode 100644
index 000000000..9e675845c
--- /dev/null
+++ b/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_1_hl7_translation.fhir
@@ -0,0 +1,33764 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729289230480310000.d0a8faf1-c83e-4397-a54d-9aa150a9dbcb",
+  "meta": {
+    "lastUpdated": "2024-10-18T15:07:10.480-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "20230607002849_0365"
+  },
+  "type": "message",
+  "timestamp": "2023-06-06T17:28:49.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729289230482642000.9a507522-8f5f-4f55-a8a1-c934d9739e4f",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729289230482642000.9a507522-8f5f-4f55-a8a1-c934d9739e4f",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20230606192849-0500"
+              },
+              {
+                "url": "MSH.15",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.16",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.4"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NG_FRN_PROFILE"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.6"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NDBS_COMPONENT"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.81"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_PRN_Component"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.22"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_TO_COMPONENT"
+                }
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "1.2.840.114350.1.13.145.2.7.2.695071"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "Epic",
+            "endpoint": "urn:oid:1.2.840.114350.1.13.145.2.7.2.695071",
+            "receiver": {
+              "reference": "Organization/1729289230482314000.e0b73312-369d-4d35-bb00-29e44222fba0"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729289230481400000.8979f480-b5ca-4bb4-a83b-fe3ef15de35d"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "Natus"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "natus.health.state.mn.us"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "DNS"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:dns:natus.health.state.mn.us"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729289230481400000.8979f480-b5ca-4bb4-a83b-fe3ef15de35d",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729289230481400000.8979f480-b5ca-4bb4-a83b-fe3ef15de35d",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "MN Public Health Lab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.10080"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729289230482314000.e0b73312-369d-4d35-bb00-29e44222fba0",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729289230482314000.e0b73312-369d-4d35-bb00-29e44222fba0",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Centracare"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "DNS"
+                }
+              ]
+            },
+            "value": "centracare.com"
+          }
+        ]
+      }
+    },
+    {
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+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "92005-8",
+              "display": "Spinal muscular atrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729289230495400000.bdcc195d-da70-437b-8552-27044d55f7cd"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729289230864374000.d1c93ea5-7ea5-4fe7-97f7-72726ed35c66"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729289230832121000.191a8740-a6b0-4651-a052-44c2def613c9"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_2_fhir_transformation.fhir b/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_2_fhir_transformation.fhir
new file mode 100644
index 000000000..0fd3571d2
--- /dev/null
+++ b/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_2_fhir_transformation.fhir
@@ -0,0 +1,33769 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729289230480310000.d0a8faf1-c83e-4397-a54d-9aa150a9dbcb",
+  "meta": {
+    "lastUpdated": "2024-10-18T15:07:10.480-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "20230607002849_0365"
+  },
+  "type": "message",
+  "timestamp": "2023-06-06T17:28:49.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729289230482642000.9a507522-8f5f-4f55-a8a1-c934d9739e4f",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729289230482642000.9a507522-8f5f-4f55-a8a1-c934d9739e4f",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20230606192849-0500"
+              },
+              {
+                "url": "MSH.15",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.16",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.4"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NG_FRN_PROFILE"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.6"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NDBS_COMPONENT"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.81"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_PRN_Component"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.22"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_TO_COMPONENT"
+                }
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "1.2.840.114350.1.13.145.2.7.2.695071"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "Epic",
+            "endpoint": "urn:oid:1.2.840.114350.1.13.145.2.7.2.695071",
+            "receiver": {
+              "reference": "Organization/1729289230482314000.e0b73312-369d-4d35-bb00-29e44222fba0"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729289230481400000.8979f480-b5ca-4bb4-a83b-fe3ef15de35d"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "Natus"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "natus.health.state.mn.us"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "DNS"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:dns:natus.health.state.mn.us"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729289230481400000.8979f480-b5ca-4bb4-a83b-fe3ef15de35d",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729289230481400000.8979f480-b5ca-4bb4-a83b-fe3ef15de35d",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "MN Public Health Lab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.10080"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729289230482314000.e0b73312-369d-4d35-bb00-29e44222fba0",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729289230482314000.e0b73312-369d-4d35-bb00-29e44222fba0",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Centracare"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "DNS"
+                }
+              ]
+            },
+            "value": "centracare.com"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729289230485004000.0668c804-76c3-44e0-ba1a-01525318679d",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729289230485004000.0668c804-76c3-44e0-ba1a-01525318679d",
+        "target": [
+          {
+            "reference": "MessageHeader/1729289230482642000.9a507522-8f5f-4f55-a8a1-c934d9739e4f"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231062609000.ec90fb02-627d-47a0-8fbb-fb869007627d"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231064846000.09b3c0a1-0c4d-42be-ae55-af4ca2a68306"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231066694000.9a86fe25-2973-47b6-b766-51ab74dfa47e"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231068571000.858fb4f5-26ff-4aa8-b573-eed85da1d6f2"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231070361000.245014a5-b13b-4b28-b4f4-342d1f6e8d78"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231072149000.d895f078-eff1-4bc0-986e-d75d73a16ed0"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231073938000.b69fc749-b7ae-444e-9319-dfdeac97b00a"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231075681000.fd7d3cc4-36c0-464f-9ac6-35b60e461ab6"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231077355000.6fc6e42f-bb54-4677-9371-cc3ee8a13f67"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231079097000.307c8497-394e-4534-9612-b96266f25b74"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231080774000.57916339-c9a4-4c63-a299-a2da3bf700ff"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231114313000.616c8010-8cd7-45c0-817e-565d6bffd905"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231115985000.6b4407d5-f99e-4acc-bc4d-2d18abca05f0"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231117588000.d016b3f4-72cb-48cf-93f3-bffbea311b34"
+          },
+          {
+            "reference": "DiagnosticReport/1729289231119213000.5e49a485-4f17-488e-b006-7e66636c5954"
+          }
+        ],
+        "recorded": "2023-06-06T19:28:49-05:00",
+        "activity": {
+          "coding": [
+            {
+              "display": "ORU^R01^ORU_R01"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729289230484734000.e4182fee-3b7b-4f12-b553-29f835ea6e90"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729289230484734000.e4182fee-3b7b-4f12-b553-29f835ea6e90",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729289230484734000.e4182fee-3b7b-4f12-b553-29f835ea6e90",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "MN Public Health Lab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.10080"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729289230485758000.a47ef1e3-d85f-4a09-b6d2-3afb0838e7f0",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729289230485758000.a47ef1e3-d85f-4a09-b6d2-3afb0838e7f0",
+        "recorded": "2024-10-18T15:07:10Z",
+        "policy": [
+          "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
+        ],
+        "activity": {
+          "coding": [
+            {
+              "code": "v2-FHIR transformation"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "assembler"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729289230485579000.60ccb7b0-b1df-41bf-ba40-5250e0bf3592"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729289230485579000.60ccb7b0-b1df-41bf-ba40-5250e0bf3592",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729289230485579000.60ccb7b0-b1df-41bf-ba40-5250e0bf3592",
+        "identifier": [
+          {
+            "value": "CDC PRIME - Atlanta"
+          },
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.237821"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729289230495400000.bdcc195d-da70-437b-8552-27044d55f7cd",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729289230495400000.bdcc195d-da70-437b-8552-27044d55f7cd",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.30",
+                "valueString": "N"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "11102779",
+            "assigner": {
+              "reference": "Organization/1729289230486701000.b568983e-456b-427e-b115-1a34bd9b56d8"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "BB SARAH"
+                  },
+                  {
+                    "url": "XPN.6",
+                    "valueString": "L"
+                  }
+                ]
+              }
+            ],
+            "family": "SMITH",
+            "given": [
+              "BB SARAH"
+            ],
+            "suffix": [
+              "L"
+            ]
+          }
+        ],
+        "birthDate": "2023-05-04",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230504131000"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2023-05-04T13:10:00Z"
+            }
+          ]
+        },
+        "deceasedBoolean": false,
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "555 STATE HIGHWAY 13"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "H"
+                  }
+                ]
+              }
+            ],
+            "use": "home",
+            "line": [
+              "555 STATE HIGHWAY 13"
+            ],
+            "city": "DEER CREEK",
+            "state": "MN",
+            "postalCode": "565279657"
+          }
+        ],
+        "contact": [
+          {
+            "extension": [
+              {
+                "url": "https://hl7.org/fhir/StructureDefinition/relationship",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                          "valueString": "HL70063"
+                        }
+                      ],
+                      "code": "MTH",
+                      "display": "Mother"
+                    }
+                  ],
+                  "text": "Mother"
+                }
+              }
+            ],
+            "name": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                  "extension": [
+                    {
+                      "url": "XPN.2",
+                      "valueString": "SADIE"
+                    },
+                    {
+                      "url": "XPN.3",
+                      "valueString": "S"
+                    },
+                    {
+                      "url": "XPN.7",
+                      "valueString": "L"
+                    }
+                  ]
+                }
+              ],
+              "use": "official",
+              "family": "SMITH",
+              "given": [
+                "SADIE",
+                "S"
+              ]
+            },
+            "telecom": [
+              {
+                "extension": [
+                  {
+                    "url": "http://hl7.org/fhir/StructureDefinition/contactpoint-area",
+                    "valueString": "763"
+                  },
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+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729289230861249000.6e60882a-0dd9-4a9d-9df7-711ffec2f550"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729289230825220000.a7a87a37-91df-4930-ac6b-500513e8f6ee"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729289231115985000.6b4407d5-f99e-4acc-bc4d-2d18abca05f0",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729289231115985000.6b4407d5-f99e-4acc-bc4d-2d18abca05f0",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "EPIC"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                    "valueString": "1.2.840.114350.1.13.145.2.7.2.695071"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                    "valueCode": "ISO"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "423787478"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "MN Public Health Lab"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                    "valueString": "2.16.840.1.114222.4.1.10080"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                    "valueCode": "ISO"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729289231021599000.7a878f72-88fe-4cda-bb78-3b0827283dc3"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "85267-3",
+              "display": "X-linked adrenoleukodystrophy (X-ALD) newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729289230495400000.bdcc195d-da70-437b-8552-27044d55f7cd"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729289230862167000.2f3082d1-ff49-4e7e-949d-da51b2672552"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729289230827548000.e86aa3c4-1167-44f4-81d9-db0cf5f7fbc5"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729289231117588000.d016b3f4-72cb-48cf-93f3-bffbea311b34",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729289231117588000.d016b3f4-72cb-48cf-93f3-bffbea311b34",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "EPIC"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                    "valueString": "1.2.840.114350.1.13.145.2.7.2.695071"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                    "valueCode": "ISO"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "423787478"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "MN Public Health Lab"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                    "valueString": "2.16.840.1.114222.4.1.10080"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                    "valueCode": "ISO"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729289231040576000.037e26e1-7f45-4830-bd95-3613a0b11272"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "62300-9",
+              "display": "Lysosomal storage disorders newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729289230495400000.bdcc195d-da70-437b-8552-27044d55f7cd"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729289230863315000.520f5520-fe28-43a9-a015-c379ca0a741c"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729289230829774000.8c5917de-9ee7-4e0a-878f-c7df044d76f0"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729289231119213000.5e49a485-4f17-488e-b006-7e66636c5954",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729289231119213000.5e49a485-4f17-488e-b006-7e66636c5954",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "EPIC"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                    "valueString": "1.2.840.114350.1.13.145.2.7.2.695071"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                    "valueCode": "ISO"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "423787478"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "MN Public Health Lab"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                    "valueString": "2.16.840.1.114222.4.1.10080"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                    "valueCode": "ISO"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729289231051207000.0fbc244e-9fbd-4769-9b70-fda05630f357"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "92005-8",
+              "display": "Spinal muscular atrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729289230495400000.bdcc195d-da70-437b-8552-27044d55f7cd"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729289230864374000.d1c93ea5-7ea5-4fe7-97f7-72726ed35c66"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729289230832121000.191a8740-a6b0-4651-a052-44c2def613c9"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_3_hl7_translation_final.hl7 b/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..b4b492080
--- /dev/null
+++ b/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|Natus^natus.health.state.mn.us^DNS|MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|Epic^1.2.840.114350.1.13.145.2.7.2.695071^ISO|Centracare^centracare.com^DNS|20230606192849-0500||ORU^R01^ORU_R01|20230607002849_0365|D|2.5.1|||AL|AL|||||LRI_NG_FRN_PROFILE^^2.16.840.1.113883.9.195.3.4^ISO~LRI_NDBS_COMPONENT^^2.16.840.1.113883.9.195.3.6^ISO~LAB_PRN_Component^^2.16.840.1.113883.9.81^ISO~LAB_TO_COMPONENT^^2.16.840.1.113883.9.22^ISO
PID|1||11102779^^^CRPMRN^MR||SMITH^BB SARAH^^^^L||20230504131000||||555 STATE HIGHWAY 13^^DEER CREEK^MN^565279657^^H|||||||||||||||||||N
NK1|1|SMITH^SADIE^S^^^^L|MTH^Mother^HL70063^^^^^^Mother|555 STATE HIGHWAY 13^^DEER CREEK^MN^565279657^USA^H|^^PH^^^763^5555555^^(763)555-5555^^^7635555555
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBR|1|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57128-1^Newborn Screening Report summary panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|CWE|57718-9^Sample quality of Dried blood spot^LN||LA12432-3^Acceptable^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|2|CWE|57130-7^Newborn screening report - overall interpretation^LN||LA12428-1^All screening is in range for the conditions tested^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|3|FT|69969-4^Newborn screening report overall laboratory comment^LN||Resources: An MDH genetic counselor is available for consultation regarding screening results at 651-201-3548. Disorder fact sheets and specialist contact list can be found here: https://www.health.state.mn.us/people/newbornscreening/materials/factsheets/bloodspotdisorders.html\.br\The purpose of newborn screening is to identify at risk infants in need of diagnostic testing. As with any screening test, false positive or false negative results are possible. Newborn screening is insufficient information on which to base, or rule out, diagnosis or treatment. CF variant analysis is completed using the Luminex xTAG Cystic Fibrosis (CFTR) 39 Kit.\.br\*This real-time PCR assay was developed and its performance characteristics were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration: 21 CFR 809.30(e).\.br\**The performance characteristics of these tests were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration.\.br\***Testing is performed by Mayo Clinic Laboratories-Rochester Main Campus; 200 First Street SW, Rochester, MN 55905\.br\ ||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|4|FT|69969-4^Newborn screening report overall laboratory comment^LN||There is decreased sensitivity in screening for CMV in dried blood spots, so not all infants with congenital CMV will be identified. Of those who are identified by newborn screening, up to 80% will be unaffected.||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|5|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12538-7^CH^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|6|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22202-8^CF^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|7|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12533-8^CAH^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|8|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12532-0^BIO^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|9|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12602-1^Hb C-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|10|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12603-9^Hb D-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|11|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12604-7^Hb E-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|12|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12606-2^Hb S (sickle)-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|13|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12607-0^Hb C-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|14|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12608-8^Hb C beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|15|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12609-6^Hb D-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|16|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12610-4^Hb D beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|17|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12612-0^Hb E-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|18|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12613-8^Hb E beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|19|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12614-6^Hb SS-disease (sickle cell anemia)^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|20|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12615-3^Hb S beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|21|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12616-1^Hb SC-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|22|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12617-9^Hb SD-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|23|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12618-7^Hb SE-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|24|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12620-3^Hb S plus Hb other than A,C,D,E,O-Arab disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|25|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12621-1^Hb disease other than A, C, D, E, H,O-Arab, S^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|26|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12622-9^Hb carrier other than C, D, E, S ,O-Arab^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|27|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA16207-5^Hemoglobinopathies^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|28|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12566-8^SCID^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|29|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12541-1^GALE^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|30|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12542-9^GALK^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|31|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21165-8^Classical galactosemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|32|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12466-1^3-MCC^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|33|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12468-7^3MGA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|34|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12499-2^HMG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|35|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12464-6^2M3HBA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|36|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12474-5^BKT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|37|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12485-1^CPT-Ia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|38|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12475-2^CACT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|39|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12486-9^CPT-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|40|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12487-7^CUD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|41|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12489-3^De-Red^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|42|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12493-5^GA-1^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|43|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12511-4^MCKAT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|44|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12491-9^EMA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|45|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12495-0^GA-2^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|46|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12504-9^IBG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|47|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12524-7^SCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|48|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12465-3^2MBG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|49|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12505-6^IVA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|50|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12507-2^LCHAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|51|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12527-0^TFP^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|52|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12508-0^MAL^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|53|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12525-4^SCHAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|54|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12509-8^MCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|55|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12476-0^CBL A^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|56|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12477-8^CBL B^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|57|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12510-6^MCD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|58|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12515-5^MUT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|59|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12523-9^PROP^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|60|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12531-2^VLCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|61|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21161-7^Argininemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|62|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21162-5^Argininosuccinic aciduria^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|63|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12482-8^CIT-I^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|64|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12483-6^CIT-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|65|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12496-8^HCY^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|66|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12512-2^MET^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|67|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21168-2^Maple syrup urine disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|68|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12472-9^BIOPT-BS^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|69|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12473-7^BIOPT-REG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|70|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12500-7^H-PHE^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|71|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12520-5^PKU^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|72|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12528-8^TYR-1^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|73|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12529-6^TYR-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|74|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12530-4^TYR-III^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|75|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA25796-6^X-ALD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|76|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA25797-4^Mucopolysaccharidosis type I^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|77|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA14037-8^GAA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|78|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22279-6^Spinal muscular atrophy^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|79|ED|57129-9^Full newborn screening summary report for display or printing^LN||^TEXT^html^Base64||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
SPM|1|423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO||440500007^Blood spot specimen^SCT|||||||||||||20230603045000^20230603045000|20230605102300
ORC|RE||20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO||||||||||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBR|2|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57717-1^Newborn screen card data panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|NM|8339-4^BIRTH WEIGHT MEASURED^LN|1|1769.859285|g^gram^UCUM|||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|2|NM|57714-8^OBSTETRIC ESTIMATION OF GESTATIONAL AGE^LN|1|32|wk^week^UCUM|||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|3|CWE|57713-0^INFANT FACTORS THAT AFFECT NEWBORN SCREENING INTERPRETATION^LN|1|LA12419-0^INFANT IN NICU AT TIME OF SPECIMEN COLLECTION^LN||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|4|CWE|MNDSIB^DOES THE BABY HAVE A DECEASED SIBLING?^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|5|CWE|MNDEFECT^DOES THE BABY HAVE BIRTH DEFECTS?^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|6|CWE|MNFAM^FAMILY HISTORY OF DISORDER ON MN SCREENING PANEL^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|7|CWE|67704-7^FEEDING TYPES^LN|1|LA16914-6^BREAST MILK^LN||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|8|CWE|57723-9^UNIQUE BAR CODE NUMBER OF CURRENT SAMPLE^LN|1|0516194254||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|9|ST|62328-0^DISCHARGE PROVIDER PRACTICE PHONE NUMBER^LN|1|Daniel Davis/218-555-1000||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|10|ST|62324-9^POST-DISCHARGE PROVIDER NAME^LN|1|Davis, Daniel, MD||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|11|ST|62326-4^POST-DISCHARGE PROVIDER PRACTICE NAME^LN|1|Lakeridge Health Revere||||||O|||20230603045000-0500|||||||||||||||QST|AOE
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|3|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54090-6^Thyroid newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN^CH^Congenital Hypothyroidism^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|4|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54078-1^Cystic fibrosis newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46769-6^Cystic fibrosis newborn screen interpretation^LN^CF^Cystic Fibrosis^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|5|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57086-1^Congenital adrenal hyperplasia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN^CAH^Congenital Adrenal Hyperplasia^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|6|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57087-9^Biotinidase newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46761-3^Biotinidase deficiency newborn screen interpretation^LN^BIOT^Biotinidase Deficiency^99MDH||LA18592-8^In range^LN^LBW^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|2|FT|57699-1^Biotinidase deficiency newborn screening comment/discussion^LN||For infants born weighing < 2000 grams, newborn screening results can be difficult to interpret. Transfusion status should be taken into account when interpreting screening results. Three newborn screening samples collected at 24-48 hours, 14 days, and 30 days of age will together give the care provider a better understanding of the infantaeuro(TM)s risk for screened disorders.||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|7|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54081-5^Hemoglobinopathies newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46740-7^Hemoglobin disorders newborn screen interpretation^LN^HGB^Hemoglobinopathies^99MDH||LA18592-8^In range^LN^FA^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|2|CWE|64117-5^Most predominant hemoglobin in Dried blood spot^LN||LA16208-3^Hb F^LN||Within Normal Limits = FA||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|3|CWE|64118-3^Second most predominant hemoglobin in Dried blood spot^LN||LA16209-1^Hb A^LN||Within Normal Limits = FA||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|8|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|62333-0^Severe combined immunodeficiency (SCID) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN^SCID^Severe Combined Immunodeficiency*^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|9|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54079-9^Galactosemia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46737-3^Galactosemias newborn screen interpretation^LN^GAL^Galactosemia^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^GJERSET^KRISTIN^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|10|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|CMV-PANEL^Cytomegalovirus DNA newborn screen panel^99MDH|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|CMV-INTERPRT^Cytomegalovirus DNA newborn screen interpretation^99MDH^CMV^Cytomegalovirus DNA^99MDH||LA18592-8^In range^LN^WNL^CMV Not Detected*^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|11|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|58092-8^Acylcarnitine newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|58088-6^Acylcarnitine newborn screen interpretation^LN^Acylcarnitine Profile^Acylcarnitine Profile^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|12|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|53261-4^Amino acid newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46733-2^Amino acidemias newborn screen interpretation^LN^Amino Acid Profile^Amino Acid Profile^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|13|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|85267-3^X-linked adrenoleukodystrophy (X-ALD) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|85269-9^X-ALD^LN^xALD^X-linked Adrenoleukodystrophy**^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|14|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|62300-9^Lysosomal storage disorders newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|62301-7^Lysosomal storage disorders newborn screen interpretation^LN^LSD^Lysosomal Disease Profile**^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|15|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|92005-8^Spinal muscular atrophy newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|92004-1^SMA^LN^SMA^Spinal Muscular Atrophy*^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP

From 4d4debe6109ef77eb39882d215f375fd0d951436 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 15:14:26 -0700
Subject: [PATCH 19/30] Renamed Oracle examples without snapshots to remove
 suffix

---
 ...S_0_initial_message.hl7 => 005_Oracle_ORM_O01_2_3_non_NBS.hl7} | 0
 ...S_0_initial_message.hl7 => 006_Oracle_ORM_O01_2_3_non_NBS.hl7} | 0
 2 files changed, 0 insertions(+), 0 deletions(-)
 rename examples/Oracle/{005_Oracle_ORM_O01_2_3_non_NBS_0_initial_message.hl7 => 005_Oracle_ORM_O01_2_3_non_NBS.hl7} (100%)
 rename examples/Oracle/{006_Oracle_ORM_O01_2_3_non_NBS_0_initial_message.hl7 => 006_Oracle_ORM_O01_2_3_non_NBS.hl7} (100%)

diff --git a/examples/Oracle/005_Oracle_ORM_O01_2_3_non_NBS_0_initial_message.hl7 b/examples/Oracle/005_Oracle_ORM_O01_2_3_non_NBS.hl7
similarity index 100%
rename from examples/Oracle/005_Oracle_ORM_O01_2_3_non_NBS_0_initial_message.hl7
rename to examples/Oracle/005_Oracle_ORM_O01_2_3_non_NBS.hl7
diff --git a/examples/Oracle/006_Oracle_ORM_O01_2_3_non_NBS_0_initial_message.hl7 b/examples/Oracle/006_Oracle_ORM_O01_2_3_non_NBS.hl7
similarity index 100%
rename from examples/Oracle/006_Oracle_ORM_O01_2_3_non_NBS_0_initial_message.hl7
rename to examples/Oracle/006_Oracle_ORM_O01_2_3_non_NBS.hl7

From b69793930bd63352f87096d68a06f5d3c8e37a4c Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 15:23:49 -0700
Subject: [PATCH 20/30] Reverted adding MN files. Wrong naming

---
 ...S_0_initial_message_1_hl7_translation.fhir | 33764 ---------------
 ...initial_message_2_fhir_transformation.fhir | 33769 ----------------
 ...nitial_message_3_hl7_translation_final.hl7 |     1 -
 3 files changed, 67534 deletions(-)
 delete mode 100644 examples/MN/004_MN_ORU_R01_NBS_0_initial_message_1_hl7_translation.fhir
 delete mode 100644 examples/MN/004_MN_ORU_R01_NBS_0_initial_message_2_fhir_transformation.fhir
 delete mode 100644 examples/MN/004_MN_ORU_R01_NBS_0_initial_message_3_hl7_translation_final.hl7

diff --git a/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_1_hl7_translation.fhir b/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_1_hl7_translation.fhir
deleted file mode 100644
index 9e675845c..000000000
--- a/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_1_hl7_translation.fhir
+++ /dev/null
@@ -1,33764 +0,0 @@
-{
-  "resourceType": "Bundle",
-  "id": "1729289230480310000.d0a8faf1-c83e-4397-a54d-9aa150a9dbcb",
-  "meta": {
-    "lastUpdated": "2024-10-18T15:07:10.480-07:00"
-  },
-  "identifier": {
-    "system": "https://reportstream.cdc.gov/prime-router",
-    "value": "20230607002849_0365"
-  },
-  "type": "message",
-  "timestamp": "2023-06-06T17:28:49.000-07:00",
-  "entry": [
-    {
-      "fullUrl": "MessageHeader/1729289230482642000.9a507522-8f5f-4f55-a8a1-c934d9739e4f",
-      "resource": {
-        "resourceType": "MessageHeader",
-        "id": "1729289230482642000.9a507522-8f5f-4f55-a8a1-c934d9739e4f",
-        "meta": {
-          "tag": [
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-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "85267-3",
-              "display": "X-linked adrenoleukodystrophy (X-ALD) newborn screening panel"
-            }
-          ]
-        },
-        "subject": {
-          "reference": "Patient/1729289230495400000.bdcc195d-da70-437b-8552-27044d55f7cd"
-        },
-        "effectiveDateTime": "2023-06-03T04:50:00Z",
-        "_effectiveDateTime": {
-          "extension": [
-            {
-              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-              "valueString": "20230603045000"
-            }
-          ]
-        },
-        "issued": "2023-06-06T19:16:13Z",
-        "_issued": {
-          "extension": [
-            {
-              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-              "valueString": "20230606191613"
-            }
-          ]
-        },
-        "specimen": [
-          {
-            "reference": "Specimen/1729289230862167000.2f3082d1-ff49-4e7e-949d-da51b2672552"
-          }
-        ],
-        "result": [
-          {
-            "reference": "Observation/1729289230827548000.e86aa3c4-1167-44f4-81d9-db0cf5f7fbc5"
-          }
-        ]
-      }
-    },
-    {
-      "fullUrl": "DiagnosticReport/1729289231117588000.d016b3f4-72cb-48cf-93f3-bffbea311b34",
-      "resource": {
-        "resourceType": "DiagnosticReport",
-        "id": "1729289231117588000.d016b3f4-72cb-48cf-93f3-bffbea311b34",
-        "identifier": [
-          {
-            "extension": [
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                "valueString": "ORC.2"
-              },
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
-                "extension": [
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                    "valueString": "EPIC"
-                  },
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                    "valueString": "1.2.840.114350.1.13.145.2.7.2.695071"
-                  },
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                    "valueCode": "ISO"
-                  }
-                ]
-              }
-            ],
-            "type": {
-              "coding": [
-                {
-                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
-                  "code": "PLAC"
-                }
-              ]
-            },
-            "value": "423787478"
-          },
-          {
-            "extension": [
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
-                "extension": [
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                    "valueString": "MN Public Health Lab"
-                  },
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                    "valueString": "2.16.840.1.114222.4.1.10080"
-                  },
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                    "valueCode": "ISO"
-                  }
-                ]
-              }
-            ],
-            "type": {
-              "coding": [
-                {
-                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
-                  "code": "FILL"
-                }
-              ]
-            },
-            "value": "20231561137"
-          }
-        ],
-        "basedOn": [
-          {
-            "reference": "ServiceRequest/1729289231040576000.037e26e1-7f45-4830-bd95-3613a0b11272"
-          }
-        ],
-        "status": "final",
-        "code": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "62300-9",
-              "display": "Lysosomal storage disorders newborn screening panel"
-            }
-          ]
-        },
-        "subject": {
-          "reference": "Patient/1729289230495400000.bdcc195d-da70-437b-8552-27044d55f7cd"
-        },
-        "effectiveDateTime": "2023-06-03T04:50:00Z",
-        "_effectiveDateTime": {
-          "extension": [
-            {
-              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-              "valueString": "20230603045000"
-            }
-          ]
-        },
-        "issued": "2023-06-06T19:16:13Z",
-        "_issued": {
-          "extension": [
-            {
-              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-              "valueString": "20230606191613"
-            }
-          ]
-        },
-        "specimen": [
-          {
-            "reference": "Specimen/1729289230863315000.520f5520-fe28-43a9-a015-c379ca0a741c"
-          }
-        ],
-        "result": [
-          {
-            "reference": "Observation/1729289230829774000.8c5917de-9ee7-4e0a-878f-c7df044d76f0"
-          }
-        ]
-      }
-    },
-    {
-      "fullUrl": "DiagnosticReport/1729289231119213000.5e49a485-4f17-488e-b006-7e66636c5954",
-      "resource": {
-        "resourceType": "DiagnosticReport",
-        "id": "1729289231119213000.5e49a485-4f17-488e-b006-7e66636c5954",
-        "identifier": [
-          {
-            "extension": [
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                "valueString": "ORC.2"
-              },
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
-                "extension": [
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                    "valueString": "EPIC"
-                  },
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                    "valueString": "1.2.840.114350.1.13.145.2.7.2.695071"
-                  },
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                    "valueCode": "ISO"
-                  }
-                ]
-              }
-            ],
-            "type": {
-              "coding": [
-                {
-                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
-                  "code": "PLAC"
-                }
-              ]
-            },
-            "value": "423787478"
-          },
-          {
-            "extension": [
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
-                "extension": [
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                    "valueString": "MN Public Health Lab"
-                  },
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                    "valueString": "2.16.840.1.114222.4.1.10080"
-                  },
-                  {
-                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                    "valueCode": "ISO"
-                  }
-                ]
-              }
-            ],
-            "type": {
-              "coding": [
-                {
-                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
-                  "code": "FILL"
-                }
-              ]
-            },
-            "value": "20231561137"
-          }
-        ],
-        "basedOn": [
-          {
-            "reference": "ServiceRequest/1729289231051207000.0fbc244e-9fbd-4769-9b70-fda05630f357"
-          }
-        ],
-        "status": "final",
-        "code": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "92005-8",
-              "display": "Spinal muscular atrophy newborn screening panel"
-            }
-          ]
-        },
-        "subject": {
-          "reference": "Patient/1729289230495400000.bdcc195d-da70-437b-8552-27044d55f7cd"
-        },
-        "effectiveDateTime": "2023-06-03T04:50:00Z",
-        "_effectiveDateTime": {
-          "extension": [
-            {
-              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-              "valueString": "20230603045000"
-            }
-          ]
-        },
-        "issued": "2023-06-06T19:16:13Z",
-        "_issued": {
-          "extension": [
-            {
-              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-              "valueString": "20230606191613"
-            }
-          ]
-        },
-        "specimen": [
-          {
-            "reference": "Specimen/1729289230864374000.d1c93ea5-7ea5-4fe7-97f7-72726ed35c66"
-          }
-        ],
-        "result": [
-          {
-            "reference": "Observation/1729289230832121000.191a8740-a6b0-4651-a052-44c2def613c9"
-          }
-        ]
-      }
-    }
-  ]
-}
diff --git a/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_2_fhir_transformation.fhir b/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_2_fhir_transformation.fhir
deleted file mode 100644
index 0fd3571d2..000000000
--- a/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_2_fhir_transformation.fhir
+++ /dev/null
@@ -1,33769 +0,0 @@
-{
-  "resourceType": "Bundle",
-  "id": "1729289230480310000.d0a8faf1-c83e-4397-a54d-9aa150a9dbcb",
-  "meta": {
-    "lastUpdated": "2024-10-18T15:07:10.480-07:00"
-  },
-  "identifier": {
-    "system": "https://reportstream.cdc.gov/prime-router",
-    "value": "20230607002849_0365"
-  },
-  "type": "message",
-  "timestamp": "2023-06-06T17:28:49.000-07:00",
-  "entry": [
-    {
-      "fullUrl": "MessageHeader/1729289230482642000.9a507522-8f5f-4f55-a8a1-c934d9739e4f",
-      "resource": {
-        "resourceType": "MessageHeader",
-        "id": "1729289230482642000.9a507522-8f5f-4f55-a8a1-c934d9739e4f",
-        "meta": {
-          "tag": [
-            {
-              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-              "code": "D"
-            },
-            {
-              "system": "http://localcodes.org/ETOR",
-              "code": "ETOR",
-              "display": "Processed by ETOR"
-            }
-          ]
-        },
-        "extension": [
-          {
-            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-            "extension": [
-              {
-                "url": "MSH.7",
-                "valueString": "20230606192849-0500"
-              },
-              {
-                "url": "MSH.15",
-                "valueString": "AL"
-              },
-              {
-                "url": "MSH.16",
-                "valueString": "AL"
-              },
-              {
-                "url": "MSH.21",
-                "valueIdentifier": {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
-                      "extension": [
-                        {
-                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                          "valueString": "2.16.840.1.113883.9.195.3.4"
-                        },
-                        {
-                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                          "valueCode": "ISO"
-                        }
-                      ]
-                    }
-                  ],
-                  "value": "LRI_NG_FRN_PROFILE"
-                }
-              },
-              {
-                "url": "MSH.21",
-                "valueIdentifier": {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
-                      "extension": [
-                        {
-                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                          "valueString": "2.16.840.1.113883.9.195.3.6"
-                        },
-                        {
-                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                          "valueCode": "ISO"
-                        }
-                      ]
-                    }
-                  ],
-                  "value": "LRI_NDBS_COMPONENT"
-                }
-              },
-              {
-                "url": "MSH.21",
-                "valueIdentifier": {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
-                      "extension": [
-                        {
-                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                          "valueString": "2.16.840.1.113883.9.81"
-                        },
-                        {
-                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                          "valueCode": "ISO"
-                        }
-                      ]
-                    }
-                  ],
-                  "value": "LAB_PRN_Component"
-                }
-              },
-              {
-                "url": "MSH.21",
-                "valueIdentifier": {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
-                      "extension": [
-                        {
-                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                          "valueString": "2.16.840.1.113883.9.22"
-                        },
-                        {
-                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                          "valueCode": "ISO"
-                        }
-                      ]
-                    }
-                  ],
-                  "value": "LAB_TO_COMPONENT"
-                }
-              }
-            ]
-          }
-        ],
-        "eventCoding": {
-          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
-          "code": "R01",
-          "display": "ORU^R01^ORU_R01"
-        },
-        "destination": [
-          {
-            "extension": [
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                "valueString": "1.2.840.114350.1.13.145.2.7.2.695071"
-              },
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                "valueString": "ISO"
-              },
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                "valueString": "MSH.5"
-              }
-            ],
-            "name": "Epic",
-            "endpoint": "urn:oid:1.2.840.114350.1.13.145.2.7.2.695071",
-            "receiver": {
-              "reference": "Organization/1729289230482314000.e0b73312-369d-4d35-bb00-29e44222fba0"
-            }
-          }
-        ],
-        "sender": {
-          "reference": "Organization/1729289230481400000.8979f480-b5ca-4bb4-a83b-fe3ef15de35d"
-        },
-        "source": {
-          "extension": [
-            {
-              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-              "valueString": "Natus"
-            },
-            {
-              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-              "valueString": "natus.health.state.mn.us"
-            },
-            {
-              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-              "valueString": "DNS"
-            },
-            {
-              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-              "valueString": "MSH.3"
-            }
-          ],
-          "endpoint": "urn:dns:natus.health.state.mn.us"
-        }
-      }
-    },
-    {
-      "fullUrl": "Organization/1729289230481400000.8979f480-b5ca-4bb4-a83b-fe3ef15de35d",
-      "resource": {
-        "resourceType": "Organization",
-        "id": "1729289230481400000.8979f480-b5ca-4bb4-a83b-fe3ef15de35d",
-        "identifier": [
-          {
-            "extension": [
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                "valueString": "HD.1"
-              }
-            ],
-            "value": "MN Public Health Lab"
-          },
-          {
-            "extension": [
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                "valueString": "HD.2,HD.3"
-              }
-            ],
-            "type": {
-              "coding": [
-                {
-                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
-                  "code": "ISO"
-                }
-              ]
-            },
-            "system": "urn:ietf:rfc:3986",
-            "value": "2.16.840.1.114222.4.1.10080"
-          }
-        ]
-      }
-    },
-    {
-      "fullUrl": "Organization/1729289230482314000.e0b73312-369d-4d35-bb00-29e44222fba0",
-      "resource": {
-        "resourceType": "Organization",
-        "id": "1729289230482314000.e0b73312-369d-4d35-bb00-29e44222fba0",
-        "extension": [
-          {
-            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-            "valueString": "MSH.6"
-          }
-        ],
-        "identifier": [
-          {
-            "extension": [
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                "valueString": "HD.1"
-              }
-            ],
-            "value": "Centracare"
-          },
-          {
-            "extension": [
-              {
-                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                "valueString": "HD.2,HD.3"
-              }
-            ],
-            "type": {
-              "coding": [
-                {
-                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
-                  "code": "DNS"
-                }
-              ]
-            },
-            "value": "centracare.com"
-          }
-        ]
-      }
-    },
-    {
-      "fullUrl": "Provenance/1729289230485004000.0668c804-76c3-44e0-ba1a-01525318679d",
-      "resource": {
-        "resourceType": "Provenance",
-        "id": "1729289230485004000.0668c804-76c3-44e0-ba1a-01525318679d",
-        "target": [
-          {
-            "reference": "MessageHeader/1729289230482642000.9a507522-8f5f-4f55-a8a1-c934d9739e4f"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231062609000.ec90fb02-627d-47a0-8fbb-fb869007627d"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231064846000.09b3c0a1-0c4d-42be-ae55-af4ca2a68306"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231066694000.9a86fe25-2973-47b6-b766-51ab74dfa47e"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231068571000.858fb4f5-26ff-4aa8-b573-eed85da1d6f2"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231070361000.245014a5-b13b-4b28-b4f4-342d1f6e8d78"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231072149000.d895f078-eff1-4bc0-986e-d75d73a16ed0"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231073938000.b69fc749-b7ae-444e-9319-dfdeac97b00a"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231075681000.fd7d3cc4-36c0-464f-9ac6-35b60e461ab6"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231077355000.6fc6e42f-bb54-4677-9371-cc3ee8a13f67"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231079097000.307c8497-394e-4534-9612-b96266f25b74"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231080774000.57916339-c9a4-4c63-a299-a2da3bf700ff"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231114313000.616c8010-8cd7-45c0-817e-565d6bffd905"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231115985000.6b4407d5-f99e-4acc-bc4d-2d18abca05f0"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231117588000.d016b3f4-72cb-48cf-93f3-bffbea311b34"
-          },
-          {
-            "reference": "DiagnosticReport/1729289231119213000.5e49a485-4f17-488e-b006-7e66636c5954"
-          }
-        ],
-        "recorded": "2023-06-06T19:28:49-05:00",
-        "activity": {
-          "coding": [
-            {
-              "display": "ORU^R01^ORU_R01"
-            }
-          ]
-        },
-        "agent": [
-          {
-            "type": {
-              "coding": [
-                {
-                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
-                  "code": "author"
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diff --git a/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_3_hl7_translation_final.hl7 b/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_3_hl7_translation_final.hl7
deleted file mode 100644
index b4b492080..000000000
--- a/examples/MN/004_MN_ORU_R01_NBS_0_initial_message_3_hl7_translation_final.hl7
+++ /dev/null
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PID|1||11102779^^^CRPMRN^MR||SMITH^BB SARAH^^^^L||20230504131000||||555 STATE HIGHWAY 13^^DEER CREEK^MN^565279657^^H|||||||||||||||||||N
NK1|1|SMITH^SADIE^S^^^^L|MTH^Mother^HL70063^^^^^^Mother|555 STATE HIGHWAY 13^^DEER CREEK^MN^565279657^USA^H|^^PH^^^763^5555555^^(763)555-5555^^^7635555555
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBR|1|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57128-1^Newborn Screening Report summary panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|CWE|57718-9^Sample quality of Dried blood spot^LN||LA12432-3^Acceptable^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|2|CWE|57130-7^Newborn screening report - overall interpretation^LN||LA12428-1^All screening is in range for the conditions tested^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|3|FT|69969-4^Newborn screening report overall laboratory comment^LN||Resources: An MDH genetic counselor is available for consultation regarding screening results at 651-201-3548. Disorder fact sheets and specialist contact list can be found here: https://www.health.state.mn.us/people/newbornscreening/materials/factsheets/bloodspotdisorders.html\.br\The purpose of newborn screening is to identify at risk infants in need of diagnostic testing. As with any screening test, false positive or false negative results are possible. Newborn screening is insufficient information on which to base, or rule out, diagnosis or treatment. CF variant analysis is completed using the Luminex xTAG Cystic Fibrosis (CFTR) 39 Kit.\.br\*This real-time PCR assay was developed and its performance characteristics were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration: 21 CFR 809.30(e).\.br\**The performance characteristics of these tests were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration.\.br\***Testing is performed by Mayo Clinic Laboratories-Rochester Main Campus; 200 First Street SW, Rochester, MN 55905\.br\ ||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|4|FT|69969-4^Newborn screening report overall laboratory comment^LN||There is decreased sensitivity in screening for CMV in dried blood spots, so not all infants with congenital CMV will be identified. Of those who are identified by newborn screening, up to 80% will be unaffected.||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|5|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12538-7^CH^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|6|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22202-8^CF^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|7|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12533-8^CAH^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|8|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12532-0^BIO^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|9|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12602-1^Hb C-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|10|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12603-9^Hb D-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|11|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12604-7^Hb E-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|12|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12606-2^Hb S (sickle)-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|13|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12607-0^Hb C-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|14|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12608-8^Hb C beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|15|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12609-6^Hb D-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|16|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12610-4^Hb D beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|17|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12612-0^Hb E-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|18|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12613-8^Hb E beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|19|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12614-6^Hb SS-disease (sickle cell anemia)^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|20|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12615-3^Hb S beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|21|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12616-1^Hb SC-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|22|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12617-9^Hb SD-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|23|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12618-7^Hb SE-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|24|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12620-3^Hb S plus Hb other than A,C,D,E,O-Arab disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|25|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12621-1^Hb disease other than A, C, D, E, H,O-Arab, S^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|26|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12622-9^Hb carrier other than C, D, E, S ,O-Arab^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|27|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA16207-5^Hemoglobinopathies^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|28|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12566-8^SCID^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|29|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12541-1^GALE^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|30|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12542-9^GALK^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|31|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21165-8^Classical galactosemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|32|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12466-1^3-MCC^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|33|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12468-7^3MGA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|34|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12499-2^HMG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|35|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12464-6^2M3HBA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|36|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12474-5^BKT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|37|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12485-1^CPT-Ia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|38|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12475-2^CACT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|39|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12486-9^CPT-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|40|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12487-7^CUD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|41|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12489-3^De-Red^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|42|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12493-5^GA-1^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|43|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12511-4^MCKAT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|44|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12491-9^EMA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|45|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12495-0^GA-2^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|46|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12504-9^IBG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|47|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12524-7^SCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|48|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12465-3^2MBG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|49|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12505-6^IVA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|50|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12507-2^LCHAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|51|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12527-0^TFP^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|52|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12508-0^MAL^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|53|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12525-4^SCHAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|54|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12509-8^MCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|55|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12476-0^CBL A^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|56|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12477-8^CBL B^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|57|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12510-6^MCD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|58|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12515-5^MUT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|59|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12523-9^PROP^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|60|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12531-2^VLCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|61|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21161-7^Argininemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|62|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21162-5^Argininosuccinic aciduria^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|63|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12482-8^CIT-I^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|64|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12483-6^CIT-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|65|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12496-8^HCY^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|66|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12512-2^MET^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|67|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21168-2^Maple syrup urine disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|68|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12472-9^BIOPT-BS^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|69|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12473-7^BIOPT-REG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|70|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12500-7^H-PHE^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|71|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12520-5^PKU^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|72|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12528-8^TYR-1^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|73|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12529-6^TYR-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|74|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12530-4^TYR-III^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|75|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA25796-6^X-ALD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|76|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA25797-4^Mucopolysaccharidosis type I^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|77|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA14037-8^GAA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|78|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22279-6^Spinal muscular atrophy^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|79|ED|57129-9^Full newborn screening summary report for display or printing^LN||^TEXT^html^Base64||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
SPM|1|423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO||440500007^Blood spot specimen^SCT|||||||||||||20230603045000^20230603045000|20230605102300
ORC|RE||20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO||||||||||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBR|2|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57717-1^Newborn screen card data panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|NM|8339-4^BIRTH WEIGHT MEASURED^LN|1|1769.859285|g^gram^UCUM|||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|2|NM|57714-8^OBSTETRIC ESTIMATION OF GESTATIONAL AGE^LN|1|32|wk^week^UCUM|||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|3|CWE|57713-0^INFANT FACTORS THAT AFFECT NEWBORN SCREENING INTERPRETATION^LN|1|LA12419-0^INFANT IN NICU AT TIME OF SPECIMEN COLLECTION^LN||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|4|CWE|MNDSIB^DOES THE BABY HAVE A DECEASED SIBLING?^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|5|CWE|MNDEFECT^DOES THE BABY HAVE BIRTH DEFECTS?^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|6|CWE|MNFAM^FAMILY HISTORY OF DISORDER ON MN SCREENING PANEL^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|7|CWE|67704-7^FEEDING TYPES^LN|1|LA16914-6^BREAST MILK^LN||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|8|CWE|57723-9^UNIQUE BAR CODE NUMBER OF CURRENT SAMPLE^LN|1|0516194254||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|9|ST|62328-0^DISCHARGE PROVIDER PRACTICE PHONE NUMBER^LN|1|Daniel Davis/218-555-1000||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|10|ST|62324-9^POST-DISCHARGE PROVIDER NAME^LN|1|Davis, Daniel, MD||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|11|ST|62326-4^POST-DISCHARGE PROVIDER PRACTICE NAME^LN|1|Lakeridge Health Revere||||||O|||20230603045000-0500|||||||||||||||QST|AOE
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|3|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54090-6^Thyroid newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN^CH^Congenital Hypothyroidism^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|4|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54078-1^Cystic fibrosis newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46769-6^Cystic fibrosis newborn screen interpretation^LN^CF^Cystic Fibrosis^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|5|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57086-1^Congenital adrenal hyperplasia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN^CAH^Congenital Adrenal Hyperplasia^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|6|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57087-9^Biotinidase newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46761-3^Biotinidase deficiency newborn screen interpretation^LN^BIOT^Biotinidase Deficiency^99MDH||LA18592-8^In range^LN^LBW^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|2|FT|57699-1^Biotinidase deficiency newborn screening comment/discussion^LN||For infants born weighing < 2000 grams, newborn screening results can be difficult to interpret. Transfusion status should be taken into account when interpreting screening results. Three newborn screening samples collected at 24-48 hours, 14 days, and 30 days of age will together give the care provider a better understanding of the infantaeuro(TM)s risk for screened disorders.||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|7|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54081-5^Hemoglobinopathies newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46740-7^Hemoglobin disorders newborn screen interpretation^LN^HGB^Hemoglobinopathies^99MDH||LA18592-8^In range^LN^FA^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|2|CWE|64117-5^Most predominant hemoglobin in Dried blood spot^LN||LA16208-3^Hb F^LN||Within Normal Limits = FA||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|3|CWE|64118-3^Second most predominant hemoglobin in Dried blood spot^LN||LA16209-1^Hb A^LN||Within Normal Limits = FA||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|8|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|62333-0^Severe combined immunodeficiency (SCID) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN^SCID^Severe Combined Immunodeficiency*^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|9|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54079-9^Galactosemia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46737-3^Galactosemias newborn screen interpretation^LN^GAL^Galactosemia^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^GJERSET^KRISTIN^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|10|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|CMV-PANEL^Cytomegalovirus DNA newborn screen panel^99MDH|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|CMV-INTERPRT^Cytomegalovirus DNA newborn screen interpretation^99MDH^CMV^Cytomegalovirus DNA^99MDH||LA18592-8^In range^LN^WNL^CMV Not Detected*^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|11|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|58092-8^Acylcarnitine newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|58088-6^Acylcarnitine newborn screen interpretation^LN^Acylcarnitine Profile^Acylcarnitine Profile^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|12|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|53261-4^Amino acid newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46733-2^Amino acidemias newborn screen interpretation^LN^Amino Acid Profile^Amino Acid Profile^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|13|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|85267-3^X-linked adrenoleukodystrophy (X-ALD) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|85269-9^X-ALD^LN^xALD^X-linked Adrenoleukodystrophy**^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|14|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|62300-9^Lysosomal storage disorders newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|62301-7^Lysosomal storage disorders newborn screen interpretation^LN^LSD^Lysosomal Disease Profile**^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|15|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|92005-8^Spinal muscular atrophy newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|92004-1^SMA^LN^SMA^Spinal Muscular Atrophy*^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP

From feff8d75a867fcfc400ede9424b6de0cd83d5910 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 15:36:49 -0700
Subject: [PATCH 21/30] Fixed issue with suffix and file naming

---
 scripts/hurl/local_test_utils.sh | 16 ++++++++--------
 scripts/hurl/update_examples.sh  |  2 +-
 2 files changed, 9 insertions(+), 9 deletions(-)

diff --git a/scripts/hurl/local_test_utils.sh b/scripts/hurl/local_test_utils.sh
index 2899aeb39..a49bb93c9 100755
--- a/scripts/hurl/local_test_utils.sh
+++ b/scripts/hurl/local_test_utils.sh
@@ -3,10 +3,10 @@
 CURRENT_DIR=$(pwd)
 RS_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/rs"
 TI_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/ti"
-FILE_NAME_SUFFIX_STEP_0="_0_initial_message.hl7"
-FILE_NAME_SUFFIX_STEP_1="_1_hl7_translation.fhir"
-FILE_NAME_SUFFIX_STEP_2="_2_fhir_transformation.fhir"
-FILE_NAME_SUFFIX_STEP_3="_3_hl7_translation_final.hl7"
+FILE_NAME_SUFFIX_STEP_0="_0_initial_message"
+FILE_NAME_SUFFIX_STEP_1="_1_hl7_translation"
+FILE_NAME_SUFFIX_STEP_2="_2_fhir_transformation"
+FILE_NAME_SUFFIX_STEP_3="_3_hl7_translation_final"
 
 TIMEOUT=180       # 3 minutes
 RETRY_INTERVAL=10 # Retry every 10 seconds
@@ -97,7 +97,7 @@ submit_message() {
     local message_file_path=$(dirname "$file")
     local message_file_name=$(basename "$file")
     local message_base_name="${message_file_name%.hl7}"
-    message_base_name="${message_base_name%FILE_NAME_SUFFIX_STEP_0}"
+    message_base_name="${message_base_name%$FILE_NAME_SUFFIX_STEP_0}"
 
     msh9=$(awk -F'|' '/^MSH/ { print $9 }' "$file")
     if [[ "$msh9" == "ORU^R01^ORU_R01" ]]; then
@@ -125,7 +125,7 @@ submit_message() {
 
     inbound_submission_id=$(get_sent_report_id_from_history_response "$history_response")
     translated_blob_name="ready/flexion.etor-service-receiver-results/$inbound_submission_id.fhir"
-    translated_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_1"
+    translated_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_1.fhir"
     download_from_azurite "$translated_blob_name" "$translated_file_path"
 
     metadata_response=$(
@@ -135,7 +135,7 @@ submit_message() {
     outbound_submission_id=$(echo "$metadata_response" | jq -r '.issue[] | select(.details.text == "outbound submission id") | .diagnostics')
 
     transformed_blob_name="receive/flexion.etor-service-sender/$outbound_submission_id.fhir"
-    transformed_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_2"
+    transformed_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_2.fhir"
     download_from_azurite "$transformed_blob_name" "$transformed_file_path"
 
     echo "[Second leg] Checking submission status for ID: $outbound_submission_id"
@@ -146,6 +146,6 @@ submit_message() {
 
     final_submission_id=$(get_sent_report_id_from_history_response "$history_response")
     final_blob_name="ready/$receiver/$final_submission_id.hl7"
-    final_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_3"
+    final_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_3.hl7"
     download_from_azurite "$final_blob_name" "$final_file_path"
 }
diff --git a/scripts/hurl/update_examples.sh b/scripts/hurl/update_examples.sh
index cc61f2302..eb301d50b 100755
--- a/scripts/hurl/update_examples.sh
+++ b/scripts/hurl/update_examples.sh
@@ -2,7 +2,7 @@
 
 source ./local_test_utils.sh
 
-find "$CDCTI_HOME/examples" -type f -name "*$FILE_NAME_SUFFIX_STEP_0" | while read -r file; do
+find "$CDCTI_HOME/examples" -type f -name "*$FILE_NAME_SUFFIX_STEP_0.hl7" | while read -r file; do
     echo "-----------------------------------------------------------------------------------------------------------"
     echo "Submitting message: $file"
     submit_message "$file"

From a91069c0466117e33eefd45781c5b0345568b75e Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 15:41:07 -0700
Subject: [PATCH 22/30] Updated snapshots in MN folder

---
 .../004_MN_ORU_R01_NBS_1_hl7_translation.fhir | 4567 +++++++++--------
 ..._MN_ORU_R01_NBS_2_fhir_transformation.fhir | 4567 +++++++++--------
 ...MN_ORU_R01_NBS_3_hl7_translation_final.hl7 |  141 +-
 3 files changed, 4799 insertions(+), 4476 deletions(-)

diff --git a/examples/MN/004_MN_ORU_R01_NBS_1_hl7_translation.fhir b/examples/MN/004_MN_ORU_R01_NBS_1_hl7_translation.fhir
index abd6fdbe6..146824bf8 100644
--- a/examples/MN/004_MN_ORU_R01_NBS_1_hl7_translation.fhir
+++ b/examples/MN/004_MN_ORU_R01_NBS_1_hl7_translation.fhir
@@ -1,26 +1,26 @@
 {
   "resourceType": "Bundle",
-  "id": "1708034743283496564.77a7e3fa-9040-4a7a-bb0f-056905c59025",
+  "id": "1729291107444872000.e40ac070-1e5e-4cd6-832f-5b53bf1c4e86",
   "meta": {
-    "lastUpdated": "2024-02-15T22:05:43.285+00:00"
+    "lastUpdated": "2024-10-18T15:38:27.444-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
     "value": "20230607002849_0365"
   },
   "type": "message",
-  "timestamp": "2023-06-07T00:28:49.000+00:00",
+  "timestamp": "2023-06-06T17:28:49.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/28e642fa-b0e7-3bc5-8084-293e36792f05",
+      "fullUrl": "MessageHeader/1729291107447411000.07549021-9f4c-4f23-8669-14729e53486e",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "28e642fa-b0e7-3bc5-8084-293e36792f05",
+        "id": "1729291107447411000.07549021-9f4c-4f23-8669-14729e53486e",
         "meta": {
           "tag": [
             {
               "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-              "code": "P"
+              "code": "D"
             }
           ]
         },
@@ -151,12 +151,12 @@
             "name": "Epic",
             "endpoint": "urn:oid:1.2.840.114350.1.13.145.2.7.2.695071",
             "receiver": {
-              "reference": "Organization/1708034743312390878.b61e734a-4d65-4e25-b423-cdb19018d84a"
+              "reference": "Organization/1729291107447084000.5391ba51-9dad-4f2e-9936-54c7a452bd60"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1708034743302204787.82104dfb-e854-47de-b7ce-19a2b71e61db"
+          "reference": "Organization/1729291107446309000.dbc0897e-6bc9-4c22-95c6-68a6f42eb67f"
         },
         "source": {
           "extension": [
@@ -182,10 +182,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034743302204787.82104dfb-e854-47de-b7ce-19a2b71e61db",
+      "fullUrl": "Organization/1729291107446309000.dbc0897e-6bc9-4c22-95c6-68a6f42eb67f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034743302204787.82104dfb-e854-47de-b7ce-19a2b71e61db",
+        "id": "1729291107446309000.dbc0897e-6bc9-4c22-95c6-68a6f42eb67f",
         "identifier": [
           {
             "extension": [
@@ -218,10 +218,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034743312390878.b61e734a-4d65-4e25-b423-cdb19018d84a",
+      "fullUrl": "Organization/1729291107447084000.5391ba51-9dad-4f2e-9936-54c7a452bd60",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034743312390878.b61e734a-4d65-4e25-b423-cdb19018d84a",
+        "id": "1729291107447084000.5391ba51-9dad-4f2e-9936-54c7a452bd60",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -259,58 +259,58 @@
       }
     },
     {
-      "fullUrl": "Provenance/1708034743358648255.25d2cf7e-4ca7-4b2e-86cc-c0ba64dc8887",
+      "fullUrl": "Provenance/1729291107450218000.57b33bad-d132-409f-89c5-9ab0ffe7971a",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1708034743358648255.25d2cf7e-4ca7-4b2e-86cc-c0ba64dc8887",
+        "id": "1729291107450218000.57b33bad-d132-409f-89c5-9ab0ffe7971a",
         "target": [
           {
-            "reference": "MessageHeader/28e642fa-b0e7-3bc5-8084-293e36792f05"
+            "reference": "MessageHeader/1729291107447411000.07549021-9f4c-4f23-8669-14729e53486e"
           },
           {
-            "reference": "DiagnosticReport/1708034748361532158.e2a9170c-98f8-4b46-899b-fba947e3418c"
+            "reference": "DiagnosticReport/1729291107937451000.01c9892e-0be4-488a-bd55-5ac4a0c62705"
           },
           {
-            "reference": "DiagnosticReport/1708034748401785805.57989be6-0d6d-48de-a084-f84d07f347ce"
+            "reference": "DiagnosticReport/1729291107939388000.c3fb3626-141e-492c-8d16-d050d22670f0"
           },
           {
-            "reference": "DiagnosticReport/1708034748411388085.422ee97d-e7e3-401a-96f8-50dfb9d1ca24"
+            "reference": "DiagnosticReport/1729291107940957000.28b9bf3c-8776-4d4a-ad5e-f581632c7829"
           },
           {
-            "reference": "DiagnosticReport/1708034748426621110.ae3e9da2-b962-474e-926f-f99efc465287"
+            "reference": "DiagnosticReport/1729291107942557000.48186f3e-a3e9-4e8a-ad18-112510ba96cd"
           },
           {
-            "reference": "DiagnosticReport/1708034748437524688.a122d197-d6cb-4fd6-b47d-d476d6f433c4"
+            "reference": "DiagnosticReport/1729291107944144000.04b557f0-d52c-4473-a0ee-5b59f1d23e55"
           },
           {
-            "reference": "DiagnosticReport/1708034748450425695.91e5f474-f127-42b4-a0b9-d5aad2c802ef"
+            "reference": "DiagnosticReport/1729291107945749000.25c447ac-7856-40d1-838f-2d2e5626363f"
           },
           {
-            "reference": "DiagnosticReport/1708034748469927759.2c623d76-76b8-4351-b809-cea06a663261"
+            "reference": "DiagnosticReport/1729291107947373000.cf62a87d-7104-4a2b-bd6a-656228e26ffd"
           },
           {
-            "reference": "DiagnosticReport/1708034748477154490.3c587c94-fd29-4b4d-9d62-03c62634d09b"
+            "reference": "DiagnosticReport/1729291107949011000.3efd48d0-480d-4bbb-807d-bcd208d02163"
           },
           {
-            "reference": "DiagnosticReport/1708034748490574162.d6d8e505-a32a-4292-8ea1-1e0d197d217c"
+            "reference": "DiagnosticReport/1729291107950608000.0b3b3d1a-b4b7-4d0b-a6f8-3a2edb165162"
           },
           {
-            "reference": "DiagnosticReport/1708034748497010438.954e9ec9-39f7-4f8f-aa95-013cc8455ce3"
+            "reference": "DiagnosticReport/1729291107952193000.c589f522-e2f1-4328-8814-bf1fd3e59806"
           },
           {
-            "reference": "DiagnosticReport/1708034748511491318.c239ad06-3964-4bf6-bc30-de9f3a1df321"
+            "reference": "DiagnosticReport/1729291107953799000.61d41968-e1fc-4a18-87e7-b48398ea1a00"
           },
           {
-            "reference": "DiagnosticReport/1708034748519975487.006f986a-2d80-429f-9516-dfbb4931f9a4"
+            "reference": "DiagnosticReport/1729291107955355000.cf2de07a-f88c-438e-8266-40ab24628977"
           },
           {
-            "reference": "DiagnosticReport/1708034748533872355.afe5314a-346e-4cd3-88e8-58e231c009a0"
+            "reference": "DiagnosticReport/1729291107956904000.798dc2d6-a996-41a0-8cbd-9333700198e5"
           },
           {
-            "reference": "DiagnosticReport/1708034748545002993.64c46ca6-1a0b-4aa2-91f6-45a8c409982c"
+            "reference": "DiagnosticReport/1729291107958474000.1c09e264-b1c4-413a-ba4e-505e66f54641"
           },
           {
-            "reference": "DiagnosticReport/1708034748550803293.d8a67a8d-795c-41e8-9437-dee2494019ef"
+            "reference": "DiagnosticReport/1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7"
           }
         ],
         "recorded": "2023-06-06T19:28:49-05:00",
@@ -332,17 +332,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1708034743357361869.1578903c-b9f5-4a8b-b110-5ffef9818379"
+              "reference": "Organization/1729291107449935000.e4879612-05fc-4e40-9bc0-984157488f0a"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1708034743357361869.1578903c-b9f5-4a8b-b110-5ffef9818379",
+      "fullUrl": "Organization/1729291107449935000.e4879612-05fc-4e40-9bc0-984157488f0a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034743357361869.1578903c-b9f5-4a8b-b110-5ffef9818379",
+        "id": "1729291107449935000.e4879612-05fc-4e40-9bc0-984157488f0a",
         "identifier": [
           {
             "extension": [
@@ -375,11 +375,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1708034743367499712.72b93e7f-e8a0-4d07-a126-b8539394fa51",
+      "fullUrl": "Provenance/1729291107450926000.8d3941f4-8bf9-4feb-815d-837dadda563b",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1708034743367499712.72b93e7f-e8a0-4d07-a126-b8539394fa51",
-        "recorded": "2024-02-15T22:05:43Z",
+        "id": "1729291107450926000.8d3941f4-8bf9-4feb-815d-837dadda563b",
+        "recorded": "2024-10-18T15:38:27Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -401,17 +401,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1708034743366905338.1a701755-ec3d-4c27-ac4e-138af440a08e"
+              "reference": "Organization/1729291107450778000.b0477565-3b08-47de-93c1-03ddd13c0400"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1708034743366905338.1a701755-ec3d-4c27-ac4e-138af440a08e",
+      "fullUrl": "Organization/1729291107450778000.b0477565-3b08-47de-93c1-03ddd13c0400",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034743366905338.1a701755-ec3d-4c27-ac4e-138af440a08e",
+        "id": "1729291107450778000.b0477565-3b08-47de-93c1-03ddd13c0400",
         "identifier": [
           {
             "value": "CDC PRIME - Atlanta"
@@ -431,10 +431,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6",
+      "fullUrl": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70",
       "resource": {
         "resourceType": "Patient",
-        "id": "1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6",
+        "id": "1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -472,7 +472,7 @@
             },
             "value": "11102779",
             "assigner": {
-              "reference": "Organization/1708034743375189502.3a219699-d1c4-4ef0-a7dc-687a0d5cd329"
+              "reference": "Organization/1729291107451677000.3dd864d6-5719-423e-bf17-d145b55f4528"
             }
           }
         ],
@@ -493,7 +493,6 @@
                 ]
               }
             ],
-            "text": "TestValue",
             "family": "SMITH",
             "given": [
               "BB SARAH"
@@ -673,10 +672,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034743375189502.3a219699-d1c4-4ef0-a7dc-687a0d5cd329",
+      "fullUrl": "Organization/1729291107451677000.3dd864d6-5719-423e-bf17-d145b55f4528",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034743375189502.3a219699-d1c4-4ef0-a7dc-687a0d5cd329",
+        "id": "1729291107451677000.3dd864d6-5719-423e-bf17-d145b55f4528",
         "identifier": [
           {
             "extension": [
@@ -691,16 +690,16 @@
       }
     },
     {
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-        "recorded": "2024-02-15T22:05:43Z",
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@@ -712,10 +711,10 @@
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -723,7 +722,7 @@
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         "patient": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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@@ -865,10 +864,10 @@
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@@ -893,6 +892,10 @@
                 "url": "OBX.2",
                 "valueId": "CWE"
               },
+              {
+                "url": "OBX.29",
+                "valueId": "RSLT"
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@@ -921,7 +924,7 @@
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@@ -934,7 +937,7 @@
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@@ -959,10 +962,10 @@
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+      "fullUrl": "Practitioner/1729291107464431000.47454e5b-8cba-4402-9a95-d044c49ec16b",
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+        "id": "1729291107464431000.47454e5b-8cba-4402-9a95-d044c49ec16b",
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@@ -985,10 +988,10 @@
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         "name": "MDH Newborn Screening Laboratory",
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@@ -1019,15 +1022,15 @@
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+      "fullUrl": "PractitionerRole/1729291107463864000.36956431-a780-440b-bb5e-7885c71d7e3b",
       "resource": {
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-        "id": "1708034743532434389.fad7bc17-de82-445a-9a62-070b6a6b2bed",
+        "id": "1729291107463864000.36956431-a780-440b-bb5e-7885c71d7e3b",
         "practitioner": {
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+          "reference": "Practitioner/1729291107464431000.47454e5b-8cba-4402-9a95-d044c49ec16b"
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+          "reference": "Organization/1729291107465102000.54987d47-2d06-4593-89a8-5146aa61d1eb"
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@@ -1042,10 +1045,10 @@
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+      "fullUrl": "Observation/1729291107467173000.94550bb4-9a66-43c3-8e5a-1d006f3c4957",
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@@ -1070,6 +1073,10 @@
                 "url": "OBX.2",
                 "valueId": "CWE"
               },
+              {
+                "url": "OBX.29",
+                "valueId": "RSLT"
+              },
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                 "url": "OBX.11",
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@@ -1098,7 +1105,7 @@
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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@@ -1111,7 +1118,7 @@
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           {
-            "reference": "PractitionerRole/1708034743573364708.d5f31f14-b7a2-47e9-a78d-489a566b3615"
+            "reference": "PractitionerRole/1729291107467330000.0ebbfa26-c7ab-4a92-bf2e-b7c952330cde"
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@@ -1136,10 +1143,10 @@
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+      "fullUrl": "Practitioner/1729291107467784000.756def94-9e98-4c9e-a718-e0087219e912",
       "resource": {
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-        "id": "1708034743578593770.b4787347-41cb-4064-b667-bf6b51dcf2ff",
+        "id": "1729291107467784000.756def94-9e98-4c9e-a718-e0087219e912",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -1162,10 +1169,10 @@
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-      "fullUrl": "Organization/1708034743589745039.2b210e54-30ff-43a1-a13a-31e8849daa38",
+      "fullUrl": "Organization/1729291107468359000.d71804cc-31da-4231-ab9c-37e85f85d265",
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+        "id": "1729291107468359000.d71804cc-31da-4231-ab9c-37e85f85d265",
         "name": "MDH Newborn Screening Laboratory",
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@@ -1196,15 +1203,15 @@
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-        "id": "1708034743573364708.d5f31f14-b7a2-47e9-a78d-489a566b3615",
+        "id": "1729291107467330000.0ebbfa26-c7ab-4a92-bf2e-b7c952330cde",
         "practitioner": {
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+          "reference": "Practitioner/1729291107467784000.756def94-9e98-4c9e-a718-e0087219e912"
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-          "reference": "Organization/1708034743589745039.2b210e54-30ff-43a1-a13a-31e8849daa38"
+          "reference": "Organization/1729291107468359000.d71804cc-31da-4231-ab9c-37e85f85d265"
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@@ -1219,10 +1226,10 @@
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     {
-      "fullUrl": "Observation/1708034743622100282.803481f0-1a59-4da4-8830-9deee0380be4",
+      "fullUrl": "Observation/1729291107470316000.ffd0155f-6fe2-44f9-bc71-ef961b624214",
       "resource": {
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-        "id": "1708034743622100282.803481f0-1a59-4da4-8830-9deee0380be4",
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@@ -1247,6 +1254,10 @@
                 "url": "OBX.2",
                 "valueId": "FT"
               },
+              {
+                "url": "OBX.29",
+                "valueId": "RSLT"
+              },
               {
                 "url": "OBX.11",
                 "valueString": "F"
@@ -1275,7 +1286,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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@@ -1288,17 +1299,17 @@
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         "performer": [
           {
-            "reference": "PractitionerRole/1708034743623273379.43c91689-43fc-4826-9f1e-c6200571b620"
+            "reference": "PractitionerRole/1729291107470479000.905c48aa-17ad-49d4-a3a4-d229bbc882e5"
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         "valueString": "Resources: An MDH genetic counselor is available for consultation regarding screening results at 651-201-3548. Disorder fact sheets and specialist contact list can be found here: https://www.health.state.mn.us/people/newbornscreening/materials/factsheets/bloodspotdisorders.html\\.br\\The purpose of newborn screening is to identify at risk infants in need of diagnostic testing. As with any screening test, false positive or false negative results are possible. Newborn screening is insufficient information on which to base, or rule out, diagnosis or treatment. CF variant analysis is completed using the Luminex xTAG Cystic Fibrosis (CFTR) 39 Kit.\\.br\\*This real-time PCR assay was developed and its performance characteristics were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration: 21 CFR 809.30(e).\\.br\\**The performance characteristics of these tests were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration.\\.br\\***Testing is performed by Mayo Clinic Laboratories-Rochester Main Campus; 200 First Street SW, Rochester, MN 55905\\.br\\ "
       }
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     {
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@@ -1321,10 +1332,10 @@
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+        "id": "1729291107471482000.f95d3526-ec7c-4194-a1c3-ad1c399eecc4",
         "name": "MDH Newborn Screening Laboratory",
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@@ -1355,15 +1366,15 @@
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-      "fullUrl": "PractitionerRole/1708034743623273379.43c91689-43fc-4826-9f1e-c6200571b620",
+      "fullUrl": "PractitionerRole/1729291107470479000.905c48aa-17ad-49d4-a3a4-d229bbc882e5",
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-        "id": "1708034743623273379.43c91689-43fc-4826-9f1e-c6200571b620",
+        "id": "1729291107470479000.905c48aa-17ad-49d4-a3a4-d229bbc882e5",
         "practitioner": {
-          "reference": "Practitioner/1708034743626789444.a16f90ad-441a-44cc-acdc-61a5be9fdab9"
+          "reference": "Practitioner/1729291107470921000.46c20196-758f-4a77-86d3-a49358a943dd"
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+          "reference": "Organization/1729291107471482000.f95d3526-ec7c-4194-a1c3-ad1c399eecc4"
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@@ -1378,10 +1389,10 @@
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-      "fullUrl": "Observation/1708034743650987384.472f5257-c6e3-46f7-aabe-db45824fe188",
+      "fullUrl": "Observation/1729291107473213000.136d7ac1-acfe-4e49-938c-480ef2233a62",
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-        "id": "1708034743650987384.472f5257-c6e3-46f7-aabe-db45824fe188",
+        "id": "1729291107473213000.136d7ac1-acfe-4e49-938c-480ef2233a62",
         "extension": [
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@@ -1406,6 +1417,10 @@
                 "url": "OBX.2",
                 "valueId": "FT"
               },
+              {
+                "url": "OBX.29",
+                "valueId": "RSLT"
+              },
               {
                 "url": "OBX.11",
                 "valueString": "F"
@@ -1434,7 +1449,7 @@
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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@@ -1447,17 +1462,17 @@
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         "performer": [
           {
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+            "reference": "PractitionerRole/1729291107473384000.8ea06619-8030-4240-9735-251639df3ed9"
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         "valueString": "There is decreased sensitivity in screening for CMV in dried blood spots, so not all infants with congenital CMV will be identified. Of those who are identified by newborn screening, up to 80% will be unaffected."
       }
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     {
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@@ -1480,10 +1495,10 @@
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@@ -1514,15 +1529,15 @@
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+          "reference": "Practitioner/1729291107473899000.da2f4a77-75e4-4978-80fd-81981d8a2a94"
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+          "reference": "Organization/1729291107474501000.99ca73ce-1ecb-469e-a2c3-9d8268d35668"
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@@ -1537,10 +1552,10 @@
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+      "fullUrl": "Observation/1729291107476410000.98f61a7c-8833-4d54-891f-153c2fc30b5f",
       "resource": {
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-        "id": "1708034743690357848.7a2cfc4f-0351-4dea-bcce-43c8e345f489",
+        "id": "1729291107476410000.98f61a7c-8833-4d54-891f-153c2fc30b5f",
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@@ -1565,6 +1580,10 @@
                 "url": "OBX.2",
                 "valueId": "CWE"
               },
+              {
+                "url": "OBX.29",
+                "valueId": "SCI"
+              },
               {
                 "url": "OBX.11",
                 "valueString": "F"
@@ -1593,7 +1612,7 @@
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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@@ -1606,7 +1625,7 @@
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@@ -1631,10 +1650,10 @@
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@@ -1657,10 +1676,10 @@
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@@ -1691,15 +1710,15 @@
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@@ -1714,10 +1733,10 @@
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@@ -1742,6 +1761,10 @@
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@@ -1770,7 +1793,7 @@
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@@ -1783,7 +1806,7 @@
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@@ -1808,10 +1831,10 @@
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@@ -1834,10 +1857,10 @@
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@@ -1868,15 +1891,15 @@
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@@ -1891,10 +1914,10 @@
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@@ -1919,6 +1942,10 @@
                 "url": "OBX.2",
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@@ -1947,7 +1974,7 @@
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@@ -1960,7 +1987,7 @@
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@@ -1985,10 +2012,10 @@
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@@ -2011,10 +2038,10 @@
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@@ -2045,15 +2072,15 @@
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@@ -2068,10 +2095,10 @@
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@@ -2096,6 +2123,10 @@
                 "url": "OBX.2",
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@@ -2124,7 +2155,7 @@
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@@ -2137,7 +2168,7 @@
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@@ -2162,10 +2193,10 @@
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@@ -2188,10 +2219,10 @@
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@@ -2222,15 +2253,15 @@
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@@ -2245,10 +2276,10 @@
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@@ -2273,6 +2304,10 @@
                 "url": "OBX.2",
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@@ -2301,7 +2336,7 @@
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@@ -2314,7 +2349,7 @@
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@@ -2339,10 +2374,10 @@
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@@ -2365,10 +2400,10 @@
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@@ -2399,15 +2434,15 @@
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@@ -2422,10 +2457,10 @@
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@@ -2450,6 +2485,10 @@
                 "url": "OBX.2",
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@@ -2478,7 +2517,7 @@
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@@ -2491,7 +2530,7 @@
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@@ -2516,10 +2555,10 @@
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@@ -2542,10 +2581,10 @@
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@@ -2576,15 +2615,15 @@
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@@ -2599,10 +2638,10 @@
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@@ -2627,6 +2666,10 @@
                 "url": "OBX.2",
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@@ -2655,7 +2698,7 @@
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@@ -2668,7 +2711,7 @@
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@@ -2693,10 +2736,10 @@
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@@ -2719,10 +2762,10 @@
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@@ -2753,15 +2796,15 @@
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@@ -2776,10 +2819,10 @@
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@@ -2804,6 +2847,10 @@
                 "url": "OBX.2",
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@@ -2832,7 +2879,7 @@
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@@ -2845,7 +2892,7 @@
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@@ -2870,10 +2917,10 @@
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@@ -2896,10 +2943,10 @@
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@@ -2930,15 +2977,15 @@
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@@ -2953,10 +3000,10 @@
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@@ -2981,6 +3028,10 @@
                 "url": "OBX.2",
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@@ -3009,7 +3060,7 @@
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@@ -3022,7 +3073,7 @@
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@@ -3047,10 +3098,10 @@
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@@ -3073,10 +3124,10 @@
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@@ -3107,15 +3158,15 @@
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@@ -3130,10 +3181,10 @@
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@@ -3158,6 +3209,10 @@
                 "url": "OBX.2",
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@@ -3186,7 +3241,7 @@
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@@ -3199,7 +3254,7 @@
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@@ -3224,10 +3279,10 @@
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@@ -3250,10 +3305,10 @@
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@@ -3284,15 +3339,15 @@
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@@ -3307,10 +3362,10 @@
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@@ -3335,6 +3390,10 @@
                 "url": "OBX.2",
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@@ -3363,7 +3422,7 @@
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@@ -3376,7 +3435,7 @@
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@@ -3401,10 +3460,10 @@
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@@ -3427,10 +3486,10 @@
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@@ -3461,15 +3520,15 @@
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@@ -3484,10 +3543,10 @@
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@@ -3512,6 +3571,10 @@
                 "url": "OBX.2",
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@@ -3540,7 +3603,7 @@
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@@ -3553,7 +3616,7 @@
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@@ -3578,10 +3641,10 @@
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@@ -3604,10 +3667,10 @@
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@@ -3638,15 +3701,15 @@
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@@ -3661,10 +3724,10 @@
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@@ -3689,6 +3752,10 @@
                 "url": "OBX.2",
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@@ -3717,7 +3784,7 @@
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@@ -3730,7 +3797,7 @@
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@@ -3755,10 +3822,10 @@
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@@ -3781,10 +3848,10 @@
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@@ -3815,15 +3882,15 @@
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@@ -3838,10 +3905,10 @@
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@@ -3866,6 +3933,10 @@
                 "url": "OBX.2",
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@@ -3894,7 +3965,7 @@
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@@ -3907,7 +3978,7 @@
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@@ -3932,10 +4003,10 @@
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@@ -3958,10 +4029,10 @@
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@@ -3992,15 +4063,15 @@
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@@ -4015,10 +4086,10 @@
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@@ -4043,6 +4114,10 @@
                 "url": "OBX.2",
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@@ -4071,7 +4146,7 @@
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@@ -4084,7 +4159,7 @@
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@@ -4109,10 +4184,10 @@
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@@ -4135,10 +4210,10 @@
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@@ -4169,15 +4244,15 @@
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@@ -4192,10 +4267,10 @@
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@@ -4220,6 +4295,10 @@
                 "url": "OBX.2",
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@@ -4248,7 +4327,7 @@
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@@ -4261,7 +4340,7 @@
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@@ -4286,10 +4365,10 @@
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@@ -4312,10 +4391,10 @@
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@@ -4346,15 +4425,15 @@
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@@ -4397,6 +4476,10 @@
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@@ -4425,7 +4508,7 @@
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@@ -4438,7 +4521,7 @@
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@@ -4489,10 +4572,10 @@
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@@ -4523,15 +4606,15 @@
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@@ -4546,10 +4629,10 @@
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@@ -4574,6 +4657,10 @@
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@@ -4602,7 +4689,7 @@
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@@ -4615,7 +4702,7 @@
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@@ -4640,10 +4727,10 @@
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@@ -4666,10 +4753,10 @@
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@@ -4700,15 +4787,15 @@
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@@ -4723,10 +4810,10 @@
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@@ -4751,6 +4838,10 @@
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@@ -4779,7 +4870,7 @@
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@@ -4792,7 +4883,7 @@
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@@ -4817,10 +4908,10 @@
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@@ -4843,10 +4934,10 @@
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@@ -4877,15 +4968,15 @@
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@@ -4928,6 +5019,10 @@
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@@ -4956,7 +5051,7 @@
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@@ -4969,7 +5064,7 @@
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@@ -4994,10 +5089,10 @@
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@@ -5020,10 +5115,10 @@
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@@ -5054,15 +5149,15 @@
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@@ -5077,10 +5172,10 @@
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@@ -5105,6 +5200,10 @@
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@@ -5133,7 +5232,7 @@
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@@ -5146,7 +5245,7 @@
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@@ -5171,10 +5270,10 @@
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@@ -5197,10 +5296,10 @@
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@@ -5231,15 +5330,15 @@
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@@ -5254,10 +5353,10 @@
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@@ -5282,6 +5381,10 @@
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@@ -5310,7 +5413,7 @@
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@@ -5323,7 +5426,7 @@
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@@ -5348,10 +5451,10 @@
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@@ -5374,10 +5477,10 @@
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@@ -5408,15 +5511,15 @@
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@@ -5431,10 +5534,10 @@
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@@ -5459,6 +5562,10 @@
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@@ -5487,7 +5594,7 @@
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@@ -5500,7 +5607,7 @@
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@@ -5525,10 +5632,10 @@
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@@ -5551,10 +5658,10 @@
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@@ -5585,15 +5692,15 @@
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@@ -5608,10 +5715,10 @@
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@@ -5636,6 +5743,10 @@
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@@ -5664,7 +5775,7 @@
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@@ -5677,7 +5788,7 @@
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@@ -5702,10 +5813,10 @@
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@@ -5728,10 +5839,10 @@
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@@ -5762,15 +5873,15 @@
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@@ -5785,10 +5896,10 @@
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@@ -5813,6 +5924,10 @@
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@@ -5841,7 +5956,7 @@
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@@ -5854,7 +5969,7 @@
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@@ -5879,10 +5994,10 @@
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@@ -5905,10 +6020,10 @@
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@@ -5939,15 +6054,15 @@
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@@ -5962,10 +6077,10 @@
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@@ -5990,6 +6105,10 @@
                 "url": "OBX.2",
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@@ -6018,7 +6137,7 @@
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@@ -6031,7 +6150,7 @@
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@@ -6056,10 +6175,10 @@
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@@ -6082,10 +6201,10 @@
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@@ -6116,15 +6235,15 @@
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@@ -6139,10 +6258,10 @@
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@@ -6167,6 +6286,10 @@
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@@ -6195,7 +6318,7 @@
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@@ -6208,7 +6331,7 @@
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@@ -6233,10 +6356,10 @@
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@@ -6259,10 +6382,10 @@
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@@ -6293,15 +6416,15 @@
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@@ -6316,10 +6439,10 @@
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@@ -6344,6 +6467,10 @@
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@@ -6372,7 +6499,7 @@
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@@ -6385,7 +6512,7 @@
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@@ -6410,10 +6537,10 @@
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@@ -6436,10 +6563,10 @@
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@@ -6470,15 +6597,15 @@
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@@ -6493,10 +6620,10 @@
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@@ -6521,6 +6648,10 @@
                 "url": "OBX.2",
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@@ -6549,7 +6680,7 @@
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@@ -6562,7 +6693,7 @@
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@@ -6587,10 +6718,10 @@
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@@ -6613,10 +6744,10 @@
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@@ -6647,15 +6778,15 @@
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@@ -6670,10 +6801,10 @@
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@@ -6698,6 +6829,10 @@
                 "url": "OBX.2",
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@@ -6726,7 +6861,7 @@
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@@ -6739,7 +6874,7 @@
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@@ -6764,10 +6899,10 @@
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@@ -6790,10 +6925,10 @@
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@@ -6824,15 +6959,15 @@
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@@ -6847,10 +6982,10 @@
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@@ -6875,6 +7010,10 @@
                 "url": "OBX.2",
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@@ -6903,7 +7042,7 @@
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@@ -6916,7 +7055,7 @@
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@@ -6941,10 +7080,10 @@
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@@ -6967,10 +7106,10 @@
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@@ -7001,15 +7140,15 @@
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@@ -7024,10 +7163,10 @@
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@@ -7052,6 +7191,10 @@
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@@ -7080,7 +7223,7 @@
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@@ -7093,7 +7236,7 @@
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@@ -7118,10 +7261,10 @@
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@@ -7144,10 +7287,10 @@
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@@ -7178,15 +7321,15 @@
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@@ -7201,10 +7344,10 @@
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@@ -7229,6 +7372,10 @@
                 "url": "OBX.2",
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@@ -7257,7 +7404,7 @@
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@@ -7270,7 +7417,7 @@
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@@ -7295,10 +7442,10 @@
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@@ -7321,10 +7468,10 @@
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@@ -7355,15 +7502,15 @@
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@@ -7378,10 +7525,10 @@
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@@ -7406,6 +7553,10 @@
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@@ -7434,7 +7585,7 @@
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@@ -7447,7 +7598,7 @@
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@@ -7472,10 +7623,10 @@
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@@ -7498,10 +7649,10 @@
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@@ -7532,15 +7683,15 @@
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@@ -7555,10 +7706,10 @@
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@@ -7583,6 +7734,10 @@
                 "url": "OBX.2",
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@@ -7611,7 +7766,7 @@
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@@ -7624,7 +7779,7 @@
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@@ -7649,10 +7804,10 @@
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@@ -7675,10 +7830,10 @@
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@@ -7709,15 +7864,15 @@
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@@ -7732,10 +7887,10 @@
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@@ -7760,6 +7915,10 @@
                 "url": "OBX.2",
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@@ -7788,7 +7947,7 @@
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@@ -7801,7 +7960,7 @@
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@@ -7852,10 +8011,10 @@
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@@ -7937,6 +8096,10 @@
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@@ -7978,7 +8141,7 @@
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@@ -8029,10 +8192,10 @@
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@@ -8063,15 +8226,15 @@
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@@ -8086,10 +8249,10 @@
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@@ -8114,6 +8277,10 @@
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@@ -8142,7 +8309,7 @@
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@@ -8155,7 +8322,7 @@
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@@ -8180,10 +8347,10 @@
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@@ -8206,10 +8373,10 @@
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@@ -8240,15 +8407,15 @@
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@@ -8263,10 +8430,10 @@
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@@ -8291,6 +8458,10 @@
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@@ -8319,7 +8490,7 @@
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@@ -8332,7 +8503,7 @@
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@@ -8357,10 +8528,10 @@
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@@ -8383,10 +8554,10 @@
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@@ -8417,15 +8588,15 @@
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@@ -8440,10 +8611,10 @@
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@@ -8468,6 +8639,10 @@
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@@ -8496,7 +8671,7 @@
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@@ -8509,7 +8684,7 @@
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@@ -8534,10 +8709,10 @@
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@@ -8560,10 +8735,10 @@
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@@ -8594,15 +8769,15 @@
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@@ -8617,10 +8792,10 @@
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@@ -8645,6 +8820,10 @@
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@@ -8673,7 +8852,7 @@
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@@ -8686,7 +8865,7 @@
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@@ -8711,10 +8890,10 @@
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@@ -8737,10 +8916,10 @@
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@@ -8771,15 +8950,15 @@
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@@ -8794,10 +8973,10 @@
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@@ -8822,6 +9001,10 @@
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@@ -8850,7 +9033,7 @@
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@@ -8863,7 +9046,7 @@
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@@ -8888,10 +9071,10 @@
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@@ -8914,10 +9097,10 @@
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@@ -8948,15 +9131,15 @@
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@@ -8971,10 +9154,10 @@
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@@ -8999,6 +9182,10 @@
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@@ -9027,7 +9214,7 @@
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@@ -9040,7 +9227,7 @@
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@@ -9065,10 +9252,10 @@
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@@ -9091,10 +9278,10 @@
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@@ -9125,15 +9312,15 @@
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@@ -9148,10 +9335,10 @@
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@@ -9176,6 +9363,10 @@
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@@ -9204,7 +9395,7 @@
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@@ -9217,7 +9408,7 @@
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@@ -9242,10 +9433,10 @@
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@@ -9268,10 +9459,10 @@
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@@ -9302,15 +9493,15 @@
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@@ -9325,10 +9516,10 @@
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@@ -9353,6 +9544,10 @@
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@@ -9381,7 +9576,7 @@
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@@ -9394,7 +9589,7 @@
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@@ -9419,10 +9614,10 @@
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@@ -9445,10 +9640,10 @@
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@@ -9479,15 +9674,15 @@
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@@ -9502,10 +9697,10 @@
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@@ -9530,6 +9725,10 @@
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@@ -9558,7 +9757,7 @@
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@@ -9571,7 +9770,7 @@
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@@ -9707,6 +9906,10 @@
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@@ -9799,10 +10002,10 @@
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@@ -9884,6 +10087,10 @@
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@@ -9925,7 +10132,7 @@
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@@ -9976,10 +10183,10 @@
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@@ -10061,6 +10268,10 @@
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@@ -10153,10 +10364,10 @@
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@@ -10238,6 +10449,10 @@
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@@ -10330,10 +10545,10 @@
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@@ -10592,6 +10811,10 @@
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@@ -10633,7 +10856,7 @@
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@@ -10684,10 +10907,10 @@
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@@ -10769,6 +10992,10 @@
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@@ -10861,10 +11088,10 @@
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@@ -10946,6 +11173,10 @@
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@@ -10974,7 +11205,7 @@
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@@ -10987,7 +11218,7 @@
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@@ -11038,10 +11269,10 @@
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@@ -11123,6 +11354,10 @@
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@@ -11164,7 +11399,7 @@
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@@ -11215,10 +11450,10 @@
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@@ -11300,6 +11535,10 @@
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@@ -11341,7 +11580,7 @@
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@@ -11366,10 +11605,10 @@
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@@ -11392,10 +11631,10 @@
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@@ -11426,15 +11665,15 @@
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@@ -11449,10 +11688,10 @@
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@@ -11477,6 +11716,10 @@
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@@ -11505,7 +11748,7 @@
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@@ -11518,7 +11761,7 @@
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@@ -11543,10 +11786,10 @@
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@@ -11569,10 +11812,10 @@
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@@ -11603,15 +11846,15 @@
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@@ -11626,10 +11869,10 @@
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@@ -11654,6 +11897,10 @@
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@@ -11682,7 +11929,7 @@
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@@ -11695,7 +11942,7 @@
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@@ -11720,10 +11967,10 @@
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@@ -11746,10 +11993,10 @@
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@@ -11780,15 +12027,15 @@
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@@ -11803,10 +12050,10 @@
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@@ -11831,6 +12078,10 @@
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@@ -11859,7 +12110,7 @@
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@@ -11872,7 +12123,7 @@
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@@ -11897,10 +12148,10 @@
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@@ -11923,10 +12174,10 @@
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@@ -11957,15 +12208,15 @@
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@@ -11980,10 +12231,10 @@
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@@ -12008,6 +12259,10 @@
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@@ -12036,7 +12291,7 @@
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@@ -12049,7 +12304,7 @@
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@@ -12074,10 +12329,10 @@
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@@ -12100,10 +12355,10 @@
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@@ -12134,15 +12389,15 @@
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@@ -12157,10 +12412,10 @@
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@@ -12185,6 +12440,10 @@
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@@ -12213,7 +12472,7 @@
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@@ -12226,7 +12485,7 @@
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@@ -12362,6 +12621,10 @@
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@@ -12454,10 +12717,10 @@
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@@ -12539,6 +12802,10 @@
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@@ -12580,7 +12847,7 @@
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@@ -12631,10 +12898,10 @@
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@@ -12716,6 +12983,10 @@
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@@ -12744,7 +13015,7 @@
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@@ -12757,7 +13028,7 @@
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@@ -12808,10 +13079,10 @@
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@@ -12893,6 +13164,10 @@
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@@ -12985,10 +13260,10 @@
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@@ -13070,6 +13345,10 @@
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@@ -13111,7 +13390,7 @@
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@@ -13136,10 +13415,10 @@
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@@ -13162,10 +13441,10 @@
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@@ -13196,15 +13475,15 @@
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@@ -13247,6 +13526,10 @@
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@@ -13275,7 +13558,7 @@
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@@ -13288,7 +13571,7 @@
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@@ -13339,10 +13622,10 @@
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@@ -13373,15 +13656,15 @@
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@@ -13396,10 +13679,10 @@
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@@ -13424,6 +13707,10 @@
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@@ -13452,7 +13739,7 @@
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@@ -13465,7 +13752,7 @@
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@@ -13490,10 +13777,10 @@
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@@ -13516,10 +13803,10 @@
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@@ -13550,15 +13837,15 @@
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@@ -13573,10 +13860,10 @@
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@@ -13601,6 +13888,10 @@
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@@ -13629,7 +13920,7 @@
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@@ -13642,7 +13933,7 @@
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@@ -13667,10 +13958,10 @@
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@@ -13693,10 +13984,10 @@
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@@ -13727,15 +14018,15 @@
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@@ -13778,6 +14069,10 @@
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@@ -13806,7 +14101,7 @@
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@@ -13819,7 +14114,7 @@
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@@ -13844,10 +14139,10 @@
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@@ -13870,10 +14165,10 @@
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@@ -13904,15 +14199,15 @@
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@@ -13955,6 +14250,10 @@
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@@ -13983,7 +14282,7 @@
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@@ -13996,7 +14295,7 @@
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@@ -14132,6 +14431,10 @@
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@@ -14173,7 +14476,7 @@
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@@ -14224,10 +14527,10 @@
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@@ -14258,15 +14561,15 @@
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@@ -14281,10 +14584,10 @@
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@@ -14309,6 +14612,10 @@
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@@ -14337,7 +14644,7 @@
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@@ -14350,7 +14657,7 @@
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@@ -14375,10 +14682,10 @@
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@@ -14401,10 +14708,10 @@
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@@ -14435,15 +14742,15 @@
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@@ -14486,6 +14793,10 @@
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@@ -14514,7 +14825,7 @@
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@@ -14527,7 +14838,7 @@
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@@ -14552,10 +14863,10 @@
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@@ -14578,10 +14889,10 @@
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@@ -14612,15 +14923,15 @@
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@@ -14699,6 +15010,10 @@
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@@ -14727,7 +15042,7 @@
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@@ -14740,16 +15055,16 @@
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@@ -14772,10 +15087,10 @@
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@@ -14871,6 +15186,10 @@
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@@ -15428,6 +15771,10 @@
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@@ -15503,6 +15850,10 @@
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@@ -15566,6 +15917,10 @@
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@@ -15594,7 +15949,7 @@
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@@ -15629,6 +15984,10 @@
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@@ -15700,6 +16059,10 @@
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@@ -15755,7 +16118,7 @@
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@@ -15820,10 +16183,10 @@
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@@ -15905,6 +16268,10 @@
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@@ -16025,10 +16392,10 @@
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@@ -16520,6 +16895,10 @@
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@@ -16679,6 +17058,10 @@
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@@ -16721,7 +17104,7 @@
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@@ -16884,6 +17267,10 @@
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@@ -16925,7 +17312,7 @@
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@@ -16981,10 +17368,10 @@
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@@ -17248,6 +17639,10 @@
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@@ -17368,10 +17763,10 @@
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@@ -17453,6 +17848,10 @@
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@@ -17495,7 +17894,7 @@
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@@ -17508,7 +17907,7 @@
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@@ -17573,10 +17972,10 @@
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@@ -17658,6 +18057,10 @@
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@@ -17699,7 +18102,7 @@
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@@ -17712,7 +18115,7 @@
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@@ -17777,10 +18180,10 @@
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@@ -17862,6 +18265,10 @@
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@@ -17917,7 +18324,7 @@
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@@ -17982,10 +18389,10 @@
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@@ -18067,6 +18474,10 @@
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@@ -18187,10 +18598,10 @@
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@@ -18272,6 +18683,10 @@
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@@ -18327,7 +18742,7 @@
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@@ -18366,10 +18781,10 @@
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@@ -18392,10 +18807,10 @@
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@@ -18426,15 +18841,15 @@
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@@ -18449,10 +18864,10 @@
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@@ -18477,6 +18892,10 @@
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@@ -18519,7 +18938,7 @@
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@@ -18532,7 +18951,7 @@
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@@ -18571,10 +18990,10 @@
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@@ -18597,10 +19016,10 @@
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@@ -18631,15 +19050,15 @@
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@@ -18654,10 +19073,10 @@
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@@ -18682,6 +19101,10 @@
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@@ -18724,7 +19147,7 @@
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@@ -18737,7 +19160,7 @@
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@@ -18776,10 +19199,10 @@
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@@ -18802,10 +19225,10 @@
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@@ -18836,15 +19259,15 @@
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@@ -18859,10 +19282,10 @@
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@@ -18872,10 +19295,10 @@
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@@ -18885,10 +19308,10 @@
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@@ -18898,10 +19321,10 @@
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@@ -18911,10 +19334,10 @@
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@@ -18924,10 +19347,10 @@
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@@ -18937,10 +19360,10 @@
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@@ -18950,10 +19373,10 @@
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@@ -18963,10 +19386,10 @@
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@@ -18976,10 +19399,10 @@
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@@ -18989,10 +19412,10 @@
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@@ -19002,10 +19425,10 @@
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@@ -19015,10 +19438,10 @@
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@@ -19028,10 +19451,10 @@
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@@ -19041,10 +19464,10 @@
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@@ -19054,10 +19477,10 @@
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@@ -19219,10 +19642,10 @@
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@@ -19234,13 +19657,13 @@
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@@ -19268,7 +19691,7 @@
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@@ -19330,6 +19753,10 @@
                 "url": "OBR.22",
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@@ -19408,7 +19835,7 @@
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@@ -19506,18 +19933,18 @@
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@@ -19532,10 +19959,10 @@
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@@ -19587,7 +20014,7 @@
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@@ -19603,10 +20030,10 @@
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@@ -19670,12 +20097,6 @@
             "type": {
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@@ -19700,23 +20121,23 @@
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@@ -19780,12 +20201,6 @@
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@@ -19798,10 +20213,10 @@
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@@ -19865,12 +20280,6 @@
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@@ -19883,10 +20292,10 @@
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@@ -19901,10 +20310,10 @@
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@@ -19952,7 +20361,7 @@
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             "assigner": {
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@@ -19968,10 +20377,10 @@
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@@ -19986,10 +20395,10 @@
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@@ -20037,7 +20446,7 @@
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             "assigner": {
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@@ -20053,10 +20462,10 @@
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@@ -20121,6 +20530,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
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@@ -20199,7 +20612,7 @@
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@@ -20297,18 +20710,18 @@
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@@ -20323,10 +20736,10 @@
       }
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@@ -20378,7 +20791,7 @@
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@@ -20394,10 +20807,10 @@
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@@ -20412,10 +20825,10 @@
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@@ -20463,7 +20876,7 @@
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@@ -20479,10 +20892,10 @@
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@@ -20494,13 +20907,13 @@
               {
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                 "valueReference": {
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+                  "reference": "Organization/1729291107765421000.6ee1bced-536e-4a9f-ae93-da81a0967b20"
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@@ -20528,7 +20941,7 @@
               {
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                 "valueReference": {
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@@ -20590,6 +21003,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
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+                "valueId": "F"
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@@ -20668,7 +21085,7 @@
               {
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@@ -20766,18 +21183,18 @@
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@@ -20792,10 +21209,10 @@
       }
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@@ -20847,7 +21264,7 @@
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             "assigner": {
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@@ -20863,10 +21280,10 @@
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@@ -20930,12 +21347,6 @@
             "type": {
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@@ -20960,23 +21371,23 @@
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@@ -21040,12 +21451,6 @@
             "type": {
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@@ -21058,10 +21463,10 @@
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@@ -21125,12 +21530,6 @@
             "type": {
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                   "code": "Submitter ID"
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@@ -21143,10 +21542,10 @@
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@@ -21161,10 +21560,10 @@
       }
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         "extension": [
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@@ -21212,7 +21611,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729291107766079000.28e7ce02-389e-4c9b-aa43-8b25210ef277"
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@@ -21228,10 +21627,10 @@
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+      "fullUrl": "Organization/1729291107768831000.e2f6a2f1-6944-4d6b-8570-4ed744bd7e25",
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@@ -21246,10 +21645,10 @@
       }
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@@ -21297,7 +21696,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729291107768831000.e2f6a2f1-6944-4d6b-8570-4ed744bd7e25"
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@@ -21313,10 +21712,10 @@
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@@ -21328,13 +21727,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747181138898.5104228a-aa3b-4f42-874a-d8907216bb5c"
+                  "reference": "Organization/1729291107775403000.10064683-c861-4bb8-86b1-ffa3c4e63b1a"
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                 "valueReference": {
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+                  "reference": "Organization/1729291107776243000.c2c08772-3fe6-47fc-a35e-2e3e28e34808"
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@@ -21362,7 +21761,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291107777699000.e3168e27-cf34-4b8e-bbfa-e661a75931a9"
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@@ -21424,6 +21823,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
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+                "valueId": "F"
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@@ -21502,7 +21905,7 @@
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291107779960000.7a9aba9f-9a7f-4f85-9d50-557e24fe816a"
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@@ -21600,18 +22003,18 @@
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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@@ -21626,10 +22029,10 @@
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@@ -21681,7 +22084,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729291107770450000.5531e8c2-7013-439a-baeb-f339044f8d36"
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@@ -21697,10 +22100,10 @@
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@@ -21764,12 +22167,6 @@
             "type": {
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@@ -21794,23 +22191,23 @@
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-        "id": "1708034747181138898.5104228a-aa3b-4f42-874a-d8907216bb5c",
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         "extension": [
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@@ -21874,12 +22271,6 @@
             "type": {
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@@ -21892,10 +22283,10 @@
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@@ -21959,12 +22350,6 @@
             "type": {
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                   "code": "Submitter ID"
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@@ -21977,10 +22362,10 @@
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@@ -21995,10 +22380,10 @@
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@@ -22046,7 +22431,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747185043731.4e043942-5d5d-4666-9481-85023b5ccf43"
+              "reference": "Organization/1729291107776854000.e09fcff3-f808-4e42-b092-df5005922fa5"
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@@ -22062,10 +22447,10 @@
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@@ -22080,10 +22465,10 @@
       }
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         "extension": [
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@@ -22131,7 +22516,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729291107779173000.87dac28d-4581-40fb-96ad-98a0e6b3dbf2"
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@@ -22147,10 +22532,10 @@
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       "resource": {
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         "extension": [
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@@ -22162,13 +22547,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747270135925.da7f7d16-170f-4573-85d3-af942c7a1490"
+                  "reference": "Organization/1729291107787984000.7292f507-4a2c-409b-b719-c810926832bf"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729291107790967000.6b6252f4-2a14-4a37-8527-f476c4feb240"
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@@ -22196,7 +22581,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747286322554.278381ff-cddb-4fda-a100-9966f321682b"
+                  "reference": "Practitioner/1729291107793664000.4e4ae246-74c7-44c4-ac6b-f5c95734cc6e"
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@@ -22258,6 +22643,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -22336,7 +22725,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747302394525.a9aeef5a-c730-4cea-ba67-08532036e50d"
+                  "reference": "Practitioner/1729291107798811000.41f11bbb-a2f5-4148-8765-b12cd257c0bb"
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@@ -22434,18 +22823,18 @@
           ]
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034747198968569.0c6e0d14-6563-47ef-83f1-700cea2c8fb1"
+          "reference": "PractitionerRole/1729291107780618000.c45b4f76-4123-47a5-b4d9-b87adf3f07f1"
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       "resource": {
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@@ -22460,10 +22849,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107781977000.395f559e-cccb-4d90-8474-815260c3d8a7",
       "resource": {
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+        "id": "1729291107781977000.395f559e-cccb-4d90-8474-815260c3d8a7",
         "extension": [
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@@ -22515,7 +22904,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747199599730.a83a6851-a3ee-48d5-82b6-49bd6df8c2a1"
+              "reference": "Organization/1729291107780830000.f6d50d2d-a7b0-46a2-9a5f-8d9e5f301c52"
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@@ -22531,10 +22920,10 @@
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       "resource": {
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+        "id": "1729291107783806000.255cc527-bbc1-4f04-87a9-78feea50a32e",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -22598,12 +22987,6 @@
             "type": {
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                 {
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-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
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@@ -22628,23 +23011,23 @@
       }
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-      "fullUrl": "PractitionerRole/1708034747198968569.0c6e0d14-6563-47ef-83f1-700cea2c8fb1",
+      "fullUrl": "PractitionerRole/1729291107780618000.c45b4f76-4123-47a5-b4d9-b87adf3f07f1",
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         "resourceType": "PractitionerRole",
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+        "id": "1729291107780618000.c45b4f76-4123-47a5-b4d9-b87adf3f07f1",
         "practitioner": {
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+          "reference": "Practitioner/1729291107781977000.395f559e-cccb-4d90-8474-815260c3d8a7"
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         "organization": {
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+          "reference": "Organization/1729291107783806000.255cc527-bbc1-4f04-87a9-78feea50a32e"
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+      "fullUrl": "Organization/1729291107787984000.7292f507-4a2c-409b-b719-c810926832bf",
       "resource": {
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-        "id": "1708034747270135925.da7f7d16-170f-4573-85d3-af942c7a1490",
+        "id": "1729291107787984000.7292f507-4a2c-409b-b719-c810926832bf",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -22708,12 +23091,6 @@
             "type": {
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                   "code": "NPI"
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@@ -22726,10 +23103,10 @@
       }
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       "resource": {
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         "extension": [
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@@ -22793,12 +23170,6 @@
             "type": {
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -22811,10 +23182,10 @@
       }
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-      "fullUrl": "Organization/1708034747284078896.271c3c42-4b81-40a5-9db0-5bf01a92c15c",
+      "fullUrl": "Organization/1729291107792021000.e2b3d2c7-c111-44ba-b5ca-e9b0285ee48e",
       "resource": {
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+        "id": "1729291107792021000.e2b3d2c7-c111-44ba-b5ca-e9b0285ee48e",
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@@ -22829,10 +23200,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107793664000.4e4ae246-74c7-44c4-ac6b-f5c95734cc6e",
       "resource": {
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+        "id": "1729291107793664000.4e4ae246-74c7-44c4-ac6b-f5c95734cc6e",
         "extension": [
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@@ -22880,7 +23251,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747284078896.271c3c42-4b81-40a5-9db0-5bf01a92c15c"
+              "reference": "Organization/1729291107792021000.e2b3d2c7-c111-44ba-b5ca-e9b0285ee48e"
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@@ -22896,10 +23267,10 @@
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+      "fullUrl": "Organization/1729291107796638000.38c113e7-a2f7-47d2-8c86-734c46e58a84",
       "resource": {
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+        "id": "1729291107796638000.38c113e7-a2f7-47d2-8c86-734c46e58a84",
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@@ -22914,10 +23285,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107798811000.41f11bbb-a2f5-4148-8765-b12cd257c0bb",
       "resource": {
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+        "id": "1729291107798811000.41f11bbb-a2f5-4148-8765-b12cd257c0bb",
         "extension": [
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@@ -22965,7 +23336,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747299498694.25bd2060-84c1-4859-bb5d-a98fa9b53d2a"
+              "reference": "Organization/1729291107796638000.38c113e7-a2f7-47d2-8c86-734c46e58a84"
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@@ -22981,10 +23352,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729291107821061000.a6a053cb-c8b2-4e59-8e68-23222f7015cd",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1708034747417374183.44db3eed-d560-47d1-9853-4204f6cd4117",
+        "id": "1729291107821061000.a6a053cb-c8b2-4e59-8e68-23222f7015cd",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -22996,13 +23367,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747353284802.de1d45b3-a19d-4054-aedf-c9192fe19d8b"
+                  "reference": "Organization/1729291107813573000.8d16dba9-a7c5-431d-bd7b-44c3991d215c"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747363823968.f0ddc322-d213-435e-bb31-d86e3eecc372"
+                  "reference": "Organization/1729291107816300000.9e29ae56-363e-4d3d-b3bf-f590c1deffc5"
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@@ -23030,7 +23401,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747385729408.8ffa63b4-7737-46b8-bf0f-2cacfdae293d"
+                  "reference": "Practitioner/1729291107818165000.2e635ad0-f76f-41b5-abd4-99f42a1734c3"
                 }
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             ]
@@ -23092,6 +23463,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -23170,7 +23545,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747415381500.193e1e97-e5a4-4d55-aadd-18eb594efd15"
+                  "reference": "Practitioner/1729291107820564000.8ff1f094-2a85-46a2-87dc-df9f82b796cb"
                 }
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@@ -23268,18 +23643,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "requester": {
-          "reference": "PractitionerRole/1708034747305657618.a5a46a1a-07cf-42dd-9461-544aa140ad65"
+          "reference": "PractitionerRole/1729291107800456000.2810f806-dea6-406c-8056-c5a64044ae7b"
         }
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     {
-      "fullUrl": "Organization/1708034747306462267.49126b46-cc3a-4c5e-989e-5d9fb7002677",
+      "fullUrl": "Organization/1729291107800987000.d98eb28b-eca1-45bf-bf3e-e272ff7d1e72",
       "resource": {
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-        "id": "1708034747306462267.49126b46-cc3a-4c5e-989e-5d9fb7002677",
+        "id": "1729291107800987000.d98eb28b-eca1-45bf-bf3e-e272ff7d1e72",
         "identifier": [
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@@ -23294,10 +23669,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1708034747321225448.312dd2d7-723e-4c08-8ee7-3ebe6df615af",
+      "fullUrl": "Practitioner/1729291107803274000.4a19435f-3bb9-4beb-916e-55590277f6fe",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747321225448.312dd2d7-723e-4c08-8ee7-3ebe6df615af",
+        "id": "1729291107803274000.4a19435f-3bb9-4beb-916e-55590277f6fe",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -23349,7 +23724,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747306462267.49126b46-cc3a-4c5e-989e-5d9fb7002677"
+              "reference": "Organization/1729291107800987000.d98eb28b-eca1-45bf-bf3e-e272ff7d1e72"
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@@ -23365,10 +23740,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747334621290.ed94f3fc-da3e-49e6-8d32-a9ee22e2c5bc",
+      "fullUrl": "Organization/1729291107807217000.e4a239eb-04da-400c-99e9-63e513edbce7",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747334621290.ed94f3fc-da3e-49e6-8d32-a9ee22e2c5bc",
+        "id": "1729291107807217000.e4a239eb-04da-400c-99e9-63e513edbce7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -23432,12 +23807,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -23462,23 +23831,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1708034747305657618.a5a46a1a-07cf-42dd-9461-544aa140ad65",
+      "fullUrl": "PractitionerRole/1729291107800456000.2810f806-dea6-406c-8056-c5a64044ae7b",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747305657618.a5a46a1a-07cf-42dd-9461-544aa140ad65",
+        "id": "1729291107800456000.2810f806-dea6-406c-8056-c5a64044ae7b",
         "practitioner": {
-          "reference": "Practitioner/1708034747321225448.312dd2d7-723e-4c08-8ee7-3ebe6df615af"
+          "reference": "Practitioner/1729291107803274000.4a19435f-3bb9-4beb-916e-55590277f6fe"
         },
         "organization": {
-          "reference": "Organization/1708034747334621290.ed94f3fc-da3e-49e6-8d32-a9ee22e2c5bc"
+          "reference": "Organization/1729291107807217000.e4a239eb-04da-400c-99e9-63e513edbce7"
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     },
     {
-      "fullUrl": "Organization/1708034747353284802.de1d45b3-a19d-4054-aedf-c9192fe19d8b",
+      "fullUrl": "Organization/1729291107813573000.8d16dba9-a7c5-431d-bd7b-44c3991d215c",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747353284802.de1d45b3-a19d-4054-aedf-c9192fe19d8b",
+        "id": "1729291107813573000.8d16dba9-a7c5-431d-bd7b-44c3991d215c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -23542,12 +23911,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
-                  ],
                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -23560,10 +23923,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034747363823968.f0ddc322-d213-435e-bb31-d86e3eecc372",
+      "fullUrl": "Organization/1729291107816300000.9e29ae56-363e-4d3d-b3bf-f590c1deffc5",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747363823968.f0ddc322-d213-435e-bb31-d86e3eecc372",
+        "id": "1729291107816300000.9e29ae56-363e-4d3d-b3bf-f590c1deffc5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -23627,12 +23990,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
-                  ],
                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
                 }
@@ -23645,10 +24002,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034747370647859.04166b48-046c-40b5-9038-36ee0f255da9",
+      "fullUrl": "Organization/1729291107817262000.e3f39d33-3772-4213-ba86-550e25dc3349",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747370647859.04166b48-046c-40b5-9038-36ee0f255da9",
+        "id": "1729291107817262000.e3f39d33-3772-4213-ba86-550e25dc3349",
         "identifier": [
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@@ -23663,10 +24020,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1708034747385729408.8ffa63b4-7737-46b8-bf0f-2cacfdae293d",
+      "fullUrl": "Practitioner/1729291107818165000.2e635ad0-f76f-41b5-abd4-99f42a1734c3",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747385729408.8ffa63b4-7737-46b8-bf0f-2cacfdae293d",
+        "id": "1729291107818165000.2e635ad0-f76f-41b5-abd4-99f42a1734c3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -23714,7 +24071,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747370647859.04166b48-046c-40b5-9038-36ee0f255da9"
+              "reference": "Organization/1729291107817262000.e3f39d33-3772-4213-ba86-550e25dc3349"
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@@ -23730,10 +24087,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747402279654.85bcd095-183a-4da5-99c7-734666f0bc31",
+      "fullUrl": "Organization/1729291107819809000.1e2b5e18-e9f3-4b71-8475-f0b7ab2225f0",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747402279654.85bcd095-183a-4da5-99c7-734666f0bc31",
+        "id": "1729291107819809000.1e2b5e18-e9f3-4b71-8475-f0b7ab2225f0",
         "identifier": [
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@@ -23748,10 +24105,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1708034747415381500.193e1e97-e5a4-4d55-aadd-18eb594efd15",
+      "fullUrl": "Practitioner/1729291107820564000.8ff1f094-2a85-46a2-87dc-df9f82b796cb",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747415381500.193e1e97-e5a4-4d55-aadd-18eb594efd15",
+        "id": "1729291107820564000.8ff1f094-2a85-46a2-87dc-df9f82b796cb",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -23799,7 +24156,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747402279654.85bcd095-183a-4da5-99c7-734666f0bc31"
+              "reference": "Organization/1729291107819809000.1e2b5e18-e9f3-4b71-8475-f0b7ab2225f0"
             }
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@@ -23815,10 +24172,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1708034747498446689.172f8119-83c0-428e-9ef2-9c4dd04865c9",
+      "fullUrl": "ServiceRequest/1729291107830839000.cd99c0cf-8522-43c5-9fda-f808c123971d",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1708034747498446689.172f8119-83c0-428e-9ef2-9c4dd04865c9",
+        "id": "1729291107830839000.cd99c0cf-8522-43c5-9fda-f808c123971d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -23830,13 +24187,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747461640695.bc0ba164-83c7-4015-b939-d27f1b62fac6"
+                  "reference": "Organization/1729291107825998000.7b87572a-2922-4634-8fda-4e2043b87904"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747467340792.2aca5d23-07b5-408f-9497-a954f9236dcc"
+                  "reference": "Organization/1729291107826836000.d0181b13-1e5d-4188-868b-f9c8a25dd3e3"
                 }
               },
               {
@@ -23864,7 +24221,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747473545284.63666022-dad0-42da-9103-ac256afe7c47"
+                  "reference": "Practitioner/1729291107828173000.e6184895-9da9-43b5-aa4e-86217d5d7693"
                 }
               }
             ]
@@ -23926,6 +24283,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -24004,7 +24365,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747491850110.c8e3b35f-0168-41b8-ae88-3b3048e43b9c"
+                  "reference": "Practitioner/1729291107830359000.c8d9e0f0-3e00-4e2b-956f-0700c21b7f4b"
                 }
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@@ -24102,18 +24463,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "requester": {
-          "reference": "PractitionerRole/1708034747418203132.cf452cde-3265-4291-9fdf-25da0ee87858"
+          "reference": "PractitionerRole/1729291107821239000.4dc618de-e8b2-4cc0-b994-b7bda67c940c"
         }
       }
     },
     {
-      "fullUrl": "Organization/1708034747418883261.cf98b2ee-cab0-41d4-84fe-983e9f1b4aa5",
+      "fullUrl": "Organization/1729291107821439000.b93189fc-b2fc-4a87-96e8-4c920cea5236",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747418883261.cf98b2ee-cab0-41d4-84fe-983e9f1b4aa5",
+        "id": "1729291107821439000.b93189fc-b2fc-4a87-96e8-4c920cea5236",
         "identifier": [
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@@ -24128,10 +24489,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1708034747423382045.c5228e20-7573-452b-89be-8163cd509faf",
+      "fullUrl": "Practitioner/1729291107822406000.3594293e-dbfa-4a23-8ce3-d0d011527542",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747423382045.c5228e20-7573-452b-89be-8163cd509faf",
+        "id": "1729291107822406000.3594293e-dbfa-4a23-8ce3-d0d011527542",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -24183,7 +24544,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747418883261.cf98b2ee-cab0-41d4-84fe-983e9f1b4aa5"
+              "reference": "Organization/1729291107821439000.b93189fc-b2fc-4a87-96e8-4c920cea5236"
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@@ -24199,10 +24560,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747441239905.f4fa7bb5-5a0d-4e48-82ec-e1474cda21e1",
+      "fullUrl": "Organization/1729291107823743000.42c046d4-4b80-49cf-b852-4129014b90b7",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747441239905.f4fa7bb5-5a0d-4e48-82ec-e1474cda21e1",
+        "id": "1729291107823743000.42c046d4-4b80-49cf-b852-4129014b90b7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -24266,12 +24627,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -24296,23 +24651,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1708034747418203132.cf452cde-3265-4291-9fdf-25da0ee87858",
+      "fullUrl": "PractitionerRole/1729291107821239000.4dc618de-e8b2-4cc0-b994-b7bda67c940c",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747418203132.cf452cde-3265-4291-9fdf-25da0ee87858",
+        "id": "1729291107821239000.4dc618de-e8b2-4cc0-b994-b7bda67c940c",
         "practitioner": {
-          "reference": "Practitioner/1708034747423382045.c5228e20-7573-452b-89be-8163cd509faf"
+          "reference": "Practitioner/1729291107822406000.3594293e-dbfa-4a23-8ce3-d0d011527542"
         },
         "organization": {
-          "reference": "Organization/1708034747441239905.f4fa7bb5-5a0d-4e48-82ec-e1474cda21e1"
+          "reference": "Organization/1729291107823743000.42c046d4-4b80-49cf-b852-4129014b90b7"
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       }
     },
     {
-      "fullUrl": "Organization/1708034747461640695.bc0ba164-83c7-4015-b939-d27f1b62fac6",
+      "fullUrl": "Organization/1729291107825998000.7b87572a-2922-4634-8fda-4e2043b87904",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747461640695.bc0ba164-83c7-4015-b939-d27f1b62fac6",
+        "id": "1729291107825998000.7b87572a-2922-4634-8fda-4e2043b87904",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -24376,12 +24731,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -24394,10 +24743,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034747467340792.2aca5d23-07b5-408f-9497-a954f9236dcc",
+      "fullUrl": "Organization/1729291107826836000.d0181b13-1e5d-4188-868b-f9c8a25dd3e3",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747467340792.2aca5d23-07b5-408f-9497-a954f9236dcc",
+        "id": "1729291107826836000.d0181b13-1e5d-4188-868b-f9c8a25dd3e3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -24461,12 +24810,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
-                  ],
                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
                 }
@@ -24479,10 +24822,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034747470324144.e17addc9-2f7b-400d-b92a-be45702966db",
+      "fullUrl": "Organization/1729291107827405000.ef674781-24b6-4880-991f-7b25ba4ea8fe",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747470324144.e17addc9-2f7b-400d-b92a-be45702966db",
+        "id": "1729291107827405000.ef674781-24b6-4880-991f-7b25ba4ea8fe",
         "identifier": [
           {
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@@ -24497,10 +24840,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1708034747473545284.63666022-dad0-42da-9103-ac256afe7c47",
+      "fullUrl": "Practitioner/1729291107828173000.e6184895-9da9-43b5-aa4e-86217d5d7693",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747473545284.63666022-dad0-42da-9103-ac256afe7c47",
+        "id": "1729291107828173000.e6184895-9da9-43b5-aa4e-86217d5d7693",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -24548,7 +24891,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729291107827405000.ef674781-24b6-4880-991f-7b25ba4ea8fe"
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@@ -24564,10 +24907,10 @@
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@@ -24582,10 +24925,10 @@
       }
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         "extension": [
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@@ -24633,7 +24976,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729291107829602000.69994105-e721-4ee5-bbaa-640e489d8c96"
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@@ -24649,10 +24992,10 @@
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       "resource": {
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -24664,13 +25007,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747529710889.7c971059-09a1-4335-889a-f691bdffbf78"
+                  "reference": "Organization/1729291107835610000.2a09665a-190b-4d2b-88b2-6c506a255e59"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729291107836460000.9c399183-a4cb-46a8-a93a-0b01490393c5"
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@@ -24698,7 +25041,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747543970035.6da63822-0fac-448f-8e37-d9ba83573790"
+                  "reference": "Practitioner/1729291107837841000.2eb3b53c-9c43-4824-87ab-11974ed42d32"
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@@ -24760,6 +25103,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
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@@ -24838,7 +25185,7 @@
               {
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+                  "reference": "Practitioner/1729291107840033000.da3fd886-b4f9-4a9c-af48-02d9df3a77bc"
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@@ -24936,18 +25283,18 @@
           ]
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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-          "reference": "PractitionerRole/1708034747499036040.b7b18296-6e82-4af5-bfa3-c32a933caecd"
+          "reference": "PractitionerRole/1729291107831030000.9bf1e05f-fc6f-48c5-9bd9-746dce3a026f"
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       "resource": {
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@@ -24962,10 +25309,10 @@
       }
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         "extension": [
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@@ -25017,7 +25364,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729291107831231000.b099f0be-3ca2-4442-adf0-ca5abab2778a"
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@@ -25033,10 +25380,10 @@
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       "resource": {
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         "extension": [
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@@ -25100,12 +25447,6 @@
             "type": {
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                 {
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@@ -25130,23 +25471,23 @@
       }
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         "practitioner": {
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+          "reference": "Practitioner/1729291107832116000.18690575-c420-439f-a9d9-758c41592e8e"
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         "organization": {
-          "reference": "Organization/1708034747517350150.f1319208-3de6-4b65-9ed4-cb841a9e7b7d"
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@@ -25210,12 +25551,6 @@
             "type": {
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@@ -25228,10 +25563,10 @@
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@@ -25295,12 +25630,6 @@
             "type": {
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@@ -25313,10 +25642,10 @@
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@@ -25331,10 +25660,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107837841000.2eb3b53c-9c43-4824-87ab-11974ed42d32",
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         "extension": [
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@@ -25382,7 +25711,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747534659849.411b1d3c-8f2d-4e8d-9e54-d2c600a4adfd"
+              "reference": "Organization/1729291107837069000.d35e017e-e479-4809-8d36-dc8a41fd4f5a"
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@@ -25398,10 +25727,10 @@
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+      "fullUrl": "Organization/1729291107839292000.ca991926-3080-46cc-98fe-ba718384f87d",
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@@ -25416,10 +25745,10 @@
       }
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         "extension": [
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@@ -25467,7 +25796,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747568041055.2c9eb278-59d4-486e-a028-4afd6e329570"
+              "reference": "Organization/1729291107839292000.ca991926-3080-46cc-98fe-ba718384f87d"
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@@ -25483,10 +25812,10 @@
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+      "fullUrl": "ServiceRequest/1729291107850012000.e799876b-9dd4-470f-9adc-720c0f51702b",
       "resource": {
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+        "id": "1729291107850012000.e799876b-9dd4-470f-9adc-720c0f51702b",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -25498,13 +25827,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747601841071.f9a9a1c8-d81b-4f56-a284-94dbdf49a897"
+                  "reference": "Organization/1729291107845224000.0e5e96e1-67bb-4edc-a566-e51d3d0674f0"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729291107846084000.53bd56de-30d2-4020-bc50-9db6297cf5f6"
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@@ -25532,7 +25861,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747632966519.f841bd33-17c7-4b80-af31-38d73425abf7"
+                  "reference": "Practitioner/1729291107847386000.55838add-f72f-4926-a02e-2d88a78262d4"
                 }
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@@ -25594,6 +25923,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
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                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -25672,7 +26005,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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+                  "reference": "Practitioner/1729291107849542000.61802282-823f-4c2b-a0dc-7dc84a52989e"
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@@ -25770,18 +26103,18 @@
           ]
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034747579744240.db74c78c-f558-4ac5-a188-2b911835d17c"
+          "reference": "PractitionerRole/1729291107840674000.fe6bf946-d060-498e-8caa-853c7d2bc4b9"
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+      "fullUrl": "Organization/1729291107840874000.06da0ce2-4920-4e17-98c3-4dbdc2da5a3b",
       "resource": {
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@@ -25796,10 +26129,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107841749000.2644b1ed-e3aa-4bb3-a822-9d85996cdc56",
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         "extension": [
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@@ -25851,7 +26184,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747581128946.46797977-61d3-48bb-b3de-922d05692c13"
+              "reference": "Organization/1729291107840874000.06da0ce2-4920-4e17-98c3-4dbdc2da5a3b"
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@@ -25867,10 +26200,10 @@
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       "resource": {
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         "extension": [
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@@ -25934,12 +26267,6 @@
             "type": {
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                 {
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@@ -25964,23 +26291,23 @@
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+      "fullUrl": "Organization/1729291107845224000.0e5e96e1-67bb-4edc-a566-e51d3d0674f0",
       "resource": {
         "resourceType": "Organization",
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+        "id": "1729291107845224000.0e5e96e1-67bb-4edc-a566-e51d3d0674f0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -26044,12 +26371,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -26062,10 +26383,10 @@
       }
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -26129,12 +26450,6 @@
             "type": {
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                 {
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-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -26147,10 +26462,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747624503015.ec59448e-3ebc-48b1-ae51-9a1828ebdfbf",
+      "fullUrl": "Organization/1729291107846624000.dacdceb3-4497-4ab4-91eb-1c31bc22d49a",
       "resource": {
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+        "id": "1729291107846624000.dacdceb3-4497-4ab4-91eb-1c31bc22d49a",
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@@ -26165,10 +26480,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107847386000.55838add-f72f-4926-a02e-2d88a78262d4",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747632966519.f841bd33-17c7-4b80-af31-38d73425abf7",
+        "id": "1729291107847386000.55838add-f72f-4926-a02e-2d88a78262d4",
         "extension": [
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@@ -26216,7 +26531,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747624503015.ec59448e-3ebc-48b1-ae51-9a1828ebdfbf"
+              "reference": "Organization/1729291107846624000.dacdceb3-4497-4ab4-91eb-1c31bc22d49a"
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@@ -26232,10 +26547,10 @@
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+      "fullUrl": "Organization/1729291107848812000.94f04de8-b5c1-4fd9-ad64-2b1abe861485",
       "resource": {
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-        "id": "1708034747649499951.399818c1-846c-4dda-9a1a-ca71bc5ce4e0",
+        "id": "1729291107848812000.94f04de8-b5c1-4fd9-ad64-2b1abe861485",
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@@ -26250,10 +26565,10 @@
       }
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     {
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+      "fullUrl": "Practitioner/1729291107849542000.61802282-823f-4c2b-a0dc-7dc84a52989e",
       "resource": {
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-        "id": "1708034747656133992.31b222b8-e86c-4947-94e4-872cc7d24ada",
+        "id": "1729291107849542000.61802282-823f-4c2b-a0dc-7dc84a52989e",
         "extension": [
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@@ -26301,7 +26616,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747649499951.399818c1-846c-4dda-9a1a-ca71bc5ce4e0"
+              "reference": "Organization/1729291107848812000.94f04de8-b5c1-4fd9-ad64-2b1abe861485"
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@@ -26317,10 +26632,10 @@
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+      "fullUrl": "ServiceRequest/1729291107859733000.8283d593-2db4-416a-9837-5ac23facad7e",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1708034747810303540.d4b0116b-018c-4a3b-9ec1-a17402f3c48a",
+        "id": "1729291107859733000.8283d593-2db4-416a-9837-5ac23facad7e",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -26332,13 +26647,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747756556434.073833e7-46d6-40b1-abfc-e5b614a26a9d"
+                  "reference": "Organization/1729291107854884000.48ed4f7c-f2eb-4758-8674-de4d45fe7a2b"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747759996415.ed7e49bc-bace-4e67-8ae4-39f313e97726"
+                  "reference": "Organization/1729291107855731000.002534d1-0c4f-4166-9411-fe6cb685fa40"
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@@ -26366,7 +26681,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747790618796.c1a0e663-1e4a-4f36-91a6-b1170c902733"
+                  "reference": "Practitioner/1729291107857094000.abdd62cc-ad5c-4c70-a3f9-d27040942d02"
                 }
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@@ -26428,6 +26743,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -26506,7 +26825,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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+                  "reference": "Practitioner/1729291107859266000.eab0f3e9-89e2-4d12-b7a5-333f94666f38"
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@@ -26603,18 +26922,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034747667798862.3a3de5b9-a70b-4ccc-835b-cfe33190acc7"
+          "reference": "PractitionerRole/1729291107850176000.8b42780c-2594-4355-a559-bd20f0e83a13"
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     {
-      "fullUrl": "Organization/1708034747669066982.ed716efa-cdbc-44ab-ad08-b76d1e243fc4",
+      "fullUrl": "Organization/1729291107850385000.7092cc2c-710a-4829-ac92-2cab80e3f785",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747669066982.ed716efa-cdbc-44ab-ad08-b76d1e243fc4",
+        "id": "1729291107850385000.7092cc2c-710a-4829-ac92-2cab80e3f785",
         "identifier": [
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@@ -26629,10 +26948,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107851307000.ab7f081f-7f0c-4a3f-9da4-5c6b010766d6",
       "resource": {
         "resourceType": "Practitioner",
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -26684,7 +27003,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747669066982.ed716efa-cdbc-44ab-ad08-b76d1e243fc4"
+              "reference": "Organization/1729291107850385000.7092cc2c-710a-4829-ac92-2cab80e3f785"
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@@ -26700,10 +27019,10 @@
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-      "fullUrl": "Organization/1708034747737302401.a20e77f5-b944-4d7a-84b6-8e818d3885f2",
+      "fullUrl": "Organization/1729291107852657000.37608313-a578-4973-8f20-d6729ae62138",
       "resource": {
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-        "id": "1708034747737302401.a20e77f5-b944-4d7a-84b6-8e818d3885f2",
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -26767,12 +27086,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -26797,23 +27110,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1708034747667798862.3a3de5b9-a70b-4ccc-835b-cfe33190acc7",
+      "fullUrl": "PractitionerRole/1729291107850176000.8b42780c-2594-4355-a559-bd20f0e83a13",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747667798862.3a3de5b9-a70b-4ccc-835b-cfe33190acc7",
+        "id": "1729291107850176000.8b42780c-2594-4355-a559-bd20f0e83a13",
         "practitioner": {
-          "reference": "Practitioner/1708034747715964429.d0683b21-a02d-4eb5-9ab3-994b428d3fc2"
+          "reference": "Practitioner/1729291107851307000.ab7f081f-7f0c-4a3f-9da4-5c6b010766d6"
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         "organization": {
-          "reference": "Organization/1708034747737302401.a20e77f5-b944-4d7a-84b6-8e818d3885f2"
+          "reference": "Organization/1729291107852657000.37608313-a578-4973-8f20-d6729ae62138"
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     {
-      "fullUrl": "Organization/1708034747756556434.073833e7-46d6-40b1-abfc-e5b614a26a9d",
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       "resource": {
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+        "id": "1729291107854884000.48ed4f7c-f2eb-4758-8674-de4d45fe7a2b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -26877,12 +27190,6 @@
             "type": {
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                 {
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-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -26895,10 +27202,10 @@
       }
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     {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -26962,12 +27269,6 @@
             "type": {
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-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -26980,10 +27281,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747778508076.7fc21514-e112-436b-8b76-f31e0f958061",
+      "fullUrl": "Organization/1729291107856277000.0a7bd8a6-447c-41ba-ab64-f752bcc3c595",
       "resource": {
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-        "id": "1708034747778508076.7fc21514-e112-436b-8b76-f31e0f958061",
+        "id": "1729291107856277000.0a7bd8a6-447c-41ba-ab64-f752bcc3c595",
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@@ -26998,10 +27299,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1708034747790618796.c1a0e663-1e4a-4f36-91a6-b1170c902733",
+      "fullUrl": "Practitioner/1729291107857094000.abdd62cc-ad5c-4c70-a3f9-d27040942d02",
       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -27049,7 +27350,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747778508076.7fc21514-e112-436b-8b76-f31e0f958061"
+              "reference": "Organization/1729291107856277000.0a7bd8a6-447c-41ba-ab64-f752bcc3c595"
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@@ -27065,10 +27366,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747797328586.1455adb3-3969-49c7-87da-747716f09ffc",
+      "fullUrl": "Organization/1729291107858527000.912afb5b-c7b3-415b-8207-dcfd30f6bdce",
       "resource": {
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-        "id": "1708034747797328586.1455adb3-3969-49c7-87da-747716f09ffc",
+        "id": "1729291107858527000.912afb5b-c7b3-415b-8207-dcfd30f6bdce",
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@@ -27083,10 +27384,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107859266000.eab0f3e9-89e2-4d12-b7a5-333f94666f38",
       "resource": {
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-        "id": "1708034747807488674.db0170dd-e310-4e06-814b-9ada374311c9",
+        "id": "1729291107859266000.eab0f3e9-89e2-4d12-b7a5-333f94666f38",
         "extension": [
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@@ -27134,7 +27435,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747797328586.1455adb3-3969-49c7-87da-747716f09ffc"
+              "reference": "Organization/1729291107858527000.912afb5b-c7b3-415b-8207-dcfd30f6bdce"
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@@ -27150,10 +27451,10 @@
       }
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     {
-      "fullUrl": "ServiceRequest/1708034747905953355.f304c856-0f57-426e-8806-5659e58fbc4a",
+      "fullUrl": "ServiceRequest/1729291107870117000.fb86fc07-a54b-444f-99f0-43ebb310b7f1",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1708034747905953355.f304c856-0f57-426e-8806-5659e58fbc4a",
+        "id": "1729291107870117000.fb86fc07-a54b-444f-99f0-43ebb310b7f1",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -27165,13 +27466,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747858955800.f8ed906e-2b28-491f-94ec-49281899b741"
+                  "reference": "Organization/1729291107864617000.0292e56c-ec5d-4b7a-9588-89740d97b1aa"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747874791240.899c4c8a-e3a5-40ae-b7e5-c1572cbd0e00"
+                  "reference": "Organization/1729291107865699000.23831811-7ce7-49e6-8de9-a2222ca8d80b"
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               {
@@ -27199,7 +27500,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747879713737.8eb62872-c62c-4c8f-83cc-50c0f04b5bbb"
+                  "reference": "Practitioner/1729291107867107000.d907dcba-3008-4ba0-9664-9f7781c8a351"
                 }
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@@ -27261,6 +27562,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -27339,7 +27644,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747902272646.845a3adc-8d64-4b17-95db-251c2d40c4a3"
+                  "reference": "Practitioner/1729291107869359000.b1ced12d-8834-45e3-aed3-872bd0ff0931"
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@@ -27437,18 +27742,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034747811409158.1c15c178-aad0-4a43-b9bd-89af8bed9098"
+          "reference": "PractitionerRole/1729291107859894000.6b313655-6fe9-4db4-8425-bb99e53f819c"
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-      "fullUrl": "Organization/1708034747813248644.c38ea17d-5dc8-4276-87ee-ec4953aed98e",
+      "fullUrl": "Organization/1729291107860095000.9b41b838-2f00-46f7-83d4-97a64027238e",
       "resource": {
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-        "id": "1708034747813248644.c38ea17d-5dc8-4276-87ee-ec4953aed98e",
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@@ -27463,10 +27768,10 @@
       }
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       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747816690216.247a1f55-7ea7-41fa-ae88-dbdce6ae63ad",
+        "id": "1729291107860988000.ead24632-43c5-47ee-9de1-e74b69904ae3",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -27518,7 +27823,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747813248644.c38ea17d-5dc8-4276-87ee-ec4953aed98e"
+              "reference": "Organization/1729291107860095000.9b41b838-2f00-46f7-83d4-97a64027238e"
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@@ -27534,10 +27839,10 @@
       }
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+      "fullUrl": "Organization/1729291107862337000.b9847dca-0139-4c05-adf3-537486628766",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747846524259.53639254-353f-4c40-a360-20fcc2cab1b7",
+        "id": "1729291107862337000.b9847dca-0139-4c05-adf3-537486628766",
         "extension": [
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@@ -27601,12 +27906,6 @@
             "type": {
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                 {
-                  "extension": [
-                    {
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@@ -27631,23 +27930,23 @@
       }
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+      "fullUrl": "PractitionerRole/1729291107859894000.6b313655-6fe9-4db4-8425-bb99e53f819c",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747811409158.1c15c178-aad0-4a43-b9bd-89af8bed9098",
+        "id": "1729291107859894000.6b313655-6fe9-4db4-8425-bb99e53f819c",
         "practitioner": {
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+          "reference": "Practitioner/1729291107860988000.ead24632-43c5-47ee-9de1-e74b69904ae3"
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         "organization": {
-          "reference": "Organization/1708034747846524259.53639254-353f-4c40-a360-20fcc2cab1b7"
+          "reference": "Organization/1729291107862337000.b9847dca-0139-4c05-adf3-537486628766"
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-        "id": "1708034747858955800.f8ed906e-2b28-491f-94ec-49281899b741",
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         "extension": [
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@@ -27711,12 +28010,6 @@
             "type": {
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                 {
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                   "code": "NPI"
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@@ -27729,10 +28022,10 @@
       }
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@@ -27796,12 +28089,6 @@
             "type": {
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                   "code": "Submitter ID"
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@@ -27814,10 +28101,10 @@
       }
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@@ -27832,10 +28119,10 @@
       }
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@@ -27883,7 +28170,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729291107866290000.7bbe75b7-6426-4f3e-b3d7-e984e6f14257"
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@@ -27899,10 +28186,10 @@
       }
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       "resource": {
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-        "id": "1708034747884664810.5edff459-970a-4229-aabd-217f33757c97",
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@@ -27917,10 +28204,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107869359000.b1ced12d-8834-45e3-aed3-872bd0ff0931",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -27968,7 +28255,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747884664810.5edff459-970a-4229-aabd-217f33757c97"
+              "reference": "Organization/1729291107868603000.0db264d7-8129-4475-86c5-f678dc2c7adc"
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@@ -27984,10 +28271,10 @@
       }
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-      "fullUrl": "ServiceRequest/1708034748011446942.dcc81434-af44-4498-a88a-657773aec8f1",
+      "fullUrl": "ServiceRequest/1729291107880225000.b792767a-10c5-4557-8cca-e4d731bb1d38",
       "resource": {
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-        "id": "1708034748011446942.dcc81434-af44-4498-a88a-657773aec8f1",
+        "id": "1729291107880225000.b792767a-10c5-4557-8cca-e4d731bb1d38",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -27999,13 +28286,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747944041013.4cf4f367-dd41-4bed-ae71-8abf8ae9752e"
+                  "reference": "Organization/1729291107875021000.15df78c9-6e7e-415b-9bd8-7c31af26b642"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747951659213.b7c4abe4-5697-4a7b-8f85-3a871f51dac3"
+                  "reference": "Organization/1729291107875874000.5d6b29a6-d8db-4763-9fd4-9b6ab518caab"
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@@ -28033,7 +28320,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747975861990.09c55d9f-f382-43f7-9eb9-cdbdd655a2b4"
+                  "reference": "Practitioner/1729291107877162000.3ddbff6b-ed21-4a53-bcfe-d52c56526d93"
                 }
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@@ -28095,6 +28382,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -28173,7 +28464,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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+                  "reference": "Practitioner/1729291107879573000.35595d03-7539-4a56-9d6d-01764b731a46"
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@@ -28271,18 +28562,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034747906748947.35684eb0-2384-4862-834e-35f62c8429e8"
+          "reference": "PractitionerRole/1729291107870304000.2db6f675-d3ed-4298-a9bb-c21a0f2df68e"
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-      "fullUrl": "Organization/1708034747907420823.9e93ba31-0db0-4b3d-9e8c-fb7fb37f0cd9",
+      "fullUrl": "Organization/1729291107870517000.f7d1b84f-91be-4b41-820b-d5f46e22bb0b",
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@@ -28297,10 +28588,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107871475000.424badd1-e9f9-42a0-9cec-8029f7148075",
       "resource": {
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+        "id": "1729291107871475000.424badd1-e9f9-42a0-9cec-8029f7148075",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -28352,7 +28643,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747907420823.9e93ba31-0db0-4b3d-9e8c-fb7fb37f0cd9"
+              "reference": "Organization/1729291107870517000.f7d1b84f-91be-4b41-820b-d5f46e22bb0b"
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@@ -28368,10 +28659,10 @@
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+      "fullUrl": "Organization/1729291107872784000.2575b1b8-e742-435d-b5ad-c6dc1382a27b",
       "resource": {
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-        "id": "1708034747927123946.b6824a84-9c60-4091-9204-0dd3a2f08866",
+        "id": "1729291107872784000.2575b1b8-e742-435d-b5ad-c6dc1382a27b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -28435,12 +28726,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -28465,23 +28750,23 @@
       }
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-      "fullUrl": "PractitionerRole/1708034747906748947.35684eb0-2384-4862-834e-35f62c8429e8",
+      "fullUrl": "PractitionerRole/1729291107870304000.2db6f675-d3ed-4298-a9bb-c21a0f2df68e",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747906748947.35684eb0-2384-4862-834e-35f62c8429e8",
+        "id": "1729291107870304000.2db6f675-d3ed-4298-a9bb-c21a0f2df68e",
         "practitioner": {
-          "reference": "Practitioner/1708034747919736719.3f3a7726-98bc-4c90-bfca-1d5c93065269"
+          "reference": "Practitioner/1729291107871475000.424badd1-e9f9-42a0-9cec-8029f7148075"
         },
         "organization": {
-          "reference": "Organization/1708034747927123946.b6824a84-9c60-4091-9204-0dd3a2f08866"
+          "reference": "Organization/1729291107872784000.2575b1b8-e742-435d-b5ad-c6dc1382a27b"
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     {
-      "fullUrl": "Organization/1708034747944041013.4cf4f367-dd41-4bed-ae71-8abf8ae9752e",
+      "fullUrl": "Organization/1729291107875021000.15df78c9-6e7e-415b-9bd8-7c31af26b642",
       "resource": {
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-        "id": "1708034747944041013.4cf4f367-dd41-4bed-ae71-8abf8ae9752e",
+        "id": "1729291107875021000.15df78c9-6e7e-415b-9bd8-7c31af26b642",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -28545,12 +28830,6 @@
             "type": {
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                 {
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -28563,10 +28842,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747951659213.b7c4abe4-5697-4a7b-8f85-3a871f51dac3",
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       "resource": {
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+        "id": "1729291107875874000.5d6b29a6-d8db-4763-9fd4-9b6ab518caab",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -28630,12 +28909,6 @@
             "type": {
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                 {
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-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -28648,10 +28921,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747960003341.98852f83-2265-478e-a918-2e95baffe83e",
+      "fullUrl": "Organization/1729291107876409000.8cfe1322-ce39-4c54-96df-0f7a9dd50e31",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747960003341.98852f83-2265-478e-a918-2e95baffe83e",
+        "id": "1729291107876409000.8cfe1322-ce39-4c54-96df-0f7a9dd50e31",
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@@ -28666,10 +28939,10 @@
       }
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-      "fullUrl": "Practitioner/1708034747975861990.09c55d9f-f382-43f7-9eb9-cdbdd655a2b4",
+      "fullUrl": "Practitioner/1729291107877162000.3ddbff6b-ed21-4a53-bcfe-d52c56526d93",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747975861990.09c55d9f-f382-43f7-9eb9-cdbdd655a2b4",
+        "id": "1729291107877162000.3ddbff6b-ed21-4a53-bcfe-d52c56526d93",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -28717,7 +28990,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747960003341.98852f83-2265-478e-a918-2e95baffe83e"
+              "reference": "Organization/1729291107876409000.8cfe1322-ce39-4c54-96df-0f7a9dd50e31"
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@@ -28733,10 +29006,10 @@
       }
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-      "fullUrl": "Organization/1708034747999119745.ec45b96a-d137-40e3-8b58-993644832f14",
+      "fullUrl": "Organization/1729291107878689000.9a61530c-0dd2-45f4-a7df-7e8801538a30",
       "resource": {
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+        "id": "1729291107878689000.9a61530c-0dd2-45f4-a7df-7e8801538a30",
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@@ -28751,10 +29024,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107879573000.35595d03-7539-4a56-9d6d-01764b731a46",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034748007374443.7cb0b678-0d11-4427-951c-59bb0caeefe0",
+        "id": "1729291107879573000.35595d03-7539-4a56-9d6d-01764b731a46",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -28802,7 +29075,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747999119745.ec45b96a-d137-40e3-8b58-993644832f14"
+              "reference": "Organization/1729291107878689000.9a61530c-0dd2-45f4-a7df-7e8801538a30"
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@@ -28818,10 +29091,10 @@
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     {
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+      "fullUrl": "ServiceRequest/1729291107890794000.1b8d1c45-eb0d-41a0-91ea-676fedd7645b",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1708034748095480648.ec0912a6-0773-40b0-a793-d6a0dc28332f",
+        "id": "1729291107890794000.1b8d1c45-eb0d-41a0-91ea-676fedd7645b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -28833,13 +29106,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034748070563993.43763d31-4943-4f8d-9df3-da539e89d850"
+                  "reference": "Organization/1729291107885687000.e668bf26-2a93-40a6-970d-535b4e8cf2df"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034748078739285.8982a50c-ea19-4017-ae16-8fe12db0f059"
+                  "reference": "Organization/1729291107886764000.5a1c460c-f08d-4801-bd64-d2d2338eb078"
                 }
               },
               {
@@ -28867,7 +29140,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034748087539206.6f4df170-d06c-41a3-a08f-eedbccc39d34"
+                  "reference": "Practitioner/1729291107888108000.1ebadded-e239-4931-8a94-9f033bd6fc02"
                 }
               }
             ]
@@ -28929,6 +29202,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -29007,7 +29284,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034748093607173.3ea8c8d8-caab-4aab-9b60-3f6894969d44"
+                  "reference": "Practitioner/1729291107890313000.ac26b3a9-330a-48ca-9937-fcd250763a41"
                 }
               }
             ]
@@ -29105,18 +29382,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "requester": {
-          "reference": "PractitionerRole/1708034748013173806.2ab99828-773b-4061-a05f-8b972ad6c497"
+          "reference": "PractitionerRole/1729291107880438000.0ed18c71-abd4-4312-87b1-9e5a01b28016"
         }
       }
     },
     {
-      "fullUrl": "Organization/1708034748014846564.c970fb1a-8e4e-40ca-9f1c-48a410b074a8",
+      "fullUrl": "Organization/1729291107880714000.07329767-5015-4e21-ad71-e2bd93ac7c32",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034748014846564.c970fb1a-8e4e-40ca-9f1c-48a410b074a8",
+        "id": "1729291107880714000.07329767-5015-4e21-ad71-e2bd93ac7c32",
         "identifier": [
           {
             "extension": [
@@ -29131,10 +29408,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1708034748019216256.28a98946-3c0d-44c4-9c3a-6f7163809891",
+      "fullUrl": "Practitioner/1729291107881902000.664535c5-69c0-4006-83f0-636caa0a1a7f",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034748019216256.28a98946-3c0d-44c4-9c3a-6f7163809891",
+        "id": "1729291107881902000.664535c5-69c0-4006-83f0-636caa0a1a7f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -29186,7 +29463,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034748014846564.c970fb1a-8e4e-40ca-9f1c-48a410b074a8"
+              "reference": "Organization/1729291107880714000.07329767-5015-4e21-ad71-e2bd93ac7c32"
             }
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@@ -29202,10 +29479,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034748023462116.72fb8989-35ca-4014-b5eb-76ceb0db8f65",
+      "fullUrl": "Organization/1729291107883386000.879db09c-f18d-4fb7-a4af-e114b4e51e55",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034748023462116.72fb8989-35ca-4014-b5eb-76ceb0db8f65",
+        "id": "1729291107883386000.879db09c-f18d-4fb7-a4af-e114b4e51e55",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -29269,12 +29546,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
-                  ],
                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
                 }
@@ -29299,23 +29570,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1708034748013173806.2ab99828-773b-4061-a05f-8b972ad6c497",
+      "fullUrl": "PractitionerRole/1729291107880438000.0ed18c71-abd4-4312-87b1-9e5a01b28016",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034748013173806.2ab99828-773b-4061-a05f-8b972ad6c497",
+        "id": "1729291107880438000.0ed18c71-abd4-4312-87b1-9e5a01b28016",
         "practitioner": {
-          "reference": "Practitioner/1708034748019216256.28a98946-3c0d-44c4-9c3a-6f7163809891"
+          "reference": "Practitioner/1729291107881902000.664535c5-69c0-4006-83f0-636caa0a1a7f"
         },
         "organization": {
-          "reference": "Organization/1708034748023462116.72fb8989-35ca-4014-b5eb-76ceb0db8f65"
+          "reference": "Organization/1729291107883386000.879db09c-f18d-4fb7-a4af-e114b4e51e55"
         }
       }
     },
     {
-      "fullUrl": "Organization/1708034748070563993.43763d31-4943-4f8d-9df3-da539e89d850",
+      "fullUrl": "Organization/1729291107885687000.e668bf26-2a93-40a6-970d-535b4e8cf2df",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034748070563993.43763d31-4943-4f8d-9df3-da539e89d850",
+        "id": "1729291107885687000.e668bf26-2a93-40a6-970d-535b4e8cf2df",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -29379,12 +29650,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
-                  ],
                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
                 }
@@ -29397,10 +29662,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034748078739285.8982a50c-ea19-4017-ae16-8fe12db0f059",
+      "fullUrl": "Organization/1729291107886764000.5a1c460c-f08d-4801-bd64-d2d2338eb078",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034748078739285.8982a50c-ea19-4017-ae16-8fe12db0f059",
+        "id": "1729291107886764000.5a1c460c-f08d-4801-bd64-d2d2338eb078",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -29464,12 +29729,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
-                  ],
                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
                 }
@@ -29482,10 +29741,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034748085126918.da61c8d1-9ec9-4d61-923c-0d036f0847ea",
+      "fullUrl": "Organization/1729291107887329000.e6131390-305a-489f-8bf8-def6273e247d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034748085126918.da61c8d1-9ec9-4d61-923c-0d036f0847ea",
+        "id": "1729291107887329000.e6131390-305a-489f-8bf8-def6273e247d",
         "identifier": [
           {
             "extension": [
@@ -29500,10 +29759,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1708034748087539206.6f4df170-d06c-41a3-a08f-eedbccc39d34",
+      "fullUrl": "Practitioner/1729291107888108000.1ebadded-e239-4931-8a94-9f033bd6fc02",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034748087539206.6f4df170-d06c-41a3-a08f-eedbccc39d34",
+        "id": "1729291107888108000.1ebadded-e239-4931-8a94-9f033bd6fc02",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -29551,7 +29810,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034748085126918.da61c8d1-9ec9-4d61-923c-0d036f0847ea"
+              "reference": "Organization/1729291107887329000.e6131390-305a-489f-8bf8-def6273e247d"
             }
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@@ -29567,10 +29826,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034748091526174.f9aa41d0-abad-482e-b004-022a47fde861",
+      "fullUrl": "Organization/1729291107889563000.6b139ae0-4038-4b25-b08e-1c399eb3439b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034748091526174.f9aa41d0-abad-482e-b004-022a47fde861",
+        "id": "1729291107889563000.6b139ae0-4038-4b25-b08e-1c399eb3439b",
         "identifier": [
           {
             "extension": [
@@ -29585,10 +29844,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1708034748093607173.3ea8c8d8-caab-4aab-9b60-3f6894969d44",
+      "fullUrl": "Practitioner/1729291107890313000.ac26b3a9-330a-48ca-9937-fcd250763a41",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034748093607173.3ea8c8d8-caab-4aab-9b60-3f6894969d44",
+        "id": "1729291107890313000.ac26b3a9-330a-48ca-9937-fcd250763a41",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -29636,7 +29895,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034748091526174.f9aa41d0-abad-482e-b004-022a47fde861"
+              "reference": "Organization/1729291107889563000.6b139ae0-4038-4b25-b08e-1c399eb3439b"
             }
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@@ -29652,10 +29911,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1708034748224323255.2f6908f8-59b3-463e-bfda-22d5af904c66",
+      "fullUrl": "ServiceRequest/1729291107906481000.02c14d41-3c3d-46e4-a4ce-b6f1c39d09c9",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1708034748224323255.2f6908f8-59b3-463e-bfda-22d5af904c66",
+        "id": "1729291107906481000.02c14d41-3c3d-46e4-a4ce-b6f1c39d09c9",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -29667,13 +29926,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034748175116849.02c53967-483e-4330-8bc8-43db163ce066"
+                  "reference": "Organization/1729291107896378000.f2e1fcb8-dea7-4d39-97fe-5b10517b7df8"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034748177996930.98c48da9-707a-470c-9d57-6902d07da5b7"
+                  "reference": "Organization/1729291107897484000.f6309b2a-92cd-4609-9755-d5c1103370bd"
                 }
               },
               {
@@ -29701,7 +29960,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034748194425193.bb3ea9f7-147f-4265-a9cd-931e9a719bb0"
+                  "reference": "Practitioner/1729291107899779000.048692aa-c53f-4b79-b758-4c35811a4067"
                 }
               }
             ]
@@ -29763,6 +30022,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -29841,7 +30104,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034748218112988.cdb14778-7d5c-4af5-99d1-dca2446bc93a"
+                  "reference": "Practitioner/1729291107905027000.e5bbef14-3c35-4076-a9c0-2fa841aa5f35"
                 }
               }
             ]
@@ -29939,18 +30202,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "requester": {
-          "reference": "PractitionerRole/1708034748096156919.bc2e2727-5d81-46d4-9f92-5a1dc3c9de65"
+          "reference": "PractitionerRole/1729291107890963000.9de57c68-9be2-4e3a-af11-5a471141bab3"
         }
       }
     },
     {
-      "fullUrl": "Organization/1708034748096733950.72a871cc-b10c-44e2-a6de-e2bd0a582f61",
+      "fullUrl": "Organization/1729291107891173000.627e164d-3ace-4800-86b9-284e0b59ffc1",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034748096733950.72a871cc-b10c-44e2-a6de-e2bd0a582f61",
+        "id": "1729291107891173000.627e164d-3ace-4800-86b9-284e0b59ffc1",
         "identifier": [
           {
             "extension": [
@@ -29965,10 +30228,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1708034748144995726.622d4234-0284-4d20-932c-66811082a688",
+      "fullUrl": "Practitioner/1729291107892093000.66f33408-f8b5-4669-a0b1-d7941397cdc5",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034748144995726.622d4234-0284-4d20-932c-66811082a688",
+        "id": "1729291107892093000.66f33408-f8b5-4669-a0b1-d7941397cdc5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -30020,7 +30283,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034748096733950.72a871cc-b10c-44e2-a6de-e2bd0a582f61"
+              "reference": "Organization/1729291107891173000.627e164d-3ace-4800-86b9-284e0b59ffc1"
             }
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@@ -30036,10 +30299,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034748154390658.fdc3488f-2520-4eed-81d5-1cf971fe6abc",
+      "fullUrl": "Organization/1729291107893453000.61bf2ef4-dcf7-4b61-b0f7-d02e6d6295fa",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034748154390658.fdc3488f-2520-4eed-81d5-1cf971fe6abc",
+        "id": "1729291107893453000.61bf2ef4-dcf7-4b61-b0f7-d02e6d6295fa",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -30103,12 +30366,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
-                  ],
                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
                 }
@@ -30133,23 +30390,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1708034748096156919.bc2e2727-5d81-46d4-9f92-5a1dc3c9de65",
+      "fullUrl": "PractitionerRole/1729291107890963000.9de57c68-9be2-4e3a-af11-5a471141bab3",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034748096156919.bc2e2727-5d81-46d4-9f92-5a1dc3c9de65",
+        "id": "1729291107890963000.9de57c68-9be2-4e3a-af11-5a471141bab3",
         "practitioner": {
-          "reference": "Practitioner/1708034748144995726.622d4234-0284-4d20-932c-66811082a688"
+          "reference": "Practitioner/1729291107892093000.66f33408-f8b5-4669-a0b1-d7941397cdc5"
         },
         "organization": {
-          "reference": "Organization/1708034748154390658.fdc3488f-2520-4eed-81d5-1cf971fe6abc"
+          "reference": "Organization/1729291107893453000.61bf2ef4-dcf7-4b61-b0f7-d02e6d6295fa"
         }
       }
     },
     {
-      "fullUrl": "Organization/1708034748175116849.02c53967-483e-4330-8bc8-43db163ce066",
+      "fullUrl": "Organization/1729291107896378000.f2e1fcb8-dea7-4d39-97fe-5b10517b7df8",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034748175116849.02c53967-483e-4330-8bc8-43db163ce066",
+        "id": "1729291107896378000.f2e1fcb8-dea7-4d39-97fe-5b10517b7df8",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -30213,12 +30470,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
-                  ],
                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
                 }
@@ -30231,10 +30482,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034748177996930.98c48da9-707a-470c-9d57-6902d07da5b7",
+      "fullUrl": "Organization/1729291107897484000.f6309b2a-92cd-4609-9755-d5c1103370bd",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034748177996930.98c48da9-707a-470c-9d57-6902d07da5b7",
+        "id": "1729291107897484000.f6309b2a-92cd-4609-9755-d5c1103370bd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -30298,12 +30549,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
-                  ],
                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
                 }
@@ -30316,10 +30561,10 @@
       }
     },
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@@ -30334,10 +30579,10 @@
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@@ -30385,7 +30630,7 @@
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@@ -30419,10 +30664,10 @@
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@@ -30470,7 +30715,7 @@
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@@ -30486,10 +30731,10 @@
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@@ -30501,13 +30746,13 @@
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@@ -30535,7 +30780,7 @@
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@@ -30597,6 +30842,10 @@
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@@ -30675,7 +30924,7 @@
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@@ -30773,18 +31022,18 @@
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@@ -30799,10 +31048,10 @@
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@@ -30854,7 +31103,7 @@
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@@ -30870,10 +31119,10 @@
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@@ -30937,12 +31186,6 @@
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@@ -30967,23 +31210,23 @@
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@@ -31047,12 +31290,6 @@
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@@ -31065,10 +31302,10 @@
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@@ -31132,12 +31369,6 @@
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@@ -31150,10 +31381,10 @@
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@@ -31168,10 +31399,10 @@
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@@ -31219,7 +31450,7 @@
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@@ -31235,10 +31466,10 @@
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@@ -31253,10 +31484,10 @@
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@@ -31304,7 +31535,7 @@
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@@ -31392,7 +31623,7 @@
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@@ -31438,258 +31669,258 @@
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+            "reference": "ServiceRequest/1729291107890794000.1b8d1c45-eb0d-41a0-91ea-676fedd7645b"
           }
         ],
         "status": "final",
@@ -33239,7 +33470,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -33261,21 +33492,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1708034746849211833.aa4be1a0-4ae7-4a66-8f22-87a46a67b28c"
+            "reference": "Specimen/1729291107728218000.67c82b8e-73a7-40d6-a0fb-45220ecc0fcf"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1708034746405052002.b0d0ab4b-34bd-468b-b335-eb23a5eaae03"
+            "reference": "Observation/1729291107709363000.62bb89b3-e268-455d-aefa-f3ed9a1dfed0"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1708034748545002993.64c46ca6-1a0b-4aa2-91f6-45a8c409982c",
+      "fullUrl": "DiagnosticReport/1729291107958474000.1c09e264-b1c4-413a-ba4e-505e66f54641",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1708034748545002993.64c46ca6-1a0b-4aa2-91f6-45a8c409982c",
+        "id": "1729291107958474000.1c09e264-b1c4-413a-ba4e-505e66f54641",
         "identifier": [
           {
             "extension": [
@@ -33344,7 +33575,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1708034748224323255.2f6908f8-59b3-463e-bfda-22d5af904c66"
+            "reference": "ServiceRequest/1729291107906481000.02c14d41-3c3d-46e4-a4ce-b6f1c39d09c9"
           }
         ],
         "status": "final",
@@ -33368,7 +33599,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -33390,21 +33621,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1708034746852451549.3e75203c-68da-4ee0-ad0a-a018f0ddc128"
+            "reference": "Specimen/1729291107728560000.3662692a-c052-4811-b3bf-76cc239e1bda"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1708034746412505233.a1de33fa-20ff-4af2-9020-6faf75555e37"
+            "reference": "Observation/1729291107711352000.bc7b5392-4460-43d2-8b01-dd6069a7fbca"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1708034748550803293.d8a67a8d-795c-41e8-9437-dee2494019ef",
+      "fullUrl": "DiagnosticReport/1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1708034748550803293.d8a67a8d-795c-41e8-9437-dee2494019ef",
+        "id": "1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7",
         "identifier": [
           {
             "extension": [
@@ -33473,7 +33704,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1708034748308527393.94affa51-2050-4398-8b15-0fc772d91304"
+            "reference": "ServiceRequest/1729291107928381000.393a5e55-bf48-4df3-9b33-0d5c0f319080"
           }
         ],
         "status": "final",
@@ -33497,7 +33728,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -33519,12 +33750,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1708034746853779371.8d7c6e7b-78ff-4b50-934f-73f474387217"
+            "reference": "Specimen/1729291107728890000.b65e0a21-8472-43c5-8186-c66a4167448e"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1708034746454582530.5bd4177d-a4c0-42f2-bddb-d67f0bbd56cf"
+            "reference": "Observation/1729291107713347000.12695555-420d-4590-be82-8d646ab4b90b"
           }
         ]
       }
diff --git a/examples/MN/004_MN_ORU_R01_NBS_2_fhir_transformation.fhir b/examples/MN/004_MN_ORU_R01_NBS_2_fhir_transformation.fhir
index 6f31ab84c..b3d077483 100644
--- a/examples/MN/004_MN_ORU_R01_NBS_2_fhir_transformation.fhir
+++ b/examples/MN/004_MN_ORU_R01_NBS_2_fhir_transformation.fhir
@@ -1,26 +1,26 @@
 {
   "resourceType": "Bundle",
-  "id": "1708034743283496564.77a7e3fa-9040-4a7a-bb0f-056905c59025",
+  "id": "1729291107444872000.e40ac070-1e5e-4cd6-832f-5b53bf1c4e86",
   "meta": {
-    "lastUpdated": "2024-02-15T22:05:43.285+00:00"
+    "lastUpdated": "2024-10-18T15:38:27.444-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
     "value": "20230607002849_0365"
   },
   "type": "message",
-  "timestamp": "2023-06-07T00:28:49.000+00:00",
+  "timestamp": "2023-06-06T17:28:49.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/28e642fa-b0e7-3bc5-8084-293e36792f05",
+      "fullUrl": "MessageHeader/1729291107447411000.07549021-9f4c-4f23-8669-14729e53486e",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "28e642fa-b0e7-3bc5-8084-293e36792f05",
+        "id": "1729291107447411000.07549021-9f4c-4f23-8669-14729e53486e",
         "meta": {
           "tag": [
             {
               "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-              "code": "P"
+              "code": "D"
             },
             {
               "system": "http://localcodes.org/ETOR",
@@ -156,12 +156,12 @@
             "name": "Epic",
             "endpoint": "urn:oid:1.2.840.114350.1.13.145.2.7.2.695071",
             "receiver": {
-              "reference": "Organization/1708034743312390878.b61e734a-4d65-4e25-b423-cdb19018d84a"
+              "reference": "Organization/1729291107447084000.5391ba51-9dad-4f2e-9936-54c7a452bd60"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1708034743302204787.82104dfb-e854-47de-b7ce-19a2b71e61db"
+          "reference": "Organization/1729291107446309000.dbc0897e-6bc9-4c22-95c6-68a6f42eb67f"
         },
         "source": {
           "extension": [
@@ -187,10 +187,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034743302204787.82104dfb-e854-47de-b7ce-19a2b71e61db",
+      "fullUrl": "Organization/1729291107446309000.dbc0897e-6bc9-4c22-95c6-68a6f42eb67f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034743302204787.82104dfb-e854-47de-b7ce-19a2b71e61db",
+        "id": "1729291107446309000.dbc0897e-6bc9-4c22-95c6-68a6f42eb67f",
         "identifier": [
           {
             "extension": [
@@ -223,10 +223,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034743312390878.b61e734a-4d65-4e25-b423-cdb19018d84a",
+      "fullUrl": "Organization/1729291107447084000.5391ba51-9dad-4f2e-9936-54c7a452bd60",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034743312390878.b61e734a-4d65-4e25-b423-cdb19018d84a",
+        "id": "1729291107447084000.5391ba51-9dad-4f2e-9936-54c7a452bd60",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -264,58 +264,58 @@
       }
     },
     {
-      "fullUrl": "Provenance/1708034743358648255.25d2cf7e-4ca7-4b2e-86cc-c0ba64dc8887",
+      "fullUrl": "Provenance/1729291107450218000.57b33bad-d132-409f-89c5-9ab0ffe7971a",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1708034743358648255.25d2cf7e-4ca7-4b2e-86cc-c0ba64dc8887",
+        "id": "1729291107450218000.57b33bad-d132-409f-89c5-9ab0ffe7971a",
         "target": [
           {
-            "reference": "MessageHeader/28e642fa-b0e7-3bc5-8084-293e36792f05"
+            "reference": "MessageHeader/1729291107447411000.07549021-9f4c-4f23-8669-14729e53486e"
           },
           {
-            "reference": "DiagnosticReport/1708034748361532158.e2a9170c-98f8-4b46-899b-fba947e3418c"
+            "reference": "DiagnosticReport/1729291107937451000.01c9892e-0be4-488a-bd55-5ac4a0c62705"
           },
           {
-            "reference": "DiagnosticReport/1708034748401785805.57989be6-0d6d-48de-a084-f84d07f347ce"
+            "reference": "DiagnosticReport/1729291107939388000.c3fb3626-141e-492c-8d16-d050d22670f0"
           },
           {
-            "reference": "DiagnosticReport/1708034748411388085.422ee97d-e7e3-401a-96f8-50dfb9d1ca24"
+            "reference": "DiagnosticReport/1729291107940957000.28b9bf3c-8776-4d4a-ad5e-f581632c7829"
           },
           {
-            "reference": "DiagnosticReport/1708034748426621110.ae3e9da2-b962-474e-926f-f99efc465287"
+            "reference": "DiagnosticReport/1729291107942557000.48186f3e-a3e9-4e8a-ad18-112510ba96cd"
           },
           {
-            "reference": "DiagnosticReport/1708034748437524688.a122d197-d6cb-4fd6-b47d-d476d6f433c4"
+            "reference": "DiagnosticReport/1729291107944144000.04b557f0-d52c-4473-a0ee-5b59f1d23e55"
           },
           {
-            "reference": "DiagnosticReport/1708034748450425695.91e5f474-f127-42b4-a0b9-d5aad2c802ef"
+            "reference": "DiagnosticReport/1729291107945749000.25c447ac-7856-40d1-838f-2d2e5626363f"
           },
           {
-            "reference": "DiagnosticReport/1708034748469927759.2c623d76-76b8-4351-b809-cea06a663261"
+            "reference": "DiagnosticReport/1729291107947373000.cf62a87d-7104-4a2b-bd6a-656228e26ffd"
           },
           {
-            "reference": "DiagnosticReport/1708034748477154490.3c587c94-fd29-4b4d-9d62-03c62634d09b"
+            "reference": "DiagnosticReport/1729291107949011000.3efd48d0-480d-4bbb-807d-bcd208d02163"
           },
           {
-            "reference": "DiagnosticReport/1708034748490574162.d6d8e505-a32a-4292-8ea1-1e0d197d217c"
+            "reference": "DiagnosticReport/1729291107950608000.0b3b3d1a-b4b7-4d0b-a6f8-3a2edb165162"
           },
           {
-            "reference": "DiagnosticReport/1708034748497010438.954e9ec9-39f7-4f8f-aa95-013cc8455ce3"
+            "reference": "DiagnosticReport/1729291107952193000.c589f522-e2f1-4328-8814-bf1fd3e59806"
           },
           {
-            "reference": "DiagnosticReport/1708034748511491318.c239ad06-3964-4bf6-bc30-de9f3a1df321"
+            "reference": "DiagnosticReport/1729291107953799000.61d41968-e1fc-4a18-87e7-b48398ea1a00"
           },
           {
-            "reference": "DiagnosticReport/1708034748519975487.006f986a-2d80-429f-9516-dfbb4931f9a4"
+            "reference": "DiagnosticReport/1729291107955355000.cf2de07a-f88c-438e-8266-40ab24628977"
           },
           {
-            "reference": "DiagnosticReport/1708034748533872355.afe5314a-346e-4cd3-88e8-58e231c009a0"
+            "reference": "DiagnosticReport/1729291107956904000.798dc2d6-a996-41a0-8cbd-9333700198e5"
           },
           {
-            "reference": "DiagnosticReport/1708034748545002993.64c46ca6-1a0b-4aa2-91f6-45a8c409982c"
+            "reference": "DiagnosticReport/1729291107958474000.1c09e264-b1c4-413a-ba4e-505e66f54641"
           },
           {
-            "reference": "DiagnosticReport/1708034748550803293.d8a67a8d-795c-41e8-9437-dee2494019ef"
+            "reference": "DiagnosticReport/1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7"
           }
         ],
         "recorded": "2023-06-06T19:28:49-05:00",
@@ -337,17 +337,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1708034743357361869.1578903c-b9f5-4a8b-b110-5ffef9818379"
+              "reference": "Organization/1729291107449935000.e4879612-05fc-4e40-9bc0-984157488f0a"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1708034743357361869.1578903c-b9f5-4a8b-b110-5ffef9818379",
+      "fullUrl": "Organization/1729291107449935000.e4879612-05fc-4e40-9bc0-984157488f0a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034743357361869.1578903c-b9f5-4a8b-b110-5ffef9818379",
+        "id": "1729291107449935000.e4879612-05fc-4e40-9bc0-984157488f0a",
         "identifier": [
           {
             "extension": [
@@ -380,11 +380,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1708034743367499712.72b93e7f-e8a0-4d07-a126-b8539394fa51",
+      "fullUrl": "Provenance/1729291107450926000.8d3941f4-8bf9-4feb-815d-837dadda563b",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1708034743367499712.72b93e7f-e8a0-4d07-a126-b8539394fa51",
-        "recorded": "2024-02-15T22:05:43Z",
+        "id": "1729291107450926000.8d3941f4-8bf9-4feb-815d-837dadda563b",
+        "recorded": "2024-10-18T15:38:27Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -406,17 +406,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1708034743366905338.1a701755-ec3d-4c27-ac4e-138af440a08e"
+              "reference": "Organization/1729291107450778000.b0477565-3b08-47de-93c1-03ddd13c0400"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1708034743366905338.1a701755-ec3d-4c27-ac4e-138af440a08e",
+      "fullUrl": "Organization/1729291107450778000.b0477565-3b08-47de-93c1-03ddd13c0400",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034743366905338.1a701755-ec3d-4c27-ac4e-138af440a08e",
+        "id": "1729291107450778000.b0477565-3b08-47de-93c1-03ddd13c0400",
         "identifier": [
           {
             "value": "CDC PRIME - Atlanta"
@@ -436,10 +436,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6",
+      "fullUrl": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70",
       "resource": {
         "resourceType": "Patient",
-        "id": "1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6",
+        "id": "1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -477,7 +477,7 @@
             },
             "value": "11102779",
             "assigner": {
-              "reference": "Organization/1708034743375189502.3a219699-d1c4-4ef0-a7dc-687a0d5cd329"
+              "reference": "Organization/1729291107451677000.3dd864d6-5719-423e-bf17-d145b55f4528"
             }
           }
         ],
@@ -498,7 +498,6 @@
                 ]
               }
             ],
-            "text": "TestValue",
             "family": "SMITH",
             "given": [
               "BB SARAH"
@@ -678,10 +677,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034743375189502.3a219699-d1c4-4ef0-a7dc-687a0d5cd329",
+      "fullUrl": "Organization/1729291107451677000.3dd864d6-5719-423e-bf17-d145b55f4528",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034743375189502.3a219699-d1c4-4ef0-a7dc-687a0d5cd329",
+        "id": "1729291107451677000.3dd864d6-5719-423e-bf17-d145b55f4528",
         "identifier": [
           {
             "extension": [
@@ -696,16 +695,16 @@
       }
     },
     {
-      "fullUrl": "Provenance/1708034743463790551.5d01b62d-a058-465f-bb1b-84766399d2c3",
+      "fullUrl": "Provenance/1729291107458727000.23eb40ff-e623-42d6-ac3d-89390dff03b2",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1708034743463790551.5d01b62d-a058-465f-bb1b-84766399d2c3",
+        "id": "1729291107458727000.23eb40ff-e623-42d6-ac3d-89390dff03b2",
         "target": [
           {
-            "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+            "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
           }
         ],
-        "recorded": "2024-02-15T22:05:43Z",
+        "recorded": "2024-10-18T15:38:27Z",
         "activity": {
           "coding": [
             {
@@ -717,10 +716,10 @@
       }
     },
     {
-      "fullUrl": "RelatedPerson/1708034743480713917.cc3cc3bb-5104-4e97-838e-758c20c5876c",
+      "fullUrl": "RelatedPerson/1729291107460471000.02fe732e-c57c-41b1-9f8e-99dc55404c4a",
       "resource": {
         "resourceType": "RelatedPerson",
-        "id": "1708034743480713917.cc3cc3bb-5104-4e97-838e-758c20c5876c",
+        "id": "1729291107460471000.02fe732e-c57c-41b1-9f8e-99dc55404c4a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -728,7 +727,7 @@
           }
         ],
         "patient": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "relationship": [
           {
@@ -870,10 +869,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1708034743528835654.f7f4bc9c-5a64-481a-afbc-e886951119f6",
+      "fullUrl": "Observation/1729291107463641000.3799e77a-5d2b-4461-9f58-6485a5a85c6c",
       "resource": {
         "resourceType": "Observation",
-        "id": "1708034743528835654.f7f4bc9c-5a64-481a-afbc-e886951119f6",
+        "id": "1729291107463641000.3799e77a-5d2b-4461-9f58-6485a5a85c6c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/analysis-date-time",
@@ -898,6 +897,10 @@
                 "url": "OBX.2",
                 "valueId": "CWE"
               },
+              {
+                "url": "OBX.29",
+                "valueId": "RSLT"
+              },
               {
                 "url": "OBX.11",
                 "valueString": "F"
@@ -926,7 +929,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -939,7 +942,7 @@
         },
         "performer": [
           {
-            "reference": "PractitionerRole/1708034743532434389.fad7bc17-de82-445a-9a62-070b6a6b2bed"
+            "reference": "PractitionerRole/1729291107463864000.36956431-a780-440b-bb5e-7885c71d7e3b"
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@@ -964,10 +967,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1708034743539564011.dd4f69c7-8fcb-404c-a241-95a6ba058222",
+      "fullUrl": "Practitioner/1729291107464431000.47454e5b-8cba-4402-9a95-d044c49ec16b",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034743539564011.dd4f69c7-8fcb-404c-a241-95a6ba058222",
+        "id": "1729291107464431000.47454e5b-8cba-4402-9a95-d044c49ec16b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -990,10 +993,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034743549405688.c8270e76-f839-45cc-88fe-04a538649701",
+      "fullUrl": "Organization/1729291107465102000.54987d47-2d06-4593-89a8-5146aa61d1eb",
       "resource": {
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-        "id": "1708034743549405688.c8270e76-f839-45cc-88fe-04a538649701",
+        "id": "1729291107465102000.54987d47-2d06-4593-89a8-5146aa61d1eb",
         "name": "MDH Newborn Screening Laboratory",
         "address": [
           {
@@ -1024,15 +1027,15 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1708034743532434389.fad7bc17-de82-445a-9a62-070b6a6b2bed",
+      "fullUrl": "PractitionerRole/1729291107463864000.36956431-a780-440b-bb5e-7885c71d7e3b",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034743532434389.fad7bc17-de82-445a-9a62-070b6a6b2bed",
+        "id": "1729291107463864000.36956431-a780-440b-bb5e-7885c71d7e3b",
         "practitioner": {
-          "reference": "Practitioner/1708034743539564011.dd4f69c7-8fcb-404c-a241-95a6ba058222"
+          "reference": "Practitioner/1729291107464431000.47454e5b-8cba-4402-9a95-d044c49ec16b"
         },
         "organization": {
-          "reference": "Organization/1708034743549405688.c8270e76-f839-45cc-88fe-04a538649701"
+          "reference": "Organization/1729291107465102000.54987d47-2d06-4593-89a8-5146aa61d1eb"
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@@ -1047,10 +1050,10 @@
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     {
-      "fullUrl": "Observation/1708034743571951811.5ff83935-4c7f-47c4-9059-6df3ab762ee1",
+      "fullUrl": "Observation/1729291107467173000.94550bb4-9a66-43c3-8e5a-1d006f3c4957",
       "resource": {
         "resourceType": "Observation",
-        "id": "1708034743571951811.5ff83935-4c7f-47c4-9059-6df3ab762ee1",
+        "id": "1729291107467173000.94550bb4-9a66-43c3-8e5a-1d006f3c4957",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/analysis-date-time",
@@ -1075,6 +1078,10 @@
                 "url": "OBX.2",
                 "valueId": "CWE"
               },
+              {
+                "url": "OBX.29",
+                "valueId": "RSLT"
+              },
               {
                 "url": "OBX.11",
                 "valueString": "F"
@@ -1103,7 +1110,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -1116,7 +1123,7 @@
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         "performer": [
           {
-            "reference": "PractitionerRole/1708034743573364708.d5f31f14-b7a2-47e9-a78d-489a566b3615"
+            "reference": "PractitionerRole/1729291107467330000.0ebbfa26-c7ab-4a92-bf2e-b7c952330cde"
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@@ -1141,10 +1148,10 @@
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     {
-      "fullUrl": "Practitioner/1708034743578593770.b4787347-41cb-4064-b667-bf6b51dcf2ff",
+      "fullUrl": "Practitioner/1729291107467784000.756def94-9e98-4c9e-a718-e0087219e912",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034743578593770.b4787347-41cb-4064-b667-bf6b51dcf2ff",
+        "id": "1729291107467784000.756def94-9e98-4c9e-a718-e0087219e912",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -1167,10 +1174,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1708034743589745039.2b210e54-30ff-43a1-a13a-31e8849daa38",
+      "fullUrl": "Organization/1729291107468359000.d71804cc-31da-4231-ab9c-37e85f85d265",
       "resource": {
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-        "id": "1708034743589745039.2b210e54-30ff-43a1-a13a-31e8849daa38",
+        "id": "1729291107468359000.d71804cc-31da-4231-ab9c-37e85f85d265",
         "name": "MDH Newborn Screening Laboratory",
         "address": [
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@@ -1201,15 +1208,15 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1708034743573364708.d5f31f14-b7a2-47e9-a78d-489a566b3615",
+      "fullUrl": "PractitionerRole/1729291107467330000.0ebbfa26-c7ab-4a92-bf2e-b7c952330cde",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034743573364708.d5f31f14-b7a2-47e9-a78d-489a566b3615",
+        "id": "1729291107467330000.0ebbfa26-c7ab-4a92-bf2e-b7c952330cde",
         "practitioner": {
-          "reference": "Practitioner/1708034743578593770.b4787347-41cb-4064-b667-bf6b51dcf2ff"
+          "reference": "Practitioner/1729291107467784000.756def94-9e98-4c9e-a718-e0087219e912"
         },
         "organization": {
-          "reference": "Organization/1708034743589745039.2b210e54-30ff-43a1-a13a-31e8849daa38"
+          "reference": "Organization/1729291107468359000.d71804cc-31da-4231-ab9c-37e85f85d265"
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@@ -1224,10 +1231,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1708034743622100282.803481f0-1a59-4da4-8830-9deee0380be4",
+      "fullUrl": "Observation/1729291107470316000.ffd0155f-6fe2-44f9-bc71-ef961b624214",
       "resource": {
         "resourceType": "Observation",
-        "id": "1708034743622100282.803481f0-1a59-4da4-8830-9deee0380be4",
+        "id": "1729291107470316000.ffd0155f-6fe2-44f9-bc71-ef961b624214",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/analysis-date-time",
@@ -1252,6 +1259,10 @@
                 "url": "OBX.2",
                 "valueId": "FT"
               },
+              {
+                "url": "OBX.29",
+                "valueId": "RSLT"
+              },
               {
                 "url": "OBX.11",
                 "valueString": "F"
@@ -1280,7 +1291,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -1293,17 +1304,17 @@
         },
         "performer": [
           {
-            "reference": "PractitionerRole/1708034743623273379.43c91689-43fc-4826-9f1e-c6200571b620"
+            "reference": "PractitionerRole/1729291107470479000.905c48aa-17ad-49d4-a3a4-d229bbc882e5"
           }
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         "valueString": "Resources: An MDH genetic counselor is available for consultation regarding screening results at 651-201-3548. Disorder fact sheets and specialist contact list can be found here: https://www.health.state.mn.us/people/newbornscreening/materials/factsheets/bloodspotdisorders.html\\.br\\The purpose of newborn screening is to identify at risk infants in need of diagnostic testing. As with any screening test, false positive or false negative results are possible. Newborn screening is insufficient information on which to base, or rule out, diagnosis or treatment. CF variant analysis is completed using the Luminex xTAG Cystic Fibrosis (CFTR) 39 Kit.\\.br\\*This real-time PCR assay was developed and its performance characteristics were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration: 21 CFR 809.30(e).\\.br\\**The performance characteristics of these tests were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration.\\.br\\***Testing is performed by Mayo Clinic Laboratories-Rochester Main Campus; 200 First Street SW, Rochester, MN 55905\\.br\\ "
       }
     },
     {
-      "fullUrl": "Practitioner/1708034743626789444.a16f90ad-441a-44cc-acdc-61a5be9fdab9",
+      "fullUrl": "Practitioner/1729291107470921000.46c20196-758f-4a77-86d3-a49358a943dd",
       "resource": {
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-        "id": "1708034743626789444.a16f90ad-441a-44cc-acdc-61a5be9fdab9",
+        "id": "1729291107470921000.46c20196-758f-4a77-86d3-a49358a943dd",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -1326,10 +1337,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034743634436974.813a1c7d-a11b-4b73-a758-71e7532940d9",
+      "fullUrl": "Organization/1729291107471482000.f95d3526-ec7c-4194-a1c3-ad1c399eecc4",
       "resource": {
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-        "id": "1708034743634436974.813a1c7d-a11b-4b73-a758-71e7532940d9",
+        "id": "1729291107471482000.f95d3526-ec7c-4194-a1c3-ad1c399eecc4",
         "name": "MDH Newborn Screening Laboratory",
         "address": [
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@@ -1360,15 +1371,15 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1708034743623273379.43c91689-43fc-4826-9f1e-c6200571b620",
+      "fullUrl": "PractitionerRole/1729291107470479000.905c48aa-17ad-49d4-a3a4-d229bbc882e5",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034743623273379.43c91689-43fc-4826-9f1e-c6200571b620",
+        "id": "1729291107470479000.905c48aa-17ad-49d4-a3a4-d229bbc882e5",
         "practitioner": {
-          "reference": "Practitioner/1708034743626789444.a16f90ad-441a-44cc-acdc-61a5be9fdab9"
+          "reference": "Practitioner/1729291107470921000.46c20196-758f-4a77-86d3-a49358a943dd"
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         "organization": {
-          "reference": "Organization/1708034743634436974.813a1c7d-a11b-4b73-a758-71e7532940d9"
+          "reference": "Organization/1729291107471482000.f95d3526-ec7c-4194-a1c3-ad1c399eecc4"
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@@ -1383,10 +1394,10 @@
       }
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     {
-      "fullUrl": "Observation/1708034743650987384.472f5257-c6e3-46f7-aabe-db45824fe188",
+      "fullUrl": "Observation/1729291107473213000.136d7ac1-acfe-4e49-938c-480ef2233a62",
       "resource": {
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-        "id": "1708034743650987384.472f5257-c6e3-46f7-aabe-db45824fe188",
+        "id": "1729291107473213000.136d7ac1-acfe-4e49-938c-480ef2233a62",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/analysis-date-time",
@@ -1411,6 +1422,10 @@
                 "url": "OBX.2",
                 "valueId": "FT"
               },
+              {
+                "url": "OBX.29",
+                "valueId": "RSLT"
+              },
               {
                 "url": "OBX.11",
                 "valueString": "F"
@@ -1439,7 +1454,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -1452,17 +1467,17 @@
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         "performer": [
           {
-            "reference": "PractitionerRole/1708034743654020211.5a55b136-d18e-4252-905c-e51535b24b66"
+            "reference": "PractitionerRole/1729291107473384000.8ea06619-8030-4240-9735-251639df3ed9"
           }
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         "valueString": "There is decreased sensitivity in screening for CMV in dried blood spots, so not all infants with congenital CMV will be identified. Of those who are identified by newborn screening, up to 80% will be unaffected."
       }
     },
     {
-      "fullUrl": "Practitioner/1708034743660575122.5338ea55-a8a8-4de2-803c-16b8ae6616a3",
+      "fullUrl": "Practitioner/1729291107473899000.da2f4a77-75e4-4978-80fd-81981d8a2a94",
       "resource": {
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-        "id": "1708034743660575122.5338ea55-a8a8-4de2-803c-16b8ae6616a3",
+        "id": "1729291107473899000.da2f4a77-75e4-4978-80fd-81981d8a2a94",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -1485,10 +1500,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034743669384931.af1d5e53-0c1b-456a-9c40-b1cd86563672",
+      "fullUrl": "Organization/1729291107474501000.99ca73ce-1ecb-469e-a2c3-9d8268d35668",
       "resource": {
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+        "id": "1729291107474501000.99ca73ce-1ecb-469e-a2c3-9d8268d35668",
         "name": "MDH Newborn Screening Laboratory",
         "address": [
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@@ -1519,15 +1534,15 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1708034743654020211.5a55b136-d18e-4252-905c-e51535b24b66",
+      "fullUrl": "PractitionerRole/1729291107473384000.8ea06619-8030-4240-9735-251639df3ed9",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034743654020211.5a55b136-d18e-4252-905c-e51535b24b66",
+        "id": "1729291107473384000.8ea06619-8030-4240-9735-251639df3ed9",
         "practitioner": {
-          "reference": "Practitioner/1708034743660575122.5338ea55-a8a8-4de2-803c-16b8ae6616a3"
+          "reference": "Practitioner/1729291107473899000.da2f4a77-75e4-4978-80fd-81981d8a2a94"
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         "organization": {
-          "reference": "Organization/1708034743669384931.af1d5e53-0c1b-456a-9c40-b1cd86563672"
+          "reference": "Organization/1729291107474501000.99ca73ce-1ecb-469e-a2c3-9d8268d35668"
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@@ -1542,10 +1557,10 @@
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     {
-      "fullUrl": "Observation/1708034743690357848.7a2cfc4f-0351-4dea-bcce-43c8e345f489",
+      "fullUrl": "Observation/1729291107476410000.98f61a7c-8833-4d54-891f-153c2fc30b5f",
       "resource": {
         "resourceType": "Observation",
-        "id": "1708034743690357848.7a2cfc4f-0351-4dea-bcce-43c8e345f489",
+        "id": "1729291107476410000.98f61a7c-8833-4d54-891f-153c2fc30b5f",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/analysis-date-time",
@@ -1570,6 +1585,10 @@
                 "url": "OBX.2",
                 "valueId": "CWE"
               },
+              {
+                "url": "OBX.29",
+                "valueId": "SCI"
+              },
               {
                 "url": "OBX.11",
                 "valueString": "F"
@@ -1598,7 +1617,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "_effectiveDateTime": {
@@ -1611,7 +1630,7 @@
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         "performer": [
           {
-            "reference": "PractitionerRole/1708034743691054901.03ca4802-d742-4ef5-b60a-ab5ca55dee33"
+            "reference": "PractitionerRole/1729291107476574000.e7b54d75-8da6-4888-bc2a-216ae537769b"
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@@ -1636,10 +1655,10 @@
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-      "fullUrl": "Practitioner/1708034743693460151.1691cbf7-0eb8-4a84-bc06-3640e8783329",
+      "fullUrl": "Practitioner/1729291107476997000.f0abf912-7182-4f8b-a33f-baa6ed1140b5",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034743693460151.1691cbf7-0eb8-4a84-bc06-3640e8783329",
+        "id": "1729291107476997000.f0abf912-7182-4f8b-a33f-baa6ed1140b5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -1662,10 +1681,10 @@
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     {
-      "fullUrl": "Organization/1708034743700923422.33ef5e8b-30ab-4f8f-b74e-610d98f54c69",
+      "fullUrl": "Organization/1729291107477583000.9cecd0b3-7c28-440d-b3a5-3c7591a785ef",
       "resource": {
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+        "id": "1729291107477583000.9cecd0b3-7c28-440d-b3a5-3c7591a785ef",
         "name": "MDH Newborn Screening Laboratory",
         "address": [
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@@ -1696,15 +1715,15 @@
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     },
     {
-      "fullUrl": "PractitionerRole/1708034743691054901.03ca4802-d742-4ef5-b60a-ab5ca55dee33",
+      "fullUrl": "PractitionerRole/1729291107476574000.e7b54d75-8da6-4888-bc2a-216ae537769b",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034743691054901.03ca4802-d742-4ef5-b60a-ab5ca55dee33",
+        "id": "1729291107476574000.e7b54d75-8da6-4888-bc2a-216ae537769b",
         "practitioner": {
-          "reference": "Practitioner/1708034743693460151.1691cbf7-0eb8-4a84-bc06-3640e8783329"
+          "reference": "Practitioner/1729291107476997000.f0abf912-7182-4f8b-a33f-baa6ed1140b5"
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         "organization": {
-          "reference": "Organization/1708034743700923422.33ef5e8b-30ab-4f8f-b74e-610d98f54c69"
+          "reference": "Organization/1729291107477583000.9cecd0b3-7c28-440d-b3a5-3c7591a785ef"
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@@ -1719,10 +1738,10 @@
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@@ -1747,6 +1766,10 @@
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@@ -1775,7 +1798,7 @@
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@@ -1788,7 +1811,7 @@
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@@ -1813,10 +1836,10 @@
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@@ -1839,10 +1862,10 @@
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@@ -1873,15 +1896,15 @@
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@@ -1896,10 +1919,10 @@
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@@ -1924,6 +1947,10 @@
                 "url": "OBX.2",
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@@ -1952,7 +1979,7 @@
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@@ -1965,7 +1992,7 @@
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@@ -1990,10 +2017,10 @@
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@@ -2016,10 +2043,10 @@
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@@ -2050,15 +2077,15 @@
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@@ -2073,10 +2100,10 @@
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@@ -2101,6 +2128,10 @@
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@@ -2129,7 +2160,7 @@
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@@ -2142,7 +2173,7 @@
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@@ -2167,10 +2198,10 @@
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@@ -2193,10 +2224,10 @@
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@@ -2227,15 +2258,15 @@
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@@ -2250,10 +2281,10 @@
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@@ -2278,6 +2309,10 @@
                 "url": "OBX.2",
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@@ -2306,7 +2341,7 @@
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@@ -2319,7 +2354,7 @@
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@@ -2344,10 +2379,10 @@
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@@ -2370,10 +2405,10 @@
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@@ -2404,15 +2439,15 @@
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@@ -2427,10 +2462,10 @@
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@@ -2455,6 +2490,10 @@
                 "url": "OBX.2",
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@@ -2483,7 +2522,7 @@
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@@ -2496,7 +2535,7 @@
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@@ -2521,10 +2560,10 @@
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@@ -2547,10 +2586,10 @@
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@@ -2581,15 +2620,15 @@
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@@ -2604,10 +2643,10 @@
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@@ -2632,6 +2671,10 @@
                 "url": "OBX.2",
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@@ -2660,7 +2703,7 @@
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@@ -2673,7 +2716,7 @@
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@@ -2698,10 +2741,10 @@
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@@ -2724,10 +2767,10 @@
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@@ -2758,15 +2801,15 @@
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@@ -2781,10 +2824,10 @@
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@@ -2809,6 +2852,10 @@
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@@ -2837,7 +2884,7 @@
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@@ -2850,7 +2897,7 @@
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@@ -2875,10 +2922,10 @@
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@@ -2901,10 +2948,10 @@
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@@ -2935,15 +2982,15 @@
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@@ -2958,10 +3005,10 @@
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@@ -2986,6 +3033,10 @@
                 "url": "OBX.2",
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@@ -3014,7 +3065,7 @@
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@@ -3027,7 +3078,7 @@
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@@ -3052,10 +3103,10 @@
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@@ -3078,10 +3129,10 @@
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@@ -3112,15 +3163,15 @@
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@@ -3135,10 +3186,10 @@
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@@ -3163,6 +3214,10 @@
                 "url": "OBX.2",
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@@ -3191,7 +3246,7 @@
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@@ -3204,7 +3259,7 @@
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@@ -3229,10 +3284,10 @@
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@@ -3255,10 +3310,10 @@
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@@ -3289,15 +3344,15 @@
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@@ -3312,10 +3367,10 @@
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@@ -3340,6 +3395,10 @@
                 "url": "OBX.2",
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@@ -3368,7 +3427,7 @@
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@@ -3381,7 +3440,7 @@
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@@ -3406,10 +3465,10 @@
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@@ -3432,10 +3491,10 @@
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@@ -3466,15 +3525,15 @@
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@@ -3489,10 +3548,10 @@
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@@ -3517,6 +3576,10 @@
                 "url": "OBX.2",
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@@ -3545,7 +3608,7 @@
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@@ -3558,7 +3621,7 @@
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@@ -3583,10 +3646,10 @@
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@@ -3609,10 +3672,10 @@
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@@ -3643,15 +3706,15 @@
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@@ -3666,10 +3729,10 @@
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@@ -3694,6 +3757,10 @@
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@@ -3722,7 +3789,7 @@
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@@ -3735,7 +3802,7 @@
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@@ -3760,10 +3827,10 @@
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@@ -3786,10 +3853,10 @@
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@@ -3820,15 +3887,15 @@
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@@ -3843,10 +3910,10 @@
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@@ -3871,6 +3938,10 @@
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@@ -3899,7 +3970,7 @@
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@@ -3912,7 +3983,7 @@
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@@ -3937,10 +4008,10 @@
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@@ -3963,10 +4034,10 @@
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@@ -3997,15 +4068,15 @@
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@@ -4020,10 +4091,10 @@
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@@ -4048,6 +4119,10 @@
                 "url": "OBX.2",
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@@ -4076,7 +4151,7 @@
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@@ -4089,7 +4164,7 @@
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@@ -4114,10 +4189,10 @@
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@@ -4140,10 +4215,10 @@
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@@ -4174,15 +4249,15 @@
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@@ -4197,10 +4272,10 @@
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@@ -4225,6 +4300,10 @@
                 "url": "OBX.2",
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@@ -4253,7 +4332,7 @@
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@@ -4266,7 +4345,7 @@
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@@ -4291,10 +4370,10 @@
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@@ -4317,10 +4396,10 @@
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@@ -4351,15 +4430,15 @@
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@@ -4374,10 +4453,10 @@
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@@ -4402,6 +4481,10 @@
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@@ -4443,7 +4526,7 @@
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@@ -4494,10 +4577,10 @@
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@@ -4579,6 +4662,10 @@
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@@ -4607,7 +4694,7 @@
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@@ -4620,7 +4707,7 @@
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@@ -4671,10 +4758,10 @@
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@@ -4756,6 +4843,10 @@
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@@ -4784,7 +4875,7 @@
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@@ -4797,7 +4888,7 @@
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@@ -4848,10 +4939,10 @@
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@@ -4933,6 +5024,10 @@
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@@ -4961,7 +5056,7 @@
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@@ -4974,7 +5069,7 @@
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@@ -5025,10 +5120,10 @@
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@@ -5059,15 +5154,15 @@
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@@ -5110,6 +5205,10 @@
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@@ -5138,7 +5237,7 @@
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@@ -5151,7 +5250,7 @@
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@@ -5176,10 +5275,10 @@
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@@ -5202,10 +5301,10 @@
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@@ -5236,15 +5335,15 @@
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@@ -5259,10 +5358,10 @@
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@@ -5287,6 +5386,10 @@
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@@ -5315,7 +5418,7 @@
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@@ -5328,7 +5431,7 @@
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@@ -5353,10 +5456,10 @@
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@@ -5379,10 +5482,10 @@
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@@ -5413,15 +5516,15 @@
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@@ -5436,10 +5539,10 @@
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@@ -5464,6 +5567,10 @@
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@@ -5492,7 +5599,7 @@
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@@ -5505,7 +5612,7 @@
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@@ -5530,10 +5637,10 @@
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@@ -5556,10 +5663,10 @@
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@@ -5590,15 +5697,15 @@
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@@ -5613,10 +5720,10 @@
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@@ -5641,6 +5748,10 @@
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@@ -5669,7 +5780,7 @@
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@@ -5682,7 +5793,7 @@
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@@ -5707,10 +5818,10 @@
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@@ -5733,10 +5844,10 @@
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@@ -5767,15 +5878,15 @@
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@@ -5790,10 +5901,10 @@
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@@ -5818,6 +5929,10 @@
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@@ -5846,7 +5961,7 @@
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@@ -5859,7 +5974,7 @@
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@@ -5884,10 +5999,10 @@
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@@ -5910,10 +6025,10 @@
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@@ -5944,15 +6059,15 @@
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@@ -5967,10 +6082,10 @@
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@@ -5995,6 +6110,10 @@
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@@ -6023,7 +6142,7 @@
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@@ -6036,7 +6155,7 @@
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@@ -6061,10 +6180,10 @@
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@@ -6087,10 +6206,10 @@
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@@ -6121,15 +6240,15 @@
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@@ -6144,10 +6263,10 @@
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@@ -6172,6 +6291,10 @@
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@@ -6200,7 +6323,7 @@
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@@ -6213,7 +6336,7 @@
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@@ -6238,10 +6361,10 @@
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@@ -6264,10 +6387,10 @@
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@@ -6298,15 +6421,15 @@
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@@ -6321,10 +6444,10 @@
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@@ -6349,6 +6472,10 @@
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@@ -6377,7 +6504,7 @@
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@@ -6390,7 +6517,7 @@
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@@ -6415,10 +6542,10 @@
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@@ -6441,10 +6568,10 @@
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@@ -6475,15 +6602,15 @@
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@@ -6498,10 +6625,10 @@
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@@ -6526,6 +6653,10 @@
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@@ -6554,7 +6685,7 @@
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@@ -6567,7 +6698,7 @@
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@@ -6592,10 +6723,10 @@
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@@ -6618,10 +6749,10 @@
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@@ -6652,15 +6783,15 @@
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@@ -6675,10 +6806,10 @@
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@@ -6703,6 +6834,10 @@
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@@ -6731,7 +6866,7 @@
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@@ -6744,7 +6879,7 @@
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@@ -6769,10 +6904,10 @@
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@@ -6795,10 +6930,10 @@
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@@ -6829,15 +6964,15 @@
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@@ -6852,10 +6987,10 @@
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@@ -6880,6 +7015,10 @@
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@@ -6908,7 +7047,7 @@
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@@ -6921,7 +7060,7 @@
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@@ -6946,10 +7085,10 @@
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@@ -6972,10 +7111,10 @@
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@@ -7006,15 +7145,15 @@
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@@ -7029,10 +7168,10 @@
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@@ -7057,6 +7196,10 @@
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@@ -7085,7 +7228,7 @@
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@@ -7098,7 +7241,7 @@
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@@ -7123,10 +7266,10 @@
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@@ -7149,10 +7292,10 @@
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@@ -7183,15 +7326,15 @@
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@@ -7206,10 +7349,10 @@
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@@ -7234,6 +7377,10 @@
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@@ -7262,7 +7409,7 @@
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@@ -7275,7 +7422,7 @@
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@@ -7300,10 +7447,10 @@
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@@ -7326,10 +7473,10 @@
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@@ -7360,15 +7507,15 @@
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@@ -7383,10 +7530,10 @@
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@@ -7411,6 +7558,10 @@
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@@ -7439,7 +7590,7 @@
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@@ -7452,7 +7603,7 @@
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@@ -7477,10 +7628,10 @@
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@@ -7503,10 +7654,10 @@
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@@ -7537,15 +7688,15 @@
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@@ -7560,10 +7711,10 @@
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@@ -7588,6 +7739,10 @@
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@@ -7616,7 +7771,7 @@
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@@ -7629,7 +7784,7 @@
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@@ -7654,10 +7809,10 @@
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@@ -7680,10 +7835,10 @@
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@@ -7714,15 +7869,15 @@
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@@ -7737,10 +7892,10 @@
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@@ -7765,6 +7920,10 @@
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@@ -7793,7 +7952,7 @@
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@@ -7806,7 +7965,7 @@
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@@ -7831,10 +7990,10 @@
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@@ -7857,10 +8016,10 @@
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@@ -7891,15 +8050,15 @@
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@@ -7914,10 +8073,10 @@
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@@ -7942,6 +8101,10 @@
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@@ -7983,7 +8146,7 @@
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@@ -8008,10 +8171,10 @@
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@@ -8034,10 +8197,10 @@
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@@ -8068,15 +8231,15 @@
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@@ -8119,6 +8282,10 @@
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@@ -8147,7 +8314,7 @@
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@@ -8160,7 +8327,7 @@
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@@ -8185,10 +8352,10 @@
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@@ -8211,10 +8378,10 @@
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@@ -8245,15 +8412,15 @@
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@@ -8268,10 +8435,10 @@
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@@ -8296,6 +8463,10 @@
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@@ -8324,7 +8495,7 @@
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@@ -8337,7 +8508,7 @@
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@@ -8362,10 +8533,10 @@
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@@ -8388,10 +8559,10 @@
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@@ -8422,15 +8593,15 @@
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@@ -8445,10 +8616,10 @@
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@@ -8473,6 +8644,10 @@
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@@ -8501,7 +8676,7 @@
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@@ -8514,7 +8689,7 @@
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@@ -8539,10 +8714,10 @@
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@@ -8565,10 +8740,10 @@
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@@ -8599,15 +8774,15 @@
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@@ -8622,10 +8797,10 @@
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@@ -8650,6 +8825,10 @@
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@@ -8678,7 +8857,7 @@
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@@ -8691,7 +8870,7 @@
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@@ -8716,10 +8895,10 @@
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@@ -8742,10 +8921,10 @@
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@@ -8776,15 +8955,15 @@
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@@ -8799,10 +8978,10 @@
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@@ -8827,6 +9006,10 @@
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@@ -9004,6 +9187,10 @@
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@@ -9181,6 +9368,10 @@
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@@ -9209,7 +9400,7 @@
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@@ -9222,7 +9413,7 @@
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@@ -9247,10 +9438,10 @@
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@@ -9273,10 +9464,10 @@
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@@ -9358,6 +9549,10 @@
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@@ -9386,7 +9581,7 @@
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@@ -9399,7 +9594,7 @@
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@@ -9424,10 +9619,10 @@
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@@ -9450,10 +9645,10 @@
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@@ -9484,15 +9679,15 @@
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@@ -9507,10 +9702,10 @@
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@@ -9535,6 +9730,10 @@
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@@ -9563,7 +9762,7 @@
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@@ -9576,7 +9775,7 @@
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@@ -9627,10 +9826,10 @@
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@@ -9661,15 +9860,15 @@
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@@ -9889,6 +10092,10 @@
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@@ -10066,6 +10273,10 @@
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@@ -10243,6 +10454,10 @@
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@@ -10335,10 +10550,10 @@
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@@ -10420,6 +10635,10 @@
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@@ -10597,6 +10816,10 @@
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@@ -10625,7 +10848,7 @@
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@@ -10638,7 +10861,7 @@
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@@ -10663,10 +10886,10 @@
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@@ -10689,10 +10912,10 @@
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@@ -10723,15 +10946,15 @@
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@@ -10774,6 +10997,10 @@
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@@ -10866,10 +11093,10 @@
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@@ -10951,6 +11178,10 @@
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@@ -10979,7 +11210,7 @@
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@@ -10992,7 +11223,7 @@
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@@ -11043,10 +11274,10 @@
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@@ -11128,6 +11359,10 @@
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@@ -11156,7 +11391,7 @@
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@@ -11169,7 +11404,7 @@
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@@ -11194,10 +11429,10 @@
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@@ -11220,10 +11455,10 @@
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@@ -11254,15 +11489,15 @@
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@@ -11305,6 +11540,10 @@
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@@ -11333,7 +11572,7 @@
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@@ -11346,7 +11585,7 @@
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@@ -11397,10 +11636,10 @@
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@@ -11431,15 +11670,15 @@
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@@ -11482,6 +11721,10 @@
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@@ -11510,7 +11753,7 @@
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@@ -11523,7 +11766,7 @@
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@@ -11548,10 +11791,10 @@
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@@ -11574,10 +11817,10 @@
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@@ -11608,15 +11851,15 @@
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@@ -11631,10 +11874,10 @@
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@@ -11659,6 +11902,10 @@
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@@ -11687,7 +11934,7 @@
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@@ -11700,7 +11947,7 @@
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@@ -11725,10 +11972,10 @@
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@@ -11751,10 +11998,10 @@
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@@ -11785,15 +12032,15 @@
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@@ -11808,10 +12055,10 @@
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@@ -11836,6 +12083,10 @@
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@@ -11864,7 +12115,7 @@
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@@ -11877,7 +12128,7 @@
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@@ -11902,10 +12153,10 @@
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@@ -11928,10 +12179,10 @@
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@@ -11962,15 +12213,15 @@
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@@ -11985,10 +12236,10 @@
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@@ -12013,6 +12264,10 @@
                 "url": "OBX.2",
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@@ -12041,7 +12296,7 @@
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@@ -12054,7 +12309,7 @@
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@@ -12079,10 +12334,10 @@
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@@ -12105,10 +12360,10 @@
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@@ -12139,15 +12394,15 @@
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@@ -12162,10 +12417,10 @@
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@@ -12190,6 +12445,10 @@
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@@ -12218,7 +12477,7 @@
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@@ -12231,7 +12490,7 @@
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@@ -12256,10 +12515,10 @@
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@@ -12282,10 +12541,10 @@
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@@ -12316,15 +12575,15 @@
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@@ -12339,10 +12598,10 @@
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@@ -12367,6 +12626,10 @@
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@@ -12408,7 +12671,7 @@
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@@ -12459,10 +12722,10 @@
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@@ -12544,6 +12807,10 @@
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@@ -12585,7 +12852,7 @@
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@@ -12636,10 +12903,10 @@
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@@ -12721,6 +12988,10 @@
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@@ -12749,7 +13020,7 @@
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@@ -12762,7 +13033,7 @@
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@@ -12813,10 +13084,10 @@
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@@ -12898,6 +13169,10 @@
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@@ -12926,7 +13201,7 @@
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@@ -12939,7 +13214,7 @@
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@@ -12990,10 +13265,10 @@
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@@ -13075,6 +13350,10 @@
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@@ -13167,10 +13446,10 @@
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@@ -13252,6 +13531,10 @@
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@@ -13293,7 +13576,7 @@
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@@ -13318,10 +13601,10 @@
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@@ -13344,10 +13627,10 @@
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@@ -13378,15 +13661,15 @@
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@@ -13401,10 +13684,10 @@
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@@ -13429,6 +13712,10 @@
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@@ -13457,7 +13744,7 @@
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@@ -13470,7 +13757,7 @@
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@@ -13495,10 +13782,10 @@
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@@ -13521,10 +13808,10 @@
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@@ -13555,15 +13842,15 @@
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@@ -13578,10 +13865,10 @@
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@@ -13606,6 +13893,10 @@
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@@ -13634,7 +13925,7 @@
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@@ -13647,7 +13938,7 @@
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@@ -13672,10 +13963,10 @@
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@@ -13698,10 +13989,10 @@
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@@ -13732,15 +14023,15 @@
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@@ -13755,10 +14046,10 @@
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@@ -13783,6 +14074,10 @@
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@@ -13811,7 +14106,7 @@
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@@ -13824,7 +14119,7 @@
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@@ -13849,10 +14144,10 @@
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@@ -13875,10 +14170,10 @@
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@@ -13909,15 +14204,15 @@
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@@ -13932,10 +14227,10 @@
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@@ -13960,6 +14255,10 @@
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@@ -13988,7 +14287,7 @@
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@@ -14001,7 +14300,7 @@
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@@ -14026,10 +14325,10 @@
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@@ -14052,10 +14351,10 @@
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@@ -14086,15 +14385,15 @@
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@@ -14109,10 +14408,10 @@
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@@ -14137,6 +14436,10 @@
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@@ -14229,10 +14532,10 @@
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@@ -14286,10 +14589,10 @@
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@@ -14314,6 +14617,10 @@
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@@ -14342,7 +14649,7 @@
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@@ -14355,7 +14662,7 @@
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@@ -14380,10 +14687,10 @@
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@@ -14406,10 +14713,10 @@
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@@ -14491,6 +14798,10 @@
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@@ -14519,7 +14830,7 @@
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@@ -14532,7 +14843,7 @@
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@@ -14557,10 +14868,10 @@
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@@ -14583,10 +14894,10 @@
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@@ -14617,15 +14928,15 @@
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@@ -14704,6 +15015,10 @@
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@@ -14745,16 +15060,16 @@
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@@ -14777,10 +15092,10 @@
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@@ -14876,6 +15191,10 @@
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@@ -14904,7 +15223,7 @@
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@@ -14966,6 +15285,10 @@
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@@ -14994,7 +15317,7 @@
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@@ -15034,6 +15357,10 @@
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@@ -15095,10 +15422,10 @@
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@@ -15571,6 +15922,10 @@
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@@ -15910,6 +16273,10 @@
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@@ -16320,6 +16691,10 @@
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@@ -16525,6 +16900,10 @@
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@@ -16684,6 +17063,10 @@
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@@ -16726,7 +17109,7 @@
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@@ -16889,6 +17272,10 @@
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@@ -16917,7 +17304,7 @@
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@@ -16930,7 +17317,7 @@
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@@ -16986,10 +17373,10 @@
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@@ -17071,6 +17458,10 @@
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@@ -17112,7 +17503,7 @@
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@@ -17458,6 +17853,10 @@
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@@ -17578,10 +17977,10 @@
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@@ -17663,6 +18062,10 @@
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@@ -17704,7 +18107,7 @@
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@@ -17782,10 +18185,10 @@
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@@ -17867,6 +18270,10 @@
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@@ -17987,10 +18394,10 @@
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@@ -18072,6 +18479,10 @@
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@@ -18114,7 +18525,7 @@
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@@ -18192,10 +18603,10 @@
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@@ -18249,10 +18660,10 @@
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@@ -18277,6 +18688,10 @@
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@@ -18319,7 +18734,7 @@
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@@ -18332,7 +18747,7 @@
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@@ -18371,10 +18786,10 @@
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@@ -18397,10 +18812,10 @@
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@@ -18431,15 +18846,15 @@
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@@ -18454,10 +18869,10 @@
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@@ -18482,6 +18897,10 @@
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@@ -18524,7 +18943,7 @@
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@@ -18537,7 +18956,7 @@
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@@ -18576,10 +18995,10 @@
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@@ -18602,10 +19021,10 @@
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@@ -18636,15 +19055,15 @@
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@@ -18659,10 +19078,10 @@
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@@ -18687,6 +19106,10 @@
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@@ -18729,7 +19152,7 @@
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@@ -18742,7 +19165,7 @@
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@@ -18781,10 +19204,10 @@
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@@ -18807,10 +19230,10 @@
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@@ -18841,15 +19264,15 @@
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@@ -18864,10 +19287,10 @@
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@@ -18877,10 +19300,10 @@
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@@ -18890,10 +19313,10 @@
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@@ -18903,10 +19326,10 @@
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@@ -18916,10 +19339,10 @@
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@@ -18929,10 +19352,10 @@
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@@ -18942,10 +19365,10 @@
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@@ -18955,10 +19378,10 @@
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@@ -18968,10 +19391,10 @@
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@@ -18981,10 +19404,10 @@
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@@ -18994,10 +19417,10 @@
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@@ -19007,10 +19430,10 @@
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@@ -19020,10 +19443,10 @@
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@@ -19033,10 +19456,10 @@
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@@ -19046,10 +19469,10 @@
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@@ -19059,10 +19482,10 @@
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@@ -19224,10 +19647,10 @@
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@@ -19239,13 +19662,13 @@
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@@ -19273,7 +19696,7 @@
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@@ -19335,6 +19758,10 @@
                 "url": "OBR.22",
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@@ -19413,7 +19840,7 @@
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@@ -19511,18 +19938,18 @@
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@@ -19537,10 +19964,10 @@
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@@ -19592,7 +20019,7 @@
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@@ -19608,10 +20035,10 @@
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@@ -19675,12 +20102,6 @@
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@@ -19705,23 +20126,23 @@
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@@ -19785,12 +20206,6 @@
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@@ -19803,10 +20218,10 @@
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@@ -19870,12 +20285,6 @@
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@@ -19888,10 +20297,10 @@
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@@ -19906,10 +20315,10 @@
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@@ -19957,7 +20366,7 @@
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@@ -19973,10 +20382,10 @@
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@@ -19991,10 +20400,10 @@
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@@ -20042,7 +20451,7 @@
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@@ -20058,10 +20467,10 @@
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@@ -20126,6 +20535,10 @@
                 "url": "OBR.22",
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@@ -20204,7 +20617,7 @@
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@@ -20302,18 +20715,18 @@
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@@ -20328,10 +20741,10 @@
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@@ -20383,7 +20796,7 @@
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@@ -20399,10 +20812,10 @@
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@@ -20417,10 +20830,10 @@
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@@ -20468,7 +20881,7 @@
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             "value": "1174911127",
             "assigner": {
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@@ -20484,10 +20897,10 @@
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@@ -20499,13 +20912,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747087259523.3931abcc-7b69-4d21-afab-d1acd9fd7e53"
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+                  "reference": "Organization/1729291107765421000.6ee1bced-536e-4a9f-ae93-da81a0967b20"
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@@ -20533,7 +20946,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291107767245000.789ca542-92e7-4238-936b-efc6a8f682fa"
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@@ -20595,6 +21008,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
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+                "valueId": "F"
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@@ -20673,7 +21090,7 @@
               {
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@@ -20771,18 +21188,18 @@
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@@ -20797,10 +21214,10 @@
       }
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@@ -20852,7 +21269,7 @@
             },
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             "assigner": {
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@@ -20868,10 +21285,10 @@
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@@ -20935,12 +21352,6 @@
             "type": {
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@@ -20965,23 +21376,23 @@
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@@ -21045,12 +21456,6 @@
             "type": {
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@@ -21063,10 +21468,10 @@
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@@ -21130,12 +21535,6 @@
             "type": {
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                   "code": "Submitter ID"
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@@ -21148,10 +21547,10 @@
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@@ -21166,10 +21565,10 @@
       }
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@@ -21217,7 +21616,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729291107766079000.28e7ce02-389e-4c9b-aa43-8b25210ef277"
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@@ -21233,10 +21632,10 @@
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+      "fullUrl": "Organization/1729291107768831000.e2f6a2f1-6944-4d6b-8570-4ed744bd7e25",
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@@ -21251,10 +21650,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107769583000.f3c4bbfd-94a7-495e-8576-dc143416cfcf",
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@@ -21302,7 +21701,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747132441256.883fc29d-1c08-4f3e-8c4c-af7b364a53c9"
+              "reference": "Organization/1729291107768831000.e2f6a2f1-6944-4d6b-8570-4ed744bd7e25"
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@@ -21318,10 +21717,10 @@
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+      "fullUrl": "ServiceRequest/1729291107780448000.18c8fa7c-1ae1-4d5b-ba99-410e59391560",
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+        "id": "1729291107780448000.18c8fa7c-1ae1-4d5b-ba99-410e59391560",
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@@ -21333,13 +21732,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747181138898.5104228a-aa3b-4f42-874a-d8907216bb5c"
+                  "reference": "Organization/1729291107775403000.10064683-c861-4bb8-86b1-ffa3c4e63b1a"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729291107776243000.c2c08772-3fe6-47fc-a35e-2e3e28e34808"
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@@ -21367,7 +21766,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747187129097.08517919-584e-47c9-a244-9372f9869d66"
+                  "reference": "Practitioner/1729291107777699000.e3168e27-cf34-4b8e-bbfa-e661a75931a9"
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@@ -21429,6 +21828,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
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+                "valueId": "F"
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@@ -21507,7 +21910,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291107779960000.7a9aba9f-9a7f-4f85-9d50-557e24fe816a"
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@@ -21605,18 +22008,18 @@
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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@@ -21631,10 +22034,10 @@
       }
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@@ -21686,7 +22089,7 @@
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             "assigner": {
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@@ -21702,10 +22105,10 @@
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@@ -21769,12 +22172,6 @@
             "type": {
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@@ -21799,23 +22196,23 @@
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@@ -21879,12 +22276,6 @@
             "type": {
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@@ -21897,10 +22288,10 @@
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -21964,12 +22355,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -21982,10 +22367,10 @@
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@@ -22000,10 +22385,10 @@
       }
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@@ -22051,7 +22436,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747185043731.4e043942-5d5d-4666-9481-85023b5ccf43"
+              "reference": "Organization/1729291107776854000.e09fcff3-f808-4e42-b092-df5005922fa5"
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@@ -22067,10 +22452,10 @@
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@@ -22085,10 +22470,10 @@
       }
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@@ -22136,7 +22521,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729291107779173000.87dac28d-4581-40fb-96ad-98a0e6b3dbf2"
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@@ -22152,10 +22537,10 @@
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         "extension": [
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@@ -22167,13 +22552,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747270135925.da7f7d16-170f-4573-85d3-af942c7a1490"
+                  "reference": "Organization/1729291107787984000.7292f507-4a2c-409b-b719-c810926832bf"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729291107790967000.6b6252f4-2a14-4a37-8527-f476c4feb240"
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@@ -22201,7 +22586,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747286322554.278381ff-cddb-4fda-a100-9966f321682b"
+                  "reference": "Practitioner/1729291107793664000.4e4ae246-74c7-44c4-ac6b-f5c95734cc6e"
                 }
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@@ -22263,6 +22648,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
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                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -22341,7 +22730,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747302394525.a9aeef5a-c730-4cea-ba67-08532036e50d"
+                  "reference": "Practitioner/1729291107798811000.41f11bbb-a2f5-4148-8765-b12cd257c0bb"
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@@ -22439,18 +22828,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034747198968569.0c6e0d14-6563-47ef-83f1-700cea2c8fb1"
+          "reference": "PractitionerRole/1729291107780618000.c45b4f76-4123-47a5-b4d9-b87adf3f07f1"
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       "resource": {
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@@ -22465,10 +22854,10 @@
       }
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+        "id": "1729291107781977000.395f559e-cccb-4d90-8474-815260c3d8a7",
         "extension": [
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@@ -22520,7 +22909,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747199599730.a83a6851-a3ee-48d5-82b6-49bd6df8c2a1"
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@@ -22536,10 +22925,10 @@
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       "resource": {
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+        "id": "1729291107783806000.255cc527-bbc1-4f04-87a9-78feea50a32e",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -22603,12 +22992,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
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-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -22633,23 +23016,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1708034747198968569.0c6e0d14-6563-47ef-83f1-700cea2c8fb1",
+      "fullUrl": "PractitionerRole/1729291107780618000.c45b4f76-4123-47a5-b4d9-b87adf3f07f1",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747198968569.0c6e0d14-6563-47ef-83f1-700cea2c8fb1",
+        "id": "1729291107780618000.c45b4f76-4123-47a5-b4d9-b87adf3f07f1",
         "practitioner": {
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+          "reference": "Practitioner/1729291107781977000.395f559e-cccb-4d90-8474-815260c3d8a7"
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         "organization": {
-          "reference": "Organization/1708034747230820081.e69e93d5-7762-4384-a6d3-2516a0f72d83"
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+      "fullUrl": "Organization/1729291107787984000.7292f507-4a2c-409b-b719-c810926832bf",
       "resource": {
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-        "id": "1708034747270135925.da7f7d16-170f-4573-85d3-af942c7a1490",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -22713,12 +23096,6 @@
             "type": {
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                   "code": "NPI"
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@@ -22731,10 +23108,10 @@
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       "resource": {
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         "extension": [
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@@ -22798,12 +23175,6 @@
             "type": {
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -22816,10 +23187,10 @@
       }
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-      "fullUrl": "Organization/1708034747284078896.271c3c42-4b81-40a5-9db0-5bf01a92c15c",
+      "fullUrl": "Organization/1729291107792021000.e2b3d2c7-c111-44ba-b5ca-e9b0285ee48e",
       "resource": {
         "resourceType": "Organization",
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+        "id": "1729291107792021000.e2b3d2c7-c111-44ba-b5ca-e9b0285ee48e",
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@@ -22834,10 +23205,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107793664000.4e4ae246-74c7-44c4-ac6b-f5c95734cc6e",
       "resource": {
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-        "id": "1708034747286322554.278381ff-cddb-4fda-a100-9966f321682b",
+        "id": "1729291107793664000.4e4ae246-74c7-44c4-ac6b-f5c95734cc6e",
         "extension": [
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@@ -22885,7 +23256,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747284078896.271c3c42-4b81-40a5-9db0-5bf01a92c15c"
+              "reference": "Organization/1729291107792021000.e2b3d2c7-c111-44ba-b5ca-e9b0285ee48e"
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@@ -22901,10 +23272,10 @@
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+      "fullUrl": "Organization/1729291107796638000.38c113e7-a2f7-47d2-8c86-734c46e58a84",
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+        "id": "1729291107796638000.38c113e7-a2f7-47d2-8c86-734c46e58a84",
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@@ -22919,10 +23290,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107798811000.41f11bbb-a2f5-4148-8765-b12cd257c0bb",
       "resource": {
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         "extension": [
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@@ -22970,7 +23341,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747299498694.25bd2060-84c1-4859-bb5d-a98fa9b53d2a"
+              "reference": "Organization/1729291107796638000.38c113e7-a2f7-47d2-8c86-734c46e58a84"
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@@ -22986,10 +23357,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729291107821061000.a6a053cb-c8b2-4e59-8e68-23222f7015cd",
       "resource": {
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-        "id": "1708034747417374183.44db3eed-d560-47d1-9853-4204f6cd4117",
+        "id": "1729291107821061000.a6a053cb-c8b2-4e59-8e68-23222f7015cd",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -23001,13 +23372,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747353284802.de1d45b3-a19d-4054-aedf-c9192fe19d8b"
+                  "reference": "Organization/1729291107813573000.8d16dba9-a7c5-431d-bd7b-44c3991d215c"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747363823968.f0ddc322-d213-435e-bb31-d86e3eecc372"
+                  "reference": "Organization/1729291107816300000.9e29ae56-363e-4d3d-b3bf-f590c1deffc5"
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@@ -23035,7 +23406,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747385729408.8ffa63b4-7737-46b8-bf0f-2cacfdae293d"
+                  "reference": "Practitioner/1729291107818165000.2e635ad0-f76f-41b5-abd4-99f42a1734c3"
                 }
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@@ -23097,6 +23468,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
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                 "valueIdentifier": {
@@ -23175,7 +23550,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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+                  "reference": "Practitioner/1729291107820564000.8ff1f094-2a85-46a2-87dc-df9f82b796cb"
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@@ -23273,18 +23648,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034747305657618.a5a46a1a-07cf-42dd-9461-544aa140ad65"
+          "reference": "PractitionerRole/1729291107800456000.2810f806-dea6-406c-8056-c5a64044ae7b"
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       "resource": {
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@@ -23299,10 +23674,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107803274000.4a19435f-3bb9-4beb-916e-55590277f6fe",
       "resource": {
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@@ -23354,7 +23729,7 @@
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+              "reference": "Organization/1729291107800987000.d98eb28b-eca1-45bf-bf3e-e272ff7d1e72"
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@@ -23370,10 +23745,10 @@
       }
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-      "fullUrl": "Organization/1708034747334621290.ed94f3fc-da3e-49e6-8d32-a9ee22e2c5bc",
+      "fullUrl": "Organization/1729291107807217000.e4a239eb-04da-400c-99e9-63e513edbce7",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747334621290.ed94f3fc-da3e-49e6-8d32-a9ee22e2c5bc",
+        "id": "1729291107807217000.e4a239eb-04da-400c-99e9-63e513edbce7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -23437,12 +23812,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
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@@ -23467,23 +23836,23 @@
       }
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-      "fullUrl": "PractitionerRole/1708034747305657618.a5a46a1a-07cf-42dd-9461-544aa140ad65",
+      "fullUrl": "PractitionerRole/1729291107800456000.2810f806-dea6-406c-8056-c5a64044ae7b",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747305657618.a5a46a1a-07cf-42dd-9461-544aa140ad65",
+        "id": "1729291107800456000.2810f806-dea6-406c-8056-c5a64044ae7b",
         "practitioner": {
-          "reference": "Practitioner/1708034747321225448.312dd2d7-723e-4c08-8ee7-3ebe6df615af"
+          "reference": "Practitioner/1729291107803274000.4a19435f-3bb9-4beb-916e-55590277f6fe"
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         "organization": {
-          "reference": "Organization/1708034747334621290.ed94f3fc-da3e-49e6-8d32-a9ee22e2c5bc"
+          "reference": "Organization/1729291107807217000.e4a239eb-04da-400c-99e9-63e513edbce7"
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-      "fullUrl": "Organization/1708034747353284802.de1d45b3-a19d-4054-aedf-c9192fe19d8b",
+      "fullUrl": "Organization/1729291107813573000.8d16dba9-a7c5-431d-bd7b-44c3991d215c",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747353284802.de1d45b3-a19d-4054-aedf-c9192fe19d8b",
+        "id": "1729291107813573000.8d16dba9-a7c5-431d-bd7b-44c3991d215c",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -23547,12 +23916,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -23565,10 +23928,10 @@
       }
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         "extension": [
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@@ -23632,12 +23995,6 @@
             "type": {
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                   "code": "Submitter ID"
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@@ -23650,10 +24007,10 @@
       }
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@@ -23668,10 +24025,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107818165000.2e635ad0-f76f-41b5-abd4-99f42a1734c3",
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         "extension": [
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@@ -23719,7 +24076,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747370647859.04166b48-046c-40b5-9038-36ee0f255da9"
+              "reference": "Organization/1729291107817262000.e3f39d33-3772-4213-ba86-550e25dc3349"
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@@ -23735,10 +24092,10 @@
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@@ -23753,10 +24110,10 @@
       }
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       "resource": {
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         "extension": [
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@@ -23804,7 +24161,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747402279654.85bcd095-183a-4da5-99c7-734666f0bc31"
+              "reference": "Organization/1729291107819809000.1e2b5e18-e9f3-4b71-8475-f0b7ab2225f0"
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@@ -23820,10 +24177,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729291107830839000.cd99c0cf-8522-43c5-9fda-f808c123971d",
       "resource": {
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-        "id": "1708034747498446689.172f8119-83c0-428e-9ef2-9c4dd04865c9",
+        "id": "1729291107830839000.cd99c0cf-8522-43c5-9fda-f808c123971d",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -23835,13 +24192,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747461640695.bc0ba164-83c7-4015-b939-d27f1b62fac6"
+                  "reference": "Organization/1729291107825998000.7b87572a-2922-4634-8fda-4e2043b87904"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747467340792.2aca5d23-07b5-408f-9497-a954f9236dcc"
+                  "reference": "Organization/1729291107826836000.d0181b13-1e5d-4188-868b-f9c8a25dd3e3"
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@@ -23869,7 +24226,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747473545284.63666022-dad0-42da-9103-ac256afe7c47"
+                  "reference": "Practitioner/1729291107828173000.e6184895-9da9-43b5-aa4e-86217d5d7693"
                 }
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@@ -23931,6 +24288,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -24009,7 +24370,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747491850110.c8e3b35f-0168-41b8-ae88-3b3048e43b9c"
+                  "reference": "Practitioner/1729291107830359000.c8d9e0f0-3e00-4e2b-956f-0700c21b7f4b"
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@@ -24107,18 +24468,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034747418203132.cf452cde-3265-4291-9fdf-25da0ee87858"
+          "reference": "PractitionerRole/1729291107821239000.4dc618de-e8b2-4cc0-b994-b7bda67c940c"
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-      "fullUrl": "Organization/1708034747418883261.cf98b2ee-cab0-41d4-84fe-983e9f1b4aa5",
+      "fullUrl": "Organization/1729291107821439000.b93189fc-b2fc-4a87-96e8-4c920cea5236",
       "resource": {
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+        "id": "1729291107821439000.b93189fc-b2fc-4a87-96e8-4c920cea5236",
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@@ -24133,10 +24494,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107822406000.3594293e-dbfa-4a23-8ce3-d0d011527542",
       "resource": {
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-        "id": "1708034747423382045.c5228e20-7573-452b-89be-8163cd509faf",
+        "id": "1729291107822406000.3594293e-dbfa-4a23-8ce3-d0d011527542",
         "extension": [
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@@ -24188,7 +24549,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747418883261.cf98b2ee-cab0-41d4-84fe-983e9f1b4aa5"
+              "reference": "Organization/1729291107821439000.b93189fc-b2fc-4a87-96e8-4c920cea5236"
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@@ -24204,10 +24565,10 @@
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+      "fullUrl": "Organization/1729291107823743000.42c046d4-4b80-49cf-b852-4129014b90b7",
       "resource": {
         "resourceType": "Organization",
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+        "id": "1729291107823743000.42c046d4-4b80-49cf-b852-4129014b90b7",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -24271,12 +24632,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
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-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -24301,23 +24656,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1708034747418203132.cf452cde-3265-4291-9fdf-25da0ee87858",
+      "fullUrl": "PractitionerRole/1729291107821239000.4dc618de-e8b2-4cc0-b994-b7bda67c940c",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747418203132.cf452cde-3265-4291-9fdf-25da0ee87858",
+        "id": "1729291107821239000.4dc618de-e8b2-4cc0-b994-b7bda67c940c",
         "practitioner": {
-          "reference": "Practitioner/1708034747423382045.c5228e20-7573-452b-89be-8163cd509faf"
+          "reference": "Practitioner/1729291107822406000.3594293e-dbfa-4a23-8ce3-d0d011527542"
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         "organization": {
-          "reference": "Organization/1708034747441239905.f4fa7bb5-5a0d-4e48-82ec-e1474cda21e1"
+          "reference": "Organization/1729291107823743000.42c046d4-4b80-49cf-b852-4129014b90b7"
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     {
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+      "fullUrl": "Organization/1729291107825998000.7b87572a-2922-4634-8fda-4e2043b87904",
       "resource": {
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-        "id": "1708034747461640695.bc0ba164-83c7-4015-b939-d27f1b62fac6",
+        "id": "1729291107825998000.7b87572a-2922-4634-8fda-4e2043b87904",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -24381,12 +24736,6 @@
             "type": {
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@@ -24399,10 +24748,10 @@
       }
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-      "fullUrl": "Organization/1708034747467340792.2aca5d23-07b5-408f-9497-a954f9236dcc",
+      "fullUrl": "Organization/1729291107826836000.d0181b13-1e5d-4188-868b-f9c8a25dd3e3",
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-        "id": "1708034747467340792.2aca5d23-07b5-408f-9497-a954f9236dcc",
+        "id": "1729291107826836000.d0181b13-1e5d-4188-868b-f9c8a25dd3e3",
         "extension": [
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@@ -24466,12 +24815,6 @@
             "type": {
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-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -24484,10 +24827,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747470324144.e17addc9-2f7b-400d-b92a-be45702966db",
+      "fullUrl": "Organization/1729291107827405000.ef674781-24b6-4880-991f-7b25ba4ea8fe",
       "resource": {
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-        "id": "1708034747470324144.e17addc9-2f7b-400d-b92a-be45702966db",
+        "id": "1729291107827405000.ef674781-24b6-4880-991f-7b25ba4ea8fe",
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@@ -24502,10 +24845,10 @@
       }
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-      "fullUrl": "Practitioner/1708034747473545284.63666022-dad0-42da-9103-ac256afe7c47",
+      "fullUrl": "Practitioner/1729291107828173000.e6184895-9da9-43b5-aa4e-86217d5d7693",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747473545284.63666022-dad0-42da-9103-ac256afe7c47",
+        "id": "1729291107828173000.e6184895-9da9-43b5-aa4e-86217d5d7693",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -24553,7 +24896,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747470324144.e17addc9-2f7b-400d-b92a-be45702966db"
+              "reference": "Organization/1729291107827405000.ef674781-24b6-4880-991f-7b25ba4ea8fe"
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@@ -24569,10 +24912,10 @@
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+      "fullUrl": "Organization/1729291107829602000.69994105-e721-4ee5-bbaa-640e489d8c96",
       "resource": {
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-        "id": "1708034747482810111.0c3cb767-5ff5-4df4-8da2-3b60dd0ca471",
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@@ -24587,10 +24930,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107830359000.c8d9e0f0-3e00-4e2b-956f-0700c21b7f4b",
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         "extension": [
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@@ -24638,7 +24981,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747482810111.0c3cb767-5ff5-4df4-8da2-3b60dd0ca471"
+              "reference": "Organization/1729291107829602000.69994105-e721-4ee5-bbaa-640e489d8c96"
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@@ -24654,10 +24997,10 @@
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+      "fullUrl": "ServiceRequest/1729291107840505000.fd9546a0-a561-4186-bd44-eccba866c08d",
       "resource": {
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+        "id": "1729291107840505000.fd9546a0-a561-4186-bd44-eccba866c08d",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -24669,13 +25012,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747529710889.7c971059-09a1-4335-889a-f691bdffbf78"
+                  "reference": "Organization/1729291107835610000.2a09665a-190b-4d2b-88b2-6c506a255e59"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747532580788.7c991752-5d7d-48a0-ad35-3b14ef62561c"
+                  "reference": "Organization/1729291107836460000.9c399183-a4cb-46a8-a93a-0b01490393c5"
                 }
               },
               {
@@ -24703,7 +25046,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747543970035.6da63822-0fac-448f-8e37-d9ba83573790"
+                  "reference": "Practitioner/1729291107837841000.2eb3b53c-9c43-4824-87ab-11974ed42d32"
                 }
               }
             ]
@@ -24765,6 +25108,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -24843,7 +25190,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747574232422.50fd11a7-38e0-47e8-b8a2-6f29b4f51719"
+                  "reference": "Practitioner/1729291107840033000.da3fd886-b4f9-4a9c-af48-02d9df3a77bc"
                 }
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@@ -24941,18 +25288,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "requester": {
-          "reference": "PractitionerRole/1708034747499036040.b7b18296-6e82-4af5-bfa3-c32a933caecd"
+          "reference": "PractitionerRole/1729291107831030000.9bf1e05f-fc6f-48c5-9bd9-746dce3a026f"
         }
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     },
     {
-      "fullUrl": "Organization/1708034747500128018.42980239-1280-414c-b7db-aa54ec06916a",
+      "fullUrl": "Organization/1729291107831231000.b099f0be-3ca2-4442-adf0-ca5abab2778a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747500128018.42980239-1280-414c-b7db-aa54ec06916a",
+        "id": "1729291107831231000.b099f0be-3ca2-4442-adf0-ca5abab2778a",
         "identifier": [
           {
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@@ -24967,10 +25314,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107832116000.18690575-c420-439f-a9d9-758c41592e8e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747510998095.de024c16-1252-42a0-ae1f-0720ccae3410",
+        "id": "1729291107832116000.18690575-c420-439f-a9d9-758c41592e8e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -25022,7 +25369,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747500128018.42980239-1280-414c-b7db-aa54ec06916a"
+              "reference": "Organization/1729291107831231000.b099f0be-3ca2-4442-adf0-ca5abab2778a"
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@@ -25038,10 +25385,10 @@
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+      "fullUrl": "Organization/1729291107833424000.2af93fe6-8ac9-4f9f-a5c5-2bc7da51b729",
       "resource": {
         "resourceType": "Organization",
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+        "id": "1729291107833424000.2af93fe6-8ac9-4f9f-a5c5-2bc7da51b729",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -25105,12 +25452,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -25135,23 +25476,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1708034747499036040.b7b18296-6e82-4af5-bfa3-c32a933caecd",
+      "fullUrl": "PractitionerRole/1729291107831030000.9bf1e05f-fc6f-48c5-9bd9-746dce3a026f",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747499036040.b7b18296-6e82-4af5-bfa3-c32a933caecd",
+        "id": "1729291107831030000.9bf1e05f-fc6f-48c5-9bd9-746dce3a026f",
         "practitioner": {
-          "reference": "Practitioner/1708034747510998095.de024c16-1252-42a0-ae1f-0720ccae3410"
+          "reference": "Practitioner/1729291107832116000.18690575-c420-439f-a9d9-758c41592e8e"
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         "organization": {
-          "reference": "Organization/1708034747517350150.f1319208-3de6-4b65-9ed4-cb841a9e7b7d"
+          "reference": "Organization/1729291107833424000.2af93fe6-8ac9-4f9f-a5c5-2bc7da51b729"
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     {
-      "fullUrl": "Organization/1708034747529710889.7c971059-09a1-4335-889a-f691bdffbf78",
+      "fullUrl": "Organization/1729291107835610000.2a09665a-190b-4d2b-88b2-6c506a255e59",
       "resource": {
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-        "id": "1708034747529710889.7c971059-09a1-4335-889a-f691bdffbf78",
+        "id": "1729291107835610000.2a09665a-190b-4d2b-88b2-6c506a255e59",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -25215,12 +25556,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -25233,10 +25568,10 @@
       }
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-      "fullUrl": "Organization/1708034747532580788.7c991752-5d7d-48a0-ad35-3b14ef62561c",
+      "fullUrl": "Organization/1729291107836460000.9c399183-a4cb-46a8-a93a-0b01490393c5",
       "resource": {
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-        "id": "1708034747532580788.7c991752-5d7d-48a0-ad35-3b14ef62561c",
+        "id": "1729291107836460000.9c399183-a4cb-46a8-a93a-0b01490393c5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -25300,12 +25635,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -25318,10 +25647,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747534659849.411b1d3c-8f2d-4e8d-9e54-d2c600a4adfd",
+      "fullUrl": "Organization/1729291107837069000.d35e017e-e479-4809-8d36-dc8a41fd4f5a",
       "resource": {
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-        "id": "1708034747534659849.411b1d3c-8f2d-4e8d-9e54-d2c600a4adfd",
+        "id": "1729291107837069000.d35e017e-e479-4809-8d36-dc8a41fd4f5a",
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@@ -25336,10 +25665,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1708034747543970035.6da63822-0fac-448f-8e37-d9ba83573790",
+      "fullUrl": "Practitioner/1729291107837841000.2eb3b53c-9c43-4824-87ab-11974ed42d32",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747543970035.6da63822-0fac-448f-8e37-d9ba83573790",
+        "id": "1729291107837841000.2eb3b53c-9c43-4824-87ab-11974ed42d32",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -25387,7 +25716,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747534659849.411b1d3c-8f2d-4e8d-9e54-d2c600a4adfd"
+              "reference": "Organization/1729291107837069000.d35e017e-e479-4809-8d36-dc8a41fd4f5a"
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@@ -25403,10 +25732,10 @@
       }
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-      "fullUrl": "Organization/1708034747568041055.2c9eb278-59d4-486e-a028-4afd6e329570",
+      "fullUrl": "Organization/1729291107839292000.ca991926-3080-46cc-98fe-ba718384f87d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747568041055.2c9eb278-59d4-486e-a028-4afd6e329570",
+        "id": "1729291107839292000.ca991926-3080-46cc-98fe-ba718384f87d",
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@@ -25421,10 +25750,10 @@
       }
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-      "fullUrl": "Practitioner/1708034747574232422.50fd11a7-38e0-47e8-b8a2-6f29b4f51719",
+      "fullUrl": "Practitioner/1729291107840033000.da3fd886-b4f9-4a9c-af48-02d9df3a77bc",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747574232422.50fd11a7-38e0-47e8-b8a2-6f29b4f51719",
+        "id": "1729291107840033000.da3fd886-b4f9-4a9c-af48-02d9df3a77bc",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -25472,7 +25801,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747568041055.2c9eb278-59d4-486e-a028-4afd6e329570"
+              "reference": "Organization/1729291107839292000.ca991926-3080-46cc-98fe-ba718384f87d"
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@@ -25488,10 +25817,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1708034747666292951.b75c2be8-f637-401b-b495-8879e37b79c4",
+      "fullUrl": "ServiceRequest/1729291107850012000.e799876b-9dd4-470f-9adc-720c0f51702b",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1708034747666292951.b75c2be8-f637-401b-b495-8879e37b79c4",
+        "id": "1729291107850012000.e799876b-9dd4-470f-9adc-720c0f51702b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -25503,13 +25832,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747601841071.f9a9a1c8-d81b-4f56-a284-94dbdf49a897"
+                  "reference": "Organization/1729291107845224000.0e5e96e1-67bb-4edc-a566-e51d3d0674f0"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747617793449.2d9bb0cc-5377-4e8c-9df6-6ef11ea87410"
+                  "reference": "Organization/1729291107846084000.53bd56de-30d2-4020-bc50-9db6297cf5f6"
                 }
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               {
@@ -25537,7 +25866,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747632966519.f841bd33-17c7-4b80-af31-38d73425abf7"
+                  "reference": "Practitioner/1729291107847386000.55838add-f72f-4926-a02e-2d88a78262d4"
                 }
               }
             ]
@@ -25599,6 +25928,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -25677,7 +26010,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747656133992.31b222b8-e86c-4947-94e4-872cc7d24ada"
+                  "reference": "Practitioner/1729291107849542000.61802282-823f-4c2b-a0dc-7dc84a52989e"
                 }
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@@ -25775,18 +26108,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "requester": {
-          "reference": "PractitionerRole/1708034747579744240.db74c78c-f558-4ac5-a188-2b911835d17c"
+          "reference": "PractitionerRole/1729291107840674000.fe6bf946-d060-498e-8caa-853c7d2bc4b9"
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     {
-      "fullUrl": "Organization/1708034747581128946.46797977-61d3-48bb-b3de-922d05692c13",
+      "fullUrl": "Organization/1729291107840874000.06da0ce2-4920-4e17-98c3-4dbdc2da5a3b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747581128946.46797977-61d3-48bb-b3de-922d05692c13",
+        "id": "1729291107840874000.06da0ce2-4920-4e17-98c3-4dbdc2da5a3b",
         "identifier": [
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@@ -25801,10 +26134,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1708034747583840320.d7b8a32c-c875-40e6-af71-fad9b6fd3896",
+      "fullUrl": "Practitioner/1729291107841749000.2644b1ed-e3aa-4bb3-a822-9d85996cdc56",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747583840320.d7b8a32c-c875-40e6-af71-fad9b6fd3896",
+        "id": "1729291107841749000.2644b1ed-e3aa-4bb3-a822-9d85996cdc56",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -25856,7 +26189,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747581128946.46797977-61d3-48bb-b3de-922d05692c13"
+              "reference": "Organization/1729291107840874000.06da0ce2-4920-4e17-98c3-4dbdc2da5a3b"
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@@ -25872,10 +26205,10 @@
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+      "fullUrl": "Organization/1729291107843026000.afc3e6ca-133c-4bc0-b922-7e89371016b7",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747587550926.4edeaaec-d493-4ba4-9f80-f0c973ceeaa0",
+        "id": "1729291107843026000.afc3e6ca-133c-4bc0-b922-7e89371016b7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -25939,12 +26272,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
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-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -25969,23 +26296,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1708034747579744240.db74c78c-f558-4ac5-a188-2b911835d17c",
+      "fullUrl": "PractitionerRole/1729291107840674000.fe6bf946-d060-498e-8caa-853c7d2bc4b9",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747579744240.db74c78c-f558-4ac5-a188-2b911835d17c",
+        "id": "1729291107840674000.fe6bf946-d060-498e-8caa-853c7d2bc4b9",
         "practitioner": {
-          "reference": "Practitioner/1708034747583840320.d7b8a32c-c875-40e6-af71-fad9b6fd3896"
+          "reference": "Practitioner/1729291107841749000.2644b1ed-e3aa-4bb3-a822-9d85996cdc56"
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         "organization": {
-          "reference": "Organization/1708034747587550926.4edeaaec-d493-4ba4-9f80-f0c973ceeaa0"
+          "reference": "Organization/1729291107843026000.afc3e6ca-133c-4bc0-b922-7e89371016b7"
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     {
-      "fullUrl": "Organization/1708034747601841071.f9a9a1c8-d81b-4f56-a284-94dbdf49a897",
+      "fullUrl": "Organization/1729291107845224000.0e5e96e1-67bb-4edc-a566-e51d3d0674f0",
       "resource": {
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+        "id": "1729291107845224000.0e5e96e1-67bb-4edc-a566-e51d3d0674f0",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -26049,12 +26376,6 @@
             "type": {
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -26067,10 +26388,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747617793449.2d9bb0cc-5377-4e8c-9df6-6ef11ea87410",
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       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -26134,12 +26455,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -26152,10 +26467,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747624503015.ec59448e-3ebc-48b1-ae51-9a1828ebdfbf",
+      "fullUrl": "Organization/1729291107846624000.dacdceb3-4497-4ab4-91eb-1c31bc22d49a",
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+        "id": "1729291107846624000.dacdceb3-4497-4ab4-91eb-1c31bc22d49a",
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@@ -26170,10 +26485,10 @@
       }
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-      "fullUrl": "Practitioner/1708034747632966519.f841bd33-17c7-4b80-af31-38d73425abf7",
+      "fullUrl": "Practitioner/1729291107847386000.55838add-f72f-4926-a02e-2d88a78262d4",
       "resource": {
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@@ -26221,7 +26536,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747624503015.ec59448e-3ebc-48b1-ae51-9a1828ebdfbf"
+              "reference": "Organization/1729291107846624000.dacdceb3-4497-4ab4-91eb-1c31bc22d49a"
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@@ -26237,10 +26552,10 @@
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+      "fullUrl": "Organization/1729291107848812000.94f04de8-b5c1-4fd9-ad64-2b1abe861485",
       "resource": {
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+        "id": "1729291107848812000.94f04de8-b5c1-4fd9-ad64-2b1abe861485",
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@@ -26255,10 +26570,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107849542000.61802282-823f-4c2b-a0dc-7dc84a52989e",
       "resource": {
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-        "id": "1708034747656133992.31b222b8-e86c-4947-94e4-872cc7d24ada",
+        "id": "1729291107849542000.61802282-823f-4c2b-a0dc-7dc84a52989e",
         "extension": [
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@@ -26306,7 +26621,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729291107848812000.94f04de8-b5c1-4fd9-ad64-2b1abe861485"
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@@ -26322,10 +26637,10 @@
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       "resource": {
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -26337,13 +26652,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747756556434.073833e7-46d6-40b1-abfc-e5b614a26a9d"
+                  "reference": "Organization/1729291107854884000.48ed4f7c-f2eb-4758-8674-de4d45fe7a2b"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729291107855731000.002534d1-0c4f-4166-9411-fe6cb685fa40"
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@@ -26371,7 +26686,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747790618796.c1a0e663-1e4a-4f36-91a6-b1170c902733"
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                 }
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@@ -26433,6 +26748,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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@@ -26511,7 +26830,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291107859266000.eab0f3e9-89e2-4d12-b7a5-333f94666f38"
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@@ -26608,18 +26927,18 @@
           ]
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034747667798862.3a3de5b9-a70b-4ccc-835b-cfe33190acc7"
+          "reference": "PractitionerRole/1729291107850176000.8b42780c-2594-4355-a559-bd20f0e83a13"
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-      "fullUrl": "Organization/1708034747669066982.ed716efa-cdbc-44ab-ad08-b76d1e243fc4",
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@@ -26634,10 +26953,10 @@
       }
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         "extension": [
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@@ -26689,7 +27008,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747669066982.ed716efa-cdbc-44ab-ad08-b76d1e243fc4"
+              "reference": "Organization/1729291107850385000.7092cc2c-710a-4829-ac92-2cab80e3f785"
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@@ -26705,10 +27024,10 @@
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@@ -26772,12 +27091,6 @@
             "type": {
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                 {
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@@ -26802,23 +27115,23 @@
       }
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         "practitioner": {
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-          "reference": "Organization/1708034747737302401.a20e77f5-b944-4d7a-84b6-8e818d3885f2"
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@@ -26882,12 +27195,6 @@
             "type": {
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@@ -26900,10 +27207,10 @@
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@@ -26967,12 +27274,6 @@
             "type": {
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -26985,10 +27286,10 @@
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@@ -27003,10 +27304,10 @@
       }
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         "extension": [
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@@ -27054,7 +27355,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747778508076.7fc21514-e112-436b-8b76-f31e0f958061"
+              "reference": "Organization/1729291107856277000.0a7bd8a6-447c-41ba-ab64-f752bcc3c595"
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@@ -27070,10 +27371,10 @@
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@@ -27088,10 +27389,10 @@
       }
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       "resource": {
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         "extension": [
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@@ -27139,7 +27440,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034747797328586.1455adb3-3969-49c7-87da-747716f09ffc"
+              "reference": "Organization/1729291107858527000.912afb5b-c7b3-415b-8207-dcfd30f6bdce"
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@@ -27155,10 +27456,10 @@
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+      "fullUrl": "ServiceRequest/1729291107870117000.fb86fc07-a54b-444f-99f0-43ebb310b7f1",
       "resource": {
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+        "id": "1729291107870117000.fb86fc07-a54b-444f-99f0-43ebb310b7f1",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -27170,13 +27471,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747858955800.f8ed906e-2b28-491f-94ec-49281899b741"
+                  "reference": "Organization/1729291107864617000.0292e56c-ec5d-4b7a-9588-89740d97b1aa"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747874791240.899c4c8a-e3a5-40ae-b7e5-c1572cbd0e00"
+                  "reference": "Organization/1729291107865699000.23831811-7ce7-49e6-8de9-a2222ca8d80b"
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@@ -27204,7 +27505,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747879713737.8eb62872-c62c-4c8f-83cc-50c0f04b5bbb"
+                  "reference": "Practitioner/1729291107867107000.d907dcba-3008-4ba0-9664-9f7781c8a351"
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@@ -27266,6 +27567,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
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@@ -27344,7 +27649,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1708034747902272646.845a3adc-8d64-4b17-95db-251c2d40c4a3"
+                  "reference": "Practitioner/1729291107869359000.b1ced12d-8834-45e3-aed3-872bd0ff0931"
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@@ -27442,18 +27747,18 @@
           ]
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
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+          "reference": "PractitionerRole/1729291107859894000.6b313655-6fe9-4db4-8425-bb99e53f819c"
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+      "fullUrl": "Organization/1729291107860095000.9b41b838-2f00-46f7-83d4-97a64027238e",
       "resource": {
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@@ -27468,10 +27773,10 @@
       }
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       "resource": {
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         "extension": [
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@@ -27523,7 +27828,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747813248644.c38ea17d-5dc8-4276-87ee-ec4953aed98e"
+              "reference": "Organization/1729291107860095000.9b41b838-2f00-46f7-83d4-97a64027238e"
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@@ -27539,10 +27844,10 @@
       }
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+      "fullUrl": "Organization/1729291107862337000.b9847dca-0139-4c05-adf3-537486628766",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -27606,12 +27911,6 @@
             "type": {
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                 {
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@@ -27636,23 +27935,23 @@
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       "resource": {
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         "practitioner": {
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+          "reference": "Practitioner/1729291107860988000.ead24632-43c5-47ee-9de1-e74b69904ae3"
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+          "reference": "Organization/1729291107862337000.b9847dca-0139-4c05-adf3-537486628766"
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     {
-      "fullUrl": "Organization/1708034747858955800.f8ed906e-2b28-491f-94ec-49281899b741",
+      "fullUrl": "Organization/1729291107864617000.0292e56c-ec5d-4b7a-9588-89740d97b1aa",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747858955800.f8ed906e-2b28-491f-94ec-49281899b741",
+        "id": "1729291107864617000.0292e56c-ec5d-4b7a-9588-89740d97b1aa",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -27716,12 +28015,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -27734,10 +28027,10 @@
       }
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-      "fullUrl": "Organization/1708034747874791240.899c4c8a-e3a5-40ae-b7e5-c1572cbd0e00",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -27801,12 +28094,6 @@
             "type": {
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                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -27819,10 +28106,10 @@
       }
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       "resource": {
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+        "id": "1729291107866290000.7bbe75b7-6426-4f3e-b3d7-e984e6f14257",
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@@ -27837,10 +28124,10 @@
       }
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-      "fullUrl": "Practitioner/1708034747879713737.8eb62872-c62c-4c8f-83cc-50c0f04b5bbb",
+      "fullUrl": "Practitioner/1729291107867107000.d907dcba-3008-4ba0-9664-9f7781c8a351",
       "resource": {
         "resourceType": "Practitioner",
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+        "id": "1729291107867107000.d907dcba-3008-4ba0-9664-9f7781c8a351",
         "extension": [
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@@ -27888,7 +28175,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747876890044.d520b133-1f2f-4a2f-a430-df8567a18c11"
+              "reference": "Organization/1729291107866290000.7bbe75b7-6426-4f3e-b3d7-e984e6f14257"
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@@ -27904,10 +28191,10 @@
       }
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+      "fullUrl": "Organization/1729291107868603000.0db264d7-8129-4475-86c5-f678dc2c7adc",
       "resource": {
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-        "id": "1708034747884664810.5edff459-970a-4229-aabd-217f33757c97",
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@@ -27922,10 +28209,10 @@
       }
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-      "fullUrl": "Practitioner/1708034747902272646.845a3adc-8d64-4b17-95db-251c2d40c4a3",
+      "fullUrl": "Practitioner/1729291107869359000.b1ced12d-8834-45e3-aed3-872bd0ff0931",
       "resource": {
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-        "id": "1708034747902272646.845a3adc-8d64-4b17-95db-251c2d40c4a3",
+        "id": "1729291107869359000.b1ced12d-8834-45e3-aed3-872bd0ff0931",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -27973,7 +28260,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747884664810.5edff459-970a-4229-aabd-217f33757c97"
+              "reference": "Organization/1729291107868603000.0db264d7-8129-4475-86c5-f678dc2c7adc"
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@@ -27989,10 +28276,10 @@
       }
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-      "fullUrl": "ServiceRequest/1708034748011446942.dcc81434-af44-4498-a88a-657773aec8f1",
+      "fullUrl": "ServiceRequest/1729291107880225000.b792767a-10c5-4557-8cca-e4d731bb1d38",
       "resource": {
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-        "id": "1708034748011446942.dcc81434-af44-4498-a88a-657773aec8f1",
+        "id": "1729291107880225000.b792767a-10c5-4557-8cca-e4d731bb1d38",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -28004,13 +28291,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747944041013.4cf4f367-dd41-4bed-ae71-8abf8ae9752e"
+                  "reference": "Organization/1729291107875021000.15df78c9-6e7e-415b-9bd8-7c31af26b642"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034747951659213.b7c4abe4-5697-4a7b-8f85-3a871f51dac3"
+                  "reference": "Organization/1729291107875874000.5d6b29a6-d8db-4763-9fd4-9b6ab518caab"
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@@ -28038,7 +28325,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034747975861990.09c55d9f-f382-43f7-9eb9-cdbdd655a2b4"
+                  "reference": "Practitioner/1729291107877162000.3ddbff6b-ed21-4a53-bcfe-d52c56526d93"
                 }
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             ]
@@ -28100,6 +28387,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -28178,7 +28469,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034748007374443.7cb0b678-0d11-4427-951c-59bb0caeefe0"
+                  "reference": "Practitioner/1729291107879573000.35595d03-7539-4a56-9d6d-01764b731a46"
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@@ -28276,18 +28567,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034747906748947.35684eb0-2384-4862-834e-35f62c8429e8"
+          "reference": "PractitionerRole/1729291107870304000.2db6f675-d3ed-4298-a9bb-c21a0f2df68e"
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     {
-      "fullUrl": "Organization/1708034747907420823.9e93ba31-0db0-4b3d-9e8c-fb7fb37f0cd9",
+      "fullUrl": "Organization/1729291107870517000.f7d1b84f-91be-4b41-820b-d5f46e22bb0b",
       "resource": {
         "resourceType": "Organization",
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+        "id": "1729291107870517000.f7d1b84f-91be-4b41-820b-d5f46e22bb0b",
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@@ -28302,10 +28593,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107871475000.424badd1-e9f9-42a0-9cec-8029f7148075",
       "resource": {
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-        "id": "1708034747919736719.3f3a7726-98bc-4c90-bfca-1d5c93065269",
+        "id": "1729291107871475000.424badd1-e9f9-42a0-9cec-8029f7148075",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -28357,7 +28648,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747907420823.9e93ba31-0db0-4b3d-9e8c-fb7fb37f0cd9"
+              "reference": "Organization/1729291107870517000.f7d1b84f-91be-4b41-820b-d5f46e22bb0b"
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@@ -28373,10 +28664,10 @@
       }
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+      "fullUrl": "Organization/1729291107872784000.2575b1b8-e742-435d-b5ad-c6dc1382a27b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747927123946.b6824a84-9c60-4091-9204-0dd3a2f08866",
+        "id": "1729291107872784000.2575b1b8-e742-435d-b5ad-c6dc1382a27b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -28440,12 +28731,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -28470,23 +28755,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1708034747906748947.35684eb0-2384-4862-834e-35f62c8429e8",
+      "fullUrl": "PractitionerRole/1729291107870304000.2db6f675-d3ed-4298-a9bb-c21a0f2df68e",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1708034747906748947.35684eb0-2384-4862-834e-35f62c8429e8",
+        "id": "1729291107870304000.2db6f675-d3ed-4298-a9bb-c21a0f2df68e",
         "practitioner": {
-          "reference": "Practitioner/1708034747919736719.3f3a7726-98bc-4c90-bfca-1d5c93065269"
+          "reference": "Practitioner/1729291107871475000.424badd1-e9f9-42a0-9cec-8029f7148075"
         },
         "organization": {
-          "reference": "Organization/1708034747927123946.b6824a84-9c60-4091-9204-0dd3a2f08866"
+          "reference": "Organization/1729291107872784000.2575b1b8-e742-435d-b5ad-c6dc1382a27b"
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     {
-      "fullUrl": "Organization/1708034747944041013.4cf4f367-dd41-4bed-ae71-8abf8ae9752e",
+      "fullUrl": "Organization/1729291107875021000.15df78c9-6e7e-415b-9bd8-7c31af26b642",
       "resource": {
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-        "id": "1708034747944041013.4cf4f367-dd41-4bed-ae71-8abf8ae9752e",
+        "id": "1729291107875021000.15df78c9-6e7e-415b-9bd8-7c31af26b642",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -28550,12 +28835,6 @@
             "type": {
               "coding": [
                 {
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-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "NPI"
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@@ -28568,10 +28847,10 @@
       }
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-      "fullUrl": "Organization/1708034747951659213.b7c4abe4-5697-4a7b-8f85-3a871f51dac3",
+      "fullUrl": "Organization/1729291107875874000.5d6b29a6-d8db-4763-9fd4-9b6ab518caab",
       "resource": {
         "resourceType": "Organization",
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+        "id": "1729291107875874000.5d6b29a6-d8db-4763-9fd4-9b6ab518caab",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -28635,12 +28914,6 @@
             "type": {
               "coding": [
                 {
-                  "extension": [
-                    {
-                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/code-index-name",
-                      "valueString": "identifier"
-                    }
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -28653,10 +28926,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747960003341.98852f83-2265-478e-a918-2e95baffe83e",
+      "fullUrl": "Organization/1729291107876409000.8cfe1322-ce39-4c54-96df-0f7a9dd50e31",
       "resource": {
         "resourceType": "Organization",
-        "id": "1708034747960003341.98852f83-2265-478e-a918-2e95baffe83e",
+        "id": "1729291107876409000.8cfe1322-ce39-4c54-96df-0f7a9dd50e31",
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@@ -28671,10 +28944,10 @@
       }
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-      "fullUrl": "Practitioner/1708034747975861990.09c55d9f-f382-43f7-9eb9-cdbdd655a2b4",
+      "fullUrl": "Practitioner/1729291107877162000.3ddbff6b-ed21-4a53-bcfe-d52c56526d93",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034747975861990.09c55d9f-f382-43f7-9eb9-cdbdd655a2b4",
+        "id": "1729291107877162000.3ddbff6b-ed21-4a53-bcfe-d52c56526d93",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -28722,7 +28995,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747960003341.98852f83-2265-478e-a918-2e95baffe83e"
+              "reference": "Organization/1729291107876409000.8cfe1322-ce39-4c54-96df-0f7a9dd50e31"
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@@ -28738,10 +29011,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034747999119745.ec45b96a-d137-40e3-8b58-993644832f14",
+      "fullUrl": "Organization/1729291107878689000.9a61530c-0dd2-45f4-a7df-7e8801538a30",
       "resource": {
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-        "id": "1708034747999119745.ec45b96a-d137-40e3-8b58-993644832f14",
+        "id": "1729291107878689000.9a61530c-0dd2-45f4-a7df-7e8801538a30",
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@@ -28756,10 +29029,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107879573000.35595d03-7539-4a56-9d6d-01764b731a46",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034748007374443.7cb0b678-0d11-4427-951c-59bb0caeefe0",
+        "id": "1729291107879573000.35595d03-7539-4a56-9d6d-01764b731a46",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -28807,7 +29080,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034747999119745.ec45b96a-d137-40e3-8b58-993644832f14"
+              "reference": "Organization/1729291107878689000.9a61530c-0dd2-45f4-a7df-7e8801538a30"
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@@ -28823,10 +29096,10 @@
       }
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     {
-      "fullUrl": "ServiceRequest/1708034748095480648.ec0912a6-0773-40b0-a793-d6a0dc28332f",
+      "fullUrl": "ServiceRequest/1729291107890794000.1b8d1c45-eb0d-41a0-91ea-676fedd7645b",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1708034748095480648.ec0912a6-0773-40b0-a793-d6a0dc28332f",
+        "id": "1729291107890794000.1b8d1c45-eb0d-41a0-91ea-676fedd7645b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -28838,13 +29111,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034748070563993.43763d31-4943-4f8d-9df3-da539e89d850"
+                  "reference": "Organization/1729291107885687000.e668bf26-2a93-40a6-970d-535b4e8cf2df"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034748078739285.8982a50c-ea19-4017-ae16-8fe12db0f059"
+                  "reference": "Organization/1729291107886764000.5a1c460c-f08d-4801-bd64-d2d2338eb078"
                 }
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               {
@@ -28872,7 +29145,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034748087539206.6f4df170-d06c-41a3-a08f-eedbccc39d34"
+                  "reference": "Practitioner/1729291107888108000.1ebadded-e239-4931-8a94-9f033bd6fc02"
                 }
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             ]
@@ -28934,6 +29207,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -29012,7 +29289,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1708034748093607173.3ea8c8d8-caab-4aab-9b60-3f6894969d44"
+                  "reference": "Practitioner/1729291107890313000.ac26b3a9-330a-48ca-9937-fcd250763a41"
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@@ -29110,18 +29387,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "requester": {
-          "reference": "PractitionerRole/1708034748013173806.2ab99828-773b-4061-a05f-8b972ad6c497"
+          "reference": "PractitionerRole/1729291107880438000.0ed18c71-abd4-4312-87b1-9e5a01b28016"
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         "resourceType": "Organization",
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+        "id": "1729291107880714000.07329767-5015-4e21-ad71-e2bd93ac7c32",
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@@ -29136,10 +29413,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107881902000.664535c5-69c0-4006-83f0-636caa0a1a7f",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1708034748019216256.28a98946-3c0d-44c4-9c3a-6f7163809891",
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@@ -29191,7 +29468,7 @@
             },
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             "assigner": {
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@@ -29207,10 +29484,10 @@
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         "extension": [
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@@ -29274,12 +29551,6 @@
             "type": {
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                 {
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@@ -29304,23 +29575,23 @@
       }
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       "resource": {
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         "practitioner": {
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+          "reference": "Practitioner/1729291107881902000.664535c5-69c0-4006-83f0-636caa0a1a7f"
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-          "reference": "Organization/1708034748023462116.72fb8989-35ca-4014-b5eb-76ceb0db8f65"
+          "reference": "Organization/1729291107883386000.879db09c-f18d-4fb7-a4af-e114b4e51e55"
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-      "fullUrl": "Organization/1708034748070563993.43763d31-4943-4f8d-9df3-da539e89d850",
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@@ -29384,12 +29655,6 @@
             "type": {
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                   "code": "NPI"
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@@ -29402,10 +29667,10 @@
       }
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@@ -29469,12 +29734,6 @@
             "type": {
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -29487,10 +29746,10 @@
       }
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-      "fullUrl": "Organization/1708034748085126918.da61c8d1-9ec9-4d61-923c-0d036f0847ea",
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@@ -29505,10 +29764,10 @@
       }
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       "resource": {
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@@ -29556,7 +29815,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729291107887329000.e6131390-305a-489f-8bf8-def6273e247d"
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@@ -29572,10 +29831,10 @@
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       "resource": {
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@@ -29590,10 +29849,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107890313000.ac26b3a9-330a-48ca-9937-fcd250763a41",
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         "extension": [
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@@ -29641,7 +29900,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729291107889563000.6b139ae0-4038-4b25-b08e-1c399eb3439b"
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@@ -29657,10 +29916,10 @@
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       "resource": {
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-        "id": "1708034748224323255.2f6908f8-59b3-463e-bfda-22d5af904c66",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -29672,13 +29931,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1708034748175116849.02c53967-483e-4330-8bc8-43db163ce066"
+                  "reference": "Organization/1729291107896378000.f2e1fcb8-dea7-4d39-97fe-5b10517b7df8"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729291107897484000.f6309b2a-92cd-4609-9755-d5c1103370bd"
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@@ -29706,7 +29965,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1708034748194425193.bb3ea9f7-147f-4265-a9cd-931e9a719bb0"
+                  "reference": "Practitioner/1729291107899779000.048692aa-c53f-4b79-b758-4c35811a4067"
                 }
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@@ -29768,6 +30027,10 @@
                 "url": "OBR.22",
                 "valueString": "20230606191613"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.29",
                 "valueIdentifier": {
@@ -29846,7 +30109,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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+                  "reference": "Practitioner/1729291107905027000.e5bbef14-3c35-4076-a9c0-2fa841aa5f35"
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@@ -29944,18 +30207,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
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         "requester": {
-          "reference": "PractitionerRole/1708034748096156919.bc2e2727-5d81-46d4-9f92-5a1dc3c9de65"
+          "reference": "PractitionerRole/1729291107890963000.9de57c68-9be2-4e3a-af11-5a471141bab3"
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       "resource": {
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@@ -29970,10 +30233,10 @@
       }
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+        "id": "1729291107892093000.66f33408-f8b5-4669-a0b1-d7941397cdc5",
         "extension": [
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@@ -30025,7 +30288,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1708034748096733950.72a871cc-b10c-44e2-a6de-e2bd0a582f61"
+              "reference": "Organization/1729291107891173000.627e164d-3ace-4800-86b9-284e0b59ffc1"
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@@ -30041,10 +30304,10 @@
       }
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+      "fullUrl": "Organization/1729291107893453000.61bf2ef4-dcf7-4b61-b0f7-d02e6d6295fa",
       "resource": {
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+        "id": "1729291107893453000.61bf2ef4-dcf7-4b61-b0f7-d02e6d6295fa",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -30108,12 +30371,6 @@
             "type": {
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                 {
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                   "code": "NPI"
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@@ -30138,23 +30395,23 @@
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-      "fullUrl": "PractitionerRole/1708034748096156919.bc2e2727-5d81-46d4-9f92-5a1dc3c9de65",
+      "fullUrl": "PractitionerRole/1729291107890963000.9de57c68-9be2-4e3a-af11-5a471141bab3",
       "resource": {
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+        "id": "1729291107890963000.9de57c68-9be2-4e3a-af11-5a471141bab3",
         "practitioner": {
-          "reference": "Practitioner/1708034748144995726.622d4234-0284-4d20-932c-66811082a688"
+          "reference": "Practitioner/1729291107892093000.66f33408-f8b5-4669-a0b1-d7941397cdc5"
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         "organization": {
-          "reference": "Organization/1708034748154390658.fdc3488f-2520-4eed-81d5-1cf971fe6abc"
+          "reference": "Organization/1729291107893453000.61bf2ef4-dcf7-4b61-b0f7-d02e6d6295fa"
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+      "fullUrl": "Organization/1729291107896378000.f2e1fcb8-dea7-4d39-97fe-5b10517b7df8",
       "resource": {
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-        "id": "1708034748175116849.02c53967-483e-4330-8bc8-43db163ce066",
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         "extension": [
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@@ -30218,12 +30475,6 @@
             "type": {
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                   "code": "NPI"
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@@ -30236,10 +30487,10 @@
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         "extension": [
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@@ -30303,12 +30554,6 @@
             "type": {
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                 {
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-                      "valueString": "identifier"
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                   "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                   "code": "Submitter ID"
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@@ -30321,10 +30566,10 @@
       }
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     {
-      "fullUrl": "Organization/1708034748185729774.de331901-9b4e-43d9-b2ca-bf3f06cdeee1",
+      "fullUrl": "Organization/1729291107898206000.c0f916f9-5f20-4362-a7a3-28b3bfd58406",
       "resource": {
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+        "id": "1729291107898206000.c0f916f9-5f20-4362-a7a3-28b3bfd58406",
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@@ -30339,10 +30584,10 @@
       }
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-      "fullUrl": "Practitioner/1708034748194425193.bb3ea9f7-147f-4265-a9cd-931e9a719bb0",
+      "fullUrl": "Practitioner/1729291107899779000.048692aa-c53f-4b79-b758-4c35811a4067",
       "resource": {
         "resourceType": "Practitioner",
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+        "id": "1729291107899779000.048692aa-c53f-4b79-b758-4c35811a4067",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -30390,7 +30635,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1708034748185729774.de331901-9b4e-43d9-b2ca-bf3f06cdeee1"
+              "reference": "Organization/1729291107898206000.c0f916f9-5f20-4362-a7a3-28b3bfd58406"
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@@ -30406,10 +30651,10 @@
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+      "fullUrl": "Organization/1729291107903277000.21aa040a-b2d9-497c-8401-6c91084be498",
       "resource": {
         "resourceType": "Organization",
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+        "id": "1729291107903277000.21aa040a-b2d9-497c-8401-6c91084be498",
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@@ -30424,10 +30669,10 @@
       }
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+      "fullUrl": "Practitioner/1729291107905027000.e5bbef14-3c35-4076-a9c0-2fa841aa5f35",
       "resource": {
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@@ -30475,7 +30720,7 @@
             },
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@@ -30506,13 +30751,13 @@
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@@ -30778,18 +31027,18 @@
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@@ -30942,12 +31191,6 @@
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@@ -31052,12 +31295,6 @@
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-            "reference": "Observation/1708034746412505233.a1de33fa-20ff-4af2-9020-6faf75555e37"
+            "reference": "Observation/1729291107711352000.bc7b5392-4460-43d2-8b01-dd6069a7fbca"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1708034748550803293.d8a67a8d-795c-41e8-9437-dee2494019ef",
+      "fullUrl": "DiagnosticReport/1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1708034748550803293.d8a67a8d-795c-41e8-9437-dee2494019ef",
+        "id": "1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7",
         "identifier": [
           {
             "extension": [
@@ -33478,7 +33709,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1708034748308527393.94affa51-2050-4398-8b15-0fc772d91304"
+            "reference": "ServiceRequest/1729291107928381000.393a5e55-bf48-4df3-9b33-0d5c0f319080"
           }
         ],
         "status": "final",
@@ -33502,7 +33733,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1708034743444726968.88adbfe1-1520-47e6-b3e1-e17a8eb7ecd6"
+          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -33524,12 +33755,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1708034746853779371.8d7c6e7b-78ff-4b50-934f-73f474387217"
+            "reference": "Specimen/1729291107728890000.b65e0a21-8472-43c5-8186-c66a4167448e"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1708034746454582530.5bd4177d-a4c0-42f2-bddb-d67f0bbd56cf"
+            "reference": "Observation/1729291107713347000.12695555-420d-4590-be82-8d646ab4b90b"
           }
         ]
       }
diff --git a/examples/MN/004_MN_ORU_R01_NBS_3_hl7_translation_final.hl7 b/examples/MN/004_MN_ORU_R01_NBS_3_hl7_translation_final.hl7
index 0c5c1287d..b4b492080 100644
--- a/examples/MN/004_MN_ORU_R01_NBS_3_hl7_translation_final.hl7
+++ b/examples/MN/004_MN_ORU_R01_NBS_3_hl7_translation_final.hl7
@@ -1,140 +1 @@
-MSH|^~\&|Natus^natus.health.state.mn.us^DNS|MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|Epic^1.2.840.114350.1.13.145.2.7.2.695071^ISO|Centracare^centracare.com^DNS|20230606192849-0500||ORU^R01^ORU_R01|20230607002849_0365|P|2.5.1|||AL|AL|||||LRI_NG_FRN_PROFILE^^2.16.840.1.113883.9.195.3.4^ISO~LRI_NDBS_COMPONENT^^2.16.840.1.113883.9.195.3.6^ISO~LAB_PRN_Component^^2.16.840.1.113883.9.81^ISO~LAB_TO_COMPONENT^^2.16.840.1.113883.9.22^ISO
-PID|1||11102779^^^CRPMRN^MR||SMITH^BB SARAH^^^^L||20230504131000||||555 STATE HIGHWAY 13^^DEER CREEK^MN^565279657^^H|||||||||||||||||||N
-NK1|1|SMITH^SADIE^S^^^^L|MTH^Mother^HL70063^^^^^^Mother|555 STATE HIGHWAY 13^^DEER CREEK^MN^565279657^USA^H|^^PH^^^763^5555555^^(763)555-5555^^^7635555555
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
-OBR|1|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57128-1^Newborn Screening Report summary panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
-OBX|1|CWE|57718-9^Sample quality of Dried blood spot^LN||LA12432-3^Acceptable^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|2|CWE|57130-7^Newborn screening report - overall interpretation^LN||LA12428-1^All screening is in range for the conditions tested^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|3|FT|69969-4^Newborn screening report overall laboratory comment^LN||Resources: An MDH genetic counselor is available for consultation regarding screening results at 651-201-3548. Disorder fact sheets and specialist contact list can be found here: https://www.health.state.mn.us/people/newbornscreening/materials/factsheets/bloodspotdisorders.html\.br\The purpose of newborn screening is to identify at risk infants in need of diagnostic testing. As with any screening test, false positive or false negative results are possible. Newborn screening is insufficient information on which to base, or rule out, diagnosis or treatment. CF variant analysis is completed using the Luminex xTAG Cystic Fibrosis (CFTR) 39 Kit.\.br\*This real-time PCR assay was developed and its performance characteristics were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration: 21 CFR 809.30(e).\.br\**The performance characteristics of these tests were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration.\.br\***Testing is performed by Mayo Clinic Laboratories-Rochester Main Campus; 200 First Street SW, Rochester, MN 55905\.br\ ||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|4|FT|69969-4^Newborn screening report overall laboratory comment^LN||There is decreased sensitivity in screening for CMV in dried blood spots, so not all infants with congenital CMV will be identified. Of those who are identified by newborn screening, up to 80% will be unaffected.||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|5|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12538-7^CH^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|6|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22202-8^CF^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|7|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12533-8^CAH^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|8|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12532-0^BIO^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|9|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12602-1^Hb C-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|10|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12603-9^Hb D-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|11|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12604-7^Hb E-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|12|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12606-2^Hb S (sickle)-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|13|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12607-0^Hb C-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|14|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12608-8^Hb C beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|15|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12609-6^Hb D-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|16|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12610-4^Hb D beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|17|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12612-0^Hb E-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|18|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12613-8^Hb E beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|19|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12614-6^Hb SS-disease (sickle cell anemia)^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|20|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12615-3^Hb S beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|21|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12616-1^Hb SC-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|22|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12617-9^Hb SD-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|23|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12618-7^Hb SE-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|24|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12620-3^Hb S plus Hb other than A,C,D,E,O-Arab disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|25|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12621-1^Hb disease other than A, C, D, E, H,O-Arab, S^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|26|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12622-9^Hb carrier other than C, D, E, S ,O-Arab^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|27|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA16207-5^Hemoglobinopathies^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|28|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12566-8^SCID^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|29|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12541-1^GALE^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|30|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12542-9^GALK^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|31|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21165-8^Classical galactosemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|32|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12466-1^3-MCC^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|33|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12468-7^3MGA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|34|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12499-2^HMG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|35|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12464-6^2M3HBA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|36|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12474-5^BKT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|37|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12485-1^CPT-Ia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|38|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12475-2^CACT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|39|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12486-9^CPT-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|40|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12487-7^CUD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|41|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12489-3^De-Red^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|42|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12493-5^GA-1^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|43|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12511-4^MCKAT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|44|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12491-9^EMA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|45|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12495-0^GA-2^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|46|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12504-9^IBG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|47|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12524-7^SCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|48|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12465-3^2MBG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|49|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12505-6^IVA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|50|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12507-2^LCHAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|51|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12527-0^TFP^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|52|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12508-0^MAL^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|53|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12525-4^SCHAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|54|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12509-8^MCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|55|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12476-0^CBL A^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|56|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12477-8^CBL B^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|57|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12510-6^MCD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|58|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12515-5^MUT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|59|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12523-9^PROP^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|60|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12531-2^VLCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|61|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21161-7^Argininemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|62|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21162-5^Argininosuccinic aciduria^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|63|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12482-8^CIT-I^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|64|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12483-6^CIT-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|65|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12496-8^HCY^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|66|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12512-2^MET^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|67|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21168-2^Maple syrup urine disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|68|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12472-9^BIOPT-BS^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|69|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12473-7^BIOPT-REG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|70|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12500-7^H-PHE^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|71|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12520-5^PKU^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|72|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12528-8^TYR-1^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|73|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12529-6^TYR-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|74|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12530-4^TYR-III^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|75|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA25796-6^X-ALD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|76|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA25797-4^Mucopolysaccharidosis type I^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|77|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA14037-8^GAA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|78|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22279-6^Spinal muscular atrophy^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|79|ED|57129-9^Full newborn screening summary report for display or printing^LN||^TEXT^html^Base64||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-SPM|1|423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO||440500007^Blood spot specimen^SCT|||||||||||||20230603045000^20230603045000|20230605102300
-ORC|RE||20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO||||||||||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
-OBR|2|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57717-1^Newborn screen card data panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
-OBX|1|NM|8339-4^BIRTH WEIGHT MEASURED^LN|1|1769.859285|g^gram^UCUM|||||O|||20230603045000-0500||||||||||||||||AOE
-OBX|2|NM|57714-8^OBSTETRIC ESTIMATION OF GESTATIONAL AGE^LN|1|32|wk^week^UCUM|||||O|||20230603045000-0500||||||||||||||||AOE
-OBX|3|CWE|57713-0^INFANT FACTORS THAT AFFECT NEWBORN SCREENING INTERPRETATION^LN|1|LA12419-0^INFANT IN NICU AT TIME OF SPECIMEN COLLECTION^LN||||||O|||20230603045000-0500||||||||||||||||AOE
-OBX|4|CWE|MNDSIB^DOES THE BABY HAVE A DECEASED SIBLING?^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500||||||||||||||||AOE
-OBX|5|CWE|MNDEFECT^DOES THE BABY HAVE BIRTH DEFECTS?^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500||||||||||||||||AOE
-OBX|6|CWE|MNFAM^FAMILY HISTORY OF DISORDER ON MN SCREENING PANEL^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500||||||||||||||||AOE
-OBX|7|CWE|67704-7^FEEDING TYPES^LN|1|LA16914-6^BREAST MILK^LN||||||O|||20230603045000-0500||||||||||||||||AOE
-OBX|8|CWE|57723-9^UNIQUE BAR CODE NUMBER OF CURRENT SAMPLE^LN|1|0516194254||||||O|||20230603045000-0500||||||||||||||||AOE
-OBX|9|ST|62328-0^DISCHARGE PROVIDER PRACTICE PHONE NUMBER^LN|1|Daniel Davis/218-555-1000||||||O|||20230603045000-0500||||||||||||||||AOE
-OBX|10|ST|62324-9^POST-DISCHARGE PROVIDER NAME^LN|1|Davis, Daniel, MD||||||O|||20230603045000-0500||||||||||||||||AOE
-OBX|11|ST|62326-4^POST-DISCHARGE PROVIDER PRACTICE NAME^LN|1|Lakeridge Health Revere||||||O|||20230603045000-0500||||||||||||||||AOE
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|3|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54090-6^Thyroid newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN^CH^Congenital Hypothyroidism^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|4|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54078-1^Cystic fibrosis newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|46769-6^Cystic fibrosis newborn screen interpretation^LN^CF^Cystic Fibrosis^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|5|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57086-1^Congenital adrenal hyperplasia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN^CAH^Congenital Adrenal Hyperplasia^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|6|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57087-9^Biotinidase newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|46761-3^Biotinidase deficiency newborn screen interpretation^LN^BIOT^Biotinidase Deficiency^99MDH||LA18592-8^In range^LN^LBW^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|2|FT|57699-1^Biotinidase deficiency newborn screening comment/discussion^LN||For infants born weighing < 2000 grams, newborn screening results can be difficult to interpret. Transfusion status should be taken into account when interpreting screening results. Three newborn screening samples collected at 24-48 hours, 14 days, and 30 days of age will together give the care provider a better understanding of the infantaeuro(TM)s risk for screened disorders.||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|7|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54081-5^Hemoglobinopathies newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|46740-7^Hemoglobin disorders newborn screen interpretation^LN^HGB^Hemoglobinopathies^99MDH||LA18592-8^In range^LN^FA^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|2|CWE|64117-5^Most predominant hemoglobin in Dried blood spot^LN||LA16208-3^Hb F^LN||Within Normal Limits = FA||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-OBX|3|CWE|64118-3^Second most predominant hemoglobin in Dried blood spot^LN||LA16209-1^Hb A^LN||Within Normal Limits = FA||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|8|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|62333-0^Severe combined immunodeficiency (SCID) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN^SCID^Severe Combined Immunodeficiency*^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|9|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54079-9^Galactosemia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|46737-3^Galactosemias newborn screen interpretation^LN^GAL^Galactosemia^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^GJERSET^KRISTIN^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|10|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|CMV-PANEL^Cytomegalovirus DNA newborn screen panel^99MDH|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|CMV-INTERPRT^Cytomegalovirus DNA newborn screen interpretation^99MDH^CMV^Cytomegalovirus DNA^99MDH||LA18592-8^In range^LN^WNL^CMV Not Detected*^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|11|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|58092-8^Acylcarnitine newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|58088-6^Acylcarnitine newborn screen interpretation^LN^Acylcarnitine Profile^Acylcarnitine Profile^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|12|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|53261-4^Amino acid newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|46733-2^Amino acidemias newborn screen interpretation^LN^Amino Acid Profile^Amino Acid Profile^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|13|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|85267-3^X-linked adrenoleukodystrophy (X-ALD) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|85269-9^X-ALD^LN^xALD^X-linked Adrenoleukodystrophy**^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|14|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|62300-9^Lysosomal storage disorders newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|62301-7^Lysosomal storage disorders newborn screen interpretation^LN^LSD^Lysosomal Disease Profile**^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
-ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBR|15|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|92005-8^Spinal muscular atrophy newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
-OBX|1|CWE|92004-1^SMA^LN^SMA^Spinal Muscular Atrophy*^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie|||||UNSP
+MSH|^~\&|Natus^natus.health.state.mn.us^DNS|MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|Epic^1.2.840.114350.1.13.145.2.7.2.695071^ISO|Centracare^centracare.com^DNS|20230606192849-0500||ORU^R01^ORU_R01|20230607002849_0365|D|2.5.1|||AL|AL|||||LRI_NG_FRN_PROFILE^^2.16.840.1.113883.9.195.3.4^ISO~LRI_NDBS_COMPONENT^^2.16.840.1.113883.9.195.3.6^ISO~LAB_PRN_Component^^2.16.840.1.113883.9.81^ISO~LAB_TO_COMPONENT^^2.16.840.1.113883.9.22^ISO
PID|1||11102779^^^CRPMRN^MR||SMITH^BB SARAH^^^^L||20230504131000||||555 STATE HIGHWAY 13^^DEER CREEK^MN^565279657^^H|||||||||||||||||||N
NK1|1|SMITH^SADIE^S^^^^L|MTH^Mother^HL70063^^^^^^Mother|555 STATE HIGHWAY 13^^DEER CREEK^MN^565279657^USA^H|^^PH^^^763^5555555^^(763)555-5555^^^7635555555
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBR|1|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57128-1^Newborn Screening Report summary panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|CWE|57718-9^Sample quality of Dried blood spot^LN||LA12432-3^Acceptable^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|2|CWE|57130-7^Newborn screening report - overall interpretation^LN||LA12428-1^All screening is in range for the conditions tested^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|3|FT|69969-4^Newborn screening report overall laboratory comment^LN||Resources: An MDH genetic counselor is available for consultation regarding screening results at 651-201-3548. Disorder fact sheets and specialist contact list can be found here: https://www.health.state.mn.us/people/newbornscreening/materials/factsheets/bloodspotdisorders.html\.br\The purpose of newborn screening is to identify at risk infants in need of diagnostic testing. As with any screening test, false positive or false negative results are possible. Newborn screening is insufficient information on which to base, or rule out, diagnosis or treatment. CF variant analysis is completed using the Luminex xTAG Cystic Fibrosis (CFTR) 39 Kit.\.br\*This real-time PCR assay was developed and its performance characteristics were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration: 21 CFR 809.30(e).\.br\**The performance characteristics of these tests were determined by the MDH Public Health Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration.\.br\***Testing is performed by Mayo Clinic Laboratories-Rochester Main Campus; 200 First Street SW, Rochester, MN 55905\.br\ ||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|4|FT|69969-4^Newborn screening report overall laboratory comment^LN||There is decreased sensitivity in screening for CMV in dried blood spots, so not all infants with congenital CMV will be identified. Of those who are identified by newborn screening, up to 80% will be unaffected.||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|5|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12538-7^CH^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|6|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22202-8^CF^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|7|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12533-8^CAH^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|8|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12532-0^BIO^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|9|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12602-1^Hb C-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|10|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12603-9^Hb D-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|11|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12604-7^Hb E-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|12|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12606-2^Hb S (sickle)-carrier^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|13|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12607-0^Hb C-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|14|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12608-8^Hb C beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|15|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12609-6^Hb D-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|16|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12610-4^Hb D beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|17|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12612-0^Hb E-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|18|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12613-8^Hb E beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|19|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12614-6^Hb SS-disease (sickle cell anemia)^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|20|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12615-3^Hb S beta-thalassemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|21|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12616-1^Hb SC-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|22|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12617-9^Hb SD-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|23|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12618-7^Hb SE-disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|24|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12620-3^Hb S plus Hb other than A,C,D,E,O-Arab disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|25|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12621-1^Hb disease other than A, C, D, E, H,O-Arab, S^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|26|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12622-9^Hb carrier other than C, D, E, S ,O-Arab^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|27|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA16207-5^Hemoglobinopathies^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|28|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12566-8^SCID^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|29|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12541-1^GALE^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|30|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12542-9^GALK^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|31|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21165-8^Classical galactosemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|32|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12466-1^3-MCC^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|33|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12468-7^3MGA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|34|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12499-2^HMG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|35|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12464-6^2M3HBA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|36|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12474-5^BKT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|37|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12485-1^CPT-Ia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|38|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12475-2^CACT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|39|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12486-9^CPT-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|40|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12487-7^CUD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|41|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12489-3^De-Red^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|42|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12493-5^GA-1^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|43|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12511-4^MCKAT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|44|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12491-9^EMA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|45|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12495-0^GA-2^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|46|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12504-9^IBG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|47|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12524-7^SCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|48|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12465-3^2MBG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|49|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12505-6^IVA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|50|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12507-2^LCHAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|51|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12527-0^TFP^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|52|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12508-0^MAL^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|53|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12525-4^SCHAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|54|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12509-8^MCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|55|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12476-0^CBL A^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|56|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12477-8^CBL B^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|57|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12510-6^MCD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|58|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12515-5^MUT^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|59|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12523-9^PROP^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|60|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12531-2^VLCAD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|61|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21161-7^Argininemia^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|62|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21162-5^Argininosuccinic aciduria^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|63|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12482-8^CIT-I^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|64|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12483-6^CIT-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|65|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12496-8^HCY^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|66|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12512-2^MET^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|67|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21168-2^Maple syrup urine disease^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|68|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12472-9^BIOPT-BS^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|69|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12473-7^BIOPT-REG^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|70|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12500-7^H-PHE^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|71|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12520-5^PKU^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|72|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12528-8^TYR-1^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|73|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12529-6^TYR-II^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|74|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12530-4^TYR-III^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|75|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA25796-6^X-ALD^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|76|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA25797-4^Mucopolysaccharidosis type I^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|77|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA14037-8^GAA^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|78|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22279-6^Spinal muscular atrophy^LN||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||SCI|UNSP
OBX|79|ED|57129-9^Full newborn screening summary report for display or printing^LN||^TEXT^html^Base64||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
SPM|1|423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO||440500007^Blood spot specimen^SCT|||||||||||||20230603045000^20230603045000|20230605102300
ORC|RE||20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO||||||||||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBR|2|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57717-1^Newborn screen card data panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|NM|8339-4^BIRTH WEIGHT MEASURED^LN|1|1769.859285|g^gram^UCUM|||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|2|NM|57714-8^OBSTETRIC ESTIMATION OF GESTATIONAL AGE^LN|1|32|wk^week^UCUM|||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|3|CWE|57713-0^INFANT FACTORS THAT AFFECT NEWBORN SCREENING INTERPRETATION^LN|1|LA12419-0^INFANT IN NICU AT TIME OF SPECIMEN COLLECTION^LN||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|4|CWE|MNDSIB^DOES THE BABY HAVE A DECEASED SIBLING?^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|5|CWE|MNDEFECT^DOES THE BABY HAVE BIRTH DEFECTS?^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|6|CWE|MNFAM^FAMILY HISTORY OF DISORDER ON MN SCREENING PANEL^99MDH|1|N^No^99MDH||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|7|CWE|67704-7^FEEDING TYPES^LN|1|LA16914-6^BREAST MILK^LN||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|8|CWE|57723-9^UNIQUE BAR CODE NUMBER OF CURRENT SAMPLE^LN|1|0516194254||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|9|ST|62328-0^DISCHARGE PROVIDER PRACTICE PHONE NUMBER^LN|1|Daniel Davis/218-555-1000||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|10|ST|62324-9^POST-DISCHARGE PROVIDER NAME^LN|1|Davis, Daniel, MD||||||O|||20230603045000-0500|||||||||||||||QST|AOE
OBX|11|ST|62326-4^POST-DISCHARGE PROVIDER PRACTICE NAME^LN|1|Lakeridge Health Revere||||||O|||20230603045000-0500|||||||||||||||QST|AOE
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|3|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54090-6^Thyroid newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN^CH^Congenital Hypothyroidism^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|4|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54078-1^Cystic fibrosis newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46769-6^Cystic fibrosis newborn screen interpretation^LN^CF^Cystic Fibrosis^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|5|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57086-1^Congenital adrenal hyperplasia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN^CAH^Congenital Adrenal Hyperplasia^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|6|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|57087-9^Biotinidase newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46761-3^Biotinidase deficiency newborn screen interpretation^LN^BIOT^Biotinidase Deficiency^99MDH||LA18592-8^In range^LN^LBW^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|2|FT|57699-1^Biotinidase deficiency newborn screening comment/discussion^LN||For infants born weighing < 2000 grams, newborn screening results can be difficult to interpret. Transfusion status should be taken into account when interpreting screening results. Three newborn screening samples collected at 24-48 hours, 14 days, and 30 days of age will together give the care provider a better understanding of the infantaeuro(TM)s risk for screened disorders.||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|7|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54081-5^Hemoglobinopathies newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46740-7^Hemoglobin disorders newborn screen interpretation^LN^HGB^Hemoglobinopathies^99MDH||LA18592-8^In range^LN^FA^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|2|CWE|64117-5^Most predominant hemoglobin in Dried blood spot^LN||LA16208-3^Hb F^LN||Within Normal Limits = FA||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
OBX|3|CWE|64118-3^Second most predominant hemoglobin in Dried blood spot^LN||LA16209-1^Hb A^LN||Within Normal Limits = FA||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|8|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|62333-0^Severe combined immunodeficiency (SCID) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN^SCID^Severe Combined Immunodeficiency*^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|9|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|54079-9^Galactosemia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46737-3^Galactosemias newborn screen interpretation^LN^GAL^Galactosemia^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^GJERSET^KRISTIN^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|10|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|CMV-PANEL^Cytomegalovirus DNA newborn screen panel^99MDH|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|CMV-INTERPRT^Cytomegalovirus DNA newborn screen interpretation^99MDH^CMV^Cytomegalovirus DNA^99MDH||LA18592-8^In range^LN^WNL^CMV Not Detected*^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|11|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|58092-8^Acylcarnitine newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|58088-6^Acylcarnitine newborn screen interpretation^LN^Acylcarnitine Profile^Acylcarnitine Profile^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|12|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|53261-4^Amino acid newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46733-2^Amino acidemias newborn screen interpretation^LN^Amino Acid Profile^Amino Acid Profile^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|13|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|85267-3^X-linked adrenoleukodystrophy (X-ALD) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|85269-9^X-ALD^LN^xALD^X-linked Adrenoleukodystrophy**^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|14|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|62300-9^Lysosomal storage disorders newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|62301-7^Lysosomal storage disorders newborn screen interpretation^LN^LSD^Lysosomal Disease Profile**^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP
ORC|RE|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||ST. CLOUD HOSPITAL^L^^^^CMS^NPI^^^1043269798~ST. CLOUD HOSPITAL^L^^^^MN Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|15|423787478^EPIC^1.2.840.114350.1.13.145.2.7.2.695071^ISO|20231561137^MN Public Health Lab^2.16.840.1.114222.4.1.10080^ISO|92005-8^Spinal muscular atrophy newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&MN Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|92004-1^SMA^LN^SMA^Spinal Muscular Atrophy*^99MDH||LA18592-8^In range^LN^WNL^Within Normal Limits^99MDH||||||F|||20230603045000|||||20230606191613||||MDH Newborn Screening Laboratory|601 Robert St N^^St. Paul^MN^55155|^Miller^Marie||||RSLT|UNSP

From 86281d3f125779a660b854f052220c8d044aef14 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 16:08:13 -0700
Subject: [PATCH 23/30] Updated snapshots in CA folder

---
 ...U_R01_CDPH_produced_1_hl7_translation.fhir |  2046 +-
 ...1_CDPH_produced_2_fhir_transformation.fhir |  1717 +-
 ..._CDPH_produced_3_hl7_translation_final.hl7 |   155 +-
 ...U_R01_CDPH_produced_1_hl7_translation.fhir | 19511 ++++++++++
 ...1_CDPH_produced_2_fhir_transformation.fhir | 16434 +++++++++
 ..._CDPH_produced_3_hl7_translation_final.hl7 |     1 +
 ..._R01_CDPH_generated_1_hl7_translation.fhir |  1742 +-
 ..._CDPH_generated_2_fhir_transformation.fhir |  1413 +-
 ...CDPH_generated_3_hl7_translation_final.hl7 |   117 +-
 ...-07-11-16-02-17-749_1_hl7_translation.fhir |  1742 +-
 ...11-16-02-17-749_2_fhir_transformation.fhir |  1413 +-
 ...1-16-02-17-749_3_hl7_translation_final.hl7 |   117 +-
 ...-07-11-16-02-17-749_1_hl7_translation.fhir |  1694 +-
 ...11-16-02-17-749_2_fhir_transformation.fhir | 24587 +++++++------
 ...1-16-02-17-749_3_hl7_translation_final.hl7 |   111 +-
 ...CSD_order_189556932_1_hl7_translation.fhir | 15699 ++++++++
 ...order_189556932_2_fhir_transformation.fhir | 12603 +++++++
 ...rder_189556932_3_hl7_translation_final.hl7 |     2 +-
 ...CSD_order_189417053_1_hl7_translation.fhir | 15470 ++++++++
 ...order_189417053_2_fhir_transformation.fhir | 12393 +++++++
 ...rder_189417053_3_hl7_translation_final.hl7 |     2 +-
 ...CSD_order_189394505_1_hl7_translation.fhir | 15470 ++++++++
 ...order_189394505_2_fhir_transformation.fhir | 12393 +++++++
 ...rder_189394505_3_hl7_translation_final.hl7 |     2 +-
 ...CSD_order_189609160_1_hl7_translation.fhir | 15355 ++++++++
 ...order_189609160_2_fhir_transformation.fhir | 12278 +++++++
 ...rder_189609160_3_hl7_translation_final.hl7 |     2 +-
 ...-07-11-16-02-17-749_1_hl7_translation.fhir | 28208 +++++++-------
 ...11-16-02-17-749_2_fhir_transformation.fhir | 22447 ++++++------
 ...1-16-02-17-749_3_hl7_translation_final.hl7 |   111 +-
 ...-07-11-16-02-17-749_1_hl7_translation.fhir | 30606 ++++++++--------
 ...11-16-02-17-749_2_fhir_transformation.fhir | 24491 ++++++-------
 ...1-16-02-17-749_3_hl7_translation_final.hl7 |   111 +-
 ...-07-11-16-02-17-749_1_hl7_translation.fhir | 28006 +++++++-------
 ...11-16-02-17-749_2_fhir_transformation.fhir | 22239 ++++++-----
 ...1-16-02-17-749_3_hl7_translation_final.hl7 |   111 +-
 ...1_CDPH_OBX_to_LOINC_1_hl7_translation.fhir | 29392 +++++++--------
 ...PH_OBX_to_LOINC_2_fhir_transformation.fhir | 23844 ++++++------
 ...H_OBX_to_LOINC_3_hl7_translation_final.hl7 |   120 +-
 39 files changed, 270442 insertions(+), 123713 deletions(-)
 create mode 100644 examples/CA/004_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
 create mode 100644 examples/CA/004_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
 create mode 100644 examples/CA/004_CA_ORU_R01_CDPH_produced_3_hl7_translation_final.hl7
 create mode 100644 examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_1_hl7_translation.fhir
 create mode 100644 examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_2_fhir_transformation.fhir
 create mode 100644 examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_1_hl7_translation.fhir
 create mode 100644 examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_2_fhir_transformation.fhir
 create mode 100644 examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_1_hl7_translation.fhir
 create mode 100644 examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_2_fhir_transformation.fhir
 create mode 100644 examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_1_hl7_translation.fhir
 create mode 100644 examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_2_fhir_transformation.fhir

diff --git a/examples/CA/003_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir b/examples/CA/003_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
index 2e0c0d0ad..d0afe3fb7 100644
--- a/examples/CA/003_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
+++ b/examples/CA/003_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1721069430098144000.9fdf6524-5d9f-46ad-aa01-da8afed7ec22",
+  "id": "1729292709395325000.18465c09-3aeb-4dd5-8c5b-fb20faafcc09",
   "meta": {
-    "lastUpdated": "2024-07-15T11:50:30.098-07:00"
+    "lastUpdated": "2024-10-18T16:05:09.395-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,15 +12,15 @@
   "timestamp": "2024-02-12T10:30:49.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/da958340-c0b1-3570-81dd-8febc8b7e5d0",
+      "fullUrl": "MessageHeader/1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "da958340-c0b1-3570-81dd-8febc8b7e5d0",
+        "id": "1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e",
         "meta": {
           "tag": [
             {
               "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-              "code": "T"
+              "code": "D"
             }
           ]
         },
@@ -58,12 +58,12 @@
             ],
             "name": "SISHIERECEIVER",
             "receiver": {
-              "reference": "Organization/1721069430100045000.152f95da-26ca-4168-b015-21f4ba2f09bc"
+              "reference": "Organization/1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1721069430099223000.aeaaa807-f977-46ac-8a96-e0ff0ee69f95"
+          "reference": "Organization/1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db"
         },
         "source": {
           "extension": [
@@ -89,10 +89,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721069430099223000.aeaaa807-f977-46ac-8a96-e0ff0ee69f95",
+      "fullUrl": "Organization/1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721069430099223000.aeaaa807-f977-46ac-8a96-e0ff0ee69f95",
+        "id": "1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db",
         "identifier": [
           {
             "extension": [
@@ -107,10 +107,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721069430100045000.152f95da-26ca-4168-b015-21f4ba2f09bc",
+      "fullUrl": "Organization/1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721069430100045000.152f95da-26ca-4168-b015-21f4ba2f09bc",
+        "id": "1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -120,73 +120,73 @@
       }
     },
     {
-      "fullUrl": "Provenance/1721069430102331000.3c6a1925-96bb-4c31-b617-6887e3701319",
+      "fullUrl": "Provenance/1729292709397520000.0dae28e9-adbc-41ba-9290-a5d0ee62eeb2",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1721069430102331000.3c6a1925-96bb-4c31-b617-6887e3701319",
+        "id": "1729292709397520000.0dae28e9-adbc-41ba-9290-a5d0ee62eeb2",
         "target": [
           {
-            "reference": "MessageHeader/da958340-c0b1-3570-81dd-8febc8b7e5d0"
+            "reference": "MessageHeader/1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e"
           },
           {
-            "reference": "DiagnosticReport/1721069430482667000.bab87d87-2dd8-4f55-9c90-98d687fdd8a7"
+            "reference": "DiagnosticReport/1729292709701475000.6e1db083-47fd-42c0-87c9-0e22425e70ed"
           },
           {
-            "reference": "DiagnosticReport/1721069430486025000.2e5c8c63-2ac9-41d3-a993-a1ff8ddc14c2"
+            "reference": "DiagnosticReport/1729292709704498000.5d6a7cfa-6821-4aaa-b987-5774fc46136b"
           },
           {
-            "reference": "DiagnosticReport/1721069430487880000.abf4f204-4443-42ea-b947-debc7cdb3807"
+            "reference": "DiagnosticReport/1729292709706382000.ccf380db-ed26-4cb0-aa17-02825cce517a"
           },
           {
-            "reference": "DiagnosticReport/1721069430489507000.dfaee520-028a-4852-9662-edc21e90c21d"
+            "reference": "DiagnosticReport/1729292709707919000.ffae80cd-eca1-466d-8498-0349d45ad767"
           },
           {
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@@ -2777,7 +2777,7 @@
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@@ -2869,7 +2869,7 @@
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@@ -2961,7 +2961,7 @@
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@@ -3053,7 +3053,7 @@
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@@ -3145,7 +3145,7 @@
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@@ -3237,7 +3237,7 @@
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@@ -14296,7 +14296,7 @@
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+          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
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@@ -14334,10 +14334,10 @@
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@@ -14347,10 +14347,10 @@
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@@ -14360,10 +14360,10 @@
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@@ -14373,10 +14373,10 @@
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@@ -14386,10 +14386,10 @@
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@@ -14399,10 +14399,10 @@
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@@ -14412,10 +14412,10 @@
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@@ -14425,10 +14425,10 @@
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@@ -14438,10 +14438,10 @@
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@@ -14451,10 +14451,10 @@
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@@ -14464,10 +14464,10 @@
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@@ -14477,10 +14477,10 @@
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@@ -14490,10 +14490,10 @@
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@@ -14503,10 +14503,10 @@
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@@ -14516,10 +14516,10 @@
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@@ -14529,10 +14529,10 @@
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@@ -14542,10 +14542,10 @@
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@@ -14555,10 +14555,10 @@
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@@ -14568,10 +14568,10 @@
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@@ -14581,10 +14581,10 @@
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@@ -14594,10 +14594,10 @@
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@@ -14609,7 +14609,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Organization/1729292709618697000.78c8c70c-96f3-4a2d-8be5-a6a66b81b5ad"
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@@ -14642,7 +14642,7 @@
               {
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                 "valueReference": {
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@@ -14671,10 +14671,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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@@ -14776,18 +14780,18 @@
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@@ -14814,10 +14818,10 @@
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@@ -14876,23 +14880,23 @@
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@@ -14913,10 +14917,10 @@
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@@ -14939,10 +14943,10 @@
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@@ -14965,10 +14969,10 @@
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@@ -14977,10 +14981,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
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+              {
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+                "valueId": "F"
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@@ -15030,18 +15038,18 @@
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@@ -15068,10 +15076,10 @@
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@@ -15094,10 +15102,10 @@
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@@ -15106,10 +15114,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
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+              {
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+                "valueId": "F"
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+                  "reference": "Practitioner/1729292709628911000.3006c42c-4c3a-4125-b769-9b009e9f4783"
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@@ -15159,18 +15171,18 @@
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@@ -15197,10 +15209,10 @@
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         "extension": [
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@@ -15223,10 +15235,10 @@
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@@ -15235,10 +15247,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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@@ -15288,18 +15304,18 @@
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+          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
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+          "reference": "Practitioner/1729292709630324000.e49b83ba-b57f-43a8-a20f-e0fab376d803"
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+      "fullUrl": "Practitioner/1729292709630324000.e49b83ba-b57f-43a8-a20f-e0fab376d803",
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@@ -15326,10 +15342,10 @@
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@@ -15352,10 +15368,10 @@
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@@ -15364,10 +15380,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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@@ -15417,18 +15437,18 @@
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+          "reference": "Practitioner/1729292709634379000.42d95b23-11b3-4e88-8156-ef5189bc2f84"
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         "extension": [
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@@ -15455,10 +15475,10 @@
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         "extension": [
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@@ -15481,10 +15501,10 @@
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@@ -15493,10 +15513,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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@@ -15546,18 +15570,18 @@
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+          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
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+          "reference": "Practitioner/1729292709638427000.299a4fb0-044b-45b6-9b50-2db3eae298ea"
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+      "fullUrl": "Practitioner/1729292709638427000.299a4fb0-044b-45b6-9b50-2db3eae298ea",
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         "extension": [
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@@ -15584,10 +15608,10 @@
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@@ -15610,10 +15634,10 @@
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@@ -15622,10 +15646,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
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+                "valueId": "F"
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+                  "reference": "Practitioner/1729292709645073000.6dfafa17-0625-4cfb-9ad1-169dea7b7840"
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@@ -15675,18 +15703,18 @@
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@@ -15713,10 +15741,10 @@
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@@ -15739,10 +15767,10 @@
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@@ -15751,10 +15779,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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@@ -15804,18 +15836,18 @@
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@@ -15842,10 +15874,10 @@
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@@ -15868,10 +15900,10 @@
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@@ -15880,10 +15912,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
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+              {
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+                "valueId": "F"
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@@ -15933,18 +15969,18 @@
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@@ -15971,10 +16007,10 @@
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@@ -15997,10 +16033,10 @@
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@@ -16009,10 +16045,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
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+              {
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+                "valueId": "F"
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+                  "reference": "Practitioner/1729292709657256000.0581a934-da36-4710-a88c-be96c809e68d"
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@@ -16062,18 +16102,18 @@
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@@ -16100,10 +16140,10 @@
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@@ -16126,10 +16166,10 @@
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@@ -16138,10 +16178,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729292709661310000.5c712ad5-cf5c-4014-a5b1-be99fafa7d4b"
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@@ -16191,18 +16235,18 @@
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+          "reference": "Practitioner/1729292709658643000.5c81d9f4-43a2-4b51-bdaa-8d2f2c3f7a22"
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+      "fullUrl": "Practitioner/1729292709658643000.5c81d9f4-43a2-4b51-bdaa-8d2f2c3f7a22",
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         "extension": [
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@@ -16229,10 +16273,10 @@
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@@ -16255,10 +16299,10 @@
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@@ -16267,10 +16311,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729292709665357000.ba5deabd-ab57-480e-a8da-bb1fe61f1fce"
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@@ -16320,18 +16368,18 @@
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+          "reference": "Practitioner/1729292709662692000.29d062db-4b5d-4d4b-9776-4dcaa3a65679"
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@@ -16358,10 +16406,10 @@
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@@ -16384,10 +16432,10 @@
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         "extension": [
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@@ -16396,10 +16444,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729292709669367000.53ae8e90-2f94-402c-9c8f-f16a707060f3"
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@@ -16449,18 +16501,18 @@
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+          "reference": "Practitioner/1729292709666760000.272f7d9b-5e73-4c80-9793-70d608ddee58"
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+      "fullUrl": "Practitioner/1729292709666760000.272f7d9b-5e73-4c80-9793-70d608ddee58",
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@@ -16487,10 +16539,10 @@
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@@ -16513,10 +16565,10 @@
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@@ -16525,10 +16577,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729292709673442000.4aaa5922-ab9d-44c1-9d09-a638e15300aa"
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@@ -16578,18 +16634,18 @@
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+          "reference": "Practitioner/1729292709670780000.bbebd610-0b4a-4a98-b6cc-7832ca4a0a91"
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+      "fullUrl": "Practitioner/1729292709670780000.bbebd610-0b4a-4a98-b6cc-7832ca4a0a91",
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@@ -16616,10 +16672,10 @@
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+      "fullUrl": "Practitioner/1729292709673442000.4aaa5922-ab9d-44c1-9d09-a638e15300aa",
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@@ -16642,10 +16698,10 @@
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@@ -16654,10 +16710,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
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@@ -16707,18 +16767,18 @@
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@@ -16745,10 +16805,10 @@
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@@ -16771,10 +16831,10 @@
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@@ -16783,10 +16843,14 @@
                 "url": "OBR.22",
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@@ -16836,18 +16900,18 @@
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@@ -16874,10 +16938,10 @@
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@@ -16900,10 +16964,10 @@
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@@ -16912,10 +16976,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
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@@ -16965,18 +17033,18 @@
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@@ -17003,10 +17071,10 @@
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@@ -17029,10 +17097,10 @@
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@@ -17041,10 +17109,14 @@
                 "url": "OBR.22",
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@@ -17094,18 +17166,18 @@
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@@ -17132,10 +17204,10 @@
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@@ -17158,10 +17230,10 @@
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@@ -17170,10 +17242,14 @@
                 "url": "OBR.22",
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@@ -17228,18 +17304,18 @@
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@@ -17266,10 +17342,10 @@
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@@ -17292,10 +17368,10 @@
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@@ -17304,10 +17380,14 @@
                 "url": "OBR.22",
                 "valueString": "20240212103049"
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@@ -17362,18 +17442,18 @@
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@@ -17400,10 +17480,10 @@
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@@ -17426,10 +17506,10 @@
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@@ -17504,7 +17584,7 @@
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@@ -17523,7 +17603,7 @@
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@@ -17545,16 +17625,16 @@
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+      "fullUrl": "DiagnosticReport/1729292709730326000.1be2950e-7895-4297-b73e-b790f288c464",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721069430519776000.12e00014-0172-4f0b-b771-94206663bbba",
+        "id": "1729292709730326000.1be2950e-7895-4297-b73e-b790f288c464",
         "identifier": [
           {
             "extension": [
@@ -19337,7 +19417,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1721069430469621000.a52c863c-81d4-4e61-b7c9-df8bccbfed5b"
+            "reference": "ServiceRequest/1729292709690137000.29615475-5341-4ca8-b11a-acec512b3551"
           }
         ],
         "status": "final",
@@ -19356,7 +19436,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1721069430110583000.f973956e-19b9-4519-925c-8a626a0e96bd"
+          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
         },
         "effectiveDateTime": "2024-02-08T14:50:00Z",
         "_effectiveDateTime": {
@@ -19378,30 +19458,30 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1721069430364115000.4a03ee22-554d-4601-9675-476479539b27"
+            "reference": "Specimen/1729292709613800000.42bc26f5-8897-43bd-bcde-6d2d478cd6c9"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1721069430342733000.799fe43a-de49-4e3d-ba8c-545b1ea41005"
+            "reference": "Observation/1729292709595321000.97d9ed93-a89c-4824-8216-ab85d2ecd4e8"
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           {
-            "reference": "Observation/1721069430344021000.a708b8f3-10bd-41fb-8d50-a585ed8395f3"
+            "reference": "Observation/1729292709596383000.e258ff78-6118-43a4-a675-e2364b96e418"
           },
           {
-            "reference": "Observation/1721069430345150000.e6809e6e-c278-4da0-b699-aaaa0cc83df9"
+            "reference": "Observation/1729292709597340000.a7215db3-150a-4365-90b5-357a6ffdb80f"
           },
           {
-            "reference": "Observation/1721069430346254000.04dd19c5-df8e-4d4e-960d-a5f679bfc3c5"
+            "reference": "Observation/1729292709598263000.d4ed8fea-c648-4277-a378-bb8d7eee69cb"
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         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1721069430523155000.e8b5f25d-382d-4457-bacb-3637714c73d1",
+      "fullUrl": "DiagnosticReport/1729292709731796000.7881396a-2298-409b-b258-57c8465cb1fa",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721069430523155000.e8b5f25d-382d-4457-bacb-3637714c73d1",
+        "id": "1729292709731796000.7881396a-2298-409b-b258-57c8465cb1fa",
         "identifier": [
           {
             "extension": [
@@ -19432,7 +19512,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1721069430474279000.fc055949-3fd9-4227-aea4-2a392d489089"
+            "reference": "ServiceRequest/1729292709694168000.4e0b8372-d2bb-48f3-ae7b-572fbfba3113"
           }
         ],
         "status": "final",
@@ -19456,7 +19536,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1721069430110583000.f973956e-19b9-4519-925c-8a626a0e96bd"
+          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
         },
         "effectiveDateTime": "2024-02-08T14:50:00Z",
         "_effectiveDateTime": {
@@ -19478,24 +19558,24 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1721069430364526000.dd43a98b-9d6d-412b-b68a-7a3700a8dce6"
+            "reference": "Specimen/1729292709614140000.2f304a8e-0054-4b1b-8304-03582bc7f953"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1721069430347518000.0ef609f1-6794-4cbc-9d44-f36f47399617"
+            "reference": "Observation/1729292709599305000.89b891cb-5fbc-450c-a4b6-816e543e1af0"
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           {
-            "reference": "Observation/1721069430348633000.eb58b6b2-fb79-4d35-b383-5e7e07052d09"
+            "reference": "Observation/1729292709600244000.a03819e1-f181-4d68-89f6-57f35eb9e05e"
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         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1721069430526485000.13133581-a7aa-4bc9-b135-60906332b2a0",
+      "fullUrl": "DiagnosticReport/1729292709733215000.12c48fca-307a-4cdc-8c2d-71236132fb57",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721069430526485000.13133581-a7aa-4bc9-b135-60906332b2a0",
+        "id": "1729292709733215000.12c48fca-307a-4cdc-8c2d-71236132fb57",
         "identifier": [
           {
             "extension": [
@@ -19526,7 +19606,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1721069430478951000.1dd279c7-188a-49f1-a2cf-09d9644b1e56"
+            "reference": "ServiceRequest/1729292709698258000.fd0d2940-41f6-4cda-a3ad-a3ce9f82f0d2"
           }
         ],
         "status": "final",
@@ -19550,7 +19630,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1721069430110583000.f973956e-19b9-4519-925c-8a626a0e96bd"
+          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
         },
         "effectiveDateTime": "2024-02-08T14:50:00Z",
         "_effectiveDateTime": {
@@ -19572,12 +19652,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1721069430364939000.4363f137-825e-4e1e-8ea5-47d056d64486"
+            "reference": "Specimen/1729292709614475000.d14ad60e-3145-433e-8f7a-a3ecd9b23ce1"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1721069430349889000.c2a34350-2ee2-4ee9-9398-5e934d86636a"
+            "reference": "Observation/1729292709601317000.e71e21d6-df9d-4d21-8750-46b80fc9650c"
           }
         ]
       }
diff --git a/examples/CA/003_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir b/examples/CA/003_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
index d67bde753..7d6e3c83d 100644
--- a/examples/CA/003_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
+++ b/examples/CA/003_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1721069430098144000.9fdf6524-5d9f-46ad-aa01-da8afed7ec22",
+  "id": "1729292709395325000.18465c09-3aeb-4dd5-8c5b-fb20faafcc09",
   "meta": {
-    "lastUpdated": "2024-07-15T11:50:30.098-07:00"
+    "lastUpdated": "2024-10-18T16:05:09.395-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,15 +12,15 @@
   "timestamp": "2024-02-12T10:30:49.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/da958340-c0b1-3570-81dd-8febc8b7e5d0",
+      "fullUrl": "MessageHeader/1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "da958340-c0b1-3570-81dd-8febc8b7e5d0",
+        "id": "1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e",
         "meta": {
           "tag": [
             {
               "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-              "code": "T"
+              "code": "D"
             },
             {
               "system": "http://localcodes.org/ETOR",
@@ -55,12 +55,12 @@
             ],
             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1721069430100045000.152f95da-26ca-4168-b015-21f4ba2f09bc"
+              "reference": "Organization/1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1721069430099223000.aeaaa807-f977-46ac-8a96-e0ff0ee69f95"
+          "reference": "Organization/1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db"
         },
         "source": {
           "extension": [
@@ -86,10 +86,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721069430099223000.aeaaa807-f977-46ac-8a96-e0ff0ee69f95",
+      "fullUrl": "Organization/1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721069430099223000.aeaaa807-f977-46ac-8a96-e0ff0ee69f95",
+        "id": "1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db",
         "identifier": [
           {
             "extension": [
@@ -104,10 +104,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721069430100045000.152f95da-26ca-4168-b015-21f4ba2f09bc",
+      "fullUrl": "Organization/1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721069430100045000.152f95da-26ca-4168-b015-21f4ba2f09bc",
+        "id": "1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -128,73 +128,73 @@
       }
     },
     {
-      "fullUrl": "Provenance/1721069430102331000.3c6a1925-96bb-4c31-b617-6887e3701319",
+      "fullUrl": "Provenance/1729292709397520000.0dae28e9-adbc-41ba-9290-a5d0ee62eeb2",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1721069430102331000.3c6a1925-96bb-4c31-b617-6887e3701319",
+        "id": "1729292709397520000.0dae28e9-adbc-41ba-9290-a5d0ee62eeb2",
         "target": [
           {
-            "reference": "MessageHeader/da958340-c0b1-3570-81dd-8febc8b7e5d0"
+            "reference": "MessageHeader/1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e"
           },
           {
-            "reference": "DiagnosticReport/1721069430482667000.bab87d87-2dd8-4f55-9c90-98d687fdd8a7"
+            "reference": "DiagnosticReport/1729292709701475000.6e1db083-47fd-42c0-87c9-0e22425e70ed"
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           {
-            "reference": "DiagnosticReport/1721069430486025000.2e5c8c63-2ac9-41d3-a993-a1ff8ddc14c2"
+            "reference": "DiagnosticReport/1729292709704498000.5d6a7cfa-6821-4aaa-b987-5774fc46136b"
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-            "reference": "DiagnosticReport/1721069430487880000.abf4f204-4443-42ea-b947-debc7cdb3807"
+            "reference": "DiagnosticReport/1729292709706382000.ccf380db-ed26-4cb0-aa17-02825cce517a"
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-            "reference": "DiagnosticReport/1721069430489507000.dfaee520-028a-4852-9662-edc21e90c21d"
+            "reference": "DiagnosticReport/1729292709707919000.ffae80cd-eca1-466d-8498-0349d45ad767"
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-            "reference": "DiagnosticReport/1721069430491763000.9fcaa2fc-59fe-44fb-ad21-3f588f81db23"
+            "reference": "DiagnosticReport/1729292709709838000.147ec6d1-4dbb-4175-b770-37a8c62d2b98"
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-            "reference": "DiagnosticReport/1721069430495930000.e6e4332c-5149-4b9f-96b6-6ff3c8387d8f"
+            "reference": "DiagnosticReport/1729292709713674000.8b7f75d2-628a-4bfa-92d0-8718cc24cca4"
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-            "reference": "DiagnosticReport/1721069430497852000.6e0d2067-bfe6-4c3f-b261-38a7883ee3ac"
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-            "reference": "DiagnosticReport/1721069430499548000.daf825f8-b0b6-4a4f-8187-ff320f5e4f61"
+            "reference": "DiagnosticReport/1729292709716859000.7640cdb0-f80f-4948-ab71-17149f329edd"
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-            "reference": "DiagnosticReport/1721069430501222000.a229e5ed-9eec-4b6e-9fc1-217b9f9c8d31"
+            "reference": "DiagnosticReport/1729292709718295000.a3589226-b8da-4e66-bbf3-e278f2e083b1"
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-            "reference": "DiagnosticReport/1721069430502916000.4813475a-75ab-4446-ae33-91fbd56b172c"
+            "reference": "DiagnosticReport/1729292709719731000.90ab44b0-ae06-47c2-8b41-5f3286913d72"
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           {
-            "reference": "DiagnosticReport/1721069430504589000.75495166-241c-41fe-b99d-9182c6206518"
+            "reference": "DiagnosticReport/1729292709721254000.532a4f9f-65e7-44df-a852-3ff618131e91"
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           {
-            "reference": "DiagnosticReport/1721069430506233000.0b7a1791-1f1b-45bb-bb4f-43243a9ee25b"
+            "reference": "DiagnosticReport/1729292709722668000.01105566-6108-409b-bc2f-20a20fbec7f4"
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           {
-            "reference": "DiagnosticReport/1721069430507917000.86bf930b-d750-4e49-8c93-6db1ac420815"
+            "reference": "DiagnosticReport/1729292709724112000.1d63227b-b9b9-419c-bf75-1147c7e960fc"
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           {
-            "reference": "DiagnosticReport/1721069430509586000.2853fb16-09e0-444f-8773-2f2b432b153f"
+            "reference": "DiagnosticReport/1729292709725533000.82172988-ea91-4215-bfab-5d66e3c8d6ec"
           },
           {
-            "reference": "DiagnosticReport/1721069430512678000.1bee8573-fb1b-46d7-9544-5e74a6a7c86d"
+            "reference": "DiagnosticReport/1729292709727011000.3e5a9e4a-8e57-4b56-8fac-dd23977e3697"
           },
           {
-            "reference": "DiagnosticReport/1721069430516297000.98d704bf-1407-44af-8dc8-e7d2ffb0d571"
+            "reference": "DiagnosticReport/1729292709728630000.bf7268b2-aac9-4571-8a0d-1f282f71e7bf"
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           {
-            "reference": "DiagnosticReport/1721069430519776000.12e00014-0172-4f0b-b771-94206663bbba"
+            "reference": "DiagnosticReport/1729292709730326000.1be2950e-7895-4297-b73e-b790f288c464"
           },
           {
-            "reference": "DiagnosticReport/1721069430523155000.e8b5f25d-382d-4457-bacb-3637714c73d1"
+            "reference": "DiagnosticReport/1729292709731796000.7881396a-2298-409b-b258-57c8465cb1fa"
           },
           {
-            "reference": "DiagnosticReport/1721069430526485000.13133581-a7aa-4bc9-b135-60906332b2a0"
+            "reference": "DiagnosticReport/1729292709733215000.12c48fca-307a-4cdc-8c2d-71236132fb57"
           }
         ],
         "recorded": "2024-02-12T10:30:49Z",
@@ -216,17 +216,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1721069430102119000.1919a877-f3f1-4740-b5f0-3463f22e825c"
+              "reference": "Organization/1729292709397395000.478f6a65-232c-49e3-9828-c64b7658df1f"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1721069430102119000.1919a877-f3f1-4740-b5f0-3463f22e825c",
+      "fullUrl": "Organization/1729292709397395000.478f6a65-232c-49e3-9828-c64b7658df1f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721069430102119000.1919a877-f3f1-4740-b5f0-3463f22e825c",
+        "id": "1729292709397395000.478f6a65-232c-49e3-9828-c64b7658df1f",
         "identifier": [
           {
             "extension": [
@@ -241,11 +241,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1721069430103081000.f0be4233-fa47-4ca3-87f4-b30826c3ea5f",
+      "fullUrl": "Provenance/1729292709398038000.66c47919-832b-4160-92ea-ba8fff1998b3",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1721069430103081000.f0be4233-fa47-4ca3-87f4-b30826c3ea5f",
-        "recorded": "2024-07-15T11:50:30Z",
+        "id": "1729292709398038000.66c47919-832b-4160-92ea-ba8fff1998b3",
+        "recorded": "2024-10-18T16:05:09Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -267,17 +267,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1721069430102931000.532966b1-c40c-487e-abfe-765f3d65c384"
+              "reference": "Organization/1729292709397934000.d41db398-c4d9-4319-8254-d557fbfe3aef"
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           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1721069430102931000.532966b1-c40c-487e-abfe-765f3d65c384",
+      "fullUrl": "Organization/1729292709397934000.d41db398-c4d9-4319-8254-d557fbfe3aef",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721069430102931000.532966b1-c40c-487e-abfe-765f3d65c384",
+        "id": "1729292709397934000.d41db398-c4d9-4319-8254-d557fbfe3aef",
         "identifier": [
           {
             "value": "CDC PRIME - Atlanta"
@@ -297,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1721069430110583000.f973956e-19b9-4519-925c-8a626a0e96bd",
+      "fullUrl": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be",
       "resource": {
         "resourceType": "Patient",
-        "id": "1721069430110583000.f973956e-19b9-4519-925c-8a626a0e96bd",
+        "id": "1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -387,7 +387,7 @@
             },
             "value": "80008715",
             "assigner": {
-              "reference": "Organization/1721069430103873000.559a6874-b66f-431d-a441-9c5fb0d76c08"
+              "reference": "Organization/1729292709398487000.cabc39ee-5787-43f0-98cc-edb5c4df907e"
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@@ -545,10 +545,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721069430103873000.559a6874-b66f-431d-a441-9c5fb0d76c08",
+      "fullUrl": "Organization/1729292709398487000.cabc39ee-5787-43f0-98cc-edb5c4df907e",
       "resource": {
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-        "id": "1721069430103873000.559a6874-b66f-431d-a441-9c5fb0d76c08",
+        "id": "1729292709398487000.cabc39ee-5787-43f0-98cc-edb5c4df907e",
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             "extension": [
@@ -569,16 +569,16 @@
       }
     },
     {
-      "fullUrl": "Provenance/1721069430111087000.f18b94c5-e7fe-40bb-9cb3-99be45b81ed4",
+      "fullUrl": "Provenance/1729292709403233000.3621b8dc-ae01-41f0-ba2a-68033949eb27",
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@@ -1494,7 +1494,7 @@
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@@ -1770,7 +1770,7 @@
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@@ -1910,10 +1910,10 @@
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@@ -1954,7 +1954,7 @@
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@@ -2002,10 +2002,10 @@
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@@ -2046,7 +2046,7 @@
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@@ -2138,7 +2138,7 @@
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@@ -2186,10 +2186,10 @@
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@@ -2370,10 +2370,10 @@
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@@ -13783,6 +13709,20 @@
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@@ -14046,7 +13986,7 @@
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@@ -14101,6 +14041,21 @@
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@@ -14193,6 +14148,21 @@
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@@ -14301,7 +14271,7 @@
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@@ -14352,10 +14322,10 @@
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@@ -14365,10 +14335,10 @@
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@@ -14378,10 +14348,10 @@
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@@ -14391,10 +14361,10 @@
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@@ -14404,10 +14374,10 @@
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           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14430,10 +14400,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430359904000.1a16b512-e71d-432e-81a9-026832035bcc",
+      "fullUrl": "Specimen/1729292709610290000.6aac37c2-780b-4942-948b-822d86ebef41",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430359904000.1a16b512-e71d-432e-81a9-026832035bcc",
+        "id": "1729292709610290000.6aac37c2-780b-4942-948b-822d86ebef41",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14443,10 +14413,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430360330000.a5319e7b-c6af-4a24-a139-2d1e4bc25b24",
+      "fullUrl": "Specimen/1729292709610682000.74d558be-08bc-46e2-98b2-07ca679dc15a",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430360330000.a5319e7b-c6af-4a24-a139-2d1e4bc25b24",
+        "id": "1729292709610682000.74d558be-08bc-46e2-98b2-07ca679dc15a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14456,10 +14426,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430360748000.b36f872e-7721-499c-be9f-c9dd5ea27c91",
+      "fullUrl": "Specimen/1729292709611059000.581752d2-b428-4ef4-9d10-a448cee4e6bd",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430360748000.b36f872e-7721-499c-be9f-c9dd5ea27c91",
+        "id": "1729292709611059000.581752d2-b428-4ef4-9d10-a448cee4e6bd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14469,10 +14439,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430361183000.f764cdf1-90b5-425d-b553-ad2e2f7171f9",
+      "fullUrl": "Specimen/1729292709611418000.8f386ccc-8e08-4217-9fbf-21d2ad02659b",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430361183000.f764cdf1-90b5-425d-b553-ad2e2f7171f9",
+        "id": "1729292709611418000.8f386ccc-8e08-4217-9fbf-21d2ad02659b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14482,10 +14452,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430361612000.25d61841-5dbb-44ec-97a2-4aa5fe075eca",
+      "fullUrl": "Specimen/1729292709611762000.03791b68-c858-4c39-8d86-23ec286c39e8",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430361612000.25d61841-5dbb-44ec-97a2-4aa5fe075eca",
+        "id": "1729292709611762000.03791b68-c858-4c39-8d86-23ec286c39e8",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14495,10 +14465,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430362028000.3ed20d7b-e42a-42bd-b816-fac67a4e834b",
+      "fullUrl": "Specimen/1729292709612104000.fe2049f0-ccdc-4962-8b24-91fd77ce14f9",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430362028000.3ed20d7b-e42a-42bd-b816-fac67a4e834b",
+        "id": "1729292709612104000.fe2049f0-ccdc-4962-8b24-91fd77ce14f9",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14508,10 +14478,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430362440000.620cd492-9585-46f4-98b9-21c524ec7762",
+      "fullUrl": "Specimen/1729292709612444000.33358a5d-f5c2-4bfe-8f02-2a76beff3792",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430362440000.620cd492-9585-46f4-98b9-21c524ec7762",
+        "id": "1729292709612444000.33358a5d-f5c2-4bfe-8f02-2a76beff3792",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14521,10 +14491,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430362846000.1e61d59a-8d9f-4c6b-bd1e-f67fa90e3291",
+      "fullUrl": "Specimen/1729292709612782000.cf21dbc3-07a7-45b9-91b6-fd5ab54ba54d",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430362846000.1e61d59a-8d9f-4c6b-bd1e-f67fa90e3291",
+        "id": "1729292709612782000.cf21dbc3-07a7-45b9-91b6-fd5ab54ba54d",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14534,10 +14504,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430363254000.19252a56-2a31-4ffa-b7f6-ecbbd1450f11",
+      "fullUrl": "Specimen/1729292709613121000.3b8378b3-7120-4fd7-9f84-234063957e99",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430363254000.19252a56-2a31-4ffa-b7f6-ecbbd1450f11",
+        "id": "1729292709613121000.3b8378b3-7120-4fd7-9f84-234063957e99",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14547,10 +14517,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430363696000.bdc78cd0-db09-4d66-a205-53dfaa441676",
+      "fullUrl": "Specimen/1729292709613460000.e12727e3-167b-4934-8034-83f016f9a29e",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430363696000.bdc78cd0-db09-4d66-a205-53dfaa441676",
+        "id": "1729292709613460000.e12727e3-167b-4934-8034-83f016f9a29e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14560,10 +14530,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430364115000.4a03ee22-554d-4601-9675-476479539b27",
+      "fullUrl": "Specimen/1729292709613800000.42bc26f5-8897-43bd-bcde-6d2d478cd6c9",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430364115000.4a03ee22-554d-4601-9675-476479539b27",
+        "id": "1729292709613800000.42bc26f5-8897-43bd-bcde-6d2d478cd6c9",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14573,10 +14543,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430364526000.dd43a98b-9d6d-412b-b68a-7a3700a8dce6",
+      "fullUrl": "Specimen/1729292709614140000.2f304a8e-0054-4b1b-8304-03582bc7f953",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1721069430364526000.dd43a98b-9d6d-412b-b68a-7a3700a8dce6",
+        "id": "1729292709614140000.2f304a8e-0054-4b1b-8304-03582bc7f953",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14586,10 +14556,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1721069430364939000.4363f137-825e-4e1e-8ea5-47d056d64486",
+      "fullUrl": "Specimen/1729292709614475000.d14ad60e-3145-433e-8f7a-a3ecd9b23ce1",
       "resource": {
         "resourceType": "Specimen",
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+        "id": "1729292709614475000.d14ad60e-3145-433e-8f7a-a3ecd9b23ce1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -14599,10 +14569,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1721069430373178000.5dcb3545-1540-4557-b856-fc29e79720e4",
+      "fullUrl": "ServiceRequest/1729292709621304000.1624737d-3a13-4dc6-8241-f79511b2c85e",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1721069430373178000.5dcb3545-1540-4557-b856-fc29e79720e4",
+        "id": "1729292709621304000.1624737d-3a13-4dc6-8241-f79511b2c85e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -14614,7 +14584,7 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1721069430370069000.d72bbce2-bbb9-400a-8f24-a9daa648920f"
+                  "reference": "Organization/1729292709618697000.78c8c70c-96f3-4a2d-8be5-a6a66b81b5ad"
                 }
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               {
@@ -14647,7 +14617,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1721069430371392000.ba5efa80-8c33-4f79-827d-915e7007edc5"
+                  "reference": "Practitioner/1729292709619775000.6f868b29-4b07-445f-858f-67dc68a3e612"
                 }
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@@ -14664,22 +14634,26 @@
                       "extension": [
                         {
                           "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                          "valueString": "FormNumber"
+                          "valueString": "HospOrdNumber"
                         }
                       ]
                     }
                   ],
-                  "value": "7171232842"
+                  "value": "189403712"
                 }
               },
               {
                 "url": "OBR.22",
                 "valueString": "20240212103049"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1721069430372626000.7e792a9b-0587-4c49-9472-1adfbf16d17f"
+                  "reference": "Practitioner/1729292709615767000.2505f0bd-aa8f-447c-b039-6a6783617ccd"
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@@ -14776,36 +14750,27 @@
                 },
                 {
                   "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
-                  "valueString": "LN"
+                  "valueString": "CDPHGSPEAP"
                 }
               ],
               "code": "54089-8",
               "display": "NB Screen Panel Patient AHIC"
-            },
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
-                  "valueString": "alt-coding"
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-              "code": "CDPHGSPEAP"
             }
           ]
         },
         "subject": {
-          "reference": "Patient/1721069430110583000.f973956e-19b9-4519-925c-8a626a0e96bd"
+          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
         },
         "requester": {
-          "reference": "PractitionerRole/1721069430365704000.b40f36ab-4508-440b-bc72-964325c4af8d"
+          "reference": "PractitionerRole/1729292709615090000.09edee9c-9082-4470-8422-24b2eac3c5db"
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       }
     },
     {
-      "fullUrl": "Practitioner/1721069430366526000.efb3c46c-98b1-4afa-9611-1f7c5459bd1d",
+      "fullUrl": "Practitioner/1729292709615767000.2505f0bd-aa8f-447c-b039-6a6783617ccd",
       "resource": {
         "resourceType": "Practitioner",
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+        "id": "1729292709615767000.2505f0bd-aa8f-447c-b039-6a6783617ccd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -14832,10 +14797,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721069430367863000.c81fbf1d-ad0b-47d1-9312-7107661c73a7",
+      "fullUrl": "Organization/1729292709616896000.8ba8629c-72a9-42a2-b201-efd156449b51",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721069430367863000.c81fbf1d-ad0b-47d1-9312-7107661c73a7",
+        "id": "1729292709616896000.8ba8629c-72a9-42a2-b201-efd156449b51",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xon-organization",
@@ -14894,23 +14859,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1721069430365704000.b40f36ab-4508-440b-bc72-964325c4af8d",
+      "fullUrl": "PractitionerRole/1729292709615090000.09edee9c-9082-4470-8422-24b2eac3c5db",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1721069430365704000.b40f36ab-4508-440b-bc72-964325c4af8d",
+        "id": "1729292709615090000.09edee9c-9082-4470-8422-24b2eac3c5db",
         "practitioner": {
-          "reference": "Practitioner/1721069430366526000.efb3c46c-98b1-4afa-9611-1f7c5459bd1d"
+          "reference": "Practitioner/1729292709615767000.2505f0bd-aa8f-447c-b039-6a6783617ccd"
         },
         "organization": {
-          "reference": "Organization/1721069430367863000.c81fbf1d-ad0b-47d1-9312-7107661c73a7"
+          "reference": "Organization/1729292709616896000.8ba8629c-72a9-42a2-b201-efd156449b51"
         }
       }
     },
     {
-      "fullUrl": "Organization/1721069430370069000.d72bbce2-bbb9-400a-8f24-a9daa648920f",
+      "fullUrl": "Organization/1729292709618697000.78c8c70c-96f3-4a2d-8be5-a6a66b81b5ad",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721069430370069000.d72bbce2-bbb9-400a-8f24-a9daa648920f",
+        "id": "1729292709618697000.78c8c70c-96f3-4a2d-8be5-a6a66b81b5ad",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xon-organization",
@@ -14931,10 +14896,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721069430371392000.ba5efa80-8c33-4f79-827d-915e7007edc5",
+      "fullUrl": "Practitioner/1729292709619775000.6f868b29-4b07-445f-858f-67dc68a3e612",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721069430371392000.ba5efa80-8c33-4f79-827d-915e7007edc5",
+        "id": "1729292709619775000.6f868b29-4b07-445f-858f-67dc68a3e612",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -14957,10 +14922,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721069430372626000.7e792a9b-0587-4c49-9472-1adfbf16d17f",
+      "fullUrl": "Practitioner/1729292709620829000.7cbf1454-051c-4106-8203-15bca0984634",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721069430372626000.7e792a9b-0587-4c49-9472-1adfbf16d17f",
+        "id": "1729292709620829000.7cbf1454-051c-4106-8203-15bca0984634",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -14983,10 +14948,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721069430374223000.77929b56-a2c1-4161-b394-0d9ad3cc3e6d",
+      "fullUrl": "Practitioner/1729292709622174000.ad2225e5-35bd-4463-ab08-e6122ada8ea3",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721069430374223000.77929b56-a2c1-4161-b394-0d9ad3cc3e6d",
+        "id": "1729292709622174000.ad2225e5-35bd-4463-ab08-e6122ada8ea3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -15013,10 +14978,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721069430377204000.9e6c073e-9732-468c-bda8-a1de91cd223b",
+      "fullUrl": "Practitioner/1729292709624831000.3d2b8759-e5a3-41a5-9085-0895c503d795",
       "resource": {
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-        "id": "1721069430377204000.9e6c073e-9732-468c-bda8-a1de91cd223b",
+        "id": "1729292709624831000.3d2b8759-e5a3-41a5-9085-0895c503d795",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -15039,10 +15004,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721069430378825000.e633ac2d-0c08-40f3-9625-f24526574f2d",
+      "fullUrl": "Practitioner/1729292709626243000.35efb07e-ecc6-4b85-a019-fe70381229e4",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721069430378825000.e633ac2d-0c08-40f3-9625-f24526574f2d",
+        "id": "1729292709626243000.35efb07e-ecc6-4b85-a019-fe70381229e4",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -15069,10 +15034,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721069430381815000.91360260-09a9-4500-bf1c-7b8900588bce",
+      "fullUrl": "Practitioner/1729292709628911000.3006c42c-4c3a-4125-b769-9b009e9f4783",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721069430381815000.91360260-09a9-4500-bf1c-7b8900588bce",
+        "id": "1729292709628911000.3006c42c-4c3a-4125-b769-9b009e9f4783",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -15095,10 +15060,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721069430383429000.110dd218-2d7a-4b52-969c-33ca656cb00d",
+      "fullUrl": "Practitioner/1729292709630324000.e49b83ba-b57f-43a8-a20f-e0fab376d803",
       "resource": {
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-        "id": "1721069430383429000.110dd218-2d7a-4b52-969c-33ca656cb00d",
+        "id": "1729292709630324000.e49b83ba-b57f-43a8-a20f-e0fab376d803",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -15125,10 +15090,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721069430386362000.07464b64-86e7-4fec-9bc1-47b6e74bf175",
+      "fullUrl": "Practitioner/1729292709632977000.eb02cc38-f076-47a3-8f96-4dfc4c4de2e0",
       "resource": {
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-        "id": "1721069430386362000.07464b64-86e7-4fec-9bc1-47b6e74bf175",
+        "id": "1729292709632977000.eb02cc38-f076-47a3-8f96-4dfc4c4de2e0",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -15151,10 +15116,10 @@
       }
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@@ -15461,10 +15426,10 @@
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@@ -15517,10 +15482,10 @@
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@@ -15599,10 +15564,10 @@
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@@ -15629,10 +15594,10 @@
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@@ -15655,10 +15620,10 @@
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@@ -15685,10 +15650,10 @@
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@@ -15711,10 +15676,10 @@
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@@ -15741,10 +15706,10 @@
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@@ -15767,10 +15732,10 @@
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@@ -15823,10 +15788,10 @@
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@@ -15853,10 +15818,10 @@
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@@ -15879,10 +15844,10 @@
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@@ -15935,10 +15900,10 @@
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@@ -15965,10 +15930,10 @@
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@@ -15991,10 +15956,10 @@
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diff --git a/examples/CA/003_CA_ORU_R01_CDPH_produced_3_hl7_translation_final.hl7 b/examples/CA/003_CA_ORU_R01_CDPH_produced_3_hl7_translation_final.hl7
index 875f159d8..841967ec5 100644
--- a/examples/CA/003_CA_ORU_R01_CDPH_produced_3_hl7_translation_final.hl7
+++ b/examples/CA/003_CA_ORU_R01_CDPH_produced_3_hl7_translation_final.hl7
@@ -1,154 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240212103049||ORU^R01|243408787|T|2.5.1
-PID|1||80008715||CDPH-FOUR^GIRL A MOMFOUR|||F||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||Y|1
-NK1|1|CDPH-FOUR^MOMFOUR|MTH^Mother|123 TOWNE-CENTER DRIVE^^SAN-DIEGO^CA^92126^USA|^^^^^619^1231234|^^^^^858^2493690
-ORC|RE|189403712^HospOrdNumber||7171232842^FormNumber||||||||^WILKINSON^LESLEY|||||||||UCSD JACOBS MEDICAL CENTER^^^^^^^^^R797|2961DR YLLUT^^SAN DIEGO^CA^99999-9999
-OBR|1|189403712^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^LN^CDPHGSPEAP|||202402081450|||||||||^MILLEN^MARLENE||||||20240212103049|||F
-OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240212103049
-OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240212103049
-OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA12428-1^All screening is in range for the conditions tested^LN|||N|||F|||20240212103049
-OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240212103049
-OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240212103049
-OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\M 57752YWKP NAEBC, ETS8021 , FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL SAW 19221DVLB NOTGNIH, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Follow-up:\.br\\.br\Amino Acid Panel: There was insufficient data to determine whether or not this newborn was at least 12 hours old when this specimen was collected. Testing of amino acids at less than 12 hours of age is not reliable for detecting certain metabolic disorder. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Rady Children's Hospital San Diego at (161) 122-8708. \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\Due to biological variability of newborns and differences in detection rates for the various disorders in the newborn period, the Newborn Screening Program will not identify all newborns with these conditions. While a positive screening result identifies newborns at an increased risk to justify a diagnostic work-up, a negative screening result does not rule out the possibility of a disorder. Health care providers should remain watchful for any sign or symptoms of these disorders in their patients. A newborn screening result should not be considered diagnostic, and cannot replace the individualized evaluation and diagnosis of an infant by a well-trained, knowledgeable health care provider. \.br\\.br\|||N|||F|||20240212103049
-OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240212103049
-OBX|8|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|1|LA22279-6^SMA^LN|||N|||F|||20240212103049
-OBX|9|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|2|LA25796-6^X-ALD^LN|||N|||F|||20240212103049
-OBX|10|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|3|LA14037-8^GAA^LN|||N|||F|||20240212103049
-OBX|11|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|4|LA25797-4^MPS-I^LN|||N|||F|||20240212103049
-OBX|12|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|5|LA12466-1^3-MCC^LN|||N|||F|||20240212103049
-OBX|13|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|6|LA12468-7^3MGA^LN|||N|||F|||20240212103049
-OBX|14|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|7|LA12469-5^5-OXO^LN|||N|||F|||20240212103049
-OBX|15|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|8|LA12470-3^ARG^LN|||N|||F|||20240212103049
-OBX|16|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|9|LA12482-8^CIT-I^LN|||N|||F|||20240212103049
-OBX|17|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|10|LA12483-6^CIT-II^LN|||N|||F|||20240212103049
-OBX|18|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|11|LA12485-1^CPT-Ia^LN|||N|||F|||20240212103049
-OBX|19|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|12|LA12486-9^CPT-II^LN|||N|||F|||20240212103049
-OBX|20|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|13|LA12493-5^GA-1^LN|||N|||F|||20240212103049
-OBX|21|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|14|LA12495-0^GA-2^LN|||N|||F|||20240212103049
-OBX|22|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|15|LA12497-6^HHH^LN|||N|||F|||20240212103049
-OBX|23|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|16|LA12499-2^HMG^LN|||N|||F|||20240212103049
-OBX|24|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|17|LA12505-6^IVA^LN|||N|||F|||20240212103049
-OBX|25|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|18|LA12507-2^LCHAD^LN|||N|||F|||20240212103049
-OBX|26|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|19|LA12508-0^MAL^LN|||N|||F|||20240212103049
-OBX|27|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|20|LA12509-8^MCAD^LN|||N|||F|||20240212103049
-OBX|28|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|21|LA12510-6^MCD^LN|||N|||F|||20240212103049
-OBX|29|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|22|LA12512-2^MET^LN|||N|||F|||20240212103049
-OBX|30|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|23|LA12513-0^MSUD^LN|||N|||F|||20240212103049
-OBX|31|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|24|LA12516-3^NKHG^LN|||N|||F|||20240212103049
-OBX|32|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|25|LA12520-5^PKU^LN|||N|||F|||20240212103049
-OBX|33|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|26|LA12521-3^PRO I^LN|||N|||F|||20240212103049
-OBX|34|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|27|LA12528-8^TYR-1^LN|||N|||F|||20240212103049
-OBX|35|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|28|LA12529-6^TYR-II^LN|||N|||F|||20240212103049
-OBX|36|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|29|LA12531-2^VLCAD^LN|||N|||F|||20240212103049
-OBX|37|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|30|LA12532-0^BIO^LN|||N|||F|||20240212103049
-OBX|38|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|31|LA12533-8^CAH^LN|||N|||F|||20240212103049
-OBX|39|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|32|LA12537-9^CF^LN|||N|||F|||20240212103049
-OBX|40|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|33|LA12543-7^GALT^LN|||N|||F|||20240212103049
-OBX|41|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|34|LA12566-8^SCID^LN|||N|||F|||20240212103049
-OBX|42|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|35|LA12576-7^SCAD or EMA or IBG or GA-2 (MADD)^LN|||N|||F|||20240212103049
-OBX|43|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|36|LA16207-5^Hemoglobinopathies^LN|||N|||F|||20240212103049
-OBX|44|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|37|99717-3^Hypothyroidism^L|||N|||F|||20240212103049
-OBX|45|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|38|LA12487-7^CUD^LN|||N|||F|||20240212103049
-OBX|46|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|39|LA12474-5^BKT^LN|||N|||F|||20240212103049
-OBX|47|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|40|LA12523-9^PA^LN|||N|||F|||20240212103049
-OBX|48|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|41|LA12515-5^MMA^LN|||N|||F|||20240212103049
-OBX|49|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|42|LA12464-6^2M3HBA^LN|||N|||F|||20240212103049
-OBX|50|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240212103049
-OBX|51|NM|8339-4^Birthweight^LN|1|3175|grams||N|||F|||20240212103049
-OBX|52|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240212103049
-OBX|53|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240212103049
-OBX|54|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240212103049
-OBX|55|TX|^^^99717-5^Accession Number^L|1|040-70-677/21-2024-21|||N|||F|||20240212103049
-OBX|56|TX|62324-9^Post-discharge provider name^LN|1|LESLEY WILKINSON|||N|||F|||20240212103049
-OBX|57|TX|62327-2^Post-discharge provider practice address^LN|1|2961DR YLLUT SAN DIEGO CA 99999-9999 USA|||N|||F|||20240212103049
-OBX|58|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240212103049
-OBX|59|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240212103049
-OBX|60|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240212103049
-OBX|61|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240212103049
-OBX|62|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240212103049
-OBX|63|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240212103049
-OBX|64|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240212103049
-OBX|65|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240212103049
-OBX|66|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240212103049
-OBX|67|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240212103049
-OBX|68|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240212103049
-OBX|69|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240212103049
-OBX|70|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240212103049
-OBX|71|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240212103049
-OBX|72|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240212103049
-OBX|73|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240212103049
-OBX|74|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240212103049
-OBX|75|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240212103049
-OBX|76|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Collected Early. No Interpretation.|||A|||F|||20240212103049
-OBX|77|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|78|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240212103049
-OBX|79|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240212103049
-OBX|80|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240212103049
-OBX|81|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240212103049
-OBX|82|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240212103049
-OBX|83|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240212103049
-OBX|84|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240212103049
-OBX|85|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240212103049
-OBX|86|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240212103049
-OBX|87|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240212103049
-OBX|88|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240212103049
-OBX|89|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240212103049
-OBX|90|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240212103049
-OBX|91|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240212103049
-OBX|92|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240212103049
-OBX|93|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240212103049
-OBX|94|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240212103049
-OBX|95|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240212103049
-OBX|96|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240212103049
-OBX|97|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240212103049
-OBX|98|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240212103049
-OBX|99|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240212103049
-OBX|100|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240212103049
-OBX|101|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240212103049
-OBX|102|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240212103049
-OBX|103|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240212103049
-OBX|104|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240212103049
-OBX|105|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240212103049
-OBX|106|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240212103049
-OBX|107|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240212103049
-OBX|108|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240212103049
-OBX|109|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240212103049
-OBX|110|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240212103049
-OBX|111|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240212103049
-OBX|112|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240212103049
-OBX|113|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240212103049
-OBX|114|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240212103049
-OBX|115|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<71|N|||F|||20240212103049
-OBX|116|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|117|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240212103049
-OBX|118|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240212103049
-OBX|119|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|120|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
-OBX|121|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240212103049
-OBX|122|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|123|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
-OBX|124|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240212103049
-OBX|125|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|126|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
-OBX|127|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240212103049
-OBX|128|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern.†These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240212103049
-OBX|129|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240212103049
-OBX|130|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|131|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
-OBX|132|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240212103049
-OBX|133|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|134|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
-OBX|135|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240212103049
-OBX|136|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|137|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240212103049
-OBX|138|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|2|Interpretation Comments: The acid alpha-glucosidase Enzyme activity level is above the 18% of the daily patient median and suggests it is screen negative for Pompe disease.|||N|||F|||20240212103049
-OBX|139|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240212103049
-OBX|140|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|141|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
-OBX|142|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|2|Interpretation Comments: The alpha-L-iduronidase Enzyme activity is above the 18% of the daily patient median and suggests it is screen negative for Mucopolysaccharidosis I (MPS I) disease.|||N|||F|||20240212103049
-OBX|143|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240212103049
-OBX|144|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|145|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240212103049
-OBX|146|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|2||||N|||F|||20240212103049
-OBX|147|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240212103049
-OBX|148|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240212103049
-OBX|149|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.49|N|||F|||20240212103049
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240212103049||ORU^R01|243408787|D|2.5.1
PID|1||80008715||CDPH-FOUR^GIRL A MOMFOUR|||F||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||Y|1
NK1|1|CDPH-FOUR^MOMFOUR|MTH^Mother|123 TOWNE-CENTER DRIVE^^SAN-DIEGO^CA^92126^USA|^^^^^619^1231234|^^^^^858^2493690
ORC|RE|189403712^HospOrdNumber||7171232842^FormNumber||||||||^WILKINSON^LESLEY|||||||||UCSD JACOBS MEDICAL CENTER^^^^^^^^^R797|2961DR YLLUT^^SAN DIEGO^CA^99999-9999
OBR|1|189403712^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202402081450|||||||||^WILKINSON^LESLEY||||||20240212103049|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240212103049
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240212103049
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA12428-1^All screening is in range for the conditions tested^LN|||N|||F|||20240212103049
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240212103049
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240212103049
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\M 57752YWKP NAEBC, ETS8021 , FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL SAW 19221DVLB NOTGNIH, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Follow-up:\.br\\.br\Amino Acid Panel: There was insufficient data to determine whether or not this newborn was at least 12 hours old when this specimen was collected. Testing of amino acids at less than 12 hours of age is not reliable for detecting certain metabolic disorder. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Rady Children's Hospital San Diego at (161) 122-8708. \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\Due to biological variability of newborns and differences in detection rates for the various disorders in the newborn period, the Newborn Screening Program will not identify all newborns with these conditions. While a positive screening result identifies newborns at an increased risk to justify a diagnostic work-up, a negative screening result does not rule out the possibility of a disorder. Health care providers should remain watchful for any sign or symptoms of these disorders in their patients. A newborn screening result should not be considered diagnostic, and cannot replace the individualized evaluation and diagnosis of an infant by a well-trained, knowledgeable health care provider. \.br\\.br\|||N|||F|||20240212103049
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240212103049
OBX|8|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|1|LA22279-6^SMA^LN|||N|||F|||20240212103049
OBX|9|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|2|LA25796-6^X-ALD^LN|||N|||F|||20240212103049
OBX|10|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|3|LA14037-8^GAA^LN|||N|||F|||20240212103049
OBX|11|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|4|LA25797-4^MPS-I^LN|||N|||F|||20240212103049
OBX|12|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|5|LA12466-1^3-MCC^LN|||N|||F|||20240212103049
OBX|13|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|6|LA12468-7^3MGA^LN|||N|||F|||20240212103049
OBX|14|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|7|LA12469-5^5-OXO^LN|||N|||F|||20240212103049
OBX|15|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|8|LA12470-3^ARG^LN|||N|||F|||20240212103049
OBX|16|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|9|LA12482-8^CIT-I^LN|||N|||F|||20240212103049
OBX|17|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|10|LA12483-6^CIT-II^LN|||N|||F|||20240212103049
OBX|18|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|11|LA12485-1^CPT-Ia^LN|||N|||F|||20240212103049
OBX|19|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|12|LA12486-9^CPT-II^LN|||N|||F|||20240212103049
OBX|20|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|13|LA12493-5^GA-1^LN|||N|||F|||20240212103049
OBX|21|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|14|LA12495-0^GA-2^LN|||N|||F|||20240212103049
OBX|22|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|15|LA12497-6^HHH^LN|||N|||F|||20240212103049
OBX|23|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|16|LA12499-2^HMG^LN|||N|||F|||20240212103049
OBX|24|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|17|LA12505-6^IVA^LN|||N|||F|||20240212103049
OBX|25|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|18|LA12507-2^LCHAD^LN|||N|||F|||20240212103049
OBX|26|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|19|LA12508-0^MAL^LN|||N|||F|||20240212103049
OBX|27|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|20|LA12509-8^MCAD^LN|||N|||F|||20240212103049
OBX|28|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|21|LA12510-6^MCD^LN|||N|||F|||20240212103049
OBX|29|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|22|LA12512-2^MET^LN|||N|||F|||20240212103049
OBX|30|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|23|LA12513-0^MSUD^LN|||N|||F|||20240212103049
OBX|31|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|24|LA12516-3^NKHG^LN|||N|||F|||20240212103049
OBX|32|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|25|LA12520-5^PKU^LN|||N|||F|||20240212103049
OBX|33|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|26|LA12521-3^PRO I^LN|||N|||F|||20240212103049
OBX|34|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|27|LA12528-8^TYR-1^LN|||N|||F|||20240212103049
OBX|35|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|28|LA12529-6^TYR-II^LN|||N|||F|||20240212103049
OBX|36|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|29|LA12531-2^VLCAD^LN|||N|||F|||20240212103049
OBX|37|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|30|LA12532-0^BIO^LN|||N|||F|||20240212103049
OBX|38|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|31|LA12533-8^CAH^LN|||N|||F|||20240212103049
OBX|39|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|32|LA12537-9^CF^LN|||N|||F|||20240212103049
OBX|40|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|33|LA12543-7^GALT^LN|||N|||F|||20240212103049
OBX|41|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|34|LA12566-8^SCID^LN|||N|||F|||20240212103049
OBX|42|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|35|LA12576-7^SCAD or EMA or IBG or GA-2 (MADD)^LN|||N|||F|||20240212103049
OBX|43|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|36|LA16207-5^Hemoglobinopathies^LN|||N|||F|||20240212103049
OBX|44|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|37|99717-3^Hypothyroidism^L|||N|||F|||20240212103049
OBX|45|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|38|LA12487-7^CUD^LN|||N|||F|||20240212103049
OBX|46|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|39|LA12474-5^BKT^LN|||N|||F|||20240212103049
OBX|47|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|40|LA12523-9^PA^LN|||N|||F|||20240212103049
OBX|48|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|41|LA12515-5^MMA^LN|||N|||F|||20240212103049
OBX|49|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|42|LA12464-6^2M3HBA^LN|||N|||F|||20240212103049
OBX|50|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240212103049
OBX|51|NM|8339-4^Birthweight^LN|1|3175|grams||N|||F|||20240212103049
OBX|52|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240212103049
OBX|53|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240212103049
OBX|54|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240212103049
OBX|55|TX|62324-9^Post-discharge provider name^LN|1|LESLEY WILKINSON|||N|||F|||20240212103049
OBX|56|TX|62327-2^Post-discharge provider practice address^LN|1|2961DR YLLUT SAN DIEGO CA 99999-9999 USA|||N|||F|||20240212103049
OBX|57|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240212103049
OBX|58|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240212103049
OBX|59|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240212103049
OBX|60|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240212103049
OBX|61|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240212103049
OBX|62|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240212103049
OBX|63|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240212103049
OBX|64|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240212103049
OBX|65|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240212103049
OBX|66|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240212103049
OBX|67|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240212103049
OBX|68|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240212103049
OBX|69|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240212103049
OBX|70|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240212103049
OBX|71|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240212103049
OBX|72|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240212103049
OBX|73|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240212103049
OBX|74|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240212103049
OBX|75|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Collected Early. No Interpretation.|||A|||F|||20240212103049
OBX|76|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|77|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240212103049
OBX|78|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240212103049
OBX|79|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240212103049
OBX|80|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240212103049
OBX|81|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240212103049
OBX|82|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240212103049
OBX|83|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240212103049
OBX|84|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240212103049
OBX|85|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240212103049
OBX|86|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240212103049
OBX|87|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240212103049
OBX|88|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240212103049
OBX|89|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240212103049
OBX|90|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240212103049
OBX|91|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240212103049
OBX|92|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240212103049
OBX|93|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240212103049
OBX|94|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240212103049
OBX|95|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240212103049
OBX|96|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240212103049
OBX|97|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240212103049
OBX|98|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240212103049
OBX|99|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240212103049
OBX|100|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240212103049
OBX|101|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240212103049
OBX|102|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240212103049
OBX|103|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240212103049
OBX|104|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240212103049
OBX|105|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240212103049
OBX|106|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240212103049
OBX|107|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240212103049
OBX|108|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240212103049
OBX|109|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240212103049
OBX|110|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240212103049
OBX|111|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240212103049
OBX|112|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240212103049
OBX|113|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240212103049
OBX|114|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<71|N|||F|||20240212103049
OBX|115|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|116|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240212103049
OBX|117|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240212103049
OBX|118|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|119|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
OBX|120|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240212103049
OBX|121|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|122|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
OBX|123|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240212103049
OBX|124|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|125|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
OBX|126|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240212103049
OBX|127|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern.†These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240212103049
OBX|128|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240212103049
OBX|129|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|130|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
OBX|131|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240212103049
OBX|132|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|133|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
OBX|134|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240212103049
OBX|135|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|136|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240212103049
OBX|137|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|2|Interpretation Comments: The acid alpha-glucosidase Enzyme activity level is above the 18% of the daily patient median and suggests it is screen negative for Pompe disease.|||N|||F|||20240212103049
OBX|138|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240212103049
OBX|139|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|140|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240212103049
OBX|141|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|2|Interpretation Comments: The alpha-L-iduronidase Enzyme activity is above the 18% of the daily patient median and suggests it is screen negative for Mucopolysaccharidosis I (MPS I) disease.|||N|||F|||20240212103049
OBX|142|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240212103049
OBX|143|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|144|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240212103049
OBX|145|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|2||||N|||F|||20240212103049
OBX|146|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240212103049
OBX|147|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240212103049
OBX|148|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.49|N|||F|||20240212103049
diff --git a/examples/CA/004_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir b/examples/CA/004_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
new file mode 100644
index 000000000..99be9aab4
--- /dev/null
+++ b/examples/CA/004_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
@@ -0,0 +1,19511 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729292223963452000.86853264-9dcc-4fb1-ae23-9b23987f6966",
+  "meta": {
+    "lastUpdated": "2024-10-18T15:57:03.963-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "243408836"
+  },
+  "type": "message",
+  "timestamp": "2024-02-26T03:43:04.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729292223965072000.d8e7d4ca-2fe2-4ff0-b1b2-e9684ed4f7a2",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729292223965072000.d8e7d4ca-2fe2-4ff0-b1b2-e9684ed4f7a2",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240226034304"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "11903029"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "L,M,N"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "SISHIERECEIVER",
+            "receiver": {
+              "reference": "Organization/1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "SISGDSP"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "name": "SISGDSP",
+          "_endpoint": {
+            "extension": [
+              {
+                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                "valueCode": "unknown"
+              }
+            ]
+          }
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2",
+        "identifier": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
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+            "value": "SISGDSP"
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+    },
+    {
+      "fullUrl": "Organization/1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7",
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+        "extension": [
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
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+      "resource": {
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+          {
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+          {
+            "reference": "DiagnosticReport/1729292224289752000.9dd735d1-0026-4585-91c5-aaf2bcf14f78"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224291670000.c991ebfe-3906-493c-91cc-a5d284ad4cbf"
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+          {
+            "reference": "DiagnosticReport/1729292224293061000.8a617c9a-5dbc-4efc-89d7-c1590ef30b3c"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224295200000.28a0a482-ff4a-4272-b44c-ee6d4dbd4e1a"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224296854000.ced71e97-3cd9-4e0d-af47-f0429e0b446c"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224298299000.8853febd-d8e4-40bd-b53d-4e6f2ae0f911"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224299703000.cf38def9-006f-4f5b-8a40-f7c2e17d7386"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224301146000.644714af-4152-4c6b-b6ce-ac924cbeed87"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224302573000.1642659a-f1b4-4f32-a8c5-1881f545ea19"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224303959000.a1fc3f75-eeb5-4a32-94c5-3b4e1520f5e4"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224305371000.dd5dd86d-76a2-44f0-959f-874531c0af56"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224306833000.1e418500-6c97-4a01-a1ef-6020ee706132"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224308318000.decc981a-d92a-461b-bc88-e0431b789a4c"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224309777000.76cb7c27-59e4-4d6b-bbd6-1675859b8254"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224311239000.94563440-4ef6-4c1b-9f8e-8251b9b8f389"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224312687000.bcf75080-bc06-444a-b0de-d1d385132ad3"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224314088000.ed3d56a5-6919-4570-8815-6dc50c5cdf59"
+          }
+        ],
+        "recorded": "2024-02-26T03:43:04Z",
+        "activity": {
+          "coding": [
+            {
+              "display": "ORU^R01^ORU_R01"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729292223966346000.2220dfd9-bdd0-4bf8-8943-4aea1651b22b"
+            }
+          }
+        ]
+      }
+    },
+    {
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+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292223966346000.2220dfd9-bdd0-4bf8-8943-4aea1651b22b",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "SISGDSP"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729292223967205000.905e6774-a8d6-495e-b060-fa143e31556a",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729292223967205000.905e6774-a8d6-495e-b060-fa143e31556a",
+        "recorded": "2024-10-18T15:57:03Z",
+        "policy": [
+          "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
+        ],
+        "activity": {
+          "coding": [
+            {
+              "code": "v2-FHIR transformation"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "assembler"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729292223967075000.3f202e94-d63e-4116-ab5d-40094141799c"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292223967075000.3f202e94-d63e-4116-ab5d-40094141799c",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292223967075000.3f202e94-d63e-4116-ab5d-40094141799c",
+        "identifier": [
+          {
+            "value": "CDC PRIME - Atlanta"
+          },
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.237821"
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+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        }
+                      ],
+                      "code": "M"
+                    }
+                  ]
+                }
+              },
+              {
+                "url": "PID.24",
+                "valueString": "N"
+              }
+            ]
+          },
+          {
+            "url": "http://ibm.com/fhir/cdm/StructureDefinition/local-race-cd",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2106-3",
+                  "display": "White"
+                }
+              ]
+            }
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ethnic-group",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2186-5",
+                  "display": "Not Hispanic or Latino"
+                }
+              ]
+            }
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
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+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
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+                      "code": "µmol/L/h"
+                    }
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+            ]
+          }
+        ],
+        "referenceRange": [
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+            "text": ">=1.2204"
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+        ]
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+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "79564-1",
+              "display": "Mucopolysaccharidosis type I newborn screen interpretation"
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+          ]
+        },
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+              "valueString": "20240226034304"
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+                "url": "OBX.2",
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+                "url": "OBX.11",
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+              ],
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+              "display": "Mucopolysaccharidosis type I newborn screening comment-discussion"
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+          ]
+        },
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+          ]
+        },
+        "valueString": "Negative",
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+                "code": "N"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224156491000.b8c1a527-eed1-4d83-950e-d2bde1bc161e",
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+        "id": "1729292224156491000.b8c1a527-eed1-4d83-950e-d2bde1bc161e",
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+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "2"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
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+              },
+              {
+                "url": "OBX.11",
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+            ]
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+        ],
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+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
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+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "79565-8",
+              "display": "Mucopolysaccharidosis type I newborn screening comment-discussion"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
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+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueString": "Interpretation Comments: The alpha-L-iduronidase Enzyme activity is above the 18% of the daily patient median and suggests it is screen negative for Mucopolysaccharidosis I (MPS I) disease.",
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+                "code": "N"
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+            ]
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+        ]
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+    },
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+      "fullUrl": "Observation/1729292224157578000.58b60be8-7e92-490d-a841-482de67b5c81",
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+                "url": "OBX.11",
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+            ]
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+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-60",
+              "display": "SMN1 Homozygous Deletion Analysis"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
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+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueString": "Exon 7 Absent",
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+            "coding": [
+              {
+                "extension": [
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+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "A"
+              }
+            ]
+          }
+        ],
+        "referenceRange": [
+          {
+            "text": "Exon 7 Present"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224158760000.ddb99504-2b67-4b00-bab4-7c789f63e98a",
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+                "url": "OBX.2",
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+              },
+              {
+                "url": "OBX.11",
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+              }
+            ]
+          }
+        ],
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+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "92004-1",
+              "display": "Spinal muscular atrophy newborn screen interpretation"
+            }
+          ]
+        },
+        "subject": {
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+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA18593-6",
+              "display": "Out of range"
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+          ]
+        },
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+                ],
+                "code": "A"
+              }
+            ]
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+        ]
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+    },
+    {
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+              ],
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+              "code": "92003-3",
+              "display": "Spinal muscular atrophy newborn screening comment-discussion"
+            }
+          ]
+        },
+        "subject": {
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+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
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+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueString": "SMA Positive",
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+                "extension": [
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+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
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+                ],
+                "code": "A"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224160879000.8724b219-b358-4bf5-b41f-b66dba158e94",
+      "resource": {
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+        "id": "1729292224160879000.8724b219-b358-4bf5-b41f-b66dba158e94",
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+            "valueString": "2"
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+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
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+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
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+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "92003-3",
+              "display": "Spinal muscular atrophy newborn screening comment-discussion"
+            }
+          ]
+        },
+        "subject": {
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+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
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+              "valueString": "20240226034304"
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+          ]
+        },
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+              {
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+            ]
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+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-32",
+              "display": "Adrenoleukodystrophy deficiency newborn screening interpretation"
+            }
+          ]
+        },
+        "subject": {
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+                {
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+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA18592-8",
+              "display": "In range"
+            }
+          ]
+        },
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+                "extension": [
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+                    "valueString": "coding"
+                  }
+                ],
+                "code": "N"
+              }
+            ]
+          }
+        ]
+      }
+    },
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+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-28",
+              "display": "Adrenoleukodystrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-13T15:46:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402131546"
+            }
+          ]
+        },
+        "issued": "2024-02-26T03:43:04Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729292224178355000.5014bf5c-7c94-4aa4-93f1-c5d803dd24f5"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729292224162059000.e9e39abf-89b9-49f4-9eae-e7fe2cc315a3"
+          },
+          {
+            "reference": "Observation/1729292224163110000.bf94d9b1-9125-4dbf-ad97-9329c355e951"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729292224314088000.ed3d56a5-6919-4570-8815-6dc50c5cdf59",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729292224314088000.ed3d56a5-6919-4570-8815-6dc50c5cdf59",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7181233072"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729292224280836000.dfbcf4e7-32fa-44f7-a26c-5744595953fd"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-29",
+              "display": "Adrenoleukodystrophy Tier-1 newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-13T15:46:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402131546"
+            }
+          ]
+        },
+        "issued": "2024-02-26T03:43:04Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729292224178757000.20ff8b12-76a5-45df-a22b-255ddae5a395"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729292224164307000.00b423cb-eff8-4dbd-bfa4-7af6cfd1359b"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/CA/004_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir b/examples/CA/004_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
new file mode 100644
index 000000000..bb5fc6da7
--- /dev/null
+++ b/examples/CA/004_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
@@ -0,0 +1,16434 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729292223963452000.86853264-9dcc-4fb1-ae23-9b23987f6966",
+  "meta": {
+    "lastUpdated": "2024-10-18T15:57:03.963-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "243408836"
+  },
+  "type": "message",
+  "timestamp": "2024-02-26T03:43:04.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729292223965072000.d8e7d4ca-2fe2-4ff0-b1b2-e9684ed4f7a2",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729292223965072000.d8e7d4ca-2fe2-4ff0-b1b2-e9684ed4f7a2",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240226034304"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "EPIC",
+            "receiver": {
+              "reference": "Organization/1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "SISGDSP"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "name": "SISGDSP",
+          "_endpoint": {
+            "extension": [
+              {
+                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                "valueCode": "unknown"
+              }
+            ]
+          }
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
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+            "value": "CDPH"
+          }
+        ]
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+    },
+    {
+      "fullUrl": "Organization/1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7",
+      "resource": {
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+        "id": "1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7",
+        "extension": [
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+            "valueString": "MSH.6"
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+        "identifier": [
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+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "R797"
+          }
+        ]
+      }
+    },
+    {
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+        "id": "1729292223966515000.b808c45a-53be-4073-ad02-4d05fc543940",
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+            "reference": "MessageHeader/1729292223965072000.d8e7d4ca-2fe2-4ff0-b1b2-e9684ed4f7a2"
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+          },
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+          },
+          {
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+          },
+          {
+            "reference": "DiagnosticReport/1729292224289752000.9dd735d1-0026-4585-91c5-aaf2bcf14f78"
+          },
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+          },
+          {
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+          {
+            "reference": "DiagnosticReport/1729292224296854000.ced71e97-3cd9-4e0d-af47-f0429e0b446c"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224298299000.8853febd-d8e4-40bd-b53d-4e6f2ae0f911"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224299703000.cf38def9-006f-4f5b-8a40-f7c2e17d7386"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224301146000.644714af-4152-4c6b-b6ce-ac924cbeed87"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224302573000.1642659a-f1b4-4f32-a8c5-1881f545ea19"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224303959000.a1fc3f75-eeb5-4a32-94c5-3b4e1520f5e4"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224305371000.dd5dd86d-76a2-44f0-959f-874531c0af56"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224306833000.1e418500-6c97-4a01-a1ef-6020ee706132"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224308318000.decc981a-d92a-461b-bc88-e0431b789a4c"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224309777000.76cb7c27-59e4-4d6b-bbd6-1675859b8254"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224311239000.94563440-4ef6-4c1b-9f8e-8251b9b8f389"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224312687000.bcf75080-bc06-444a-b0de-d1d385132ad3"
+          },
+          {
+            "reference": "DiagnosticReport/1729292224314088000.ed3d56a5-6919-4570-8815-6dc50c5cdf59"
+          }
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+        "recorded": "2024-02-26T03:43:04Z",
+        "activity": {
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+              "display": "ORU^R01^ORU_R01"
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+        },
+        "agent": [
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+            "type": {
+              "coding": [
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+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729292223966346000.2220dfd9-bdd0-4bf8-8943-4aea1651b22b"
+            }
+          }
+        ]
+      }
+    },
+    {
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+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292223966346000.2220dfd9-bdd0-4bf8-8943-4aea1651b22b",
+        "identifier": [
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+            "extension": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "SISGDSP"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729292223967205000.905e6774-a8d6-495e-b060-fa143e31556a",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729292223967205000.905e6774-a8d6-495e-b060-fa143e31556a",
+        "recorded": "2024-10-18T15:57:03Z",
+        "policy": [
+          "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
+        ],
+        "activity": {
+          "coding": [
+            {
+              "code": "v2-FHIR transformation"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "assembler"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729292223967075000.3f202e94-d63e-4116-ab5d-40094141799c"
+            }
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+        ]
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+    },
+    {
+      "fullUrl": "Organization/1729292223967075000.3f202e94-d63e-4116-ab5d-40094141799c",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292223967075000.3f202e94-d63e-4116-ab5d-40094141799c",
+        "identifier": [
+          {
+            "value": "CDC PRIME - Atlanta"
+          },
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.237821"
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+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        }
+                      ],
+                      "code": "M"
+                    }
+                  ]
+                }
+              },
+              {
+                "url": "PID.24",
+                "valueString": "N"
+              }
+            ]
+          },
+          {
+            "url": "http://ibm.com/fhir/cdm/StructureDefinition/local-race-cd",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2106-3",
+                  "display": "White"
+                }
+              ]
+            }
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ethnic-group",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2186-5",
+                  "display": "Not Hispanic or Latino"
+                }
+              ]
+            }
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "80008836",
+            "assigner": {
+              "reference": "Organization/1729292223967819000.609effee-d2cc-40ae-96c6-304f9af964e8"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "BOY  MOMSIX"
+                  },
+                  {
+                    "url": "XPN.7"
+                  }
+                ]
+              }
+            ],
+            "use": "official",
+            "family": "CDPHSIX",
+            "given": [
+              "BOY  MOMSIX"
+            ]
+          }
+        ],
+        "gender": "male",
+        "multipleBirthInteger": 1,
+        "contact": [
+          {
+            "extension": [
+              {
+                "url": "https://hl7.org/fhir/StructureDefinition/relationship",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        }
+                      ],
+                      "code": "MTH",
+                      "display": "Mother"
+                    }
+                  ]
+                }
+              }
+            ],
+            "name": {
+              "family": "CDPHSIX"
+            },
+            "address": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                      "extension": [
+                        {
+                          "url": "SAD.1",
+                          "valueString": "132 ST"
+                        }
+                      ]
+                    }
+                  ]
+                }
+              ],
+              "line": [
+                "132 ST"
+              ],
+              "city": "SAN DIEGO",
+              "state": "CA",
+              "postalCode": "92126",
+              "country": "USA"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292223967819000.609effee-d2cc-40ae-96c6-304f9af964e8",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292223967819000.609effee-d2cc-40ae-96c6-304f9af964e8",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
+                }
+              ]
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729292223973500000.dc60f774-7de9-4252-88e6-49727213fc78",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729292223973500000.dc60f774-7de9-4252-88e6-49727213fc78",
+        "target": [
+          {
+            "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+          }
+        ],
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+        "valueString": "ACTION REQUIRED\\.br\\\\.br\\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB ~M 57752YWKP NAEBC, ETS8021 , FRESNO, CA 99999\\.br\\\\.br\\Genetic Disease Laboratory - GDL SAW 19221DVLB NOTGNIH, RICHMOND, CA 99999-9999\\.br\\\\.br\\Lab Director - Genetic Disease Laboratory, (510) 231-1790\\.br\\\\.br\\Follow-up:\\.br\\\\.br\\Amino Acid Panel: There was insufficient data to determine whether or not this newborn was at least 12 hours old when this specimen was collected. Testing of amino acids at less than 12 hours of age is not reliable for detecting certain metabolic disorder. \\.br\\\\.br\\Spinal Muscular Atrophy (SMA): An immediate referral to a CCS-approved Neuromuscular Center for evaluation and additional testing is strongly recommended due an apparent SMN1 exon 7 homozygous deletion. \\.br\\\\.br\\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Rady Children's Hospital San Diego at (161) 122-8708. \\.br\\\\.br\\Methods and Limitations:\\.br\\\\.br\\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \\.br\\Attention Healthcare Provider:\\.br\\\\.br\\Due to biological variability of newborns and differences in detection rates for the various disorders in the newborn period, the Newborn Screening Program will not identify all newborns with these conditions. While a positive screening result identifies newborns at an increased risk to justify a diagnostic work-up, a negative screening result does not rule out the possibility of a disorder. Health care providers should remain watchful for any sign or symptoms of these disorders in their patients. A newborn screening result should not be considered diagnostic, and cannot replace the individualized evaluation and diagnosis of an infant by a well-trained, knowledgeable health care provider. \\.br\\\\.br\\",
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+        "valueString": "Negative",
+        "interpretation": [
+          {
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "N"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224156491000.b8c1a527-eed1-4d83-950e-d2bde1bc161e",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729292224156491000.b8c1a527-eed1-4d83-950e-d2bde1bc161e",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "2"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "79565-8",
+              "display": "Mucopolysaccharidosis type I newborn screening comment-discussion"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueString": "Interpretation Comments: The alpha-L-iduronidase Enzyme activity is above the 18% of the daily patient median and suggests it is screen negative for Mucopolysaccharidosis I (MPS I) disease.",
+        "interpretation": [
+          {
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "N"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224157578000.58b60be8-7e92-490d-a841-482de67b5c81",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729292224157578000.58b60be8-7e92-490d-a841-482de67b5c81",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "PLT"
+                }
+              ],
+              "code": "PLT3293",
+              "display": "SMN1 exon 7 deletion analysis in DBS by Sequencing"
+            },
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-60",
+              "display": "SMN1 Homozygous Deletion Analysis"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueString": "Exon 7 Absent",
+        "interpretation": [
+          {
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "A"
+              }
+            ]
+          }
+        ],
+        "referenceRange": [
+          {
+            "text": "Exon 7 Present"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224158760000.ddb99504-2b67-4b00-bab4-7c789f63e98a",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729292224158760000.ddb99504-2b67-4b00-bab4-7c789f63e98a",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "92004-1",
+              "display": "Spinal muscular atrophy newborn screen interpretation"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueCodeableConcept": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA18593-6",
+              "display": "Out of range"
+            }
+          ]
+        },
+        "interpretation": [
+          {
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "A"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224159829000.b1ab5139-499c-4d08-959a-de1d7d4864d4",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729292224159829000.b1ab5139-499c-4d08-959a-de1d7d4864d4",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "92003-3",
+              "display": "Spinal muscular atrophy newborn screening comment-discussion"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueString": "SMA Positive",
+        "interpretation": [
+          {
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "A"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224160879000.8724b219-b358-4bf5-b41f-b66dba158e94",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729292224160879000.8724b219-b358-4bf5-b41f-b66dba158e94",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "2"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "92003-3",
+              "display": "Spinal muscular atrophy newborn screening comment-discussion"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueString": "Interpretation Comments: qPCR detected possible homozygoues deletion in exon 7 of the SMN1 gene. Confirmatory test for SMN1 and SMN2 copy determination are required.",
+        "interpretation": [
+          {
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "A"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224162059000.e9e39abf-89b9-49f4-9eae-e7fe2cc315a3",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729292224162059000.e9e39abf-89b9-49f4-9eae-e7fe2cc315a3",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "85269-9",
+              "display": "X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation"
+            },
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-32",
+              "display": "Adrenoleukodystrophy deficiency newborn screening interpretation"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueCodeableConcept": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA18592-8",
+              "display": "In range"
+            }
+          ]
+        },
+        "interpretation": [
+          {
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "N"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224163110000.bf94d9b1-9125-4dbf-ad97-9329c355e951",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729292224163110000.bf94d9b1-9125-4dbf-ad97-9329c355e951",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "85268-1",
+              "display": "X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion"
+            },
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-33",
+              "display": "Adrenoleukodystrophy deficiency newborn screening comments-discussion"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueString": "Negative",
+        "interpretation": [
+          {
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "N"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729292224164307000.00b423cb-eff8-4dbd-bfa4-7af6cfd1359b",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729292224164307000.00b423cb-eff8-4dbd-bfa4-7af6cfd1359b",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "NM"
+              },
+              {
+                "url": "OBX.6",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        }
+                      ],
+                      "code": "µmol/L"
+                    }
+                  ]
+                }
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "79321-6",
+              "display": "Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+        },
+        "effectiveDateTime": "2024-02-26T03:43:04Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240226034304"
+            }
+          ]
+        },
+        "valueQuantity": {
+          "value": 0.2,
+          "unit": "µmol/L"
+        },
+        "interpretation": [
+          {
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "N"
+              }
+            ]
+          }
+        ],
+        "referenceRange": [
+          {
+            "text": "<0.49"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729292224171466000.3582ae53-db1d-4fa2-b197-c6fc595393ce",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729292224171466000.3582ae53-db1d-4fa2-b197-c6fc595393ce",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "OBR"
+          }
+        ]
+      }
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diff --git a/examples/CA/004_CA_ORU_R01_CDPH_produced_3_hl7_translation_final.hl7 b/examples/CA/004_CA_ORU_R01_CDPH_produced_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..4207d4c91
--- /dev/null
+++ b/examples/CA/004_CA_ORU_R01_CDPH_produced_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240226034304||ORU^R01|243408836|D|2.5.1
PID|1||80008836||CDPHSIX^BOY  MOMSIX|||M||2106-3^White||||||||||||2186-5^Not Hispanic or Latino||N|1
NK1|1|CDPHSIX|MTH^Mother|132 ST^^SAN DIEGO^CA^92126^USA
ORC|RE|189430284^HospOrdNumber||7181233072^FormNumber||||||||^ROSEN^REBECCA|||||||||UCSD JACOBS MEDICAL CENTER^^^^^^^^^R797|2961DR YLLUT^^SAN DIEGO^CA^99999-9999
OBR|1|189430284^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202402131546|||||||||^ROSEN^REBECCA||||||20240226034304|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240226034304
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240226034304
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240226034304
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA22279-6^SMA^LN|||N|||F|||20240226034304
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240226034304
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\M 57752YWKP NAEBC, ETS8021 , FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL SAW 19221DVLB NOTGNIH, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Follow-up:\.br\\.br\Amino Acid Panel: There was insufficient data to determine whether or not this newborn was at least 12 hours old when this specimen was collected. Testing of amino acids at less than 12 hours of age is not reliable for detecting certain metabolic disorder. \.br\\.br\Spinal Muscular Atrophy (SMA): An immediate referral to a CCS-approved Neuromuscular Center for evaluation and additional testing is strongly recommended due an apparent SMN1 exon 7 homozygous deletion. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Rady Children's Hospital San Diego at (161) 122-8708. \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\Due to biological variability of newborns and differences in detection rates for the various disorders in the newborn period, the Newborn Screening Program will not identify all newborns with these conditions. While a positive screening result identifies newborns at an increased risk to justify a diagnostic work-up, a negative screening result does not rule out the possibility of a disorder. Health care providers should remain watchful for any sign or symptoms of these disorders in their patients. A newborn screening result should not be considered diagnostic, and cannot replace the individualized evaluation and diagnosis of an infant by a well-trained, knowledgeable health care provider. \.br\\.br\|||N|||F|||20240226034304
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240226034304
OBX|8|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|1|LA22279-6^SMA^LN|||N|||F|||20240226034304
OBX|9|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|2|LA25796-6^X-ALD^LN|||N|||F|||20240226034304
OBX|10|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|3|LA14037-8^GAA^LN|||N|||F|||20240226034304
OBX|11|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|4|LA25797-4^MPS-I^LN|||N|||F|||20240226034304
OBX|12|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|5|LA12466-1^3-MCC^LN|||N|||F|||20240226034304
OBX|13|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|6|LA12468-7^3MGA^LN|||N|||F|||20240226034304
OBX|14|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|7|LA12469-5^5-OXO^LN|||N|||F|||20240226034304
OBX|15|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|8|LA12470-3^ARG^LN|||N|||F|||20240226034304
OBX|16|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|9|LA12482-8^CIT-I^LN|||N|||F|||20240226034304
OBX|17|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|10|LA12483-6^CIT-II^LN|||N|||F|||20240226034304
OBX|18|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|11|LA12485-1^CPT-Ia^LN|||N|||F|||20240226034304
OBX|19|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|12|LA12486-9^CPT-II^LN|||N|||F|||20240226034304
OBX|20|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|13|LA12493-5^GA-1^LN|||N|||F|||20240226034304
OBX|21|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|14|LA12495-0^GA-2^LN|||N|||F|||20240226034304
OBX|22|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|15|LA12497-6^HHH^LN|||N|||F|||20240226034304
OBX|23|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|16|LA12499-2^HMG^LN|||N|||F|||20240226034304
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OBX|31|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|24|LA12516-3^NKHG^LN|||N|||F|||20240226034304
OBX|32|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|25|LA12520-5^PKU^LN|||N|||F|||20240226034304
OBX|33|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|26|LA12521-3^PRO I^LN|||N|||F|||20240226034304
OBX|34|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|27|LA12528-8^TYR-1^LN|||N|||F|||20240226034304
OBX|35|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|28|LA12529-6^TYR-II^LN|||N|||F|||20240226034304
OBX|36|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|29|LA12531-2^VLCAD^LN|||N|||F|||20240226034304
OBX|37|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|30|LA12532-0^BIO^LN|||N|||F|||20240226034304
OBX|38|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|31|LA12533-8^CAH^LN|||N|||F|||20240226034304
OBX|39|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|32|LA12537-9^CF^LN|||N|||F|||20240226034304
OBX|40|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|33|LA12543-7^GALT^LN|||N|||F|||20240226034304
OBX|41|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|34|LA12566-8^SCID^LN|||N|||F|||20240226034304
OBX|42|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|35|LA12576-7^SCAD or EMA or IBG or GA-2 (MADD)^LN|||N|||F|||20240226034304
OBX|43|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|36|LA16207-5^Hemoglobinopathies^LN|||N|||F|||20240226034304
OBX|44|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|37|99717-3^Hypothyroidism^L|||N|||F|||20240226034304
OBX|45|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|38|LA12487-7^CUD^LN|||N|||F|||20240226034304
OBX|46|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|39|LA12474-5^BKT^LN|||N|||F|||20240226034304
OBX|47|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|40|LA12523-9^PA^LN|||N|||F|||20240226034304
OBX|48|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|41|LA12515-5^MMA^LN|||N|||F|||20240226034304
OBX|49|CE|57719-7^Conditions tested for in this newborn screening study [Identifier] in Dried blood spot^LN|42|LA12464-6^2M3HBA^LN|||N|||F|||20240226034304
OBX|50|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240226034304
OBX|51|NM|8339-4^Birthweight^LN|1|3000|grams||N|||F|||20240226034304
OBX|52|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240226034304
OBX|53|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240226034304
OBX|54|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240226034304
OBX|55|TX|62324-9^Post-discharge provider name^LN|1|REBECCA ROSEN|||N|||F|||20240226034304
OBX|56|TX|62327-2^Post-discharge provider practice address^LN|1|2961DR YLLUT SAN DIEGO CA 99999-9999 USA|||N|||F|||20240226034304
OBX|57|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240226034304
OBX|58|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240226034304
OBX|59|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240226034304
OBX|60|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240226034304
OBX|61|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240226034304
OBX|62|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240226034304
OBX|63|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240226034304
OBX|64|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240226034304
OBX|65|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240226034304
OBX|66|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240226034304
OBX|67|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240226034304
OBX|68|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240226034304
OBX|69|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240226034304
OBX|70|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240226034304
OBX|71|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240226034304
OBX|72|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240226034304
OBX|73|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240226034304
OBX|74|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240226034304
OBX|75|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Collected Early. No Interpretation.|||A|||F|||20240226034304
OBX|76|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240226034304
OBX|77|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240226034304
OBX|78|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240226034304
OBX|79|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240226034304
OBX|80|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240226034304
OBX|81|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240226034304
OBX|82|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240226034304
OBX|83|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240226034304
OBX|84|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240226034304
OBX|85|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240226034304
OBX|86|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240226034304
OBX|87|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240226034304
OBX|88|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240226034304
OBX|89|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240226034304
OBX|90|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240226034304
OBX|91|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240226034304
OBX|92|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240226034304
OBX|93|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240226034304
OBX|94|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240226034304
OBX|95|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240226034304
OBX|96|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240226034304
OBX|97|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240226034304
OBX|98|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240226034304
OBX|99|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240226034304
OBX|100|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240226034304
OBX|101|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240226034304
OBX|102|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240226034304
OBX|103|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240226034304
OBX|104|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240226034304
OBX|105|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240226034304
OBX|106|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240226034304
OBX|107|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240226034304
OBX|108|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240226034304
OBX|109|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240226034304
OBX|110|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240226034304
OBX|111|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240226034304
OBX|112|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240226034304
OBX|113|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240226034304
OBX|114|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<71|N|||F|||20240226034304
OBX|115|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240226034304
OBX|116|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240226034304
OBX|117|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240226034304
OBX|118|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240226034304
OBX|119|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240226034304
OBX|120|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240226034304
OBX|121|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240226034304
OBX|122|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240226034304
OBX|123|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240226034304
OBX|124|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240226034304
OBX|125|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240226034304
OBX|126|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240226034304
OBX|127|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern.†These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240226034304
OBX|128|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240226034304
OBX|129|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240226034304
OBX|130|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240226034304
OBX|131|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240226034304
OBX|132|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240226034304
OBX|133|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240226034304
OBX|134|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240226034304
OBX|135|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240226034304
OBX|136|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240226034304
OBX|137|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|2|Interpretation Comments: The acid alpha-glucosidase Enzyme activity level is above the 18% of the daily patient median and suggests it is screen negative for Pompe disease.|||N|||F|||20240226034304
OBX|138|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240226034304
OBX|139|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240226034304
OBX|140|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240226034304
OBX|141|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|2|Interpretation Comments: The alpha-L-iduronidase Enzyme activity is above the 18% of the daily patient median and suggests it is screen negative for Mucopolysaccharidosis I (MPS I) disease.|||N|||F|||20240226034304
OBX|142|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Absent||Exon 7 Present|A|||F|||20240226034304
OBX|143|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240226034304
OBX|144|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Positive|||A|||F|||20240226034304
OBX|145|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|2|Interpretation Comments: qPCR detected possible homozygoues deletion in exon 7 of the SMN1 gene. Confirmatory test for SMN1 and SMN2 copy determination are required.|||A|||F|||20240226034304
OBX|146|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240226034304
OBX|147|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240226034304
OBX|148|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.49|N|||F|||20240226034304
diff --git a/examples/CA/005_CA_ORU_R01_CDPH_generated_1_hl7_translation.fhir b/examples/CA/005_CA_ORU_R01_CDPH_generated_1_hl7_translation.fhir
index 354387784..ecfc14f1c 100644
--- a/examples/CA/005_CA_ORU_R01_CDPH_generated_1_hl7_translation.fhir
+++ b/examples/CA/005_CA_ORU_R01_CDPH_generated_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1721238051134539000.e4e00091-2347-46f7-af4b-1b52c6a9df5d",
+  "id": "1729291987199744000.c3d04406-8a4d-4616-8fc8-865a0e427f53",
   "meta": {
-    "lastUpdated": "2024-07-17T10:40:51.135-07:00"
+    "lastUpdated": "2024-10-18T15:53:07.199-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,15 +12,15 @@
   "timestamp": "2024-07-16T09:06:32.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/09750e90-6433-3b6d-8f2e-1498ab5b1a9c",
+      "fullUrl": "MessageHeader/1729291987202217000.19132f10-715d-4388-bd52-718fba74a13e",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "09750e90-6433-3b6d-8f2e-1498ab5b1a9c",
+        "id": "1729291987202217000.19132f10-715d-4388-bd52-718fba74a13e",
         "meta": {
           "tag": [
             {
               "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-              "code": "T"
+              "code": "D"
             }
           ]
         },
@@ -58,12 +58,12 @@
             ],
             "name": "SISHIERECEIVER",
             "receiver": {
-              "reference": "Organization/1721238051170417000.48412617-7895-4243-8f7b-471224fec9f3"
+              "reference": "Organization/1729291987201999000.0894917a-ec9b-4349-8159-b6f73a4c7390"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1721238051157800000.db87cac4-86b0-4c1e-a554-932844c4f271"
+          "reference": "Organization/1729291987201196000.172535b8-1bdb-4b93-b6d5-c6ef6205936d"
         },
         "source": {
           "extension": [
@@ -89,10 +89,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721238051157800000.db87cac4-86b0-4c1e-a554-932844c4f271",
+      "fullUrl": "Organization/1729291987201196000.172535b8-1bdb-4b93-b6d5-c6ef6205936d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721238051157800000.db87cac4-86b0-4c1e-a554-932844c4f271",
+        "id": "1729291987201196000.172535b8-1bdb-4b93-b6d5-c6ef6205936d",
         "identifier": [
           {
             "extension": [
@@ -107,10 +107,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721238051170417000.48412617-7895-4243-8f7b-471224fec9f3",
+      "fullUrl": "Organization/1729291987201999000.0894917a-ec9b-4349-8159-b6f73a4c7390",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721238051170417000.48412617-7895-4243-8f7b-471224fec9f3",
+        "id": "1729291987201999000.0894917a-ec9b-4349-8159-b6f73a4c7390",
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@@ -10580,7 +10580,7 @@
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@@ -10628,10 +10628,10 @@
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@@ -10672,7 +10672,7 @@
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@@ -10702,10 +10702,10 @@
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@@ -10762,7 +10762,7 @@
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@@ -10800,10 +10800,10 @@
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@@ -10813,10 +10813,10 @@
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@@ -10826,10 +10826,10 @@
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@@ -10839,10 +10839,10 @@
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@@ -10852,10 +10852,10 @@
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@@ -10865,10 +10865,10 @@
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@@ -10878,10 +10878,10 @@
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@@ -10891,10 +10891,10 @@
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@@ -10904,10 +10904,10 @@
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@@ -10917,10 +10917,10 @@
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@@ -10930,10 +10930,10 @@
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@@ -10943,10 +10943,10 @@
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@@ -10956,10 +10956,10 @@
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@@ -10969,10 +10969,10 @@
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@@ -10982,10 +10982,10 @@
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@@ -10995,10 +10995,10 @@
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@@ -11008,10 +11008,10 @@
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@@ -11021,10 +11021,10 @@
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@@ -11034,10 +11034,10 @@
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@@ -11047,10 +11047,10 @@
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@@ -11060,10 +11060,10 @@
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@@ -11075,7 +11075,7 @@
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@@ -11108,7 +11108,7 @@
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@@ -11137,10 +11137,14 @@
                 "url": "OBR.22",
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@@ -11242,18 +11246,18 @@
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@@ -11284,10 +11288,10 @@
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@@ -11346,23 +11350,23 @@
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@@ -11383,10 +11387,10 @@
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         "extension": [
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@@ -11413,10 +11417,10 @@
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         "extension": [
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@@ -11439,10 +11443,10 @@
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@@ -11451,10 +11455,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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+              {
+                "url": "OBR.25",
+                "valueId": "F"
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@@ -11504,18 +11512,18 @@
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@@ -11542,10 +11550,10 @@
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         "extension": [
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@@ -11568,10 +11576,10 @@
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@@ -11580,10 +11588,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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+              {
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+                "valueId": "F"
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@@ -11633,18 +11645,18 @@
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@@ -11671,10 +11683,10 @@
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@@ -11697,10 +11709,10 @@
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@@ -11709,10 +11721,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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+              {
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+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291987418221000.35de5043-6743-42f5-8c96-66ea6e999d0b"
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@@ -11762,18 +11778,18 @@
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+        "id": "1729291987415270000.a742829e-7750-4e14-85d8-f2210b9c7422",
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@@ -11800,10 +11816,10 @@
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         "extension": [
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@@ -11826,10 +11842,10 @@
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@@ -11838,10 +11854,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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+              {
+                "url": "OBR.25",
+                "valueId": "F"
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@@ -11891,18 +11911,18 @@
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+          "reference": "Practitioner/1729291987419757000.e4062287-e775-43f8-87f4-d25605ee0b75"
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@@ -11929,10 +11949,10 @@
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         "extension": [
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@@ -11955,10 +11975,10 @@
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@@ -11967,10 +11987,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
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+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291987427036000.d9380372-986c-42f0-8ef6-83ac0e0b796f"
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@@ -12020,18 +12044,18 @@
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+          "reference": "Practitioner/1729291987424158000.d121b5ba-4deb-49e8-a3ba-00942067130a"
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+      "fullUrl": "Practitioner/1729291987424158000.d121b5ba-4deb-49e8-a3ba-00942067130a",
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@@ -12058,10 +12082,10 @@
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@@ -12084,10 +12108,10 @@
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@@ -12096,10 +12120,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
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+                "valueId": "F"
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@@ -12149,18 +12177,18 @@
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@@ -12187,10 +12215,10 @@
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@@ -12213,10 +12241,10 @@
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@@ -12225,10 +12253,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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+                  "reference": "Practitioner/1729291987440949000.79f9b675-b5da-4fdf-96d4-2bc6e61bd660"
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@@ -12278,18 +12310,18 @@
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@@ -12316,10 +12348,10 @@
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@@ -12342,10 +12374,10 @@
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@@ -12354,10 +12386,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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+              {
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+                "valueId": "F"
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@@ -12407,18 +12443,18 @@
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+          "reference": "Practitioner/1729291987443870000.7c2669e5-1407-455a-9c65-114de17e24b7"
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-      "fullUrl": "Practitioner/1721238051520181000.7938130c-d20e-4796-ba73-8b881afd8331",
+      "fullUrl": "Practitioner/1729291987443870000.7c2669e5-1407-455a-9c65-114de17e24b7",
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+        "id": "1729291987443870000.7c2669e5-1407-455a-9c65-114de17e24b7",
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@@ -12445,10 +12481,10 @@
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         "extension": [
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@@ -12471,10 +12507,10 @@
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         "extension": [
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@@ -12483,10 +12519,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291987453887000.e143842a-9ceb-4db4-a846-2f639ff61b04"
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@@ -12536,18 +12576,18 @@
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+          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
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+          "reference": "Practitioner/1729291987450932000.a2fd9e00-2ab3-4c77-8c18-13bd97283d0c"
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-      "fullUrl": "Practitioner/1721238051524112000.3170cb62-2b4f-4e4d-b1d0-25b90722b8d5",
+      "fullUrl": "Practitioner/1729291987450932000.a2fd9e00-2ab3-4c77-8c18-13bd97283d0c",
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         "extension": [
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@@ -12574,10 +12614,10 @@
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         "extension": [
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@@ -12600,10 +12640,10 @@
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         "extension": [
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@@ -12612,10 +12652,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291987458427000.1dd4fad9-ac6b-408a-bc71-07e6028bcbff"
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@@ -12665,18 +12709,18 @@
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+          "reference": "Practitioner/1729291987455518000.dbaa6710-5cbc-44c4-98bf-39d254f61fb4"
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+        "id": "1729291987455518000.dbaa6710-5cbc-44c4-98bf-39d254f61fb4",
         "extension": [
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@@ -12703,10 +12747,10 @@
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         "extension": [
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@@ -12729,10 +12773,10 @@
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@@ -12741,10 +12785,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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+              {
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+                "valueId": "F"
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+                  "reference": "Practitioner/1729291987462900000.681c00f3-9456-4745-9b6c-dfeeb13e89dd"
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@@ -12794,18 +12842,18 @@
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@@ -12832,10 +12880,10 @@
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         "extension": [
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@@ -12858,10 +12906,10 @@
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@@ -12870,10 +12918,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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+              {
+                "url": "OBR.25",
+                "valueId": "F"
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+                  "reference": "Practitioner/1729291987467515000.3856ffd2-bbf8-4ab1-ad2b-62d256fb0951"
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@@ -12923,18 +12975,18 @@
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+          "reference": "Practitioner/1729291987464520000.9fb881b0-ce5c-47a4-946d-4c78362511b0"
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@@ -12961,10 +13013,10 @@
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@@ -12987,10 +13039,10 @@
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@@ -12999,10 +13051,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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@@ -13052,18 +13108,18 @@
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@@ -13090,10 +13146,10 @@
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@@ -13116,10 +13172,10 @@
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@@ -13128,10 +13184,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291987477146000.03c017a4-0bc7-4ceb-a431-f1b668806dc0"
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@@ -13181,18 +13241,18 @@
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+          "reference": "Practitioner/1729291987474157000.5f2b5f15-9cc0-4ed7-9d27-36ca5e507bfc"
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@@ -13219,10 +13279,10 @@
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@@ -13245,10 +13305,10 @@
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@@ -13257,10 +13317,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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+              {
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+                "valueId": "F"
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@@ -13310,18 +13374,18 @@
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@@ -13348,10 +13412,10 @@
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@@ -13374,10 +13438,10 @@
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@@ -13386,10 +13450,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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+              {
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+                "valueId": "F"
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@@ -13439,18 +13507,18 @@
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@@ -13477,10 +13545,10 @@
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         "extension": [
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@@ -13503,10 +13571,10 @@
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@@ -13515,10 +13583,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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@@ -13568,18 +13640,18 @@
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@@ -13606,10 +13678,10 @@
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         "extension": [
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@@ -13632,10 +13704,10 @@
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@@ -13644,10 +13716,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291987494911000.84570077-a4db-4234-a424-f07827ced929"
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@@ -13702,18 +13778,18 @@
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+          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
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         "extension": [
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@@ -13740,10 +13816,10 @@
       }
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@@ -13766,10 +13842,10 @@
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@@ -13778,10 +13854,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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@@ -13836,18 +13916,18 @@
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@@ -13874,10 +13954,10 @@
       }
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@@ -13900,10 +13980,10 @@
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@@ -13978,7 +14058,7 @@
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@@ -13997,7 +14077,7 @@
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@@ -15240,7 +15320,7 @@
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@@ -15259,7 +15339,7 @@
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@@ -15281,24 +15361,24 @@
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@@ -15329,7 +15409,7 @@
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@@ -15348,7 +15428,7 @@
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@@ -15370,27 +15450,27 @@
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@@ -15421,7 +15501,7 @@
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@@ -15440,7 +15520,7 @@
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@@ -15462,27 +15542,27 @@
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+            "reference": "Observation/1729291987368143000.9cba1502-c7fc-448d-8d27-87e84066d2ec"
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     {
-      "fullUrl": "DiagnosticReport/1721238051595631000.bd933823-bf16-4204-98b4-396d96a4269a",
+      "fullUrl": "DiagnosticReport/1729291987534302000.27b7afab-1d6c-45e3-8a20-4418a5a3eb90",
       "resource": {
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-        "id": "1721238051595631000.bd933823-bf16-4204-98b4-396d96a4269a",
+        "id": "1729291987534302000.27b7afab-1d6c-45e3-8a20-4418a5a3eb90",
         "identifier": [
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@@ -15513,7 +15593,7 @@
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+            "reference": "ServiceRequest/1729291987482161000.20652d8c-a5e2-4ea3-8879-0675ea61b896"
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@@ -15532,7 +15612,7 @@
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         "subject": {
-          "reference": "Patient/1721238051225760000.64893115-2271-447c-8172-526b7e07a2c3"
+          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
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         "_effectiveDateTime": {
@@ -15554,27 +15634,27 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1721238051481609000.91933f77-e998-407f-8942-af1a0fa69041"
+            "reference": "Specimen/1729291987395835000.588cef91-3ee0-4ca9-9587-0df686e04d16"
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         "result": [
           {
-            "reference": "Observation/1721238051348205000.92f52df0-15a4-4624-9ffb-dd5606135fab"
+            "reference": "Observation/1729291987370110000.50d9fb07-3a47-40f9-85ef-2e147bf3ee10"
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           {
-            "reference": "Observation/1721238051349307000.1719eb4b-0627-45c0-a070-f2ef499a1f25"
+            "reference": "Observation/1729291987371716000.48f3af8a-dfec-4a9b-a320-93ae81356fe0"
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           {
-            "reference": "Observation/1721238051350258000.eac22e1e-a254-4863-9181-9190a6b1c879"
+            "reference": "Observation/1729291987372950000.8e63484f-6884-4552-9607-16e5138b7306"
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-      "fullUrl": "DiagnosticReport/1721238051597033000.b34949d5-bb4b-4a42-8f55-c9049c79fb52",
+      "fullUrl": "DiagnosticReport/1729291987535919000.eae86477-0f78-4632-be4a-948a713c41e9",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721238051597033000.b34949d5-bb4b-4a42-8f55-c9049c79fb52",
+        "id": "1729291987535919000.eae86477-0f78-4632-be4a-948a713c41e9",
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             "extension": [
@@ -15605,7 +15685,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1721238051554896000.ac1d6896-8d98-4b64-a224-a6cc5d536ba3"
+            "reference": "ServiceRequest/1729291987486576000.5251876c-639b-4002-be4e-ecf752d820f9"
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         "status": "final",
@@ -15624,7 +15704,7 @@
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+          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
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         "_effectiveDateTime": {
@@ -15646,27 +15726,27 @@
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         "specimen": [
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-            "reference": "Specimen/1721238051481974000.807f8cbd-56c8-4ed4-be54-172b1a5404b2"
+            "reference": "Specimen/1729291987396220000.e5550353-0211-4984-a55b-471339d5c3d1"
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         "result": [
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-            "reference": "Observation/1721238051351334000.ea25888f-a4a9-45d7-8f76-e226ead249ba"
+            "reference": "Observation/1729291987374203000.774a5a9d-5fbf-4de1-be81-c19678751ee8"
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-            "reference": "Observation/1721238051352467000.f3f75d6d-8ebc-4ea6-9bf9-18915b6e79f7"
+            "reference": "Observation/1729291987375388000.5a874662-1823-496a-8036-974306b6afe3"
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           {
-            "reference": "Observation/1721238051353478000.040db378-ca47-4333-8fea-ed2e711e8367"
+            "reference": "Observation/1729291987376391000.ab95638b-f6c9-412a-9ab8-b4a41ae09f3f"
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     },
     {
-      "fullUrl": "DiagnosticReport/1721238051598482000.b13e779b-36cf-459f-b7ba-089f8400239b",
+      "fullUrl": "DiagnosticReport/1729291987537581000.c393d484-f86d-462e-bef5-d80cb42427c5",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721238051598482000.b13e779b-36cf-459f-b7ba-089f8400239b",
+        "id": "1729291987537581000.c393d484-f86d-462e-bef5-d80cb42427c5",
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             "extension": [
@@ -15697,7 +15777,7 @@
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+            "reference": "ServiceRequest/1729291987490976000.cdb0d96e-10d0-40f5-a564-6a25ca08518c"
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@@ -15716,7 +15796,7 @@
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         "subject": {
-          "reference": "Patient/1721238051225760000.64893115-2271-447c-8172-526b7e07a2c3"
+          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
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         "_effectiveDateTime": {
@@ -15738,30 +15818,30 @@
         },
         "specimen": [
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-            "reference": "Specimen/1721238051482349000.436b213f-d5e4-4d33-ab4a-365a775639b9"
+            "reference": "Specimen/1729291987396603000.916a30fa-447a-44b7-bd53-4c8f9c67e13d"
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         "result": [
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+            "reference": "Observation/1729291987377498000.d73f74a5-d889-4987-bedd-2d7ebb5c6b38"
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+            "reference": "Observation/1729291987378696000.062bebcb-2578-4090-a634-d532df8c39f9"
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-            "reference": "Observation/1721238051356525000.c024e7f2-fde4-4a29-a212-c8c9c63fb372"
+            "reference": "Observation/1729291987379851000.01da0a7d-ba92-46f1-9288-dd144464467d"
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-            "reference": "Observation/1721238051357479000.3369a53b-408c-46c4-95b8-d02fd94bfba5"
+            "reference": "Observation/1729291987380931000.84e79984-b6bb-448c-a426-3a53b3ec0288"
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     },
     {
-      "fullUrl": "DiagnosticReport/1721238051599902000.a85842f2-408f-4b44-8d3d-b4497d8aad35",
+      "fullUrl": "DiagnosticReport/1729291987539269000.ed5d3a61-2ec6-45ce-9a3a-f1fcfa9ef5a0",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721238051599902000.a85842f2-408f-4b44-8d3d-b4497d8aad35",
+        "id": "1729291987539269000.ed5d3a61-2ec6-45ce-9a3a-f1fcfa9ef5a0",
         "identifier": [
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             "extension": [
@@ -15792,7 +15872,7 @@
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+            "reference": "ServiceRequest/1729291987495492000.d273d503-2184-4d2f-b64d-49f577e8b75f"
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@@ -15816,7 +15896,7 @@
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-          "reference": "Patient/1721238051225760000.64893115-2271-447c-8172-526b7e07a2c3"
+          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
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         "_effectiveDateTime": {
@@ -15838,24 +15918,24 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1721238051482707000.17d56a10-affa-4e99-85f7-30b2b7d601da"
+            "reference": "Specimen/1729291987396986000.dd4097d0-4ba4-485b-bb4c-1687c4f2159a"
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         "result": [
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-            "reference": "Observation/1721238051358586000.8518f41e-ea3f-4fe3-9b92-78e8e3bf20d9"
+            "reference": "Observation/1729291987382153000.c970ff31-08e3-4add-8d1d-bb975e265c68"
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           {
-            "reference": "Observation/1721238051359558000.76f05fd3-e3c3-4929-a801-fd630fac74f0"
+            "reference": "Observation/1729291987383223000.e6b4f0b2-e1c9-4be7-ba65-63fa70ca124a"
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     },
     {
-      "fullUrl": "DiagnosticReport/1721238051601275000.bce94e9e-a11d-451e-8ec1-d26370cebc08",
+      "fullUrl": "DiagnosticReport/1729291987540872000.73e2bb90-8b98-4ee4-b290-58154a8c53f6",
       "resource": {
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-        "id": "1721238051601275000.bce94e9e-a11d-451e-8ec1-d26370cebc08",
+        "id": "1729291987540872000.73e2bb90-8b98-4ee4-b290-58154a8c53f6",
         "identifier": [
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             "extension": [
@@ -15886,7 +15966,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1721238051567111000.6898d4d5-57aa-4a63-9a46-5cd032f16c9a"
+            "reference": "ServiceRequest/1729291987499849000.c440482e-b439-4d28-a277-670dac86247c"
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         "status": "final",
@@ -15910,7 +15990,7 @@
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         "subject": {
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+          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
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         "_effectiveDateTime": {
@@ -15932,12 +16012,12 @@
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         "specimen": [
           {
-            "reference": "Specimen/1721238051483061000.da48d466-26ec-4114-afe6-8ca8ca39e6e6"
+            "reference": "Specimen/1729291987397360000.1cdc5a9a-e408-4185-a4b5-23a0ef741f04"
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-            "reference": "Observation/1721238051360643000.25c0053a-7ee0-4f8e-99c0-1caebc2f8310"
+            "reference": "Observation/1729291987384413000.79253e60-a8b8-4b65-9826-4587d4f440f3"
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diff --git a/examples/CA/005_CA_ORU_R01_CDPH_generated_2_fhir_transformation.fhir b/examples/CA/005_CA_ORU_R01_CDPH_generated_2_fhir_transformation.fhir
index 7d66c7dd3..30f1bb660 100644
--- a/examples/CA/005_CA_ORU_R01_CDPH_generated_2_fhir_transformation.fhir
+++ b/examples/CA/005_CA_ORU_R01_CDPH_generated_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1721238051134539000.e4e00091-2347-46f7-af4b-1b52c6a9df5d",
+  "id": "1729291987199744000.c3d04406-8a4d-4616-8fc8-865a0e427f53",
   "meta": {
-    "lastUpdated": "2024-07-17T10:40:51.135-07:00"
+    "lastUpdated": "2024-10-18T15:53:07.199-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,15 +12,15 @@
   "timestamp": "2024-07-16T09:06:32.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/09750e90-6433-3b6d-8f2e-1498ab5b1a9c",
+      "fullUrl": "MessageHeader/1729291987202217000.19132f10-715d-4388-bd52-718fba74a13e",
       "resource": {
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-        "id": "09750e90-6433-3b6d-8f2e-1498ab5b1a9c",
+        "id": "1729291987202217000.19132f10-715d-4388-bd52-718fba74a13e",
         "meta": {
           "tag": [
             {
               "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-              "code": "T"
+              "code": "D"
             },
             {
               "system": "http://localcodes.org/ETOR",
@@ -55,12 +55,12 @@
             ],
             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1721238051170417000.48412617-7895-4243-8f7b-471224fec9f3"
+              "reference": "Organization/1729291987201999000.0894917a-ec9b-4349-8159-b6f73a4c7390"
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           }
         ],
         "sender": {
-          "reference": "Organization/1721238051157800000.db87cac4-86b0-4c1e-a554-932844c4f271"
+          "reference": "Organization/1729291987201196000.172535b8-1bdb-4b93-b6d5-c6ef6205936d"
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         "source": {
           "extension": [
@@ -86,10 +86,10 @@
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     },
     {
-      "fullUrl": "Organization/1721238051157800000.db87cac4-86b0-4c1e-a554-932844c4f271",
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@@ -10249,6 +10175,20 @@
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@@ -10394,10 +10334,10 @@
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@@ -10438,7 +10378,7 @@
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@@ -10468,10 +10408,10 @@
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@@ -10512,7 +10452,7 @@
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@@ -10541,10 +10481,10 @@
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@@ -10567,6 +10507,21 @@
         "status": "final",
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+            {
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+                  "valueString": "coding"
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+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
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@@ -10585,7 +10540,7 @@
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@@ -10633,10 +10588,10 @@
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@@ -10659,6 +10614,21 @@
         "status": "final",
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+            {
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+                {
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+                  "valueString": "coding"
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+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
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+              "code": "85268-1",
+              "display": "X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion"
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@@ -10677,7 +10647,7 @@
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@@ -10707,10 +10677,10 @@
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@@ -10767,7 +10737,7 @@
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@@ -10805,10 +10775,10 @@
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@@ -10818,10 +10788,10 @@
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@@ -10831,10 +10801,10 @@
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@@ -10844,10 +10814,10 @@
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@@ -10857,10 +10827,10 @@
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@@ -10870,10 +10840,10 @@
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@@ -10883,10 +10853,10 @@
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@@ -10896,10 +10866,10 @@
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@@ -10909,10 +10879,10 @@
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@@ -10922,10 +10892,10 @@
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@@ -10935,10 +10905,10 @@
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@@ -10948,10 +10918,10 @@
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@@ -10961,10 +10931,10 @@
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@@ -10974,10 +10944,10 @@
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@@ -10987,10 +10957,10 @@
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@@ -11000,10 +10970,10 @@
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@@ -11013,10 +10983,10 @@
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@@ -11026,10 +10996,10 @@
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@@ -11039,10 +11009,10 @@
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@@ -11052,10 +11022,10 @@
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@@ -11065,10 +11035,10 @@
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@@ -11080,7 +11050,7 @@
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@@ -11113,7 +11083,7 @@
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                 "valueReference": {
-                  "reference": "Practitioner/1721238051489456000.3f577cbd-e599-45a6-b634-8416f71d9114"
+                  "reference": "Practitioner/1729291987403538000.c67fd2a0-ecb3-4c68-9ec4-52669b264499"
                 }
               }
             ]
@@ -11130,22 +11100,26 @@
                       "extension": [
                         {
                           "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                          "valueString": "FormNumber"
+                          "valueString": "HospOrdNumber"
                         }
                       ]
                     }
                   ],
-                  "value": "ABC888"
+                  "value": "Q12345"
                 }
               },
               {
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1721238051490480000.8b158db0-43db-4a2e-bad0-792364e98203"
+                  "reference": "Practitioner/1729291987398851000.e480cb40-6b0c-43a3-b10c-d5b0d1c9dd8a"
                 }
               }
             ]
@@ -11242,36 +11216,27 @@
                 },
                 {
                   "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
-                  "valueString": "LN"
+                  "valueString": "CDPHGSPEAP"
                 }
               ],
               "code": "54089-8",
               "display": "NB Screen Panel Patient AHIC"
-            },
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
-                  "valueString": "alt-coding"
-                }
-              ],
-              "code": "CDPHGSPEAP"
             }
           ]
         },
         "subject": {
-          "reference": "Patient/1721238051225760000.64893115-2271-447c-8172-526b7e07a2c3"
+          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
         },
         "requester": {
-          "reference": "PractitionerRole/1721238051484412000.67c34b49-3a03-49ad-b250-3a5e3c623fb4"
+          "reference": "PractitionerRole/1729291987398048000.bd009782-c82d-4a6b-a3b7-381bcde85762"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051485239000.03fae352-ef49-4221-bf35-4c7b038de00b",
+      "fullUrl": "Practitioner/1729291987398851000.e480cb40-6b0c-43a3-b10c-d5b0d1c9dd8a",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051485239000.03fae352-ef49-4221-bf35-4c7b038de00b",
+        "id": "1729291987398851000.e480cb40-6b0c-43a3-b10c-d5b0d1c9dd8a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11302,10 +11267,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721238051486407000.c88daf44-38c0-4eed-abca-cc9ab0bd8958",
+      "fullUrl": "Organization/1729291987400104000.4f85dd44-6f7c-49ef-88ac-da131b5bb7ce",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721238051486407000.c88daf44-38c0-4eed-abca-cc9ab0bd8958",
+        "id": "1729291987400104000.4f85dd44-6f7c-49ef-88ac-da131b5bb7ce",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xon-organization",
@@ -11364,23 +11329,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1721238051484412000.67c34b49-3a03-49ad-b250-3a5e3c623fb4",
+      "fullUrl": "PractitionerRole/1729291987398048000.bd009782-c82d-4a6b-a3b7-381bcde85762",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1721238051484412000.67c34b49-3a03-49ad-b250-3a5e3c623fb4",
+        "id": "1729291987398048000.bd009782-c82d-4a6b-a3b7-381bcde85762",
         "practitioner": {
-          "reference": "Practitioner/1721238051485239000.03fae352-ef49-4221-bf35-4c7b038de00b"
+          "reference": "Practitioner/1729291987398851000.e480cb40-6b0c-43a3-b10c-d5b0d1c9dd8a"
         },
         "organization": {
-          "reference": "Organization/1721238051486407000.c88daf44-38c0-4eed-abca-cc9ab0bd8958"
+          "reference": "Organization/1729291987400104000.4f85dd44-6f7c-49ef-88ac-da131b5bb7ce"
         }
       }
     },
     {
-      "fullUrl": "Organization/1721238051488332000.461ff3e5-78b5-4a45-b2ff-7f914de4201b",
+      "fullUrl": "Organization/1729291987402243000.3b7ecbe4-5496-4404-a676-af329e8722d7",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721238051488332000.461ff3e5-78b5-4a45-b2ff-7f914de4201b",
+        "id": "1729291987402243000.3b7ecbe4-5496-4404-a676-af329e8722d7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xon-organization",
@@ -11401,10 +11366,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051489456000.3f577cbd-e599-45a6-b634-8416f71d9114",
+      "fullUrl": "Practitioner/1729291987403538000.c67fd2a0-ecb3-4c68-9ec4-52669b264499",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051489456000.3f577cbd-e599-45a6-b634-8416f71d9114",
+        "id": "1729291987403538000.c67fd2a0-ecb3-4c68-9ec4-52669b264499",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11431,10 +11396,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051490480000.8b158db0-43db-4a2e-bad0-792364e98203",
+      "fullUrl": "Practitioner/1729291987404792000.f08933ff-2462-4f6a-b2fb-27e1c1d5640f",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051490480000.8b158db0-43db-4a2e-bad0-792364e98203",
+        "id": "1729291987404792000.f08933ff-2462-4f6a-b2fb-27e1c1d5640f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11457,10 +11422,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051492031000.dcf485fd-b84a-49d2-98ec-2bf6147abec6",
+      "fullUrl": "Practitioner/1729291987406344000.d61307e3-f664-4bc9-bed8-240b6479e774",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051492031000.dcf485fd-b84a-49d2-98ec-2bf6147abec6",
+        "id": "1729291987406344000.d61307e3-f664-4bc9-bed8-240b6479e774",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11487,10 +11452,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051494683000.bb9172bd-9a6b-49a3-b8f7-6d3e92243862",
+      "fullUrl": "Practitioner/1729291987409265000.79430696-2f9c-4fcc-8361-9b7bcc7b66a7",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051494683000.bb9172bd-9a6b-49a3-b8f7-6d3e92243862",
+        "id": "1729291987409265000.79430696-2f9c-4fcc-8361-9b7bcc7b66a7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11513,10 +11478,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051496168000.6a7169b2-b927-4369-866f-716351d42b18",
+      "fullUrl": "Practitioner/1729291987410794000.0d5e6fb3-a7fb-4e51-984a-1eaa7e082a55",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051496168000.6a7169b2-b927-4369-866f-716351d42b18",
+        "id": "1729291987410794000.0d5e6fb3-a7fb-4e51-984a-1eaa7e082a55",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11543,10 +11508,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051498845000.545cd8a7-a19a-425c-9dfa-4d979b0e93a2",
+      "fullUrl": "Practitioner/1729291987413702000.f01eef0b-ea8a-4108-8a68-031d7f011d92",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051498845000.545cd8a7-a19a-425c-9dfa-4d979b0e93a2",
+        "id": "1729291987413702000.f01eef0b-ea8a-4108-8a68-031d7f011d92",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11569,10 +11534,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051500272000.97e14b0f-1d88-4924-b112-9ccd89dac7ec",
+      "fullUrl": "Practitioner/1729291987415270000.a742829e-7750-4e14-85d8-f2210b9c7422",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051500272000.97e14b0f-1d88-4924-b112-9ccd89dac7ec",
+        "id": "1729291987415270000.a742829e-7750-4e14-85d8-f2210b9c7422",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11599,10 +11564,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051502868000.9fbec462-3fc5-4285-ad24-df9fa41effd2",
+      "fullUrl": "Practitioner/1729291987418221000.35de5043-6743-42f5-8c96-66ea6e999d0b",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051502868000.9fbec462-3fc5-4285-ad24-df9fa41effd2",
+        "id": "1729291987418221000.35de5043-6743-42f5-8c96-66ea6e999d0b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11625,10 +11590,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051504285000.bcaa5455-563c-4f24-930a-53ee3446414d",
+      "fullUrl": "Practitioner/1729291987419757000.e4062287-e775-43f8-87f4-d25605ee0b75",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051504285000.bcaa5455-563c-4f24-930a-53ee3446414d",
+        "id": "1729291987419757000.e4062287-e775-43f8-87f4-d25605ee0b75",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11655,10 +11620,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051506877000.6cce15ee-de5a-4461-9962-ff0de0cb5136",
+      "fullUrl": "Practitioner/1729291987422637000.e4b7d735-5fea-4c35-9f20-9c2aef635f37",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051506877000.6cce15ee-de5a-4461-9962-ff0de0cb5136",
+        "id": "1729291987422637000.e4b7d735-5fea-4c35-9f20-9c2aef635f37",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11681,10 +11646,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051508321000.eb05e239-f51a-4574-9add-f1d699d54ef4",
+      "fullUrl": "Practitioner/1729291987424158000.d121b5ba-4deb-49e8-a3ba-00942067130a",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051508321000.eb05e239-f51a-4574-9add-f1d699d54ef4",
+        "id": "1729291987424158000.d121b5ba-4deb-49e8-a3ba-00942067130a",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11711,10 +11676,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1721238051510872000.b4199e16-1055-4177-a6a0-4dba64367865",
+      "fullUrl": "Practitioner/1729291987427036000.d9380372-986c-42f0-8ef6-83ac0e0b796f",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051510872000.b4199e16-1055-4177-a6a0-4dba64367865",
+        "id": "1729291987427036000.d9380372-986c-42f0-8ef6-83ac0e0b796f",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11737,10 +11702,10 @@
       }
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-      "fullUrl": "Practitioner/1721238051512286000.8cd0c3e4-dd13-4682-80cf-cef32e01ae22",
+      "fullUrl": "Practitioner/1729291987428620000.6cc5d1f9-6741-4aff-b78b-83e9d30a74ab",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051512286000.8cd0c3e4-dd13-4682-80cf-cef32e01ae22",
+        "id": "1729291987428620000.6cc5d1f9-6741-4aff-b78b-83e9d30a74ab",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11767,10 +11732,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1721238051514833000.7e1f66cb-e560-4031-9ef8-fbfb03d6b0e3",
+      "fullUrl": "Practitioner/1729291987432948000.79500c9b-c36a-4aac-97df-4e2bcc9eb0be",
       "resource": {
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-        "id": "1721238051514833000.7e1f66cb-e560-4031-9ef8-fbfb03d6b0e3",
+        "id": "1729291987432948000.79500c9b-c36a-4aac-97df-4e2bcc9eb0be",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11793,10 +11758,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1721238051516232000.565a1011-cb57-4e52-b90c-e7b0d2f83734",
+      "fullUrl": "Practitioner/1729291987435378000.4e20c692-cca5-4fc2-837c-c8c74d63eeef",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1721238051516232000.565a1011-cb57-4e52-b90c-e7b0d2f83734",
+        "id": "1729291987435378000.4e20c692-cca5-4fc2-837c-c8c74d63eeef",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11823,10 +11788,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1721238051518791000.44dfddd4-089c-4b58-86ea-aff5a747bd3b",
+      "fullUrl": "Practitioner/1729291987440949000.79f9b675-b5da-4fdf-96d4-2bc6e61bd660",
       "resource": {
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-        "id": "1721238051518791000.44dfddd4-089c-4b58-86ea-aff5a747bd3b",
+        "id": "1729291987440949000.79f9b675-b5da-4fdf-96d4-2bc6e61bd660",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11849,10 +11814,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1721238051520181000.7938130c-d20e-4796-ba73-8b881afd8331",
+      "fullUrl": "Practitioner/1729291987443870000.7c2669e5-1407-455a-9c65-114de17e24b7",
       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11879,10 +11844,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1721238051522710000.c0671ce5-77a3-4720-ab7b-6eada98db116",
+      "fullUrl": "Practitioner/1729291987449378000.ce644917-b658-4346-b239-8d88c5b76ce3",
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         "extension": [
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@@ -11905,10 +11870,10 @@
       }
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         "extension": [
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@@ -11935,10 +11900,10 @@
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@@ -11961,10 +11926,10 @@
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         "extension": [
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@@ -11991,10 +11956,10 @@
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+      "fullUrl": "Practitioner/1729291987458427000.1dd4fad9-ac6b-408a-bc71-07e6028bcbff",
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         "extension": [
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@@ -12017,10 +11982,10 @@
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         "extension": [
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diff --git a/examples/CA/005_CA_ORU_R01_CDPH_generated_3_hl7_translation_final.hl7 b/examples/CA/005_CA_ORU_R01_CDPH_generated_3_hl7_translation_final.hl7
index d665edac8..0220d5c18 100644
--- a/examples/CA/005_CA_ORU_R01_CDPH_generated_3_hl7_translation_final.hl7
+++ b/examples/CA/005_CA_ORU_R01_CDPH_generated_3_hl7_translation_final.hl7
@@ -1,116 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240716090632||ORU^R01|220220550|T|2.5.1
-PID|1||80008715||Bird^Tweety||202407100000|M||2106-3^White||||||||||||2186-5^Not Hispanic or Latino||N|1
-NK1|1|Bird^Big|MTH^Mother|850 Marina Bay Parkway, APT 125^^Richmond^CA^94806-4000^USA|^^^^^916^3720117|^^^^^916^3729999||||||||||199301010000
-ORC|RE|Q12345^HospOrdNumber||ABC888^FormNumber||||||||^CORTEZ^ALAN^^^^^^^NPI|||||||||UCSD JACOBS MEDICAL CENTER^^^^^^^^^R797|300 PASTEUR DR, RM H1524^^PALO ALTO^CA^94305-2200
-OBR|1|Q12345^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^LN^CDPHGSPEAP|||202407120000|||||||||^James^Smith||||||20240716090632|||F
-OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240716090632
-OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240716090632
-OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240716090632
-OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12533-8^CAH^LN|||N|||F|||20240716090632
-OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240716090632
-OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\2823 FRESNO ST, FRESNO, CA 93721-1324\.br\\.br\Genetic Disease Laboratory - GDL 850 MARINA BAY PKWY, # G265, RICHMOND, CA 94804-6403\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Follow-up:\.br\\.br\CAH: An immediate referral to a CCS endocrine center or pediatric endocrinologist, for evaluation and additional testing, is strongly recommended. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Stanford University Medical Center at (510) 412-1562. \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, GAMT, Pompe Disease Tier-1, MPS I Tier-1, MPS II Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\Due to biological variability of newborns and differences in detection rates for the various disorders in the newborn period, the Newborn Screening Program will not identify all newborns with these conditions. While a positive screening result identifies newborns at an increased risk to justify a diagnostic work-up, a negative screening result does not rule out the possibility of a disorder. Health care providers should remain watchful for any sign or symptoms of these disorders in their patients. A newborn screening result should not be considered diagnostic, and cannot replace the individualized evaluation and diagnosis of an infant by a well-trained, knowledgeable health care provider. \.br\\.br\|||N|||F|||20240716090632
-OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240716090632
-OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240716090632
-OBX|9|NM|8339-4^Birthweight^LN|1|3035|grams||N|||F|||20240716090632
-OBX|10|TM|57715-5^Time of birth^LN|1|0000|||N|||F|||20240716090632
-OBX|11|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240716090632
-OBX|12|NM|73806-2^Newborn age in hours^LN|1|24|hour(s)||N|||F|||20240716090632
-OBX|13|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240716090632
-OBX|14|CE|67704-7^Feeding types^LN|1|LA16917-9^NPO^LN|||N|||F|||20240716090632
-OBX|15|CE|67704-7^Feeding types^LN|3|LA12418-2^TPN^LN|||N|||F|||20240716090632
-OBX|16|TX|^^^99717-5^Accession Number^L|1|091-83-561/21-2013-11|||N|||F|||20240716090632
-OBX|17|TX|62324-9^Post-discharge provider name^LN||Dr Sue Great||||||F|||20240716090632
-OBX|18|TX|62325-6^Post-discharge provider practice ID^LN||1234567890||||||F|||20240716090632
-OBX|19|TX|62327-2^Post-discharge provider practice address^LN||333 Best Care Place, Suite 3B, Los Angeles, California 90001||||||F|||20240716090632
-OBX|20|TX|62328-0^Post-discharge provider practice telephone number^LN||(323) 123-4567||||||F|||20240716090632
-OBX|21|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|22|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240716090632
-OBX|23|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|24|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<3.5|N|||F|||20240716090632
-OBX|25|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<250|N|||F|||20240716090632
-OBX|26|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.1|N|||F|||20240716090632
-OBX|27|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<165|N|||F|||20240716090632
-OBX|28|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.4|N|||F|||20240716090632
-OBX|29|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<850|N|||F|||20240716090632
-OBX|30|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<4.5|N|||F|||20240716090632
-OBX|31|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|8-100|N|||F|||20240716090632
-OBX|32|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-60|N|||F|||20240716090632
-OBX|33|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<6|N|||F|||20240716090632
-OBX|34|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240716090632
-OBX|35|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240716090632
-OBX|36|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<50|N|||F|||20240716090632
-OBX|37|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.4|N|||F|||20240716090632
-OBX|38|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240716090632
-OBX|39|NM|53232-5^5-Oxoproline+Pipecolate [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|40|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|41|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|42|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|43|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6-125|N|||F|||20240716090632
-OBX|44|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<75|N|||F|||20240716090632
-OBX|45|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|11-80|N|||F|||20240716090632
-OBX|46|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<5.2|N|||F|||20240716090632
-OBX|47|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240716090632
-OBX|48|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.6|N|||F|||20240716090632
-OBX|49|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240716090632
-OBX|50|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240716090632
-OBX|51|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240716090632
-OBX|52|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240716090632
-OBX|53|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240716090632
-OBX|54|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|55|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240716090632
-OBX|56|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.8|N|||F|||20240716090632
-OBX|57|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240716090632
-OBX|58|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|59|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240716090632
-OBX|60|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<10|N|||F|||20240716090632
-OBX|61|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240716090632
-OBX|62|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
-OBX|63|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240716090632
-OBX|64|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240716090632
-OBX|65|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240716090632
-OBX|66|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|67|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
-OBX|68|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
-OBX|69|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<6.3|N|||F|||20240716090632
-OBX|70|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.3|N|||F|||20240716090632
-OBX|71|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.38|N|||F|||20240716090632
-OBX|72|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240716090632
-OBX|73|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<1|N|||F|||20240716090632
-OBX|74|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.45|N|||F|||20240716090632
-OBX|75|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240716090632
-OBX|76|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<0.85|N|||F|||20240716090632
-OBX|77|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240716090632
-OBX|78|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.6|N|||F|||20240716090632
-OBX|79|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<63|N|||F|||20240716090632
-OBX|80|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|81|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|82|NM|38473-5^17-Hydroxyprogesterone^LN|1|305|nmol/L|<70|H|||F|||20240716090632
-OBX|83|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240716090632
-OBX|84|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240716090632
-OBX|85|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240716090632
-OBX|86|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|87|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|88|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240716090632
-OBX|89|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|90|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|91|TX|54104-5^Hemoglobin pattern^LN|1|FA|||N|||F|||20240716090632
-OBX|92|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.|||N|||F|||20240716090632
-OBX|93|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240716090632
-OBX|94|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|95|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|96|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240716090632
-OBX|97|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|98|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|99|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|14.313|µmol/L/h|>=2.079|N|||F|||20240716090632
-OBX|100|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|101|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|102|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|7.64|µmol/L/h|>=1.2204|N|||F|||20240716090632
-OBX|103|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|104|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|105|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240716090632
-OBX|106|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|107|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240716090632
-OBX|108|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|2||||N|||F|||20240716090632
-OBX|109|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|110|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240716090632
-OBX|111|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.42|N|||F|||20240716090632
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240716090632||ORU^R01|220220550|D|2.5.1
PID|1||80008715||Bird^Tweety||202407100000|M||2106-3^White||||||||||||2186-5^Not Hispanic or Latino||N|1
NK1|1|Bird^Big|MTH^Mother|850 Marina Bay Parkway, APT 125^^Richmond^CA^94806-4000^USA|^^^^^916^3720117|^^^^^916^3729999||||||||||199301010000
ORC|RE|Q12345^HospOrdNumber||ABC888^FormNumber||||||||^CORTEZ^ALAN^^^^^^^NPI|||||||||UCSD JACOBS MEDICAL CENTER^^^^^^^^^R797|300 PASTEUR DR, RM H1524^^PALO ALTO^CA^94305-2200
OBR|1|Q12345^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407120000|||||||||^CORTEZ^ALAN^^^^^^^NPI||||||20240716090632|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240716090632
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240716090632
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240716090632
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12533-8^CAH^LN|||N|||F|||20240716090632
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240716090632
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\2823 FRESNO ST, FRESNO, CA 93721-1324\.br\\.br\Genetic Disease Laboratory - GDL 850 MARINA BAY PKWY, # G265, RICHMOND, CA 94804-6403\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Follow-up:\.br\\.br\CAH: An immediate referral to a CCS endocrine center or pediatric endocrinologist, for evaluation and additional testing, is strongly recommended. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Stanford University Medical Center at (510) 412-1562. \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, GAMT, Pompe Disease Tier-1, MPS I Tier-1, MPS II Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\Due to biological variability of newborns and differences in detection rates for the various disorders in the newborn period, the Newborn Screening Program will not identify all newborns with these conditions. While a positive screening result identifies newborns at an increased risk to justify a diagnostic work-up, a negative screening result does not rule out the possibility of a disorder. Health care providers should remain watchful for any sign or symptoms of these disorders in their patients. A newborn screening result should not be considered diagnostic, and cannot replace the individualized evaluation and diagnosis of an infant by a well-trained, knowledgeable health care provider. \.br\\.br\|||N|||F|||20240716090632
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240716090632
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240716090632
OBX|9|NM|8339-4^Birthweight^LN|1|3035|grams||N|||F|||20240716090632
OBX|10|TM|57715-5^Time of birth^LN|1|0000|||N|||F|||20240716090632
OBX|11|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240716090632
OBX|12|NM|73806-2^Newborn age in hours^LN|1|24|hour(s)||N|||F|||20240716090632
OBX|13|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240716090632
OBX|14|CE|67704-7^Feeding types^LN|1|LA16917-9^NPO^LN|||N|||F|||20240716090632
OBX|15|CE|67704-7^Feeding types^LN|3|LA12418-2^TPN^LN|||N|||F|||20240716090632
OBX|16|TX|62324-9^Post-discharge provider name^LN||Dr Sue Great||||||F|||20240716090632
OBX|17|TX|62325-6^Post-discharge provider practice ID^LN||1234567890||||||F|||20240716090632
OBX|18|TX|62327-2^Post-discharge provider practice address^LN||333 Best Care Place, Suite 3B, Los Angeles, California 90001||||||F|||20240716090632
OBX|19|TX|62328-0^Post-discharge provider practice telephone number^LN||(323) 123-4567||||||F|||20240716090632
OBX|20|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|21|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240716090632
OBX|22|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|23|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<3.5|N|||F|||20240716090632
OBX|24|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<250|N|||F|||20240716090632
OBX|25|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.1|N|||F|||20240716090632
OBX|26|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<165|N|||F|||20240716090632
OBX|27|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.4|N|||F|||20240716090632
OBX|28|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<850|N|||F|||20240716090632
OBX|29|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<4.5|N|||F|||20240716090632
OBX|30|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|8-100|N|||F|||20240716090632
OBX|31|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-60|N|||F|||20240716090632
OBX|32|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<6|N|||F|||20240716090632
OBX|33|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240716090632
OBX|34|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240716090632
OBX|35|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<50|N|||F|||20240716090632
OBX|36|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.4|N|||F|||20240716090632
OBX|37|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240716090632
OBX|38|NM|53232-5^5-Oxoproline+Pipecolate [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|39|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|40|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|41|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|42|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6-125|N|||F|||20240716090632
OBX|43|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<75|N|||F|||20240716090632
OBX|44|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|11-80|N|||F|||20240716090632
OBX|45|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<5.2|N|||F|||20240716090632
OBX|46|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240716090632
OBX|47|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.6|N|||F|||20240716090632
OBX|48|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240716090632
OBX|49|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240716090632
OBX|50|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240716090632
OBX|51|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240716090632
OBX|52|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240716090632
OBX|53|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|54|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240716090632
OBX|55|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.8|N|||F|||20240716090632
OBX|56|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240716090632
OBX|57|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|58|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240716090632
OBX|59|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<10|N|||F|||20240716090632
OBX|60|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240716090632
OBX|61|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
OBX|62|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240716090632
OBX|63|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240716090632
OBX|64|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240716090632
OBX|65|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|66|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
OBX|67|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
OBX|68|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<6.3|N|||F|||20240716090632
OBX|69|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.3|N|||F|||20240716090632
OBX|70|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.38|N|||F|||20240716090632
OBX|71|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240716090632
OBX|72|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<1|N|||F|||20240716090632
OBX|73|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.45|N|||F|||20240716090632
OBX|74|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240716090632
OBX|75|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<0.85|N|||F|||20240716090632
OBX|76|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240716090632
OBX|77|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.6|N|||F|||20240716090632
OBX|78|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<63|N|||F|||20240716090632
OBX|79|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|80|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|81|NM|38473-5^17-Hydroxyprogesterone^LN|1|305|nmol/L|<70|H|||F|||20240716090632
OBX|82|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240716090632
OBX|83|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240716090632
OBX|84|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240716090632
OBX|85|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|86|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|87|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240716090632
OBX|88|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|89|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|90|TX|54104-5^Hemoglobin pattern^LN|1|FA|||N|||F|||20240716090632
OBX|91|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.|||N|||F|||20240716090632
OBX|92|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240716090632
OBX|93|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|94|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|95|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240716090632
OBX|96|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|97|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|98|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|14.313|µmol/L/h|>=2.079|N|||F|||20240716090632
OBX|99|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|100|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|101|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|7.64|µmol/L/h|>=1.2204|N|||F|||20240716090632
OBX|102|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|103|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|104|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240716090632
OBX|105|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|106|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240716090632
OBX|107|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|2||||N|||F|||20240716090632
OBX|108|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|109|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240716090632
OBX|110|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.42|N|||F|||20240716090632
diff --git a/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir b/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
index c6983fb1d..c37feb7c5 100644
--- a/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
+++ b/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1721320027084960000.c1999345-46af-4a60-98a6-a8e2a11a26b4",
+  "id": "1729291511454070000.194c5f84-1a87-41b0-93be-ef534a044eae",
   "meta": {
-    "lastUpdated": "2024-07-18T09:27:07.085-07:00"
+    "lastUpdated": "2024-10-18T15:45:11.454-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,15 +12,15 @@
   "timestamp": "2024-07-16T09:06:32.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/09750e90-6433-3b6d-8f2e-1498ab5b1a9c",
+      "fullUrl": "MessageHeader/1729291511455037000.31bf17d9-8213-47fd-b013-3459724e6ed8",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "09750e90-6433-3b6d-8f2e-1498ab5b1a9c",
+        "id": "1729291511455037000.31bf17d9-8213-47fd-b013-3459724e6ed8",
         "meta": {
           "tag": [
             {
               "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-              "code": "T"
+              "code": "D"
             }
           ]
         },
@@ -58,12 +58,12 @@
             ],
             "name": "SISHIERECEIVER",
             "receiver": {
-              "reference": "Organization/1721320027134002000.535239e3-7596-46f7-aa43-15a7bc23cc5a"
+              "reference": "Organization/1729291511454941000.cb898328-21b8-4731-97f4-95bb9c61b13c"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1721320027111901000.c6d4863a-d26c-4162-8268-069f98fb54e4"
+          "reference": "Organization/1729291511454605000.01ac40a1-434c-4595-b432-b3996df90de9"
         },
         "source": {
           "extension": [
@@ -89,10 +89,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721320027111901000.c6d4863a-d26c-4162-8268-069f98fb54e4",
+      "fullUrl": "Organization/1729291511454605000.01ac40a1-434c-4595-b432-b3996df90de9",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721320027111901000.c6d4863a-d26c-4162-8268-069f98fb54e4",
+        "id": "1729291511454605000.01ac40a1-434c-4595-b432-b3996df90de9",
         "identifier": [
           {
             "extension": [
@@ -107,10 +107,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721320027134002000.535239e3-7596-46f7-aa43-15a7bc23cc5a",
+      "fullUrl": "Organization/1729291511454941000.cb898328-21b8-4731-97f4-95bb9c61b13c",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721320027134002000.535239e3-7596-46f7-aa43-15a7bc23cc5a",
+        "id": "1729291511454941000.cb898328-21b8-4731-97f4-95bb9c61b13c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -120,73 +120,73 @@
       }
     },
     {
-      "fullUrl": "Provenance/1721320027171558000.43a1edfd-ab4f-46f1-b4b0-896a2708718a",
+      "fullUrl": "Provenance/1729291511456068000.4df8b02a-9051-4a3b-a39c-be7c922af594",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1721320027171558000.43a1edfd-ab4f-46f1-b4b0-896a2708718a",
+        "id": "1729291511456068000.4df8b02a-9051-4a3b-a39c-be7c922af594",
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@@ -10671,7 +10671,7 @@
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@@ -10701,10 +10701,10 @@
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@@ -10761,7 +10761,7 @@
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@@ -10799,10 +10799,10 @@
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@@ -10812,10 +10812,10 @@
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@@ -10825,10 +10825,10 @@
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@@ -10838,10 +10838,10 @@
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@@ -10851,10 +10851,10 @@
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@@ -10864,10 +10864,10 @@
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@@ -10877,10 +10877,10 @@
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@@ -10890,10 +10890,10 @@
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@@ -10903,10 +10903,10 @@
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@@ -10916,10 +10916,10 @@
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@@ -10929,10 +10929,10 @@
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@@ -10942,10 +10942,10 @@
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@@ -10955,10 +10955,10 @@
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@@ -10968,10 +10968,10 @@
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@@ -10981,10 +10981,10 @@
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@@ -10994,10 +10994,10 @@
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@@ -11007,10 +11007,10 @@
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@@ -11020,10 +11020,10 @@
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@@ -11033,10 +11033,10 @@
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@@ -11046,10 +11046,10 @@
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@@ -11059,10 +11059,10 @@
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@@ -11074,7 +11074,7 @@
               {
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                 "valueReference": {
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@@ -11107,7 +11107,7 @@
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@@ -11136,10 +11136,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
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+                "valueId": "F"
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@@ -11241,18 +11245,18 @@
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@@ -11283,10 +11287,10 @@
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@@ -11345,23 +11349,23 @@
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@@ -11382,10 +11386,10 @@
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         "extension": [
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@@ -11412,10 +11416,10 @@
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         "extension": [
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@@ -11438,10 +11442,10 @@
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@@ -11450,10 +11454,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291511694515000.e2941fdb-73aa-4fbc-a98b-a772c10af10f"
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@@ -11503,18 +11511,18 @@
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+          "reference": "Practitioner/1729291511691358000.51f8bb52-fed7-42c6-9a12-386d3f60eec6"
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         "extension": [
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@@ -11541,10 +11549,10 @@
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@@ -11567,10 +11575,10 @@
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         "extension": [
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@@ -11579,10 +11587,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291511699320000.ff3cef68-84fa-43d9-8276-be1ea4cc7057"
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@@ -11632,18 +11644,18 @@
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@@ -11670,10 +11682,10 @@
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@@ -11696,10 +11708,10 @@
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@@ -11708,10 +11720,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291511704028000.a632b742-a547-4b15-874e-46288e7bd8c0"
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@@ -11761,18 +11777,18 @@
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+          "reference": "Practitioner/1729291511701000000.9c08295a-848b-463d-9599-69aacce8b292"
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+      "fullUrl": "Practitioner/1729291511701000000.9c08295a-848b-463d-9599-69aacce8b292",
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         "extension": [
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@@ -11799,10 +11815,10 @@
       }
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         "extension": [
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@@ -11825,10 +11841,10 @@
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@@ -11837,10 +11853,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291511708549000.1ade49b2-7760-408b-838f-8384f750cf1f"
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@@ -11890,18 +11910,18 @@
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+      "fullUrl": "Practitioner/1729291511705591000.96e2227b-ef45-4188-bf6b-dc2fc2d92ae3",
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         "extension": [
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@@ -11928,10 +11948,10 @@
       }
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-      "fullUrl": "Practitioner/1721320027508116000.b977d526-e6ed-4167-9cb3-e6b1f8b2363f",
+      "fullUrl": "Practitioner/1729291511708549000.1ade49b2-7760-408b-838f-8384f750cf1f",
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         "extension": [
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@@ -11954,10 +11974,10 @@
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         "extension": [
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@@ -11966,10 +11986,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291511712938000.f1c40737-dfda-4642-b326-1d13dbd50876"
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@@ -12019,18 +12043,18 @@
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+          "reference": "Practitioner/1729291511710111000.b15d823f-c451-4ad8-b547-acdc645415f9"
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+      "fullUrl": "Practitioner/1729291511710111000.b15d823f-c451-4ad8-b547-acdc645415f9",
       "resource": {
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         "extension": [
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@@ -12057,10 +12081,10 @@
       }
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-      "fullUrl": "Practitioner/1721320027512831000.188abf91-ef87-4768-abc3-60839ebf843b",
+      "fullUrl": "Practitioner/1729291511712938000.f1c40737-dfda-4642-b326-1d13dbd50876",
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@@ -12083,10 +12107,10 @@
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@@ -12095,10 +12119,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291511717222000.8b2210bd-bacd-4e10-92b8-06bfa83ebe5f"
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@@ -12148,18 +12176,18 @@
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+          "reference": "Practitioner/1729291511714410000.aafe015b-83c4-47bb-aade-25c945e9785d"
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+      "fullUrl": "Practitioner/1729291511714410000.aafe015b-83c4-47bb-aade-25c945e9785d",
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@@ -12186,10 +12214,10 @@
       }
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-      "fullUrl": "Practitioner/1721320027517342000.3c1ba6e2-72d1-4e41-b9a6-077d5a936aff",
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@@ -12212,10 +12240,10 @@
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@@ -12224,10 +12252,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
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@@ -12277,18 +12309,18 @@
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@@ -12315,10 +12347,10 @@
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@@ -12341,10 +12373,10 @@
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@@ -12353,10 +12385,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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@@ -12406,18 +12442,18 @@
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+          "reference": "Practitioner/1729291511723008000.6b8ba15e-3ad8-4b2e-a99a-3d6df634a7b2"
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         "extension": [
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@@ -12444,10 +12480,10 @@
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         "extension": [
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@@ -12470,10 +12506,10 @@
       }
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         "extension": [
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@@ -12482,10 +12518,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291511729990000.7912847d-d093-49fb-883d-08d3b83128f0"
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@@ -12535,18 +12575,18 @@
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+          "reference": "Practitioner/1729291511727231000.06ceeb8b-cf61-477f-8cb9-2fb379aaa856"
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+      "fullUrl": "Practitioner/1729291511727231000.06ceeb8b-cf61-477f-8cb9-2fb379aaa856",
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         "extension": [
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@@ -12573,10 +12613,10 @@
       }
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-      "fullUrl": "Practitioner/1721320027533651000.78a2b6e4-01b7-4034-8ca8-55c3503173f4",
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         "extension": [
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@@ -12599,10 +12639,10 @@
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
@@ -12611,10 +12651,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291511734255000.6a69a482-5d4b-426f-950a-28a5821d0062"
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@@ -12664,18 +12708,18 @@
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+          "reference": "Patient/1729291511461077000.3d58d356-0859-4832-9013-61ac61ee45e5"
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+          "reference": "Practitioner/1729291511731454000.b1846a91-a3ee-4155-9965-498c06cef284"
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       "resource": {
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         "extension": [
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@@ -12702,10 +12746,10 @@
       }
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         "extension": [
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@@ -12728,10 +12772,10 @@
       }
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         "extension": [
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@@ -12740,10 +12784,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
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+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291511738499000.7de1d591-a0a6-4bde-9307-41432c974fe2"
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@@ -12793,18 +12841,18 @@
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         "extension": [
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@@ -12831,10 +12879,10 @@
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         "extension": [
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@@ -12857,10 +12905,10 @@
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         "extension": [
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@@ -12869,10 +12917,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
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+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729291511742799000.7051758b-f74e-46d7-ae38-fa91e9915b33"
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@@ -12922,18 +12974,18 @@
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+          "reference": "Practitioner/1729291511740025000.a104718c-c4d3-4bba-91c2-c375f3b96958"
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+      "fullUrl": "Practitioner/1729291511740025000.a104718c-c4d3-4bba-91c2-c375f3b96958",
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@@ -12960,10 +13012,10 @@
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-      "fullUrl": "Practitioner/1721320027548821000.d262e9be-c75c-47eb-8f5d-1c46630a8e70",
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@@ -12986,10 +13038,10 @@
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@@ -12998,10 +13050,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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@@ -13051,18 +13107,18 @@
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+          "reference": "Practitioner/1729291511744311000.f46bad24-45b3-44dc-a1e7-516435f853b5"
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+      "fullUrl": "Practitioner/1729291511744311000.f46bad24-45b3-44dc-a1e7-516435f853b5",
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@@ -13089,10 +13145,10 @@
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-      "fullUrl": "Practitioner/1721320027553217000.f78778d2-79e0-42e3-84fc-df2f7b386a39",
+      "fullUrl": "Practitioner/1729291511747360000.9364cf5e-54ff-4041-98af-3876d18c34ca",
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@@ -13115,10 +13171,10 @@
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@@ -13127,10 +13183,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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+              {
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@@ -13180,18 +13240,18 @@
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@@ -13218,10 +13278,10 @@
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@@ -13244,10 +13304,10 @@
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@@ -13256,10 +13316,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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@@ -13309,18 +13373,18 @@
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@@ -13347,10 +13411,10 @@
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@@ -13373,10 +13437,10 @@
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@@ -13385,10 +13449,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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@@ -13438,18 +13506,18 @@
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@@ -13476,10 +13544,10 @@
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@@ -13502,10 +13570,10 @@
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@@ -13514,10 +13582,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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@@ -13567,18 +13639,18 @@
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@@ -13605,10 +13677,10 @@
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@@ -13631,10 +13703,10 @@
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@@ -13643,10 +13715,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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@@ -13701,18 +13777,18 @@
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@@ -13739,10 +13815,10 @@
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@@ -13765,10 +13841,10 @@
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@@ -13777,10 +13853,14 @@
                 "url": "OBR.22",
                 "valueString": "20240716090632"
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@@ -13835,18 +13915,18 @@
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@@ -13873,10 +13953,10 @@
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@@ -13899,10 +13979,10 @@
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@@ -13977,7 +14057,7 @@
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@@ -13996,7 +14076,7 @@
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@@ -14018,16 +14098,16 @@
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@@ -14058,7 +14138,7 @@
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@@ -15328,7 +15408,7 @@
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@@ -15347,7 +15427,7 @@
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@@ -15369,27 +15449,27 @@
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@@ -15420,7 +15500,7 @@
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@@ -15439,7 +15519,7 @@
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@@ -15461,27 +15541,27 @@
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@@ -15512,7 +15592,7 @@
         ],
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           {
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@@ -15531,7 +15611,7 @@
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+          "reference": "Patient/1729291511461077000.3d58d356-0859-4832-9013-61ac61ee45e5"
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         "_effectiveDateTime": {
@@ -15553,27 +15633,27 @@
         },
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+            "reference": "Observation/1729291511651168000.ac66098a-a9aa-4f45-9864-75c32fe45aa3"
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           {
-            "reference": "Observation/1721320027336134000.9b683b4f-8585-44b2-8965-1ef438a1d9f9"
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           {
-            "reference": "Observation/1721320027337370000.c1448dd5-e2f7-4712-8dbe-d456fd401123"
+            "reference": "Observation/1729291511653880000.de4047d5-368b-44d2-bf29-3cb46b8c0e8c"
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     {
-      "fullUrl": "DiagnosticReport/1721320027613131000.738410ba-7ab5-4f7a-a314-ba597fb52c02",
+      "fullUrl": "DiagnosticReport/1729291511806209000.1840b8f4-80f3-4188-8360-4da742cf414e",
       "resource": {
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-        "id": "1721320027613131000.738410ba-7ab5-4f7a-a314-ba597fb52c02",
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@@ -15604,7 +15684,7 @@
         ],
         "basedOn": [
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         "status": "final",
@@ -15623,7 +15703,7 @@
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@@ -15645,27 +15725,27 @@
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     {
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+      "fullUrl": "DiagnosticReport/1729291511807712000.36611e1c-1910-4c98-8d3b-6b07c014ef2b",
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-        "id": "1721320027614727000.58176169-91c9-4fbe-b93d-d29f75eba24d",
+        "id": "1729291511807712000.36611e1c-1910-4c98-8d3b-6b07c014ef2b",
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@@ -15696,7 +15776,7 @@
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+            "reference": "ServiceRequest/1729291511766137000.f48e3c89-67be-4b79-a184-3255f12bb346"
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@@ -15715,7 +15795,7 @@
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         "_effectiveDateTime": {
@@ -15737,30 +15817,30 @@
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         "specimen": [
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-            "reference": "Specimen/1721320027481210000.8847ccc2-22c5-4535-bd6b-f585ee47ea60"
+            "reference": "Specimen/1729291511680835000.a7569816-99f3-4775-abad-26b1dfc0ced5"
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     {
-      "fullUrl": "DiagnosticReport/1721320027616258000.2a5a9f4a-d6c9-49e6-8a2e-763d43bd3b89",
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-        "id": "1721320027616258000.2a5a9f4a-d6c9-49e6-8a2e-763d43bd3b89",
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@@ -15791,7 +15871,7 @@
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@@ -15815,7 +15895,7 @@
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+          "reference": "Patient/1729291511461077000.3d58d356-0859-4832-9013-61ac61ee45e5"
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         "_effectiveDateTime": {
@@ -15837,24 +15917,24 @@
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-            "reference": "Specimen/1721320027481597000.ccbe3ac5-d608-499c-9848-66c629a0f043"
+            "reference": "Specimen/1729291511681292000.7b5441a6-912f-4bbb-b390-f903cd139952"
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         "result": [
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+            "reference": "Observation/1729291511664025000.01faeb37-0037-4fb2-9802-8f4b00bb0754"
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+            "reference": "Observation/1729291511665336000.820be223-f5dc-4717-bdf9-e29bf897ab71"
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     {
-      "fullUrl": "DiagnosticReport/1721320027617853000.292b65de-76a9-40ac-b6ad-c918835ee39e",
+      "fullUrl": "DiagnosticReport/1729291511810686000.b6ce5267-6a35-4a8b-ae06-28a7e76265ca",
       "resource": {
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-        "id": "1721320027617853000.292b65de-76a9-40ac-b6ad-c918835ee39e",
+        "id": "1729291511810686000.b6ce5267-6a35-4a8b-ae06-28a7e76265ca",
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@@ -15885,7 +15965,7 @@
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         "basedOn": [
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+            "reference": "ServiceRequest/1729291511775226000.227733d0-b9bd-4005-94ba-b0555d08e74b"
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         "status": "final",
@@ -15909,7 +15989,7 @@
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+          "reference": "Patient/1729291511461077000.3d58d356-0859-4832-9013-61ac61ee45e5"
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         "_effectiveDateTime": {
@@ -15931,12 +16011,12 @@
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-            "reference": "Specimen/1721320027481986000.f41f7484-38e3-44e6-9014-88fa7ff5f7ef"
+            "reference": "Specimen/1729291511681729000.db76f5d7-b3fb-4990-8d87-77f92a2a38ae"
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+            "reference": "Observation/1729291511666727000.7cec3aeb-3793-44eb-9428-315a6fc5b772"
           }
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diff --git a/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir b/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
index 68c421db0..4fc952739 100644
--- a/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
+++ b/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1721320027084960000.c1999345-46af-4a60-98a6-a8e2a11a26b4",
+  "id": "1729291511454070000.194c5f84-1a87-41b0-93be-ef534a044eae",
   "meta": {
-    "lastUpdated": "2024-07-18T09:27:07.085-07:00"
+    "lastUpdated": "2024-10-18T15:45:11.454-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,15 +12,15 @@
   "timestamp": "2024-07-16T09:06:32.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/09750e90-6433-3b6d-8f2e-1498ab5b1a9c",
+      "fullUrl": "MessageHeader/1729291511455037000.31bf17d9-8213-47fd-b013-3459724e6ed8",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "09750e90-6433-3b6d-8f2e-1498ab5b1a9c",
+        "id": "1729291511455037000.31bf17d9-8213-47fd-b013-3459724e6ed8",
         "meta": {
           "tag": [
             {
               "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-              "code": "T"
+              "code": "D"
             },
             {
               "system": "http://localcodes.org/ETOR",
@@ -55,12 +55,12 @@
             ],
             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1721320027134002000.535239e3-7596-46f7-aa43-15a7bc23cc5a"
+              "reference": "Organization/1729291511454941000.cb898328-21b8-4731-97f4-95bb9c61b13c"
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           }
         ],
         "sender": {
-          "reference": "Organization/1721320027111901000.c6d4863a-d26c-4162-8268-069f98fb54e4"
+          "reference": "Organization/1729291511454605000.01ac40a1-434c-4595-b432-b3996df90de9"
         },
         "source": {
           "extension": [
@@ -86,10 +86,10 @@
       }
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     {
-      "fullUrl": "Organization/1721320027111901000.c6d4863a-d26c-4162-8268-069f98fb54e4",
+      "fullUrl": "Organization/1729291511454605000.01ac40a1-434c-4595-b432-b3996df90de9",
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+        "id": "1729291511454605000.01ac40a1-434c-4595-b432-b3996df90de9",
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@@ -104,10 +104,10 @@
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     {
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+      "fullUrl": "Organization/1729291511454941000.cb898328-21b8-4731-97f4-95bb9c61b13c",
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+        "id": "1729291511454941000.cb898328-21b8-4731-97f4-95bb9c61b13c",
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@@ -10467,10 +10407,10 @@
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+      "fullUrl": "Observation/1729291511662719000.f6ed69eb-8374-43ff-a9f0-c7d6d2fbb16d",
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@@ -10511,7 +10451,7 @@
           ]
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+          "reference": "Patient/1729291511461077000.3d58d356-0859-4832-9013-61ac61ee45e5"
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@@ -10540,10 +10480,10 @@
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@@ -10566,6 +10506,21 @@
         "status": "final",
         "code": {
           "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "85269-9",
+              "display": "X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation"
+            },
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@@ -10584,7 +10539,7 @@
           ]
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@@ -10632,10 +10587,10 @@
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@@ -10658,6 +10613,21 @@
         "status": "final",
         "code": {
           "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "85268-1",
+              "display": "X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion"
+            },
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@@ -10676,7 +10646,7 @@
           ]
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+          "reference": "Patient/1729291511461077000.3d58d356-0859-4832-9013-61ac61ee45e5"
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@@ -10706,10 +10676,10 @@
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@@ -10766,7 +10736,7 @@
           ]
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+          "reference": "Patient/1729291511461077000.3d58d356-0859-4832-9013-61ac61ee45e5"
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@@ -10804,10 +10774,10 @@
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@@ -10817,10 +10787,10 @@
       }
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     {
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@@ -10830,10 +10800,10 @@
       }
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+      "fullUrl": "Specimen/1729291511673971000.b49c1a5f-2990-4e32-8651-9e4d63ccf83d",
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@@ -10843,10 +10813,10 @@
       }
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@@ -10856,10 +10826,10 @@
       }
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         "extension": [
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@@ -10869,10 +10839,10 @@
       }
     },
     {
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+      "fullUrl": "Specimen/1729291511675313000.50a3f465-08cd-4993-9bb6-3cd32c682f0f",
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@@ -10882,10 +10852,10 @@
       }
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-      "fullUrl": "Specimen/1721320027476945000.4ab2f824-63a8-4ecd-97f6-20f47e32d92e",
+      "fullUrl": "Specimen/1729291511675751000.68b982b3-af0f-4c62-b236-f8134b4f5cc3",
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@@ -10895,10 +10865,10 @@
       }
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-      "fullUrl": "Specimen/1721320027477349000.b5ab937f-14c8-41d1-8f29-657f24e743d3",
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@@ -10908,10 +10878,10 @@
       }
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@@ -10921,10 +10891,10 @@
       }
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@@ -10934,10 +10904,10 @@
       }
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@@ -10947,10 +10917,10 @@
       }
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-      "fullUrl": "Specimen/1721320027478859000.d5d76e62-cf58-462b-9af1-146cc8f6beac",
+      "fullUrl": "Specimen/1729291511678091000.30ae0c72-9ace-4864-93ea-3cc9ef0c0e16",
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@@ -10960,10 +10930,10 @@
       }
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@@ -10973,10 +10943,10 @@
       }
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@@ -10986,10 +10956,10 @@
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@@ -10999,10 +10969,10 @@
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@@ -11012,10 +10982,10 @@
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@@ -11025,10 +10995,10 @@
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@@ -11038,10 +11008,10 @@
       }
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@@ -11051,10 +11021,10 @@
       }
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@@ -11064,10 +11034,10 @@
       }
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@@ -11079,7 +11049,7 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1721320027487472000.7e4e701a-2931-489a-8af8-83b918668100"
+                  "reference": "Organization/1729291511687317000.04daee28-b859-4a93-9abf-5edaecc35ad8"
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@@ -11112,7 +11082,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1721320027488719000.3843493a-61b1-45b8-881d-b10d506d817a"
+                  "reference": "Practitioner/1729291511688605000.bfe004d4-352a-4efc-85a2-ece9b50487fb"
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@@ -11129,22 +11099,26 @@
                       "extension": [
                         {
                           "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                          "valueString": "FormNumber"
+                          "valueString": "HospOrdNumber"
                         }
                       ]
                     }
                   ],
-                  "value": "ABC888"
+                  "value": "Q12345"
                 }
               },
               {
                 "url": "OBR.22",
                 "valueString": "20240716090632"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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@@ -11241,36 +11215,27 @@
                 },
                 {
                   "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
-                  "valueString": "LN"
+                  "valueString": "CDPHGSPEAP"
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               "code": "54089-8",
               "display": "NB Screen Panel Patient AHIC"
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         "extension": [
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@@ -11301,10 +11266,10 @@
       }
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     {
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         "extension": [
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@@ -11363,23 +11328,23 @@
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     {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xon-organization",
@@ -11400,10 +11365,10 @@
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         "extension": [
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@@ -11430,10 +11395,10 @@
       }
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     {
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         "extension": [
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@@ -11456,10 +11421,10 @@
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         "extension": [
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@@ -11486,10 +11451,10 @@
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       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -11512,10 +11477,10 @@
       }
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         "extension": [
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@@ -11542,10 +11507,10 @@
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         "extension": [
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@@ -11568,10 +11533,10 @@
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         "extension": [
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@@ -11598,10 +11563,10 @@
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         "extension": [
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@@ -11624,10 +11589,10 @@
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         "extension": [
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@@ -11654,10 +11619,10 @@
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         "extension": [
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@@ -11680,10 +11645,10 @@
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         "extension": [
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@@ -11710,10 +11675,10 @@
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@@ -11736,10 +11701,10 @@
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@@ -11766,10 +11731,10 @@
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@@ -11792,10 +11757,10 @@
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@@ -11822,10 +11787,10 @@
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@@ -11848,10 +11813,10 @@
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@@ -11878,10 +11843,10 @@
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@@ -11904,10 +11869,10 @@
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@@ -11934,10 +11899,10 @@
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@@ -11960,10 +11925,10 @@
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@@ -11990,10 +11955,10 @@
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@@ -12016,10 +11981,10 @@
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@@ -12046,10 +12011,10 @@
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@@ -12072,10 +12037,10 @@
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diff --git a/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7 b/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
index 34a83853d..862207560 100644
--- a/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
+++ b/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
@@ -1,116 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240716090632||ORU^R01|220220550|T|2.5.1
-PID|1||80008715||Bird^Tweety||202407100000|M||2106-3^White||||||||||||2186-5^Not Hispanic or Latino||N|1
-NK1|1|Bird^Big|MTH^Mother|850 Marina Bay Parkway, APT 125^^Richmond^CA^94806-4000^USA|^^^^^916^3720117|^^^^^916^3729999||||||||||199301010000
-ORC|RE|Q12345^HospOrdNumber||ABC888^FormNumber||||||||^CORTEZ^ALAN^^^^^^^NPI|||||||||UCSD JACOBS MEDICAL CENTER^^^^^^^^^R797|300 PASTEUR DR, RM H1524^^PALO ALTO^CA^94305-2200
-OBR|1|Q12345^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^LN^CDPHGSPEAP|||202407120000|||||||||^James^Smith||||||20240716090632|||F
-OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240716090632
-OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240716090632
-OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240716090632
-OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12533-8^CAH^LN|||N|||F|||20240716090632
-OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240716090632
-OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\2823 FRESNO ST, FRESNO, CA 93721-1324\.br\\.br\Genetic Disease Laboratory - GDL 850 MARINA BAY PKWY, # G265, RICHMOND, CA 94804-6403\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Follow-up:\.br\\.br\CAH: An immediate referral to a CCS endocrine center or pediatric endocrinologist, for evaluation and additional testing, is strongly recommended. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Stanford University Medical Center at (510) 412-1562. \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, GAMT, Pompe Disease Tier-1, MPS I Tier-1, MPS II Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\Due to biological variability of newborns and differences in detection rates for the various disorders in the newborn period, the Newborn Screening Program will not identify all newborns with these conditions. While a positive screening result identifies newborns at an increased risk to justify a diagnostic work-up, a negative screening result does not rule out the possibility of a disorder. Health care providers should remain watchful for any sign or symptoms of these disorders in their patients. A newborn screening result should not be considered diagnostic, and cannot replace the individualized evaluation and diagnosis of an infant by a well-trained, knowledgeable health care provider. \.br\\.br\|||N|||F|||20240716090632
-OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240716090632
-OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240716090632
-OBX|9|NM|8339-4^Birthweight^LN|1|3035|grams||N|||F|||20240716090632
-OBX|10|TM|57715-5^Time of birth^LN|1|0000|||N|||F|||20240716090632
-OBX|11|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240716090632
-OBX|12|NM|73806-2^Newborn age in hours^LN|1|24|hour(s)||N|||F|||20240716090632
-OBX|13|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240716090632
-OBX|14|CE|67704-7^Feeding types^LN|1|LA16917-9^NPO^LN|||N|||F|||20240716090632
-OBX|15|CE|67704-7^Feeding types^LN|3|LA12418-2^TPN^LN|||N|||F|||20240716090632
-OBX|16|TX|^^^99717-5^Accession Number^L|1|091-83-561/21-2013-11|||N|||F|||20240716090632
-OBX|17|TX|62324-9^Post-discharge provider name^LN||Dr Sue Great||||||F|||20240716090632
-OBX|18|TX|62325-6^Post-discharge provider practice ID^LN||1234567890||||||F|||20240716090632
-OBX|19|TX|62327-2^Post-discharge provider practice address^LN||333 Best Care Place, Suite 3B, Los Angeles, California 90001||||||F|||20240716090632
-OBX|20|XTN|62328-0^Post-discharge provider practice telephone number^LN||||||||F|||20240716090632
-OBX|21|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|22|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240716090632
-OBX|23|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|24|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<3.5|N|||F|||20240716090632
-OBX|25|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<250|N|||F|||20240716090632
-OBX|26|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.1|N|||F|||20240716090632
-OBX|27|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<165|N|||F|||20240716090632
-OBX|28|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.4|N|||F|||20240716090632
-OBX|29|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<850|N|||F|||20240716090632
-OBX|30|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<4.5|N|||F|||20240716090632
-OBX|31|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|8-100|N|||F|||20240716090632
-OBX|32|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-60|N|||F|||20240716090632
-OBX|33|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<6|N|||F|||20240716090632
-OBX|34|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240716090632
-OBX|35|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240716090632
-OBX|36|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<50|N|||F|||20240716090632
-OBX|37|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.4|N|||F|||20240716090632
-OBX|38|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240716090632
-OBX|39|NM|53232-5^5-Oxoproline+Pipecolate [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|40|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|41|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|42|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|43|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6-125|N|||F|||20240716090632
-OBX|44|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<75|N|||F|||20240716090632
-OBX|45|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|11-80|N|||F|||20240716090632
-OBX|46|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<5.2|N|||F|||20240716090632
-OBX|47|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240716090632
-OBX|48|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.6|N|||F|||20240716090632
-OBX|49|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240716090632
-OBX|50|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240716090632
-OBX|51|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240716090632
-OBX|52|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240716090632
-OBX|53|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240716090632
-OBX|54|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|55|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240716090632
-OBX|56|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.8|N|||F|||20240716090632
-OBX|57|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240716090632
-OBX|58|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|59|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240716090632
-OBX|60|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<10|N|||F|||20240716090632
-OBX|61|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240716090632
-OBX|62|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
-OBX|63|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240716090632
-OBX|64|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240716090632
-OBX|65|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240716090632
-OBX|66|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240716090632
-OBX|67|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
-OBX|68|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
-OBX|69|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<6.3|N|||F|||20240716090632
-OBX|70|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.3|N|||F|||20240716090632
-OBX|71|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.38|N|||F|||20240716090632
-OBX|72|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240716090632
-OBX|73|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<1|N|||F|||20240716090632
-OBX|74|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.45|N|||F|||20240716090632
-OBX|75|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240716090632
-OBX|76|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<0.85|N|||F|||20240716090632
-OBX|77|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240716090632
-OBX|78|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.6|N|||F|||20240716090632
-OBX|79|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<63|N|||F|||20240716090632
-OBX|80|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|81|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|82|NM|38473-5^17-Hydroxyprogesterone^LN|1|305|nmol/L|<70|H|||F|||20240716090632
-OBX|83|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240716090632
-OBX|84|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240716090632
-OBX|85|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240716090632
-OBX|86|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|87|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|88|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240716090632
-OBX|89|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|90|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|91|TX|54104-5^Hemoglobin pattern^LN|1|FA|||N|||F|||20240716090632
-OBX|92|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.|||N|||F|||20240716090632
-OBX|93|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240716090632
-OBX|94|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|95|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|96|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240716090632
-OBX|97|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|98|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|99|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|14.313|µmol/L/h|>=2.079|N|||F|||20240716090632
-OBX|100|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|101|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|102|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|7.64|µmol/L/h|>=1.2204|N|||F|||20240716090632
-OBX|103|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|104|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
-OBX|105|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240716090632
-OBX|106|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|107|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240716090632
-OBX|108|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|2||||N|||F|||20240716090632
-OBX|109|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240716090632
-OBX|110|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240716090632
-OBX|111|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.42|N|||F|||20240716090632
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240716090632||ORU^R01|220220550|D|2.5.1
PID|1||80008715||Bird^Tweety||202407100000|M||2106-3^White||||||||||||2186-5^Not Hispanic or Latino||N|1
NK1|1|Bird^Big|MTH^Mother|850 Marina Bay Parkway, APT 125^^Richmond^CA^94806-4000^USA|^^^^^916^3720117|^^^^^916^3729999||||||||||199301010000
ORC|RE|Q12345^HospOrdNumber||ABC888^FormNumber||||||||^CORTEZ^ALAN^^^^^^^NPI|||||||||UCSD JACOBS MEDICAL CENTER^^^^^^^^^R797|300 PASTEUR DR, RM H1524^^PALO ALTO^CA^94305-2200
OBR|1|Q12345^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407120000|||||||||^CORTEZ^ALAN^^^^^^^NPI||||||20240716090632|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240716090632
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240716090632
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240716090632
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12533-8^CAH^LN|||N|||F|||20240716090632
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240716090632
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\2823 FRESNO ST, FRESNO, CA 93721-1324\.br\\.br\Genetic Disease Laboratory - GDL 850 MARINA BAY PKWY, # G265, RICHMOND, CA 94804-6403\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Follow-up:\.br\\.br\CAH: An immediate referral to a CCS endocrine center or pediatric endocrinologist, for evaluation and additional testing, is strongly recommended. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Stanford University Medical Center at (510) 412-1562. \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, GAMT, Pompe Disease Tier-1, MPS I Tier-1, MPS II Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\Due to biological variability of newborns and differences in detection rates for the various disorders in the newborn period, the Newborn Screening Program will not identify all newborns with these conditions. While a positive screening result identifies newborns at an increased risk to justify a diagnostic work-up, a negative screening result does not rule out the possibility of a disorder. Health care providers should remain watchful for any sign or symptoms of these disorders in their patients. A newborn screening result should not be considered diagnostic, and cannot replace the individualized evaluation and diagnosis of an infant by a well-trained, knowledgeable health care provider. \.br\\.br\|||N|||F|||20240716090632
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240716090632
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240716090632
OBX|9|NM|8339-4^Birthweight^LN|1|3035|grams||N|||F|||20240716090632
OBX|10|TM|57715-5^Time of birth^LN|1|0000|||N|||F|||20240716090632
OBX|11|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240716090632
OBX|12|NM|73806-2^Newborn age in hours^LN|1|24|hour(s)||N|||F|||20240716090632
OBX|13|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240716090632
OBX|14|CE|67704-7^Feeding types^LN|1|LA16917-9^NPO^LN|||N|||F|||20240716090632
OBX|15|CE|67704-7^Feeding types^LN|3|LA12418-2^TPN^LN|||N|||F|||20240716090632
OBX|16|TX|62324-9^Post-discharge provider name^LN||Dr Sue Great||||||F|||20240716090632
OBX|17|TX|62325-6^Post-discharge provider practice ID^LN||1234567890||||||F|||20240716090632
OBX|18|TX|62327-2^Post-discharge provider practice address^LN||333 Best Care Place, Suite 3B, Los Angeles, California 90001||||||F|||20240716090632
OBX|19|XTN|62328-0^Post-discharge provider practice telephone number^LN||||||||F|||20240716090632
OBX|20|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|21|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240716090632
OBX|22|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|23|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<3.5|N|||F|||20240716090632
OBX|24|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<250|N|||F|||20240716090632
OBX|25|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.1|N|||F|||20240716090632
OBX|26|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<165|N|||F|||20240716090632
OBX|27|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.4|N|||F|||20240716090632
OBX|28|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<850|N|||F|||20240716090632
OBX|29|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<4.5|N|||F|||20240716090632
OBX|30|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|8-100|N|||F|||20240716090632
OBX|31|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-60|N|||F|||20240716090632
OBX|32|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<6|N|||F|||20240716090632
OBX|33|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240716090632
OBX|34|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240716090632
OBX|35|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<50|N|||F|||20240716090632
OBX|36|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.4|N|||F|||20240716090632
OBX|37|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240716090632
OBX|38|NM|53232-5^5-Oxoproline+Pipecolate [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|39|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|40|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|41|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|42|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6-125|N|||F|||20240716090632
OBX|43|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<75|N|||F|||20240716090632
OBX|44|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|11-80|N|||F|||20240716090632
OBX|45|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<5.2|N|||F|||20240716090632
OBX|46|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240716090632
OBX|47|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.6|N|||F|||20240716090632
OBX|48|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240716090632
OBX|49|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240716090632
OBX|50|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240716090632
OBX|51|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240716090632
OBX|52|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240716090632
OBX|53|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|54|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240716090632
OBX|55|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.8|N|||F|||20240716090632
OBX|56|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240716090632
OBX|57|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|58|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240716090632
OBX|59|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<10|N|||F|||20240716090632
OBX|60|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240716090632
OBX|61|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
OBX|62|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240716090632
OBX|63|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240716090632
OBX|64|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240716090632
OBX|65|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240716090632
OBX|66|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
OBX|67|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240716090632
OBX|68|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<6.3|N|||F|||20240716090632
OBX|69|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.3|N|||F|||20240716090632
OBX|70|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.38|N|||F|||20240716090632
OBX|71|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240716090632
OBX|72|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<1|N|||F|||20240716090632
OBX|73|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.45|N|||F|||20240716090632
OBX|74|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240716090632
OBX|75|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<0.85|N|||F|||20240716090632
OBX|76|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240716090632
OBX|77|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.6|N|||F|||20240716090632
OBX|78|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<63|N|||F|||20240716090632
OBX|79|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|80|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|81|NM|38473-5^17-Hydroxyprogesterone^LN|1|305|nmol/L|<70|H|||F|||20240716090632
OBX|82|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240716090632
OBX|83|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240716090632
OBX|84|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240716090632
OBX|85|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|86|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|87|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240716090632
OBX|88|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|89|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|90|TX|54104-5^Hemoglobin pattern^LN|1|FA|||N|||F|||20240716090632
OBX|91|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.|||N|||F|||20240716090632
OBX|92|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240716090632
OBX|93|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|94|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|95|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240716090632
OBX|96|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|97|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|98|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|14.313|µmol/L/h|>=2.079|N|||F|||20240716090632
OBX|99|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|100|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|101|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|7.64|µmol/L/h|>=1.2204|N|||F|||20240716090632
OBX|102|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|103|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240716090632
OBX|104|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240716090632
OBX|105|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|106|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240716090632
OBX|107|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|2||||N|||F|||20240716090632
OBX|108|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240716090632
OBX|109|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240716090632
OBX|110|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.42|N|||F|||20240716090632
diff --git a/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir b/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
index 6b686bcc7..8f9a20957 100644
--- a/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
+++ b/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1721843660233276000.622013c3-e425-4a48-b721-8e6e63837128",
+  "id": "1729292348001421000.c8cae004-945a-4d87-8524-55fab3f2801b",
   "meta": {
-    "lastUpdated": "2024-07-24T10:54:20.234-07:00"
+    "lastUpdated": "2024-10-18T15:59:08.001-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,15 +12,15 @@
   "timestamp": "2024-07-11T03:49:13.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/a43f68e7-8a7b-3739-80c9-bfac26e59d90",
+      "fullUrl": "MessageHeader/1729292348002485000.bc245c3f-2b57-4b1b-a644-9ea49b71e9ff",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "a43f68e7-8a7b-3739-80c9-bfac26e59d90",
+        "id": "1729292348002485000.bc245c3f-2b57-4b1b-a644-9ea49b71e9ff",
         "meta": {
           "tag": [
             {
               "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-              "code": "T"
+              "code": "D"
             }
           ]
         },
@@ -58,12 +58,12 @@
             ],
             "name": "SISHIERECEIVER",
             "receiver": {
-              "reference": "Organization/1721843660242972000.7067ce9f-a65e-4004-947f-85506f21e12d"
+              "reference": "Organization/1729292348002385000.7264dea7-c5df-44c9-9c3f-5903d9bbea27"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1721843660240758000.fc0d42e1-6998-4cbe-865f-9f715521df97"
+          "reference": "Organization/1729292348002048000.3c407adc-893e-4fb5-b674-8e4cdfc1e519"
         },
         "source": {
           "extension": [
@@ -89,10 +89,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721843660240758000.fc0d42e1-6998-4cbe-865f-9f715521df97",
+      "fullUrl": "Organization/1729292348002048000.3c407adc-893e-4fb5-b674-8e4cdfc1e519",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721843660240758000.fc0d42e1-6998-4cbe-865f-9f715521df97",
+        "id": "1729292348002048000.3c407adc-893e-4fb5-b674-8e4cdfc1e519",
         "identifier": [
           {
             "extension": [
@@ -107,10 +107,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1721843660242972000.7067ce9f-a65e-4004-947f-85506f21e12d",
+      "fullUrl": "Organization/1729292348002385000.7264dea7-c5df-44c9-9c3f-5903d9bbea27",
       "resource": {
         "resourceType": "Organization",
-        "id": "1721843660242972000.7067ce9f-a65e-4004-947f-85506f21e12d",
+        "id": "1729292348002385000.7264dea7-c5df-44c9-9c3f-5903d9bbea27",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -120,73 +120,73 @@
       }
     },
     {
-      "fullUrl": "Provenance/1721843660251922000.642c6d75-1afd-4d11-8a18-1e47ffe621ec",
+      "fullUrl": "Provenance/1729292348003373000.c6be32b7-129c-4a81-b299-c3fae23b5919",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1721843660251922000.642c6d75-1afd-4d11-8a18-1e47ffe621ec",
+        "id": "1729292348003373000.c6be32b7-129c-4a81-b299-c3fae23b5919",
         "target": [
           {
-            "reference": "MessageHeader/a43f68e7-8a7b-3739-80c9-bfac26e59d90"
+            "reference": "MessageHeader/1729292348002485000.bc245c3f-2b57-4b1b-a644-9ea49b71e9ff"
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@@ -10204,10 +10204,10 @@
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@@ -10217,10 +10217,10 @@
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@@ -10230,10 +10230,10 @@
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@@ -10243,10 +10243,10 @@
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@@ -10256,10 +10256,10 @@
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@@ -10269,10 +10269,10 @@
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@@ -10282,10 +10282,10 @@
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@@ -10295,10 +10295,10 @@
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@@ -10308,10 +10308,10 @@
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@@ -10321,10 +10321,10 @@
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@@ -10334,10 +10334,10 @@
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@@ -10347,10 +10347,10 @@
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@@ -10360,10 +10360,10 @@
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@@ -10373,10 +10373,10 @@
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@@ -10386,10 +10386,10 @@
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@@ -10399,10 +10399,10 @@
       }
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@@ -10414,7 +10414,7 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1721843660494009000.554cd05d-c7fe-43f8-a367-d461910c2718"
+                  "reference": "Organization/1729292348156219000.0881d584-2e12-4294-a366-52756e7c1600"
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@@ -10447,7 +10447,7 @@
               {
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-                  "reference": "Practitioner/1721843660495500000.68d03c54-f3c8-4c9a-8b39-4f764ee8b614"
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@@ -10476,10 +10476,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
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                 "valueReference": {
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+                  "reference": "Practitioner/1729292348159051000.d58ac767-0f91-40d5-bace-dae9d6c9e101"
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@@ -10581,18 +10585,18 @@
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+          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
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@@ -10628,10 +10632,10 @@
       }
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         "extension": [
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@@ -10689,23 +10693,23 @@
       }
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+      "fullUrl": "PractitionerRole/1729292348151653000.50315c64-2ca3-47be-b715-8a7b0f48af56",
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         "practitioner": {
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+          "reference": "Practitioner/1729292348152554000.7b7ea512-fe19-42fc-a92d-dd44bbad0f67"
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         "organization": {
-          "reference": "Organization/1721843660491589000.650f64b5-d11d-43d0-9c20-49723135a816"
+          "reference": "Organization/1729292348153918000.cba3d4a7-6e3c-464a-9069-46b75e7d5ce5"
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         "extension": [
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@@ -10725,10 +10729,10 @@
       }
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@@ -10760,10 +10764,10 @@
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@@ -10786,10 +10790,10 @@
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@@ -10798,10 +10802,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729292348163669000.8302c566-12fc-4c55-9306-f00f18d243f2"
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@@ -10851,18 +10859,18 @@
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+          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
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+          "reference": "Practitioner/1729292348160666000.494a9b31-d159-4a44-a583-17e233fbc46e"
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@@ -10889,10 +10897,10 @@
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+      "fullUrl": "Practitioner/1729292348163669000.8302c566-12fc-4c55-9306-f00f18d243f2",
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@@ -10915,10 +10923,10 @@
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@@ -10927,10 +10935,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
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@@ -10980,18 +10992,18 @@
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@@ -11018,10 +11030,10 @@
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@@ -11044,10 +11056,10 @@
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@@ -11056,10 +11068,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
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@@ -11109,18 +11125,18 @@
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@@ -11147,10 +11163,10 @@
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@@ -11173,10 +11189,10 @@
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@@ -11185,10 +11201,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
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@@ -11238,18 +11258,18 @@
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@@ -11276,10 +11296,10 @@
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@@ -11302,10 +11322,10 @@
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@@ -11314,10 +11334,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
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@@ -11367,18 +11391,18 @@
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@@ -11405,10 +11429,10 @@
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@@ -11431,10 +11455,10 @@
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@@ -11443,10 +11467,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
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@@ -11496,18 +11524,18 @@
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@@ -11534,10 +11562,10 @@
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@@ -11560,10 +11588,10 @@
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@@ -11572,10 +11600,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
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@@ -11625,18 +11657,18 @@
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@@ -11663,10 +11695,10 @@
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@@ -11689,10 +11721,10 @@
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@@ -11701,10 +11733,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
+              {
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+                "valueId": "F"
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@@ -11754,18 +11790,18 @@
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@@ -11792,10 +11828,10 @@
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@@ -11818,10 +11854,10 @@
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@@ -11830,10 +11866,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729292348199801000.4081806f-0817-4995-b3ee-51fd51e9c98c"
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@@ -11883,18 +11923,18 @@
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@@ -11921,10 +11961,10 @@
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@@ -11947,10 +11987,10 @@
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         "extension": [
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@@ -11959,10 +11999,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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@@ -12012,18 +12056,18 @@
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+          "reference": "Practitioner/1729292348201377000.32e25f1f-f02d-437f-b584-9a0361d84dc0"
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         "extension": [
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@@ -12050,10 +12094,10 @@
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@@ -12076,10 +12120,10 @@
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         "extension": [
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@@ -12088,10 +12132,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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@@ -12141,18 +12189,18 @@
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+          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
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+          "reference": "Practitioner/1729292348205987000.6f8545f1-0451-4f9b-881c-241b214bffd9"
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+      "fullUrl": "Practitioner/1729292348205987000.6f8545f1-0451-4f9b-881c-241b214bffd9",
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         "extension": [
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@@ -12179,10 +12227,10 @@
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         "extension": [
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@@ -12205,10 +12253,10 @@
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         "extension": [
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@@ -12217,10 +12265,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729292348213362000.b617e650-eab4-41af-9288-afa5de62d5eb"
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@@ -12270,18 +12322,18 @@
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+          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
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+          "reference": "Practitioner/1729292348210534000.1775fcf0-98b9-45f9-969b-b0e7f4af307a"
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+      "fullUrl": "Practitioner/1729292348210534000.1775fcf0-98b9-45f9-969b-b0e7f4af307a",
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         "extension": [
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@@ -12308,10 +12360,10 @@
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-      "fullUrl": "Practitioner/1721843660571641000.43102e4d-0a9b-4e34-afa2-6446fe4d5830",
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         "extension": [
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@@ -12334,10 +12386,10 @@
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         "extension": [
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@@ -12346,10 +12398,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
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                 "valueReference": {
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+                  "reference": "Practitioner/1729292348217777000.ad3a0871-603d-4f6a-a6a5-c74e0b00d16c"
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@@ -12399,18 +12455,18 @@
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+          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
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+          "reference": "Practitioner/1729292348214890000.0f25f754-90a5-4880-ab75-13e03f8cc7a4"
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         "extension": [
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@@ -12437,10 +12493,10 @@
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@@ -12463,10 +12519,10 @@
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@@ -12475,10 +12531,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
+              {
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+                "valueId": "F"
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                 "valueReference": {
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@@ -12528,18 +12588,18 @@
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+          "reference": "Practitioner/1729292348219299000.78f7c883-928a-4759-a40e-d1e87f64f54c"
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@@ -12566,10 +12626,10 @@
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@@ -12592,10 +12652,10 @@
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@@ -12604,10 +12664,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
               },
+              {
+                "url": "OBR.25",
+                "valueId": "F"
+              },
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@@ -12657,18 +12721,18 @@
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@@ -12695,10 +12759,10 @@
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@@ -12721,10 +12785,10 @@
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@@ -12733,10 +12797,14 @@
                 "url": "OBR.22",
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@@ -12786,18 +12854,18 @@
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@@ -12824,10 +12892,10 @@
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@@ -12850,10 +12918,10 @@
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@@ -12862,10 +12930,14 @@
                 "url": "OBR.22",
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@@ -12915,18 +12987,18 @@
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@@ -12953,10 +13025,10 @@
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@@ -12979,10 +13051,10 @@
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@@ -12991,10 +13063,14 @@
                 "url": "OBR.22",
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@@ -13049,18 +13125,18 @@
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@@ -13087,10 +13163,10 @@
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@@ -13113,10 +13189,10 @@
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@@ -13125,10 +13201,14 @@
                 "url": "OBR.22",
                 "valueString": "20240711034913"
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@@ -13183,18 +13263,18 @@
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@@ -13221,10 +13301,10 @@
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@@ -13247,10 +13327,10 @@
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@@ -13325,7 +13405,7 @@
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@@ -13344,7 +13424,7 @@
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@@ -13366,16 +13446,16 @@
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@@ -13406,7 +13486,7 @@
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@@ -13425,7 +13505,7 @@
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@@ -13447,39 +13527,39 @@
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@@ -13510,7 +13590,7 @@
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@@ -13529,7 +13609,7 @@
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+            "reference": "Specimen/1729292348145973000.fcf4a660-2493-47f3-8d3e-5344ef77a57e"
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         ],
         "result": [
           {
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+            "reference": "Observation/1729292348119996000.fca07016-6a19-41ee-8f45-e7bec30cd5f2"
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           {
-            "reference": "Observation/1721843660446516000.aeea7d27-3638-4931-b858-f168e0564f16"
+            "reference": "Observation/1729292348121227000.e7c5b7e0-0d24-44ef-a8bc-5f4ea5287eed"
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           {
-            "reference": "Observation/1721843660449090000.f186beaf-84ff-4fc1-9465-3ad85315c7e6"
+            "reference": "Observation/1729292348122275000.b582c921-ebd2-4fd7-9373-dde0c9707819"
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         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1721843660646472000.07e9110e-faf1-40ec-bb79-a11b9763045c",
+      "fullUrl": "DiagnosticReport/1729292348282155000.5ca0061e-e36c-48ee-af4e-5d3890adb71b",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721843660646472000.07e9110e-faf1-40ec-bb79-a11b9763045c",
+        "id": "1729292348282155000.5ca0061e-e36c-48ee-af4e-5d3890adb71b",
         "identifier": [
           {
             "extension": [
@@ -14845,7 +14925,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1721843660588512000.477ca7db-e136-46a5-8fa0-a69e73980916"
+            "reference": "ServiceRequest/1729292348227046000.e70a5d9e-8393-4cb4-b22b-aa68ad0f2b97"
           }
         ],
         "status": "final",
@@ -14864,7 +14944,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1721843660266914000.f80184ae-55d8-4774-8a60-1e44c8e575a2"
+          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -14886,27 +14966,27 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1721843660486525000.6ff0d1c5-64a4-4731-83de-83ba87336843"
+            "reference": "Specimen/1729292348146361000.56f60985-c0bb-4f95-be79-09dce3dc7959"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1721843660451417000.4e332981-59e6-4655-b308-16c38dc8389c"
+            "reference": "Observation/1729292348123398000.7fb61193-8ce3-4cd3-b91a-2cbc9c915d00"
           },
           {
-            "reference": "Observation/1721843660454223000.269ba8e8-5679-4346-98e8-0ea8a201a7ca"
+            "reference": "Observation/1729292348124564000.17c80dd5-9df0-4432-81a2-f5e52d279ba9"
           },
           {
-            "reference": "Observation/1721843660456270000.39d97712-613b-44fb-9e58-a548cec27df2"
+            "reference": "Observation/1729292348125601000.76f5b14e-9a92-4e58-9c9a-ec8699454152"
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         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1721843660648272000.4ca7e718-8cdf-4059-85e6-4b21d51011d2",
+      "fullUrl": "DiagnosticReport/1729292348285126000.e3022996-7306-41c3-896a-cf715cf100c8",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721843660648272000.4ca7e718-8cdf-4059-85e6-4b21d51011d2",
+        "id": "1729292348285126000.e3022996-7306-41c3-896a-cf715cf100c8",
         "identifier": [
           {
             "extension": [
@@ -14937,7 +15017,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1721843660593854000.82f8e1bd-eef0-4d57-aaa0-0912690bfcba"
+            "reference": "ServiceRequest/1729292348231369000.05c7d553-98ae-4da7-8592-ee5a7dc1c22c"
           }
         ],
         "status": "final",
@@ -14956,7 +15036,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1721843660266914000.f80184ae-55d8-4774-8a60-1e44c8e575a2"
+          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -14978,27 +15058,27 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1721843660486946000.cf066f27-434b-45e3-9978-afb7d64d42e8"
+            "reference": "Specimen/1729292348146735000.671c147c-be45-4009-87d1-47ed0799a75f"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1721843660458717000.a240a679-5675-4bb3-8198-980b44ea263a"
+            "reference": "Observation/1729292348126734000.fc00ba97-b166-4657-8c95-be1daa51596b"
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           {
-            "reference": "Observation/1721843660461159000.c11f77e1-ad9b-415e-acf9-112531bbce20"
+            "reference": "Observation/1729292348127907000.86b8888d-8a47-48a8-aae1-71ca562ae110"
           },
           {
-            "reference": "Observation/1721843660463273000.be884dbf-f5b3-4e5b-9f61-8d944845082a"
+            "reference": "Observation/1729292348128940000.c4bd9b01-5964-4537-bfc6-e080c0937a4d"
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         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1721843660650016000.e1809abc-361c-4cc2-b47b-9415e410fd0b",
+      "fullUrl": "DiagnosticReport/1729292348294196000.11df5fe3-6b79-4e11-9450-d56979a896c6",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721843660650016000.e1809abc-361c-4cc2-b47b-9415e410fd0b",
+        "id": "1729292348294196000.11df5fe3-6b79-4e11-9450-d56979a896c6",
         "identifier": [
           {
             "extension": [
@@ -15029,7 +15109,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1721843660600927000.78a95631-58ff-460c-85c1-1044c97eaee5"
+            "reference": "ServiceRequest/1729292348235679000.c38d9030-ee71-408a-99b8-957479ae5c66"
           }
         ],
         "status": "final",
@@ -15048,7 +15128,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1721843660266914000.f80184ae-55d8-4774-8a60-1e44c8e575a2"
+          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -15070,27 +15150,27 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1721843660487382000.fd418c92-2c88-4b96-9e93-1750627daa1d"
+            "reference": "Specimen/1729292348147114000.82ab2769-f7eb-4981-9f06-ea56a0570bd9"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1721843660465129000.de875f3f-ce1a-47a3-94ca-8c4e43cde178"
+            "reference": "Observation/1729292348129972000.8723d6c3-68c7-4d0e-b890-5eaca1385138"
           },
           {
-            "reference": "Observation/1721843660467736000.5e8a9204-038a-4a32-92ae-f272e9d378cc"
+            "reference": "Observation/1729292348131115000.1ce963d9-7287-4248-967d-591d0b00eec7"
           },
           {
-            "reference": "Observation/1721843660469096000.8c49dec8-a001-4f2a-ad39-a4c99c68a079"
+            "reference": "Observation/1729292348132164000.4b93987a-27e8-499d-8d3f-7db11cea1683"
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         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1721843660651926000.406b09e0-294f-40fc-8d39-84d0fd100aec",
+      "fullUrl": "DiagnosticReport/1729292348295898000.f9014c78-f8c5-4b6d-9551-b7ffe9f14999",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721843660651926000.406b09e0-294f-40fc-8d39-84d0fd100aec",
+        "id": "1729292348295898000.f9014c78-f8c5-4b6d-9551-b7ffe9f14999",
         "identifier": [
           {
             "extension": [
@@ -15121,7 +15201,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1721843660606503000.82fc174e-9cbc-4e8f-9b1f-c7521f930343"
+            "reference": "ServiceRequest/1729292348240037000.46bf37bc-934e-4e4e-ba4e-6ba60eb4485e"
           }
         ],
         "status": "final",
@@ -15145,7 +15225,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1721843660266914000.f80184ae-55d8-4774-8a60-1e44c8e575a2"
+          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -15167,24 +15247,24 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1721843660487816000.e1ad5727-7374-48d4-a3a4-97006b6762ef"
+            "reference": "Specimen/1729292348147494000.03f56c22-e4d9-43ee-9a22-8ea31be4c9ba"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1721843660470586000.a4cb3ebf-3d4d-459e-a37b-6b3a42690f95"
+            "reference": "Observation/1729292348133292000.0af70fb4-1589-4e27-8764-6af785871ac1"
           },
           {
-            "reference": "Observation/1721843660471950000.54f842ee-8b30-480a-b4af-4fe4dc700942"
+            "reference": "Observation/1729292348134303000.7a1d2327-6212-474a-89d6-b40e00cd4cbe"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1721843660653708000.c5b9bb30-a2cd-4924-84e0-938a01a8e0ad",
+      "fullUrl": "DiagnosticReport/1729292348297900000.4ec94a21-f56e-4f50-974e-78d9513c2be5",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1721843660653708000.c5b9bb30-a2cd-4924-84e0-938a01a8e0ad",
+        "id": "1729292348297900000.4ec94a21-f56e-4f50-974e-78d9513c2be5",
         "identifier": [
           {
             "extension": [
@@ -15215,7 +15295,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1721843660612081000.fe0124e6-f04e-4bf6-a017-a8ced0c5e719"
+            "reference": "ServiceRequest/1729292348244409000.d86ba55e-a14a-4358-8c87-a3ddbbb28d2d"
           }
         ],
         "status": "final",
@@ -15239,7 +15319,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1721843660266914000.f80184ae-55d8-4774-8a60-1e44c8e575a2"
+          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -15261,12 +15341,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1721843660488275000.ffd6aaa1-3438-4629-a25a-9acf72e06d9d"
+            "reference": "Specimen/1729292348147885000.fd18eb23-4f73-4dd5-8b29-b7b0972a9dd2"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1721843660473345000.30ef0622-a285-4f79-b754-896c073c56f0"
+            "reference": "Observation/1729292348135440000.d303a5c3-3923-46e6-8440-98a8902fbeff"
           }
         ]
       }
diff --git a/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir b/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
index 59869466b..47e0ff3b0 100644
--- a/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
+++ b/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
@@ -1,12313 +1,12278 @@
 {
-	"resourceType": "Bundle",
-	"id": "1721843660233276000.622013c3-e425-4a48-b721-8e6e63837128",
-	"meta": {
-		"lastUpdated": "2024-07-24T10:54:20.234-07:00"
-	},
-	"identifier": {
-		"system": "https://reportstream.cdc.gov/prime-router",
-		"value": "243747623"
-	},
-	"type": "message",
-	"timestamp": "2024-07-11T03:49:13.000-07:00",
-	"entry": [
-		{
-			"fullUrl": "MessageHeader/a43f68e7-8a7b-3739-80c9-bfac26e59d90",
-			"resource": {
-				"resourceType": "MessageHeader",
-				"id": "a43f68e7-8a7b-3739-80c9-bfac26e59d90",
-				"meta": {
-					"tag": [
-						{
-							"system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-							"code": "T"
-						},
-						{
-							"system": "http://localcodes.org/ETOR",
-							"code": "ETOR",
-							"display": "Processed by ETOR"
-						}
-					]
-				},
-				"extension": [
-					{
-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-						"extension": [
-							{
-								"url": "MSH.7",
-								"valueString": "20240711034913"
-							}
-						]
-					}
-				],
-				"eventCoding": {
-					"system": "http://terminology.hl7.org/CodeSystem/v2-0003",
-					"code": "R01",
-					"display": "ORU^R01"
-				},
-				"destination": [
-					{
-						"extension": [
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-								"valueString": "MSH.5"
-							}
-						],
-						"name": "EPIC",
-						"receiver": {
-							"reference": "Organization/1721843660242972000.7067ce9f-a65e-4004-947f-85506f21e12d"
-						}
-					}
-				],
-				"sender": {
-					"reference": "Organization/1721843660240758000.fc0d42e1-6998-4cbe-865f-9f715521df97"
-				},
-				"source": {
-					"extension": [
-						{
-							"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-							"valueString": "SISGDSP"
-						},
-						{
-							"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-							"valueString": "MSH.3"
-						}
-					],
-					"name": "SISGDSP",
-					"_endpoint": {
-						"extension": [
-							{
-								"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
-								"valueCode": "unknown"
-							}
-						]
-					}
-				}
-			}
-		},
-		{
-			"fullUrl": "Organization/1721843660240758000.fc0d42e1-6998-4cbe-865f-9f715521df97",
-			"resource": {
-				"resourceType": "Organization",
-				"id": "1721843660240758000.fc0d42e1-6998-4cbe-865f-9f715521df97",
-				"identifier": [
-					{
-						"extension": [
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-								"valueString": "HD.1"
-							}
-						],
-						"value": "CDPH"
-					}
-				]
-			}
-		},
-		{
-			"fullUrl": "Organization/1721843660242972000.7067ce9f-a65e-4004-947f-85506f21e12d",
-			"resource": {
-				"resourceType": "Organization",
-				"id": "1721843660242972000.7067ce9f-a65e-4004-947f-85506f21e12d",
-				"extension": [
-					{
-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-						"valueString": "MSH.6"
-					}
-				],
-				"identifier": [
-					{
-						"extension": [
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-								"valueString": "HD.1"
-							}
-						],
-						"value": "R797"
-					}
-				]
-			}
-		},
-		{
-			"fullUrl": "Provenance/1721843660251922000.642c6d75-1afd-4d11-8a18-1e47ffe621ec",
-			"resource": {
-				"resourceType": "Provenance",
-				"id": "1721843660251922000.642c6d75-1afd-4d11-8a18-1e47ffe621ec",
-				"target": [
-					{
-						"reference": "MessageHeader/a43f68e7-8a7b-3739-80c9-bfac26e59d90"
-					},
-					{
-						"reference": "DiagnosticReport/1721843660616764000.226775ae-be0d-4edf-94f8-ee0f39f23e31"
-					},
-					{
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-					{
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-					{
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-					{
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-					{
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-					{
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-					{
-						"reference": "DiagnosticReport/1721843660634225000.41d82f5f-c783-4149-9f65-d940d1c09ac4"
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-					{
-						"reference": "DiagnosticReport/1721843660641190000.676a84a7-e601-4429-acd0-56c80dce20ac"
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-					{
-						"reference": "DiagnosticReport/1721843660642961000.6f8c7313-8d05-45b9-8178-f25e38b2f878"
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-					{
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-					{
-						"reference": "DiagnosticReport/1721843660648272000.4ca7e718-8cdf-4059-85e6-4b21d51011d2"
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-					{
-						"reference": "DiagnosticReport/1721843660650016000.e1809abc-361c-4cc2-b47b-9415e410fd0b"
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-					{
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-						"reference": "DiagnosticReport/1721843660653708000.c5b9bb30-a2cd-4924-84e0-938a01a8e0ad"
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diff --git a/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7 b/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
index 9a53fa70c..49c1128cc 100644
--- a/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
+++ b/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
@@ -1,110 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|T|2.5.1
-PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
-NK1|1|NICUABG|MTH^Mother
-ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI|||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
-OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^LN^CDPHGSPEAP|||202407111346|||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI||||||20240711034913
-OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
-OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
-OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
-OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
-OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
-OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
-OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
-OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
-OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
-OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
-OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
-OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
-OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
-OBX|14|TX|^^^99717-5^Accession Number^L|1|193-08-269/21-2024-21|||N|||F|||20240711034913
-OBX|15|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
-OBX|16|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
-OBX|17|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|18|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
-OBX|19|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|20|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
-OBX|21|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
-OBX|22|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
-OBX|23|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
-OBX|24|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
-OBX|25|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
-OBX|26|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
-OBX|27|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
-OBX|28|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
-OBX|29|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
-OBX|30|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
-OBX|31|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|32|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
-OBX|33|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
-OBX|34|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
-OBX|35|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|36|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|37|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|38|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
-OBX|39|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
-OBX|40|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
-OBX|41|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240711034913
-OBX|42|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
-OBX|43|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
-OBX|44|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|45|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
-OBX|46|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
-OBX|47|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
-OBX|48|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
-OBX|49|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|50|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
-OBX|51|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
-OBX|52|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|53|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|54|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
-OBX|55|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
-OBX|56|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
-OBX|57|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|58|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240711034913
-OBX|59|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
-OBX|60|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
-OBX|61|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|62|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|63|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|64|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
-OBX|65|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
-OBX|66|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
-OBX|67|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
-OBX|68|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
-OBX|69|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
-OBX|70|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
-OBX|71|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
-OBX|72|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
-OBX|73|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240711034913
-OBX|74|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240711034913
-OBX|75|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|76|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|77|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
-OBX|78|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|79|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|80|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240711034913
-OBX|81|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|82|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|83|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240711034913
-OBX|84|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|85|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|86|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
-OBX|87|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
-OBX|88|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.00|ERU|>10|L|||F|||20240711034913
-OBX|89|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
-OBX|90|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
-OBX|91|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
-OBX|92|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|93|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|94|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
-OBX|95|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|96|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|97|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
-OBX|98|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|99|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|100|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
-OBX|101|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|102|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
-OBX|103|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|104|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
-OBX|105|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|D|2.5.1
PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
NK1|1|NICUABG|MTH^Mother
ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI|||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407111346|||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI||||||20240711034913|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
OBX|14|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
OBX|15|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
OBX|16|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|17|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
OBX|18|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|19|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
OBX|20|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
OBX|21|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
OBX|22|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
OBX|23|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
OBX|24|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
OBX|25|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
OBX|26|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
OBX|27|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
OBX|28|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
OBX|29|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
OBX|30|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|31|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
OBX|32|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
OBX|33|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
OBX|34|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|35|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|36|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|37|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
OBX|38|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
OBX|39|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
OBX|40|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240711034913
OBX|41|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
OBX|42|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
OBX|43|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|44|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
OBX|45|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
OBX|46|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
OBX|47|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
OBX|48|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|49|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
OBX|50|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
OBX|51|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|52|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|53|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
OBX|54|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
OBX|55|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
OBX|56|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|57|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240711034913
OBX|58|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
OBX|59|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
OBX|60|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|61|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|62|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|63|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
OBX|64|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
OBX|65|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
OBX|66|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
OBX|67|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
OBX|68|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
OBX|69|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
OBX|70|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
OBX|71|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
OBX|72|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240711034913
OBX|73|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240711034913
OBX|74|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|75|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|76|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
OBX|77|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|78|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|79|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240711034913
OBX|80|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|81|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|82|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240711034913
OBX|83|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|84|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|85|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
OBX|86|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
OBX|87|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.00|ERU|>10|L|||F|||20240711034913
OBX|88|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
OBX|89|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
OBX|90|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
OBX|91|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|92|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|93|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
OBX|94|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|95|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|96|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
OBX|97|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|98|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|99|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
OBX|100|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|101|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
OBX|102|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|103|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
OBX|104|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
diff --git a/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_1_hl7_translation.fhir b/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_1_hl7_translation.fhir
new file mode 100644
index 000000000..32545975e
--- /dev/null
+++ b/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_1_hl7_translation.fhir
@@ -0,0 +1,15699 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729291862952487000.d21a4e14-69b4-4f0b-9e08-edb761f2c028",
+  "meta": {
+    "lastUpdated": "2024-10-18T15:51:02.952-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "243747672"
+  },
+  "type": "message",
+  "timestamp": "2024-07-22T10:35:44.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729291862954620000.d17e3b25-72bb-4f1e-85b2-37093221f5db",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729291862954620000.d17e3b25-72bb-4f1e-85b2-37093221f5db",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240722103544"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "11903029"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "L,M,N"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "SISHIERECEIVER",
+            "receiver": {
+              "reference": "Organization/1729291862954324000.6bafa13a-dd18-442a-a596-821cdda9114c"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729291862953681000.e1f005ee-72b0-4ae9-ae99-2cd88d0199cb"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "SISGDSP"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "name": "SISGDSP",
+          "_endpoint": {
+            "extension": [
+              {
+                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                "valueCode": "unknown"
+              }
+            ]
+          }
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291862953681000.e1f005ee-72b0-4ae9-ae99-2cd88d0199cb",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729291862953681000.e1f005ee-72b0-4ae9-ae99-2cd88d0199cb",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "SISGDSP"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291862954324000.6bafa13a-dd18-442a-a596-821cdda9114c",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729291862954324000.6bafa13a-dd18-442a-a596-821cdda9114c",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
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+                  "code": "L,M,N"
+                }
+              ]
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+            "value": "1730127069"
+          }
+        ]
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+    {
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+      "resource": {
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+        "id": "1729291862957087000.b4e726f0-ba5a-46fc-a45b-16aae9411d26",
+        "target": [
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+            "reference": "MessageHeader/1729291862954620000.d17e3b25-72bb-4f1e-85b2-37093221f5db"
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+          {
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+          },
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+            "reference": "DiagnosticReport/1729291863244988000.b931757d-05b2-49f7-9eb5-64f5eed129b4"
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+          },
+          {
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+          {
+            "reference": "DiagnosticReport/1729291863251214000.6acffb01-2c5d-4384-93c5-47a2423a8a08"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863252829000.8fcc3da5-4844-4313-b406-6baceafa4f0e"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863254524000.b7917e3f-83a5-439e-8aaa-ba131335ae56"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863256204000.c52a1111-b58b-4dc8-8258-98067a4dc257"
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+            "reference": "DiagnosticReport/1729291863257861000.c2b84a9d-5874-4975-b5b0-1d96f91c58bd"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863259527000.fc951c22-64f8-4a29-8765-1c2170afa96b"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863261114000.ba209d3b-79cc-4ac7-88ae-ff0fd0cda1ce"
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+          {
+            "reference": "DiagnosticReport/1729291863262781000.7daa45ba-bf17-44dd-8f97-f9aec83cf5d3"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863264426000.0d58b335-1ee3-4374-a8fa-b9f58b90096e"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863266113000.8227baa8-6502-47d1-9c67-77b4dd3d510a"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863267782000.f16f0edb-7d3e-45ed-9e05-e43c61822c6e"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863269439000.5c76fb62-be9f-48ea-b735-f12c92eb64ec"
+          }
+        ],
+        "recorded": "2024-07-22T10:35:44Z",
+        "activity": {
+          "coding": [
+            {
+              "display": "ORU^R01^ORU_R01"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729291862956874000.1bdc2512-8da7-46d9-85a4-1e82103c63c0"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291862956874000.1bdc2512-8da7-46d9-85a4-1e82103c63c0",
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+              "display": "Newborn conditions with positive markers [Identifier] in Dried blood spot"
+            }
+          ]
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+            }
+          ]
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+                }
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+              "code": "57724-7",
+              "display": "Newborn screening short narrative summary"
+            }
+          ]
+        },
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+        },
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+        "valueString": "ACTION REQUIRED\\.br\\\\.br\\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB ~EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\\.br\\\\.br\\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\\.br\\\\.br\\Lab Director - Genetic Disease Laboratory, (510) 231-1790\\.br\\\\.br\\Follow-up:\\.br\\\\.br\\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \\.br\\\\.br\\Primary Congenital Hypothyroidism: Additional testing in consultation with a CCS-approved Endocrine Center or Pediatric Endocrinologist is strongly recommended. Call your Newborn Screening Coordinator for assistance. \\.br\\\\.br\\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Rady Children's Hospital San Diego at (115) 118-8708. \\.br\\\\.br\\Methods and Limitations:\\.br\\\\.br\\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \\.br\\Attention Healthcare Provider:\\.br\\\\.br\\\\.br\\",
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+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291863121172000.5c23f9e6-fa88-4bb5-b92d-e87a838b2fed"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729291863105550000.98ece4ce-9969-4606-a5e7-80bf50e9f54a"
+          },
+          {
+            "reference": "Observation/1729291863106612000.d131ba4e-3f82-49d5-9e7e-a1155ec5eb1b"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729291863269439000.5c76fb62-be9f-48ea-b735-f12c92eb64ec",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729291863269439000.5c76fb62-be9f-48ea-b735-f12c92eb64ec",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7251234856"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729291863232186000.8c4679e8-e6ac-48e8-943f-416af8839da7"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-29",
+              "display": "Adrenoleukodystrophy Tier-1 newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729291862965195000.f2fd2b1b-d8ea-4d21-be06-f73ed5911807"
+        },
+        "effectiveDateTime": "2024-07-17T12:26:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407171226"
+            }
+          ]
+        },
+        "issued": "2024-07-22T10:35:44Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240722103544"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291863121578000.494d55aa-e52f-4220-a523-984c87d7568b"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729291863107853000.a3a01789-e3af-4a28-9e59-2d3df4eab9bc"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_2_fhir_transformation.fhir b/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_2_fhir_transformation.fhir
new file mode 100644
index 000000000..709a6726f
--- /dev/null
+++ b/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_2_fhir_transformation.fhir
@@ -0,0 +1,12603 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729291862952487000.d21a4e14-69b4-4f0b-9e08-edb761f2c028",
+  "meta": {
+    "lastUpdated": "2024-10-18T15:51:02.952-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "243747672"
+  },
+  "type": "message",
+  "timestamp": "2024-07-22T10:35:44.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729291862954620000.d17e3b25-72bb-4f1e-85b2-37093221f5db",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729291862954620000.d17e3b25-72bb-4f1e-85b2-37093221f5db",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240722103544"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "EPIC",
+            "receiver": {
+              "reference": "Organization/1729291862954324000.6bafa13a-dd18-442a-a596-821cdda9114c"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729291862953681000.e1f005ee-72b0-4ae9-ae99-2cd88d0199cb"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "SISGDSP"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "name": "SISGDSP",
+          "_endpoint": {
+            "extension": [
+              {
+                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                "valueCode": "unknown"
+              }
+            ]
+          }
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291862953681000.e1f005ee-72b0-4ae9-ae99-2cd88d0199cb",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729291862953681000.e1f005ee-72b0-4ae9-ae99-2cd88d0199cb",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "CDPH"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291862954324000.6bafa13a-dd18-442a-a596-821cdda9114c",
+      "resource": {
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+        "id": "1729291862954324000.6bafa13a-dd18-442a-a596-821cdda9114c",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "R508"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729291862957087000.b4e726f0-ba5a-46fc-a45b-16aae9411d26",
+      "resource": {
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+        "id": "1729291862957087000.b4e726f0-ba5a-46fc-a45b-16aae9411d26",
+        "target": [
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+            "reference": "MessageHeader/1729291862954620000.d17e3b25-72bb-4f1e-85b2-37093221f5db"
+          },
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+          },
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+            "reference": "DiagnosticReport/1729291863237555000.743c01cf-d3bc-44af-a5bb-219e39617e6e"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863239469000.4b24a2df-c7ed-406d-beeb-3acafa8345f1"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863241062000.988c458f-30a7-4def-8629-95c48e9f3976"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863243344000.c08f92f7-1f7f-4e36-9650-0a51ca909ff9"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863244988000.b931757d-05b2-49f7-9eb5-64f5eed129b4"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863247504000.687e45dc-f3d0-4df4-b8bd-7c3e975a4616"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863249466000.24735df5-4681-4aca-946c-a47268d22893"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863251214000.6acffb01-2c5d-4384-93c5-47a2423a8a08"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863252829000.8fcc3da5-4844-4313-b406-6baceafa4f0e"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863254524000.b7917e3f-83a5-439e-8aaa-ba131335ae56"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863256204000.c52a1111-b58b-4dc8-8258-98067a4dc257"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863257861000.c2b84a9d-5874-4975-b5b0-1d96f91c58bd"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863259527000.fc951c22-64f8-4a29-8765-1c2170afa96b"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863261114000.ba209d3b-79cc-4ac7-88ae-ff0fd0cda1ce"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863262781000.7daa45ba-bf17-44dd-8f97-f9aec83cf5d3"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863264426000.0d58b335-1ee3-4374-a8fa-b9f58b90096e"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863266113000.8227baa8-6502-47d1-9c67-77b4dd3d510a"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863267782000.f16f0edb-7d3e-45ed-9e05-e43c61822c6e"
+          },
+          {
+            "reference": "DiagnosticReport/1729291863269439000.5c76fb62-be9f-48ea-b735-f12c92eb64ec"
+          }
+        ],
+        "recorded": "2024-07-22T10:35:44Z",
+        "activity": {
+          "coding": [
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+              "display": "ORU^R01^ORU_R01"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729291862956874000.1bdc2512-8da7-46d9-85a4-1e82103c63c0"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291862956874000.1bdc2512-8da7-46d9-85a4-1e82103c63c0",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729291862956874000.1bdc2512-8da7-46d9-85a4-1e82103c63c0",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "SISGDSP"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729291862957899000.f5b6be1c-a5f0-46ae-a9f4-a7a2c809393e",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729291862957899000.f5b6be1c-a5f0-46ae-a9f4-a7a2c809393e",
+        "recorded": "2024-10-18T15:51:02Z",
+        "policy": [
+          "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
+        ],
+        "activity": {
+          "coding": [
+            {
+              "code": "v2-FHIR transformation"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "assembler"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729291862957719000.bda49e0b-fd43-4ab0-9c32-7021a8912366"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291862957719000.bda49e0b-fd43-4ab0-9c32-7021a8912366",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729291862957719000.bda49e0b-fd43-4ab0-9c32-7021a8912366",
+        "identifier": [
+          {
+            "value": "CDC PRIME - Atlanta"
+          },
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.237821"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729291862965195000.f2fd2b1b-d8ea-4d21-be06-f73ed5911807",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729291862965195000.f2fd2b1b-d8ea-4d21-be06-f73ed5911807",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        }
+                      ],
+                      "code": "M"
+                    }
+                  ]
+                }
+              },
+              {
+                "url": "PID.24",
+                "valueString": "Y"
+              }
+            ]
+          },
+          {
+            "url": "http://ibm.com/fhir/cdm/StructureDefinition/local-race-cd",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2131-1",
+                  "display": "Other Race"
+                }
+              ]
+            }
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ethnic-group",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2135-2",
+                  "display": "Hispanic or Latino"
+                }
+              ]
+            }
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "80008765",
+            "assigner": {
+              "reference": "Organization/1729291862958613000.80d1162c-b05f-49b3-bbe0-1e7186b7836d"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "BOY  MOM"
+                  },
+                  {
+                    "url": "XPN.7"
+                  }
+                ]
+              }
+            ],
+            "use": "official",
+            "family": "CDPHTWENTYFIVE",
+            "given": [
+              "BOY  MOM"
+            ]
+          }
+        ],
+        "gender": "male",
+        "birthDate": "2023-08-10",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202308101318"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2023-08-10T13:18:00Z"
+            }
+          ]
+        },
+        "multipleBirthInteger": 2,
+        "contact": [
+          {
+            "extension": [
+              {
+                "url": "https://hl7.org/fhir/StructureDefinition/relationship",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        }
+                      ],
+                      "code": "MTH",
+                      "display": "Mother"
+                    }
+                  ]
+                }
+              }
+            ],
+            "name": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                  "extension": [
+                    {
+                      "url": "XPN.2",
+                      "valueString": "MOM"
+                    }
+                  ]
+                }
+              ],
+              "family": "CDPHTWENTYFIVE",
+              "given": [
+                "MOM"
+              ]
+            },
+            "telecom": [
+              {
+                "extension": [
+                  {
+                    "url": "http://hl7.org/fhir/StructureDefinition/contactpoint-area",
+                    "valueString": "619"
+                  },
+                  {
+                    "url": "http://hl7.org/fhir/StructureDefinition/contactpoint-local",
+                    "valueString": "6363636"
+                  },
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xtn-contact-point",
+                    "extension": [
+                      {
+                        "url": "XTN.7",
+                        "valueString": "6363636"
+                      }
+                    ]
+                  }
+                ],
+                "_system": {
+                  "extension": [
+                    {
+                      "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                      "valueCode": "unknown"
+                    }
+                  ]
+                }
+              }
+            ],
+            "address": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                      "extension": [
+                        {
+                          "url": "SAD.1",
+                          "valueString": "125 STREET"
+                        }
+                      ]
+                    }
+                  ]
+                }
+              ],
+              "line": [
+                "125 STREET"
+              ],
+              "city": "SAN DIEGO",
+              "state": "CA",
+              "postalCode": "92126",
+              "country": "USA"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291862958613000.80d1162c-b05f-49b3-bbe0-1e7186b7836d",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729291862958613000.80d1162c-b05f-49b3-bbe0-1e7186b7836d",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ]
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
+                }
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+            "reference": "Observation/1729291863057280000.c2e11d51-06ad-4f74-8ff6-c453fbab669b"
+          },
+          {
+            "reference": "Observation/1729291863058541000.f0976719-5dc9-4e32-bcbb-3f13cc3d16f0"
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+          {
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+          {
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+          {
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+          {
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+          {
+            "reference": "Observation/1729291863102166000.17d43f83-9c47-4c10-a23d-9af694af5f89"
+          },
+          {
+            "reference": "Observation/1729291863103367000.108ba412-ad07-4c0c-b458-b9aeaf0ee39d"
+          },
+          {
+            "reference": "Observation/1729291863104405000.d462d352-d5bf-4153-ad73-da9727f70a71"
+          },
+          {
+            "reference": "Observation/1729291863105550000.98ece4ce-9969-4606-a5e7-80bf50e9f54a"
+          },
+          {
+            "reference": "Observation/1729291863106612000.d131ba4e-3f82-49d5-9e7e-a1155ec5eb1b"
+          },
+          {
+            "reference": "Observation/1729291863107853000.a3a01789-e3af-4a28-9e59-2d3df4eab9bc"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_3_hl7_translation_final.hl7 b/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_3_hl7_translation_final.hl7
index 7a4cf5689..6fa84d24f 100644
--- a/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_3_hl7_translation_final.hl7
+++ b/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_3_hl7_translation_final.hl7
@@ -1 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R508|20240722103544||ORU^R01|243747672|T|2.5.1
PID|1||80008765^^^&NPI||CDPHTWENTYFIVE^BOY  MOM||202308101318|M||2131-1^Other Race||||||||||||2135-2^Hispanic or Latino||Y|2
NK1|1|CDPHTWENTYFIVE^MOM|MTH^Mother|125 STREET^^SAN DIEGO^CA^92126^USA|^^^^^619^6363636
ORC|RE|189556932^HospOrdNumber||7251234856^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI|||||||||UC SAN DIEGO MEDICAL CENTER^^^^^^^^^R508|5421TS HT61, SR ET^^SAN DIEGO^CA^99999-9999
OBR|1|189556932^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^LN^CDPHGSPEAP|||202407171226|||||||||^HUBBARD^EUSTRATIA||||||20240722103544|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240722103544
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240722103544
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240722103544
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|99717-3^Hypothyroidism^L|||N|||F|||20240722103544
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240722103544
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Primary Congenital Hypothyroidism: Additional testing in consultation with a CCS-approved Endocrine Center or Pediatric Endocrinologist is strongly recommended. Call your Newborn Screening Coordinator for assistance. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Rady Children's Hospital San Diego at (115) 118-8708. \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240722103544
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240722103544
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240722103544
OBX|9|NM|8339-4^Birthweight^LN|1|3629|grams||N|||F|||20240722103544
OBX|10|TM|57715-5^Time of birth^LN|1|1318|||N|||F|||20240722103544
OBX|11|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12412-5^Twins^LN|||N|||F|||20240722103544
OBX|12|NM|73806-2^Newborn age in hours^LN|1|341|day(s)||N|||F|||20240722103544
OBX|13|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240722103544
OBX|14|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240722103544
OBX|15|TX|^^^99717-5^Accession Number^L|1|200-61-279/21-2024-21|||N|||F|||20240722103544
OBX|16|TX|62324-9^Post-discharge provider name^LN|1|STEPHEN HEBERT|||N|||F|||20240722103544
OBX|17|TX|62325-6^Post-discharge provider practice ID^LN|1|1730127069|||N|||F|||20240722103544
OBX|18|TX|62327-2^Post-discharge provider practice address^LN|1|5421TS HT61, SR ET SAN DIEGO CA 99999-9999 USA|||N|||F|||20240722103544
OBX|19|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722103544
OBX|20|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240722103544
OBX|21|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722103544
OBX|22|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240722103544
OBX|23|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240722103544
OBX|24|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240722103544
OBX|25|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240722103544
OBX|26|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240722103544
OBX|27|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240722103544
OBX|28|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240722103544
OBX|29|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240722103544
OBX|30|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240722103544
OBX|31|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240722103544
OBX|32|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240722103544
OBX|33|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240722103544
OBX|34|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240722103544
OBX|35|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240722103544
OBX|36|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240722103544
OBX|37|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|38|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|39|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|40|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240722103544
OBX|41|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240722103544
OBX|42|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240722103544
OBX|43|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240722103544
OBX|44|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240722103544
OBX|45|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240722103544
OBX|46|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240722103544
OBX|47|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240722103544
OBX|48|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240722103544
OBX|49|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240722103544
OBX|50|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240722103544
OBX|51|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240722103544
OBX|52|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240722103544
OBX|53|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240722103544
OBX|54|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240722103544
OBX|55|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240722103544
OBX|56|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240722103544
OBX|57|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240722103544
OBX|58|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240722103544
OBX|59|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722103544
OBX|60|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240722103544
OBX|61|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240722103544
OBX|62|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240722103544
OBX|63|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240722103544
OBX|64|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722103544
OBX|65|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722103544
OBX|66|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240722103544
OBX|67|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240722103544
OBX|68|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240722103544
OBX|69|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240722103544
OBX|70|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240722103544
OBX|71|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240722103544
OBX|72|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240722103544
OBX|73|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240722103544
OBX|74|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240722103544
OBX|75|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240722103544
OBX|76|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240722103544
OBX|77|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|78|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|79|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240722103544
OBX|80|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|81|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|82|NM|29575-8^Thyrotropin^LN|1|34.00|mIU/L|<29|H|||F|||20240722103544
OBX|83|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240722103544
OBX|84|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240722103544
OBX|85|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240722103544
OBX|86|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|87|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|88|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240722103544
OBX|89|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240722103544
OBX|90|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240722103544
OBX|91|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|92|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|93|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240722103544
OBX|94|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|95|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|96|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240722103544
OBX|97|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|98|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|99|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240722103544
OBX|100|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|101|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|102|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240722103544
OBX|103|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|104|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240722103544
OBX|105|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|106|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240722103544
OBX|107|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240722103544
+MSH|^~\&|SISGDSP|CDPH|EPIC|R508|20240722103544||ORU^R01|243747672|D|2.5.1
PID|1||80008765^^^&NPI||CDPHTWENTYFIVE^BOY  MOM||202308101318|M||2131-1^Other Race||||||||||||2135-2^Hispanic or Latino||Y|2
NK1|1|CDPHTWENTYFIVE^MOM|MTH^Mother|125 STREET^^SAN DIEGO^CA^92126^USA|^^^^^619^6363636
ORC|RE|189556932^HospOrdNumber||7251234856^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI|||||||||UC SAN DIEGO MEDICAL CENTER^^^^^^^^^R508|5421TS HT61, SR ET^^SAN DIEGO^CA^99999-9999
OBR|1|189556932^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407171226|||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI||||||20240722103544|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240722103544
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240722103544
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240722103544
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|99717-3^Hypothyroidism^L|||N|||F|||20240722103544
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240722103544
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Primary Congenital Hypothyroidism: Additional testing in consultation with a CCS-approved Endocrine Center or Pediatric Endocrinologist is strongly recommended. Call your Newborn Screening Coordinator for assistance. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at Rady Children's Hospital San Diego at (115) 118-8708. \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240722103544
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240722103544
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240722103544
OBX|9|NM|8339-4^Birthweight^LN|1|3629|grams||N|||F|||20240722103544
OBX|10|TM|57715-5^Time of birth^LN|1|1318|||N|||F|||20240722103544
OBX|11|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12412-5^Twins^LN|||N|||F|||20240722103544
OBX|12|NM|73806-2^Newborn age in hours^LN|1|341|day(s)||N|||F|||20240722103544
OBX|13|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240722103544
OBX|14|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240722103544
OBX|15|TX|62324-9^Post-discharge provider name^LN|1|STEPHEN HEBERT|||N|||F|||20240722103544
OBX|16|TX|62325-6^Post-discharge provider practice ID^LN|1|1730127069|||N|||F|||20240722103544
OBX|17|TX|62327-2^Post-discharge provider practice address^LN|1|5421TS HT61, SR ET SAN DIEGO CA 99999-9999 USA|||N|||F|||20240722103544
OBX|18|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722103544
OBX|19|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240722103544
OBX|20|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722103544
OBX|21|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240722103544
OBX|22|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240722103544
OBX|23|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240722103544
OBX|24|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240722103544
OBX|25|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240722103544
OBX|26|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240722103544
OBX|27|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240722103544
OBX|28|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240722103544
OBX|29|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240722103544
OBX|30|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240722103544
OBX|31|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240722103544
OBX|32|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240722103544
OBX|33|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240722103544
OBX|34|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240722103544
OBX|35|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240722103544
OBX|36|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|37|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|38|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|39|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240722103544
OBX|40|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240722103544
OBX|41|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240722103544
OBX|42|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240722103544
OBX|43|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240722103544
OBX|44|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240722103544
OBX|45|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240722103544
OBX|46|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240722103544
OBX|47|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240722103544
OBX|48|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240722103544
OBX|49|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240722103544
OBX|50|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240722103544
OBX|51|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240722103544
OBX|52|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240722103544
OBX|53|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240722103544
OBX|54|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240722103544
OBX|55|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240722103544
OBX|56|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240722103544
OBX|57|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240722103544
OBX|58|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722103544
OBX|59|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240722103544
OBX|60|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240722103544
OBX|61|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240722103544
OBX|62|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240722103544
OBX|63|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722103544
OBX|64|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722103544
OBX|65|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240722103544
OBX|66|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240722103544
OBX|67|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240722103544
OBX|68|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240722103544
OBX|69|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240722103544
OBX|70|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240722103544
OBX|71|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240722103544
OBX|72|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240722103544
OBX|73|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240722103544
OBX|74|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240722103544
OBX|75|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240722103544
OBX|76|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|77|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|78|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240722103544
OBX|79|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|80|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|81|NM|29575-8^Thyrotropin^LN|1|34.00|mIU/L|<29|H|||F|||20240722103544
OBX|82|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240722103544
OBX|83|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240722103544
OBX|84|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240722103544
OBX|85|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|86|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|87|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240722103544
OBX|88|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240722103544
OBX|89|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240722103544
OBX|90|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|91|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|92|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240722103544
OBX|93|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|94|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|95|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240722103544
OBX|96|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|97|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|98|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240722103544
OBX|99|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|100|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722103544
OBX|101|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240722103544
OBX|102|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|103|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240722103544
OBX|104|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240722103544
OBX|105|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240722103544
OBX|106|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240722103544
diff --git a/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_1_hl7_translation.fhir b/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_1_hl7_translation.fhir
new file mode 100644
index 000000000..fade85488
--- /dev/null
+++ b/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_1_hl7_translation.fhir
@@ -0,0 +1,15470 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729291295299574000.a2c1571d-8ca1-4a1b-aa63-134ee2bfdce1",
+  "meta": {
+    "lastUpdated": "2024-10-18T15:41:35.299-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "243747677"
+  },
+  "type": "message",
+  "timestamp": "2024-07-22T01:02:05.000-07:00",
+  "entry": [
+    {
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+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729291295302140000.d2861530-097d-414a-983a-7f0443ca3fec",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240722010205"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "11903029"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "L,M,N"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
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+            "name": "SISHIERECEIVER",
+            "receiver": {
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+              "valueString": "SISGDSP"
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+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "name": "SISGDSP",
+          "_endpoint": {
+            "extension": [
+              {
+                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                "valueCode": "unknown"
+              }
+            ]
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+                "valueString": "HD.1"
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+            "valueString": "MSH.6"
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+          {
+            "reference": "DiagnosticReport/1729291295620036000.34956397-3f7b-4003-a779-737989831100"
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+          {
+            "reference": "DiagnosticReport/1729291295621563000.1d424ad4-820a-4d4e-b126-f03e5bebbc7f"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295623087000.49857adb-fc9a-4320-9890-32be1492f1a5"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295624579000.6769fc61-08a7-4ee2-9462-b6ddd5aa0c47"
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+          {
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+          },
+          {
+            "reference": "DiagnosticReport/1729291295630709000.7bd76dd8-3d8b-4fc1-975f-ebc5a8e350ad"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295632237000.e4031dbf-75f9-4355-bc2d-ae271c594726"
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+          {
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+        "recorded": "2024-07-22T01:02:05Z",
+        "activity": {
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+        "agent": [
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+            "type": {
+              "coding": [
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+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
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+              ]
+            },
+            "who": {
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+            }
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+      }
+    },
+    {
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+      "resource": {
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+        "id": "1729291295304349000.fcf6e34e-cb7d-4d92-b636-085ca210f66b",
+        "identifier": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
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+            "value": "SISGDSP"
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+        ]
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+    },
+    {
+      "fullUrl": "Provenance/1729291295305403000.268a5701-4d61-473a-9b8d-4ad9781b7fb0",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729291295305403000.268a5701-4d61-473a-9b8d-4ad9781b7fb0",
+        "recorded": "2024-10-18T15:41:35Z",
+        "policy": [
+          "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
+        ],
+        "activity": {
+          "coding": [
+            {
+              "code": "v2-FHIR transformation"
+            }
+          ]
+        },
+        "agent": [
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+            "type": {
+              "coding": [
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+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
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+    {
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+        "id": "1729291295305253000.c2e7d744-2e7a-4b83-a361-79d309134d26",
+        "identifier": [
+          {
+            "value": "CDC PRIME - Atlanta"
+          },
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+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
+                }
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+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.237821"
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+      "resource": {
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+        "id": "1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf",
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
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+                "url": "PID.8",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
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+                      "code": "M"
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+              {
+                "url": "PID.24",
+                "valueString": "Y"
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+          },
+          {
+            "url": "http://ibm.com/fhir/cdm/StructureDefinition/local-race-cd",
+            "valueCodeableConcept": {
+              "coding": [
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+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2131-1",
+                  "display": "Other Race"
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+              ]
+            }
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ethnic-group",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
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+                  ],
+                  "code": "2135-2",
+                  "display": "Hispanic or Latino"
+                }
+              ]
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+        ],
+        "identifier": [
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+            "extension": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
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+            "value": "80008766",
+            "assigner": {
+              "reference": "Organization/1729291295306247000.fd765a5a-f50d-46e3-b09f-7740b21ba4d0"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "BOY B MOM"
+                  },
+                  {
+                    "url": "XPN.7",
+                    "valueString": "B"
+                  }
+                ]
+              }
+            ],
+            "use": "official",
+            "family": "CDPHTWENTYFIVE",
+            "given": [
+              "BOY B MOM"
+            ]
+          }
+        ],
+        "gender": "male",
+        "birthDate": "2023-08-10",
+        "_birthDate": {
+          "extension": [
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+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202308101318"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2023-08-10T13:18:00Z"
+            }
+          ]
+        },
+        "multipleBirthInteger": 1,
+        "contact": [
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+            "extension": [
+              {
+                "url": "https://hl7.org/fhir/StructureDefinition/relationship",
+                "valueCodeableConcept": {
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+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        }
+                      ],
+                      "code": "MTH",
+                      "display": "Mother"
+                    }
+                  ]
+                }
+              }
+            ],
+            "name": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                  "extension": [
+                    {
+                      "url": "XPN.2",
+                      "valueString": "MOM"
+                    }
+                  ]
+                }
+              ],
+              "family": "CDPHTWENTYFIVE",
+              "given": [
+                "MOM"
+              ]
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291295306247000.fd765a5a-f50d-46e3-b09f-7740b21ba4d0",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729291295306247000.fd765a5a-f50d-46e3-b09f-7740b21ba4d0",
+        "identifier": [
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+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
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+            "type": {
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+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
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+            "value": "NPI"
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+        ]
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+    },
+    {
+      "fullUrl": "Provenance/1729291295312529000.a31d87a5-ad0b-45c2-af0b-e605ea2e474c",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729291295312529000.a31d87a5-ad0b-45c2-af0b-e605ea2e474c",
+        "target": [
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+            "reference": "Patient/1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf"
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+        ],
+        "recorded": "2024-10-18T15:41:35Z",
+        "activity": {
+          "coding": [
+            {
+              "system": "https://terminology.hl7.org/CodeSystem/v3-DataOperation",
+              "code": "UPDATE"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "RelatedPerson/1729291295314670000.548ec0b3-0d68-405c-9853-dadc50cbb26c",
+      "resource": {
+        "resourceType": "RelatedPerson",
+        "id": "1729291295314670000.548ec0b3-0d68-405c-9853-dadc50cbb26c",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "NK1"
+          }
+        ],
+        "patient": {
+          "reference": "Patient/1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf"
+        },
+        "relationship": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "NK1.3"
+              }
+            ],
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "MTH",
+                "display": "Mother"
+              }
+            ]
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "NK1.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "MOM"
+                  }
+                ]
+              }
+            ],
+            "family": "CDPHTWENTYFIVE",
+            "given": [
+              "MOM"
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729291295331983000.73720fe7-057e-4c8c-89b7-2feadb847f8c",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729291295331983000.73720fe7-057e-4c8c-89b7-2feadb847f8c",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
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+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7261235086"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729291295591674000.731b02ba-8300-4c51-9f28-c293bf3e5a37"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                }
+              ],
+              "code": "92005-8",
+              "display": "Spinal muscular atrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf"
+        },
+        "effectiveDateTime": "2024-07-17T12:28:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407171228"
+            }
+          ]
+        },
+        "issued": "2024-07-22T01:02:05Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240722010205"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291295489432000.4c5aba00-3ae3-458d-ab7c-051e28ac9923"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729291295471836000.67bf5e1c-4097-41b3-bafc-0eb224265d97"
+          },
+          {
+            "reference": "Observation/1729291295473039000.3e38e192-72c1-414a-b2a8-0218fa787c00"
+          },
+          {
+            "reference": "Observation/1729291295474097000.12a74700-76ef-445d-9d3d-b5041e441209"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729291295635009000.fd242864-d2b3-4610-8a96-bdf46067a3ca",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729291295635009000.fd242864-d2b3-4610-8a96-bdf46067a3ca",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7261235086"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729291295596127000.a7216c88-0a78-467f-8eb3-ca8ca24fe982"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-28",
+              "display": "Adrenoleukodystrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf"
+        },
+        "effectiveDateTime": "2024-07-17T12:28:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407171228"
+            }
+          ]
+        },
+        "issued": "2024-07-22T01:02:05Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240722010205"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291295489815000.0370cf6e-836b-4bb2-a0a2-0d64f2e0a6a3"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729291295475278000.407afb37-39ec-400f-b6a2-40422f4ce0f6"
+          },
+          {
+            "reference": "Observation/1729291295476328000.e4ef28b1-0f1d-4fe5-93c4-242ec094e7a2"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729291295637863000.850a5878-c7fd-4b0d-9cb1-12098c317dd4",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729291295637863000.850a5878-c7fd-4b0d-9cb1-12098c317dd4",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7261235086"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729291295600584000.2340cce5-3422-48fc-9e73-1ff06e437756"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-29",
+              "display": "Adrenoleukodystrophy Tier-1 newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf"
+        },
+        "effectiveDateTime": "2024-07-17T12:28:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407171228"
+            }
+          ]
+        },
+        "issued": "2024-07-22T01:02:05Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240722010205"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291295490210000.56b183e3-5b61-4de5-ad73-84d15c8a55c3"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729291295477503000.1a0211e0-1e7e-45d4-aedb-fcbf6f2610a5"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_2_fhir_transformation.fhir b/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_2_fhir_transformation.fhir
new file mode 100644
index 000000000..9c08d7231
--- /dev/null
+++ b/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_2_fhir_transformation.fhir
@@ -0,0 +1,12393 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729291295299574000.a2c1571d-8ca1-4a1b-aa63-134ee2bfdce1",
+  "meta": {
+    "lastUpdated": "2024-10-18T15:41:35.299-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "243747677"
+  },
+  "type": "message",
+  "timestamp": "2024-07-22T01:02:05.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729291295302140000.d2861530-097d-414a-983a-7f0443ca3fec",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729291295302140000.d2861530-097d-414a-983a-7f0443ca3fec",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240722010205"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "EPIC",
+            "receiver": {
+              "reference": "Organization/1729291295301945000.5ed62576-5ece-47b7-bfce-cd29b7b71499"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729291295301181000.5fbf4ba9-afb0-431e-bc42-d5e3bd798c06"
+        },
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+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "SISGDSP"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "name": "SISGDSP",
+          "_endpoint": {
+            "extension": [
+              {
+                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                "valueCode": "unknown"
+              }
+            ]
+          }
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291295301181000.5fbf4ba9-afb0-431e-bc42-d5e3bd798c06",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729291295301181000.5fbf4ba9-afb0-431e-bc42-d5e3bd798c06",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "CDPH"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291295301945000.5ed62576-5ece-47b7-bfce-cd29b7b71499",
+      "resource": {
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+        "id": "1729291295301945000.5ed62576-5ece-47b7-bfce-cd29b7b71499",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "R508"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729291295304544000.5dfda4f2-3e74-4648-bb87-def9ccbb033b",
+      "resource": {
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+        "id": "1729291295304544000.5dfda4f2-3e74-4648-bb87-def9ccbb033b",
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+          },
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+          },
+          {
+            "reference": "DiagnosticReport/1729291295607769000.5ac12326-2d6c-4b50-b947-e3529f1559fd"
+          },
+          {
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+          },
+          {
+            "reference": "DiagnosticReport/1729291295616953000.4cc4e97e-eb3b-45e2-a1d5-8feab4a4fc05"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295618494000.f29249de-1334-45a3-9a31-ae7fe6ba6c85"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295620036000.34956397-3f7b-4003-a779-737989831100"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295621563000.1d424ad4-820a-4d4e-b126-f03e5bebbc7f"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295623087000.49857adb-fc9a-4320-9890-32be1492f1a5"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295624579000.6769fc61-08a7-4ee2-9462-b6ddd5aa0c47"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295626106000.b3d89cab-24d4-4950-8c98-82f9efd1687a"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295627640000.6572e5bf-1b74-4397-990f-e7de6379d265"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295629177000.a15d563a-f686-437b-832c-b31a1a7294f0"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295630709000.7bd76dd8-3d8b-4fc1-975f-ebc5a8e350ad"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295632237000.e4031dbf-75f9-4355-bc2d-ae271c594726"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295635009000.fd242864-d2b3-4610-8a96-bdf46067a3ca"
+          },
+          {
+            "reference": "DiagnosticReport/1729291295637863000.850a5878-c7fd-4b0d-9cb1-12098c317dd4"
+          }
+        ],
+        "recorded": "2024-07-22T01:02:05Z",
+        "activity": {
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+              "display": "ORU^R01^ORU_R01"
+            }
+          ]
+        },
+        "agent": [
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+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729291295304349000.fcf6e34e-cb7d-4d92-b636-085ca210f66b"
+            }
+          }
+        ]
+      }
+    },
+    {
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+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729291295304349000.fcf6e34e-cb7d-4d92-b636-085ca210f66b",
+        "identifier": [
+          {
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+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "SISGDSP"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729291295305403000.268a5701-4d61-473a-9b8d-4ad9781b7fb0",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729291295305403000.268a5701-4d61-473a-9b8d-4ad9781b7fb0",
+        "recorded": "2024-10-18T15:41:35Z",
+        "policy": [
+          "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
+        ],
+        "activity": {
+          "coding": [
+            {
+              "code": "v2-FHIR transformation"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "assembler"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729291295305253000.c2e7d744-2e7a-4b83-a361-79d309134d26"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729291295305253000.c2e7d744-2e7a-4b83-a361-79d309134d26",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729291295305253000.c2e7d744-2e7a-4b83-a361-79d309134d26",
+        "identifier": [
+          {
+            "value": "CDC PRIME - Atlanta"
+          },
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.237821"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        }
+                      ],
+                      "code": "M"
+                    }
+                  ]
+                }
+              },
+              {
+                "url": "PID.24",
+                "valueString": "Y"
+              }
+            ]
+          },
+          {
+            "url": "http://ibm.com/fhir/cdm/StructureDefinition/local-race-cd",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2131-1",
+                  "display": "Other Race"
+                }
+              ]
+            }
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ethnic-group",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2135-2",
+                  "display": "Hispanic or Latino"
+                }
+              ]
+            }
+          }
+        ],
+        "identifier": [
+          {
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+            "reference": "Observation/1729291295420161000.c719672f-d678-4b46-80eb-de8fb311fa7d"
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+          {
+            "reference": "Observation/1729291295427049000.d853faf8-7739-49fc-a667-fd5e37355ceb"
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+          {
+            "reference": "Observation/1729291295428246000.c98166e3-6c07-48bb-a065-3c5e2295c51a"
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+          {
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+            "reference": "Observation/1729291295450729000.2ccd2a4f-439a-4df1-9d73-f16f64ec1779"
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+            "reference": "Observation/1729291295451797000.8ff78ff0-d974-4475-9e0b-5dbb8e3433d4"
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+            "reference": "Observation/1729291295458253000.714268ab-2835-4289-bbda-8407e24bcb68"
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+          {
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+          {
+            "reference": "Observation/1729291295460505000.dab16457-0f12-4671-b82f-7833286ab078"
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+            "reference": "Observation/1729291295461677000.6e242383-de8f-4ec9-9fb0-7e04c292c981"
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+          {
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+          {
+            "reference": "Observation/1729291295467345000.3fc97b94-ce1d-4787-9f7f-2fab41ded530"
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+          {
+            "reference": "Observation/1729291295468512000.dc5c5c51-c03c-404b-92d8-f1ac41491070"
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+          {
+            "reference": "Observation/1729291295469711000.04c095cb-1049-4988-84ec-bf0e7627dac0"
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+          {
+            "reference": "Observation/1729291295470757000.c19a078d-afaf-487a-90a8-393e68ea5a9b"
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+          {
+            "reference": "Observation/1729291295471836000.67bf5e1c-4097-41b3-bafc-0eb224265d97"
+          },
+          {
+            "reference": "Observation/1729291295473039000.3e38e192-72c1-414a-b2a8-0218fa787c00"
+          },
+          {
+            "reference": "Observation/1729291295474097000.12a74700-76ef-445d-9d3d-b5041e441209"
+          },
+          {
+            "reference": "Observation/1729291295475278000.407afb37-39ec-400f-b6a2-40422f4ce0f6"
+          },
+          {
+            "reference": "Observation/1729291295476328000.e4ef28b1-0f1d-4fe5-93c4-242ec094e7a2"
+          },
+          {
+            "reference": "Observation/1729291295477503000.1a0211e0-1e7e-45d4-aedb-fcbf6f2610a5"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_3_hl7_translation_final.hl7 b/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_3_hl7_translation_final.hl7
index f8d572df1..060742356 100644
--- a/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_3_hl7_translation_final.hl7
+++ b/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_3_hl7_translation_final.hl7
@@ -1 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R508|20240722010205||ORU^R01|243747677|T|2.5.1
PID|1||80008766||CDPHTWENTYFIVE^BOY B MOM||202308101318|M||2131-1^Other Race||||||||||||2135-2^Hispanic or Latino||Y|1
NK1|1|CDPHTWENTYFIVE^MOM|MTH^Mother
ORC|RE|189417053^HospOrdNumber||7261235086^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI|||||||||^^^^^^^^^R508|5421TS HT61, SR ET^^SAN DIEGO^CA^99999-9999
OBR|1|189417053^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^LN^CDPHGSPEAP|||202407171228|||||||||^HUBBARD^EUSTRATIA||||||20240722010205|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240722010205
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240722010205
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA12428-1^All screening is in range for the conditions tested^LN|||N|||F|||20240722010205
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240722010205
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240722010205
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240722010205
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240722010205
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240722010205
OBX|9|NM|8339-4^Birthweight^LN|1|2722|grams||N|||F|||20240722010205
OBX|10|TM|57715-5^Time of birth^LN|1|1318|||N|||F|||20240722010205
OBX|11|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240722010205
OBX|12|NM|73806-2^Newborn age in hours^LN|1|341|day(s)||N|||F|||20240722010205
OBX|13|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240722010205
OBX|14|CE|67704-7^Feeding types^LN|1|LA16915-3^Lactose formula^LN|||N|||F|||20240722010205
OBX|15|TX|^^^99717-5^Accession Number^L|1|200-49-846/21-2024-21|||N|||F|||20240722010205
OBX|16|TX|62324-9^Post-discharge provider name^LN|1|STEPHEN HEBERT|||N|||F|||20240722010205
OBX|17|TX|62327-2^Post-discharge provider practice address^LN|1|5421TS HT61, SR ET SAN DIEGO CA 99999-9999 USA|||N|||F|||20240722010205
OBX|18|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722010205
OBX|19|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240722010205
OBX|20|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722010205
OBX|21|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240722010205
OBX|22|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240722010205
OBX|23|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240722010205
OBX|24|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240722010205
OBX|25|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240722010205
OBX|26|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240722010205
OBX|27|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240722010205
OBX|28|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240722010205
OBX|29|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240722010205
OBX|30|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240722010205
OBX|31|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240722010205
OBX|32|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240722010205
OBX|33|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240722010205
OBX|34|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240722010205
OBX|35|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240722010205
OBX|36|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|37|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|38|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|39|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240722010205
OBX|40|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240722010205
OBX|41|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240722010205
OBX|42|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240722010205
OBX|43|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240722010205
OBX|44|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240722010205
OBX|45|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240722010205
OBX|46|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240722010205
OBX|47|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240722010205
OBX|48|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240722010205
OBX|49|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240722010205
OBX|50|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240722010205
OBX|51|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240722010205
OBX|52|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240722010205
OBX|53|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240722010205
OBX|54|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240722010205
OBX|55|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240722010205
OBX|56|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240722010205
OBX|57|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240722010205
OBX|58|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722010205
OBX|59|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240722010205
OBX|60|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240722010205
OBX|61|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240722010205
OBX|62|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240722010205
OBX|63|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722010205
OBX|64|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722010205
OBX|65|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240722010205
OBX|66|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240722010205
OBX|67|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240722010205
OBX|68|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240722010205
OBX|69|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240722010205
OBX|70|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240722010205
OBX|71|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240722010205
OBX|72|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240722010205
OBX|73|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240722010205
OBX|74|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240722010205
OBX|75|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240722010205
OBX|76|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|77|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|78|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240722010205
OBX|79|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|80|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|81|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240722010205
OBX|82|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|83|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|84|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240722010205
OBX|85|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|86|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|87|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240722010205
OBX|88|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240722010205
OBX|89|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240722010205
OBX|90|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|91|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|92|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240722010205
OBX|93|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|94|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|95|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240722010205
OBX|96|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|97|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|98|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240722010205
OBX|99|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|100|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|101|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240722010205
OBX|102|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|103|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240722010205
OBX|104|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|105|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240722010205
OBX|106|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240722010205
+MSH|^~\&|SISGDSP|CDPH|EPIC|R508|20240722010205||ORU^R01|243747677|D|2.5.1
PID|1||80008766||CDPHTWENTYFIVE^BOY B MOM||202308101318|M||2131-1^Other Race||||||||||||2135-2^Hispanic or Latino||Y|1
NK1|1|CDPHTWENTYFIVE^MOM|MTH^Mother
ORC|RE|189417053^HospOrdNumber||7261235086^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI|||||||||^^^^^^^^^R508|5421TS HT61, SR ET^^SAN DIEGO^CA^99999-9999
OBR|1|189417053^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407171228|||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI||||||20240722010205|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240722010205
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240722010205
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA12428-1^All screening is in range for the conditions tested^LN|||N|||F|||20240722010205
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240722010205
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240722010205
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240722010205
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240722010205
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240722010205
OBX|9|NM|8339-4^Birthweight^LN|1|2722|grams||N|||F|||20240722010205
OBX|10|TM|57715-5^Time of birth^LN|1|1318|||N|||F|||20240722010205
OBX|11|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240722010205
OBX|12|NM|73806-2^Newborn age in hours^LN|1|341|day(s)||N|||F|||20240722010205
OBX|13|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240722010205
OBX|14|CE|67704-7^Feeding types^LN|1|LA16915-3^Lactose formula^LN|||N|||F|||20240722010205
OBX|15|TX|62324-9^Post-discharge provider name^LN|1|STEPHEN HEBERT|||N|||F|||20240722010205
OBX|16|TX|62327-2^Post-discharge provider practice address^LN|1|5421TS HT61, SR ET SAN DIEGO CA 99999-9999 USA|||N|||F|||20240722010205
OBX|17|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722010205
OBX|18|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240722010205
OBX|19|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722010205
OBX|20|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240722010205
OBX|21|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240722010205
OBX|22|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240722010205
OBX|23|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240722010205
OBX|24|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240722010205
OBX|25|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240722010205
OBX|26|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240722010205
OBX|27|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240722010205
OBX|28|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240722010205
OBX|29|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240722010205
OBX|30|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240722010205
OBX|31|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240722010205
OBX|32|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240722010205
OBX|33|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240722010205
OBX|34|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240722010205
OBX|35|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|36|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|37|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|38|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240722010205
OBX|39|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240722010205
OBX|40|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240722010205
OBX|41|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240722010205
OBX|42|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240722010205
OBX|43|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240722010205
OBX|44|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240722010205
OBX|45|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240722010205
OBX|46|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240722010205
OBX|47|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240722010205
OBX|48|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240722010205
OBX|49|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240722010205
OBX|50|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240722010205
OBX|51|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240722010205
OBX|52|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240722010205
OBX|53|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240722010205
OBX|54|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240722010205
OBX|55|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240722010205
OBX|56|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240722010205
OBX|57|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722010205
OBX|58|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240722010205
OBX|59|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240722010205
OBX|60|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240722010205
OBX|61|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240722010205
OBX|62|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722010205
OBX|63|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722010205
OBX|64|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240722010205
OBX|65|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240722010205
OBX|66|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240722010205
OBX|67|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240722010205
OBX|68|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240722010205
OBX|69|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240722010205
OBX|70|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240722010205
OBX|71|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240722010205
OBX|72|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240722010205
OBX|73|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240722010205
OBX|74|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240722010205
OBX|75|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|76|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|77|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240722010205
OBX|78|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|79|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|80|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240722010205
OBX|81|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|82|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|83|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240722010205
OBX|84|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|85|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|86|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240722010205
OBX|87|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240722010205
OBX|88|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240722010205
OBX|89|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|90|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|91|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240722010205
OBX|92|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|93|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|94|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240722010205
OBX|95|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|96|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|97|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240722010205
OBX|98|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|99|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722010205
OBX|100|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240722010205
OBX|101|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|102|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240722010205
OBX|103|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240722010205
OBX|104|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240722010205
OBX|105|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240722010205
diff --git a/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_1_hl7_translation.fhir b/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_1_hl7_translation.fhir
new file mode 100644
index 000000000..6de8cf898
--- /dev/null
+++ b/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_1_hl7_translation.fhir
@@ -0,0 +1,15470 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729292473762840000.6a08be9a-72cb-4fd5-b005-065ec4c7366f",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:01:13.763-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "243747680"
+  },
+  "type": "message",
+  "timestamp": "2024-07-22T02:17:21.000-07:00",
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+        "valueString": "ACTION REQUIRED\\.br\\\\.br\\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB ~EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\\.br\\\\.br\\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\\.br\\\\.br\\Lab Director - Genetic Disease Laboratory, (510) 231-1790\\.br\\\\.br\\Duplicate\\.br\\\\.br\\Follow-up:\\.br\\\\.br\\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \\.br\\\\.br\\SCID: A liquid blood specimen for CBC differential and flow cytometry at Quest Diagnostics is required to rule out or confirm SCID or a related immune disorder. \\.br\\\\.br\\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \\.br\\\\.br\\Methods and Limitations:\\.br\\\\.br\\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \\.br\\Attention Healthcare Provider:\\.br\\\\.br\\\\.br\\",
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+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7271235330"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729292474133849000.5ad51fed-3bbf-4fed-a07c-5ab1c30f1e26"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-28",
+              "display": "Adrenoleukodystrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292473794302000.9afff3b5-208d-4f55-b18a-3b00dd8de1d0"
+        },
+        "effectiveDateTime": "2024-07-17T12:29:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407171229"
+            }
+          ]
+        },
+        "issued": "2024-07-22T02:17:21Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240722021721"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729292474017857000.21ef05dd-9fbf-4e11-bfc2-4e7bf3e61d24"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729292474001860000.3a02ff9e-185e-41f7-be39-c278a791fca2"
+          },
+          {
+            "reference": "Observation/1729292474002918000.67e3097d-8b89-4a3b-b190-ecf01bff1b4d"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729292474183807000.0d6bb849-a322-4dc4-b91e-f855afeaed69",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729292474183807000.0d6bb849-a322-4dc4-b91e-f855afeaed69",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7271235330"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729292474141599000.59dd6339-47e3-4662-9dbf-4afc9aec8b22"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-29",
+              "display": "Adrenoleukodystrophy Tier-1 newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292473794302000.9afff3b5-208d-4f55-b18a-3b00dd8de1d0"
+        },
+        "effectiveDateTime": "2024-07-17T12:29:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407171229"
+            }
+          ]
+        },
+        "issued": "2024-07-22T02:17:21Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240722021721"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729292474018262000.12b6c8bb-68e4-469b-a86e-d5d036e45072"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729292474004144000.e38367ac-f46b-44e4-b80f-7572c217cbdb"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_2_fhir_transformation.fhir b/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_2_fhir_transformation.fhir
new file mode 100644
index 000000000..660172880
--- /dev/null
+++ b/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_2_fhir_transformation.fhir
@@ -0,0 +1,12393 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729292473762840000.6a08be9a-72cb-4fd5-b005-065ec4c7366f",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:01:13.763-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "243747680"
+  },
+  "type": "message",
+  "timestamp": "2024-07-22T02:17:21.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729292473773890000.8d49428f-6963-4991-9abd-a148adecd18e",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729292473773890000.8d49428f-6963-4991-9abd-a148adecd18e",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240722021721"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "EPIC",
+            "receiver": {
+              "reference": "Organization/1729292473773794000.4c58f585-7a46-484b-9027-88a97fe0ca32"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729292473772093000.af9803b7-868e-4827-813a-066e34c3078a"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "SISGDSP"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "name": "SISGDSP",
+          "_endpoint": {
+            "extension": [
+              {
+                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                "valueCode": "unknown"
+              }
+            ]
+          }
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292473772093000.af9803b7-868e-4827-813a-066e34c3078a",
+      "resource": {
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+        "id": "1729292473772093000.af9803b7-868e-4827-813a-066e34c3078a",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
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+            ],
+            "value": "CDPH"
+          }
+        ]
+      }
+    },
+    {
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+      "resource": {
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+        "id": "1729292473773794000.4c58f585-7a46-484b-9027-88a97fe0ca32",
+        "extension": [
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
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+        "identifier": [
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+            "extension": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "R797"
+          }
+        ]
+      }
+    },
+    {
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+          },
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+          },
+          {
+            "reference": "DiagnosticReport/1729292474149783000.615f4416-9739-42e0-8bbe-c1cee0fcbc9f"
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+          {
+            "reference": "DiagnosticReport/1729292474151308000.200ceb42-4de6-4cd5-99d8-0a28f7bca30e"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474153789000.5462c83e-6f90-4a0d-a5a4-93ef664ecf30"
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+          {
+            "reference": "DiagnosticReport/1729292474155339000.77268524-b46b-4738-b3bb-902c01b18800"
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+            "reference": "DiagnosticReport/1729292474157849000.47099ed2-cc93-4af1-a2d4-60b64c2720be"
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+          {
+            "reference": "DiagnosticReport/1729292474159758000.4449fd30-f198-4e7e-a886-2de4241caa3e"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474161989000.dc0b8a7e-b53b-4398-8a26-ae9327a6a95f"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474163939000.71f065b1-1414-4e38-bddb-714bf248be8c"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474165636000.a1f5efee-2c71-4f0f-86f2-4acc5ddf41fc"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474167236000.53632a35-fa56-431a-a522-7325f6e2f12f"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474169125000.5fc55e28-f8c2-4f67-bf47-9da4217b1d56"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474170762000.b60c7ecd-aae3-4b6f-b5c3-2661a7172336"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474172390000.9495e3e8-3033-46d4-94d3-e76833659b93"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474174135000.17df9af5-0480-4091-96a9-7e5e1321eb84"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474175750000.ad5043f5-c453-4df6-bbaf-45d37627e541"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474177886000.c89858c7-3a83-40b5-8892-00fe4111d030"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474182248000.95f44946-ac3c-406c-b9fc-f014126f98c2"
+          },
+          {
+            "reference": "DiagnosticReport/1729292474183807000.0d6bb849-a322-4dc4-b91e-f855afeaed69"
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+        ],
+        "recorded": "2024-07-22T02:17:21Z",
+        "activity": {
+          "coding": [
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+              "display": "ORU^R01^ORU_R01"
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+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729292473781578000.832676ce-1975-43ca-9139-c823a002e23e"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292473781578000.832676ce-1975-43ca-9139-c823a002e23e",
+      "resource": {
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+        "id": "1729292473781578000.832676ce-1975-43ca-9139-c823a002e23e",
+        "identifier": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "SISGDSP"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729292473788167000.0642e67a-4627-4f99-b12f-aa15c6224d88",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729292473788167000.0642e67a-4627-4f99-b12f-aa15c6224d88",
+        "recorded": "2024-10-18T16:01:13Z",
+        "policy": [
+          "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
+        ],
+        "activity": {
+          "coding": [
+            {
+              "code": "v2-FHIR transformation"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "assembler"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729292473788084000.4361372b-883e-4bf7-a05a-b24154cc3b09"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292473788084000.4361372b-883e-4bf7-a05a-b24154cc3b09",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292473788084000.4361372b-883e-4bf7-a05a-b24154cc3b09",
+        "identifier": [
+          {
+            "value": "CDC PRIME - Atlanta"
+          },
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
+                }
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+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.237821"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729292473794302000.9afff3b5-208d-4f55-b18a-3b00dd8de1d0",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729292473794302000.9afff3b5-208d-4f55-b18a-3b00dd8de1d0",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        }
+                      ],
+                      "code": "M"
+                    }
+                  ]
+                }
+              },
+              {
+                "url": "PID.24",
+                "valueString": "Y"
+              }
+            ]
+          },
+          {
+            "url": "http://ibm.com/fhir/cdm/StructureDefinition/local-race-cd",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2076-8",
+                  "display": "Native Hawaiian or Other Pacific Islander"
+                }
+              ]
+            }
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ethnic-group",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    }
+                  ],
+                  "code": "2186-5",
+                  "display": "Not Hispanic or Latino"
+                }
+              ]
+            }
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "80008667",
+            "assigner": {
+              "reference": "Organization/1729292473789681000.136d17d2-f028-4d78-bbe6-043697561517"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "BOY A ARTICHOKE"
+                  },
+                  {
+                    "url": "XPN.7"
+                  }
+                ]
+              }
+            ],
+            "use": "official",
+            "family": "ADT",
+            "given": [
+              "BOY A ARTICHOKE"
+            ]
+          }
+        ],
+        "gender": "male",
+        "birthDate": "2023-05-25",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202305250959"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2023-05-25T09:59:00Z"
+            }
+          ]
+        },
+        "multipleBirthInteger": 1,
+        "contact": [
+          {
+            "extension": [
+              {
+                "url": "https://hl7.org/fhir/StructureDefinition/relationship",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        }
+                      ],
+                      "code": "MTH",
+                      "display": "Mother"
+                    }
+                  ]
+                }
+              }
+            ],
+            "name": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                  "extension": [
+                    {
+                      "url": "XPN.2",
+                      "valueString": "ARTICHOKE"
+                    }
+                  ]
+                }
+              ],
+              "family": "ADT",
+              "given": [
+                "ARTICHOKE"
+              ]
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292473789681000.136d17d2-f028-4d78-bbe6-043697561517",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292473789681000.136d17d2-f028-4d78-bbe6-043697561517",
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+            "reference": "Observation/1729292473976461000.cd2727f3-ef96-48b9-bcc2-5774263c4f26"
+          },
+          {
+            "reference": "Observation/1729292473977612000.73180e1f-585a-4a28-bb4d-086f6b1e8803"
+          },
+          {
+            "reference": "Observation/1729292473978814000.d8b22f42-b681-471f-ae45-4930d54f3094"
+          },
+          {
+            "reference": "Observation/1729292473979850000.d71b4989-c089-41a0-a7cb-c3781254474c"
+          },
+          {
+            "reference": "Observation/1729292473980912000.1c42c530-bc4b-4e4e-849c-be189a52c79b"
+          },
+          {
+            "reference": "Observation/1729292473982040000.60a6f01e-a323-409b-9daa-9d0087f70cc8"
+          },
+          {
+            "reference": "Observation/1729292473983098000.5c76581c-7468-41d8-bb77-9099badb1748"
+          },
+          {
+            "reference": "Observation/1729292473984650000.3262fe1d-3673-433a-8e4a-efa0c21d103f"
+          },
+          {
+            "reference": "Observation/1729292473985785000.285a6a23-6145-480b-bd42-763b438bedd5"
+          },
+          {
+            "reference": "Observation/1729292473987004000.1c18e347-c9c9-492b-9f0f-f5d9c04b1908"
+          },
+          {
+            "reference": "Observation/1729292473988248000.49ed0504-b9ac-48ae-b630-fa3c4b19931e"
+          },
+          {
+            "reference": "Observation/1729292473989282000.90c58069-d96b-45c1-a9ad-fc74a842b4a1"
+          },
+          {
+            "reference": "Observation/1729292473990443000.90d2b674-f452-4b54-9966-e54fb648b2ce"
+          },
+          {
+            "reference": "Observation/1729292473991673000.c096287c-a17c-4acb-8bc3-ede6230cf6f4"
+          },
+          {
+            "reference": "Observation/1729292473992711000.6285d440-016a-42ca-b5d6-0c9ed86ad92f"
+          },
+          {
+            "reference": "Observation/1729292473993976000.f24f3bbd-2f11-4623-a0c0-69aaacb7b1c1"
+          },
+          {
+            "reference": "Observation/1729292473995583000.bd8d1107-0501-442b-ad7c-7950d59cfad6"
+          },
+          {
+            "reference": "Observation/1729292473996896000.e43881e1-8f24-4fa7-bb61-d43a5f89cbf2"
+          },
+          {
+            "reference": "Observation/1729292473998097000.d146845b-de20-41d6-aba9-96d0fd39eaed"
+          },
+          {
+            "reference": "Observation/1729292473999289000.b5a193dc-d06d-4936-a1b7-6ae1ce06ede7"
+          },
+          {
+            "reference": "Observation/1729292474000617000.310d9447-d1a5-4a7c-8fe0-5673e69c86d0"
+          },
+          {
+            "reference": "Observation/1729292474001860000.3a02ff9e-185e-41f7-be39-c278a791fca2"
+          },
+          {
+            "reference": "Observation/1729292474002918000.67e3097d-8b89-4a3b-b190-ecf01bff1b4d"
+          },
+          {
+            "reference": "Observation/1729292474004144000.e38367ac-f46b-44e4-b80f-7572c217cbdb"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_3_hl7_translation_final.hl7 b/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_3_hl7_translation_final.hl7
index b5d22f1b0..cc307d5e5 100644
--- a/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_3_hl7_translation_final.hl7
+++ b/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_3_hl7_translation_final.hl7
@@ -1 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240722021721||ORU^R01|243747680|T|2.5.1
PID|1||80008667||ADT^BOY A ARTICHOKE||202305250959|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||Y|1
NK1|1|ADT^ARTICHOKE|MTH^Mother
ORC|RE|189394505^HospOrdNumber||7271235330^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI|||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
OBR|1|189394505^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^LN^CDPHGSPEAP|||202407171229|||||||||^HUBBARD^EUSTRATIA||||||20240722021721|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240722021721
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240722021721
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240722021721
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12566-8^SCID^LN|||N|||F|||20240722021721
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240722021721
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\SCID: A liquid blood specimen for CBC differential and flow cytometry at Quest Diagnostics is required to rule out or confirm SCID or a related immune disorder. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240722021721
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240722021721
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240722021721
OBX|9|NM|8339-4^Birthweight^LN|1|3175|grams||N|||F|||20240722021721
OBX|10|TM|57715-5^Time of birth^LN|1|0959|||N|||F|||20240722021721
OBX|11|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240722021721
OBX|12|NM|73806-2^Newborn age in hours^LN|1|419|day(s)||N|||F|||20240722021721
OBX|13|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240722021721
OBX|14|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240722021721
OBX|15|TX|^^^99717-5^Accession Number^L|1|200-85-428/21-2024-21|||N|||F|||20240722021721
OBX|16|TX|62324-9^Post-discharge provider name^LN|1|GENEEN GIN|||N|||F|||20240722021721
OBX|17|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240722021721
OBX|18|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722021721
OBX|19|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240722021721
OBX|20|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722021721
OBX|21|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240722021721
OBX|22|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240722021721
OBX|23|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240722021721
OBX|24|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240722021721
OBX|25|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240722021721
OBX|26|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240722021721
OBX|27|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240722021721
OBX|28|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240722021721
OBX|29|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240722021721
OBX|30|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240722021721
OBX|31|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240722021721
OBX|32|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240722021721
OBX|33|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240722021721
OBX|34|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240722021721
OBX|35|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240722021721
OBX|36|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|37|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|38|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|39|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240722021721
OBX|40|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240722021721
OBX|41|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240722021721
OBX|42|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240722021721
OBX|43|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240722021721
OBX|44|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240722021721
OBX|45|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240722021721
OBX|46|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240722021721
OBX|47|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240722021721
OBX|48|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240722021721
OBX|49|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240722021721
OBX|50|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240722021721
OBX|51|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240722021721
OBX|52|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240722021721
OBX|53|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240722021721
OBX|54|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240722021721
OBX|55|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240722021721
OBX|56|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240722021721
OBX|57|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240722021721
OBX|58|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722021721
OBX|59|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240722021721
OBX|60|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240722021721
OBX|61|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240722021721
OBX|62|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240722021721
OBX|63|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722021721
OBX|64|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722021721
OBX|65|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240722021721
OBX|66|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240722021721
OBX|67|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240722021721
OBX|68|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240722021721
OBX|69|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240722021721
OBX|70|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240722021721
OBX|71|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240722021721
OBX|72|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240722021721
OBX|73|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240722021721
OBX|74|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240722021721
OBX|75|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240722021721
OBX|76|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|77|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|78|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240722021721
OBX|79|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|80|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|81|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240722021721
OBX|82|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|83|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|84|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240722021721
OBX|85|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|86|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|87|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240722021721
OBX|88|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240722021721
OBX|89|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240722021721
OBX|90|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|91|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|92|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|2|copies/µL|>18|L|||F|||20240722021721
OBX|93|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240722021721
OBX|94|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240722021721
OBX|95|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240722021721
OBX|96|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|97|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|98|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240722021721
OBX|99|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|100|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|101|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240722021721
OBX|102|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|103|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240722021721
OBX|104|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|105|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240722021721
OBX|106|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240722021721
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240722021721||ORU^R01|243747680|D|2.5.1
PID|1||80008667||ADT^BOY A ARTICHOKE||202305250959|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||Y|1
NK1|1|ADT^ARTICHOKE|MTH^Mother
ORC|RE|189394505^HospOrdNumber||7271235330^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI|||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
OBR|1|189394505^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407171229|||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI||||||20240722021721|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240722021721
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240722021721
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240722021721
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12566-8^SCID^LN|||N|||F|||20240722021721
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240722021721
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\SCID: A liquid blood specimen for CBC differential and flow cytometry at Quest Diagnostics is required to rule out or confirm SCID or a related immune disorder. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240722021721
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240722021721
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240722021721
OBX|9|NM|8339-4^Birthweight^LN|1|3175|grams||N|||F|||20240722021721
OBX|10|TM|57715-5^Time of birth^LN|1|0959|||N|||F|||20240722021721
OBX|11|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240722021721
OBX|12|NM|73806-2^Newborn age in hours^LN|1|419|day(s)||N|||F|||20240722021721
OBX|13|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240722021721
OBX|14|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240722021721
OBX|15|TX|62324-9^Post-discharge provider name^LN|1|GENEEN GIN|||N|||F|||20240722021721
OBX|16|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240722021721
OBX|17|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722021721
OBX|18|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240722021721
OBX|19|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240722021721
OBX|20|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240722021721
OBX|21|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240722021721
OBX|22|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240722021721
OBX|23|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240722021721
OBX|24|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240722021721
OBX|25|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240722021721
OBX|26|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240722021721
OBX|27|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240722021721
OBX|28|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240722021721
OBX|29|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240722021721
OBX|30|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240722021721
OBX|31|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240722021721
OBX|32|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240722021721
OBX|33|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240722021721
OBX|34|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240722021721
OBX|35|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|36|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|37|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|38|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240722021721
OBX|39|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240722021721
OBX|40|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240722021721
OBX|41|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240722021721
OBX|42|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240722021721
OBX|43|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240722021721
OBX|44|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240722021721
OBX|45|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240722021721
OBX|46|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240722021721
OBX|47|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240722021721
OBX|48|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240722021721
OBX|49|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240722021721
OBX|50|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240722021721
OBX|51|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240722021721
OBX|52|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240722021721
OBX|53|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240722021721
OBX|54|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240722021721
OBX|55|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240722021721
OBX|56|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240722021721
OBX|57|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722021721
OBX|58|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240722021721
OBX|59|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240722021721
OBX|60|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240722021721
OBX|61|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240722021721
OBX|62|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722021721
OBX|63|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240722021721
OBX|64|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240722021721
OBX|65|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240722021721
OBX|66|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240722021721
OBX|67|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240722021721
OBX|68|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240722021721
OBX|69|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240722021721
OBX|70|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240722021721
OBX|71|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240722021721
OBX|72|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240722021721
OBX|73|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240722021721
OBX|74|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240722021721
OBX|75|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|76|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|77|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240722021721
OBX|78|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|79|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|80|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240722021721
OBX|81|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|82|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|83|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240722021721
OBX|84|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|85|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|86|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240722021721
OBX|87|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240722021721
OBX|88|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|15.00|ERU|>10|N|||F|||20240722021721
OBX|89|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|90|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|91|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|2|copies/µL|>18|L|||F|||20240722021721
OBX|92|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240722021721
OBX|93|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240722021721
OBX|94|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240722021721
OBX|95|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|96|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|97|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240722021721
OBX|98|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|99|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240722021721
OBX|100|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240722021721
OBX|101|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|102|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240722021721
OBX|103|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240722021721
OBX|104|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240722021721
OBX|105|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240722021721
diff --git a/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_1_hl7_translation.fhir b/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_1_hl7_translation.fhir
new file mode 100644
index 000000000..2f01f2052
--- /dev/null
+++ b/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_1_hl7_translation.fhir
@@ -0,0 +1,15355 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729292585784729000.e5f6d5dd-cd3c-4cbc-84a4-89e7c80a6340",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:03:05.784-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "243747623"
+  },
+  "type": "message",
+  "timestamp": "2024-07-11T03:49:13.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729292585786249000.8c980a6f-9b04-4344-bd03-c2e26a056983",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729292585786249000.8c980a6f-9b04-4344-bd03-c2e26a056983",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240711034913"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "11903029"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "L,M,N"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "SISHIERECEIVER",
+            "receiver": {
+              "reference": "Organization/1729292585786088000.29d75606-bbd1-4683-8cc0-748ffc633afa"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729292585785509000.dd41e1db-00d4-4f55-ae20-aa8c2d66b816"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "SISGDSP"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "name": "SISGDSP",
+          "_endpoint": {
+            "extension": [
+              {
+                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                "valueCode": "unknown"
+              }
+            ]
+          }
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292585785509000.dd41e1db-00d4-4f55-ae20-aa8c2d66b816",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292585785509000.dd41e1db-00d4-4f55-ae20-aa8c2d66b816",
+        "identifier": [
+          {
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+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA18944-1",
+              "display": "Screen is out of range for at least one condition"
+            }
+          ]
+        },
+        "interpretation": [
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+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "N"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
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+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729292585803595000.715d1767-b06d-462e-a63a-69742fa454cb",
+        "extension": [
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "1"
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+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
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+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57131-5",
+              "display": "Newborn conditions with positive markers [Identifier] in Dried blood spot"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292585794022000.8fceeebd-7b26-4cc8-ab01-503065b0ea25"
+        },
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+              "valueString": "20240711034913"
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+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA12532-0",
+              "display": "BIO"
+            }
+          ]
+        },
+        "interpretation": [
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+                "extension": [
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+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "N"
+              }
+            ]
+          }
+        ]
+      }
+    },
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+        "id": "1729292585805462000.ce6bab3d-922f-4eac-afd1-439a273b71db",
+        "extension": [
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+            "valueString": "1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
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+              }
+            ]
+          }
+        ],
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+        "code": {
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+              "extension": [
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+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57720-5",
+              "display": "Newborn conditions with equivocal markers [Identifier] in Dried blood spot"
+            }
+          ]
+        },
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+        "_effectiveDateTime": {
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+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA137-2",
+              "display": "None"
+            }
+          ]
+        },
+        "interpretation": [
+          {
+            "coding": [
+              {
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
+                ],
+                "code": "N"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
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+        "id": "1729292585807172000.4eec4c6e-11ed-4376-8cd4-53af4e6aabe2",
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
+            "valueString": "1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
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+        "code": {
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+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57724-7",
+              "display": "Newborn screening short narrative summary"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292585794022000.8fceeebd-7b26-4cc8-ab01-503065b0ea25"
+        },
+        "effectiveDateTime": "2024-07-11T03:49:13Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
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+              "valueString": "20240711034913"
+            }
+          ]
+        },
+        "valueString": "ACTION REQUIRED\\.br\\\\.br\\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB ~EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\\.br\\\\.br\\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\\.br\\\\.br\\Lab Director - Genetic Disease Laboratory, (510) 231-1790\\.br\\\\.br\\Duplicate\\.br\\\\.br\\Follow-up:\\.br\\\\.br\\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \\.br\\\\.br\\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \\.br\\\\.br\\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \\.br\\\\.br\\Methods and Limitations:\\.br\\\\.br\\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \\.br\\Attention Healthcare Provider:\\.br\\\\.br\\\\.br\\",
+        "interpretation": [
+          {
+            "coding": [
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+                "extension": [
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+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                    "valueString": "coding"
+                  }
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+                "code": "N"
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+            ]
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+        ]
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+            "valueString": "1"
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+          {
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+              {
+                "url": "OBX.11",
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+            ]
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+                  "valueString": "LN"
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+              ],
+              "system": "http://loinc.org",
+              "code": "57129-9",
+              "display": "Full newborn screening summary report for display or printing"
+            }
+          ]
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+                "code": "N"
+              }
+            ]
+          }
+        ]
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+    },
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+            "valueString": "1"
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+          {
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+                "valueId": "ST"
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+                "url": "OBX.11",
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+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57716-3",
+              "display": "State printed on filter paper card [Identifier] in NBS card"
+            }
+          ]
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+                "code": "N"
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+            ]
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+        "id": "1729292585812232000.d73878cb-ae00-4714-8d97-83dcc0f8b331",
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+          {
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+              "system": "http://loinc.org",
+              "code": "8339-4",
+              "display": "Birthweight"
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+                "code": "N"
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+              "code": "57722-1",
+              "display": "Birth plurality of Pregnancy"
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+              "code": "LA12411-7",
+              "display": "Singleton"
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+                  "valueString": "L"
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+              "valueString": "202407111346"
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+        "_issued": {
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+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_2_fhir_transformation.fhir b/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_2_fhir_transformation.fhir
new file mode 100644
index 000000000..4df14d0b0
--- /dev/null
+++ b/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_2_fhir_transformation.fhir
@@ -0,0 +1,12278 @@
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diff --git a/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_3_hl7_translation_final.hl7 b/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_3_hl7_translation_final.hl7
index 8b6a5ecc5..49c1128cc 100644
--- a/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_3_hl7_translation_final.hl7
+++ b/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_3_hl7_translation_final.hl7
@@ -1 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|T|2.5.1
PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
NK1|1|NICUABG|MTH^Mother
ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI|||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^LN^CDPHGSPEAP|||202407111346|||||||||^HUBBARD^EUSTRATIA||||||20240711034913|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
OBX|14|TX|^^^99717-5^Accession Number^L|1|193-08-269/21-2024-21|||N|||F|||20240711034913
OBX|15|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
OBX|16|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
OBX|17|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|18|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
OBX|19|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|20|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
OBX|21|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
OBX|22|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
OBX|23|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
OBX|24|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
OBX|25|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
OBX|26|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
OBX|27|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
OBX|28|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
OBX|29|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
OBX|30|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
OBX|31|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|32|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
OBX|33|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
OBX|34|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
OBX|35|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|36|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|37|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|38|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
OBX|39|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
OBX|40|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
OBX|41|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240711034913
OBX|42|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
OBX|43|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
OBX|44|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|45|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
OBX|46|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
OBX|47|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
OBX|48|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
OBX|49|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|50|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
OBX|51|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
OBX|52|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|53|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|54|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
OBX|55|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
OBX|56|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
OBX|57|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|58|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240711034913
OBX|59|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
OBX|60|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
OBX|61|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|62|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|63|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|64|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
OBX|65|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
OBX|66|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
OBX|67|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
OBX|68|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
OBX|69|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
OBX|70|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
OBX|71|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
OBX|72|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
OBX|73|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240711034913
OBX|74|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240711034913
OBX|75|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|76|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|77|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
OBX|78|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|79|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|80|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240711034913
OBX|81|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|82|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|83|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240711034913
OBX|84|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|85|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|86|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
OBX|87|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
OBX|88|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.00|ERU|>10|L|||F|||20240711034913
OBX|89|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
OBX|90|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
OBX|91|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
OBX|92|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|93|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|94|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
OBX|95|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|96|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|97|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
OBX|98|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|99|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|100|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
OBX|101|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|102|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
OBX|103|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|104|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
OBX|105|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|D|2.5.1
PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
NK1|1|NICUABG|MTH^Mother
ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI|||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407111346|||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^NPI||||||20240711034913|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
OBX|14|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
OBX|15|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
OBX|16|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|17|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
OBX|18|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|19|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
OBX|20|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
OBX|21|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
OBX|22|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
OBX|23|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
OBX|24|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
OBX|25|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
OBX|26|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
OBX|27|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
OBX|28|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
OBX|29|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
OBX|30|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|31|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
OBX|32|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
OBX|33|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
OBX|34|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|35|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|36|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|37|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
OBX|38|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
OBX|39|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
OBX|40|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240711034913
OBX|41|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
OBX|42|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
OBX|43|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|44|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
OBX|45|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
OBX|46|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
OBX|47|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
OBX|48|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|49|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
OBX|50|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
OBX|51|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|52|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|53|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
OBX|54|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
OBX|55|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
OBX|56|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|57|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240711034913
OBX|58|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
OBX|59|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
OBX|60|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|61|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|62|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|63|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
OBX|64|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
OBX|65|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
OBX|66|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
OBX|67|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
OBX|68|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
OBX|69|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
OBX|70|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
OBX|71|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
OBX|72|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240711034913
OBX|73|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240711034913
OBX|74|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|75|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|76|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
OBX|77|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|78|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|79|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240711034913
OBX|80|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|81|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|82|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240711034913
OBX|83|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|84|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|85|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
OBX|86|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
OBX|87|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.00|ERU|>10|L|||F|||20240711034913
OBX|88|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
OBX|89|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
OBX|90|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
OBX|91|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|92|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|93|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
OBX|94|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|95|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|96|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
OBX|97|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|98|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|99|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
OBX|100|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|101|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
OBX|102|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|103|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
OBX|104|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
diff --git a/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir b/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
index 56f5e78ad..8ca53a3a7 100644
--- a/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
+++ b/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
@@ -1,14106 +1,14106 @@
 {
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-	"meta": {
-		"lastUpdated": "2024-08-30T14:51:19.308+00:00"
-	},
-	"identifier": {
-		"system": "https://reportstream.cdc.gov/prime-router",
-		"value": "243747623"
-	},
-	"type": "message",
-	"timestamp": "2024-07-11T03:49:13.000+00:00",
-	"entry": [
-		{
-			"fullUrl": "MessageHeader/1725029479460773794.10e48594-c43c-4610-a004-16af731b32bb",
-			"resource": {
-				"resourceType": "MessageHeader",
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-				"meta": {
-					"tag": [
-						{
-							"system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-							"code": "T"
-						}
-					]
-				},
-				"extension": [
-					{
-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-						"extension": [
-							{
-								"url": "MSH.7",
-								"valueString": "20240711034913"
-							}
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-				"eventCoding": {
-					"system": "http://terminology.hl7.org/CodeSystem/v2-0003",
-					"code": "R01",
-					"display": "ORU^R01^ORU_R01"
-				},
-				"destination": [
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-						"extension": [
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-								"valueString": "11903029"
-							},
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-								"valueString": "L,M,N"
-							},
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-								"valueString": "MSH.5"
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-						"name": "SISHIERECEIVER",
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-							"valueString": "SISGDSP"
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-							"valueString": "MSH.3"
-						}
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-					"name": "SISGDSP",
-					"_endpoint": {
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-								"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
-								"valueCode": "unknown"
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-				"recorded": "2024-07-11T03:49:13Z",
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-					"coding": [
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-							"display": "ORU^R01^ORU_R01"
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-				"agent": [
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-									"code": "2076-8",
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+              "code": "79563-3",
+              "display": "Mucopolysaccharidosis type I newborn screening panel"
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+              "valueString": "20240711034913"
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+      "fullUrl": "DiagnosticReport/1729291387920875000.c9ac35e7-ed9f-403b-acc1-cc89a7b93dc2",
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+                "valueString": "OBR.2"
+              },
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
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+                    "valueString": "FormNumber"
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+                ]
+              }
+            ],
+            "type": {
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+                  "code": "PLAC"
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+            "value": "7241234515"
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+                  "valueString": "coding"
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+              "code": "92005-8",
+              "display": "Spinal muscular atrophy newborn screening panel"
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+                    "valueString": "FormNumber"
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+              "code": "99717-28",
+              "display": "Adrenoleukodystrophy newborn screening panel"
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+        "_issued": {
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+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240711034913"
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+      }
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+    {
+      "fullUrl": "DiagnosticReport/1729291387924000000.48ceecc7-2f7c-41fe-bd8d-28dce15c7749",
+      "resource": {
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+        "id": "1729291387924000000.48ceecc7-2f7c-41fe-bd8d-28dce15c7749",
+        "identifier": [
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+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
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+            ],
+            "type": {
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+                {
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+                  "code": "PLAC"
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+            "value": "7241234515"
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+        "status": "final",
+        "code": {
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+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-29",
+              "display": "Adrenoleukodystrophy Tier-1 newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729291387609725000.b383348f-48d9-4ff0-9a6a-225fb1810fdb"
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+        "effectiveDateTime": "2024-07-11T13:46:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407111346"
+            }
+          ]
+        },
+        "issued": "2024-07-11T03:49:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240711034913"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291387810842000.44753a01-d2ac-443f-b5ae-ba92a8966d15"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729291387798054000.43b76662-0b0e-480e-985e-418b6f0083ed"
+          }
+        ]
+      }
+    }
+  ]
 }
diff --git a/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir b/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
index 799875b1f..a1d880a1e 100644
--- a/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
+++ b/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
@@ -1,11245 +1,11206 @@
 {
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-	},
-	"identifier": {
-		"system": "https://reportstream.cdc.gov/prime-router",
-		"value": "243747623"
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-	"type": "message",
-	"timestamp": "2024-07-11T03:49:13.000+00:00",
-	"entry": [
-		{
-			"fullUrl": "MessageHeader/1725029479460773794.10e48594-c43c-4610-a004-16af731b32bb",
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-				"meta": {
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-							"code": "T"
-						},
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-							"system": "http://localcodes.org/ETOR",
-							"code": "ETOR",
-							"display": "Processed by ETOR"
-						}
-					]
-				},
-				"extension": [
-					{
-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-						"extension": [
-							{
-								"url": "MSH.7",
-								"valueString": "20240711034913"
-							}
-						]
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-				],
-				"eventCoding": {
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diff --git a/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7 b/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
index b37977ea3..97a54cd79 100644
--- a/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
+++ b/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
@@ -1,110 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|T|2.5.1
-PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
-NK1|1|NICUABG|MTH^Mother
-ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^^^^NPI|||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
-OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^LN^CDPHGSPEAP|||202407111346|||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^^^^NPI||||||20240711034913|||F
-OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
-OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
-OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
-OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
-OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
-OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
-OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
-OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
-OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
-OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
-OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
-OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
-OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
-OBX|14|TX|^^^99717-5^Accession Number^L|1|193-08-269/21-2024-21|||N|||F|||20240711034913
-OBX|15|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
-OBX|16|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
-OBX|17|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|18|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
-OBX|19|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|20|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
-OBX|21|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
-OBX|22|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
-OBX|23|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
-OBX|24|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
-OBX|25|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
-OBX|26|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
-OBX|27|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
-OBX|28|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
-OBX|29|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
-OBX|30|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
-OBX|31|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|32|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
-OBX|33|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
-OBX|34|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
-OBX|35|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|36|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|37|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|38|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
-OBX|39|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
-OBX|40|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
-OBX|41|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.625|{Ratio}|<7.6|N|||F|||20240711034913
-OBX|42|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
-OBX|43|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
-OBX|44|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|45|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
-OBX|46|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
-OBX|47|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
-OBX|48|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
-OBX|49|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|50|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
-OBX|51|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
-OBX|52|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|53|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|54|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
-OBX|55|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
-OBX|56|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
-OBX|57|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|58|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01|{Ratio}|<0.07|N|||F|||20240711034913
-OBX|59|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
-OBX|60|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
-OBX|61|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|62|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|63|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|64|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
-OBX|65|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
-OBX|66|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
-OBX|67|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
-OBX|68|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
-OBX|69|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
-OBX|70|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
-OBX|71|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
-OBX|72|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
-OBX|73|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.5|{Ratio}|>0.1|N|||F|||20240711034913
-OBX|74|NM|48633-2^Trypsinogen I.free^LN|1|31.0|ng/mL|<69|N|||F|||20240711034913
-OBX|75|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|76|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|77|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
-OBX|78|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|79|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|80|NM|29575-8^Thyrotropin^LN|1|14.5|mIU/L|<29|N|||F|||20240711034913
-OBX|81|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|82|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|83|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.0|enzyme units|>50|N|||F|||20240711034913
-OBX|84|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|85|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|86|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
-OBX|87|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
-OBX|88|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.0|ERU|>10|L|||F|||20240711034913
-OBX|89|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
-OBX|90|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
-OBX|91|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
-OBX|92|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|93|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|94|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
-OBX|95|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|96|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|97|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
-OBX|98|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|99|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|100|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
-OBX|101|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|102|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
-OBX|103|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|104|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
-OBX|105|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|D|2.5.1
PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
NK1|1|NICUABG|MTH^Mother
ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^^^^NPI|||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407111346|||||||||1790743185^HUBBARD^EUSTRATIA^^^^^^^^^^NPI||||||20240711034913|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
OBX|14|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
OBX|15|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
OBX|16|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|17|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
OBX|18|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|19|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
OBX|20|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
OBX|21|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
OBX|22|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
OBX|23|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
OBX|24|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
OBX|25|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
OBX|26|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
OBX|27|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
OBX|28|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
OBX|29|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
OBX|30|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|31|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
OBX|32|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
OBX|33|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
OBX|34|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|35|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|36|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|37|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
OBX|38|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
OBX|39|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
OBX|40|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240711034913
OBX|41|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
OBX|42|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
OBX|43|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|44|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
OBX|45|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
OBX|46|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
OBX|47|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
OBX|48|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|49|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
OBX|50|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
OBX|51|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|52|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|53|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
OBX|54|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
OBX|55|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
OBX|56|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|57|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240711034913
OBX|58|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
OBX|59|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
OBX|60|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|61|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|62|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|63|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
OBX|64|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
OBX|65|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
OBX|66|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
OBX|67|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
OBX|68|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
OBX|69|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
OBX|70|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
OBX|71|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
OBX|72|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240711034913
OBX|73|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240711034913
OBX|74|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|75|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|76|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
OBX|77|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|78|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|79|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240711034913
OBX|80|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|81|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|82|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240711034913
OBX|83|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|84|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|85|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
OBX|86|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
OBX|87|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.00|ERU|>10|L|||F|||20240711034913
OBX|88|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
OBX|89|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
OBX|90|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
OBX|91|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|92|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|93|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
OBX|94|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|95|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|96|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
OBX|97|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|98|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|99|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
OBX|100|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|101|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
OBX|102|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|103|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
OBX|104|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
diff --git a/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir b/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
index 77d0fd199..7f9962a29 100644
--- a/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
+++ b/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
@@ -1,15305 +1,15305 @@
 {
-	"resourceType": "Bundle",
-	"id": "1724947236337393794.8a8742f9-b0f0-4d77-9459-7c5192d99893",
-	"meta": {
-		"lastUpdated": "2024-08-29T16:00:36.337+00:00"
-	},
-	"identifier": {
-		"system": "https://reportstream.cdc.gov/prime-router",
-		"value": "243747623"
-	},
-	"type": "message",
-	"timestamp": "2024-07-11T03:49:13.000+00:00",
-	"entry": [
-		{
-			"fullUrl": "MessageHeader/1724947236339331378.d9de01c0-35cb-4159-ba6d-44852a46aef6",
-			"resource": {
-				"resourceType": "MessageHeader",
-				"id": "1724947236339331378.d9de01c0-35cb-4159-ba6d-44852a46aef6",
-				"meta": {
-					"tag": [
-						{
-							"system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-							"code": "T"
-						}
-					]
-				},
-				"extension": [
-					{
-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-						"extension": [
-							{
-								"url": "MSH.7",
-								"valueString": "20240711034913"
-							}
-						]
-					}
-				],
-				"eventCoding": {
-					"system": "http://terminology.hl7.org/CodeSystem/v2-0003",
-					"code": "R01",
-					"display": "ORU^R01^ORU_R01"
-				},
-				"destination": [
-					{
-						"extension": [
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-								"valueString": "11903029"
-							},
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-								"valueString": "L,M,N"
-							},
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-								"valueString": "MSH.5"
-							}
-						],
-						"name": "SISHIERECEIVER",
-						"receiver": {
-							"reference": "Organization/1724947236339085528.a1f740bd-eef8-41cc-9725-49a15cab0b4c"
-						}
-					}
-				],
-				"sender": {
-					"reference": "Organization/1724947236338279153.73d9069c-54cb-49c9-b861-5875b1fb568e"
-				},
-				"source": {
-					"extension": [
-						{
-							"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-							"valueString": "SISGDSP"
-						},
-						{
-							"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-							"valueString": "MSH.3"
-						}
-					],
-					"name": "SISGDSP",
-					"_endpoint": {
-						"extension": [
-							{
-								"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
-								"valueCode": "unknown"
-							}
-						]
-					}
-				}
-			}
-		},
-		{
-			"fullUrl": "Organization/1724947236338279153.73d9069c-54cb-49c9-b861-5875b1fb568e",
-			"resource": {
-				"resourceType": "Organization",
-				"id": "1724947236338279153.73d9069c-54cb-49c9-b861-5875b1fb568e",
-				"identifier": [
-					{
-						"extension": [
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-								"valueString": "HD.1"
-							}
-						],
-						"value": "SISGDSP"
-					}
-				]
-			}
-		},
-		{
-			"fullUrl": "Organization/1724947236339085528.a1f740bd-eef8-41cc-9725-49a15cab0b4c",
-			"resource": {
-				"resourceType": "Organization",
-				"id": "1724947236339085528.a1f740bd-eef8-41cc-9725-49a15cab0b4c",
-				"extension": [
-					{
-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-						"valueString": "MSH.6"
-					}
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-			}
-		},
-		{
-			"fullUrl": "Provenance/1724947236340722537.c5d1cfe8-5556-42f7-95a6-d3f2d7f616fd",
-			"resource": {
-				"resourceType": "Provenance",
-				"id": "1724947236340722537.c5d1cfe8-5556-42f7-95a6-d3f2d7f616fd",
-				"target": [
-					{
-						"reference": "MessageHeader/1724947236339331378.d9de01c0-35cb-4159-ba6d-44852a46aef6"
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-					{
-						"reference": "DiagnosticReport/1724947236893128355.4db828c2-5265-4033-ba9c-18fbf163f8b5"
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-						"reference": "DiagnosticReport/1724947236902766872.ff96362a-663b-4bb1-9063-185799213818"
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-						"reference": "DiagnosticReport/1724947236906707011.77e995ab-fbc8-428c-8f38-56c75c43296d"
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-						"reference": "DiagnosticReport/1724947236909766687.cfe60d81-6c77-49dd-99ed-caa6ec8cf71e"
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+              "code": "57724-7",
+              "display": "Newborn screening short narrative summary"
+            }
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+              "valueString": "20240711034913"
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+        "valueString": "ACTION REQUIRED\\.br\\\\.br\\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB ~EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\\.br\\\\.br\\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\\.br\\\\.br\\Lab Director - Genetic Disease Laboratory, (510) 231-1790\\.br\\\\.br\\Duplicate\\.br\\\\.br\\Follow-up:\\.br\\\\.br\\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \\.br\\\\.br\\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \\.br\\\\.br\\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \\.br\\\\.br\\Methods and Limitations:\\.br\\\\.br\\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \\.br\\Attention Healthcare Provider:\\.br\\\\.br\\\\.br\\",
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+              "code": "57129-9",
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+                    "valueString": "FormNumber"
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+                "valueString": "OBR.2"
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+                    "valueString": "FormNumber"
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+                  "code": "PLAC"
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+                {
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+                  "valueString": "L"
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+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-29",
+              "display": "Adrenoleukodystrophy Tier-1 newborn screening panel"
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+        "_effectiveDateTime": {
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+              "valueString": "202407111346"
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+        "issued": "2024-07-11T03:49:13Z",
+        "_issued": {
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+              "valueString": "20240711034913"
+            }
+          ]
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+        "specimen": [
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+        "result": [
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+          }
+        ]
+      }
+    }
+  ]
 }
diff --git a/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir b/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
index 4813eb20e..eb707dca2 100644
--- a/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
+++ b/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
@@ -1,12267 +1,12228 @@
 {
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-	},
-	"identifier": {
-		"system": "https://reportstream.cdc.gov/prime-router",
-		"value": "243747623"
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-	"type": "message",
-	"timestamp": "2024-07-11T03:49:13.000+00:00",
-	"entry": [
-		{
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-				"extension": [
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-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-						"extension": [
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-								"url": "MSH.7",
-								"valueString": "20240711034913"
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diff --git a/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7 b/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
index df673dc83..788291644 100644
--- a/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
+++ b/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
@@ -1,110 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|T|2.5.1
-PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
-NK1|1|NICUABG|MTH^Mother
-ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber|||||||||||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
-OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^LN^CDPHGSPEAP|||202407111346|||||||||^HUBBARD^EUSTRATIA||||||20240711034913|||F
-OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
-OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
-OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
-OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
-OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
-OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
-OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
-OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
-OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
-OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
-OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
-OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
-OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
-OBX|14|TX|^^^99717-5^Accession Number^L|1|193-08-269/21-2024-21|||N|||F|||20240711034913
-OBX|15|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
-OBX|16|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
-OBX|17|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|18|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
-OBX|19|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|20|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
-OBX|21|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
-OBX|22|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
-OBX|23|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
-OBX|24|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
-OBX|25|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
-OBX|26|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
-OBX|27|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
-OBX|28|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
-OBX|29|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
-OBX|30|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
-OBX|31|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|32|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
-OBX|33|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
-OBX|34|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
-OBX|35|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|36|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|37|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|38|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
-OBX|39|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
-OBX|40|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
-OBX|41|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.625|{Ratio}|<7.6|N|||F|||20240711034913
-OBX|42|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
-OBX|43|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
-OBX|44|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|45|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
-OBX|46|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
-OBX|47|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
-OBX|48|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
-OBX|49|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|50|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
-OBX|51|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
-OBX|52|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|53|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|54|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
-OBX|55|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
-OBX|56|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
-OBX|57|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|58|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01|{Ratio}|<0.07|N|||F|||20240711034913
-OBX|59|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
-OBX|60|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
-OBX|61|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|62|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|63|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|64|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
-OBX|65|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
-OBX|66|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
-OBX|67|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
-OBX|68|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
-OBX|69|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
-OBX|70|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
-OBX|71|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
-OBX|72|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
-OBX|73|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.5|{Ratio}|>0.1|N|||F|||20240711034913
-OBX|74|NM|48633-2^Trypsinogen I.free^LN|1|31.0|ng/mL|<69|N|||F|||20240711034913
-OBX|75|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|76|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|77|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
-OBX|78|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|79|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|80|NM|29575-8^Thyrotropin^LN|1|14.5|mIU/L|<29|N|||F|||20240711034913
-OBX|81|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|82|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|83|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.0|enzyme units|>50|N|||F|||20240711034913
-OBX|84|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|85|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|86|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
-OBX|87|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
-OBX|88|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.0|ERU|>10|L|||F|||20240711034913
-OBX|89|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
-OBX|90|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
-OBX|91|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
-OBX|92|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|93|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|94|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
-OBX|95|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|96|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|97|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
-OBX|98|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|99|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|100|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
-OBX|101|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|102|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
-OBX|103|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|104|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
-OBX|105|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|D|2.5.1
PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
NK1|1|NICUABG|MTH^Mother
ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber|||||||||||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407111346|||||||||^HUBBARD^EUSTRATIA||||||20240711034913|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
OBX|14|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
OBX|15|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
OBX|16|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|17|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
OBX|18|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|19|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
OBX|20|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
OBX|21|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
OBX|22|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
OBX|23|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
OBX|24|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
OBX|25|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
OBX|26|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
OBX|27|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
OBX|28|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
OBX|29|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
OBX|30|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|31|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
OBX|32|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
OBX|33|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
OBX|34|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|35|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|36|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|37|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
OBX|38|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
OBX|39|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
OBX|40|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240711034913
OBX|41|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
OBX|42|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
OBX|43|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|44|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
OBX|45|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
OBX|46|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
OBX|47|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
OBX|48|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|49|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
OBX|50|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
OBX|51|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|52|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|53|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
OBX|54|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
OBX|55|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
OBX|56|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|57|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240711034913
OBX|58|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
OBX|59|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
OBX|60|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|61|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|62|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|63|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
OBX|64|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
OBX|65|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
OBX|66|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
OBX|67|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
OBX|68|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
OBX|69|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
OBX|70|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
OBX|71|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
OBX|72|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240711034913
OBX|73|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240711034913
OBX|74|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|75|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|76|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
OBX|77|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|78|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|79|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240711034913
OBX|80|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|81|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|82|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240711034913
OBX|83|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|84|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|85|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
OBX|86|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
OBX|87|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.00|ERU|>10|L|||F|||20240711034913
OBX|88|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
OBX|89|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
OBX|90|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
OBX|91|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|92|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|93|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
OBX|94|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|95|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|96|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
OBX|97|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|98|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|99|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
OBX|100|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|101|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
OBX|102|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|103|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
OBX|104|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
diff --git a/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir b/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
index de947dcc8..6131c569b 100644
--- a/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
+++ b/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
@@ -1,14005 +1,14005 @@
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-								"valueString": "L,M,N"
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+              "system": "http://loinc.org",
+              "code": "57131-5",
+              "display": "Newborn conditions with positive markers [Identifier] in Dried blood spot"
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+            ]
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
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+                  "valueString": "LN"
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+              "code": "57720-5",
+              "display": "Newborn conditions with equivocal markers [Identifier] in Dried blood spot"
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+              "display": "Newborn screening short narrative summary"
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+          ]
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+        "_effectiveDateTime": {
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+              "valueString": "20240711034913"
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+        "valueString": "ACTION REQUIRED\\.br\\\\.br\\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB ~EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\\.br\\\\.br\\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\\.br\\\\.br\\Lab Director - Genetic Disease Laboratory, (510) 231-1790\\.br\\\\.br\\Duplicate\\.br\\\\.br\\Follow-up:\\.br\\\\.br\\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \\.br\\\\.br\\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \\.br\\\\.br\\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \\.br\\\\.br\\Methods and Limitations:\\.br\\\\.br\\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \\.br\\Attention Healthcare Provider:\\.br\\\\.br\\\\.br\\",
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+              "code": "57129-9",
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+              "display": "State printed on filter paper card [Identifier] in NBS card"
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+              "code": "57722-1",
+              "display": "Birth plurality of Pregnancy"
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+              "code": "57713-0",
+              "display": "Infant NICU factors that affect newborn screening interpretation"
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+              "code": "99717-29",
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+              "valueString": "202407111346"
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+              "valueString": "20240711034913"
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+      }
+    }
+  ]
 }
diff --git a/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir b/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
index d3d8f1f21..6fefeee4a 100644
--- a/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
+++ b/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
@@ -1,11141 +1,11102 @@
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diff --git a/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7 b/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
index 135585d99..65a3c1786 100644
--- a/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
+++ b/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_3_hl7_translation_final.hl7
@@ -1,110 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|T|2.5.1
-PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
-NK1|1|NICUABG|MTH^Mother
-ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber|||||||||||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
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-OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
-OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
-OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
-OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
-OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
-OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
-OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
-OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
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-OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
-OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
-OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
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-OBX|16|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
-OBX|17|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
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-OBX|19|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
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-OBX|21|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
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-OBX|29|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
-OBX|30|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
-OBX|31|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|32|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
-OBX|33|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
-OBX|34|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
-OBX|35|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|36|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|37|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|38|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
-OBX|39|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
-OBX|40|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
-OBX|41|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.625|{Ratio}|<7.6|N|||F|||20240711034913
-OBX|42|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
-OBX|43|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
-OBX|44|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|45|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
-OBX|46|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
-OBX|47|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
-OBX|48|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
-OBX|49|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|50|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
-OBX|51|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
-OBX|52|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|53|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|54|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
-OBX|55|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
-OBX|56|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
-OBX|57|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|58|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01|{Ratio}|<0.07|N|||F|||20240711034913
-OBX|59|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
-OBX|60|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
-OBX|61|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|62|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|63|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|64|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
-OBX|65|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
-OBX|66|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
-OBX|67|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
-OBX|68|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
-OBX|69|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
-OBX|70|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
-OBX|71|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
-OBX|72|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
-OBX|73|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.5|{Ratio}|>0.1|N|||F|||20240711034913
-OBX|74|NM|48633-2^Trypsinogen I.free^LN|1|31.0|ng/mL|<69|N|||F|||20240711034913
-OBX|75|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|76|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|77|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
-OBX|78|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|79|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|80|NM|29575-8^Thyrotropin^LN|1|14.5|mIU/L|<29|N|||F|||20240711034913
-OBX|81|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|82|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|83|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.0|enzyme units|>50|N|||F|||20240711034913
-OBX|84|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|85|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|86|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
-OBX|87|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
-OBX|88|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.0|ERU|>10|L|||F|||20240711034913
-OBX|89|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
-OBX|90|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
-OBX|91|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
-OBX|92|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|93|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|94|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
-OBX|95|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|96|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|97|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
-OBX|98|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|99|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|100|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
-OBX|101|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|102|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
-OBX|103|CE|^^^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|104|TX|^^^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
-OBX|105|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|D|2.5.1
PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
NK1|1|NICUABG|MTH^Mother
ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber|||||||||||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407111346|||||||||||||||20240711034913|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
OBX|14|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
OBX|15|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
OBX|16|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|17|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
OBX|18|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|19|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
OBX|20|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
OBX|21|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
OBX|22|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
OBX|23|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
OBX|24|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
OBX|25|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
OBX|26|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
OBX|27|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
OBX|28|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
OBX|29|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
OBX|30|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|31|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
OBX|32|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
OBX|33|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
OBX|34|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|35|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|36|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|37|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
OBX|38|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
OBX|39|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
OBX|40|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240711034913
OBX|41|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
OBX|42|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
OBX|43|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|44|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
OBX|45|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
OBX|46|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
OBX|47|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
OBX|48|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|49|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
OBX|50|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
OBX|51|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|52|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|53|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
OBX|54|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
OBX|55|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
OBX|56|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|57|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240711034913
OBX|58|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
OBX|59|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
OBX|60|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|61|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|62|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|63|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
OBX|64|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
OBX|65|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
OBX|66|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
OBX|67|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
OBX|68|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
OBX|69|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
OBX|70|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
OBX|71|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
OBX|72|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240711034913
OBX|73|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240711034913
OBX|74|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|75|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|76|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
OBX|77|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|78|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|79|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240711034913
OBX|80|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|81|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|82|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240711034913
OBX|83|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|84|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|85|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
OBX|86|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
OBX|87|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.00|ERU|>10|L|||F|||20240711034913
OBX|88|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
OBX|89|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
OBX|90|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
OBX|91|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|92|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|93|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
OBX|94|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|95|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|96|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
OBX|97|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|98|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|99|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
OBX|100|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|101|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
OBX|102|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|103|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
OBX|104|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
diff --git a/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_1_hl7_translation.fhir b/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_1_hl7_translation.fhir
index af6f6116f..9ca4f8102 100644
--- a/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_1_hl7_translation.fhir
+++ b/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_1_hl7_translation.fhir
@@ -1,14698 +1,14698 @@
 {
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-	"meta": {
-		"lastUpdated": "2024-09-12T19:42:02.860+00:00"
-	},
-	"identifier": {
-		"system": "https://reportstream.cdc.gov/prime-router",
-		"value": "243747623"
-	},
-	"type": "message",
-	"timestamp": "2024-07-11T03:49:13.000+00:00",
-	"entry": [
-		{
-			"fullUrl": "MessageHeader/1726170123051686180.72fd9ab1-4a6e-42b2-b1ab-d4d69c1e3898",
-			"resource": {
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-				"id": "1726170123051686180.72fd9ab1-4a6e-42b2-b1ab-d4d69c1e3898",
-				"meta": {
-					"tag": [
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-							"system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-							"code": "T"
-						}
-					]
-				},
-				"extension": [
-					{
-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-						"extension": [
-							{
-								"url": "MSH.7",
-								"valueString": "20240711034913"
-							}
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-				"eventCoding": {
-					"system": "http://terminology.hl7.org/CodeSystem/v2-0003",
-					"code": "R01",
-					"display": "ORU^R01^ORU_R01"
-				},
-				"destination": [
-					{
-						"extension": [
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-								"valueString": "11903029"
-							},
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-								"valueString": "L,M,N"
-							},
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-								"valueString": "MSH.5"
-							}
-						],
-						"name": "SISHIERECEIVER",
-						"receiver": {
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-					"reference": "Organization/1726170122979597059.70c3245f-c100-4e54-bfdc-80faee706c47"
-				},
-				"source": {
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-						{
-							"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-							"valueString": "SISGDSP"
-						},
-						{
-							"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-							"valueString": "MSH.3"
-						}
-					],
-					"name": "SISGDSP",
-					"_endpoint": {
-						"extension": [
-							{
-								"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
-								"valueCode": "unknown"
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-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-								"valueString": "HD.1"
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-						"value": "SISGDSP"
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-			"resource": {
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-				"extension": [
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-						"valueString": "MSH.6"
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-				"recorded": "2024-07-11T03:49:13Z",
-				"activity": {
-					"coding": [
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-							"display": "ORU^R01^ORU_R01"
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-				"agent": [
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-						"type": {
-							"coding": [
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-									"system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
-									"code": "author"
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-					"coding": [
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-							"code": "v2-FHIR transformation"
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-				"agent": [
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-									"system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
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-						"value": "CDC PRIME - Atlanta"
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-						"type": {
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-									"system": "http://terminology.hl7.org/CodeSystem/v2-0301"
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-			"resource": {
-				"resourceType": "Patient",
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-				"extension": [
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-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
-						"extension": [
-							{
-								"url": "PID.8",
-								"valueCodeableConcept": {
-									"coding": [
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-											"extension": [
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-													"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
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-											"code": "M"
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-							{
-								"url": "PID.24",
-								"valueString": "N"
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-					{
-						"url": "http://ibm.com/fhir/cdm/StructureDefinition/local-race-cd",
-						"valueCodeableConcept": {
-							"coding": [
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-									"extension": [
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-											"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
-											"valueString": "coding"
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-									"code": "2076-8",
-									"display": "Native Hawaiian or Other Pacific Islander"
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-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ethnic-group",
-						"valueCodeableConcept": {
-							"coding": [
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-									"extension": [
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-											"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
-											"valueString": "coding"
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-									"code": "2186-5",
-									"display": "Not Hispanic or Latino"
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-				"identifier": [
-					{
-						"extension": [
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-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
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+          ]
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+          {
+            "reference": "Observation/1729291749540317000.0d8014c0-249e-4995-a5dc-d89fd6cdce5a"
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+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729291749680334000.23deec80-1a25-44c3-9687-cf097574ffb9",
+        "identifier": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
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+            "value": "7241234515"
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+                  "valueString": "coding"
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+              "code": "63414-7",
+              "display": "Pompe Disease newborn screening panel"
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+          ]
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+          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
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+        "effectiveDateTime": "2024-07-11T13:46:00Z",
+        "_effectiveDateTime": {
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+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407111346"
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+        "issued": "2024-07-11T03:49:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240711034913"
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+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291749578486000.e58db279-4fe8-412c-8048-b9f71eb17fdb"
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+        "result": [
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+            "reference": "Observation/1729291749541555000.6f0f2839-5bdd-480e-9059-36c5b30ed362"
+          },
+          {
+            "reference": "Observation/1729291749542916000.bd83e69b-63ed-47bc-8305-579df126c73a"
+          },
+          {
+            "reference": "Observation/1729291749544024000.188d214d-95b8-41e4-a9d6-6174a56400bd"
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+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729291749682216000.f7def470-a4ff-44f7-8b4f-967d6f480503",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729291749682216000.f7def470-a4ff-44f7-8b4f-967d6f480503",
+        "identifier": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7241234515"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729291749639137000.ddd49a73-72bb-4bd3-9f5f-404d236b427c"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                }
+              ],
+              "code": "79563-3",
+              "display": "Mucopolysaccharidosis type I newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
+        },
+        "effectiveDateTime": "2024-07-11T13:46:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407111346"
+            }
+          ]
+        },
+        "issued": "2024-07-11T03:49:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240711034913"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291749578914000.1080c9a1-4e1e-4ff4-a6c7-572e2bdcd4b5"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729291749545309000.99a6840b-0fd9-454e-ad3f-1a4b708447ed"
+          },
+          {
+            "reference": "Observation/1729291749546583000.caaecdad-1afe-4d0b-883e-a5368c3c040d"
+          },
+          {
+            "reference": "Observation/1729291749547979000.90c23c47-6004-412a-a18f-cc5c18fee61a"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729291749683803000.f3fe6412-7fd3-4ac0-acf3-d90895a5586b",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729291749683803000.f3fe6412-7fd3-4ac0-acf3-d90895a5586b",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7241234515"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729291749642182000.8e3fcb69-a1ac-4a64-a9fc-7ae3f1f8a870"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                }
+              ],
+              "code": "92005-8",
+              "display": "Spinal muscular atrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
+        },
+        "effectiveDateTime": "2024-07-11T13:46:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407111346"
+            }
+          ]
+        },
+        "issued": "2024-07-11T03:49:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240711034913"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291749579568000.9fd5db95-4403-415f-804f-52727a8ad400"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729291749549105000.03326ca3-a0b4-4f02-93d5-b48187705508"
+          },
+          {
+            "reference": "Observation/1729291749550362000.25102293-daf4-4ae6-a8ce-fd91af56644e"
+          },
+          {
+            "reference": "Observation/1729291749551521000.c60b1fe3-e1d9-4168-bac3-12b8d4f07dd4"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729291749685711000.c24eb62c-ddea-4ebf-ab9d-1a9ff00d6bd1",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729291749685711000.c24eb62c-ddea-4ebf-ab9d-1a9ff00d6bd1",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7241234515"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729291749645321000.e01eb349-e0a1-4442-9919-46fa6223c75e"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-28",
+              "display": "Adrenoleukodystrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
+        },
+        "effectiveDateTime": "2024-07-11T13:46:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407111346"
+            }
+          ]
+        },
+        "issued": "2024-07-11T03:49:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240711034913"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291749580033000.16a17961-9524-4163-b4fc-a8b700cb8a68"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729291749552753000.bb2e13c4-bcbf-407c-ab84-ab44f4d1e1f8"
+          },
+          {
+            "reference": "Observation/1729291749553853000.bb89d858-a4e4-4944-9da4-0bf3462ae606"
+          },
+          {
+            "reference": "Observation/1729291749554955000.38ee0da1-a99b-436a-9e9d-9ec6f6b4c053"
+          },
+          {
+            "reference": "Observation/1729291749556315000.18e8cd82-f3d7-41d7-8e09-c2668ef8a5a2"
+          },
+          {
+            "reference": "Observation/1729291749557453000.d15656cc-1324-463d-9066-61e71cde6980"
+          },
+          {
+            "reference": "Observation/1729291749558557000.b98bb767-d8e9-4032-bbed-4a49d9b09ba8"
+          },
+          {
+            "reference": "Observation/1729291749559742000.20fda380-0e5f-4e16-a9d0-0f28ef5e2832"
+          },
+          {
+            "reference": "Observation/1729291749560819000.80a6bedc-d95d-4e5f-a990-8886814fddfe"
+          },
+          {
+            "reference": "Observation/1729291749561984000.9c425fd9-68d9-4f1a-999c-42a83e06a157"
+          },
+          {
+            "reference": "Observation/1729291749563125000.944cd98f-7766-4ffb-9efc-e6e5f0fdaae3"
+          },
+          {
+            "reference": "Observation/1729291749564512000.a4b811a1-640b-45f5-87fa-ad4e4da403cf"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729291749687266000.58dc2ce2-63ec-4550-a3f4-604c608bd784",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729291749687266000.58dc2ce2-63ec-4550-a3f4-604c608bd784",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "OBR.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "FormNumber"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "7241234515"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729291749648428000.a90d0c97-25a8-435e-a4de-edff7dd0ed5f"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "alt-coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "L"
+                }
+              ],
+              "system": "https://terminology.hl7.org/CodeSystem-v2-0396.html#v2-0396-99zzzorL",
+              "code": "99717-29",
+              "display": "Adrenoleukodystrophy Tier-1 newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
+        },
+        "effectiveDateTime": "2024-07-11T13:46:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202407111346"
+            }
+          ]
+        },
+        "issued": "2024-07-11T03:49:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20240711034913"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729291749580456000.1fcc01d0-a672-4d36-b83e-7f70a42be9ec"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729291749565780000.bf10a594-8b98-481e-8f63-9bc6e75b7dff"
+          }
+        ]
+      }
+    }
+  ]
 }
diff --git a/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_2_fhir_transformation.fhir b/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_2_fhir_transformation.fhir
index d05619337..6e32cda45 100644
--- a/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_2_fhir_transformation.fhir
+++ b/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_2_fhir_transformation.fhir
@@ -1,11926 +1,11922 @@
 {
-	"resourceType": "Bundle",
-	"id": "1727126142730097942.97f281cc-b211-42f1-a498-022141c7b76d",
-	"meta": {
-		"lastUpdated": "2024-09-23T21:15:42.740+00:00"
-	},
-	"identifier": {
-		"system": "https://reportstream.cdc.gov/prime-router",
-		"value": "243747623"
-	},
-	"type": "message",
-	"timestamp": "2024-07-11T03:49:13.000+00:00",
-	"entry": [
-		{
-			"fullUrl": "MessageHeader/1727126142928321891.5301019a-040e-4ad0-ad49-a28f63c4321f",
-			"resource": {
-				"resourceType": "MessageHeader",
-				"id": "1727126142928321891.5301019a-040e-4ad0-ad49-a28f63c4321f",
-				"meta": {
-					"tag": [
-						{
-							"system": "http://terminology.hl7.org/CodeSystem/v2-0103",
-							"code": "T"
-						},
-						{
-							"system": "http://localcodes.org/ETOR",
-							"code": "ETOR",
-							"display": "Processed by ETOR"
-						}
-					]
-				},
-				"extension": [
-					{
-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-						"extension": [
-							{
-								"url": "MSH.7",
-								"valueString": "20240711034913"
-							}
-						]
-					}
-				],
-				"eventCoding": {
-					"system": "http://terminology.hl7.org/CodeSystem/v2-0003",
-					"code": "R01",
-					"display": "ORU^R01"
-				},
-				"destination": [
-					{
-						"extension": [
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-								"valueString": "MSH.5"
-							}
-						],
-						"name": "EPIC",
-						"receiver": {
-							"reference": "Organization/1727126142927538359.9474ff2f-543a-4f7a-a4e0-0ae276088619"
-						}
-					}
-				],
-				"sender": {
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-				"source": {
-					"extension": [
-						{
-							"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-							"valueString": "SISGDSP"
-						},
-						{
-							"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-							"valueString": "MSH.3"
-						}
-					],
-					"name": "SISGDSP",
-					"_endpoint": {
-						"extension": [
-							{
-								"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
-								"valueCode": "unknown"
-							}
-						]
-					}
-				}
-			}
-		},
-		{
-			"fullUrl": "Organization/1727126142864062753.9300ba1a-8730-437b-8ea2-ebc9c24d44bd",
-			"resource": {
-				"resourceType": "Organization",
-				"id": "1727126142864062753.9300ba1a-8730-437b-8ea2-ebc9c24d44bd",
-				"identifier": [
-					{
-						"extension": [
-							{
-								"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-								"valueString": "HD.1"
-							}
-						],
-						"value": "CDPH"
-					}
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-			}
-		},
-		{
-			"fullUrl": "Organization/1727126142927538359.9474ff2f-543a-4f7a-a4e0-0ae276088619",
-			"resource": {
-				"resourceType": "Organization",
-				"id": "1727126142927538359.9474ff2f-543a-4f7a-a4e0-0ae276088619",
-				"extension": [
-					{
-						"url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-						"valueString": "MSH.6"
-					}
-				],
-				"identifier": [
-					{
-						"extension": [
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+              "code": "57131-5",
+              "display": "Newborn conditions with positive markers [Identifier] in Dried blood spot"
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+          ]
+        },
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+              "system": "http://loinc.org",
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+            ]
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+        ]
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+              "code": "57720-5",
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+          ]
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+              "system": "http://loinc.org",
+              "code": "LA137-2",
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+              "system": "http://loinc.org",
+              "code": "57724-7",
+              "display": "Newborn screening short narrative summary"
+            }
+          ]
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+        },
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+        "valueString": "ACTION REQUIRED\\.br\\\\.br\\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB ~EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\\.br\\\\.br\\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\\.br\\\\.br\\Lab Director - Genetic Disease Laboratory, (510) 231-1790\\.br\\\\.br\\Duplicate\\.br\\\\.br\\Follow-up:\\.br\\\\.br\\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \\.br\\\\.br\\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \\.br\\\\.br\\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \\.br\\\\.br\\Methods and Limitations:\\.br\\\\.br\\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \\.br\\Attention Healthcare Provider:\\.br\\\\.br\\\\.br\\",
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+              "code": "57129-9",
+              "display": "Full newborn screening summary report for display or printing"
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+              "code": "57716-3",
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+            "reference": "Observation/1729291749559742000.20fda380-0e5f-4e16-a9d0-0f28ef5e2832"
+          },
+          {
+            "reference": "Observation/1729291749560819000.80a6bedc-d95d-4e5f-a990-8886814fddfe"
+          },
+          {
+            "reference": "Observation/1729291749561984000.9c425fd9-68d9-4f1a-999c-42a83e06a157"
+          },
+          {
+            "reference": "Observation/1729291749563125000.944cd98f-7766-4ffb-9efc-e6e5f0fdaae3"
+          },
+          {
+            "reference": "Observation/1729291749564512000.a4b811a1-640b-45f5-87fa-ad4e4da403cf"
+          },
+          {
+            "reference": "Observation/1729291749565780000.bf10a594-8b98-481e-8f63-9bc6e75b7dff"
+          }
+        ]
+      }
+    }
+  ]
 }
diff --git a/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_3_hl7_translation_final.hl7 b/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_3_hl7_translation_final.hl7
index de622955c..8c79cdf8d 100644
--- a/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_3_hl7_translation_final.hl7
+++ b/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_3_hl7_translation_final.hl7
@@ -1,119 +1 @@
-MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|T|2.5.1
-PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
-NK1|1|NICUABG|MTH^Mother
-ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber|||||||||||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
-OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407111346|||||||||||||||20240711034913|||F
-OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
-OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
-OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
-OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
-OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
-OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
-OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
-OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
-OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
-OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
-OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
-OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
-OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
-OBX|14|TX|^^^99717-5^Accession Number^L|1|193-08-269/21-2024-21|||N|||F|||20240711034913
-OBX|15|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
-OBX|16|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
-OBX|17|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|18|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
-OBX|19|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|20|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
-OBX|21|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
-OBX|22|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
-OBX|23|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
-OBX|24|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
-OBX|25|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
-OBX|26|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
-OBX|27|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
-OBX|28|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
-OBX|29|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
-OBX|30|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
-OBX|31|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|32|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
-OBX|33|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
-OBX|34|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
-OBX|35|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|36|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|37|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|38|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
-OBX|39|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
-OBX|40|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
-OBX|41|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240711034913
-OBX|42|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
-OBX|43|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
-OBX|44|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|45|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
-OBX|46|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
-OBX|47|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
-OBX|48|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
-OBX|49|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|50|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
-OBX|51|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
-OBX|52|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
-OBX|53|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|54|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
-OBX|55|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
-OBX|56|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
-OBX|57|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|58|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240711034913
-OBX|59|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
-OBX|60|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
-OBX|61|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
-OBX|62|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|63|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
-OBX|64|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
-OBX|65|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
-OBX|66|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
-OBX|67|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
-OBX|68|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
-OBX|69|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
-OBX|70|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
-OBX|71|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
-OBX|72|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
-OBX|73|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240711034913
-OBX|74|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240711034913
-OBX|75|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|76|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|77|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
-OBX|78|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|79|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|80|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240711034913
-OBX|81|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|82|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|83|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240711034913
-OBX|84|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|85|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|86|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
-OBX|87|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
-OBX|88|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.00|ERU|>10|L|||F|||20240711034913
-OBX|89|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
-OBX|90|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
-OBX|91|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
-OBX|92|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|93|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|94|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
-OBX|95|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|96|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|97|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
-OBX|98|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|99|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
-OBX|100|TX|^^^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
-OBX|101|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|102|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
-OBX|103|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
-OBX|104|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
-OBX|105|TX|PLT325^ABCD1 gene mutation found [Identifier] in DBS by Sequencing^PLT^99717-34^Adrenoleukodystrophy Mutation comments/discussion^L|1|Negative|||N|||F|||20240711034913
-OBX|106|TX|53340-6^17-Hydroxyprogesterone [Moles/volume] in DBS^LN^99717-6^17-Hydroxyprogesterone (CAH II)^L|1|Negative|||N|||F|||20240711034913
-OBX|107|TX|^^^99717-35^Cystic fibrosis Sequencing newborn screening interpretation^L|1|Negative|||N|||F|||20240711034913
-OBX|108|TX|^^^99717-36^Cystic fibrosis Sequencing newborn screening comment/discussion^L|1|Negative|||N|||F|||20240711034913
-OBX|109|TX|PLT3258^IDUA gene mutations found [Identifier] in DBS by Sequencing^PLT^99717-48^MPS I IDUA Gene Sequence Mutation Information^L|1|Negative|||N|||F|||20240711034913
-OBX|110|TX|^^^99717-44^MPS I IDUA Gene Sequence Analysis comments/discussion^L|1|Negative|||N|||F|||20240711034913
-OBX|111|TX|PLT3275^IDS gene mutations found [Identifier] in Dried Bloodspot by Molecular genetics method Nominal^PLT^99717-50^MPS II IDS Gene Sequence Mutation Information^L|1|Negative|||N|||F|||20240711034913
-OBX|112|TX|PLT3252^GAA gene mutation found [Identifier] in DBS by Sequencing^PLT^99717-47^Pompe GAA Gene Sequence Analysis Information^L|1|Negative|||N|||F|||20240711034913
-OBX|113|TX|^^^99717-46^Pompe GAA Gene Sequence Analysis comments/discussion^L|1|Negative|||N|||F|||20240711034913
-OBX|114|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913
+MSH|^~\&|SISGDSP|CDPH|EPIC|R797|20240711034913||ORU^R01|243747623|D|2.5.1
PID|1||80009197||NICUABG^TESTONE||20240607|M||2076-8^Native Hawaiian or Other Pacific Islander||||||||||||2186-5^Not Hispanic or Latino||N|1
NK1|1|NICUABG|MTH^Mother
ORC|RE|189609160^HospOrdNumber||7241234515^FormNumber|||||||||||||||||^^^^^^^^^R797|N 054TS ARALC, TS102 E^^SAN DIEGO^CA^99999-9999
OBR|1|189609160^HospOrdNumber||54089-8^NB Screen Panel Patient AHIC^CDPHGSPEAP|||202407111346|||||||||||||||20240711034913|||F
OBX|1|CE|57721-3^Reason for lab test in Dried blood spot^LN|1|LA12421-6^Initial screen^LN|||N|||F|||20240711034913
OBX|2|CE|57718-9^Sample quality of Dried blood spot^LN|1|LA12432-3^Acceptable^LN|||N|||F|||20240711034913
OBX|3|CE|57130-7^Newborn screening report - overall interpretation^LN|1|LA18944-1^Screen is out of range for at least one condition^LN|||N|||F|||20240711034913
OBX|4|CE|57131-5^Newborn conditions with positive markers [Identifier] in Dried blood spot^LN|1|LA12532-0^BIO^LN|||N|||F|||20240711034913
OBX|5|CE|57720-5^Newborn conditions with equivocal markers [Identifier] in Dried blood spot^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|6|TX|57724-7^Newborn screening short narrative summary^LN|1|ACTION REQUIRED\.br\\.br\NBS Testing Lab - COMMUNITY REG MEDICAL CENTER LAB \R\EG 4389EVA EESEN, TS054 E, FRESNO, CA 99999\.br\\.br\Genetic Disease Laboratory - GDL W 057DR HCLE, TS016 E, RICHMOND, CA 99999-9999\.br\\.br\Lab Director - Genetic Disease Laboratory, (510) 231-1790\.br\\.br\Duplicate\.br\\.br\Follow-up:\.br\\.br\Acyl Carnitine Panel: Reference Ranges for acylcarnitines are based on specimens collected on newborns who are less than 10 days old. \.br\\.br\Biotinidase Deficiency: This screen for Biotinidase Deficiency was positive. Another specimen MUST be collected on this infant. \.br\\.br\If you have any questions regarding these screening outcomes, please contact the Newborn Screening Staff at at . \.br\\.br\Methods and Limitations:\.br\\.br\Assays for ALD Tier-1, BD, CAH, CF, GAL, MS/MS Acylcarnitine and Amino Acid Panels, PCH, hemoglobinopathies, and SCID were performed at the testing laboratory specified on the front of this report. Assays for ALD Tier-2, CAH Tier-2, Pompe Disease Tier-1, MPS I Tier-1, and SMA were developed and/or optimized by the Genetic Disease Laboratory (GDL), and performed at GDL. Performance characteristics of these assays are determined by GDL. The SMA assay is designed to identify 95% of SMA patients who have homozygous deletions of the SMN1 gene on chromosome 5q. These assays have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. The assays are used for clinical purposes. They should not be regarded as investigational or for research. GDL is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) to perform high complexity genetic disease screening. \.br\Attention Healthcare Provider:\.br\\.br\\.br\|||N|||F|||20240711034913
OBX|7|TX|57129-9^Full newborn screening summary report for display or printing^LN|1||||N|||F|||20240711034913
OBX|8|ST|57716-3^State printed on filter paper card [Identifier] in NBS card^LN|1|CA|||N|||F|||20240711034913
OBX|9|NM|8339-4^Birthweight^LN|1|3500|grams||N|||F|||20240711034913
OBX|10|CE|57722-1^Birth plurality of Pregnancy^LN|1|LA12411-7^Singleton^LN|||N|||F|||20240711034913
OBX|11|NM|73806-2^Newborn age in hours^LN|1|34|day(s)||N|||F|||20240711034913
OBX|12|CE|57713-0^Infant NICU factors that affect newborn screening interpretation^LN|1|LA137-2^None^LN|||N|||F|||20240711034913
OBX|13|CE|67704-7^Feeding types^LN|1|LA16914-6^Breast milk^LN|||N|||F|||20240711034913
OBX|14|TX|62324-9^Post-discharge provider name^LN|1|EUSTRATIA HUBBARD|||N|||F|||20240711034913
OBX|15|TX|62327-2^Post-discharge provider practice address^LN|1|N 054TS ARALC, TS102 E SAN DIEGO CA 99999-9999 USA|||N|||F|||20240711034913
OBX|16|NM|47633-3^Glycine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|17|NM|53150-9^Alanine+Beta Alanine+Sarcosine [Moles/volume] in Dried blood spot^LN|1|500|µmol/L|<1000|N|||F|||20240711034913
OBX|18|NM|47799-2^Valine [Moles/volume] in Dried blood spot^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|19|NM|53151-7^Valine/Phenylalanine [Molar ratio] in Dried blood spot^LN|1|0.00645|{Ratio}|<4.3|N|||F|||20240711034913
OBX|20|NM|53152-5^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline^LN|1|125|µmol/L|<230|N|||F|||20240711034913
OBX|21|NM|53154-1^Alloisoleucine+Isoleucine+Leucine+Hydroxyproline/Alanine [Molar ratio] in Dried blood spot^LN|1|0.65|{Ratio}|<1.35|N|||F|||20240711034913
OBX|22|NM|29573-3^Phenylalanine [Moles/volume] in Dried blood spot^LN|1|77.5|µmol/L|<175|N|||F|||20240711034913
OBX|23|NM|35572-7^Phenylalanine/Tyrosine [Molar ratio] in Dried blood spot^LN|1|0.75|{Ratio}|<2.6|N|||F|||20240711034913
OBX|24|NM|35571-9^Tyrosine [Moles/volume] in Dried blood spot^LN|1|425|µmol/L|<680|N|||F|||20240711034913
OBX|25|NM|53231-7^Succinylacetone [Moles/volume] in Dried blood spot^LN|1|2.25|µmol/L|<6.1|N|||F|||20240711034913
OBX|26|NM|47700-0^Methionine [Moles/volume] in Dried blood spot^LN|1|27|µmol/L|6.3-100|N|||F|||20240711034913
OBX|27|NM|42892-0^Citrulline [Moles/volume] in Dried blood spot^LN|1|16.25|µmol/L|5-49|N|||F|||20240711034913
OBX|28|NM|54092-2^Citrulline/Arginine [Molar ratio] in Dried blood spot^LN|1|3|{Ratio}|<4.8|N|||F|||20240711034913
OBX|29|NM|53155-8^Asparagine+Ornithine [Moles/volume] in Dried blood spot^LN|1|400|µmol/L|<800|N|||F|||20240711034913
OBX|30|NM|75215-4^Ornithine/Citrulline [Molar ratio] in Dried blood spot^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|31|NM|47562-4^Arginine [Moles/volume] in Dried blood spot^LN|1|25|µmol/L|<63|N|||F|||20240711034913
OBX|32|NM|75214-7^Arginine/Ornithine [Molar ratio] in Dried blood spot^LN|1|0.7|{Ratio}|<1.9|N|||F|||20240711034913
OBX|33|NM|47732-3^Proline [Moles/volume] in Dried blood spot^LN|1|750|µmol/L|<1500|N|||F|||20240711034913
OBX|34|TX|57710-6^Amino acidemias newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|35|CE|58088-6^Acylcarnitine newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|36|TX|58093-6^Acylcarnitine newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|37|NM|38481-8^Carnitine.free (C0)^LN|1|33|µmol/L|6.4-125|N|||F|||20240711034913
OBX|38|NM|53235-8^Carnitine.free (C0)/Palmitoylcarnitine (C16)+Stearoylcarnitine (C18)^LN|1|37.5|{Ratio}|<70|N|||F|||20240711034913
OBX|39|NM|50157-7^Acetylcarnitine (C2)^LN|1|20.38|µmol/L|10-80|N|||F|||20240711034913
OBX|40|NM|75212-1^Malonylcarnitine (C3-DC)/Decanoylcarnitine (C10) [Molar ratio] in Dried blood spot^LN|1|0.62500|{Ratio}|<7.6|N|||F|||20240711034913
OBX|41|NM|45211-0^Hexanoylcarnitine (C6)^LN|1|0.48|µmol/L|<0.95|N|||F|||20240711034913
OBX|42|NM|53175-6^Octanoylcarnitine (C8)^LN|1|0.3|µmol/L|<0.45|N|||F|||20240711034913
OBX|43|NM|53177-2^Octanoylcarnitine (C8)/Decanoylcarnitine (C10)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|44|NM|53174-9^Octenoylcarnitine (C8:1)^LN|1|0.35|µmol/L|<0.65|N|||F|||20240711034913
OBX|45|NM|45197-1^Decanoylcarnitine (C10)^LN|1|0.32|µmol/L|<0.65|N|||F|||20240711034913
OBX|46|NM|45198-9^Decenoylcarnitine (C10:1)^LN|1|0.22|µmol/L|<0.45|N|||F|||20240711034913
OBX|47|NM|45199-7^Dodecanoylcarnitine (C12)^LN|1|1|µmol/L|<2|N|||F|||20240711034913
OBX|48|NM|45200-3^Dodecenoylcarnitine (C12:1)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|49|NM|53192-1^Tetradecanoylcarnitine (C14)^LN|1|0.6|µmol/L|<1.2|N|||F|||20240711034913
OBX|50|NM|53191-3^Tetradecenoylcarnitine (C14:1)^LN|1|0.4|µmol/L|<0.9|N|||F|||20240711034913
OBX|51|NM|53194-7^Tetradecenoylcarnitine (C14:1)/Dodecenoylcarnitine (C12:1)^LN|1|0.5|{Ratio}||N|||F|||20240711034913
OBX|52|NM|53190-5^Tetradecadienoylcarnitine (C14:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|53|NM|50281-5^3-Hydroxytetradecanoylcarnitine (C14-OH)^LN|1|0.1|µmol/L|<0.2|N|||F|||20240711034913
OBX|54|NM|53199-6^Palmitoylcarnitine (C16)^LN|1|5|µmol/L|<12|N|||F|||20240711034913
OBX|55|NM|53198-8^Palmitoleylcarnitine (C16:1)^LN|1|0.7|µmol/L|<1.4|N|||F|||20240711034913
OBX|56|NM|50125-4^3-Hydroxypalmitoylcarnitine (C16-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|57|NM|53201-0^3-Hydroxypalmitoylcarnitine (C16-OH)/Palmitoylcarnitine (C16)^LN|1|0.01000|{Ratio}|<0.07|N|||F|||20240711034913
OBX|58|NM|53241-6^Stearoylcarnitine (C18)^LN|1|2|µmol/L|<3.5|N|||F|||20240711034913
OBX|59|NM|53202-8^Oleoylcarnitine (C18:1)^LN|1|3.5|µmol/L|<7|N|||F|||20240711034913
OBX|60|NM|45217-7^Linoleoylcarnitine (C18:2)^LN|1|0.5|µmol/L||N|||F|||20240711034913
OBX|61|NM|50132-0^3-Hydroxystearoylcarnitine (C18-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|62|NM|50113-0^3-Hydroxyoleoylcarnitine (C18:1-OH)^LN|1|0.05|µmol/L|<0.1|N|||F|||20240711034913
OBX|63|NM|53160-8^Propionylcarnitine (C3)^LN|1|3.15|µmol/L|<7.9|N|||F|||20240711034913
OBX|64|NM|53163-2^Propionylcarnitine (C3)/Acetylcarnitine (C2)^LN|1|0.15|{Ratio}|<0.42|N|||F|||20240711034913
OBX|65|NM|67708-8^Malonylcarnitine (C3-DC)+3-Hydroxybutyrylcarnitine (C4-OH)^LN|1|0.2|µmol/L|<0.48|N|||F|||20240711034913
OBX|66|NM|53166-5^Butyrylcarnitine+Isobutyrylcarnitine (C4)^LN|1|0.85|µmol/L|<1.7|N|||F|||20240711034913
OBX|67|NM|45216-9^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)^LN|1|0.5|µmol/L|<0.95|N|||F|||20240711034913
OBX|68|NM|53240-8^Isovalerylcarnitine+Methylbutyrylcarnitine (C5)/Propionylcarnitine (C3)^LN|1|0.15873|{Ratio}|<0.38|N|||F|||20240711034913
OBX|69|NM|53170-7^Tiglylcarnitine (C5:1)^LN|1|0.3|µmol/L|<0.5|N|||F|||20240711034913
OBX|70|NM|50106-4^3-Hydroxyisovalerylcarnitine (C5-OH)^LN|1|0.45|µmol/L|<1.15|N|||F|||20240711034913
OBX|71|NM|67710-4^Glutarylcarnitine (C5-DC)+3-Hydroxyhexanoylcarnitine (C6-OH)^LN|1|0.3|µmol/L|<0.38|N|||F|||20240711034913
OBX|72|NM|75216-2^Glutarylcarnitine (C5-DC)/Malonylcarnitine (C3-DC) [Molar ratio] in Dried blood spot^LN|1|1.50000|{Ratio}|>0.1|N|||F|||20240711034913
OBX|73|NM|48633-2^Trypsinogen I.free^LN|1|31.00|ng/mL|<69|N|||F|||20240711034913
OBX|74|CE|46769-6^Cystic fibrosis newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|75|TX|57707-2^Cystic fibrosis newborn screening comment/discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|76|NM|38473-5^17-Hydroxyprogesterone^LN|1|35|nmol/L|<85|N|||F|||20240711034913
OBX|77|CE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|78|TX|57706-4^Congenital adrenal hyperplasia newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|79|NM|29575-8^Thyrotropin^LN|1|14.50|mIU/L|<29|N|||F|||20240711034913
OBX|80|CE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|81|TX|57705-6^Congenital hypothyroidism newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|82|NM|42906-8^Galactose 1 phosphate uridyl transferase^LN|1|55.00|enzyme units|>50|N|||F|||20240711034913
OBX|83|CE|46737-3^Galactosemias newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|84|TX|57704-9^Galactosemias newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|85|TX|54104-5^Hemoglobin pattern^LN|1|FA||||||F|||20240711034913
OBX|86|TX|57703-1^Hemoglobin disorders newborn screening comment/discussion^LN|1|Usual hemoglobin pattern. These results assume no transfusion prior to testing and do not rule out the possibility of a thalassemia trait or rare hemoglobin variants.||||||F|||20240711034913
OBX|87|NM|75217-0^Biotinidase [Enzymatic activity/volume] in Dried blood spot^LN|1|8.00|ERU|>10|L|||F|||20240711034913
OBX|88|CE|46761-3^Biotinidase deficiency newborn screen interpretation^LN|1|LA18593-6^Out of range^LN|||A|||F|||20240711034913
OBX|89|TX|57699-1^Biotinidase deficiency newborn screening comment-discussion^LN|1|Positive|||A|||F|||20240711034913
OBX|90|NM|62320-7^T-cell receptor excision circle [#/volume] in Dried blood spot by Probe and target amplification method^LN|1|33|copies/µL|>18|N|||F|||20240711034913
OBX|91|CE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|92|TX|62322-3^Severe combined immunodeficiency newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|93|NM|55827-0^Acid alpha glucosidase [Enzymatic activity/volume] in DBS^LN|1|12.923|µmol/L/h|>=2.079|N|||F|||20240711034913
OBX|94|CE|63415-4^Pompe Disease deficiency newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|95|TX|63416-2^Pompe Disease deficiency newborn screening comments-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|96|NM|55909-6^Alpha-L-iduronidase [Enzymatic activity/volume] in DBS^LN|1|3.117|µmol/L/h|>=1.2204|N|||F|||20240711034913
OBX|97|CE|79564-1^Mucopolysaccharidosis type I newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|98|TX|79565-8^Mucopolysaccharidosis type I newborn screening comment-discussion^LN|1|Negative|||N|||F|||20240711034913
OBX|99|TX|PLT3293^SMN1 exon 7 deletion analysis in DBS by Sequencing^PLT^99717-60^SMN1 Homozygous Deletion Analysis^L|1|Exon 7 Present||Exon 7 Present|N|||F|||20240711034913
OBX|100|CE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|101|TX|92003-3^Spinal muscular atrophy newborn screening comment-discussion^LN|1|SMA Negative|||N|||F|||20240711034913
OBX|102|CE|85269-9^X-linked Adrenoleukodystrophy (X- ALD) newborn screen interpretation^LN^99717-32^Adrenoleukodystrophy deficiency newborn screening interpretation^L|1|LA18592-8^In range^LN|||N|||F|||20240711034913
OBX|103|TX|85268-1^X-linked Adrenoleukodystrophy (X- ALD) newborn screening comment-discussion^LN^99717-33^Adrenoleukodystrophy deficiency newborn screening comments-discussion^L|1|Negative|||N|||F|||20240711034913
OBX|104|TX|PLT325^ABCD1 gene mutation found [Identifier] in DBS by Sequencing^PLT^99717-34^Adrenoleukodystrophy Mutation comments/discussion^L|1|Negative|||N|||F|||20240711034913
OBX|105|TX|53340-6^17-Hydroxyprogesterone [Moles/volume] in DBS^LN^99717-6^17-Hydroxyprogesterone (CAH II)^L|1|Negative|||N|||F|||20240711034913
OBX|106|TX|PLT3289^CFTR gene mutation found [Interpretation] in DBS by Sequencing^PLT^99717-35^Cystic fibrosis Sequencing newborn screening interpretation^L|1|Negative|||N|||F|||20240711034913
OBX|107|TX|PLT3290^CFTR gene variant found [Identifier] in DBS by Sequencing comments/discussion^PLT^99717-36^Cystic fibrosis Sequencing newborn screening comment/discussion^L|1|Negative|||N|||F|||20240711034913
OBX|108|TX|PLT3258^IDUA gene mutations found [Identifier] in DBS by Sequencing^PLT^99717-48^MPS I IDUA Gene Sequence Mutation Information^L|1|Negative|||N|||F|||20240711034913
OBX|109|TX|PLT3291^IDUA gene variant analysis in DBS by Sequencing comments/discussion^PLT^99717-44^MPS I IDUA Gene Sequence Analysis comments/discussion^L|1|Negative|||N|||F|||20240711034913
OBX|110|TX|PLT3294^IDS gene mutations found [Identifier] in Dried Bloodspot by Molecular genetics method^PLT^99717-50^MPS II IDS Gene Sequence Mutation Information^L|1|Negative|||N|||F|||20240711034913
OBX|111|TX|PLT3252^GAA gene mutation found [Identifier] in DBS by Sequencing^PLT^99717-47^Pompe GAA Gene Sequence Analysis Information^L|1|Negative|||N|||F|||20240711034913
OBX|112|TX|PLT3292^GAA gene variant analysis in DBS by Sequencing comments/discussion^PLT^99717-46^Pompe GAA Gene Sequence Analysis comments/discussion^L|1|Negative|||N|||F|||20240711034913
OBX|113|NM|79321-6^Lysophosphatidylcholine(26:0) [Moles/volume] in Dried blood spot^LN|1|0.2|µmol/L|<0.47|N|||F|||20240711034913

From 0e8aa67213f754af46c48a5902f99a613239fd4d Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 16:20:22 -0700
Subject: [PATCH 24/30] Updated snapshots in Test/Results/ folder

---
 ...NBS_Fully_Populated_1_hl7_translation.fhir | 17910 +++++++++++++++
 ...Fully_Populated_2_fhir_transformation.fhir | 17915 ++++++++++++++++
 ...ully_Populated_3_hl7_translation_final.hl7 |     1 +
 ...nd_Abnormal_Results_1_hl7_translation.fhir | 17910 +++++++++++++++
 ...bnormal_Results_2_fhir_transformation.fhir | 17915 ++++++++++++++++
 ...normal_Results_3_hl7_translation_final.hl7 |     1 +
 ...imen_Unsatisfactory_1_hl7_translation.fhir | 17910 +++++++++++++++
 ..._Unsatisfactory_2_fhir_transformation.fhir | 17915 ++++++++++++++++
 ...Unsatisfactory_3_hl7_translation_final.hl7 |     1 +
 9 files changed, 107478 insertions(+)

diff --git a/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_1_hl7_translation.fhir b/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_1_hl7_translation.fhir
index e69de29bb..449e00d98 100644
--- a/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_1_hl7_translation.fhir
+++ b/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_1_hl7_translation.fhir
@@ -0,0 +1,17910 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729293246229836000.a7c033db-c175-4683-8ff8-3b3e2b2e5523",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:14:06.229-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "20230607002849_0365"
+  },
+  "type": "message",
+  "timestamp": "2023-06-06T17:28:49.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20230606192849-0500"
+              },
+              {
+                "url": "MSH.15",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.16",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.4"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NG_FRN_PROFILE"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
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+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293246321404000.88c5c40c-9df9-4753-96ff-835cc5064015"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729293246312631000.f9ced165-28e1-4839-94c2-800c7f81debc"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_2_fhir_transformation.fhir b/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_2_fhir_transformation.fhir
index e69de29bb..2533f3479 100644
--- a/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_2_fhir_transformation.fhir
+++ b/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_2_fhir_transformation.fhir
@@ -0,0 +1,17915 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729293246229836000.a7c033db-c175-4683-8ff8-3b3e2b2e5523",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:14:06.229-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "20230607002849_0365"
+  },
+  "type": "message",
+  "timestamp": "2023-06-06T17:28:49.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20230606192849-0500"
+              },
+              {
+                "url": "MSH.15",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.16",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.4"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NG_FRN_PROFILE"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.6"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NDBS_COMPONENT"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.81"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_PRN_Component"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.22"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_TO_COMPONENT"
+                }
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.000000"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "BaptistOracle",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000",
+            "receiver": {
+              "reference": "Organization/1729293246231738000.4579de5b-b509-4463-b5dd-b6310a8e3c0f"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729293246230833000.cf643d8f-a03c-44bd-bb55-0e020b7d3e6b"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "ALlabNatus"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.181960.2"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293246230833000.cf643d8f-a03c-44bd-bb55-0e020b7d3e6b",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293246230833000.cf643d8f-a03c-44bd-bb55-0e020b7d3e6b",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.181960"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293246231738000.4579de5b-b509-4463-b5dd-b6310a8e3c0f",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293246231738000.4579de5b-b509-4463-b5dd-b6310a8e3c0f",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729293246235324000.86f10fe7-f0fd-4883-82d5-5498a77ae28d",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729293246235324000.86f10fe7-f0fd-4883-82d5-5498a77ae28d",
+        "target": [
+          {
+            "reference": "MessageHeader/1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246457454000.09c90ca0-5f1f-4f6c-ad36-cfd07beedb6c"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246459109000.6ecb3465-632d-4990-bd5a-21a1acd59543"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246460494000.41d40c15-e832-4ecd-9d92-9d19ce3a3fcb"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246461882000.e6884d68-29a3-41d4-9fce-debf070c9c1f"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246463338000.a175cd81-ba65-46f0-8e6e-67303327e1fe"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246464712000.906ec640-0671-4dca-9bc2-94edd7a0eeab"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246466061000.0fb8eed7-87d5-4768-ae11-ac8bea2a5b94"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246467495000.b7c5901b-d525-4c48-9dcc-135d9a86769e"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246468892000.8b00ef17-5538-42de-8cc5-3b60c0ede4c3"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246470298000.6069a206-73c3-431d-acf4-ded8188d6217"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246471762000.ff90458f-7e6e-4981-b2c1-80b2eaf49bc3"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246473069000.6e05461f-2d84-4f47-b37a-5f2d32144e97"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246474425000.d1782e46-8a6f-4835-b81d-dc3a8f53c2cb"
+          },
+          {
+            "reference": "DiagnosticReport/1729293246475799000.095f2271-b0cc-486f-9096-b778a2548966"
+          }
+        ],
+        "recorded": "2023-06-06T19:28:49-05:00",
+        "activity": {
+          "coding": [
+            {
+              "display": "ORU^R01^ORU_R01"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729293246234923000.451c30f9-9a03-4f8a-98a5-03ee9e9eef61"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293246234923000.451c30f9-9a03-4f8a-98a5-03ee9e9eef61",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293246234923000.451c30f9-9a03-4f8a-98a5-03ee9e9eef61",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.181960"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729293246236211000.3a51aaf4-5046-4b4b-ae9a-ec293182dc1f",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729293246236211000.3a51aaf4-5046-4b4b-ae9a-ec293182dc1f",
+        "recorded": "2024-10-18T16:14:06Z",
+        "policy": [
+          "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
+        ],
+        "activity": {
+          "coding": [
+            {
+              "code": "v2-FHIR transformation"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "assembler"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729293246236014000.5c24a510-e660-4b0b-98a7-4fb35c32ffce"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293246236014000.5c24a510-e660-4b0b-98a7-4fb35c32ffce",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293246236014000.5c24a510-e660-4b0b-98a7-4fb35c32ffce",
+        "identifier": [
+          {
+            "value": "CDC PRIME - Atlanta"
+          },
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.237821"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                          "valueString": "HL70001"
+                        }
+                      ],
+                      "code": "F",
+                      "display": "Female"
+                    }
+                  ]
+                }
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              },
+              {
+                "url": "PID.30",
+                "valueString": "N"
+              }
+            ]
+          },
+          {
+            "url": "http://ibm.com/fhir/cdm/StructureDefinition/local-race-cd",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    },
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                      "valueString": "HL70005"
+                    }
+                  ],
+                  "system": "http://terminology.hl7.org/CodeSystem/v3-Race",
+                  "code": "2106-3",
+                  "display": "White"
+                }
+              ]
+            }
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ethnic-group",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    },
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                      "valueString": "HL70189"
+                    }
+                  ],
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0189",
+                  "code": "N",
+                  "display": "Not Hispanic or Latino"
+                }
+              ]
+            }
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729293246236979000.d30009b3-0ae6-4f17-80c0-19478b0f4bd4"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
+            ],
+            "family": "ONE",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "birthDate": "2023-05-04",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230504131000"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2023-05-04T13:10:00Z"
+            }
+          ]
+        },
+        "deceasedBoolean": false,
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1,
+        "contact": [
+          {
+            "extension": [
+              {
+                "url": "https://hl7.org/fhir/StructureDefinition/relationship",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        },
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+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293246321055000.7bf4466c-50ff-40e1-9bd0-e6c4ce703cb7"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729293246310603000.8e46b86c-f508-4b52-b8d3-f6c552dd5d9f"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729293246475799000.095f2271-b0cc-486f-9096-b778a2548966",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729293246475799000.095f2271-b0cc-486f-9096-b778a2548966",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729293246451331000.70b2af01-67dc-4fc5-a976-14e5eab579d4"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57085-3",
+              "display": "Organic acid newborn screen panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293246321404000.88c5c40c-9df9-4753-96ff-835cc5064015"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729293246312631000.f9ced165-28e1-4839-94c2-800c7f81debc"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_3_hl7_translation_final.hl7 b/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_3_hl7_translation_final.hl7
index e69de29bb..e127066ee 100644
--- a/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_3_hl7_translation_final.hl7
+++ b/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^2.16.840.1.114222.4.1.181960^ISO|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistEast^2.16.840.1.114222.4.1.000001^ISO|20230606192849-0500||ORU^R01^ORU_R01|20230607002849_0365|D|2.5.1|||AL|AL|||||LRI_NG_FRN_PROFILE^^2.16.840.1.113883.9.195.3.4^ISO~LRI_NDBS_COMPONENT^^2.16.840.1.113883.9.195.3.6^ISO~LAB_PRN_Component^^2.16.840.1.113883.9.81^ISO~LAB_TO_COMPONENT^^2.16.840.1.113883.9.22^ISO
PID|1||1300974^^^Baptist East^MR||ONE^TESTCASE||20230504131000|F^Female^HL70001||2106-3^White^HL70005|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^home^^Montgomery|||||||2227600015||||N^Not Hispanic or Latino^HL70189|||1|||||N
NK1|1|ONE^MOMFIRST|MTH^Mother^HL70063^^^^^^Mother||^^^^^804^5693861||||||||||||||||||||||||||||123456789^^^Medicaid&2.16.840.1.113883.4.446&ISO^MD||||000-00-0000
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBR|1|4560411583^ORDERID|20231561137^ALPHL|57128-1^Newborn Screening Report summary panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|CWE|57718-9^Sample quality of Dried blood spot^LN||LA12432-3^Acceptable^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
OBX|2|CWE|57130-7^Newborn screening report - overall interpretation^LN||LA12428-1^All screening is in range for the conditions tested^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
OBX|3|FT|69969-4^Newborn screening report overall laboratory comment^LN||Example notes from AL PHL||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
OBX|4|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21165-8^Classical galactosemia^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|5|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22202-8^Cystic fibrosis^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|6|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12538-7^Primary congenital hypothyroidism^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|7|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12532-0^Biotinidase deficiency^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|8|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21168-2^Maple syrup urine disease^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|9|ED|57129-9^Full newborn screening summary report for display or printing^LN||^TEXT^html^Base64||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
SPM|1|423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO||440500007^Blood spot specimen^SCT|||||||||||||20230603045000^20230603045000|20230605102300
ORC|RE||20231561137^ALPHL||||||||||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBR|2|4560411583^ORDERID|20231561137^ALPHL|57717-1^Newborn screen card data panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|ST|57723-9^Unique bar code number of Current sample^LN||123456||||||F|||20230603045000-0500
OBX|2|NM|58229-6^Body weight Measured --when specimen taken^LN||3122|g^gram^UCUM|||||F|||20230603045000-0500
OBX|3|CWE|57722-1^Birth plurality of Pregnancy^LN||LA6112-2^1^LN||||||F|||20230603045000-0500
OBX|4|NM|57714-8^Obstetric estimation of gestational age^LN||38|wk^week^UCUM|||||F|||20230603045000-0500
OBX|5|CE|67704-7^Feeding types^LN||LA16914-6^Breast milk^LN||||||F|||20230603045000-0500
OBX|6|DTM|62317-3^Date of last blood product transfusion^LN||202402211218-0500||||||F|||20230603045000-0500
OBX|7|TX|62330-6^Birth hospital facility name^LN||HOME||||||F|||20230603045000-0500
OBX|8|XAD|62331-4^Birth hospital facility address^LN||||||||F|||20230603045000-0500
OBX|9|TX|62324-9^Post-discharge provider name in Provider^LN||TEST, PROVIDER||||||F|||20230603045000-0500
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|3|4560411583^ORDERID|20231561137^ALPHL|54090-6^Thyroid newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|4|4560411583^ORDERID|20231561137^ALPHL|54078-1^Cystic fibrosis newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46769-6^Cystic fibrosis newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|5|4560411583^ORDERID|20231561137^ALPHL|57086-1^Congenital adrenal hyperplasia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|6|4560411583^ORDERID|20231561137^ALPHL|57087-9^Biotinidase newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46761-3^Biotinidase deficiency newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|7|4560411583^ORDERID|20231561137^ALPHL|54081-5^Hemoglobinopathies newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46740-7^Hemoglobin disorders newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|8|4560411583^ORDERID|20231561137^ALPHL|62333-0^Severe combined immunodeficiency (SCID) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|9|4560411583^ORDERID|20231561137^ALPHL|54079-9^Galactosemia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46737-3^Galactosemias newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|10|4560411583^ORDERID|20231561137^ALPHL|53261-4^Amino acid newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46733-2^Amino acidemias newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|11|4560411583^ORDERID|20231561137^ALPHL|85267-3^X-linked adrenoleukodystrophy (X-ALD) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|85269-9^X-linked adrenoleukodystrophy newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|12|4560411583^ORDERID|20231561137^ALPHL|92005-8^Spinal muscular atrophy newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|13|4560411583^ORDERID|20231561137^ALPHL|57084-6^Fatty acid oxidation newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46736-5^Fatty acid oxidation defects newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|14|4560411583^ORDERID|20231561137^ALPHL|57085-3^Organic acid newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46744-9^Organic acidemias newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
diff --git a/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_1_hl7_translation.fhir b/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_1_hl7_translation.fhir
index e69de29bb..8e4bf325c 100644
--- a/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_1_hl7_translation.fhir
+++ b/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_1_hl7_translation.fhir
@@ -0,0 +1,17910 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729292960519319000.0ecef2bb-80d6-4c8a-9e69-60b9e8569329",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:09:20.519-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "20230607002849_0365"
+  },
+  "type": "message",
+  "timestamp": "2023-06-06T17:28:49.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729292960521914000.75f14dbb-1ae5-4720-837d-8725b1dffbfe",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729292960521914000.75f14dbb-1ae5-4720-837d-8725b1dffbfe",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20230606192849-0500"
+              },
+              {
+                "url": "MSH.15",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.16",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.4"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NG_FRN_PROFILE"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.6"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NDBS_COMPONENT"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.81"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_PRN_Component"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.22"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_TO_COMPONENT"
+                }
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.000000"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "BaptistOracle",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000",
+            "receiver": {
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+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "ALlabNatus"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.181960.2"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292960520446000.217de4fb-78a9-4675-a426-5c05fc7c608a",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292960520446000.217de4fb-78a9-4675-a426-5c05fc7c608a",
+        "identifier": [
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+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.181960"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729292960521456000.296f1ea7-b381-4d17-adc9-fd1cd11cd103",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729292960521456000.296f1ea7-b381-4d17-adc9-fd1cd11cd103",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
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+            "type": {
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+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
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+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
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+      "resource": {
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+        "id": "1729292960524945000.87685cf4-a0fb-4d66-803b-433c5af45810",
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+            "reference": "MessageHeader/1729292960521914000.75f14dbb-1ae5-4720-837d-8725b1dffbfe"
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+            "reference": "DiagnosticReport/1729292960783110000.cd959e7f-abba-4cb3-a84e-0494ddf57ac9"
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+          {
+            "reference": "DiagnosticReport/1729292960792829000.19e7d02d-9bcd-4244-bb20-499669066cc5"
+          },
+          {
+            "reference": "DiagnosticReport/1729292960794258000.b71f93df-77ef-4b37-a134-5cdbc254ccd4"
+          },
+          {
+            "reference": "DiagnosticReport/1729292960795639000.62c88e2d-10b8-4aaa-94f6-cace410dd6c3"
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+          {
+            "reference": "DiagnosticReport/1729292960797049000.b7a29488-c86e-4d82-b78f-2a3ce72274d9"
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+        "recorded": "2023-06-06T19:28:49-05:00",
+        "activity": {
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+            {
+              "display": "ORU^R01^ORU_R01"
+            }
+          ]
+        },
+        "agent": [
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+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729292960524635000.54f1e633-4f0d-477b-b004-f3f5467d4c15"
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+    {
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+      "resource": {
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+        "id": "1729292960524635000.54f1e633-4f0d-477b-b004-f3f5467d4c15",
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+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.181960"
+          }
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+    {
+      "fullUrl": "Provenance/1729292960525823000.d4d07c2b-9c62-497f-a676-de67fa0fff4b",
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+        "recorded": "2024-10-18T16:09:20Z",
+        "policy": [
+          "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
+        ],
+        "activity": {
+          "coding": [
+            {
+              "code": "v2-FHIR transformation"
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+        "agent": [
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+              "coding": [
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+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "assembler"
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+              "reference": "Organization/1729292960525658000.4ff5e10d-bc5b-492c-82af-fb81a9d47151"
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+      "resource": {
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+        "id": "1729292960525658000.4ff5e10d-bc5b-492c-82af-fb81a9d47151",
+        "identifier": [
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+            "value": "CDC PRIME - Atlanta"
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+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.237821"
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+    {
+      "fullUrl": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8",
+                "valueCodeableConcept": {
+                  "coding": [
+                    {
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                          "valueString": "coding"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                          "valueString": "HL70001"
+                        }
+                      ],
+                      "code": "F",
+                      "display": "Female"
+                    }
+                  ]
+                }
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
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+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
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+              },
+              {
+                "url": "PID.30",
+                "valueString": "N"
+              }
+            ]
+          },
+          {
+            "url": "http://ibm.com/fhir/cdm/StructureDefinition/local-race-cd",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    },
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                      "valueString": "HL70005"
+                    }
+                  ],
+                  "system": "http://terminology.hl7.org/CodeSystem/v3-Race",
+                  "code": "2106-3",
+                  "display": "White"
+                }
+              ]
+            }
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ethnic-group",
+            "valueCodeableConcept": {
+              "coding": [
+                {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                      "valueString": "coding"
+                    },
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                      "valueString": "HL70189"
+                    }
+                  ],
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0189",
+                  "code": "N",
+                  "display": "Not Hispanic or Latino"
+                }
+              ]
+            }
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
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+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729292960526728000.dc075120-8a71-4833-9124-94277c375bc4"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729292960756533000.0e296372-42f4-4627-9206-327e138f0431"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57084-6",
+              "display": "Fatty acid oxidation newborn screen panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
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+        "specimen": [
+          {
+            "reference": "Specimen/1729292960615176000.0e296c27-4fef-4cc0-9b5b-2f795d6c5eb3"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729292960604735000.ebcfa323-3dc8-46a8-9df5-25f9a3bcca87"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729292960799953000.5b9dbcb3-1a3d-4c68-aa08-6b290f89a939",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729292960799953000.5b9dbcb3-1a3d-4c68-aa08-6b290f89a939",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729292960769148000.18eaed63-7c32-4e20-ab8e-2f517bb9f268"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57085-3",
+              "display": "Organic acid newborn screen panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729292960615535000.7c1a5234-11fa-4b22-993f-9fff275b4635"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729292960606721000.7dbbab11-778d-4ec6-a1ca-aca5b49606eb"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_2_fhir_transformation.fhir b/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_2_fhir_transformation.fhir
index e69de29bb..cd118187f 100644
--- a/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_2_fhir_transformation.fhir
+++ b/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_2_fhir_transformation.fhir
@@ -0,0 +1,17915 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729292960519319000.0ecef2bb-80d6-4c8a-9e69-60b9e8569329",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:09:20.519-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "20230607002849_0365"
+  },
+  "type": "message",
+  "timestamp": "2023-06-06T17:28:49.000-07:00",
+  "entry": [
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+      "fullUrl": "MessageHeader/1729292960521914000.75f14dbb-1ae5-4720-837d-8725b1dffbfe",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729292960521914000.75f14dbb-1ae5-4720-837d-8725b1dffbfe",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20230606192849-0500"
+              },
+              {
+                "url": "MSH.15",
+                "valueString": "AL"
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+              {
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+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
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+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.4"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NG_FRN_PROFILE"
+                }
+              },
+              {
+                "url": "MSH.21",
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+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.6"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
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+                  ],
+                  "value": "LRI_NDBS_COMPONENT"
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+              },
+              {
+                "url": "MSH.21",
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+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.81"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
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+                      ]
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+                  ],
+                  "value": "LAB_PRN_Component"
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+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.22"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
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+                  "value": "LAB_TO_COMPONENT"
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+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
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+                "valueString": "2.16.840.1.114222.4.1.000000"
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+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
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+            ],
+            "name": "BaptistOracle",
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+              "valueString": "ALlabNatus"
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+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.181960.2"
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+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2"
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+        "id": "1729292960520446000.217de4fb-78a9-4675-a426-5c05fc7c608a",
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
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+            "value": "ALlab"
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
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+            "type": {
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+                {
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+                  "code": "ISO"
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+            "value": "2.16.840.1.114222.4.1.181960"
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+      "fullUrl": "Organization/1729292960521456000.296f1ea7-b381-4d17-adc9-fd1cd11cd103",
+      "resource": {
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+        "id": "1729292960521456000.296f1ea7-b381-4d17-adc9-fd1cd11cd103",
+        "extension": [
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
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+            ],
+            "value": "BaptistEast"
+          },
+          {
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+                "valueString": "HD.2,HD.3"
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+                  "code": "ISO"
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+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
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+            ],
+            "type": {
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+                  "code": "ISO"
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+            "value": "2.16.840.1.114222.4.1.181960"
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+        "recorded": "2024-10-18T16:09:20Z",
+        "policy": [
+          "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
+        ],
+        "activity": {
+          "coding": [
+            {
+              "code": "v2-FHIR transformation"
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+            "extension": [
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+                "url": "PID.8",
+                "valueCodeableConcept": {
+                  "coding": [
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+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729292960747334000.76edf288-2560-44e5-937f-60d398eb6434"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "92005-8",
+              "display": "Spinal muscular atrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729292960614832000.72409220-1fed-4476-bf47-2d6f5006665c"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729292960602651000.106430d0-e4bd-4214-a5d7-26229cf420a1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729292960798503000.11957d43-2f87-4226-a831-d3de6ca2de00",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729292960798503000.11957d43-2f87-4226-a831-d3de6ca2de00",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729292960756533000.0e296372-42f4-4627-9206-327e138f0431"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57084-6",
+              "display": "Fatty acid oxidation newborn screen panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729292960615176000.0e296c27-4fef-4cc0-9b5b-2f795d6c5eb3"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729292960604735000.ebcfa323-3dc8-46a8-9df5-25f9a3bcca87"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729292960799953000.5b9dbcb3-1a3d-4c68-aa08-6b290f89a939",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729292960799953000.5b9dbcb3-1a3d-4c68-aa08-6b290f89a939",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729292960769148000.18eaed63-7c32-4e20-ab8e-2f517bb9f268"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57085-3",
+              "display": "Organic acid newborn screen panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729292960615535000.7c1a5234-11fa-4b22-993f-9fff275b4635"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729292960606721000.7dbbab11-778d-4ec6-a1ca-aca5b49606eb"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_3_hl7_translation_final.hl7 b/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_3_hl7_translation_final.hl7
index e69de29bb..85365cdaa 100644
--- a/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_3_hl7_translation_final.hl7
+++ b/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
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OBR|1|4560411583^ORDERID|20231561137^ALPHL|57128-1^Newborn Screening Report summary panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|CWE|57718-9^Sample quality of Dried blood spot^LN||LA12432-3^Acceptable^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
OBX|2|CWE|57130-7^Newborn screening report - overall interpretation^LN||LA18944-1^Screen is out of range for at least one condition^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
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OBX|4|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21165-8^Classical galactosemia^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|5|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22202-8^Cystic fibrosis^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|6|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12538-7^Primary congenital hypothyroidism^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|7|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12532-0^Biotinidase deficiency^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|8|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21168-2^Maple syrup urine disease^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|9|ED|57129-9^Full newborn screening summary report for display or printing^LN||^TEXT^html^Base64||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
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ORC|RE||20231561137^ALPHL||||||||||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
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OBX|2|NM|58229-6^Body weight Measured --when specimen taken^LN||3122|g^gram^UCUM|||||F|||20230603045000-0500
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OBX|8|XAD|62331-4^Birth hospital facility address^LN||||||||F|||20230603045000-0500
OBX|9|TX|62324-9^Post-discharge provider name in Provider^LN||TEST, PROVIDER||||||F|||20230603045000-0500
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ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|7|4560411583^ORDERID|20231561137^ALPHL|54081-5^Hemoglobinopathies newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46740-7^Hemoglobin disorders newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|8|4560411583^ORDERID|20231561137^ALPHL|62333-0^Severe combined immunodeficiency (SCID) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|9|4560411583^ORDERID|20231561137^ALPHL|54079-9^Galactosemia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46737-3^Galactosemias newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|10|4560411583^ORDERID|20231561137^ALPHL|53261-4^Amino acid newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46733-2^Amino acidemias newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|11|4560411583^ORDERID|20231561137^ALPHL|85267-3^X-linked adrenoleukodystrophy (X-ALD) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|85269-9^X-linked adrenoleukodystrophy newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|12|4560411583^ORDERID|20231561137^ALPHL|92005-8^Spinal muscular atrophy newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|13|4560411583^ORDERID|20231561137^ALPHL|57084-6^Fatty acid oxidation newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46736-5^Fatty acid oxidation defects newborn screen interpretation^LN||LA25817-0^Out of range requiring immediate referral^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|14|4560411583^ORDERID|20231561137^ALPHL|57085-3^Organic acid newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46744-9^Organic acidemias newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
diff --git a/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_1_hl7_translation.fhir b/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_1_hl7_translation.fhir
index e69de29bb..5a68d67b4 100644
--- a/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_1_hl7_translation.fhir
+++ b/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_1_hl7_translation.fhir
@@ -0,0 +1,17910 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729293370398334000.2a393687-0862-412f-8529-077241d85208",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:16:10.398-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "20230607002849_0365"
+  },
+  "type": "message",
+  "timestamp": "2023-06-06T17:28:49.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20230606192849-0500"
+              },
+              {
+                "url": "MSH.15",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.16",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.4"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NG_FRN_PROFILE"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.6"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NDBS_COMPONENT"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.81"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_PRN_Component"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.22"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_TO_COMPONENT"
+                }
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.000000"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "BaptistOracle",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000",
+            "receiver": {
+              "reference": "Organization/1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "ALlabNatus"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.181960.2"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.181960"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729293370416105000.3f4b5e28-ebb1-4a26-857f-19b8077b2b8f",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729293370416105000.3f4b5e28-ebb1-4a26-857f-19b8077b2b8f",
+        "target": [
+          {
+            "reference": "MessageHeader/1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370608814000.e3661cfd-5e37-4f8d-a673-8efa91e7ece5"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370610173000.50f41c41-b0f1-4e69-b719-66ef5b902b94"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370611433000.e69eb03f-a3f1-484d-aa24-04b030ef513d"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370612592000.37cee68f-3d05-4a9a-a573-aa2d9b0c8a91"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370613820000.40eeb3b8-b9f3-49e7-961c-9e39317ffb6f"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370614980000.7e711c73-9f62-4b45-82fb-efe3934707f3"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370616153000.57d4b495-761c-44ca-80d3-9cbb63c94150"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370617300000.e2532e84-fc25-4c89-ace7-afc9c9b01798"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370618478000.4ee45569-9901-475d-8741-2ce987dd2d1b"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370619626000.8309ea4d-77ba-4fa2-b92d-2a785d98adc4"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370620804000.2ed130be-bc00-4177-9b8c-0f1f11f857e3"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370622057000.73367673-7ca0-4e22-9f0c-71f78d3c7fb6"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370623399000.c885ba78-ff58-43d8-9f06-25b96a13080f"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370624615000.fa48bf41-cbeb-447a-b745-04971bb3321c"
+          }
+        ],
+        "recorded": "2023-06-06T19:28:49-05:00",
+        "activity": {
+          "coding": [
+            {
+              "display": "ORU^R01^ORU_R01"
+            }
+          ]
+        },
+        "agent": [
+          {
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
+                  "code": "author"
+                }
+              ]
+            },
+            "who": {
+              "reference": "Organization/1729293370415503000.f971f977-7417-4f45-be4d-dba4bfbedcf8"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293370415503000.f971f977-7417-4f45-be4d-dba4bfbedcf8",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293370415503000.f971f977-7417-4f45-be4d-dba4bfbedcf8",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.181960"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729293370416979000.aa29025e-5371-4892-81c4-b41a3a124c64",
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+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293370495240000.cefdfb55-4bb1-4f2b-ae3c-069776553ff0"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729293370482296000.594d0b98-a064-45c1-8144-d1562a0aa7b9"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729293370622057000.73367673-7ca0-4e22-9f0c-71f78d3c7fb6",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729293370622057000.73367673-7ca0-4e22-9f0c-71f78d3c7fb6",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729293370587797000.425ee6b5-e004-46d8-92de-ad755105ad93"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "92005-8",
+              "display": "Spinal muscular atrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293370495546000.a18176fd-a0f2-4208-b069-8528a7e43b4c"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729293370484238000.56ac1fa7-f887-4def-85a5-7635a20a88f5"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729293370623399000.c885ba78-ff58-43d8-9f06-25b96a13080f",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729293370623399000.c885ba78-ff58-43d8-9f06-25b96a13080f",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729293370595276000.794fef48-a04d-45af-9312-ced460d80e08"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57084-6",
+              "display": "Fatty acid oxidation newborn screen panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293370495842000.c7875c4c-37ca-435e-aa27-ad0bfec02dd6"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729293370486076000.7ef8b361-acf0-4d6c-9c08-f20f01895b80"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729293370624615000.fa48bf41-cbeb-447a-b745-04971bb3321c",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729293370624615000.fa48bf41-cbeb-447a-b745-04971bb3321c",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729293370602844000.728ca6ec-5617-480d-825b-635a9747d4f5"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57085-3",
+              "display": "Organic acid newborn screen panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293370496129000.d5c1344f-e127-41c7-8a08-3816715ddd56"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729293370487848000.f0e59b04-66cb-4ed5-bdb5-f6b4224864db"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_2_fhir_transformation.fhir b/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_2_fhir_transformation.fhir
index e69de29bb..16a172ccc 100644
--- a/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_2_fhir_transformation.fhir
+++ b/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_2_fhir_transformation.fhir
@@ -0,0 +1,17915 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729293370398334000.2a393687-0862-412f-8529-077241d85208",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:16:10.398-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "20230607002849_0365"
+  },
+  "type": "message",
+  "timestamp": "2023-06-06T17:28:49.000-07:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20230606192849-0500"
+              },
+              {
+                "url": "MSH.15",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.16",
+                "valueString": "AL"
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.4"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NG_FRN_PROFILE"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.195.3.6"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LRI_NDBS_COMPONENT"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.81"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_PRN_Component"
+                }
+              },
+              {
+                "url": "MSH.21",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                          "valueString": "2.16.840.1.113883.9.22"
+                        },
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                          "valueCode": "ISO"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "LAB_TO_COMPONENT"
+                }
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "R01",
+          "display": "ORU^R01^ORU_R01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.000000"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "BaptistOracle",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000",
+            "receiver": {
+              "reference": "Organization/1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "ALlabNatus"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.181960.2"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.181960"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Provenance/1729293370416105000.3f4b5e28-ebb1-4a26-857f-19b8077b2b8f",
+      "resource": {
+        "resourceType": "Provenance",
+        "id": "1729293370416105000.3f4b5e28-ebb1-4a26-857f-19b8077b2b8f",
+        "target": [
+          {
+            "reference": "MessageHeader/1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370608814000.e3661cfd-5e37-4f8d-a673-8efa91e7ece5"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370610173000.50f41c41-b0f1-4e69-b719-66ef5b902b94"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370611433000.e69eb03f-a3f1-484d-aa24-04b030ef513d"
+          },
+          {
+            "reference": "DiagnosticReport/1729293370612592000.37cee68f-3d05-4a9a-a573-aa2d9b0c8a91"
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+          {
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+                "extension": [
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+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
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+                ]
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+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
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+            "value": "20231561137"
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+        "basedOn": [
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+        "status": "final",
+        "code": {
+          "coding": [
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+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "85267-3",
+              "display": "X-linked adrenoleukodystrophy (X-ALD) newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
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+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
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+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293370495240000.cefdfb55-4bb1-4f2b-ae3c-069776553ff0"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729293370482296000.594d0b98-a064-45c1-8144-d1562a0aa7b9"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729293370622057000.73367673-7ca0-4e22-9f0c-71f78d3c7fb6",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729293370622057000.73367673-7ca0-4e22-9f0c-71f78d3c7fb6",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729293370587797000.425ee6b5-e004-46d8-92de-ad755105ad93"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "92005-8",
+              "display": "Spinal muscular atrophy newborn screening panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
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+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
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+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293370495546000.a18176fd-a0f2-4208-b069-8528a7e43b4c"
+          }
+        ],
+        "result": [
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+            "reference": "Observation/1729293370484238000.56ac1fa7-f887-4def-85a5-7635a20a88f5"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729293370623399000.c885ba78-ff58-43d8-9f06-25b96a13080f",
+      "resource": {
+        "resourceType": "DiagnosticReport",
+        "id": "1729293370623399000.c885ba78-ff58-43d8-9f06-25b96a13080f",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729293370595276000.794fef48-a04d-45af-9312-ced460d80e08"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57084-6",
+              "display": "Fatty acid oxidation newborn screen panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
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+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293370495842000.c7875c4c-37ca-435e-aa27-ad0bfec02dd6"
+          }
+        ],
+        "result": [
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+            "reference": "Observation/1729293370486076000.7ef8b361-acf0-4d6c-9c08-f20f01895b80"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "DiagnosticReport/1729293370624615000.fa48bf41-cbeb-447a-b745-04971bb3321c",
+      "resource": {
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+        "id": "1729293370624615000.fa48bf41-cbeb-447a-b745-04971bb3321c",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ALPHL"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "FILL"
+                }
+              ]
+            },
+            "value": "20231561137"
+          }
+        ],
+        "basedOn": [
+          {
+            "reference": "ServiceRequest/1729293370602844000.728ca6ec-5617-480d-825b-635a9747d4f5"
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "57085-3",
+              "display": "Organic acid newborn screen panel"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+        },
+        "effectiveDateTime": "2023-06-03T04:50:00Z",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230603045000"
+            }
+          ]
+        },
+        "issued": "2023-06-06T19:16:13Z",
+        "_issued": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "20230606191613"
+            }
+          ]
+        },
+        "specimen": [
+          {
+            "reference": "Specimen/1729293370496129000.d5c1344f-e127-41c7-8a08-3816715ddd56"
+          }
+        ],
+        "result": [
+          {
+            "reference": "Observation/1729293370487848000.f0e59b04-66cb-4ed5-bdb5-f6b4224864db"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_3_hl7_translation_final.hl7 b/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_3_hl7_translation_final.hl7
index e69de29bb..5766f34b2 100644
--- a/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_3_hl7_translation_final.hl7
+++ b/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
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OBR|1|4560411583^ORDERID|20231561137^ALPHL|57128-1^Newborn Screening Report summary panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|CWE|57718-9^Sample quality of Dried blood spot^LN||LA20627-8^Specimen has uneven saturation^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
OBX|2|CWE|57130-7^Newborn screening report - overall interpretation^LN||LA16205-9^Specimen unsatisfactory for at least one condition^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
OBX|3|FT|69969-4^Newborn screening report overall laboratory comment^LN||Example notes from AL PHL||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
OBX|4|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21165-8^Classical galactosemia^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|5|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA22202-8^Cystic fibrosis^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|6|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12538-7^Primary congenital hypothyroidism^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|7|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA12532-0^Biotinidase deficiency^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|8|CWE|57719-7^Conditions tested for in this newborn screening study [Identifier] in DBS^LN||LA21168-2^Maple syrup urine disease^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||SCI|UNSP
OBX|9|ED|57129-9^Full newborn screening summary report for display or printing^LN||^TEXT^html^Base64||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
SPM|1|423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO||440500007^Blood spot specimen^SCT|||||||||||||20230603045000^20230603045000|20230605102300
ORC|RE||20231561137^ALPHL||||||||||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBR|2|4560411583^ORDERID|20231561137^ALPHL|57717-1^Newborn screen card data panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||54089-8^Newborn screening panel American Health Information Community (AHIC)^LN
OBX|1|ST|57723-9^Unique bar code number of Current sample^LN||123456||||||F|||20230603045000-0500
OBX|2|NM|58229-6^Body weight Measured --when specimen taken^LN||3122|g^gram^UCUM|||||F|||20230603045000-0500
OBX|3|CWE|57722-1^Birth plurality of Pregnancy^LN||LA6112-2^1^LN||||||F|||20230603045000-0500
OBX|4|NM|57714-8^Obstetric estimation of gestational age^LN||38|wk^week^UCUM|||||F|||20230603045000-0500
OBX|5|CE|67704-7^Feeding types^LN||LA16914-6^Breast milk^LN||||||F|||20230603045000-0500
OBX|6|DTM|62317-3^Date of last blood product transfusion^LN||202402211218-0500||||||F|||20230603045000-0500
OBX|7|TX|62330-6^Birth hospital facility name^LN||HOME||||||F|||20230603045000-0500
OBX|8|XAD|62331-4^Birth hospital facility address^LN||||||||F|||20230603045000-0500
OBX|9|TX|62324-9^Post-discharge provider name in Provider^LN||TEST, PROVIDER||||||F|||20230603045000-0500
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|3|4560411583^ORDERID|20231561137^ALPHL|54090-6^Thyroid newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46762-1^Congenital hypothyroidism newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|4|4560411583^ORDERID|20231561137^ALPHL|54078-1^Cystic fibrosis newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46769-6^Cystic fibrosis newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|5|4560411583^ORDERID|20231561137^ALPHL|57086-1^Congenital adrenal hyperplasia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46758-9^Congenital adrenal hyperplasia newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|6|4560411583^ORDERID|20231561137^ALPHL|57087-9^Biotinidase newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46761-3^Biotinidase deficiency newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|7|4560411583^ORDERID|20231561137^ALPHL|54081-5^Hemoglobinopathies newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46740-7^Hemoglobin disorders newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|8|4560411583^ORDERID|20231561137^ALPHL|62333-0^Severe combined immunodeficiency (SCID) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|62321-5^Severe combined immunodeficiency newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|9|4560411583^ORDERID|20231561137^ALPHL|54079-9^Galactosemia newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46737-3^Galactosemias newborn screen interpretation^LN||LA20627-8^Specimen has uneven saturation^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|10|4560411583^ORDERID|20231561137^ALPHL|53261-4^Amino acid newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46733-2^Amino acidemias newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|11|4560411583^ORDERID|20231561137^ALPHL|85267-3^X-linked adrenoleukodystrophy (X-ALD) newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|85269-9^X-linked adrenoleukodystrophy newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|12|4560411583^ORDERID|20231561137^ALPHL|92005-8^Spinal muscular atrophy newborn screening panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|92004-1^Spinal muscular atrophy newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|13|4560411583^ORDERID|20231561137^ALPHL|57084-6^Fatty acid oxidation newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46736-5^Fatty acid oxidation defects newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP
ORC|RE|4560411583^ORDERID|20231561137^ALPHL|||||||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI|||||||||BAPTIST EAST^L^^^^CMS^NPI^^^1043269798~BAPTIST EAST^L^^^^AL Public Health Lab^Submitter ID^^^739||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBR|14|4560411583^ORDERID|20231561137^ALPHL|57085-3^Organic acid newborn screen panel^LN|||20230603045000||||O|||||1174911127^SMITH^SAMANTHA^^^^^^NPI^L^^^NPI||||||20230606191613|||F||||423787478&EPIC&1.2.840.114350.1.13.145.2.7.2.695071&ISO^20231561137&AL Public Health Lab&2.16.840.1.114222.4.1.10080&ISO|||||||||||||||||||||57794-0^Newborn screening test results panel - Dried blood spot^LN
OBX|1|CWE|46744-9^Organic acidemias newborn screen interpretation^LN||LA18592-8^In range^LN||||||F|||20230603045000|||||20230606191613||||AL PHL Newborn Screening Laboratory|204 Legends Court^^Prattville^AL^36066|^Miller^Marie||||RSLT|UNSP

From 524e811c83a230d3065a7e1fb4daeb64a5e0f040 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 17:04:38 -0700
Subject: [PATCH 25/30] Updated snapshots in Test/Orders/ folder

---
 ...Fully_Populated_2_fhir_transformation.fhir |  994 +++++++++
 ...ully_Populated_3_hl7_translation_final.hl7 |    1 +
 ...ces_Multiple_Births_1_hl7_translation.fhir | 1832 ++++++++---------
 ...Multiple_Births_2_fhir_transformation.fhir |  985 +++++++++
 ...ultiple_Births_3_hl7_translation_final.hl7 |    1 +
 ...NBS_Incorrect_Units_1_hl7_translation.fhir | 1832 ++++++++---------
 ...Incorrect_Units_2_fhir_transformation.fhir |  985 +++++++++
 ...ncorrect_Units_3_hl7_translation_final.hl7 |    1 +
 ...ncorrect_Data_Types_1_hl7_translation.fhir | 1820 ++++++++--------
 ...rect_Data_Types_2_fhir_transformation.fhir |  979 +++++++++
 ...ect_Data_Types_3_hl7_translation_final.hl7 |    1 +
 ...Required_Fields_2_fhir_transformation.fhir |  860 ++++++++
 ...equired_Fields_3_hl7_translation_final.hl7 |    1 +
 ...ect_Code_System_2_fhir_transformation.fhir |  985 +++++++++
 ...ct_Code_System_3_hl7_translation_final.hl7 |    1 +
 ...Non_Required_Fields_1_hl7_translation.fhir | 1744 ++++++++--------
 ...Required_Fields_2_fhir_transformation.fhir |  935 +++++++++
 ...equired_Fields_3_hl7_translation_final.hl7 |    1 +
 ...ntant_Phone_Numbers_1_hl7_translation.fhir | 1832 ++++++++---------
 ...t_Phone_Numbers_2_fhir_transformation.fhir |  985 +++++++++
 ..._Phone_Numbers_3_hl7_translation_final.hl7 |    1 +
 ...formed_DTM_datatype_1_hl7_translation.fhir |    0
 ...ed_DTM_datatype_2_fhir_transformation.fhir |  664 ++++++
 ...d_DTM_datatype_3_hl7_translation_final.hl7 |    1 +
 ...formed_XAD_datatype_1_hl7_translation.fhir |    0
 ...ed_XAD_datatype_2_fhir_transformation.fhir |  656 ++++++
 ...d_XAD_datatype_3_hl7_translation_final.hl7 |    1 +
 ...ext_as_txt_datatype_1_hl7_translation.fhir |    0
 ...as_txt_datatype_2_fhir_transformation.fhir |  657 ++++++
 ...s_txt_datatype_3_hl7_translation_final.hl7 |    1 +
 30 files changed, 14226 insertions(+), 4530 deletions(-)
 create mode 100644 examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_3_hl7_translation_final.hl7
 create mode 100644 examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_3_hl7_translation_final.hl7
 create mode 100644 examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_3_hl7_translation_final.hl7
 create mode 100644 examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_3_hl7_translation_final.hl7
 create mode 100644 examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_3_hl7_translation_final.hl7
 create mode 100644 examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_3_hl7_translation_final.hl7
 create mode 100644 examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_3_hl7_translation_final.hl7
 create mode 100644 examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_3_hl7_translation_final.hl7
 create mode 100644 examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_1_hl7_translation.fhir
 create mode 100644 examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_3_hl7_translation_final.hl7
 create mode 100644 examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_1_hl7_translation.fhir
 create mode 100644 examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_3_hl7_translation_final.hl7
 create mode 100644 examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_1_hl7_translation.fhir
 create mode 100644 examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_2_fhir_transformation.fhir
 create mode 100644 examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_3_hl7_translation_final.hl7

diff --git a/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_2_fhir_transformation.fhir b/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_2_fhir_transformation.fhir
new file mode 100644
index 000000000..3c5a0aad9
--- /dev/null
+++ b/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_2_fhir_transformation.fhir
@@ -0,0 +1,994 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729293731960903000.d6c5211b-4b66-42ea-9c55-109a209eaa5f",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:22:11.960-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T13:40:09.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729293731963240000.f8113b10-512c-45b9-b6ba-8d29615908cf",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729293731963240000.f8113b10-512c-45b9-b6ba-8d29615908cf",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240224134009"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O21",
+          "display": "OML^O21^OML_O21"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729293731962786000.b1837cad-0d4b-4656-baa7-8abc7b373595"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729293731961700000.96b7dd93-722d-454a-8463-30ed7cce400f"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "DTM"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueDateTime": "2024-02-21T12:18:00-05:00",
+        "_valueDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402211218-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729293732001953000.7631bc65-33b0-4a8f-a00c-607ffccb23b8",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729293732001953000.7631bc65-33b0-4a8f-a00c-607ffccb23b8",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "HOME"
+      }
+    },
+    {
+      "fullUrl": "Observation/1729293732003589000.5aab4cb3-ac54-4679-90c1-9405d0dfe0e3",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729293732003589000.5aab4cb3-ac54-4679-90c1-9405d0dfe0e3",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729293732005089000.6837b6e0-3d49-41ab-9031-5b6276cd2bdf",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729293732005089000.6837b6e0-3d49-41ab-9031-5b6276cd2bdf",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "TEST, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 2"
+              }
+            ],
+            "text": "note 2"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729293732008494000.c8ae3d11-e219-43df-b5cb-48f367131e67",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729293732008494000.c8ae3d11-e219-43df-b5cb-48f367131e67",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_3_hl7_translation_final.hl7 b/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..2c2029290
--- /dev/null
+++ b/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistEast^2.16.840.1.114222.4.1.000001^ISO|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^simulated-lab-id^ISO|20240224134009||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1300974^^^^MR||ONE^TESTCASE||202402210152-0500|F|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||1
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|2801690163|||unknown
OBR|1||||||||||P
OBX|1|ST|||123456||||||F|||202402221854-0500
OBX|2|NM|||3122||||||F|||202402221854-0500
OBX|3|CWE|||LA6112-2^1^LN||||||F|||202402221854-0500
OBX|4|NM|||38||||||F|||202402221854-0500
OBX|5||||||||||F|||202402221854-0500
OBX|6|DT|||202402211218-0500||||||F|||202402221854-0500
OBX|7|ST|||HOME||||||F|||202402221854-0500
OBX|8||||||||||F|||202402221854-0500
OBX|9|ST|||TEST, PROVIDER||||||F|||202402221854-0500
NTE|1||note 1
NTE|2||note 2
SPM|1
diff --git a/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_1_hl7_translation.fhir b/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_1_hl7_translation.fhir
index 29a24c7d8..a99ce37aa 100644
--- a/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_1_hl7_translation.fhir
+++ b/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_1_hl7_translation.fhir
@@ -1,966 +1,966 @@
 {
-    "resourceType": "Bundle",
-    "id": "1710185434144159506.5d4aa0cb-449d-42ee-9ef0-fa4969f0e475",
-    "meta": {
-        "lastUpdated": "2024-03-11T19:30:34.156+00:00"
+  "resourceType": "Bundle",
+  "id": "1710185434144159506.5d4aa0cb-449d-42ee-9ef0-fa4969f0e475",
+  "meta": {
+    "lastUpdated": "2024-03-11T19:30:34.156+00:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-01-18T01:52:00.000+00:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202401180152"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O01",
+          "display": "ORM^O01^ORM_O01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1710185434295205215.917ef1f8-1a60-4af0-903e-6a4b68c2765b"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1710185434235689715.bff2bbbc-6580-4f99-94ee-b84f93fc4496"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
     },
-    "identifier": {
-        "system": "https://reportstream.cdc.gov/prime-router",
-        "value": "Q1960841872T2476960690"
+    {
+      "fullUrl": "Organization/1710185434235689715.bff2bbbc-6580-4f99-94ee-b84f93fc4496",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1710185434235689715.bff2bbbc-6580-4f99-94ee-b84f93fc4496",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistSouth"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000002"
+          }
+        ]
+      }
     },
-    "type": "message",
-    "timestamp": "2024-01-18T01:52:00.000+00:00",
-    "entry": [
-        {
-            "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
-            "resource": {
-                "resourceType": "MessageHeader",
-                "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
-                        "valueString": "8859/1"
-                    },
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-                        "extension": [
-                            {
-                                "url": "MSH.7",
-                                "valueString": "202401180152"
-                            }
-                        ]
-                    }
-                ],
-                "eventCoding": {
-                    "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
-                    "code": "O01",
-                    "display": "ORM^O01^ORM_O01"
-                },
-                "destination": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                                "valueString": "2.16.840.1.114222.4.1.181960.2"
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                                "valueString": "ISO"
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "MSH.5"
-                            }
-                        ],
-                        "name": "ALlabNatus",
-                        "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
-                        "receiver": {
-                            "reference": "Organization/1710185434295205215.917ef1f8-1a60-4af0-903e-6a4b68c2765b"
-                        }
-                    }
-                ],
-                "sender": {
-                    "reference": "Organization/1710185434235689715.bff2bbbc-6580-4f99-94ee-b84f93fc4496"
-                },
-                "source": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                            "valueString": "BaptistOracle"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                            "valueString": "2.16.840.1.114222.4.1.000000"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                            "valueString": "ISO"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                            "valueString": "MSH.3"
-                        }
-                    ],
-                    "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+    {
+      "fullUrl": "Organization/1710185434295205215.917ef1f8-1a60-4af0-903e-6a4b68c2765b",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1710185434295205215.917ef1f8-1a60-4af0-903e-6a4b68c2765b",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
                 }
-            }
-        },
-        {
-            "fullUrl": "Organization/1710185434235689715.bff2bbbc-6580-4f99-94ee-b84f93fc4496",
-            "resource": {
-                "resourceType": "Organization",
-                "id": "1710185434235689715.bff2bbbc-6580-4f99-94ee-b84f93fc4496",
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.1"
-                            }
-                        ],
-                        "value": "BaptistSouth"
-                    },
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.2,HD.3"
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
-                                    "code": "ISO"
-                                }
-                            ]
-                        },
-                        "system": "urn:ietf:rfc:3986",
-                        "value": "2.16.840.1.114222.4.1.000002"
-                    }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227644455"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
                 ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1256872",
+            "assigner": {
+              "reference": "Organization/1710185434749364132.b4ab280f-c511-4eb2-b87b-404081e422be"
             }
-        },
-        {
-            "fullUrl": "Organization/1710185434295205215.917ef1f8-1a60-4af0-903e-6a4b68c2765b",
-            "resource": {
-                "resourceType": "Organization",
-                "id": "1710185434295205215.917ef1f8-1a60-4af0-903e-6a4b68c2765b",
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
                 "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                        "valueString": "MSH.6"
-                    }
-                ],
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.1"
-                            }
-                        ],
-                        "value": "ALlab"
-                    },
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.2,HD.3"
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
-                                    "code": "ISO"
-                                }
-                            ]
-                        },
-                        "system": "urn:ietf:rfc:3986",
-                        "value": "simulated-lab-id"
-                    }
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
                 ]
+              }
+            ],
+            "text": "TestValue",
+            "family": "TWO",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "male",
+        "birthDate": "2024-01-15",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401150152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-01-15T01:52:00-05:00"
             }
+          ]
         },
-        {
-            "fullUrl": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26",
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+        "extension": [
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+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+        },
+        "effectiveDateTime": "2024-01-16T15:00:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401161500-0500"
             }
+          ]
         }
-    ]
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+    },
+    {
+      "fullUrl": "Observation/1710185435335532549.c370f515-22e3-4556-b705-5211d9a92d03",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710185435335532549.c370f515-22e3-4556-b705-5211d9a92d03",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+        },
+        "effectiveDateTime": "2024-01-16T15:00:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
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+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401161500-0500"
+            }
+          ]
+        },
+        "valueString": "TESTTWO, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1710185435351469382.9f7fad5b-c5f7-40bc-95a5-6d7c5beebb98",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1710185435351469382.9f7fad5b-c5f7-40bc-95a5-6d7c5beebb98",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
 }
diff --git a/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_2_fhir_transformation.fhir b/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_2_fhir_transformation.fhir
new file mode 100644
index 000000000..7db5b1280
--- /dev/null
+++ b/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_2_fhir_transformation.fhir
@@ -0,0 +1,985 @@
+{
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+  },
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+            "valueString": "8859/1"
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+                "valueString": "ISO"
+              },
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
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+              "valueString": "MSH.3"
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+                "valueString": "HD.2,HD.3"
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+            "valueString": "MSH.6"
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+        "resourceType": "Patient",
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+        "extension": [
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+            "extension": [
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+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
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+                      "valueString": "PID.18"
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+                "extension": [
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+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
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+            "type": {
+              "coding": [
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
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+                ]
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+            ],
+            "family": "TWO",
+            "given": [
+              "TESTCASE"
+            ]
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+        ],
+        "gender": "male",
+        "birthDate": "2024-01-15",
+        "_birthDate": {
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+              "valueString": "202401150152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-01-15T01:52:00-05:00"
+            }
+          ]
+        },
+        "address": [
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+            "extension": [
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+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 2,
+        "contact": [
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+                    "code": "MTH",
+                    "display": "mother"
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+                ]
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+            "address": {
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+                  "extension": [
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+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                      "extension": [
+                        {
+                          "url": "SAD.1",
+                          "valueString": "1234 GPCS WAY"
+                        }
+                      ]
+                    },
+                    {
+                      "url": "XAD.7",
+                      "valueCode": "home"
+                    }
+                  ]
+                }
+              ],
+              "line": [
+                "1234 GPCS WAY"
+              ],
+              "city": "MONTGOMERY",
+              "district": "Montgomery",
+              "state": "Alabama",
+              "postalCode": "36117",
+              "country": "USA"
+            }
+          }
+        ]
+      }
+    },
+    {
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+                "valueString": "HD.1"
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+            "value": "Baptist South"
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+        "extension": [
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
+            "valueCode": "NW"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
+            "extension": [
+              {
+                "url": "orc-12-ordering-provider",
+                "valueReference": {
+                  "reference": "Practitioner/1729293853808046000.4765e90f-3c15-4e07-9e25-eb4abec65131"
+                }
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+          {
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+            "extension": [
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+                      "extension": [
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+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                          "valueString": "ORDERID"
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+                  "value": "5560411468"
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+                "valueString": "ORC.2"
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+                "valueString": "2.16.840.1.113883.4.6"
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+                "valueCode": "ISO"
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+            ]
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+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
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+                "url": "XCN.10",
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+            "valueString": "ORC.12"
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+                "valueString": "NPI"
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+                "valueString": "2.16.840.1.113883.4.6"
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+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
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+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
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+                "valueString": "2.16.840.1.113883.4.6"
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+                "valueCode": "ISO"
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+            ]
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+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
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+            "extension": [
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+                "url": "OBX.2",
+                "valueId": "NM"
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+                }
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+              "code": "LA6114-8",
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+            "extension": [
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+                "url": "OBX.2",
+                "valueId": "NM"
+              },
+              {
+                "url": "OBX.6"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
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+        },
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+            }
+          ]
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+          "value": 35,
+          "unit": "week",
+          "system": "UCUM",
+          "code": "wk"
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+        "id": "1729293853821382000.7b2fdc78-bfda-4077-bf9b-fd785906f413",
+        "extension": [
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
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+              "valueString": "202401161500-0500"
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+            "extension": [
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+                "url": "OBX.2",
+                "valueId": "DTM"
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+                "valueString": "F"
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+        "extension": [
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
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+        "subject": {
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+        },
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+              "valueString": "202401161500-0500"
+            }
+          ]
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+        "valueString": "Baptist South"
+      }
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+      "resource": {
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+            "extension": [
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+                "url": "OBX.2",
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+                "valueString": "F"
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+              "valueString": "202401161500-0500"
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+        "extension": [
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
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+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+        },
+        "effectiveDateTime": "2024-01-16T15:00:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
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+              "valueString": "202401161500-0500"
+            }
+          ]
+        },
+        "valueString": "TESTTWO, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
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+        "extension": [
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_3_hl7_translation_final.hl7 b/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..851beb561
--- /dev/null
+++ b/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistSouth^2.16.840.1.114222.4.1.000002^ISO|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^simulated-lab-id^ISO|202401180152||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1256872^^^^MR||TWO^TESTCASE||202401150152-0500|M|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||2
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|5560411468|||unknown
OBR|1||||||||||P
OBX|1|ST|||544678||||||F|||202401161500-0500
OBX|2|NM|||2100||||||F|||202401161500-0500
OBX|3|CWE|||LA6114-8^3^LN||||||F|||202401161500-0500
OBX|4|NM|||35||||||F|||202401161500-0500
OBX|5||||||||||F|||202401161500-0500
OBX|6|DT|||202401160500-0500||||||F|||202401161500-0500
OBX|7|ST|||Baptist South||||||F|||202401161500-0500
OBX|8||||||||||F|||202401161500-0500
OBX|9|ST|||TESTTWO, PROVIDER||||||F|||202401161500-0500
NTE|1||note 1
SPM|1
diff --git a/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_1_hl7_translation.fhir b/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_1_hl7_translation.fhir
index f6c0c02d7..9cea481e3 100644
--- a/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_1_hl7_translation.fhir
+++ b/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_1_hl7_translation.fhir
@@ -1,966 +1,966 @@
 {
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+  "resourceType": "Bundle",
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+  "meta": {
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+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
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+  "timestamp": "2024-01-20T01:52:00.000+00:00",
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+      "resource": {
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+        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202401200152"
+              }
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+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O01",
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+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
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+        },
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+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
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     },
-    "identifier": {
-        "system": "https://reportstream.cdc.gov/prime-router",
-        "value": "Q1960841872T2476960690"
+    {
+      "fullUrl": "Organization/1710187328194283716.9bb519dd-b70e-4131-bd65-45f846df241a",
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+                "valueString": "HD.1"
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+            "value": "BaptistSouth"
+          },
+          {
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+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
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+                  "code": "ISO"
+                }
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+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000002"
+          }
+        ]
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+    },
+    {
+      "fullUrl": "Observation/1710187328272616466.34e6cb78-1106-4789-80a2-d6dd5f0c6f85",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710187328272616466.34e6cb78-1106-4789-80a2-d6dd5f0c6f85",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "DTM"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
         },
-        {
-            "fullUrl": "Observation/1710187328276760425.feec07f0-b05f-4a63-8370-fe64aee99b7c",
-            "resource": {
-                "resourceType": "Observation",
-                "id": "1710187328276760425.feec07f0-b05f-4a63-8370-fe64aee99b7c",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "TX"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
-                },
-                "effectiveDateTime": "2024-01-17T01:52:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202401170152-0500"
-                        }
-                    ]
-                },
-                "valueString": "Baptist South"
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
             }
+          ]
         },
-        {
-            "fullUrl": "Observation/1710187328280783258.0bd9eedb-1207-4d65-b53c-2bb066760111",
-            "resource": {
-                "resourceType": "Observation",
-                "id": "1710187328280783258.0bd9eedb-1207-4d65-b53c-2bb066760111",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "XAD"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
-                },
-                "effectiveDateTime": "2024-01-17T01:52:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202401170152-0500"
-                        }
-                    ]
-                }
+        "valueDateTime": "2024-01-16T05:00:00-05:00",
+        "_valueDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401160500-0500"
             }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1710187328276760425.feec07f0-b05f-4a63-8370-fe64aee99b7c",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710187328276760425.feec07f0-b05f-4a63-8370-fe64aee99b7c",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
         },
-        {
-            "fullUrl": "Observation/1710187328284601050.ce5f15de-b77d-4010-b462-e06f5e6b244a",
-            "resource": {
-                "resourceType": "Observation",
-                "id": "1710187328284601050.ce5f15de-b77d-4010-b462-e06f5e6b244a",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "TX"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
-                },
-                "effectiveDateTime": "2024-01-17T01:52:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202401170152-0500"
-                        }
-                    ]
-                },
-                "valueString": "TESTTHREE, PROVIDER",
-                "note": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
-                                "valueId": "note 1"
-                            }
-                        ],
-                        "text": "note 1"
-                    }
-                ]
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
             }
+          ]
         },
-        {
-            "fullUrl": "Specimen/1710187328294739883.876c658c-c76e-4f81-8271-79d5497b8cd6",
-            "resource": {
-                "resourceType": "Specimen",
-                "id": "1710187328294739883.876c658c-c76e-4f81-8271-79d5497b8cd6",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
-                        "valueString": "SPM"
-                    }
-                ]
+        "valueString": "Baptist South"
+      }
+    },
+    {
+      "fullUrl": "Observation/1710187328280783258.0bd9eedb-1207-4d65-b53c-2bb066760111",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710187328280783258.0bd9eedb-1207-4d65-b53c-2bb066760111",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
             }
+          ]
         }
-    ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1710187328284601050.ce5f15de-b77d-4010-b462-e06f5e6b244a",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710187328284601050.ce5f15de-b77d-4010-b462-e06f5e6b244a",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        },
+        "valueString": "TESTTHREE, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1710187328294739883.876c658c-c76e-4f81-8271-79d5497b8cd6",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1710187328294739883.876c658c-c76e-4f81-8271-79d5497b8cd6",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
 }
diff --git a/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_2_fhir_transformation.fhir b/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_2_fhir_transformation.fhir
new file mode 100644
index 000000000..fb9af291f
--- /dev/null
+++ b/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_2_fhir_transformation.fhir
@@ -0,0 +1,985 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729294809541500000.7bdeaa4d-fec7-4805-bd8c-bf7605a4693c",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:40:09.541-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-01-20T01:52:00.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729294809544209000.690b4763-fb98-4c3a-a352-64d107c2057d",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729294809544209000.690b4763-fb98-4c3a-a352-64d107c2057d",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202401200152"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O21",
+          "display": "OML^O21^OML_O21"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729294809543576000.e922401a-5225-403c-b8f0-9b122fbbb225"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729294809542255000.bde757d3-c43c-416a-87cf-3d481bae0e9d"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294809542255000.bde757d3-c43c-416a-87cf-3d481bae0e9d",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294809542255000.bde757d3-c43c-416a-87cf-3d481bae0e9d",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistSouth"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000002"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294809543576000.e922401a-5225-403c-b8f0-9b122fbbb225",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294809543576000.e922401a-5225-403c-b8f0-9b122fbbb225",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227644455"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1256872",
+            "assigner": {
+              "reference": "Organization/1729294809546485000.18e3d38d-06df-4e8d-b1ee-294cebcb22e1"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
+            ],
+            "family": "THREE",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "unknown",
+        "birthDate": "2024-01-16",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401160152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-01-16T01:52:00-05:00"
+            }
+          ]
+        },
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1,
+        "contact": [
+          {
+            "relationship": [
+              {
+                "coding": [
+                  {
+                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
+                    "code": "MTH",
+                    "display": "mother"
+                  }
+                ]
+              }
+            ],
+            "address": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                      "extension": [
+                        {
+                          "url": "SAD.1",
+                          "valueString": "1234 GPCS WAY"
+                        }
+                      ]
+                    },
+                    {
+                      "url": "XAD.7",
+                      "valueCode": "home"
+                    }
+                  ]
+                }
+              ],
+              "line": [
+                "1234 GPCS WAY"
+              ],
+              "city": "MONTGOMERY",
+              "district": "Montgomery",
+              "state": "Alabama",
+              "postalCode": "36117",
+              "country": "USA"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294809546485000.18e3d38d-06df-4e8d-b1ee-294cebcb22e1",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294809546485000.18e3d38d-06df-4e8d-b1ee-294cebcb22e1",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Baptist South"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "ServiceRequest/1729294809561023000.784a311f-6eb1-466e-b366-7b17e080f4b6",
+      "resource": {
+        "resourceType": "ServiceRequest",
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
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+                }
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
+            "extension": [
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+                "url": "OBR.2",
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+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                          "valueString": "ORDERID"
+                        }
+                      ]
+                    }
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+                  "value": "8765411468"
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+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
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+                  "code": "PLAC"
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+            "valueString": "ORC.12"
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+            "value": "90535"
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+        ],
+        "identifier": [
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+            "extension": [
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+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
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+                "valueCode": "ISO"
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
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+                "url": "XCN.10",
+                "valueString": "L"
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+            ]
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+        "identifier": [
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+            "system": "NPI",
+            "value": "90535"
+          }
+        ],
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+            "use": "official"
+          }
+        ]
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+        "extension": [
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+            "extension": [
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+                "url": "OBX.11",
+                "valueString": "F"
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+        },
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+        "_effectiveDateTime": {
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+              "valueString": "202401170152-0500"
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+        "valueString": "787646"
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+      "resource": {
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "NM"
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+              {
+                "url": "OBX.6"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
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+            ]
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+        "subject": {
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+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
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+              "valueString": "202401170152-0500"
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+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
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+                "url": "OBX.2",
+                "valueId": "CWE"
+              },
+              {
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+                "valueString": "F"
+              }
+            ]
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+        ],
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+        "subject": {
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+        },
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+        "_effectiveDateTime": {
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+              "valueString": "202401170152-0500"
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+                  "valueString": "coding"
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+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA6114-8",
+              "display": "3"
+            }
+          ]
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+      }
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+    {
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+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "NM"
+              },
+              {
+                "url": "OBX.6"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        },
+        "valueQuantity": {
+          "value": 35,
+          "unit": "month",
+          "system": "UCUM",
+          "code": "mo"
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294809572641000.e529a29d-a38d-4f59-aa8b-8121f825b367",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294809572641000.e529a29d-a38d-4f59-aa8b-8121f825b367",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
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+              "valueString": "202401170152-0500"
+            }
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+    },
+    {
+      "fullUrl": "Observation/1729294809574625000.ff2a82fc-1d93-4a93-83dd-eee540848267",
+      "resource": {
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+        "id": "1729294809574625000.ff2a82fc-1d93-4a93-83dd-eee540848267",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "DTM"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
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+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        },
+        "valueDateTime": "2024-01-16T05:00:00-05:00",
+        "_valueDateTime": {
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+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401160500-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294809576514000.41de17f4-3eb3-4412-9198-a25c4ac176d9",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294809576514000.41de17f4-3eb3-4412-9198-a25c4ac176d9",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        },
+        "valueString": "Baptist South"
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294809578164000.dbdb8a85-4a9a-4fc4-b679-e9ead5085bcf",
+      "resource": {
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+        "id": "1729294809578164000.dbdb8a85-4a9a-4fc4-b679-e9ead5085bcf",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294809579839000.6e914907-83d6-4b8b-b181-17fa9b964dd5",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294809579839000.6e914907-83d6-4b8b-b181-17fa9b964dd5",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        },
+        "valueString": "TESTTHREE, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729294809583150000.41fcd698-d0a8-4864-af74-ef53f36bbc8c",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729294809583150000.41fcd698-d0a8-4864-af74-ef53f36bbc8c",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_3_hl7_translation_final.hl7 b/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..99e7384f8
--- /dev/null
+++ b/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistSouth^2.16.840.1.114222.4.1.000002^ISO|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^simulated-lab-id^ISO|202401200152||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1256872^^^^MR||THREE^TESTCASE||202401160152-0500|U|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||1
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|8765411468|||unknown
OBR|1||||||||||P
OBX|1|ST|||787646||||||F|||202401170152-0500
OBX|2|NM|||2100||||||F|||202401170152-0500
OBX|3|CWE|||LA6114-8^3^LN||||||F|||202401170152-0500
OBX|4|NM|||35||||||F|||202401170152-0500
OBX|5||||||||||F|||202401170152-0500
OBX|6|DT|||202401160500-0500||||||F|||202401170152-0500
OBX|7|ST|||Baptist South||||||F|||202401170152-0500
OBX|8||||||||||F|||202401170152-0500
OBX|9|ST|||TESTTHREE, PROVIDER||||||F|||202401170152-0500
NTE|1||note 1
SPM|1
diff --git a/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_1_hl7_translation.fhir b/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_1_hl7_translation.fhir
index f21593b7c..9af72ea56 100644
--- a/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_1_hl7_translation.fhir
+++ b/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_1_hl7_translation.fhir
@@ -1,960 +1,960 @@
 {
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-    "meta": {
-        "lastUpdated": "2024-03-11T20:26:32.314+00:00"
+  "resourceType": "Bundle",
+  "id": "1710188792313526755.af8d823f-4e1f-4f27-8d60-fb1b91cf9de6",
+  "meta": {
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+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-01-20T01:52:00.000+00:00",
+  "entry": [
+    {
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+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202401200152"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O01",
+          "display": "ORM^O01^ORM_O01"
+        },
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+          {
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+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
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+        },
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+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
     },
-    "identifier": {
-        "system": "https://reportstream.cdc.gov/prime-router",
-        "value": "Q1960841872T2476960690"
+    {
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+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistSouth"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000002"
+          }
+        ]
+      }
     },
-    "type": "message",
-    "timestamp": "2024-01-20T01:52:00.000+00:00",
-    "entry": [
-        {
-            "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
-            "resource": {
-                "resourceType": "MessageHeader",
-                "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
-                        "valueString": "8859/1"
-                    },
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-                        "extension": [
-                            {
-                                "url": "MSH.7",
-                                "valueString": "202401200152"
-                            }
-                        ]
-                    }
-                ],
-                "eventCoding": {
-                    "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
-                    "code": "O01",
-                    "display": "ORM^O01^ORM_O01"
-                },
-                "destination": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                                "valueString": "2.16.840.1.114222.4.1.181960.2"
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                                "valueString": "ISO"
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "MSH.5"
-                            }
-                        ],
-                        "name": "ALlabNatus",
-                        "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
-                        "receiver": {
-                            "reference": "Organization/1710188792357600922.a7033f6b-7622-456d-9811-0fd982dc9dd0"
-                        }
-                    }
-                ],
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-                },
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-                    "extension": [
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-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                            "valueString": "BaptistOracle"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                            "valueString": "2.16.840.1.114222.4.1.000000"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                            "valueString": "ISO"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                            "valueString": "MSH.3"
-                        }
-                    ],
-                    "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+    {
+      "fullUrl": "Organization/1710188792357600922.a7033f6b-7622-456d-9811-0fd982dc9dd0",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1710188792357600922.a7033f6b-7622-456d-9811-0fd982dc9dd0",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
                 }
-            }
-        },
-        {
-            "fullUrl": "Organization/1710188792344011880.b62bcab8-ed28-4f5d-a49b-aca0cab603fd",
-            "resource": {
-                "resourceType": "Organization",
-                "id": "1710188792344011880.b62bcab8-ed28-4f5d-a49b-aca0cab603fd",
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.1"
-                            }
-                        ],
-                        "value": "BaptistSouth"
-                    },
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.2,HD.3"
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
-                                    "code": "ISO"
-                                }
-                            ]
-                        },
-                        "system": "urn:ietf:rfc:3986",
-                        "value": "2.16.840.1.114222.4.1.000002"
-                    }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227644455"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
                 ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1256872",
+            "assigner": {
+              "reference": "Organization/1710188792367587505.cabbc41c-b5fa-4c27-94d6-5392ed4be1fa"
             }
-        },
-        {
-            "fullUrl": "Organization/1710188792357600922.a7033f6b-7622-456d-9811-0fd982dc9dd0",
-            "resource": {
-                "resourceType": "Organization",
-                "id": "1710188792357600922.a7033f6b-7622-456d-9811-0fd982dc9dd0",
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
                 "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                        "valueString": "MSH.6"
-                    }
-                ],
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.1"
-                            }
-                        ],
-                        "value": "ALlab"
-                    },
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.2,HD.3"
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
-                                    "code": "ISO"
-                                }
-                            ]
-                        },
-                        "system": "urn:ietf:rfc:3986",
-                        "value": "simulated-lab-id"
-                    }
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
                 ]
+              }
+            ],
+            "text": "TestValue",
+            "family": "FOUR",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "unknown",
+        "birthDate": "2024-01-16",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401160152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-01-16T01:52:00-05:00"
             }
+          ]
         },
-        {
-            "fullUrl": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b",
-            "resource": {
-                "resourceType": "Patient",
-                "id": "1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b",
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
                 "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
-                        "extension": [
-                            {
-                                "url": "PID.8"
-                            },
-                            {
-                                "url": "PID.18",
-                                "valueIdentifier": {
-                                    "extension": [
-                                        {
-                                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                            "valueString": "PID.18"
-                                        }
-                                    ],
-                                    "value": "2227644455"
-                                }
-                            }
-                        ]
-                    }
-                ],
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
-                                "extension": [
-                                    {
-                                        "url": "CX.5",
-                                        "valueString": "MR"
-                                    }
-                                ]
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "PID.3"
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "code": "MR"
-                                }
-                            ]
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-                        "value": "1256872",
-                        "assigner": {
-                            "reference": "Organization/1710188792367587505.cabbc41c-b5fa-4c27-94d6-5392ed4be1fa"
-                        }
-                    }
-                ],
-                "name": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
-                                "extension": [
-                                    {
-                                        "url": "XPN.2",
-                                        "valueString": "TESTCASE"
-                                    }
-                                ]
-                            }
-                        ],
-                        "text": "TestValue",
-                        "family": "FOUR",
-                        "given": [
-                            "TESTCASE"
-                        ]
-                    }
-                ],
-                "gender": "unknown",
-                "birthDate": "2024-01-16",
-                "_birthDate": {
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
                     "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202401160152-0500"
-                        },
-                        {
-                            "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
-                            "valueDateTime": "2024-01-16T01:52:00-05:00"
-                        }
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
                     ]
-                },
-                "address": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
-                                "extension": [
-                                    {
-                                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
-                                        "extension": [
-                                            {
-                                                "url": "SAD.1",
-                                                "valueString": "1234 GPCS WAY"
-                                            }
-                                        ]
-                                    },
-                                    {
-                                        "url": "XAD.7",
-                                        "valueCode": "home"
-                                    }
-                                ]
-                            }
-                        ],
-                        "line": [
-                            "1234 GPCS WAY"
-                        ],
-                        "city": "MONTGOMERY",
-                        "district": "Montgomery",
-                        "state": "Alabama",
-                        "postalCode": "36117",
-                        "country": "USA"
-                    }
-                ],
-                "multipleBirthInteger": 1
-            }
-        },
-        {
-            "fullUrl": "Organization/1710188792367587505.cabbc41c-b5fa-4c27-94d6-5392ed4be1fa",
-            "resource": {
-                "resourceType": "Organization",
-                "id": "1710188792367587505.cabbc41c-b5fa-4c27-94d6-5392ed4be1fa",
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.1"
-                            }
-                        ],
-                        "value": "Baptist South"
-                    }
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
                 ]
-            }
-        },
-        {
-            "fullUrl": "ServiceRequest/1710188792427888547.7a0249e3-d1f5-4b2b-b4da-b2cc46d025f6",
-            "resource": {
-                "resourceType": "ServiceRequest",
-                "id": "1710188792427888547.7a0249e3-d1f5-4b2b-b4da-b2cc46d025f6",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
-                        "valueCode": "NW"
-                    },
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
-                        "extension": [
-                            {
-                                "url": "orc-12-ordering-provider",
-                                "valueReference": {
-                                    "reference": "Practitioner/1710188792422870922.40a539db-08d3-43ae-9fdd-51ef62420bc5"
-                                }
-                            }
-                        ]
-                    },
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
-                        "extension": [
-                            {
-                                "url": "OBR.2",
-                                "valueIdentifier": {
-                                    "extension": [
-                                        {
-                                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
-                                            "extension": [
-                                                {
-                                                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                                                    "valueString": "ORDERID"
-                                                }
-                                            ]
-                                        }
-                                    ],
-                                    "value": "8765411468"
-                                }
-                            },
-                            {
-                                "url": "OBR.16",
-                                "valueReference": {
-                                    "reference": "Practitioner/1710188792426594422.8e5b250e-486e-4da3-9dfc-ed7c238cce61"
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-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "ORC.2"
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
-                                "extension": [
-                                    {
-                                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                                        "valueString": "ORDERID"
-                                    }
-                                ]
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
-                                    "code": "PLAC"
-                                }
-                            ]
-                        },
-                        "value": "8765411468"
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1
+      }
+    },
+    {
+      "fullUrl": "Organization/1710188792367587505.cabbc41c-b5fa-4c27-94d6-5392ed4be1fa",
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-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "NM"
-                            },
-                            {
-                                "url": "OBX.6"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
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-                "status": "final",
-                "subject": {
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-                            "valueString": "202401170152-0500"
-                        }
-                    ]
+        "valueQuantity": {
+          "value": 35,
+          "unit": "week",
+          "system": "UCUM",
+          "code": "wk"
+        }
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+    {
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+      "resource": {
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+        "id": "1710188792446528713.ce82ac6e-f6b0-4e1d-a318-5ab0a6f1ba45",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
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+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
+                  "valueString": "coding"
                 },
-                "valueQuantity": {
-                    "value": 35,
-                    "unit": "week",
-                    "system": "UCUM",
-                    "code": "wk"
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
+                  "valueString": "LN"
                 }
+              ],
+              "system": "http://loinc.org",
+              "code": "67704-7",
+              "display": "Feeding types"
             }
+          ]
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-            "fullUrl": "Observation/1710188792446528713.ce82ac6e-f6b0-4e1d-a318-5ab0a6f1ba45",
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-                "extension": [
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-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "CE"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
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-                "status": "final",
-                "code": {
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-                                    "valueString": "coding"
-                                },
-                                {
-                                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                                    "valueString": "LN"
-                                }
-                            ],
-                            "system": "http://loinc.org",
-                            "code": "67704-7",
-                            "display": "Feeding types"
-                        }
-                    ]
-                },
-                "subject": {
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-                        {
-                            "extension": [
-                                {
-                                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                                    "valueString": "coding"
-                                },
-                                {
-                                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                                    "valueString": "LN"
-                                }
-                            ],
-                            "system": "http://loinc.org",
-                            "code": "LA16915-3",
-                            "display": "Lactose formula"
-                        }
-                    ]
-                }
+        "subject": {
+          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
             }
+          ]
         },
-        {
-            "fullUrl": "Observation/1710188792451528172.69385ef0-1e3a-4fdd-bc33-9c01ce8b1488",
-            "resource": {
-                "resourceType": "Observation",
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-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "DTM"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
-                },
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-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202401170152-0500"
-                        }
-                    ]
+        "valueCodeableConcept": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
+                  "valueString": "coding"
                 },
-                "valueDateTime": "2024-01-16T05:00:00-05:00",
-                "_valueDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202401160500-0500"
-                        }
-                    ]
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
+                  "valueString": "LN"
                 }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA16915-3",
+              "display": "Lactose formula"
             }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1710188792451528172.69385ef0-1e3a-4fdd-bc33-9c01ce8b1488",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710188792451528172.69385ef0-1e3a-4fdd-bc33-9c01ce8b1488",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "DTM"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
         },
-        {
-            "fullUrl": "Observation/1710188792454420172.dbc7c418-53c1-407a-9364-e39118a5006e",
-            "resource": {
-                "resourceType": "Observation",
-                "id": "1710188792454420172.dbc7c418-53c1-407a-9364-e39118a5006e",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "TX"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
-                },
-                "effectiveDateTime": "2024-01-17T01:52:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202401170152-0500"
-                        }
-                    ]
-                },
-                "valueString": "Baptist South"
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
             }
+          ]
         },
-        {
-            "fullUrl": "Observation/1710188792458448547.ff760483-c087-4e97-8d15-3d032987ea7e",
-            "resource": {
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-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "XAD"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
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-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202401170152-0500"
-                        }
-                    ]
-                }
+        "valueDateTime": "2024-01-16T05:00:00-05:00",
+        "_valueDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401160500-0500"
             }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1710188792454420172.dbc7c418-53c1-407a-9364-e39118a5006e",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710188792454420172.dbc7c418-53c1-407a-9364-e39118a5006e",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
         },
-        {
-            "fullUrl": "Observation/1710188792462730005.014df8ff-3f96-41da-9756-e1af82df3e7d",
-            "resource": {
-                "resourceType": "Observation",
-                "id": "1710188792462730005.014df8ff-3f96-41da-9756-e1af82df3e7d",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "TX"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
-                },
-                "effectiveDateTime": "2024-01-17T01:52:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202401170152-0500"
-                        }
-                    ]
-                },
-                "valueString": "TESTFOUR, PROVIDER",
-                "note": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
-                                "valueId": "note 1"
-                            }
-                        ],
-                        "text": "note 1"
-                    }
-                ]
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
             }
+          ]
         },
-        {
-            "fullUrl": "Specimen/1710188792472506172.8a25fc36-3a7c-474e-b7e2-156b2df5fccf",
-            "resource": {
-                "resourceType": "Specimen",
-                "id": "1710188792472506172.8a25fc36-3a7c-474e-b7e2-156b2df5fccf",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
-                        "valueString": "SPM"
-                    }
-                ]
+        "valueString": "Baptist South"
+      }
+    },
+    {
+      "fullUrl": "Observation/1710188792458448547.ff760483-c087-4e97-8d15-3d032987ea7e",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710188792458448547.ff760483-c087-4e97-8d15-3d032987ea7e",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
             }
+          ]
         }
-    ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1710188792462730005.014df8ff-3f96-41da-9756-e1af82df3e7d",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710188792462730005.014df8ff-3f96-41da-9756-e1af82df3e7d",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        },
+        "valueString": "TESTFOUR, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1710188792472506172.8a25fc36-3a7c-474e-b7e2-156b2df5fccf",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1710188792472506172.8a25fc36-3a7c-474e-b7e2-156b2df5fccf",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
 }
diff --git a/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_2_fhir_transformation.fhir b/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_2_fhir_transformation.fhir
new file mode 100644
index 000000000..f4f38963a
--- /dev/null
+++ b/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_2_fhir_transformation.fhir
@@ -0,0 +1,979 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729293968076765000.608ef3ae-4f32-43f5-8e5c-be0869c445e3",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:26:08.076-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-01-20T01:52:00.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729293968079747000.71b6ecf2-dbc8-4e26-bff5-28f89d17785c",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729293968079747000.71b6ecf2-dbc8-4e26-bff5-28f89d17785c",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202401200152"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O21",
+          "display": "OML^O21^OML_O21"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729293968079272000.3ffbf2b1-d7a0-4b4b-b5fd-15e79375277d"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729293968078004000.503923e6-23d5-48f4-a0e9-8371af498405"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293968078004000.503923e6-23d5-48f4-a0e9-8371af498405",
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+          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        },
+        "valueDateTime": "2024-01-16T05:00:00-05:00",
+        "_valueDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401160500-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729293968110860000.62b013e8-cde1-4159-98b0-69a8f51bbd19",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729293968110860000.62b013e8-cde1-4159-98b0-69a8f51bbd19",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        },
+        "valueString": "Baptist South"
+      }
+    },
+    {
+      "fullUrl": "Observation/1729293968112474000.93cfcf7e-4239-4887-803c-b8236d849474",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729293968112474000.93cfcf7e-4239-4887-803c-b8236d849474",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729293968114037000.908bcca7-7193-441e-870b-90c204884141",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729293968114037000.908bcca7-7193-441e-870b-90c204884141",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+        },
+        "effectiveDateTime": "2024-01-17T01:52:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202401170152-0500"
+            }
+          ]
+        },
+        "valueString": "TESTFOUR, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729293968117226000.bbfd1112-0fc8-457a-953e-31d6a877df05",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729293968117226000.bbfd1112-0fc8-457a-953e-31d6a877df05",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_3_hl7_translation_final.hl7 b/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..ab34363d0
--- /dev/null
+++ b/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistSouth^2.16.840.1.114222.4.1.000002^ISO|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^simulated-lab-id^ISO|202401200152||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1256872^^^^MR||FOUR^TESTCASE||202401160152-0500|U|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||1
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|8765411468|||unknown
OBR|1||||||||||P
OBX|1|ST|||787646||||||F|||202401170152-0500
OBX|2|NM|||2100||||||F|||202401170152-0500
OBX|3|CWE|||LA6114-8^3^LN||||||F|||202401170152-0500
OBX|4|NM|||35||||||F|||202401170152-0500
OBX|5||||||||||F|||202401170152-0500
OBX|6|DT|||202401160500-0500||||||F|||202401170152-0500
OBX|7|ST|||Baptist South||||||F|||202401170152-0500
OBX|8||||||||||F|||202401170152-0500
OBX|9|ST|||TESTFOUR, PROVIDER||||||F|||202401170152-0500
NTE|1||note 1
SPM|1
diff --git a/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_2_fhir_transformation.fhir b/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_2_fhir_transformation.fhir
new file mode 100644
index 000000000..2eacd9aa9
--- /dev/null
+++ b/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_2_fhir_transformation.fhir
@@ -0,0 +1,860 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729294687049336000.830fb29a-6626-4978-a3c4-813fbe79be28",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:38:07.049-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T01:52:00.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729294687050648000.0b249881-d561-4700-bfdc-2d5f49ca3ef9",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729294687050648000.0b249881-d561-4700-bfdc-2d5f49ca3ef9",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202402240152"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O21",
+          "display": "OML^O21^OML_O21"
+        }
+      }
+    },
+    {
+      "fullUrl": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729294687052552000.c875e5c5-e898-4b31-ac86-a341ae352bd8"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
+            ],
+            "family": "FIVE",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "birthDate": "2024-02-21",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402210152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-02-21T01:52:00-05:00"
+            }
+          ]
+        },
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1,
+        "contact": [
+          {
+            "relationship": [
+              {
+                "coding": [
+                  {
+                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
+                    "code": "MTH",
+                    "display": "mother"
+                  }
+                ]
+              }
+            ],
+            "address": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                      "extension": [
+                        {
+                          "url": "SAD.1",
+                          "valueString": "1234 GPCS WAY"
+                        }
+                      ]
+                    },
+                    {
+                      "url": "XAD.7",
+                      "valueCode": "home"
+                    }
+                  ]
+                }
+              ],
+              "line": [
+                "1234 GPCS WAY"
+              ],
+              "city": "MONTGOMERY",
+              "district": "Montgomery",
+              "state": "Alabama",
+              "postalCode": "36117",
+              "country": "USA"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294687052552000.c875e5c5-e898-4b31-ac86-a341ae352bd8",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294687052552000.c875e5c5-e898-4b31-ac86-a341ae352bd8",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Baptist East"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "ServiceRequest/1729294687068496000.54bfcfab-e6c1-4b84-9191-50ef21263b3f",
+      "resource": {
+        "resourceType": "ServiceRequest",
+        "id": "1729294687068496000.54bfcfab-e6c1-4b84-9191-50ef21263b3f",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
+            "valueCode": "NW"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
+            "extension": [
+              {
+                "url": "orc-12-ordering-provider",
+                "valueReference": {
+                  "reference": "Practitioner/1729294687066333000.b0a5fc75-d743-4d64-98aa-99dbcd1df413"
+                }
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
+            "extension": [
+              {
+                "url": "OBR.2",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                          "valueString": "ORDERID"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "4560411583"
+                }
+              },
+              {
+                "url": "OBR.16",
+                "valueReference": {
+                  "reference": "Practitioner/1729294687067909000.abbf6e99-3c45-4428-bdf8-9178f40990d2"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          }
+        ],
+        "status": "unknown",
+        "subject": {
+          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+        },
+        "requester": {
+          "reference": "Practitioner/1729294687063473000.f1ddded0-19f0-402b-a086-f512b210b42c"
+        }
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294687063473000.f1ddded0-19f0-402b-a086-f512b210b42c",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294687063473000.f1ddded0-19f0-402b-a086-f512b210b42c",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "ORC.12"
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294687066333000.b0a5fc75-d743-4d64-98aa-99dbcd1df413",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294687066333000.b0a5fc75-d743-4d64-98aa-99dbcd1df413",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294687067909000.abbf6e99-3c45-4428-bdf8-9178f40990d2",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294687067909000.abbf6e99-3c45-4428-bdf8-9178f40990d2",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294687070464000.e6f3dc8e-04a4-48a1-8341-8a3ce881b18c",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294687070464000.e6f3dc8e-04a4-48a1-8341-8a3ce881b18c",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "ST"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "123456"
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294687073337000.1d8d84a9-76e0-4a8a-9400-f6b4f1805825",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294687073337000.1d8d84a9-76e0-4a8a-9400-f6b4f1805825",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "NM"
+              },
+              {
+                "url": "OBX.6"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueQuantity": {
+          "value": 3122,
+          "unit": "gram",
+          "system": "UCUM",
+          "code": "g"
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294687076289000.63742533-d66d-4716-a022-947b1e754df8",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294687076289000.63742533-d66d-4716-a022-947b1e754df8",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CWE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueCodeableConcept": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA6112-2",
+              "display": "1"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294687078506000.eb94dbda-f1ba-40a5-92af-86a5591a0afe",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294687078506000.eb94dbda-f1ba-40a5-92af-86a5591a0afe",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "NM"
+              },
+              {
+                "url": "OBX.6"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueQuantity": {
+          "value": 38,
+          "unit": "week",
+          "system": "UCUM",
+          "code": "wk"
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294687080583000.78361666-0875-48aa-af14-10d338fbef20",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294687080583000.78361666-0875-48aa-af14-10d338fbef20",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294687082494000.a7641311-d8f9-424a-a5a5-9a60d1ff3612",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294687082494000.a7641311-d8f9-424a-a5a5-9a60d1ff3612",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "DTM"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueDateTime": "2024-02-21T12:18:00-05:00",
+        "_valueDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402211218-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294687084372000.e0198319-8f0d-498d-8dbf-1804a32f7b3f",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294687084372000.e0198319-8f0d-498d-8dbf-1804a32f7b3f",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "Baptist East"
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294687086164000.e1ee3893-5b32-4094-bac8-b7a79da5a5f2",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294687086164000.e1ee3893-5b32-4094-bac8-b7a79da5a5f2",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294687087828000.8e0843da-2401-48dd-96e3-fffa0de5f3b4",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294687087828000.8e0843da-2401-48dd-96e3-fffa0de5f3b4",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "TEST, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729294687091120000.285018b8-6689-41ea-a44f-62725c5264f7",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729294687091120000.285018b8-6689-41ea-a44f-62725c5264f7",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_3_hl7_translation_final.hl7 b/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..a9c1c2c0b
--- /dev/null
+++ b/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|||||202402240152||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1300974^^^^MR||FIVE^TESTCASE||202402210152-0500|F|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||1
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|4560411583|||unknown
OBR|1||||||||||P
OBX|1|ST|||123456||||||F|||202402221854-0500
OBX|2|NM|||3122||||||F|||202402221854-0500
OBX|3|CWE|||LA6112-2^1^LN||||||F|||202402221854-0500
OBX|4|NM|||38||||||F|||202402221854-0500
OBX|5||||||||||F|||202402221854-0500
OBX|6|DT|||202402211218-0500||||||F|||202402221854-0500
OBX|7|ST|||Baptist East||||||F|||202402221854-0500
OBX|8||||||||||F|||202402221854-0500
OBX|9|ST|||TEST, PROVIDER||||||F|||202402221854-0500
NTE|1||note 1
SPM|1
diff --git a/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_2_fhir_transformation.fhir b/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_2_fhir_transformation.fhir
new file mode 100644
index 000000000..2ec134064
--- /dev/null
+++ b/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_2_fhir_transformation.fhir
@@ -0,0 +1,985 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729294326497307000.76fe46a3-9ad3-4ef5-a524-30bcf116d656",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:32:06.497-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T01:52:00.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729294326499346000.1f10f807-390c-43a5-a13e-14e84e342811",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729294326499346000.1f10f807-390c-43a5-a13e-14e84e342811",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202402240152"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O21",
+          "display": "OML^O21^OML_O21"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729294326498759000.5f884252-2e8a-413d-9ab9-8f11b8ac21f6"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729294326497869000.020c15da-5ce4-44b4-b99b-f3941b9cf6d9"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294326497869000.020c15da-5ce4-44b4-b99b-f3941b9cf6d9",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294326497869000.020c15da-5ce4-44b4-b99b-f3941b9cf6d9",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294326498759000.5f884252-2e8a-413d-9ab9-8f11b8ac21f6",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294326498759000.5f884252-2e8a-413d-9ab9-8f11b8ac21f6",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729294326501094000.d99a9273-b572-4db5-975f-b6272132e4c2"
+            }
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+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "TEST, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729294326529308000.00f493b9-8ff1-4a76-bd77-a360a78cc923",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729294326529308000.00f493b9-8ff1-4a76-bd77-a360a78cc923",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_3_hl7_translation_final.hl7 b/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..9bea0b260
--- /dev/null
+++ b/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistEast^2.16.840.1.114222.4.1.000001^ISO|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^simulated-lab-id^ISO|202402240152||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1300974^^^^MR||SIX^TESTCASE||202402210152-0500|F|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||1
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|4560411583|||unknown
OBR|1||||||||||P
OBX|1|ST|||123456||||||F|||202402221854-0500
OBX|2|NM|||3122||||||F|||202402221854-0500
OBX|3|CWE|||LA6112-2^1^LN||||||F|||202402221854-0500
OBX|4|NM|||38||||||F|||202402221854-0500
OBX|5||||||||||F|||202402221854-0500
OBX|6|DT|||202402211218-0500||||||F|||202402221854-0500
OBX|7|ST|||Baptist East||||||F|||202402221854-0500
OBX|8||||||||||F|||202402221854-0500
OBX|9|ST|||TEST, PROVIDER||||||F|||202402221854-0500
NTE|1||note 1
SPM|1
diff --git a/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_1_hl7_translation.fhir b/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_1_hl7_translation.fhir
index 138b5d9ef..4855f1239 100644
--- a/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_1_hl7_translation.fhir
+++ b/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_1_hl7_translation.fhir
@@ -1,916 +1,916 @@
 {
-    "resourceType": "Bundle",
-    "id": "1710191037028009502.d4e6f24d-44ea-4a60-a678-b5424456dd1d",
-    "meta": {
-        "lastUpdated": "2024-03-11T21:03:57.028+00:00"
+  "resourceType": "Bundle",
+  "id": "1710191037028009502.d4e6f24d-44ea-4a60-a678-b5424456dd1d",
+  "meta": {
+    "lastUpdated": "2024-03-11T21:03:57.028+00:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T01:52:00.000+00:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202402240152"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O01",
+          "display": "ORM^O01^ORM_O01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1710191037059476044.4e40b3f3-3d8d-44af-a4e1-1e0a17a1719b"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1710191037056103336.450a74ae-29bb-43aa-902b-105e6158f174"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
     },
-    "identifier": {
-        "system": "https://reportstream.cdc.gov/prime-router",
-        "value": "Q1960841872T2476960690"
+    {
+      "fullUrl": "Organization/1710191037056103336.450a74ae-29bb-43aa-902b-105e6158f174",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1710191037056103336.450a74ae-29bb-43aa-902b-105e6158f174",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
     },
-    "type": "message",
-    "timestamp": "2024-02-24T01:52:00.000+00:00",
-    "entry": [
-        {
-            "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
-            "resource": {
-                "resourceType": "MessageHeader",
-                "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
-                        "valueString": "8859/1"
-                    },
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-                        "extension": [
-                            {
-                                "url": "MSH.7",
-                                "valueString": "202402240152"
-                            }
-                        ]
-                    }
-                ],
-                "eventCoding": {
-                    "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
-                    "code": "O01",
-                    "display": "ORM^O01^ORM_O01"
-                },
-                "destination": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                                "valueString": "2.16.840.1.114222.4.1.181960.2"
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                                "valueString": "ISO"
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "MSH.5"
-                            }
-                        ],
-                        "name": "ALlabNatus",
-                        "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
-                        "receiver": {
-                            "reference": "Organization/1710191037059476044.4e40b3f3-3d8d-44af-a4e1-1e0a17a1719b"
-                        }
-                    }
-                ],
-                "sender": {
-                    "reference": "Organization/1710191037056103336.450a74ae-29bb-43aa-902b-105e6158f174"
-                },
-                "source": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
-                            "valueString": "BaptistOracle"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                            "valueString": "2.16.840.1.114222.4.1.000000"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                            "valueString": "ISO"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                            "valueString": "MSH.3"
-                        }
-                    ],
-                    "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+    {
+      "fullUrl": "Organization/1710191037059476044.4e40b3f3-3d8d-44af-a4e1-1e0a17a1719b",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1710191037059476044.4e40b3f3-3d8d-44af-a4e1-1e0a17a1719b",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
                 }
-            }
-        },
-        {
-            "fullUrl": "Organization/1710191037056103336.450a74ae-29bb-43aa-902b-105e6158f174",
-            "resource": {
-                "resourceType": "Organization",
-                "id": "1710191037056103336.450a74ae-29bb-43aa-902b-105e6158f174",
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.1"
-                            }
-                        ],
-                        "value": "BaptistEast"
-                    },
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.2,HD.3"
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
-                                    "code": "ISO"
-                                }
-                            ]
-                        },
-                        "system": "urn:ietf:rfc:3986",
-                        "value": "2.16.840.1.114222.4.1.000001"
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
                     }
-                ]
-            }
-        },
-        {
-            "fullUrl": "Organization/1710191037059476044.4e40b3f3-3d8d-44af-a4e1-1e0a17a1719b",
-            "resource": {
-                "resourceType": "Organization",
-                "id": "1710191037059476044.4e40b3f3-3d8d-44af-a4e1-1e0a17a1719b",
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
                 "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                        "valueString": "MSH.6"
-                    }
-                ],
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.1"
-                            }
-                        ],
-                        "value": "ALlab"
-                    },
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.2,HD.3"
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
-                                    "code": "ISO"
-                                }
-                            ]
-                        },
-                        "system": "urn:ietf:rfc:3986",
-                        "value": "simulated-lab-id"
-                    }
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
                 ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1710191037067151961.b55938eb-97ca-4807-a6d6-2e5ea969e1ff"
             }
-        },
-        {
-            "fullUrl": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220",
-            "resource": {
-                "resourceType": "Patient",
-                "id": "1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220",
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
                 "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
-                        "extension": [
-                            {
-                                "url": "PID.8"
-                            },
-                            {
-                                "url": "PID.18",
-                                "valueIdentifier": {
-                                    "extension": [
-                                        {
-                                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                            "valueString": "PID.18"
-                                        }
-                                    ],
-                                    "value": "2227600015"
-                                }
-                            }
-                        ]
-                    }
-                ],
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
-                                "extension": [
-                                    {
-                                        "url": "CX.5",
-                                        "valueString": "MR"
-                                    }
-                                ]
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "PID.3"
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "code": "MR"
-                                }
-                            ]
-                        },
-                        "value": "1300974",
-                        "assigner": {
-                            "reference": "Organization/1710191037067151961.b55938eb-97ca-4807-a6d6-2e5ea969e1ff"
-                        }
-                    }
-                ],
-                "name": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
-                                "extension": [
-                                    {
-                                        "url": "XPN.2",
-                                        "valueString": "TESTCASE"
-                                    }
-                                ]
-                            }
-                        ],
-                        "text": "TestValue",
-                        "given": [
-                            "TESTCASE"
-                        ]
-                    }
-                ],
-                "gender": "female",
-                "address": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
-                                "extension": [
-                                    {
-                                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
-                                        "extension": [
-                                            {
-                                                "url": "SAD.1",
-                                                "valueString": "1234 GPCS WAY"
-                                            }
-                                        ]
-                                    },
-                                    {
-                                        "url": "XAD.7",
-                                        "valueCode": "home"
-                                    }
-                                ]
-                            }
-                        ],
-                        "line": [
-                            "1234 GPCS WAY"
-                        ],
-                        "city": "MONTGOMERY",
-                        "district": "Montgomery",
-                        "state": "Alabama",
-                        "postalCode": "36117",
-                        "country": "USA"
-                    }
-                ],
-                "multipleBirthInteger": 1
-            }
-        },
-        {
-            "fullUrl": "Organization/1710191037067151961.b55938eb-97ca-4807-a6d6-2e5ea969e1ff",
-            "resource": {
-                "resourceType": "Organization",
-                "id": "1710191037067151961.b55938eb-97ca-4807-a6d6-2e5ea969e1ff",
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.1"
-                            }
-                        ],
-                        "value": "Baptist East"
-                    }
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
                 ]
-            }
-        },
-        {
-            "fullUrl": "ServiceRequest/1710191037091112502.b3edb4bc-e347-47f0-9054-087311f7024b",
-            "resource": {
-                "resourceType": "ServiceRequest",
-                "id": "1710191037091112502.b3edb4bc-e347-47f0-9054-087311f7024b",
+              }
+            ],
+            "text": "TestValue",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
                 "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
-                        "valueCode": "NW"
-                    },
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
-                        "extension": [
-                            {
-                                "url": "orc-12-ordering-provider",
-                                "valueReference": {
-                                    "reference": "Practitioner/1710191037086937377.5564fbc6-f6f0-4bd0-9570-c423a819ee85"
-                                }
-                            }
-                        ]
-                    },
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
-                        "extension": [
-                            {
-                                "url": "OBR.2",
-                                "valueIdentifier": {
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+              {
+                "url": "OBX.2",
+                "valueId": "NM"
+              },
+              {
+                "url": "OBX.6"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
         },
-        {
-            "fullUrl": "Observation/1710191037105947961.44f5fbe3-145e-4666-8b17-55044e6743bb",
-            "resource": {
-                "resourceType": "Observation",
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-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "CWE"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
-                },
-                "effectiveDateTime": "2024-02-22T18:54:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
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-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202402221854-0500"
-                        }
-                    ]
-                },
-                "valueCodeableConcept": {
-                    "coding": [
-                        {
-                            "extension": [
-                                {
-                                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
-                                    "valueString": "coding"
-                                },
-                                {
-                                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
-                                    "valueString": "LN"
-                                }
-                            ],
-                            "system": "http://loinc.org",
-                            "code": "LA6112-2",
-                            "display": "1"
-                        }
-                    ]
-                }
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
             }
+          ]
         },
-        {
-            "fullUrl": "Observation/1710191037109255127.10607d95-b889-4e34-af00-a66950a6287c",
-            "resource": {
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-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "NM"
-                            },
-                            {
-                                "url": "OBX.6"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
-                },
-                "effectiveDateTime": "2024-02-22T18:54:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202402221854-0500"
-                        }
-                    ]
+        "valueQuantity": {
+          "value": 38,
+          "unit": "week",
+          "system": "UCUM",
+          "code": "wk"
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1710191037113508919.70f8c453-900b-47a5-bbc2-a5359d0657b3",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710191037113508919.70f8c453-900b-47a5-bbc2-a5359d0657b3",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "code": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
+                  "valueString": "coding"
                 },
-                "valueQuantity": {
-                    "value": 38,
-                    "unit": "week",
-                    "system": "UCUM",
-                    "code": "wk"
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
+                  "valueString": "LN"
                 }
+              ],
+              "system": "http://loinc.org",
+              "code": "67704-7",
+              "display": "Feeding types"
             }
+          ]
         },
-        {
-            "fullUrl": "Observation/1710191037113508919.70f8c453-900b-47a5-bbc2-a5359d0657b3",
-            "resource": {
-                "resourceType": "Observation",
-                "id": "1710191037113508919.70f8c453-900b-47a5-bbc2-a5359d0657b3",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "CE"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "code": {
-                    "coding": [
-                        {
-                            "extension": [
-                                {
-                                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                                    "valueString": "coding"
-                                },
-                                {
-                                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                                    "valueString": "LN"
-                                }
-                            ],
-                            "system": "http://loinc.org",
-                            "code": "67704-7",
-                            "display": "Feeding types"
-                        }
-                    ]
-                },
-                "subject": {
-                    "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
-                },
-                "effectiveDateTime": "2024-02-22T18:54:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202402221854-0500"
-                        }
-                    ]
-                },
-                "valueCodeableConcept": {
-                    "coding": [
-                        {
-                            "extension": [
-                                {
-                                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                                    "valueString": "coding"
-                                },
-                                {
-                                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                                    "valueString": "LN"
-                                }
-                            ],
-                            "system": "http://loinc.org",
-                            "code": "LA16914-6",
-                            "display": "Breast milk"
-                        }
-                    ]
-                }
+        "subject": {
+          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
             }
+          ]
         },
-        {
-            "fullUrl": "Observation/1710191037118169252.d810fc88-2f38-4df8-af06-288c6b9c8a2d",
-            "resource": {
-                "resourceType": "Observation",
-                "id": "1710191037118169252.d810fc88-2f38-4df8-af06-288c6b9c8a2d",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "DTM"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
-                },
-                "effectiveDateTime": "2024-02-22T18:54:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202402221854-0500"
-                        }
-                    ]
+        "valueCodeableConcept": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
+                  "valueString": "coding"
                 },
-                "valueDateTime": "2024-02-21T12:18:00-05:00",
-                "_valueDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202402211218-0500"
-                        }
-                    ]
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
+                  "valueString": "LN"
                 }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA16914-6",
+              "display": "Breast milk"
             }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1710191037118169252.d810fc88-2f38-4df8-af06-288c6b9c8a2d",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710191037118169252.d810fc88-2f38-4df8-af06-288c6b9c8a2d",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "DTM"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
         },
-        {
-            "fullUrl": "Observation/1710191037120499752.0d38982e-9048-413c-b278-a39dabf85aad",
-            "resource": {
-                "resourceType": "Observation",
-                "id": "1710191037120499752.0d38982e-9048-413c-b278-a39dabf85aad",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "TX"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
-                },
-                "effectiveDateTime": "2024-02-22T18:54:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202402221854-0500"
-                        }
-                    ]
-                },
-                "valueString": "Baptist East"
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
             }
+          ]
         },
-        {
-            "fullUrl": "Observation/1710191037123117169.b41587bc-4743-46e5-bfd1-e6e87a01912d",
-            "resource": {
-                "resourceType": "Observation",
-                "id": "1710191037123117169.b41587bc-4743-46e5-bfd1-e6e87a01912d",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
-                        "extension": [
-                            {
-                                "url": "OBX.2",
-                                "valueId": "XAD"
-                            },
-                            {
-                                "url": "OBX.11",
-                                "valueString": "F"
-                            }
-                        ]
-                    }
-                ],
-                "status": "final",
-                "subject": {
-                    "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
-                },
-                "effectiveDateTime": "2024-02-22T18:54:00-05:00",
-                "_effectiveDateTime": {
-                    "extension": [
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
-                            "valueString": "202402221854-0500"
-                        }
-                    ]
-                },
-                "note": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
-                                "valueId": "note 1"
-                            }
-                        ],
-                        "text": "note 1"
-                    }
-                ]
+        "valueDateTime": "2024-02-21T12:18:00-05:00",
+        "_valueDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402211218-0500"
             }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1710191037120499752.0d38982e-9048-413c-b278-a39dabf85aad",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710191037120499752.0d38982e-9048-413c-b278-a39dabf85aad",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
         },
-        {
-            "fullUrl": "Specimen/1710191037132924919.617b66b1-3e6b-4ec0-948b-01058778d5e0",
-            "resource": {
-                "resourceType": "Specimen",
-                "id": "1710191037132924919.617b66b1-3e6b-4ec0-948b-01058778d5e0",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
-                        "valueString": "SPM"
-                    }
-                ]
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
             }
-        }
-    ]
+          ]
+        },
+        "valueString": "Baptist East"
+      }
+    },
+    {
+      "fullUrl": "Observation/1710191037123117169.b41587bc-4743-46e5-bfd1-e6e87a01912d",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1710191037123117169.b41587bc-4743-46e5-bfd1-e6e87a01912d",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1710191037132924919.617b66b1-3e6b-4ec0-948b-01058778d5e0",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1710191037132924919.617b66b1-3e6b-4ec0-948b-01058778d5e0",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
 }
diff --git a/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_2_fhir_transformation.fhir b/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_2_fhir_transformation.fhir
new file mode 100644
index 000000000..1517bef76
--- /dev/null
+++ b/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_2_fhir_transformation.fhir
@@ -0,0 +1,935 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729294204218212000.92c86202-5999-4f88-84ce-dfd32b3f6a22",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:30:04.218-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T01:52:00.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729294204220840000.663d2b20-ed0b-4016-84a1-bc9e08457d60",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729294204220840000.663d2b20-ed0b-4016-84a1-bc9e08457d60",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202402240152"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O21",
+          "display": "OML^O21^OML_O21"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729294204220331000.16ce3211-c181-42b4-94d9-c6741ea2d172"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729294204219263000.d3227467-255e-4de1-9d35-4397466cfbe4"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
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+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueDateTime": "2024-02-21T12:18:00-05:00",
+        "_valueDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402211218-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294204250787000.a002c395-23af-40fa-90b4-4c71ae4dbbc6",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294204250787000.a002c395-23af-40fa-90b4-4c71ae4dbbc6",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "Baptist East"
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294204252413000.9850bbd9-5178-49c7-b19b-038b9befa4b6",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294204252413000.9850bbd9-5178-49c7-b19b-038b9befa4b6",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729294204255603000.7a939287-597f-41a7-811f-2d79971be327",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729294204255603000.7a939287-597f-41a7-811f-2d79971be327",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_3_hl7_translation_final.hl7 b/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..9a5710ea7
--- /dev/null
+++ b/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistEast^2.16.840.1.114222.4.1.000001^ISO|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^simulated-lab-id^ISO|202402240152||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1300974^^^^MR||^TESTCASE|||F|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||1
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|4560411583|||unknown
OBR|1||||||||||P
OBX|1|ST|||TEST, PROVIDER||||||F|||202402221854-0500
OBX|2|NM|||3122||||||F|||202402221854-0500
OBX|3|CWE|||LA6112-2^1^LN||||||F|||202402221854-0500
OBX|4|NM|||38||||||F|||202402221854-0500
OBX|5||||||||||F|||202402221854-0500
OBX|6|DT|||202402211218-0500||||||F|||202402221854-0500
OBX|7|ST|||Baptist East||||||F|||202402221854-0500
OBX|8||||||||||F|||202402221854-0500
NTE|1||note 1
SPM|1
diff --git a/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_1_hl7_translation.fhir b/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_1_hl7_translation.fhir
index e6d7bcb4e..9e893553d 100644
--- a/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_1_hl7_translation.fhir
+++ b/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_1_hl7_translation.fhir
@@ -1,966 +1,966 @@
 {
-    "resourceType": "Bundle",
-    "id": "1710273861575958264.575537a7-2c27-4b0f-9d5d-c748cd2b6d06",
-    "meta": {
-        "lastUpdated": "2024-03-12T20:04:21.576+00:00"
+  "resourceType": "Bundle",
+  "id": "1710273861575958264.575537a7-2c27-4b0f-9d5d-c748cd2b6d06",
+  "meta": {
+    "lastUpdated": "2024-03-12T20:04:21.576+00:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T01:52:00.000+00:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202402240152"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O01",
+          "display": "ORM^O01^ORM_O01"
+        },
+        "destination": [
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+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1710273861592012639.3634a113-9a76-4df9-b949-fc5b922e7002"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1710273861586960097.bb302017-f586-456e-9def-13dba4450796"
+        },
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+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
     },
-    "identifier": {
-        "system": "https://reportstream.cdc.gov/prime-router",
-        "value": "Q1960841872T2476960690"
+    {
+      "fullUrl": "Organization/1710273861586960097.bb302017-f586-456e-9def-13dba4450796",
+      "resource": {
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+        "id": "1710273861586960097.bb302017-f586-456e-9def-13dba4450796",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
     },
-    "type": "message",
-    "timestamp": "2024-02-24T01:52:00.000+00:00",
-    "entry": [
-        {
-            "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
-            "resource": {
-                "resourceType": "MessageHeader",
-                "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
-                "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
-                        "valueString": "8859/1"
-                    },
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
-                        "extension": [
-                            {
-                                "url": "MSH.7",
-                                "valueString": "202402240152"
-                            }
-                        ]
-                    }
-                ],
-                "eventCoding": {
-                    "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
-                    "code": "O01",
-                    "display": "ORM^O01^ORM_O01"
-                },
-                "destination": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                                "valueString": "2.16.840.1.114222.4.1.181960.2"
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                                "valueString": "ISO"
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "MSH.5"
-                            }
-                        ],
-                        "name": "ALlabNatus",
-                        "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
-                        "receiver": {
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-                            "valueString": "BaptistOracle"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
-                            "valueString": "2.16.840.1.114222.4.1.000000"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
-                            "valueString": "ISO"
-                        },
-                        {
-                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                            "valueString": "MSH.3"
-                        }
-                    ],
-                    "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+    {
+      "fullUrl": "Organization/1710273861592012639.3634a113-9a76-4df9-b949-fc5b922e7002",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1710273861592012639.3634a113-9a76-4df9-b949-fc5b922e7002",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
                 }
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-        {
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-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.1"
-                            }
-                        ],
-                        "value": "BaptistEast"
-                    },
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.2,HD.3"
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
-                                    "code": "ISO"
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-                            ]
-                        },
-                        "system": "urn:ietf:rfc:3986",
-                        "value": "2.16.840.1.114222.4.1.000001"
-                    }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
                 ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1710273861607587722.c55e84d4-8611-4ee4-94bb-191791e25a1e"
             }
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-            "resource": {
-                "resourceType": "Organization",
-                "id": "1710273861592012639.3634a113-9a76-4df9-b949-fc5b922e7002",
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
                 "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                        "valueString": "MSH.6"
-                    }
-                ],
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.1"
-                            }
-                        ],
-                        "value": "ALlab"
-                    },
-                    {
-                        "extension": [
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-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "HD.2,HD.3"
-                            }
-                        ],
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-                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
-                                    "code": "ISO"
-                                }
-                            ]
-                        },
-                        "system": "urn:ietf:rfc:3986",
-                        "value": "simulated-lab-id"
-                    }
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
                 ]
+              }
+            ],
+            "text": "TestValue",
+            "family": "SIX",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "birthDate": "2024-02-21",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402210152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-02-21T01:52:00-05:00"
             }
+          ]
         },
-        {
-            "fullUrl": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1",
-            "resource": {
-                "resourceType": "Patient",
-                "id": "1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1",
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
                 "extension": [
-                    {
-                        "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
-                        "extension": [
-                            {
-                                "url": "PID.8"
-                            },
-                            {
-                                "url": "PID.18",
-                                "valueIdentifier": {
-                                    "extension": [
-                                        {
-                                            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                            "valueString": "PID.18"
-                                        }
-                                    ],
-                                    "value": "2227600015"
-                                }
-                            }
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-                    }
-                ],
-                "identifier": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
-                                "extension": [
-                                    {
-                                        "url": "CX.5",
-                                        "valueString": "MR"
-                                    }
-                                ]
-                            },
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
-                                "valueString": "PID.3"
-                            }
-                        ],
-                        "type": {
-                            "coding": [
-                                {
-                                    "code": "MR"
-                                }
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-                        "value": "1300974",
-                        "assigner": {
-                            "reference": "Organization/1710273861607587722.c55e84d4-8611-4ee4-94bb-191791e25a1e"
-                        }
-                    }
-                ],
-                "name": [
-                    {
-                        "extension": [
-                            {
-                                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
-                                "extension": [
-                                    {
-                                        "url": "XPN.2",
-                                        "valueString": "TESTCASE"
-                                    }
-                                ]
-                            }
-                        ],
-                        "text": "TestValue",
-                        "family": "SIX",
-                        "given": [
-                            "TESTCASE"
-                        ]
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+          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "TEST, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1710273861707690597.88a22055-ae5e-4a27-b2db-d3b41dd6e1ee",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1710273861707690597.88a22055-ae5e-4a27-b2db-d3b41dd6e1ee",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
 }
diff --git a/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_2_fhir_transformation.fhir b/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_2_fhir_transformation.fhir
new file mode 100644
index 000000000..43913117e
--- /dev/null
+++ b/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_2_fhir_transformation.fhir
@@ -0,0 +1,985 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729294450742979000.d3a80d91-3072-483f-a1af-46b75335f232",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:34:10.743-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T01:52:00.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729294450745785000.1c4695d8-4e85-4960-850d-f65e3561b8f3",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729294450745785000.1c4695d8-4e85-4960-850d-f65e3561b8f3",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "202402240152"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O21",
+          "display": "OML^O21^OML_O21"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729294450745325000.cb5220ed-63b7-4026-9e9f-18b4b9a9f9df"
+            }
+          }
+        ],
+        "sender": {
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+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294450744258000.f2c3e36d-ae89-42e0-bee4-6eb6e41a27d3",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294450744258000.f2c3e36d-ae89-42e0-bee4-6eb6e41a27d3",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294450745325000.cb5220ed-63b7-4026-9e9f-18b4b9a9f9df",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294450745325000.cb5220ed-63b7-4026-9e9f-18b4b9a9f9df",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729294450748570000.570df638-02c7-48d5-a098-825f1fd1cf99"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
+            ],
+            "family": "SIX",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "birthDate": "2024-02-21",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402210152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-02-21T01:52:00-05:00"
+            }
+          ]
+        },
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1,
+        "contact": [
+          {
+            "relationship": [
+              {
+                "coding": [
+                  {
+                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
+                    "code": "MTH",
+                    "display": "mother"
+                  }
+                ]
+              }
+            ],
+            "address": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                      "extension": [
+                        {
+                          "url": "SAD.1",
+                          "valueString": "1234 GPCS WAY"
+                        }
+                      ]
+                    },
+                    {
+                      "url": "XAD.7",
+                      "valueCode": "home"
+                    }
+                  ]
+                }
+              ],
+              "line": [
+                "1234 GPCS WAY"
+              ],
+              "city": "MONTGOMERY",
+              "district": "Montgomery",
+              "state": "Alabama",
+              "postalCode": "36117",
+              "country": "USA"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294450748570000.570df638-02c7-48d5-a098-825f1fd1cf99",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294450748570000.570df638-02c7-48d5-a098-825f1fd1cf99",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Baptist East"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "ServiceRequest/1729294450760857000.44841786-81be-4d38-851c-92df3312304c",
+      "resource": {
+        "resourceType": "ServiceRequest",
+        "id": "1729294450760857000.44841786-81be-4d38-851c-92df3312304c",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
+            "valueCode": "NW"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
+            "extension": [
+              {
+                "url": "orc-12-ordering-provider",
+                "valueReference": {
+                  "reference": "Practitioner/1729294450758383000.8d763590-690c-4d75-b770-348f018656c3"
+                }
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
+            "extension": [
+              {
+                "url": "OBR.2",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                          "valueString": "ORDERID"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "4560411583"
+                }
+              },
+              {
+                "url": "OBR.16",
+                "valueReference": {
+                  "reference": "Practitioner/1729294450760260000.af0a3d2a-00b0-450c-8bfa-e9f8ca851a6d"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "4560411583"
+          }
+        ],
+        "status": "unknown",
+        "subject": {
+          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+        },
+        "requester": {
+          "reference": "Practitioner/1729294450755719000.d69a0a12-c13f-4761-87b1-5f11c6be4829"
+        }
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294450755719000.d69a0a12-c13f-4761-87b1-5f11c6be4829",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294450755719000.d69a0a12-c13f-4761-87b1-5f11c6be4829",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "ORC.12"
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294450758383000.8d763590-690c-4d75-b770-348f018656c3",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294450758383000.8d763590-690c-4d75-b770-348f018656c3",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294450760260000.af0a3d2a-00b0-450c-8bfa-e9f8ca851a6d",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294450760260000.af0a3d2a-00b0-450c-8bfa-e9f8ca851a6d",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294450762840000.0ad3a3cc-e5e6-4498-9ede-adde30c1c06b",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294450762840000.0ad3a3cc-e5e6-4498-9ede-adde30c1c06b",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "ST"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "123456"
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294450764606000.fde6cbcd-d10c-4a41-9ad6-220167fbd7eb",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294450764606000.fde6cbcd-d10c-4a41-9ad6-220167fbd7eb",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "NM"
+              },
+              {
+                "url": "OBX.6"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueQuantity": {
+          "value": 3122,
+          "unit": "gram",
+          "system": "UCUM",
+          "code": "g"
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294450766657000.2e54569b-ed46-42f4-8c95-87c88e16f3a0",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294450766657000.2e54569b-ed46-42f4-8c95-87c88e16f3a0",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CWE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueCodeableConcept": {
+          "coding": [
+            {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding",
+                  "valueString": "coding"
+                },
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cwe-coding-system",
+                  "valueString": "LN"
+                }
+              ],
+              "system": "http://loinc.org",
+              "code": "LA6112-2",
+              "display": "1"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294450768186000.43f8be15-7683-4551-b43c-078f2b64987a",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294450768186000.43f8be15-7683-4551-b43c-078f2b64987a",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "NM"
+              },
+              {
+                "url": "OBX.6"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueQuantity": {
+          "value": 38,
+          "unit": "week",
+          "system": "UCUM",
+          "code": "wk"
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294450769659000.421c5990-892d-413d-a459-b1302b98a32b",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294450769659000.421c5990-892d-413d-a459-b1302b98a32b",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "CE"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294450771182000.87aa1626-9b0f-4f10-b438-b95c7fb3ebc9",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294450771182000.87aa1626-9b0f-4f10-b438-b95c7fb3ebc9",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "DTM"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueDateTime": "2024-02-21T12:18:00-05:00",
+        "_valueDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402211218-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294450772719000.19d40d0b-0d75-403a-8844-502b2a9d1e6c",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294450772719000.19d40d0b-0d75-403a-8844-502b2a9d1e6c",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "Baptist East"
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294450774592000.02bb4fc9-ff03-45d1-b386-deacaf29caf9",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294450774592000.02bb4fc9-ff03-45d1-b386-deacaf29caf9",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        }
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294450776290000.d221ea95-61b6-4a20-81ca-c2d3f9175ce6",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294450776290000.d221ea95-61b6-4a20-81ca-c2d3f9175ce6",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "TEST, PROVIDER",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729294450780065000.c1a186e8-d6e4-479d-b14f-e9635da3a8c3",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729294450780065000.c1a186e8-d6e4-479d-b14f-e9635da3a8c3",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_3_hl7_translation_final.hl7 b/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..9bea0b260
--- /dev/null
+++ b/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistEast^2.16.840.1.114222.4.1.000001^ISO|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^simulated-lab-id^ISO|202402240152||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1300974^^^^MR||SIX^TESTCASE||202402210152-0500|F|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||1
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|4560411583|||unknown
OBR|1||||||||||P
OBX|1|ST|||123456||||||F|||202402221854-0500
OBX|2|NM|||3122||||||F|||202402221854-0500
OBX|3|CWE|||LA6112-2^1^LN||||||F|||202402221854-0500
OBX|4|NM|||38||||||F|||202402221854-0500
OBX|5||||||||||F|||202402221854-0500
OBX|6|DT|||202402211218-0500||||||F|||202402221854-0500
OBX|7|ST|||Baptist East||||||F|||202402221854-0500
OBX|8||||||||||F|||202402221854-0500
OBX|9|ST|||TEST, PROVIDER||||||F|||202402221854-0500
NTE|1||note 1
SPM|1
diff --git a/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_1_hl7_translation.fhir b/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_1_hl7_translation.fhir
new file mode 100644
index 000000000..e69de29bb
diff --git a/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_2_fhir_transformation.fhir b/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_2_fhir_transformation.fhir
new file mode 100644
index 000000000..d14d56ab2
--- /dev/null
+++ b/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_2_fhir_transformation.fhir
@@ -0,0 +1,664 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729293608350739000.46215d0d-75f3-4171-9d19-aec9c5e0250b",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:20:08.350-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T13:40:09.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729293608352419000.bc3212d0-3e9c-4112-872c-beb43e74486c",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729293608352419000.bc3212d0-3e9c-4112-872c-beb43e74486c",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240224134009"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O21",
+          "display": "OML^O21^OML_O21"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729293608352204000.ec9949b4-07a5-4efe-9c2f-4c111bc6b1e4"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729293608351547000.1622f176-4883-4e4f-9f87-c8540e417328"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293608351547000.1622f176-4883-4e4f-9f87-c8540e417328",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293608351547000.1622f176-4883-4e4f-9f87-c8540e417328",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293608352204000.ec9949b4-07a5-4efe-9c2f-4c111bc6b1e4",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293608352204000.ec9949b4-07a5-4efe-9c2f-4c111bc6b1e4",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729293608365060000.1a16b183-f641-4114-bb20-d27dfa39e493",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729293608365060000.1a16b183-f641-4114-bb20-d27dfa39e493",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729293608354147000.3cdc4c00-1624-41a5-aa53-631bd471ee19"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
+            ],
+            "family": "ONE",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "birthDate": "2024-02-21",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402210152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-02-21T01:52:00-05:00"
+            }
+          ]
+        },
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1,
+        "contact": [
+          {
+            "relationship": [
+              {
+                "coding": [
+                  {
+                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
+                    "code": "MTH",
+                    "display": "mother"
+                  }
+                ]
+              }
+            ],
+            "address": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                      "extension": [
+                        {
+                          "url": "SAD.1",
+                          "valueString": "1234 GPCS WAY"
+                        }
+                      ]
+                    },
+                    {
+                      "url": "XAD.7",
+                      "valueCode": "home"
+                    }
+                  ]
+                }
+              ],
+              "line": [
+                "1234 GPCS WAY"
+              ],
+              "city": "MONTGOMERY",
+              "district": "Montgomery",
+              "state": "Alabama",
+              "postalCode": "36117",
+              "country": "USA"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729293608354147000.3cdc4c00-1624-41a5-aa53-631bd471ee19",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729293608354147000.3cdc4c00-1624-41a5-aa53-631bd471ee19",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Baptist East"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "ServiceRequest/1729293608369053000.21a6a755-5a62-4bea-b247-64788dfb8f8b",
+      "resource": {
+        "resourceType": "ServiceRequest",
+        "id": "1729293608369053000.21a6a755-5a62-4bea-b247-64788dfb8f8b",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
+            "valueCode": "NW"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
+            "extension": [
+              {
+                "url": "orc-12-ordering-provider",
+                "valueReference": {
+                  "reference": "Practitioner/1729293608367962000.4930df54-8bb2-4ebc-845e-9434d22b945e"
+                }
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
+            "extension": [
+              {
+                "url": "OBR.2",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                          "valueString": "ORDERID"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "2801690163"
+                }
+              },
+              {
+                "url": "OBR.16",
+                "valueReference": {
+                  "reference": "Practitioner/1729293608368799000.12ce891e-6c3f-40a8-b812-fe59dbbc7e71"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "2801690163"
+          }
+        ],
+        "status": "unknown",
+        "subject": {
+          "reference": "Patient/1729293608365060000.1a16b183-f641-4114-bb20-d27dfa39e493"
+        },
+        "requester": {
+          "reference": "Practitioner/1729293608366324000.e3b85302-d2ed-43a1-b44f-ad533af66b9e"
+        }
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729293608366324000.e3b85302-d2ed-43a1-b44f-ad533af66b9e",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729293608366324000.e3b85302-d2ed-43a1-b44f-ad533af66b9e",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "ORC.12"
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729293608367962000.4930df54-8bb2-4ebc-845e-9434d22b945e",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729293608367962000.4930df54-8bb2-4ebc-845e-9434d22b945e",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729293608368799000.12ce891e-6c3f-40a8-b812-fe59dbbc7e71",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729293608368799000.12ce891e-6c3f-40a8-b812-fe59dbbc7e71",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729293608370570000.25dd61cb-f071-409c-819c-1ded6cabc7ec",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729293608370570000.25dd61cb-f071-409c-819c-1ded6cabc7ec",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "DTM"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729293608365060000.1a16b183-f641-4114-bb20-d27dfa39e493"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "_valueDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "February 2 2024"
+            }
+          ]
+        },
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729293608373187000.28186737-a907-4e8c-9e99-ccdb44efbe7f",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729293608373187000.28186737-a907-4e8c-9e99-ccdb44efbe7f",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_3_hl7_translation_final.hl7 b/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..a1edfbfc7
--- /dev/null
+++ b/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistEast^2.16.840.1.114222.4.1.000001^ISO|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^simulated-lab-id^ISO|20240224134009||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1300974^^^^MR||ONE^TESTCASE||202402210152-0500|F|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||1
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|2801690163|||unknown
OBR|1||||||||||P
OBX|1|DT|||February 2 2024||||||F|||202402221854-0500
NTE|1||note 1
SPM|1
diff --git a/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_1_hl7_translation.fhir b/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_1_hl7_translation.fhir
new file mode 100644
index 000000000..e69de29bb
diff --git a/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_2_fhir_transformation.fhir b/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_2_fhir_transformation.fhir
new file mode 100644
index 000000000..1f5fcec2b
--- /dev/null
+++ b/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_2_fhir_transformation.fhir
@@ -0,0 +1,656 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729294090266383000.393650a3-2e9d-4481-a6b3-747ab47b55b6",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:28:10.266-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T13:40:09.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729294090268769000.5bccb410-4ead-4558-a4f7-9a37e159c0df",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729294090268769000.5bccb410-4ead-4558-a4f7-9a37e159c0df",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240224134009"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O21",
+          "display": "OML^O21^OML_O21"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729294090268254000.aee5ade4-aed0-46fd-b8ab-3d15df2f17c1"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729294090267203000.6e025895-3cd5-4b6c-8650-9013316b92b9"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294090267203000.6e025895-3cd5-4b6c-8650-9013316b92b9",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294090267203000.6e025895-3cd5-4b6c-8650-9013316b92b9",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294090268254000.aee5ade4-aed0-46fd-b8ab-3d15df2f17c1",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294090268254000.aee5ade4-aed0-46fd-b8ab-3d15df2f17c1",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729294090278016000.aa64f3a7-b096-4ea5-8042-256c6da27e23",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729294090278016000.aa64f3a7-b096-4ea5-8042-256c6da27e23",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729294090271038000.4fd74fea-58f8-4ac2-bb27-8c355cd2cb8e"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
+            ],
+            "family": "ONE",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "birthDate": "2024-02-21",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402210152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-02-21T01:52:00-05:00"
+            }
+          ]
+        },
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1,
+        "contact": [
+          {
+            "relationship": [
+              {
+                "coding": [
+                  {
+                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
+                    "code": "MTH",
+                    "display": "mother"
+                  }
+                ]
+              }
+            ],
+            "address": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                      "extension": [
+                        {
+                          "url": "SAD.1",
+                          "valueString": "1234 GPCS WAY"
+                        }
+                      ]
+                    },
+                    {
+                      "url": "XAD.7",
+                      "valueCode": "home"
+                    }
+                  ]
+                }
+              ],
+              "line": [
+                "1234 GPCS WAY"
+              ],
+              "city": "MONTGOMERY",
+              "district": "Montgomery",
+              "state": "Alabama",
+              "postalCode": "36117",
+              "country": "USA"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294090271038000.4fd74fea-58f8-4ac2-bb27-8c355cd2cb8e",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294090271038000.4fd74fea-58f8-4ac2-bb27-8c355cd2cb8e",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Baptist East"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "ServiceRequest/1729294090285006000.d08d8187-0595-408a-a8cc-838adc7ee523",
+      "resource": {
+        "resourceType": "ServiceRequest",
+        "id": "1729294090285006000.d08d8187-0595-408a-a8cc-838adc7ee523",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
+            "valueCode": "NW"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
+            "extension": [
+              {
+                "url": "orc-12-ordering-provider",
+                "valueReference": {
+                  "reference": "Practitioner/1729294090282918000.3b80cfdd-4bc6-4bbb-88c0-3c57f8647540"
+                }
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
+            "extension": [
+              {
+                "url": "OBR.2",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                          "valueString": "ORDERID"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "2801690163"
+                }
+              },
+              {
+                "url": "OBR.16",
+                "valueReference": {
+                  "reference": "Practitioner/1729294090284424000.e912b324-0302-4d3d-a7cf-5a9ed33de2da"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "2801690163"
+          }
+        ],
+        "status": "unknown",
+        "subject": {
+          "reference": "Patient/1729294090278016000.aa64f3a7-b096-4ea5-8042-256c6da27e23"
+        },
+        "requester": {
+          "reference": "Practitioner/1729294090280103000.2b882880-a9b6-4172-a42c-6a89e9f0e790"
+        }
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294090280103000.2b882880-a9b6-4172-a42c-6a89e9f0e790",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294090280103000.2b882880-a9b6-4172-a42c-6a89e9f0e790",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "ORC.12"
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294090282918000.3b80cfdd-4bc6-4bbb-88c0-3c57f8647540",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294090282918000.3b80cfdd-4bc6-4bbb-88c0-3c57f8647540",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294090284424000.e912b324-0302-4d3d-a7cf-5a9ed33de2da",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294090284424000.e912b324-0302-4d3d-a7cf-5a9ed33de2da",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294090286625000.8ee6599a-226b-4fe2-bdbd-71e463f04207",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294090286625000.8ee6599a-226b-4fe2-bdbd-71e463f04207",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294090278016000.aa64f3a7-b096-4ea5-8042-256c6da27e23"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729294090290469000.81457f28-afa8-459e-a4d5-f604ea512265",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729294090290469000.81457f28-afa8-459e-a4d5-f604ea512265",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_3_hl7_translation_final.hl7 b/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..2774d837c
--- /dev/null
+++ b/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistEast^2.16.840.1.114222.4.1.000001^ISO|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^simulated-lab-id^ISO|20240224134009||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1300974^^^^MR||ONE^TESTCASE||202402210152-0500|F|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||1
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|2801690163|||unknown
OBR|1||||||||||P
OBX|1||||||||||F|||202402221854-0500
NTE|1||note 1
SPM|1
diff --git a/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_1_hl7_translation.fhir b/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_1_hl7_translation.fhir
new file mode 100644
index 000000000..e69de29bb
diff --git a/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_2_fhir_transformation.fhir b/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_2_fhir_transformation.fhir
new file mode 100644
index 000000000..f47e0f9ba
--- /dev/null
+++ b/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_2_fhir_transformation.fhir
@@ -0,0 +1,657 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729294572801182000.c051a6c6-ecf2-4f95-ba33-9ec5ccf22c39",
+  "meta": {
+    "lastUpdated": "2024-10-18T16:36:12.801-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T13:40:09.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729294572803889000.0db4570e-894b-4ca2-8869-872cdf4ea17d",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729294572803889000.0db4570e-894b-4ca2-8869-872cdf4ea17d",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            },
+            {
+              "system": "http://localcodes.org/ETOR",
+              "code": "ETOR",
+              "display": "Processed by ETOR"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240224134009"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O21",
+          "display": "OML^O21^OML_O21"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729294572803383000.2fdf5530-fdca-4a16-93dd-d7715591ce9a"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729294572802106000.9362d963-1074-481c-94f8-ad209c2f04ff"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294572802106000.9362d963-1074-481c-94f8-ad209c2f04ff",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294572802106000.9362d963-1074-481c-94f8-ad209c2f04ff",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294572803383000.2fdf5530-fdca-4a16-93dd-d7715591ce9a",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294572803383000.2fdf5530-fdca-4a16-93dd-d7715591ce9a",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729294572812841000.7b03ccc8-f131-459c-95e6-8ebd0bdb1305",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729294572812841000.7b03ccc8-f131-459c-95e6-8ebd0bdb1305",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729294572805815000.05679a1b-96f7-4d7a-968b-bb1053108b63"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
+            ],
+            "family": "ONE",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "birthDate": "2024-02-21",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402210152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-02-21T01:52:00-05:00"
+            }
+          ]
+        },
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1,
+        "contact": [
+          {
+            "relationship": [
+              {
+                "coding": [
+                  {
+                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
+                    "code": "MTH",
+                    "display": "mother"
+                  }
+                ]
+              }
+            ],
+            "address": {
+              "extension": [
+                {
+                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                      "extension": [
+                        {
+                          "url": "SAD.1",
+                          "valueString": "1234 GPCS WAY"
+                        }
+                      ]
+                    },
+                    {
+                      "url": "XAD.7",
+                      "valueCode": "home"
+                    }
+                  ]
+                }
+              ],
+              "line": [
+                "1234 GPCS WAY"
+              ],
+              "city": "MONTGOMERY",
+              "district": "Montgomery",
+              "state": "Alabama",
+              "postalCode": "36117",
+              "country": "USA"
+            }
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729294572805815000.05679a1b-96f7-4d7a-968b-bb1053108b63",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729294572805815000.05679a1b-96f7-4d7a-968b-bb1053108b63",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Baptist East"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "ServiceRequest/1729294572816353000.fc7e5055-c3e3-4c49-9278-d982ada7b351",
+      "resource": {
+        "resourceType": "ServiceRequest",
+        "id": "1729294572816353000.fc7e5055-c3e3-4c49-9278-d982ada7b351",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
+            "valueCode": "NW"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
+            "extension": [
+              {
+                "url": "orc-12-ordering-provider",
+                "valueReference": {
+                  "reference": "Practitioner/1729294572815383000.2cf83374-13c7-4938-aae8-0d83050c87e8"
+                }
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
+            "extension": [
+              {
+                "url": "OBR.2",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                          "valueString": "ORDERID"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "2801690163"
+                }
+              },
+              {
+                "url": "OBR.16",
+                "valueReference": {
+                  "reference": "Practitioner/1729294572816098000.a8781df2-1340-40e9-9d47-25456256b8a3"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "2801690163"
+          }
+        ],
+        "status": "unknown",
+        "subject": {
+          "reference": "Patient/1729294572812841000.7b03ccc8-f131-459c-95e6-8ebd0bdb1305"
+        },
+        "requester": {
+          "reference": "Practitioner/1729294572813967000.86ad03b0-cf2e-49d3-b6e7-2c3a9d52e025"
+        }
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294572813967000.86ad03b0-cf2e-49d3-b6e7-2c3a9d52e025",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294572813967000.86ad03b0-cf2e-49d3-b6e7-2c3a9d52e025",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "ORC.12"
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294572815383000.2cf83374-13c7-4938-aae8-0d83050c87e8",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294572815383000.2cf83374-13c7-4938-aae8-0d83050c87e8",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729294572816098000.a8781df2-1340-40e9-9d47-25456256b8a3",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729294572816098000.a8781df2-1340-40e9-9d47-25456256b8a3",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729294572817163000.816e6916-d6e3-4335-a219-b982f12648de",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729294572817163000.816e6916-d6e3-4335-a219-b982f12648de",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729294572812841000.7b03ccc8-f131-459c-95e6-8ebd0bdb1305"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "1234 GPCS WAY",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729294572819226000.3dc17b63-d361-4613-8c4e-4141f9bddfd2",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729294572819226000.3dc17b63-d361-4613-8c4e-4141f9bddfd2",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_3_hl7_translation_final.hl7 b/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_3_hl7_translation_final.hl7
new file mode 100644
index 000000000..53062aeb3
--- /dev/null
+++ b/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_3_hl7_translation_final.hl7
@@ -0,0 +1 @@
+MSH|^~\&|BaptistOracle^2.16.840.1.114222.4.1.000000^ISO|BaptistEast^2.16.840.1.114222.4.1.000001^ISO|ALlabNatus^2.16.840.1.114222.4.1.181960.2^ISO|ALlab^simulated-lab-id^ISO|20240224134009||OML^O21^OML_O21|Q1960841872T2476960690|D|2.5.1||||||8859/1
PID|1||1300974^^^^MR||ONE^TESTCASE||202402210152-0500|F|||1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery||||||||||||||1
NK1|1||MTH^mother|1234 GPCS WAY^^MONTGOMERY^Alabama^36117^USA^^^Montgomery
ORC|NW|2801690163|||unknown
OBR|1||||||||||P
OBX|1|ST|||1234 GPCS WAY||||||F|||202402221854-0500
NTE|1||note 1
SPM|1

From dbab7f55619550be94282cfce020b42342f66ed3 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 18:46:41 -0700
Subject: [PATCH 26/30] Fixed azurite path for orders receiver

---
 scripts/hurl/local_test_utils.sh | 14 ++++++++------
 1 file changed, 8 insertions(+), 6 deletions(-)

diff --git a/scripts/hurl/local_test_utils.sh b/scripts/hurl/local_test_utils.sh
index a49bb93c9..efc2cd695 100755
--- a/scripts/hurl/local_test_utils.sh
+++ b/scripts/hurl/local_test_utils.sh
@@ -101,15 +101,17 @@ submit_message() {
 
     msh9=$(awk -F'|' '/^MSH/ { print $9 }' "$file")
     if [[ "$msh9" == "ORU^R01^ORU_R01" ]]; then
-        receiver="flexion.simulated-hospital"
+        first_leg_receiver="flexion.etor-service-receiver-results"
+        second_leg_receiver="flexion.simulated-hospital"
     elif [[ "$msh9" == "OML^O21^OML_O21" || "$msh9" == "ORM^O01^ORM_O01" ]]; then
-        receiver="flexion.simulated-lab"
+        first_leg_receiver="flexion.etor-service-receiver-orders"
+        second_leg_receiver="flexion.simulated-lab"
     else
-        echo "Unknown receiver for MSH-9 value '$msh9'. Skipping the message"
+        echo "Unknown receivers for MSH-9 value '$msh9'. Skipping the message"
         return
     fi
 
-    echo "Assuming receiver is '$receiver' because of MSH-9 value '$msh9'"
+    echo "Assuming receivers are '$first_leg_receiver' and '$second_leg_receiver' because of MSH-9 value '$msh9'"
 
     waters_response=$(
         cd "$RS_HRL_SCRIPT_PATH" || exit 1
@@ -124,7 +126,7 @@ submit_message() {
     fi
 
     inbound_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    translated_blob_name="ready/flexion.etor-service-receiver-results/$inbound_submission_id.fhir"
+    translated_blob_name="ready/$first_leg_receiver/$inbound_submission_id.fhir"
     translated_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_1.fhir"
     download_from_azurite "$translated_blob_name" "$translated_file_path"
 
@@ -145,7 +147,7 @@ submit_message() {
     fi
 
     final_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    final_blob_name="ready/$receiver/$final_submission_id.hl7"
+    final_blob_name="ready/$second_leg_receiver/$final_submission_id.hl7"
     final_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_3.hl7"
     download_from_azurite "$final_blob_name" "$final_file_path"
 }

From e5390d337fabab053bcd4de6a7c386524da037d4 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 18:48:45 -0700
Subject: [PATCH 27/30] Revert "Fixed azurite path for orders receiver"

This reverts commit dbab7f55619550be94282cfce020b42342f66ed3.
---
 scripts/hurl/local_test_utils.sh | 14 ++++++--------
 1 file changed, 6 insertions(+), 8 deletions(-)

diff --git a/scripts/hurl/local_test_utils.sh b/scripts/hurl/local_test_utils.sh
index efc2cd695..a49bb93c9 100755
--- a/scripts/hurl/local_test_utils.sh
+++ b/scripts/hurl/local_test_utils.sh
@@ -101,17 +101,15 @@ submit_message() {
 
     msh9=$(awk -F'|' '/^MSH/ { print $9 }' "$file")
     if [[ "$msh9" == "ORU^R01^ORU_R01" ]]; then
-        first_leg_receiver="flexion.etor-service-receiver-results"
-        second_leg_receiver="flexion.simulated-hospital"
+        receiver="flexion.simulated-hospital"
     elif [[ "$msh9" == "OML^O21^OML_O21" || "$msh9" == "ORM^O01^ORM_O01" ]]; then
-        first_leg_receiver="flexion.etor-service-receiver-orders"
-        second_leg_receiver="flexion.simulated-lab"
+        receiver="flexion.simulated-lab"
     else
-        echo "Unknown receivers for MSH-9 value '$msh9'. Skipping the message"
+        echo "Unknown receiver for MSH-9 value '$msh9'. Skipping the message"
         return
     fi
 
-    echo "Assuming receivers are '$first_leg_receiver' and '$second_leg_receiver' because of MSH-9 value '$msh9'"
+    echo "Assuming receiver is '$receiver' because of MSH-9 value '$msh9'"
 
     waters_response=$(
         cd "$RS_HRL_SCRIPT_PATH" || exit 1
@@ -126,7 +124,7 @@ submit_message() {
     fi
 
     inbound_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    translated_blob_name="ready/$first_leg_receiver/$inbound_submission_id.fhir"
+    translated_blob_name="ready/flexion.etor-service-receiver-results/$inbound_submission_id.fhir"
     translated_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_1.fhir"
     download_from_azurite "$translated_blob_name" "$translated_file_path"
 
@@ -147,7 +145,7 @@ submit_message() {
     fi
 
     final_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    final_blob_name="ready/$second_leg_receiver/$final_submission_id.hl7"
+    final_blob_name="ready/$receiver/$final_submission_id.hl7"
     final_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_3.hl7"
     download_from_azurite "$final_blob_name" "$final_file_path"
 }

From ac7e3dcb234c443044513c7ff0523768401685f4 Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Fri, 18 Oct 2024 18:52:05 -0700
Subject: [PATCH 28/30] Fixed azurite path for orders receiver

---
 scripts/hurl/local_test_utils.sh | 14 ++++++++------
 1 file changed, 8 insertions(+), 6 deletions(-)

diff --git a/scripts/hurl/local_test_utils.sh b/scripts/hurl/local_test_utils.sh
index a49bb93c9..efc2cd695 100755
--- a/scripts/hurl/local_test_utils.sh
+++ b/scripts/hurl/local_test_utils.sh
@@ -101,15 +101,17 @@ submit_message() {
 
     msh9=$(awk -F'|' '/^MSH/ { print $9 }' "$file")
     if [[ "$msh9" == "ORU^R01^ORU_R01" ]]; then
-        receiver="flexion.simulated-hospital"
+        first_leg_receiver="flexion.etor-service-receiver-results"
+        second_leg_receiver="flexion.simulated-hospital"
     elif [[ "$msh9" == "OML^O21^OML_O21" || "$msh9" == "ORM^O01^ORM_O01" ]]; then
-        receiver="flexion.simulated-lab"
+        first_leg_receiver="flexion.etor-service-receiver-orders"
+        second_leg_receiver="flexion.simulated-lab"
     else
-        echo "Unknown receiver for MSH-9 value '$msh9'. Skipping the message"
+        echo "Unknown receivers for MSH-9 value '$msh9'. Skipping the message"
         return
     fi
 
-    echo "Assuming receiver is '$receiver' because of MSH-9 value '$msh9'"
+    echo "Assuming receivers are '$first_leg_receiver' and '$second_leg_receiver' because of MSH-9 value '$msh9'"
 
     waters_response=$(
         cd "$RS_HRL_SCRIPT_PATH" || exit 1
@@ -124,7 +126,7 @@ submit_message() {
     fi
 
     inbound_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    translated_blob_name="ready/flexion.etor-service-receiver-results/$inbound_submission_id.fhir"
+    translated_blob_name="ready/$first_leg_receiver/$inbound_submission_id.fhir"
     translated_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_1.fhir"
     download_from_azurite "$translated_blob_name" "$translated_file_path"
 
@@ -145,7 +147,7 @@ submit_message() {
     fi
 
     final_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    final_blob_name="ready/$receiver/$final_submission_id.hl7"
+    final_blob_name="ready/$second_leg_receiver/$final_submission_id.hl7"
     final_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_3.hl7"
     download_from_azurite "$final_blob_name" "$final_file_path"
 }

From b6bed0c0357f3d2e9b1f64d8c7c2423a708fdb7e Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Sat, 19 Oct 2024 09:23:07 -0700
Subject: [PATCH 29/30] Updated all snapshots in examples/ folder

---
 ...U_R01_CDPH_produced_1_hl7_translation.fhir | 1964 ++++-----
 ...1_CDPH_produced_2_fhir_transformation.fhir | 1578 +++----
 ...U_R01_CDPH_produced_1_hl7_translation.fhir | 1964 ++++-----
 ...1_CDPH_produced_2_fhir_transformation.fhir | 1578 +++----
 ..._R01_CDPH_generated_1_hl7_translation.fhir | 1660 +++----
 ..._CDPH_generated_2_fhir_transformation.fhir | 1274 +++---
 ...-07-11-16-02-17-749_1_hl7_translation.fhir | 1660 +++----
 ...11-16-02-17-749_2_fhir_transformation.fhir | 1274 +++---
 ...-07-11-16-02-17-749_1_hl7_translation.fhir | 1612 +++----
 ...11-16-02-17-749_2_fhir_transformation.fhir | 1226 +++---
 ...CSD_order_189556932_1_hl7_translation.fhir | 1628 +++----
 ...order_189556932_2_fhir_transformation.fhir | 1242 +++---
 ...CSD_order_189417053_1_hl7_translation.fhir | 1620 +++----
 ...order_189417053_2_fhir_transformation.fhir | 1234 +++---
 ...CSD_order_189394505_1_hl7_translation.fhir | 1620 +++----
 ...order_189394505_2_fhir_transformation.fhir | 1234 +++---
 ...CSD_order_189609160_1_hl7_translation.fhir | 1612 +++----
 ...order_189609160_2_fhir_transformation.fhir | 1226 +++---
 ...-07-11-16-02-17-749_1_hl7_translation.fhir | 1378 +++---
 ...11-16-02-17-749_2_fhir_transformation.fhir | 1070 ++---
 ...-07-11-16-02-17-749_1_hl7_translation.fhir | 1606 +++----
 ...11-16-02-17-749_2_fhir_transformation.fhir | 1220 +++---
 ...-07-11-16-02-17-749_1_hl7_translation.fhir | 1366 +++---
 ...11-16-02-17-749_2_fhir_transformation.fhir | 1056 ++---
 ...1_CDPH_OBX_to_LOINC_1_hl7_translation.fhir | 1438 +++----
 ...PH_OBX_to_LOINC_2_fhir_transformation.fhir | 1128 ++---
 .../004_MN_ORU_R01_NBS_1_hl7_translation.fhir | 3826 ++++++++---------
 ..._MN_ORU_R01_NBS_2_fhir_transformation.fhir | 3826 ++++++++---------
 ...NBS_Fully_Populated_1_hl7_translation.fhir |  161 +-
 ...Fully_Populated_2_fhir_transformation.fhir |  112 +-
 ...ces_Multiple_Births_1_hl7_translation.fhir |  161 +-
 ...Multiple_Births_2_fhir_transformation.fhir |  112 +-
 ...NBS_Incorrect_Units_1_hl7_translation.fhir |  161 +-
 ...Incorrect_Units_2_fhir_transformation.fhir |  112 +-
 ...ncorrect_Data_Types_1_hl7_translation.fhir |  161 +-
 ...rect_Data_Types_2_fhir_transformation.fhir |  112 +-
 ...ing_Required_Fields_1_hl7_translation.fhir |  159 +-
 ...Required_Fields_2_fhir_transformation.fhir |  100 +-
 ...correct_Code_System_1_hl7_translation.fhir |  161 +-
 ...ect_Code_System_2_fhir_transformation.fhir |  112 +-
 ...Non_Required_Fields_1_hl7_translation.fhir |  155 +-
 ...Required_Fields_2_fhir_transformation.fhir |  106 +-
 ...ntant_Phone_Numbers_1_hl7_translation.fhir |  161 +-
 ...t_Phone_Numbers_2_fhir_transformation.fhir |  112 +-
 ...formed_DTM_datatype_1_hl7_translation.fhir |  614 +++
 ...ed_DTM_datatype_2_fhir_transformation.fhir |   64 +-
 ...formed_XAD_datatype_1_hl7_translation.fhir |  606 +++
 ...ed_XAD_datatype_2_fhir_transformation.fhir |   64 +-
 ...ext_as_txt_datatype_1_hl7_translation.fhir |  607 +++
 ...as_txt_datatype_2_fhir_transformation.fhir |   64 +-
 ...NBS_Fully_Populated_1_hl7_translation.fhir | 1804 ++++----
 ...Fully_Populated_2_fhir_transformation.fhir | 1804 ++++----
 ...nd_Abnormal_Results_1_hl7_translation.fhir | 1804 ++++----
 ...bnormal_Results_2_fhir_transformation.fhir | 1804 ++++----
 ...imen_Unsatisfactory_1_hl7_translation.fhir | 1804 ++++----
 ..._Unsatisfactory_2_fhir_transformation.fhir | 1804 ++++----
 56 files changed, 30845 insertions(+), 29276 deletions(-)

diff --git a/examples/CA/003_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir b/examples/CA/003_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
index d0afe3fb7..dc92d7581 100644
--- a/examples/CA/003_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
+++ b/examples/CA/003_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729292709395325000.18465c09-3aeb-4dd5-8c5b-fb20faafcc09",
+  "id": "1729354690127252000.919e899c-a162-4de3-998a-f4e04113154e",
   "meta": {
-    "lastUpdated": "2024-10-18T16:05:09.395-07:00"
+    "lastUpdated": "2024-10-19T09:18:10.127-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-12T10:30:49.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e",
+      "fullUrl": "MessageHeader/1729354690129725000.47c4db23-e7e7-493c-bbd3-d011bc156d52",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e",
+        "id": "1729354690129725000.47c4db23-e7e7-493c-bbd3-d011bc156d52",
         "meta": {
           "tag": [
             {
@@ -58,12 +58,12 @@
             ],
             "name": "SISHIERECEIVER",
             "receiver": {
-              "reference": "Organization/1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6"
+              "reference": "Organization/1729354690129513000.fee8aa08-acf1-412a-b23b-8cf9b42faa6b"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db"
+          "reference": "Organization/1729354690128717000.ac3bcc8e-159a-4026-9236-ae158c4c7068"
         },
         "source": {
           "extension": [
@@ -89,10 +89,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db",
+      "fullUrl": "Organization/1729354690128717000.ac3bcc8e-159a-4026-9236-ae158c4c7068",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db",
+        "id": "1729354690128717000.ac3bcc8e-159a-4026-9236-ae158c4c7068",
         "identifier": [
           {
             "extension": [
@@ -107,10 +107,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6",
+      "fullUrl": "Organization/1729354690129513000.fee8aa08-acf1-412a-b23b-8cf9b42faa6b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6",
+        "id": "1729354690129513000.fee8aa08-acf1-412a-b23b-8cf9b42faa6b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -120,73 +120,73 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292709397520000.0dae28e9-adbc-41ba-9290-a5d0ee62eeb2",
+      "fullUrl": "Provenance/1729354690131757000.bdbf66a0-2c71-4ff2-9387-1a3057d4bbcf",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292709397520000.0dae28e9-adbc-41ba-9290-a5d0ee62eeb2",
+        "id": "1729354690131757000.bdbf66a0-2c71-4ff2-9387-1a3057d4bbcf",
         "target": [
           {
-            "reference": "MessageHeader/1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e"
+            "reference": "MessageHeader/1729354690129725000.47c4db23-e7e7-493c-bbd3-d011bc156d52"
           },
           {
-            "reference": "DiagnosticReport/1729292709701475000.6e1db083-47fd-42c0-87c9-0e22425e70ed"
+            "reference": "DiagnosticReport/1729354690425746000.bfefa915-645b-48f5-b92b-4804570eb52b"
           },
           {
-            "reference": "DiagnosticReport/1729292709704498000.5d6a7cfa-6821-4aaa-b987-5774fc46136b"
+            "reference": "DiagnosticReport/1729354690428431000.bdfafe14-86f5-4c82-bd25-22bf5a1abec4"
           },
           {
-            "reference": "DiagnosticReport/1729292709706382000.ccf380db-ed26-4cb0-aa17-02825cce517a"
+            "reference": "DiagnosticReport/1729354690429963000.d82ef1e5-922f-4c1b-8059-3a77ec7aa599"
           },
           {
-            "reference": "DiagnosticReport/1729292709707919000.ffae80cd-eca1-466d-8498-0349d45ad767"
+            "reference": "DiagnosticReport/1729354690431271000.9d8d3ef0-587d-41e6-98ef-dcac8f95e38f"
           },
           {
-            "reference": "DiagnosticReport/1729292709709838000.147ec6d1-4dbb-4175-b770-37a8c62d2b98"
+            "reference": "DiagnosticReport/1729354690433097000.aea182f8-3b02-4407-9302-31f806fd9bf4"
           },
           {
-            "reference": "DiagnosticReport/1729292709711296000.362d7fea-758f-4aeb-9e86-5135224c5bbe"
+            "reference": "DiagnosticReport/1729354690434420000.9556434f-83e3-4c3b-b763-17a9beef2351"
           },
           {
-            "reference": "DiagnosticReport/1729292709713674000.8b7f75d2-628a-4bfa-92d0-8718cc24cca4"
+            "reference": "DiagnosticReport/1729354690436453000.56f2d6af-0c19-4187-bc09-6f17eb3a7a2a"
           },
           {
-            "reference": "DiagnosticReport/1729292709715430000.ebde3aa7-825c-48c3-bd2b-847196d4d421"
+            "reference": "DiagnosticReport/1729354690438025000.9465f651-5a9c-4406-9246-576cf69bd466"
           },
           {
-            "reference": "DiagnosticReport/1729292709716859000.7640cdb0-f80f-4948-ab71-17149f329edd"
+            "reference": "DiagnosticReport/1729354690439391000.f79d8fbb-6199-46f6-99b9-55de435193af"
           },
           {
-            "reference": "DiagnosticReport/1729292709718295000.a3589226-b8da-4e66-bbf3-e278f2e083b1"
+            "reference": "DiagnosticReport/1729354690440765000.d7a0456a-d91d-4f01-9771-acdd05382a04"
           },
           {
-            "reference": "DiagnosticReport/1729292709719731000.90ab44b0-ae06-47c2-8b41-5f3286913d72"
+            "reference": "DiagnosticReport/1729354690442115000.64cf33c3-6a0a-4f7a-8a96-6259f2eb2f98"
           },
           {
-            "reference": "DiagnosticReport/1729292709721254000.532a4f9f-65e7-44df-a852-3ff618131e91"
+            "reference": "DiagnosticReport/1729354690443450000.7d6c52e9-00b4-4005-9279-e5634165006c"
           },
           {
-            "reference": "DiagnosticReport/1729292709722668000.01105566-6108-409b-bc2f-20a20fbec7f4"
+            "reference": "DiagnosticReport/1729354690444752000.affe9fb0-23a3-44ce-9395-1a3dcfdecbcc"
           },
           {
-            "reference": "DiagnosticReport/1729292709724112000.1d63227b-b9b9-419c-bf75-1147c7e960fc"
+            "reference": "DiagnosticReport/1729354690446096000.68b8d9be-c258-4309-8bd7-7c1c22e17a84"
           },
           {
-            "reference": "DiagnosticReport/1729292709725533000.82172988-ea91-4215-bfab-5d66e3c8d6ec"
+            "reference": "DiagnosticReport/1729354690447488000.b7d89073-3e2c-4f77-a3a7-4d70f321eaa8"
           },
           {
-            "reference": "DiagnosticReport/1729292709727011000.3e5a9e4a-8e57-4b56-8fac-dd23977e3697"
+            "reference": "DiagnosticReport/1729354690448860000.5ec9780a-7a27-4d1a-81fc-9af5faec6597"
           },
           {
-            "reference": "DiagnosticReport/1729292709728630000.bf7268b2-aac9-4571-8a0d-1f282f71e7bf"
+            "reference": "DiagnosticReport/1729354690450239000.9d681617-4e73-4569-ae18-7b4fc3cd25b0"
           },
           {
-            "reference": "DiagnosticReport/1729292709730326000.1be2950e-7895-4297-b73e-b790f288c464"
+            "reference": "DiagnosticReport/1729354690451613000.56d4b861-41e0-4ded-8575-449df99313f4"
           },
           {
-            "reference": "DiagnosticReport/1729292709731796000.7881396a-2298-409b-b258-57c8465cb1fa"
+            "reference": "DiagnosticReport/1729354690452974000.4e5538bd-1060-4718-8a37-ffb17018b95c"
           },
           {
-            "reference": "DiagnosticReport/1729292709733215000.12c48fca-307a-4cdc-8c2d-71236132fb57"
+            "reference": "DiagnosticReport/1729354690454322000.8059b3b5-3e6d-46af-8d83-27a4adc21559"
           }
         ],
         "recorded": "2024-02-12T10:30:49Z",
@@ -208,17 +208,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729292709397395000.478f6a65-232c-49e3-9828-c64b7658df1f"
+              "reference": "Organization/1729354690131529000.c026d3df-a744-4633-aa6a-d2ed0bdf93ce"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729292709397395000.478f6a65-232c-49e3-9828-c64b7658df1f",
+      "fullUrl": "Organization/1729354690131529000.c026d3df-a744-4633-aa6a-d2ed0bdf93ce",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292709397395000.478f6a65-232c-49e3-9828-c64b7658df1f",
+        "id": "1729354690131529000.c026d3df-a744-4633-aa6a-d2ed0bdf93ce",
         "identifier": [
           {
             "extension": [
@@ -233,11 +233,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292709398038000.66c47919-832b-4160-92ea-ba8fff1998b3",
+      "fullUrl": "Provenance/1729354690132533000.ff851149-57ad-43f1-9cdb-b7ead62b255f",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292709398038000.66c47919-832b-4160-92ea-ba8fff1998b3",
-        "recorded": "2024-10-18T16:05:09Z",
+        "id": "1729354690132533000.ff851149-57ad-43f1-9cdb-b7ead62b255f",
+        "recorded": "2024-10-19T09:18:10Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -259,17 +259,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729292709397934000.d41db398-c4d9-4319-8254-d557fbfe3aef"
+              "reference": "Organization/1729354690132380000.e2a1b5b1-05c6-4b9f-9e43-ff53c99a5d6b"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729292709397934000.d41db398-c4d9-4319-8254-d557fbfe3aef",
+      "fullUrl": "Organization/1729354690132380000.e2a1b5b1-05c6-4b9f-9e43-ff53c99a5d6b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292709397934000.d41db398-c4d9-4319-8254-d557fbfe3aef",
+        "id": "1729354690132380000.e2a1b5b1-05c6-4b9f-9e43-ff53c99a5d6b",
         "identifier": [
           {
             "value": "CDC PRIME - Atlanta"
@@ -289,10 +289,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be",
+      "fullUrl": "Patient/1729354690140801000.ac2cf630-cf38-44d6-92fd-c6b022d837a1",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be",
+        "id": "1729354690140801000.ac2cf630-cf38-44d6-92fd-c6b022d837a1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -380,7 +380,7 @@
             },
             "value": "80008715",
             "assigner": {
-              "reference": "Organization/1729292709398487000.cabc39ee-5787-43f0-98cc-edb5c4df907e"
+              "reference": "Organization/1729354690133342000.2180ed80-a667-4817-b35b-d78ee9cd1503"
             }
           }
         ],
@@ -539,10 +539,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292709398487000.cabc39ee-5787-43f0-98cc-edb5c4df907e",
+      "fullUrl": "Organization/1729354690133342000.2180ed80-a667-4817-b35b-d78ee9cd1503",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292709398487000.cabc39ee-5787-43f0-98cc-edb5c4df907e",
+        "id": "1729354690133342000.2180ed80-a667-4817-b35b-d78ee9cd1503",
         "identifier": [
           {
             "extension": [
@@ -564,16 +564,16 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292709403233000.3621b8dc-ae01-41f0-ba2a-68033949eb27",
+      "fullUrl": "Provenance/1729354690141421000.5c9a009f-de89-4e43-a323-77d477b02a33",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292709403233000.3621b8dc-ae01-41f0-ba2a-68033949eb27",
+        "id": "1729354690141421000.5c9a009f-de89-4e43-a323-77d477b02a33",
         "target": [
           {
-            "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
+            "reference": "Patient/1729354690140801000.ac2cf630-cf38-44d6-92fd-c6b022d837a1"
           }
         ],
-        "recorded": "2024-10-18T16:05:09Z",
+        "recorded": "2024-10-19T09:18:10Z",
         "activity": {
           "coding": [
             {
@@ -585,10 +585,10 @@
       }
     },
     {
-      "fullUrl": "RelatedPerson/1729292709404572000.fcd25e51-f16e-419a-9525-bee3af542767",
+      "fullUrl": "RelatedPerson/1729354690143481000.a41914cb-0cc6-4a67-8fd1-96889a728592",
       "resource": {
         "resourceType": "RelatedPerson",
-        "id": "1729292709404572000.fcd25e51-f16e-419a-9525-bee3af542767",
+        "id": "1729354690143481000.a41914cb-0cc6-4a67-8fd1-96889a728592",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -596,7 +596,7 @@
           }
         ],
         "patient": {
-          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
+          "reference": "Patient/1729354690140801000.ac2cf630-cf38-44d6-92fd-c6b022d837a1"
         },
         "relationship": [
           {
@@ -746,10 +746,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729292709406680000.95327ddc-1557-4fe9-8ac2-b420aef85e14",
+      "fullUrl": "Observation/1729354690146751000.651169aa-d375-4461-a43a-d981903fa549",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729292709406680000.95327ddc-1557-4fe9-8ac2-b420aef85e14",
+        "id": "1729354690146751000.651169aa-d375-4461-a43a-d981903fa549",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
@@ -790,7 +790,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
+          "reference": "Patient/1729354690140801000.ac2cf630-cf38-44d6-92fd-c6b022d837a1"
         },
         "effectiveDateTime": "2024-02-12T10:30:49Z",
         "_effectiveDateTime": {
@@ -838,10 +838,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729292709408292000.7b895a09-9a64-41ff-bb4d-39b0ae377f24",
+      "fullUrl": "Observation/1729354690148823000.4e76c140-7c2a-46c4-939d-0ebb627830a6",
       "resource": {
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@@ -13967,7 +13967,7 @@
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@@ -14041,7 +14041,7 @@
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@@ -14070,10 +14070,10 @@
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@@ -14114,7 +14114,7 @@
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@@ -14162,10 +14162,10 @@
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@@ -14206,7 +14206,7 @@
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@@ -14296,7 +14296,7 @@
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@@ -14347,10 +14347,10 @@
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@@ -14360,10 +14360,10 @@
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@@ -14373,10 +14373,10 @@
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@@ -14386,10 +14386,10 @@
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@@ -14399,10 +14399,10 @@
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@@ -14412,10 +14412,10 @@
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@@ -14425,10 +14425,10 @@
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@@ -14438,10 +14438,10 @@
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@@ -14451,10 +14451,10 @@
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@@ -14464,10 +14464,10 @@
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@@ -14477,10 +14477,10 @@
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@@ -14490,10 +14490,10 @@
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@@ -14503,10 +14503,10 @@
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@@ -14555,10 +14555,10 @@
       }
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@@ -14568,10 +14568,10 @@
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@@ -14581,10 +14581,10 @@
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@@ -14594,10 +14594,10 @@
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@@ -14609,7 +14609,7 @@
               {
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                 "valueReference": {
-                  "reference": "Organization/1729292709618697000.78c8c70c-96f3-4a2d-8be5-a6a66b81b5ad"
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@@ -14642,7 +14642,7 @@
               {
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@@ -14678,7 +14678,7 @@
               {
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@@ -14780,18 +14780,18 @@
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@@ -14818,10 +14818,10 @@
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@@ -14880,23 +14880,23 @@
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@@ -14917,10 +14917,10 @@
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         "extension": [
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@@ -14943,10 +14943,10 @@
       }
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@@ -14969,10 +14969,10 @@
       }
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@@ -14988,7 +14988,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292709624831000.3d2b8759-e5a3-41a5-9085-0895c503d795"
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@@ -15038,18 +15038,18 @@
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+          "reference": "Practitioner/1729354690346970000.bf182ef7-b7de-44f2-afa7-7c33807bc3d7"
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@@ -15076,10 +15076,10 @@
       }
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-      "fullUrl": "Practitioner/1729292709624831000.3d2b8759-e5a3-41a5-9085-0895c503d795",
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         "extension": [
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@@ -15102,10 +15102,10 @@
       }
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         "extension": [
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@@ -15121,7 +15121,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292709628911000.3006c42c-4c3a-4125-b769-9b009e9f4783"
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@@ -15171,18 +15171,18 @@
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+          "reference": "Practitioner/1729354690351057000.764b71ed-4cf8-45f8-849e-d9db6c8d2a94"
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+      "fullUrl": "Practitioner/1729354690351057000.764b71ed-4cf8-45f8-849e-d9db6c8d2a94",
       "resource": {
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         "extension": [
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@@ -15209,10 +15209,10 @@
       }
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-      "fullUrl": "Practitioner/1729292709628911000.3006c42c-4c3a-4125-b769-9b009e9f4783",
+      "fullUrl": "Practitioner/1729354690353689000.c398d6f4-8ee3-4f57-b68b-eb691794cb4d",
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         "extension": [
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@@ -15235,10 +15235,10 @@
       }
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         "extension": [
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@@ -15254,7 +15254,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292709632977000.eb02cc38-f076-47a3-8f96-4dfc4c4de2e0"
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@@ -15304,18 +15304,18 @@
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         "extension": [
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@@ -15342,10 +15342,10 @@
       }
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-      "fullUrl": "Practitioner/1729292709632977000.eb02cc38-f076-47a3-8f96-4dfc4c4de2e0",
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         "extension": [
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@@ -15368,10 +15368,10 @@
       }
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@@ -15387,7 +15387,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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@@ -15437,18 +15437,18 @@
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         "extension": [
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@@ -15475,10 +15475,10 @@
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@@ -15501,10 +15501,10 @@
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@@ -15520,7 +15520,7 @@
               {
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                 "valueReference": {
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@@ -15570,18 +15570,18 @@
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@@ -15608,10 +15608,10 @@
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@@ -15634,10 +15634,10 @@
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@@ -15653,7 +15653,7 @@
               {
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@@ -15703,18 +15703,18 @@
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@@ -15741,10 +15741,10 @@
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@@ -15767,10 +15767,10 @@
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@@ -15786,7 +15786,7 @@
               {
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                 "valueReference": {
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@@ -15836,18 +15836,18 @@
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@@ -15874,10 +15874,10 @@
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@@ -15900,10 +15900,10 @@
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@@ -15919,7 +15919,7 @@
               {
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                 "valueReference": {
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@@ -15969,18 +15969,18 @@
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@@ -16007,10 +16007,10 @@
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         "extension": [
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@@ -16033,10 +16033,10 @@
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@@ -16052,7 +16052,7 @@
               {
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                 "valueReference": {
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@@ -16102,18 +16102,18 @@
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@@ -16140,10 +16140,10 @@
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         "extension": [
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@@ -16166,10 +16166,10 @@
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@@ -16185,7 +16185,7 @@
               {
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                 "valueReference": {
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@@ -16235,18 +16235,18 @@
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@@ -16273,10 +16273,10 @@
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@@ -16299,10 +16299,10 @@
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@@ -16318,7 +16318,7 @@
               {
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                 "valueReference": {
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@@ -16368,18 +16368,18 @@
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@@ -16406,10 +16406,10 @@
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@@ -16432,10 +16432,10 @@
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@@ -16451,7 +16451,7 @@
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@@ -16501,18 +16501,18 @@
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@@ -16539,10 +16539,10 @@
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@@ -16565,10 +16565,10 @@
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@@ -16584,7 +16584,7 @@
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@@ -16634,18 +16634,18 @@
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@@ -16672,10 +16672,10 @@
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@@ -16698,10 +16698,10 @@
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@@ -16717,7 +16717,7 @@
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@@ -16767,18 +16767,18 @@
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@@ -16805,10 +16805,10 @@
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@@ -16831,10 +16831,10 @@
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@@ -16850,7 +16850,7 @@
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@@ -16900,18 +16900,18 @@
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@@ -16938,10 +16938,10 @@
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@@ -16964,10 +16964,10 @@
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@@ -16983,7 +16983,7 @@
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@@ -17033,18 +17033,18 @@
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@@ -17071,10 +17071,10 @@
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@@ -17097,10 +17097,10 @@
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@@ -17116,7 +17116,7 @@
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@@ -17166,18 +17166,18 @@
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@@ -17204,10 +17204,10 @@
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@@ -17230,10 +17230,10 @@
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@@ -17249,7 +17249,7 @@
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@@ -17304,18 +17304,18 @@
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@@ -17342,10 +17342,10 @@
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@@ -19227,7 +19227,7 @@
         ],
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+            "reference": "ServiceRequest/1729354690406760000.d1c7996b-afa7-4c0b-8ab3-161f4542986f"
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@@ -19246,7 +19246,7 @@
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+          "reference": "Patient/1729354690140801000.ac2cf630-cf38-44d6-92fd-c6b022d837a1"
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         "_effectiveDateTime": {
@@ -19268,30 +19268,30 @@
         },
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-            "reference": "Specimen/1729292709613121000.3b8378b3-7120-4fd7-9f84-234063957e99"
+            "reference": "Specimen/1729354690338046000.1dff0b87-8e53-40d4-98f7-cad97229b951"
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-            "reference": "Observation/1729292709587290000.65df99e1-2db7-4c8f-8898-b6431b7bb91a"
+            "reference": "Observation/1729354690311943000.b30be126-8a92-47e4-ae78-d8dddebe4695"
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-            "reference": "Observation/1729292709589306000.fec39f0f-63c4-498a-b737-f94d345264bd"
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-            "reference": "Observation/1729292709590278000.2db4b7bf-f577-4025-9ddd-25841e22e341"
+            "reference": "Observation/1729354690314970000.3a33eadd-d04e-476f-bff7-2382526db3c3"
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-      "fullUrl": "DiagnosticReport/1729292709728630000.bf7268b2-aac9-4571-8a0d-1f282f71e7bf",
+      "fullUrl": "DiagnosticReport/1729354690450239000.9d681617-4e73-4569-ae18-7b4fc3cd25b0",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292709728630000.bf7268b2-aac9-4571-8a0d-1f282f71e7bf",
+        "id": "1729354690450239000.9d681617-4e73-4569-ae18-7b4fc3cd25b0",
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@@ -19322,7 +19322,7 @@
         ],
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+            "reference": "ServiceRequest/1729354690410636000.e22a9135-6fd9-4de6-9271-e5d6b4ed4c3f"
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@@ -19341,7 +19341,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
+          "reference": "Patient/1729354690140801000.ac2cf630-cf38-44d6-92fd-c6b022d837a1"
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@@ -19363,30 +19363,30 @@
         },
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-            "reference": "Specimen/1729292709613460000.e12727e3-167b-4934-8034-83f016f9a29e"
+            "reference": "Specimen/1729354690338393000.342623cd-2840-4c69-ad07-e3d9abdc86b5"
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-            "reference": "Observation/1729292709592455000.495e6192-9326-497b-a4d9-bda469aa1a38"
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-            "reference": "Observation/1729292709593410000.bda2353a-dcda-493f-9e47-17830e72ab0d"
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-            "reference": "Observation/1729292709594364000.3452e998-7443-4ce2-85ba-f4b5bb5c68ac"
+            "reference": "Observation/1729354690319155000.3bf98b9b-9ef1-4de4-92b0-c29fe66c1f9b"
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-      "fullUrl": "DiagnosticReport/1729292709730326000.1be2950e-7895-4297-b73e-b790f288c464",
+      "fullUrl": "DiagnosticReport/1729354690451613000.56d4b861-41e0-4ded-8575-449df99313f4",
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-        "id": "1729292709730326000.1be2950e-7895-4297-b73e-b790f288c464",
+        "id": "1729354690451613000.56d4b861-41e0-4ded-8575-449df99313f4",
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@@ -19417,7 +19417,7 @@
         ],
         "basedOn": [
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+            "reference": "ServiceRequest/1729354690414434000.6a4e2c70-7228-4cb2-843d-9aaaeb28a8d4"
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@@ -19436,7 +19436,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292709402870000.303a49f4-c123-4bc3-a9c4-b97500d9b6be"
+          "reference": "Patient/1729354690140801000.ac2cf630-cf38-44d6-92fd-c6b022d837a1"
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         "_effectiveDateTime": {
@@ -19458,30 +19458,30 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292709613800000.42bc26f5-8897-43bd-bcde-6d2d478cd6c9"
+            "reference": "Specimen/1729354690338742000.0a4dc8a4-b06d-40f7-97ee-703a7974fd46"
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+            "reference": "Observation/1729354690320107000.782c6f2d-f6df-40a4-9a62-5ef4841e481e"
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-            "reference": "Observation/1729292709597340000.a7215db3-150a-4365-90b5-357a6ffdb80f"
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+            "reference": "Observation/1729354690323122000.e19a62a5-713e-48aa-8ac8-ac7d9544c7d6"
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     },
     {
-      "fullUrl": "DiagnosticReport/1729292709731796000.7881396a-2298-409b-b258-57c8465cb1fa",
+      "fullUrl": "DiagnosticReport/1729354690452974000.4e5538bd-1060-4718-8a37-ffb17018b95c",
       "resource": {
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-        "id": "1729292709731796000.7881396a-2298-409b-b258-57c8465cb1fa",
+        "id": "1729354690452974000.4e5538bd-1060-4718-8a37-ffb17018b95c",
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@@ -19512,7 +19512,7 @@
         ],
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+            "reference": "ServiceRequest/1729354690418426000.891a1e49-9146-4344-8de1-67933aedf5c8"
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@@ -19536,7 +19536,7 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729354690140801000.ac2cf630-cf38-44d6-92fd-c6b022d837a1"
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@@ -19558,24 +19558,24 @@
         },
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-            "reference": "Specimen/1729292709614140000.2f304a8e-0054-4b1b-8304-03582bc7f953"
+            "reference": "Specimen/1729354690339087000.c20aac69-0b9c-4403-9ada-b88971194817"
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         "result": [
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+            "reference": "Observation/1729354690324189000.78cd8fea-04bb-4674-abda-42ce3a8e48d7"
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+            "reference": "Observation/1729354690325146000.ea57b514-fc4c-4f5b-a5d3-dccf23bd5e06"
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     },
     {
-      "fullUrl": "DiagnosticReport/1729292709733215000.12c48fca-307a-4cdc-8c2d-71236132fb57",
+      "fullUrl": "DiagnosticReport/1729354690454322000.8059b3b5-3e6d-46af-8d83-27a4adc21559",
       "resource": {
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-        "id": "1729292709733215000.12c48fca-307a-4cdc-8c2d-71236132fb57",
+        "id": "1729354690454322000.8059b3b5-3e6d-46af-8d83-27a4adc21559",
         "identifier": [
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@@ -19606,7 +19606,7 @@
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         "basedOn": [
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+            "reference": "ServiceRequest/1729354690422469000.9c82c438-d41d-4d29-bf4a-9545faf89dc9"
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@@ -19630,7 +19630,7 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729354690140801000.ac2cf630-cf38-44d6-92fd-c6b022d837a1"
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         "_effectiveDateTime": {
@@ -19652,12 +19652,12 @@
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-            "reference": "Specimen/1729292709614475000.d14ad60e-3145-433e-8f7a-a3ecd9b23ce1"
+            "reference": "Specimen/1729354690339436000.08178aee-0c78-4a5f-8a89-8d2f788544bf"
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         "result": [
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+            "reference": "Observation/1729354690326214000.df0daa25-3a88-463d-8fee-5f825b06ce89"
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diff --git a/examples/CA/003_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir b/examples/CA/003_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
index 7d6e3c83d..5ae1e2f21 100644
--- a/examples/CA/003_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
+++ b/examples/CA/003_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729292709395325000.18465c09-3aeb-4dd5-8c5b-fb20faafcc09",
+  "id": "1729354690127252000.919e899c-a162-4de3-998a-f4e04113154e",
   "meta": {
-    "lastUpdated": "2024-10-18T16:05:09.395-07:00"
+    "lastUpdated": "2024-10-19T09:18:10.127-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-12T10:30:49.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e",
+      "fullUrl": "MessageHeader/1729354690129725000.47c4db23-e7e7-493c-bbd3-d011bc156d52",
       "resource": {
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-        "id": "1729292709396508000.ea03e9ad-2782-4c57-8101-9360e838287e",
+        "id": "1729354690129725000.47c4db23-e7e7-493c-bbd3-d011bc156d52",
         "meta": {
           "tag": [
             {
@@ -55,12 +55,12 @@
             ],
             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6"
+              "reference": "Organization/1729354690129513000.fee8aa08-acf1-412a-b23b-8cf9b42faa6b"
             }
           }
         ],
         "sender": {
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+          "reference": "Organization/1729354690128717000.ac3bcc8e-159a-4026-9236-ae158c4c7068"
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         "source": {
           "extension": [
@@ -86,10 +86,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db",
+      "fullUrl": "Organization/1729354690128717000.ac3bcc8e-159a-4026-9236-ae158c4c7068",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292709395982000.bc72b833-c0ec-487b-b635-0c46ddd163db",
+        "id": "1729354690128717000.ac3bcc8e-159a-4026-9236-ae158c4c7068",
         "identifier": [
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             "extension": [
@@ -104,10 +104,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6",
+      "fullUrl": "Organization/1729354690129513000.fee8aa08-acf1-412a-b23b-8cf9b42faa6b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292709396394000.d121bd3b-6753-40d1-b77b-19e541a1c1d6",
+        "id": "1729354690129513000.fee8aa08-acf1-412a-b23b-8cf9b42faa6b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -128,73 +128,73 @@
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     },
     {
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+      "fullUrl": "Provenance/1729354690131757000.bdbf66a0-2c71-4ff2-9387-1a3057d4bbcf",
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@@ -14361,10 +14361,10 @@
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@@ -14374,10 +14374,10 @@
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@@ -14387,10 +14387,10 @@
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@@ -14400,10 +14400,10 @@
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@@ -14413,10 +14413,10 @@
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@@ -14426,10 +14426,10 @@
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@@ -14439,10 +14439,10 @@
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@@ -14452,10 +14452,10 @@
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@@ -14465,10 +14465,10 @@
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@@ -14478,10 +14478,10 @@
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@@ -14491,10 +14491,10 @@
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@@ -14504,10 +14504,10 @@
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@@ -14517,10 +14517,10 @@
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@@ -14530,10 +14530,10 @@
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@@ -14543,10 +14543,10 @@
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@@ -14556,10 +14556,10 @@
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@@ -14569,10 +14569,10 @@
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@@ -14584,7 +14584,7 @@
               {
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                 "valueReference": {
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@@ -14617,7 +14617,7 @@
               {
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                 "valueReference": {
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@@ -14653,7 +14653,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729354690340719000.3fff973a-544a-487b-b896-0e9e4b5b012a"
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@@ -14759,18 +14759,18 @@
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@@ -14797,10 +14797,10 @@
       }
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@@ -14859,23 +14859,23 @@
       }
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+          "reference": "Practitioner/1729354690340719000.3fff973a-544a-487b-b896-0e9e4b5b012a"
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@@ -14896,10 +14896,10 @@
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@@ -14922,10 +14922,10 @@
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@@ -14948,10 +14948,10 @@
       }
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@@ -14978,10 +14978,10 @@
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@@ -15004,10 +15004,10 @@
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@@ -15034,10 +15034,10 @@
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@@ -15060,10 +15060,10 @@
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@@ -15370,10 +15370,10 @@
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@@ -15396,10 +15396,10 @@
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@@ -15426,10 +15426,10 @@
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@@ -15452,10 +15452,10 @@
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@@ -15482,10 +15482,10 @@
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@@ -15508,10 +15508,10 @@
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@@ -15538,10 +15538,10 @@
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@@ -15564,10 +15564,10 @@
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@@ -15594,10 +15594,10 @@
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@@ -15620,10 +15620,10 @@
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@@ -15650,10 +15650,10 @@
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@@ -15676,10 +15676,10 @@
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@@ -15706,10 +15706,10 @@
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@@ -15732,10 +15732,10 @@
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@@ -15762,10 +15762,10 @@
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@@ -15788,10 +15788,10 @@
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@@ -15818,10 +15818,10 @@
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@@ -15844,10 +15844,10 @@
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@@ -15874,10 +15874,10 @@
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@@ -15900,10 +15900,10 @@
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diff --git a/examples/CA/004_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir b/examples/CA/004_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
index 99be9aab4..d183c73b6 100644
--- a/examples/CA/004_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
+++ b/examples/CA/004_CA_ORU_R01_CDPH_produced_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729292223963452000.86853264-9dcc-4fb1-ae23-9b23987f6966",
+  "id": "1729354205244107000.dce22360-2820-445b-9559-6bc83797a5ed",
   "meta": {
-    "lastUpdated": "2024-10-18T15:57:03.963-07:00"
+    "lastUpdated": "2024-10-19T09:10:05.244-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-26T03:43:04.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729292223965072000.d8e7d4ca-2fe2-4ff0-b1b2-e9684ed4f7a2",
+      "fullUrl": "MessageHeader/1729354205245478000.3bef4ce7-d807-4139-8532-ce8a2715d3fa",
       "resource": {
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-        "id": "1729292223965072000.d8e7d4ca-2fe2-4ff0-b1b2-e9684ed4f7a2",
+        "id": "1729354205245478000.3bef4ce7-d807-4139-8532-ce8a2715d3fa",
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@@ -58,12 +58,12 @@
             ],
             "name": "SISHIERECEIVER",
             "receiver": {
-              "reference": "Organization/1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7"
+              "reference": "Organization/1729354205245304000.303523a2-4a31-4e77-9027-898d7ee6870f"
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         "sender": {
-          "reference": "Organization/1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2"
+          "reference": "Organization/1729354205244762000.7acb04cd-d2b0-4066-be54-807adc484d74"
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@@ -89,10 +89,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2",
+      "fullUrl": "Organization/1729354205244762000.7acb04cd-d2b0-4066-be54-807adc484d74",
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+        "id": "1729354205244762000.7acb04cd-d2b0-4066-be54-807adc484d74",
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@@ -107,10 +107,10 @@
       }
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     {
-      "fullUrl": "Organization/1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7",
+      "fullUrl": "Organization/1729354205245304000.303523a2-4a31-4e77-9027-898d7ee6870f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7",
+        "id": "1729354205245304000.303523a2-4a31-4e77-9027-898d7ee6870f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -120,73 +120,73 @@
       }
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-      "fullUrl": "Provenance/1729292223966515000.b808c45a-53be-4073-ad02-4d05fc543940",
+      "fullUrl": "Provenance/1729354205247044000.e7d909fa-8292-471c-8f9e-87b36aa0c2f3",
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@@ -208,17 +208,17 @@
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-              "reference": "Organization/1729292223966346000.2220dfd9-bdd0-4bf8-8943-4aea1651b22b"
+              "reference": "Organization/1729354205246844000.13ed2734-c73e-4f11-bf45-41a4e95bc754"
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-      "fullUrl": "Organization/1729292223966346000.2220dfd9-bdd0-4bf8-8943-4aea1651b22b",
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-        "id": "1729292223966346000.2220dfd9-bdd0-4bf8-8943-4aea1651b22b",
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@@ -233,11 +233,11 @@
       }
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+      "fullUrl": "Provenance/1729354205247730000.23d992e6-875f-4c53-ba99-e1ebac095899",
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-        "id": "1729292223967205000.905e6774-a8d6-495e-b060-fa143e31556a",
-        "recorded": "2024-10-18T15:57:03Z",
+        "id": "1729354205247730000.23d992e6-875f-4c53-ba99-e1ebac095899",
+        "recorded": "2024-10-19T09:10:05Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -259,17 +259,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729292223967075000.3f202e94-d63e-4116-ab5d-40094141799c"
+              "reference": "Organization/1729354205247563000.e50ec612-5b1f-4315-8643-ee1abd55c21e"
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+      "fullUrl": "Organization/1729354205247563000.e50ec612-5b1f-4315-8643-ee1abd55c21e",
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@@ -289,10 +289,10 @@
       }
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-      "fullUrl": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0",
+      "fullUrl": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce",
       "resource": {
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-        "id": "1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0",
+        "id": "1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce",
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@@ -380,7 +380,7 @@
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             "assigner": {
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+              "reference": "Organization/1729354205248446000.be39ec21-482a-4c1e-88cc-9b9cf094954d"
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@@ -464,10 +464,10 @@
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+      "fullUrl": "Organization/1729354205248446000.be39ec21-482a-4c1e-88cc-9b9cf094954d",
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@@ -489,16 +489,16 @@
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+            "reference": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce"
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-        "recorded": "2024-10-18T15:57:03Z",
+        "recorded": "2024-10-19T09:10:05Z",
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@@ -510,10 +510,10 @@
       }
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-      "fullUrl": "RelatedPerson/1729292223974590000.10499b88-2028-4fa0-b169-a7b5cc034d12",
+      "fullUrl": "RelatedPerson/1729354205255607000.7173c5dc-17a4-43e3-8ba6-70dcb5f202b3",
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@@ -521,7 +521,7 @@
           }
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         "patient": {
-          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+          "reference": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce"
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@@ -590,10 +590,10 @@
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@@ -634,7 +634,7 @@
           ]
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+          "reference": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce"
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@@ -682,10 +682,10 @@
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@@ -726,7 +726,7 @@
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@@ -774,10 +774,10 @@
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@@ -818,7 +818,7 @@
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@@ -866,10 +866,10 @@
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@@ -910,7 +910,7 @@
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+          "reference": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce"
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@@ -958,10 +958,10 @@
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@@ -1002,7 +1002,7 @@
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@@ -13841,10 +13841,10 @@
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@@ -13885,7 +13885,7 @@
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@@ -13915,10 +13915,10 @@
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@@ -13959,7 +13959,7 @@
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@@ -14007,10 +14007,10 @@
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@@ -14051,7 +14051,7 @@
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@@ -14081,10 +14081,10 @@
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@@ -14141,7 +14141,7 @@
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@@ -14179,10 +14179,10 @@
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@@ -14192,10 +14192,10 @@
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@@ -14205,10 +14205,10 @@
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@@ -14218,10 +14218,10 @@
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@@ -14231,10 +14231,10 @@
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@@ -14244,10 +14244,10 @@
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@@ -14257,10 +14257,10 @@
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@@ -14270,10 +14270,10 @@
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@@ -14283,10 +14283,10 @@
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@@ -14296,10 +14296,10 @@
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@@ -14309,10 +14309,10 @@
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@@ -14322,10 +14322,10 @@
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@@ -14335,10 +14335,10 @@
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@@ -14348,10 +14348,10 @@
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@@ -14361,10 +14361,10 @@
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@@ -14374,10 +14374,10 @@
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@@ -14387,10 +14387,10 @@
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@@ -14400,10 +14400,10 @@
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@@ -14413,10 +14413,10 @@
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@@ -14426,10 +14426,10 @@
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@@ -14439,10 +14439,10 @@
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@@ -14454,7 +14454,7 @@
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@@ -14487,7 +14487,7 @@
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@@ -14523,7 +14523,7 @@
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@@ -14625,18 +14625,18 @@
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@@ -14663,10 +14663,10 @@
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@@ -14725,23 +14725,23 @@
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@@ -14762,10 +14762,10 @@
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@@ -14788,10 +14788,10 @@
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@@ -14814,10 +14814,10 @@
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@@ -14833,7 +14833,7 @@
               {
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@@ -14883,18 +14883,18 @@
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@@ -14921,10 +14921,10 @@
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@@ -14947,10 +14947,10 @@
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@@ -14966,7 +14966,7 @@
               {
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@@ -15016,18 +15016,18 @@
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@@ -15054,10 +15054,10 @@
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@@ -15080,10 +15080,10 @@
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@@ -15099,7 +15099,7 @@
               {
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@@ -15149,18 +15149,18 @@
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@@ -15187,10 +15187,10 @@
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@@ -15213,10 +15213,10 @@
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@@ -15232,7 +15232,7 @@
               {
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                 "valueReference": {
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@@ -15282,18 +15282,18 @@
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@@ -15320,10 +15320,10 @@
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@@ -15346,10 +15346,10 @@
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@@ -15365,7 +15365,7 @@
               {
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@@ -15415,18 +15415,18 @@
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@@ -15453,10 +15453,10 @@
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@@ -15479,10 +15479,10 @@
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@@ -15498,7 +15498,7 @@
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@@ -15548,18 +15548,18 @@
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@@ -15586,10 +15586,10 @@
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@@ -15612,10 +15612,10 @@
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@@ -15631,7 +15631,7 @@
               {
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                 "valueReference": {
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@@ -15681,18 +15681,18 @@
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@@ -15719,10 +15719,10 @@
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@@ -15745,10 +15745,10 @@
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@@ -15764,7 +15764,7 @@
               {
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@@ -15814,18 +15814,18 @@
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@@ -15852,10 +15852,10 @@
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@@ -15878,10 +15878,10 @@
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@@ -15897,7 +15897,7 @@
               {
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@@ -15947,18 +15947,18 @@
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@@ -15985,10 +15985,10 @@
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@@ -16011,10 +16011,10 @@
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@@ -16030,7 +16030,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292224243041000.605ed556-fac1-4721-931c-8189fe91642b"
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@@ -16080,18 +16080,18 @@
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         "extension": [
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@@ -16118,10 +16118,10 @@
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@@ -16144,10 +16144,10 @@
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@@ -16163,7 +16163,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292224247149000.31dea842-9576-4209-8ca8-427cc875426b"
+                  "reference": "Practitioner/1729354205516702000.f3065e26-699c-40af-bf5f-bdc8561d96b5"
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@@ -16213,18 +16213,18 @@
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+          "reference": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce"
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@@ -16251,10 +16251,10 @@
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@@ -16277,10 +16277,10 @@
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@@ -16296,7 +16296,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292224251460000.d74be815-87dd-4a49-89e7-fd390589e8b9"
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@@ -16346,18 +16346,18 @@
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@@ -16384,10 +16384,10 @@
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@@ -16410,10 +16410,10 @@
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@@ -16429,7 +16429,7 @@
               {
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                 "valueReference": {
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@@ -16479,18 +16479,18 @@
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@@ -16517,10 +16517,10 @@
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@@ -16543,10 +16543,10 @@
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@@ -16562,7 +16562,7 @@
               {
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@@ -16612,18 +16612,18 @@
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@@ -16650,10 +16650,10 @@
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@@ -16676,10 +16676,10 @@
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@@ -16695,7 +16695,7 @@
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@@ -16745,18 +16745,18 @@
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@@ -16783,10 +16783,10 @@
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@@ -16809,10 +16809,10 @@
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@@ -16828,7 +16828,7 @@
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@@ -16878,18 +16878,18 @@
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@@ -16916,10 +16916,10 @@
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@@ -16942,10 +16942,10 @@
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@@ -16961,7 +16961,7 @@
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@@ -17011,18 +17011,18 @@
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@@ -17049,10 +17049,10 @@
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@@ -17075,10 +17075,10 @@
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@@ -17094,7 +17094,7 @@
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@@ -17149,18 +17149,18 @@
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@@ -17187,10 +17187,10 @@
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@@ -17213,10 +17213,10 @@
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@@ -17232,7 +17232,7 @@
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@@ -17287,18 +17287,18 @@
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@@ -17325,10 +17325,10 @@
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@@ -17351,10 +17351,10 @@
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@@ -17429,7 +17429,7 @@
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@@ -17448,7 +17448,7 @@
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@@ -17470,16 +17470,16 @@
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@@ -17510,7 +17510,7 @@
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@@ -17529,7 +17529,7 @@
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+            "reference": "ServiceRequest/1729354205544051000.072d675b-38cc-4989-bb6a-65763c4c140f"
           }
         ],
         "status": "final",
@@ -19281,7 +19281,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+          "reference": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce"
         },
         "effectiveDateTime": "2024-02-13T15:46:00Z",
         "_effectiveDateTime": {
@@ -19303,30 +19303,30 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292224177972000.91c023f7-27fc-4b73-b833-4150b3c028c4"
+            "reference": "Specimen/1729354205453191000.64d29ff7-e64b-497b-8031-6f520bb5e658"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729292224157578000.58b60be8-7e92-490d-a841-482de67b5c81"
+            "reference": "Observation/1729354205432231000.b1a2f6be-ece7-4986-aeb8-ffc5a944f9cf"
           },
           {
-            "reference": "Observation/1729292224158760000.ddb99504-2b67-4b00-bab4-7c789f63e98a"
+            "reference": "Observation/1729354205433498000.f083dd6c-e956-40b5-9e3d-96c8db87b0aa"
           },
           {
-            "reference": "Observation/1729292224159829000.b1ab5139-499c-4d08-959a-de1d7d4864d4"
+            "reference": "Observation/1729354205434628000.eabcd5a9-6e97-4954-b5b5-ba368508c306"
           },
           {
-            "reference": "Observation/1729292224160879000.8724b219-b358-4bf5-b41f-b66dba158e94"
+            "reference": "Observation/1729354205435731000.e1ee1021-71d0-442b-8bc5-4215154d54bc"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292224312687000.bcf75080-bc06-444a-b0de-d1d385132ad3",
+      "fullUrl": "DiagnosticReport/1729354205584424000.f4afb581-9f77-42d3-87d1-b682fb0f89bb",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292224312687000.bcf75080-bc06-444a-b0de-d1d385132ad3",
+        "id": "1729354205584424000.f4afb581-9f77-42d3-87d1-b682fb0f89bb",
         "identifier": [
           {
             "extension": [
@@ -19357,7 +19357,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292224276756000.b1212c05-fab9-4425-8792-8157e2c59096"
+            "reference": "ServiceRequest/1729354205548074000.eb6127ef-ac34-4a7d-80f3-6b59597ea0ba"
           }
         ],
         "status": "final",
@@ -19381,7 +19381,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+          "reference": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce"
         },
         "effectiveDateTime": "2024-02-13T15:46:00Z",
         "_effectiveDateTime": {
@@ -19403,24 +19403,24 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292224178355000.5014bf5c-7c94-4aa4-93f1-c5d803dd24f5"
+            "reference": "Specimen/1729354205453567000.ac9bb8e5-18bd-40d0-b832-cd3e34731e10"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729292224162059000.e9e39abf-89b9-49f4-9eae-e7fe2cc315a3"
+            "reference": "Observation/1729354205436953000.04062d19-fe7f-4e27-a7ec-4f2e73e15632"
           },
           {
-            "reference": "Observation/1729292224163110000.bf94d9b1-9125-4dbf-ad97-9329c355e951"
+            "reference": "Observation/1729354205438003000.ecdc1f6a-d36e-44b6-9ff5-b81cdff2f851"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292224314088000.ed3d56a5-6919-4570-8815-6dc50c5cdf59",
+      "fullUrl": "DiagnosticReport/1729354205585847000.db2f644e-e433-4c69-b9b8-068e8688b188",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292224314088000.ed3d56a5-6919-4570-8815-6dc50c5cdf59",
+        "id": "1729354205585847000.db2f644e-e433-4c69-b9b8-068e8688b188",
         "identifier": [
           {
             "extension": [
@@ -19451,7 +19451,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292224280836000.dfbcf4e7-32fa-44f7-a26c-5744595953fd"
+            "reference": "ServiceRequest/1729354205552155000.f070184e-88b4-4c73-94f5-324c81f0f94e"
           }
         ],
         "status": "final",
@@ -19475,7 +19475,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+          "reference": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce"
         },
         "effectiveDateTime": "2024-02-13T15:46:00Z",
         "_effectiveDateTime": {
@@ -19497,12 +19497,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292224178757000.20ff8b12-76a5-45df-a22b-255ddae5a395"
+            "reference": "Specimen/1729354205453950000.e3d02236-0945-40b4-af9b-a6214c72b2e6"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729292224164307000.00b423cb-eff8-4dbd-bfa4-7af6cfd1359b"
+            "reference": "Observation/1729354205439189000.2884b4fd-fd51-42a8-833a-abe70110ef60"
           }
         ]
       }
diff --git a/examples/CA/004_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir b/examples/CA/004_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
index bb5fc6da7..0fe0b83ff 100644
--- a/examples/CA/004_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
+++ b/examples/CA/004_CA_ORU_R01_CDPH_produced_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729292223963452000.86853264-9dcc-4fb1-ae23-9b23987f6966",
+  "id": "1729354205244107000.dce22360-2820-445b-9559-6bc83797a5ed",
   "meta": {
-    "lastUpdated": "2024-10-18T15:57:03.963-07:00"
+    "lastUpdated": "2024-10-19T09:10:05.244-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-26T03:43:04.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729292223965072000.d8e7d4ca-2fe2-4ff0-b1b2-e9684ed4f7a2",
+      "fullUrl": "MessageHeader/1729354205245478000.3bef4ce7-d807-4139-8532-ce8a2715d3fa",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729292223965072000.d8e7d4ca-2fe2-4ff0-b1b2-e9684ed4f7a2",
+        "id": "1729354205245478000.3bef4ce7-d807-4139-8532-ce8a2715d3fa",
         "meta": {
           "tag": [
             {
@@ -55,12 +55,12 @@
             ],
             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7"
+              "reference": "Organization/1729354205245304000.303523a2-4a31-4e77-9027-898d7ee6870f"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2"
+          "reference": "Organization/1729354205244762000.7acb04cd-d2b0-4066-be54-807adc484d74"
         },
         "source": {
           "extension": [
@@ -86,10 +86,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2",
+      "fullUrl": "Organization/1729354205244762000.7acb04cd-d2b0-4066-be54-807adc484d74",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292223964381000.a707804b-8302-4608-bdbb-eb9cab6e20a2",
+        "id": "1729354205244762000.7acb04cd-d2b0-4066-be54-807adc484d74",
         "identifier": [
           {
             "extension": [
@@ -104,10 +104,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7",
+      "fullUrl": "Organization/1729354205245304000.303523a2-4a31-4e77-9027-898d7ee6870f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292223964918000.c5a5f93d-3aae-41fc-b4c9-e51d265f09e7",
+        "id": "1729354205245304000.303523a2-4a31-4e77-9027-898d7ee6870f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -128,73 +128,73 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292223966515000.b808c45a-53be-4073-ad02-4d05fc543940",
+      "fullUrl": "Provenance/1729354205247044000.e7d909fa-8292-471c-8f9e-87b36aa0c2f3",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292223966515000.b808c45a-53be-4073-ad02-4d05fc543940",
+        "id": "1729354205247044000.e7d909fa-8292-471c-8f9e-87b36aa0c2f3",
         "target": [
           {
-            "reference": "MessageHeader/1729292223965072000.d8e7d4ca-2fe2-4ff0-b1b2-e9684ed4f7a2"
+            "reference": "MessageHeader/1729354205245478000.3bef4ce7-d807-4139-8532-ce8a2715d3fa"
           },
           {
-            "reference": "DiagnosticReport/1729292224284006000.915f6a34-da41-4970-a027-b411f06bc2ba"
+            "reference": "DiagnosticReport/1729354205555402000.fb96f636-6055-4de9-a3bb-6ff39fe7cd33"
           },
           {
-            "reference": "DiagnosticReport/1729292224286776000.41749e21-cca5-42fc-af64-afadfaf3a4e5"
+            "reference": "DiagnosticReport/1729354205558233000.d42aa818-2967-4970-9fe4-69581b2de9db"
           },
           {
-            "reference": "DiagnosticReport/1729292224288339000.2bedec21-45e1-40ec-bde0-6d7c6f034d90"
+            "reference": "DiagnosticReport/1729354205559834000.47888624-ea17-40ec-ab06-315abc6d9afa"
           },
           {
-            "reference": "DiagnosticReport/1729292224289752000.9dd735d1-0026-4585-91c5-aaf2bcf14f78"
+            "reference": "DiagnosticReport/1729354205561214000.38becf1e-eabb-4826-be27-7430d9f3d225"
           },
           {
-            "reference": "DiagnosticReport/1729292224291670000.c991ebfe-3906-493c-91cc-a5d284ad4cbf"
+            "reference": "DiagnosticReport/1729354205563148000.d150303a-37b7-443b-860f-921860d11414"
           },
           {
-            "reference": "DiagnosticReport/1729292224293061000.8a617c9a-5dbc-4efc-89d7-c1590ef30b3c"
+            "reference": "DiagnosticReport/1729354205564609000.9bba5805-0dfd-4e7e-808b-e63b9a2266e7"
           },
           {
-            "reference": "DiagnosticReport/1729292224295200000.28a0a482-ff4a-4272-b44c-ee6d4dbd4e1a"
+            "reference": "DiagnosticReport/1729354205566778000.cde1291c-f351-41c3-9dca-c99952761177"
           },
           {
-            "reference": "DiagnosticReport/1729292224296854000.ced71e97-3cd9-4e0d-af47-f0429e0b446c"
+            "reference": "DiagnosticReport/1729354205568432000.ce8e8fa1-6bcb-43a7-9858-9e3cdf657406"
           },
           {
-            "reference": "DiagnosticReport/1729292224298299000.8853febd-d8e4-40bd-b53d-4e6f2ae0f911"
+            "reference": "DiagnosticReport/1729354205569871000.472f4695-ac52-4987-bc2f-e061547070bd"
           },
           {
-            "reference": "DiagnosticReport/1729292224299703000.cf38def9-006f-4f5b-8a40-f7c2e17d7386"
+            "reference": "DiagnosticReport/1729354205571321000.214c4a1e-440e-4e7c-9c3c-4f416b747654"
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           {
-            "reference": "DiagnosticReport/1729292224301146000.644714af-4152-4c6b-b6ce-ac924cbeed87"
+            "reference": "DiagnosticReport/1729354205572794000.7b39e937-4406-468a-97c9-a7212a2de51a"
           },
           {
-            "reference": "DiagnosticReport/1729292224302573000.1642659a-f1b4-4f32-a8c5-1881f545ea19"
+            "reference": "DiagnosticReport/1729354205574236000.7b3dc9a0-8469-4c36-87e1-c63ca5cd824d"
           },
           {
-            "reference": "DiagnosticReport/1729292224303959000.a1fc3f75-eeb5-4a32-94c5-3b4e1520f5e4"
+            "reference": "DiagnosticReport/1729354205575651000.604de371-58b2-4e12-bc70-c47d0002d4da"
           },
           {
-            "reference": "DiagnosticReport/1729292224305371000.dd5dd86d-76a2-44f0-959f-874531c0af56"
+            "reference": "DiagnosticReport/1729354205577098000.f14cf8c9-263c-4671-ad7a-8994b1349b62"
           },
           {
-            "reference": "DiagnosticReport/1729292224306833000.1e418500-6c97-4a01-a1ef-6020ee706132"
+            "reference": "DiagnosticReport/1729354205578541000.88d8de47-092f-4200-a4b6-a0ee67e19b65"
           },
           {
-            "reference": "DiagnosticReport/1729292224308318000.decc981a-d92a-461b-bc88-e0431b789a4c"
+            "reference": "DiagnosticReport/1729354205580039000.d4f76a34-3253-4f6a-907f-7e81c865b8c0"
           },
           {
-            "reference": "DiagnosticReport/1729292224309777000.76cb7c27-59e4-4d6b-bbd6-1675859b8254"
+            "reference": "DiagnosticReport/1729354205581507000.4dc55f16-0053-4bfb-8eeb-bf20d45de9e3"
           },
           {
-            "reference": "DiagnosticReport/1729292224311239000.94563440-4ef6-4c1b-9f8e-8251b9b8f389"
+            "reference": "DiagnosticReport/1729354205582979000.0dbf4522-ca68-42d5-8f4f-202571c628de"
           },
           {
-            "reference": "DiagnosticReport/1729292224312687000.bcf75080-bc06-444a-b0de-d1d385132ad3"
+            "reference": "DiagnosticReport/1729354205584424000.f4afb581-9f77-42d3-87d1-b682fb0f89bb"
           },
           {
-            "reference": "DiagnosticReport/1729292224314088000.ed3d56a5-6919-4570-8815-6dc50c5cdf59"
+            "reference": "DiagnosticReport/1729354205585847000.db2f644e-e433-4c69-b9b8-068e8688b188"
           }
         ],
         "recorded": "2024-02-26T03:43:04Z",
@@ -216,17 +216,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729292223966346000.2220dfd9-bdd0-4bf8-8943-4aea1651b22b"
+              "reference": "Organization/1729354205246844000.13ed2734-c73e-4f11-bf45-41a4e95bc754"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729292223966346000.2220dfd9-bdd0-4bf8-8943-4aea1651b22b",
+      "fullUrl": "Organization/1729354205246844000.13ed2734-c73e-4f11-bf45-41a4e95bc754",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292223966346000.2220dfd9-bdd0-4bf8-8943-4aea1651b22b",
+        "id": "1729354205246844000.13ed2734-c73e-4f11-bf45-41a4e95bc754",
         "identifier": [
           {
             "extension": [
@@ -241,11 +241,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292223967205000.905e6774-a8d6-495e-b060-fa143e31556a",
+      "fullUrl": "Provenance/1729354205247730000.23d992e6-875f-4c53-ba99-e1ebac095899",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292223967205000.905e6774-a8d6-495e-b060-fa143e31556a",
-        "recorded": "2024-10-18T15:57:03Z",
+        "id": "1729354205247730000.23d992e6-875f-4c53-ba99-e1ebac095899",
+        "recorded": "2024-10-19T09:10:05Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -267,17 +267,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729292223967075000.3f202e94-d63e-4116-ab5d-40094141799c"
+              "reference": "Organization/1729354205247563000.e50ec612-5b1f-4315-8643-ee1abd55c21e"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729292223967075000.3f202e94-d63e-4116-ab5d-40094141799c",
+      "fullUrl": "Organization/1729354205247563000.e50ec612-5b1f-4315-8643-ee1abd55c21e",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292223967075000.3f202e94-d63e-4116-ab5d-40094141799c",
+        "id": "1729354205247563000.e50ec612-5b1f-4315-8643-ee1abd55c21e",
         "identifier": [
           {
             "value": "CDC PRIME - Atlanta"
@@ -297,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0",
+      "fullUrl": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0",
+        "id": "1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -387,7 +387,7 @@
             },
             "value": "80008836",
             "assigner": {
-              "reference": "Organization/1729292223967819000.609effee-d2cc-40ae-96c6-304f9af964e8"
+              "reference": "Organization/1729354205248446000.be39ec21-482a-4c1e-88cc-9b9cf094954d"
             }
           }
         ],
@@ -470,10 +470,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292223967819000.609effee-d2cc-40ae-96c6-304f9af964e8",
+      "fullUrl": "Organization/1729354205248446000.be39ec21-482a-4c1e-88cc-9b9cf094954d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292223967819000.609effee-d2cc-40ae-96c6-304f9af964e8",
+        "id": "1729354205248446000.be39ec21-482a-4c1e-88cc-9b9cf094954d",
         "identifier": [
           {
             "extension": [
@@ -494,16 +494,16 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292223973500000.dc60f774-7de9-4252-88e6-49727213fc78",
+      "fullUrl": "Provenance/1729354205254459000.281af2b8-5ca7-4dde-8307-152fbb463291",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292223973500000.dc60f774-7de9-4252-88e6-49727213fc78",
+        "id": "1729354205254459000.281af2b8-5ca7-4dde-8307-152fbb463291",
         "target": [
           {
-            "reference": "Patient/1729292223973023000.5292dc59-de13-484f-8359-9421ea2954d0"
+            "reference": "Patient/1729354205254040000.6b7b3925-4c55-4631-9700-ddedbfc282ce"
           }
         ],
-        "recorded": "2024-10-18T15:57:03Z",
+        "recorded": "2024-10-19T09:10:05Z",
         "activity": {
           "coding": [
             {
@@ -515,10 +515,10 @@
       }
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@@ -1173,7 +1173,7 @@
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@@ -13919,7 +13919,7 @@
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@@ -14026,7 +14026,7 @@
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@@ -14116,7 +14116,7 @@
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@@ -14167,10 +14167,10 @@
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@@ -14180,10 +14180,10 @@
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@@ -14193,10 +14193,10 @@
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@@ -14206,10 +14206,10 @@
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@@ -14219,10 +14219,10 @@
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@@ -14245,10 +14245,10 @@
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@@ -14258,10 +14258,10 @@
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@@ -14271,10 +14271,10 @@
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@@ -14388,10 +14388,10 @@
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@@ -14401,10 +14401,10 @@
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@@ -14414,10 +14414,10 @@
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@@ -14429,7 +14429,7 @@
               {
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                 "valueReference": {
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@@ -14462,7 +14462,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292224184769000.0e55f84a-86fb-4923-a62b-efbdfb9d701d"
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@@ -14498,7 +14498,7 @@
               {
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@@ -14604,18 +14604,18 @@
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@@ -14642,10 +14642,10 @@
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@@ -14704,23 +14704,23 @@
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@@ -14741,10 +14741,10 @@
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@@ -14767,10 +14767,10 @@
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@@ -14793,10 +14793,10 @@
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@@ -14823,10 +14823,10 @@
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@@ -14849,10 +14849,10 @@
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@@ -14879,10 +14879,10 @@
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@@ -14905,10 +14905,10 @@
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@@ -14935,10 +14935,10 @@
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@@ -14961,10 +14961,10 @@
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@@ -14991,10 +14991,10 @@
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@@ -15017,10 +15017,10 @@
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@@ -15047,10 +15047,10 @@
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@@ -15073,10 +15073,10 @@
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@@ -15103,10 +15103,10 @@
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@@ -15129,10 +15129,10 @@
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@@ -15159,10 +15159,10 @@
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@@ -15185,10 +15185,10 @@
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@@ -15215,10 +15215,10 @@
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@@ -15241,10 +15241,10 @@
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@@ -15271,10 +15271,10 @@
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diff --git a/examples/CA/005_CA_ORU_R01_CDPH_generated_1_hl7_translation.fhir b/examples/CA/005_CA_ORU_R01_CDPH_generated_1_hl7_translation.fhir
index ecfc14f1c..0401d9f8c 100644
--- a/examples/CA/005_CA_ORU_R01_CDPH_generated_1_hl7_translation.fhir
+++ b/examples/CA/005_CA_ORU_R01_CDPH_generated_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
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@@ -12,10 +12,10 @@
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@@ -89,10 +89,10 @@
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@@ -107,10 +107,10 @@
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@@ -120,73 +120,73 @@
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@@ -208,17 +208,17 @@
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@@ -611,7 +611,7 @@
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@@ -1130,10 +1130,10 @@
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@@ -1174,7 +1174,7 @@
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@@ -1266,7 +1266,7 @@
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@@ -1296,10 +1296,10 @@
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@@ -1340,7 +1340,7 @@
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@@ -1369,10 +1369,10 @@
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@@ -1413,7 +1413,7 @@
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@@ -1443,10 +1443,10 @@
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@@ -1503,7 +1503,7 @@
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@@ -1536,10 +1536,10 @@
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@@ -1580,7 +1580,7 @@
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@@ -1618,10 +1618,10 @@
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@@ -1662,7 +1662,7 @@
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@@ -1710,10 +1710,10 @@
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@@ -1770,7 +1770,7 @@
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@@ -1847,7 +1847,7 @@
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@@ -2717,7 +2717,7 @@
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@@ -2815,7 +2815,7 @@
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@@ -2913,7 +2913,7 @@
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@@ -3109,7 +3109,7 @@
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@@ -3207,7 +3207,7 @@
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@@ -8282,7 +8282,7 @@
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@@ -8456,7 +8456,7 @@
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@@ -8628,7 +8628,7 @@
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@@ -10826,10 +10826,10 @@
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@@ -10839,10 +10839,10 @@
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@@ -10852,10 +10852,10 @@
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@@ -10865,10 +10865,10 @@
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@@ -10878,10 +10878,10 @@
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@@ -10891,10 +10891,10 @@
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@@ -10904,10 +10904,10 @@
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@@ -10917,10 +10917,10 @@
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@@ -10930,10 +10930,10 @@
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@@ -10943,10 +10943,10 @@
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@@ -10956,10 +10956,10 @@
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@@ -10969,10 +10969,10 @@
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@@ -10982,10 +10982,10 @@
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@@ -10995,10 +10995,10 @@
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@@ -11008,10 +11008,10 @@
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@@ -11021,10 +11021,10 @@
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@@ -11034,10 +11034,10 @@
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@@ -11047,10 +11047,10 @@
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@@ -11060,10 +11060,10 @@
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@@ -11075,7 +11075,7 @@
               {
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                 "valueReference": {
-                  "reference": "Organization/1729291987402243000.3b7ecbe4-5496-4404-a676-af329e8722d7"
+                  "reference": "Organization/1729353967431827000.16fa0fa4-e107-44cf-a13d-7f9ebb2aec3f"
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@@ -11108,7 +11108,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729353967434496000.eafc6fec-f124-46d0-b407-f8528f76d57b"
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@@ -11144,7 +11144,7 @@
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-                  "reference": "Practitioner/1729291987404792000.f08933ff-2462-4f6a-b2fb-27e1c1d5640f"
+                  "reference": "Practitioner/1729353967436257000.dde8f7df-76ec-4f4d-b9c9-10d970b4d12d"
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@@ -11246,18 +11246,18 @@
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+          "reference": "Patient/1729353967265980000.776892cf-f340-40a6-942a-04ca46b4b945"
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@@ -11288,10 +11288,10 @@
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         "extension": [
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@@ -11350,23 +11350,23 @@
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+          "reference": "Practitioner/1729353967420011000.08d4f882-b31f-4234-8b78-66395e72c613"
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@@ -11387,10 +11387,10 @@
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@@ -11417,10 +11417,10 @@
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@@ -11443,10 +11443,10 @@
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@@ -11462,7 +11462,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291987409265000.79430696-2f9c-4fcc-8361-9b7bcc7b66a7"
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@@ -11512,18 +11512,18 @@
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+          "reference": "Patient/1729353967265980000.776892cf-f340-40a6-942a-04ca46b4b945"
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+          "reference": "Practitioner/1729353967438600000.89030451-249f-4fa4-bc43-6df39b0c806a"
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@@ -11550,10 +11550,10 @@
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@@ -11576,10 +11576,10 @@
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@@ -11595,7 +11595,7 @@
               {
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                 "valueReference": {
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@@ -11645,18 +11645,18 @@
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@@ -11683,10 +11683,10 @@
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@@ -11709,10 +11709,10 @@
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@@ -11728,7 +11728,7 @@
               {
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@@ -11778,18 +11778,18 @@
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@@ -11816,10 +11816,10 @@
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@@ -11842,10 +11842,10 @@
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@@ -11861,7 +11861,7 @@
               {
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-                  "reference": "Practitioner/1729291987422637000.e4b7d735-5fea-4c35-9f20-9c2aef635f37"
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@@ -11911,18 +11911,18 @@
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@@ -11949,10 +11949,10 @@
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@@ -11975,10 +11975,10 @@
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@@ -11994,7 +11994,7 @@
               {
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                 "valueReference": {
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@@ -12044,18 +12044,18 @@
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@@ -12082,10 +12082,10 @@
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@@ -12108,10 +12108,10 @@
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@@ -12127,7 +12127,7 @@
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-                  "reference": "Practitioner/1729291987432948000.79500c9b-c36a-4aac-97df-4e2bcc9eb0be"
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@@ -12177,18 +12177,18 @@
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@@ -12215,10 +12215,10 @@
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@@ -12241,10 +12241,10 @@
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@@ -12260,7 +12260,7 @@
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@@ -12310,18 +12310,18 @@
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@@ -12348,10 +12348,10 @@
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@@ -12374,10 +12374,10 @@
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@@ -12393,7 +12393,7 @@
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@@ -12443,18 +12443,18 @@
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@@ -12481,10 +12481,10 @@
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@@ -12507,10 +12507,10 @@
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@@ -12526,7 +12526,7 @@
               {
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                 "valueReference": {
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@@ -12576,18 +12576,18 @@
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@@ -12614,10 +12614,10 @@
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@@ -12640,10 +12640,10 @@
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@@ -12659,7 +12659,7 @@
               {
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@@ -12709,18 +12709,18 @@
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@@ -12747,10 +12747,10 @@
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@@ -12773,10 +12773,10 @@
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@@ -12792,7 +12792,7 @@
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@@ -12842,18 +12842,18 @@
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@@ -12880,10 +12880,10 @@
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@@ -12906,10 +12906,10 @@
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@@ -12925,7 +12925,7 @@
               {
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                 "valueReference": {
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@@ -12975,18 +12975,18 @@
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@@ -13013,10 +13013,10 @@
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@@ -13039,10 +13039,10 @@
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@@ -13058,7 +13058,7 @@
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                 "valueReference": {
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@@ -13108,18 +13108,18 @@
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@@ -13146,10 +13146,10 @@
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@@ -13172,10 +13172,10 @@
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@@ -13191,7 +13191,7 @@
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@@ -13241,18 +13241,18 @@
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@@ -13279,10 +13279,10 @@
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@@ -13305,10 +13305,10 @@
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@@ -13324,7 +13324,7 @@
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@@ -13374,18 +13374,18 @@
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@@ -13412,10 +13412,10 @@
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@@ -13438,10 +13438,10 @@
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@@ -13457,7 +13457,7 @@
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@@ -13507,18 +13507,18 @@
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@@ -13545,10 +13545,10 @@
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@@ -13571,10 +13571,10 @@
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@@ -13590,7 +13590,7 @@
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@@ -13640,18 +13640,18 @@
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@@ -13678,10 +13678,10 @@
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@@ -13723,7 +13723,7 @@
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@@ -13816,10 +13816,10 @@
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@@ -13842,10 +13842,10 @@
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@@ -13861,7 +13861,7 @@
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@@ -13916,18 +13916,18 @@
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@@ -13954,10 +13954,10 @@
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@@ -13980,10 +13980,10 @@
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@@ -14058,7 +14058,7 @@
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@@ -14077,7 +14077,7 @@
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@@ -14099,16 +14099,16 @@
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@@ -14139,7 +14139,7 @@
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@@ -14180,39 +14180,39 @@
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@@ -14243,7 +14243,7 @@
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-      "fullUrl": "DiagnosticReport/1729291987534302000.27b7afab-1d6c-45e3-8a20-4418a5a3eb90",
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+        "id": "1729353967542671000.1a507555-1dd8-4770-9a20-90dffd1bfcbf",
         "identifier": [
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             "extension": [
@@ -15593,7 +15593,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291987482161000.20652d8c-a5e2-4ea3-8879-0675ea61b896"
+            "reference": "ServiceRequest/1729353967501239000.2b4b197c-6497-46b8-82b4-a14b903b1eda"
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         "status": "final",
@@ -15612,7 +15612,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
+          "reference": "Patient/1729353967265980000.776892cf-f340-40a6-942a-04ca46b4b945"
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         "effectiveDateTime": "2024-07-12T00:00:00Z",
         "_effectiveDateTime": {
@@ -15634,27 +15634,27 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291987395835000.588cef91-3ee0-4ca9-9587-0df686e04d16"
+            "reference": "Specimen/1729353967416241000.2b85d3bf-55a8-4730-bc46-25bd0242ea1e"
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         "result": [
           {
-            "reference": "Observation/1729291987370110000.50d9fb07-3a47-40f9-85ef-2e147bf3ee10"
+            "reference": "Observation/1729353967391316000.c65efc88-7163-4c18-a6cd-a988c24accd5"
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           {
-            "reference": "Observation/1729291987371716000.48f3af8a-dfec-4a9b-a320-93ae81356fe0"
+            "reference": "Observation/1729353967392482000.bbc63746-5cdf-4907-8e1d-2d18fc48745d"
           },
           {
-            "reference": "Observation/1729291987372950000.8e63484f-6884-4552-9607-16e5138b7306"
+            "reference": "Observation/1729353967393517000.ce6b0140-de87-40a4-a4ab-d9d92c0f41f7"
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     },
     {
-      "fullUrl": "DiagnosticReport/1729291987535919000.eae86477-0f78-4632-be4a-948a713c41e9",
+      "fullUrl": "DiagnosticReport/1729353967544033000.10e89a3f-934a-4845-99ca-c650f3b63f87",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729291987535919000.eae86477-0f78-4632-be4a-948a713c41e9",
+        "id": "1729353967544033000.10e89a3f-934a-4845-99ca-c650f3b63f87",
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             "extension": [
@@ -15685,7 +15685,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291987486576000.5251876c-639b-4002-be4e-ecf752d820f9"
+            "reference": "ServiceRequest/1729353967505290000.989a2028-a334-4650-a754-6cc9148e893d"
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         "status": "final",
@@ -15704,7 +15704,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
+          "reference": "Patient/1729353967265980000.776892cf-f340-40a6-942a-04ca46b4b945"
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         "_effectiveDateTime": {
@@ -15726,27 +15726,27 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291987396220000.e5550353-0211-4984-a55b-471339d5c3d1"
+            "reference": "Specimen/1729353967416631000.92a78d01-fe09-45f8-a321-a90f32b48366"
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         "result": [
           {
-            "reference": "Observation/1729291987374203000.774a5a9d-5fbf-4de1-be81-c19678751ee8"
+            "reference": "Observation/1729353967394666000.bc54cac0-0b05-4278-b7f0-63633a109e05"
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           {
-            "reference": "Observation/1729291987375388000.5a874662-1823-496a-8036-974306b6afe3"
+            "reference": "Observation/1729353967395844000.e143f8bf-54a4-49b1-8aaf-a9d603d42f05"
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           {
-            "reference": "Observation/1729291987376391000.ab95638b-f6c9-412a-9ab8-b4a41ae09f3f"
+            "reference": "Observation/1729353967396861000.7f57a897-fecb-4f78-814d-2049b6a08d98"
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       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729291987537581000.c393d484-f86d-462e-bef5-d80cb42427c5",
+      "fullUrl": "DiagnosticReport/1729353967545493000.ce3a3413-0d9b-4484-9a58-2b18a34c146a",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729291987537581000.c393d484-f86d-462e-bef5-d80cb42427c5",
+        "id": "1729353967545493000.ce3a3413-0d9b-4484-9a58-2b18a34c146a",
         "identifier": [
           {
             "extension": [
@@ -15777,7 +15777,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291987490976000.cdb0d96e-10d0-40f5-a564-6a25ca08518c"
+            "reference": "ServiceRequest/1729353967509568000.05c3a38d-4384-41bd-869f-fa570ceaccd3"
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         "status": "final",
@@ -15796,7 +15796,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
+          "reference": "Patient/1729353967265980000.776892cf-f340-40a6-942a-04ca46b4b945"
         },
         "effectiveDateTime": "2024-07-12T00:00:00Z",
         "_effectiveDateTime": {
@@ -15818,30 +15818,30 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291987396603000.916a30fa-447a-44b7-bd53-4c8f9c67e13d"
+            "reference": "Specimen/1729353967417015000.d6d34630-2db8-4f83-8882-f19e8829c404"
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         "result": [
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-            "reference": "Observation/1729291987377498000.d73f74a5-d889-4987-bedd-2d7ebb5c6b38"
+            "reference": "Observation/1729353967397905000.ecc6c182-1d02-4d94-bcda-4222d4d819f8"
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-            "reference": "Observation/1729291987378696000.062bebcb-2578-4090-a634-d532df8c39f9"
+            "reference": "Observation/1729353967399156000.79d6cfef-0bcb-4f64-8d76-146d89911aca"
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           {
-            "reference": "Observation/1729291987379851000.01da0a7d-ba92-46f1-9288-dd144464467d"
+            "reference": "Observation/1729353967400207000.76acc98f-2613-4db6-8f71-d8b014f1cc71"
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           {
-            "reference": "Observation/1729291987380931000.84e79984-b6bb-448c-a426-3a53b3ec0288"
+            "reference": "Observation/1729353967401233000.0f3b5c7e-2b16-4404-8268-81263d9bae9d"
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       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729291987539269000.ed5d3a61-2ec6-45ce-9a3a-f1fcfa9ef5a0",
+      "fullUrl": "DiagnosticReport/1729353967546908000.ef937199-1ce2-4014-9a40-cf3138821c85",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729291987539269000.ed5d3a61-2ec6-45ce-9a3a-f1fcfa9ef5a0",
+        "id": "1729353967546908000.ef937199-1ce2-4014-9a40-cf3138821c85",
         "identifier": [
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             "extension": [
@@ -15872,7 +15872,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291987495492000.d273d503-2184-4d2f-b64d-49f577e8b75f"
+            "reference": "ServiceRequest/1729353967513431000.a9f47760-d3db-4aed-b8e7-818ce7a338f1"
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         "status": "final",
@@ -15896,7 +15896,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
+          "reference": "Patient/1729353967265980000.776892cf-f340-40a6-942a-04ca46b4b945"
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         "effectiveDateTime": "2024-07-12T00:00:00Z",
         "_effectiveDateTime": {
@@ -15918,24 +15918,24 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291987396986000.dd4097d0-4ba4-485b-bb4c-1687c4f2159a"
+            "reference": "Specimen/1729353967417394000.d37d1b34-f575-40d6-8e84-650bcb274bc0"
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         "result": [
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-            "reference": "Observation/1729291987382153000.c970ff31-08e3-4add-8d1d-bb975e265c68"
+            "reference": "Observation/1729353967402485000.681206a3-5c3d-4d7e-b1eb-57771e67d625"
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           {
-            "reference": "Observation/1729291987383223000.e6b4f0b2-e1c9-4be7-ba65-63fa70ca124a"
+            "reference": "Observation/1729353967403592000.36d23a74-65c7-4760-9df6-e0e3e916850a"
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     },
     {
-      "fullUrl": "DiagnosticReport/1729291987540872000.73e2bb90-8b98-4ee4-b290-58154a8c53f6",
+      "fullUrl": "DiagnosticReport/1729353967548355000.2969ebf4-87bc-4aed-892e-9651025df2b1",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729291987540872000.73e2bb90-8b98-4ee4-b290-58154a8c53f6",
+        "id": "1729353967548355000.2969ebf4-87bc-4aed-892e-9651025df2b1",
         "identifier": [
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             "extension": [
@@ -15966,7 +15966,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291987499849000.c440482e-b439-4d28-a277-670dac86247c"
+            "reference": "ServiceRequest/1729353967517297000.bf1e89ef-c6ee-418e-9e15-5fc7208d6852"
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         "status": "final",
@@ -15990,7 +15990,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291987215729000.97590d47-57ab-4c8c-acb8-042443fd6d84"
+          "reference": "Patient/1729353967265980000.776892cf-f340-40a6-942a-04ca46b4b945"
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         "effectiveDateTime": "2024-07-12T00:00:00Z",
         "_effectiveDateTime": {
@@ -16012,12 +16012,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291987397360000.1cdc5a9a-e408-4185-a4b5-23a0ef741f04"
+            "reference": "Specimen/1729353967417766000.36438d22-103a-4d0c-967d-0da99ace22db"
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         "result": [
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-            "reference": "Observation/1729291987384413000.79253e60-a8b8-4b65-9826-4587d4f440f3"
+            "reference": "Observation/1729353967404829000.2a46dcdd-d4c0-4e6e-ae30-b8ba75aaeb38"
           }
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diff --git a/examples/CA/005_CA_ORU_R01_CDPH_generated_2_fhir_transformation.fhir b/examples/CA/005_CA_ORU_R01_CDPH_generated_2_fhir_transformation.fhir
index 30f1bb660..c0b720777 100644
--- a/examples/CA/005_CA_ORU_R01_CDPH_generated_2_fhir_transformation.fhir
+++ b/examples/CA/005_CA_ORU_R01_CDPH_generated_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729291987199744000.c3d04406-8a4d-4616-8fc8-865a0e427f53",
+  "id": "1729353967258963000.eab02f18-f382-469d-b19b-6a6a3e28a1d0",
   "meta": {
-    "lastUpdated": "2024-10-18T15:53:07.199-07:00"
+    "lastUpdated": "2024-10-19T09:06:07.258-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-07-16T09:06:32.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729291987202217000.19132f10-715d-4388-bd52-718fba74a13e",
+      "fullUrl": "MessageHeader/1729353967259804000.432cdf21-42ec-4fe8-b917-765b24c18ed7",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729291987202217000.19132f10-715d-4388-bd52-718fba74a13e",
+        "id": "1729353967259804000.432cdf21-42ec-4fe8-b917-765b24c18ed7",
         "meta": {
           "tag": [
             {
@@ -55,12 +55,12 @@
             ],
             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1729291987201999000.0894917a-ec9b-4349-8159-b6f73a4c7390"
+              "reference": "Organization/1729353967259689000.d266a6b5-707d-457c-af3c-8cd88400138d"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729291987201196000.172535b8-1bdb-4b93-b6d5-c6ef6205936d"
+          "reference": "Organization/1729353967259307000.bc7d0f83-557a-4b61-a745-caed38414a9b"
         },
         "source": {
           "extension": [
@@ -86,10 +86,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291987201196000.172535b8-1bdb-4b93-b6d5-c6ef6205936d",
+      "fullUrl": "Organization/1729353967259307000.bc7d0f83-557a-4b61-a745-caed38414a9b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291987201196000.172535b8-1bdb-4b93-b6d5-c6ef6205936d",
+        "id": "1729353967259307000.bc7d0f83-557a-4b61-a745-caed38414a9b",
         "identifier": [
           {
             "extension": [
@@ -104,10 +104,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291987201999000.0894917a-ec9b-4349-8159-b6f73a4c7390",
+      "fullUrl": "Organization/1729353967259689000.d266a6b5-707d-457c-af3c-8cd88400138d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291987201999000.0894917a-ec9b-4349-8159-b6f73a4c7390",
+        "id": "1729353967259689000.d266a6b5-707d-457c-af3c-8cd88400138d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -128,73 +128,73 @@
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     },
     {
-      "fullUrl": "Provenance/1729291987206609000.9490fc66-2a69-4118-b56e-a1d923a3c870",
+      "fullUrl": "Provenance/1729353967260684000.c2d22985-4236-4a56-a3af-971418fab75d",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729291987206609000.9490fc66-2a69-4118-b56e-a1d923a3c870",
+        "id": "1729353967260684000.c2d22985-4236-4a56-a3af-971418fab75d",
         "target": [
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-            "reference": "MessageHeader/1729291987202217000.19132f10-715d-4388-bd52-718fba74a13e"
+            "reference": "MessageHeader/1729353967259804000.432cdf21-42ec-4fe8-b917-765b24c18ed7"
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-            "reference": "DiagnosticReport/1729291987503485000.e5b40a5b-093c-4857-b372-2e7b25f4d6f0"
+            "reference": "DiagnosticReport/1729353967520295000.7148c078-2b7b-4e6b-8603-6847d684fe5d"
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@@ -1179,7 +1179,7 @@
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@@ -1271,7 +1271,7 @@
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@@ -1345,7 +1345,7 @@
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@@ -1374,10 +1374,10 @@
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@@ -1418,7 +1418,7 @@
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@@ -1448,10 +1448,10 @@
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@@ -1508,7 +1508,7 @@
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@@ -1541,10 +1541,10 @@
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@@ -1585,7 +1585,7 @@
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@@ -1623,10 +1623,10 @@
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@@ -1667,7 +1667,7 @@
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@@ -1775,7 +1775,7 @@
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@@ -1852,7 +1852,7 @@
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@@ -2036,7 +2036,7 @@
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@@ -2364,7 +2364,7 @@
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@@ -2457,7 +2457,7 @@
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@@ -2648,7 +2648,7 @@
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@@ -2746,7 +2746,7 @@
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@@ -2844,7 +2844,7 @@
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@@ -3040,7 +3040,7 @@
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@@ -3530,7 +3530,7 @@
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@@ -6969,7 +6969,7 @@
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@@ -10814,10 +10814,10 @@
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@@ -10827,10 +10827,10 @@
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@@ -10840,10 +10840,10 @@
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@@ -10853,10 +10853,10 @@
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@@ -10866,10 +10866,10 @@
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@@ -10879,10 +10879,10 @@
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@@ -10892,10 +10892,10 @@
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@@ -10905,10 +10905,10 @@
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@@ -10918,10 +10918,10 @@
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@@ -10931,10 +10931,10 @@
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@@ -10944,10 +10944,10 @@
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@@ -10957,10 +10957,10 @@
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@@ -10970,10 +10970,10 @@
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@@ -10983,10 +10983,10 @@
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@@ -10996,10 +10996,10 @@
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@@ -11009,10 +11009,10 @@
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@@ -11022,10 +11022,10 @@
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@@ -11035,10 +11035,10 @@
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@@ -11050,7 +11050,7 @@
               {
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                 "valueReference": {
-                  "reference": "Organization/1729291987402243000.3b7ecbe4-5496-4404-a676-af329e8722d7"
+                  "reference": "Organization/1729353967431827000.16fa0fa4-e107-44cf-a13d-7f9ebb2aec3f"
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@@ -11083,7 +11083,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729353967434496000.eafc6fec-f124-46d0-b407-f8528f76d57b"
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@@ -11119,7 +11119,7 @@
               {
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+                  "reference": "Practitioner/1729353967420011000.08d4f882-b31f-4234-8b78-66395e72c613"
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@@ -11225,18 +11225,18 @@
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+          "reference": "Patient/1729353967265980000.776892cf-f340-40a6-942a-04ca46b4b945"
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@@ -11267,10 +11267,10 @@
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@@ -11329,23 +11329,23 @@
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+          "reference": "Practitioner/1729353967420011000.08d4f882-b31f-4234-8b78-66395e72c613"
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+          "reference": "Organization/1729353967425627000.ca313d83-5aa8-42c1-8c3d-0479389ae4ee"
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@@ -11366,10 +11366,10 @@
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@@ -11396,10 +11396,10 @@
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@@ -11422,10 +11422,10 @@
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@@ -11452,10 +11452,10 @@
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@@ -11478,10 +11478,10 @@
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@@ -11508,10 +11508,10 @@
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@@ -11534,10 +11534,10 @@
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@@ -11564,10 +11564,10 @@
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@@ -11590,10 +11590,10 @@
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@@ -11620,10 +11620,10 @@
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@@ -11646,10 +11646,10 @@
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@@ -11676,10 +11676,10 @@
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@@ -11702,10 +11702,10 @@
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@@ -11732,10 +11732,10 @@
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@@ -11758,10 +11758,10 @@
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@@ -11788,10 +11788,10 @@
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@@ -11814,10 +11814,10 @@
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@@ -11844,10 +11844,10 @@
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@@ -11870,10 +11870,10 @@
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@@ -11900,10 +11900,10 @@
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@@ -11926,10 +11926,10 @@
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@@ -11956,10 +11956,10 @@
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@@ -11982,10 +11982,10 @@
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@@ -12012,10 +12012,10 @@
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@@ -12038,10 +12038,10 @@
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@@ -12068,10 +12068,10 @@
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@@ -12094,10 +12094,10 @@
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@@ -12124,10 +12124,10 @@
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@@ -12150,10 +12150,10 @@
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@@ -12180,10 +12180,10 @@
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@@ -12206,10 +12206,10 @@
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@@ -12236,10 +12236,10 @@
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@@ -12262,10 +12262,10 @@
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@@ -12292,10 +12292,10 @@
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@@ -12318,10 +12318,10 @@
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@@ -12348,10 +12348,10 @@
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diff --git a/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir b/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
index c37feb7c5..b8495dd07 100644
--- a/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
+++ b/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
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@@ -58,12 +58,12 @@
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@@ -89,10 +89,10 @@
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@@ -107,10 +107,10 @@
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@@ -1413,7 +1413,7 @@
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@@ -1580,7 +1580,7 @@
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@@ -1770,7 +1770,7 @@
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@@ -1847,7 +1847,7 @@
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@@ -10825,10 +10825,10 @@
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@@ -10838,10 +10838,10 @@
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@@ -10851,10 +10851,10 @@
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@@ -10864,10 +10864,10 @@
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@@ -10877,10 +10877,10 @@
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@@ -10890,10 +10890,10 @@
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@@ -10903,10 +10903,10 @@
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@@ -10916,10 +10916,10 @@
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@@ -10929,10 +10929,10 @@
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@@ -10942,10 +10942,10 @@
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@@ -10955,10 +10955,10 @@
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@@ -10968,10 +10968,10 @@
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@@ -10981,10 +10981,10 @@
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@@ -10994,10 +10994,10 @@
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@@ -11007,10 +11007,10 @@
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@@ -11020,10 +11020,10 @@
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@@ -11033,10 +11033,10 @@
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@@ -11046,10 +11046,10 @@
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@@ -11059,10 +11059,10 @@
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@@ -11074,7 +11074,7 @@
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                 "valueReference": {
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@@ -11107,7 +11107,7 @@
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@@ -11143,7 +11143,7 @@
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@@ -11245,18 +11245,18 @@
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@@ -11287,10 +11287,10 @@
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@@ -11349,23 +11349,23 @@
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@@ -11386,10 +11386,10 @@
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@@ -11416,10 +11416,10 @@
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@@ -11442,10 +11442,10 @@
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@@ -11461,7 +11461,7 @@
               {
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                 "valueReference": {
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@@ -11511,18 +11511,18 @@
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@@ -11549,10 +11549,10 @@
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@@ -11575,10 +11575,10 @@
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@@ -11594,7 +11594,7 @@
               {
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                 "valueReference": {
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@@ -11644,18 +11644,18 @@
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@@ -11682,10 +11682,10 @@
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@@ -11708,10 +11708,10 @@
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@@ -11727,7 +11727,7 @@
               {
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@@ -11777,18 +11777,18 @@
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@@ -11815,10 +11815,10 @@
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@@ -11841,10 +11841,10 @@
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@@ -11860,7 +11860,7 @@
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@@ -11910,18 +11910,18 @@
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@@ -11948,10 +11948,10 @@
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@@ -11974,10 +11974,10 @@
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@@ -11993,7 +11993,7 @@
               {
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@@ -12043,18 +12043,18 @@
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@@ -12081,10 +12081,10 @@
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@@ -12107,10 +12107,10 @@
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@@ -12126,7 +12126,7 @@
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@@ -12176,18 +12176,18 @@
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@@ -12214,10 +12214,10 @@
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@@ -12240,10 +12240,10 @@
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@@ -12259,7 +12259,7 @@
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@@ -12309,18 +12309,18 @@
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@@ -12347,10 +12347,10 @@
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@@ -12373,10 +12373,10 @@
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@@ -12392,7 +12392,7 @@
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@@ -12442,18 +12442,18 @@
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         "extension": [
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@@ -12480,10 +12480,10 @@
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     {
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+        "id": "1729353484453315000.657831e6-2bb6-49da-9697-faad6bf283ad",
         "extension": [
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@@ -12506,10 +12506,10 @@
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+      "fullUrl": "ServiceRequest/1729353484457696000.988e3952-ca47-4840-911b-5b5285be4563",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
@@ -12525,7 +12525,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729291511729990000.7912847d-d093-49fb-883d-08d3b83128f0"
+                  "reference": "Practitioner/1729353484457232000.de7ee1b3-e9ed-49c4-9f51-595234e2a41b"
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@@ -12575,18 +12575,18 @@
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+          "reference": "Patient/1729353484191528000.89fbebb3-0428-44cf-be18-661f5bee629e"
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+          "reference": "Practitioner/1729353484454663000.e7d965cf-537d-4212-a370-6e74420de81f"
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@@ -12613,10 +12613,10 @@
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         "extension": [
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@@ -12639,10 +12639,10 @@
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         "extension": [
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@@ -12658,7 +12658,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729353484461110000.9f1a623b-eded-4bab-b5dc-3a66449d49c2"
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@@ -12708,18 +12708,18 @@
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+          "reference": "Patient/1729353484191528000.89fbebb3-0428-44cf-be18-661f5bee629e"
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+          "reference": "Practitioner/1729353484458560000.ae413b75-a82e-4217-9735-ea6e2a35237a"
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       "resource": {
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         "extension": [
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@@ -12746,10 +12746,10 @@
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         "extension": [
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@@ -12772,10 +12772,10 @@
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@@ -12791,7 +12791,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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+                  "reference": "Practitioner/1729353484465020000.594d55ab-aa2d-4325-b502-c38f8b4fdab5"
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@@ -12841,18 +12841,18 @@
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+          "reference": "Patient/1729353484191528000.89fbebb3-0428-44cf-be18-661f5bee629e"
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+          "reference": "Practitioner/1729353484462441000.843f33c4-14b6-496f-ba0b-32fbe046ada4"
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@@ -12879,10 +12879,10 @@
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         "extension": [
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@@ -12905,10 +12905,10 @@
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@@ -12924,7 +12924,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291511742799000.7051758b-f74e-46d7-ae38-fa91e9915b33"
+                  "reference": "Practitioner/1729353484468912000.ec51c563-459a-40c3-9985-184fc5081e36"
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@@ -12974,18 +12974,18 @@
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+          "reference": "Patient/1729353484191528000.89fbebb3-0428-44cf-be18-661f5bee629e"
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         "extension": [
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@@ -13012,10 +13012,10 @@
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@@ -13038,10 +13038,10 @@
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@@ -13057,7 +13057,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291511747360000.9364cf5e-54ff-4041-98af-3876d18c34ca"
+                  "reference": "Practitioner/1729353484472824000.3c8fbc34-70ac-4c99-ad99-c8d45cf9f407"
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@@ -13107,18 +13107,18 @@
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+          "reference": "Patient/1729353484191528000.89fbebb3-0428-44cf-be18-661f5bee629e"
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+          "reference": "Practitioner/1729353484470282000.9fd3e04e-d8ed-414f-980b-2240ed276000"
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@@ -13145,10 +13145,10 @@
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@@ -13171,10 +13171,10 @@
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@@ -13190,7 +13190,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729291511751957000.34cdf612-acc9-4003-a2cb-49e694906fee"
+                  "reference": "Practitioner/1729353484476720000.e51e83b4-1c30-494f-8ac1-aa1dc60a128f"
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@@ -13240,18 +13240,18 @@
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@@ -13278,10 +13278,10 @@
       }
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@@ -13304,10 +13304,10 @@
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@@ -13323,7 +13323,7 @@
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-                  "reference": "Practitioner/1729291511756486000.090e029e-64b1-4c16-b5d1-26eb154d6b7f"
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@@ -13373,18 +13373,18 @@
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@@ -13456,7 +13456,7 @@
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@@ -13589,7 +13589,7 @@
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@@ -13722,7 +13722,7 @@
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@@ -13860,7 +13860,7 @@
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@@ -15592,7 +15592,7 @@
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@@ -15611,7 +15611,7 @@
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@@ -15633,27 +15633,27 @@
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@@ -15684,7 +15684,7 @@
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@@ -15703,7 +15703,7 @@
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@@ -15725,27 +15725,27 @@
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@@ -15776,7 +15776,7 @@
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@@ -15795,7 +15795,7 @@
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@@ -15817,30 +15817,30 @@
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+            "reference": "Specimen/1729353484411329000.96bd7ff5-72c5-4315-9fe4-26b8a231c0eb"
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@@ -15871,7 +15871,7 @@
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@@ -15895,7 +15895,7 @@
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@@ -15917,24 +15917,24 @@
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@@ -15965,7 +15965,7 @@
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@@ -15989,7 +15989,7 @@
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@@ -16011,12 +16011,12 @@
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+            "reference": "Observation/1729353484400364000.6714e943-25fe-4e8f-8817-635cb74bce60"
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diff --git a/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir b/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
index 4fc952739..228c903c1 100644
--- a/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
+++ b/examples/CA/006_CA_ORU_R01_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
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+  "id": "1729353484172077000.eaafbfe8-1dff-4a80-961c-d855c8be8963",
   "meta": {
-    "lastUpdated": "2024-10-18T15:45:11.454-07:00"
+    "lastUpdated": "2024-10-19T08:58:04.172-07:00"
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@@ -12,10 +12,10 @@
   "timestamp": "2024-07-16T09:06:32.000-07:00",
   "entry": [
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+        "id": "1729353484175678000.a6e63d42-4c9a-45d4-9eb8-06073f065b89",
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@@ -55,12 +55,12 @@
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             "name": "EPIC",
             "receiver": {
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+              "reference": "Organization/1729353484175283000.ed424666-51d9-4d07-81af-7039ac4aabf9"
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         "sender": {
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+          "reference": "Organization/1729353484174015000.e60929ce-8c30-485f-8274-8c51e8922fca"
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@@ -86,10 +86,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729353484174015000.e60929ce-8c30-485f-8274-8c51e8922fca",
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@@ -104,10 +104,10 @@
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     {
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+      "fullUrl": "Organization/1729353484175283000.ed424666-51d9-4d07-81af-7039ac4aabf9",
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+        "id": "1729353484175283000.ed424666-51d9-4d07-81af-7039ac4aabf9",
         "extension": [
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@@ -128,73 +128,73 @@
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@@ -1345,7 +1345,7 @@
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@@ -1418,7 +1418,7 @@
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@@ -1508,7 +1508,7 @@
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@@ -1667,7 +1667,7 @@
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@@ -1775,7 +1775,7 @@
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@@ -1852,7 +1852,7 @@
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@@ -6129,10 +6129,10 @@
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@@ -6189,7 +6189,7 @@
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@@ -6325,10 +6325,10 @@
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@@ -10826,10 +10826,10 @@
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@@ -10839,10 +10839,10 @@
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@@ -10852,10 +10852,10 @@
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@@ -10865,10 +10865,10 @@
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@@ -10878,10 +10878,10 @@
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@@ -10891,10 +10891,10 @@
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@@ -10904,10 +10904,10 @@
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@@ -10917,10 +10917,10 @@
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@@ -10930,10 +10930,10 @@
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@@ -10943,10 +10943,10 @@
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@@ -10956,10 +10956,10 @@
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@@ -10969,10 +10969,10 @@
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@@ -10982,10 +10982,10 @@
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@@ -10995,10 +10995,10 @@
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@@ -11008,10 +11008,10 @@
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@@ -11021,10 +11021,10 @@
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@@ -11034,10 +11034,10 @@
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@@ -11049,7 +11049,7 @@
               {
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@@ -11082,7 +11082,7 @@
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@@ -11118,7 +11118,7 @@
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@@ -11224,18 +11224,18 @@
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@@ -11266,10 +11266,10 @@
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@@ -11328,23 +11328,23 @@
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@@ -11365,10 +11365,10 @@
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@@ -11395,10 +11395,10 @@
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@@ -11421,10 +11421,10 @@
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@@ -11451,10 +11451,10 @@
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@@ -11477,10 +11477,10 @@
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@@ -11507,10 +11507,10 @@
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@@ -11533,10 +11533,10 @@
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@@ -11563,10 +11563,10 @@
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@@ -11589,10 +11589,10 @@
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@@ -11619,10 +11619,10 @@
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@@ -11645,10 +11645,10 @@
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@@ -11675,10 +11675,10 @@
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@@ -11701,10 +11701,10 @@
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@@ -11731,10 +11731,10 @@
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@@ -11757,10 +11757,10 @@
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@@ -11787,10 +11787,10 @@
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@@ -11813,10 +11813,10 @@
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@@ -11843,10 +11843,10 @@
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@@ -11869,10 +11869,10 @@
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@@ -11899,10 +11899,10 @@
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@@ -11925,10 +11925,10 @@
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@@ -11955,10 +11955,10 @@
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@@ -11981,10 +11981,10 @@
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@@ -12011,10 +12011,10 @@
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@@ -12037,10 +12037,10 @@
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@@ -12067,10 +12067,10 @@
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@@ -12093,10 +12093,10 @@
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@@ -12123,10 +12123,10 @@
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@@ -12149,10 +12149,10 @@
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@@ -12179,10 +12179,10 @@
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@@ -12205,10 +12205,10 @@
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@@ -12235,10 +12235,10 @@
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@@ -12261,10 +12261,10 @@
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@@ -12291,10 +12291,10 @@
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@@ -12317,10 +12317,10 @@
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@@ -12347,10 +12347,10 @@
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@@ -12373,10 +12373,10 @@
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diff --git a/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir b/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
index 8f9a20957..ea341e63c 100644
--- a/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
+++ b/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
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@@ -233,11 +233,11 @@
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@@ -1150,10 +1150,10 @@
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@@ -1194,7 +1194,7 @@
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@@ -1284,7 +1284,7 @@
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@@ -1361,7 +1361,7 @@
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@@ -1469,7 +1469,7 @@
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@@ -1546,7 +1546,7 @@
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@@ -1638,7 +1638,7 @@
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@@ -3036,7 +3036,7 @@
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@@ -9102,10 +9102,10 @@
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@@ -9244,7 +9244,7 @@
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@@ -9292,10 +9292,10 @@
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@@ -9336,7 +9336,7 @@
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@@ -9426,7 +9426,7 @@
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@@ -9464,10 +9464,10 @@
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@@ -9508,7 +9508,7 @@
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@@ -9556,10 +9556,10 @@
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@@ -9600,7 +9600,7 @@
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@@ -9630,10 +9630,10 @@
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@@ -9674,7 +9674,7 @@
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@@ -9709,10 +9709,10 @@
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@@ -9753,7 +9753,7 @@
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@@ -9845,7 +9845,7 @@
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@@ -9875,10 +9875,10 @@
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@@ -9919,7 +9919,7 @@
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@@ -9967,10 +9967,10 @@
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@@ -10011,7 +10011,7 @@
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@@ -10101,7 +10101,7 @@
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@@ -10152,10 +10152,10 @@
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@@ -10165,10 +10165,10 @@
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@@ -10178,10 +10178,10 @@
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@@ -10191,10 +10191,10 @@
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@@ -10204,10 +10204,10 @@
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@@ -10295,10 +10295,10 @@
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@@ -10308,10 +10308,10 @@
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@@ -10321,10 +10321,10 @@
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@@ -10334,10 +10334,10 @@
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@@ -10347,10 +10347,10 @@
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@@ -10360,10 +10360,10 @@
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@@ -10373,10 +10373,10 @@
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@@ -10386,10 +10386,10 @@
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@@ -10399,10 +10399,10 @@
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@@ -10414,7 +10414,7 @@
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                 "valueReference": {
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@@ -10447,7 +10447,7 @@
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@@ -10483,7 +10483,7 @@
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@@ -10585,18 +10585,18 @@
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@@ -10632,10 +10632,10 @@
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@@ -10693,23 +10693,23 @@
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@@ -10729,10 +10729,10 @@
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@@ -10764,10 +10764,10 @@
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@@ -10790,10 +10790,10 @@
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@@ -10809,7 +10809,7 @@
               {
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                 "valueReference": {
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@@ -10859,18 +10859,18 @@
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@@ -10897,10 +10897,10 @@
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@@ -10923,10 +10923,10 @@
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@@ -10942,7 +10942,7 @@
               {
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@@ -10992,18 +10992,18 @@
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@@ -11030,10 +11030,10 @@
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@@ -11056,10 +11056,10 @@
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@@ -11075,7 +11075,7 @@
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@@ -11125,18 +11125,18 @@
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@@ -11163,10 +11163,10 @@
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@@ -11189,10 +11189,10 @@
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@@ -11208,7 +11208,7 @@
               {
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                 "valueReference": {
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@@ -11258,18 +11258,18 @@
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@@ -11296,10 +11296,10 @@
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@@ -11322,10 +11322,10 @@
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@@ -11341,7 +11341,7 @@
               {
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@@ -11391,18 +11391,18 @@
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@@ -11429,10 +11429,10 @@
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         "extension": [
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@@ -11455,10 +11455,10 @@
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@@ -11474,7 +11474,7 @@
               {
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                 "valueReference": {
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@@ -11524,18 +11524,18 @@
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+          "reference": "Patient/1729354327565104000.65f00cef-db4c-4646-a734-e0f189146f3b"
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@@ -11562,10 +11562,10 @@
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         "extension": [
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@@ -11588,10 +11588,10 @@
       }
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@@ -11607,7 +11607,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729354327717189000.929fa24e-d72d-4d80-975d-3112ef50c315"
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@@ -11657,18 +11657,18 @@
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@@ -11695,10 +11695,10 @@
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@@ -11721,10 +11721,10 @@
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@@ -11740,7 +11740,7 @@
               {
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                 "valueReference": {
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@@ -11790,18 +11790,18 @@
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@@ -11828,10 +11828,10 @@
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@@ -11854,10 +11854,10 @@
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@@ -11873,7 +11873,7 @@
               {
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                 "valueReference": {
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@@ -11923,18 +11923,18 @@
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@@ -11961,10 +11961,10 @@
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@@ -11987,10 +11987,10 @@
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@@ -12006,7 +12006,7 @@
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@@ -12056,18 +12056,18 @@
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@@ -12094,10 +12094,10 @@
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@@ -12120,10 +12120,10 @@
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@@ -12139,7 +12139,7 @@
               {
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@@ -12189,18 +12189,18 @@
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@@ -12227,10 +12227,10 @@
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@@ -12253,10 +12253,10 @@
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@@ -12272,7 +12272,7 @@
               {
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@@ -12322,18 +12322,18 @@
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@@ -12360,10 +12360,10 @@
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@@ -12386,10 +12386,10 @@
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@@ -12405,7 +12405,7 @@
               {
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@@ -12455,18 +12455,18 @@
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@@ -12493,10 +12493,10 @@
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         "extension": [
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@@ -12519,10 +12519,10 @@
       }
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@@ -12538,7 +12538,7 @@
               {
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                 "valueReference": {
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@@ -12588,18 +12588,18 @@
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+          "reference": "Patient/1729354327565104000.65f00cef-db4c-4646-a734-e0f189146f3b"
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@@ -12626,10 +12626,10 @@
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@@ -12652,10 +12652,10 @@
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@@ -12671,7 +12671,7 @@
               {
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@@ -12721,18 +12721,18 @@
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@@ -12759,10 +12759,10 @@
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@@ -12785,10 +12785,10 @@
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@@ -12804,7 +12804,7 @@
               {
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                 "valueReference": {
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@@ -12854,18 +12854,18 @@
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@@ -12892,10 +12892,10 @@
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@@ -12918,10 +12918,10 @@
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@@ -12937,7 +12937,7 @@
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                 "valueReference": {
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@@ -12987,18 +12987,18 @@
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+            "reference": "Observation/1729354327667858000.7cb23c78-ae8d-405f-bb27-5c44afea00d5"
           },
           {
-            "reference": "Observation/1729292348131115000.1ce963d9-7287-4248-967d-591d0b00eec7"
+            "reference": "Observation/1729354327668885000.9dc3f19e-c694-4378-9296-3f90ece126c2"
           },
           {
-            "reference": "Observation/1729292348132164000.4b93987a-27e8-499d-8d3f-7db11cea1683"
+            "reference": "Observation/1729354327669795000.4fb7deed-ae4b-46ca-8935-1dedcee2b919"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292348295898000.f9014c78-f8c5-4b6d-9551-b7ffe9f14999",
+      "fullUrl": "DiagnosticReport/1729354327793089000.a861b721-7faa-4212-8246-2cae7e0c9e5d",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292348295898000.f9014c78-f8c5-4b6d-9551-b7ffe9f14999",
+        "id": "1729354327793089000.a861b721-7faa-4212-8246-2cae7e0c9e5d",
         "identifier": [
           {
             "extension": [
@@ -15201,7 +15201,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292348240037000.46bf37bc-934e-4e4e-ba4e-6ba60eb4485e"
+            "reference": "ServiceRequest/1729354327760014000.2a35415b-66ef-4151-8578-018b4a1f224b"
           }
         ],
         "status": "final",
@@ -15225,7 +15225,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
+          "reference": "Patient/1729354327565104000.65f00cef-db4c-4646-a734-e0f189146f3b"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -15247,24 +15247,24 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292348147494000.03f56c22-e4d9-43ee-9a22-8ea31be4c9ba"
+            "reference": "Specimen/1729354327683764000.c55f7e88-f9e1-40dd-b6d2-7b77204506ac"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729292348133292000.0af70fb4-1589-4e27-8764-6af785871ac1"
+            "reference": "Observation/1729354327670902000.684dcba7-02ef-4a7b-a98a-b7a45ed9f3ce"
           },
           {
-            "reference": "Observation/1729292348134303000.7a1d2327-6212-474a-89d6-b40e00cd4cbe"
+            "reference": "Observation/1729354327671885000.dd224347-3aca-4f85-b8cf-70e8e09bc2a1"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292348297900000.4ec94a21-f56e-4f50-974e-78d9513c2be5",
+      "fullUrl": "DiagnosticReport/1729354327794486000.deb33394-4371-4c8b-ad48-32d1592c80b1",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292348297900000.4ec94a21-f56e-4f50-974e-78d9513c2be5",
+        "id": "1729354327794486000.deb33394-4371-4c8b-ad48-32d1592c80b1",
         "identifier": [
           {
             "extension": [
@@ -15295,7 +15295,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292348244409000.d86ba55e-a14a-4358-8c87-a3ddbbb28d2d"
+            "reference": "ServiceRequest/1729354327763845000.1da18b47-212a-4a5c-b05f-38925e82123f"
           }
         ],
         "status": "final",
@@ -15319,7 +15319,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
+          "reference": "Patient/1729354327565104000.65f00cef-db4c-4646-a734-e0f189146f3b"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -15341,12 +15341,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292348147885000.fd18eb23-4f73-4dd5-8b29-b7b0972a9dd2"
+            "reference": "Specimen/1729354327684087000.66b20797-e9b6-488b-b756-1ce68f893eef"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729292348135440000.d303a5c3-3923-46e6-8440-98a8902fbeff"
+            "reference": "Observation/1729354327672919000.8c088513-fb55-49cd-a73d-da211d3a4d5e"
           }
         ]
       }
diff --git a/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir b/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
index 47e0ff3b0..6e37f0424 100644
--- a/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
+++ b/examples/CA/007_CA_ORU_R01_CDPH_produced_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729292348001421000.c8cae004-945a-4d87-8524-55fab3f2801b",
+  "id": "1729354327560879000.b6f151cd-3cef-4245-bcc8-dcfa4ee46889",
   "meta": {
-    "lastUpdated": "2024-10-18T15:59:08.001-07:00"
+    "lastUpdated": "2024-10-19T09:12:07.560-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-07-11T03:49:13.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729292348002485000.bc245c3f-2b57-4b1b-a644-9ea49b71e9ff",
+      "fullUrl": "MessageHeader/1729354327561418000.c8db502a-5de1-44ab-a3b4-b2502f659f17",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729292348002485000.bc245c3f-2b57-4b1b-a644-9ea49b71e9ff",
+        "id": "1729354327561418000.c8db502a-5de1-44ab-a3b4-b2502f659f17",
         "meta": {
           "tag": [
             {
@@ -55,12 +55,12 @@
             ],
             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1729292348002385000.7264dea7-c5df-44c9-9c3f-5903d9bbea27"
+              "reference": "Organization/1729354327561343000.d1433993-1b6e-4045-859c-c7eedd2e894a"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729292348002048000.3c407adc-893e-4fb5-b674-8e4cdfc1e519"
+          "reference": "Organization/1729354327561098000.bc7e40ff-e09a-498e-973c-e7d33d0bb25c"
         },
         "source": {
           "extension": [
@@ -86,10 +86,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292348002048000.3c407adc-893e-4fb5-b674-8e4cdfc1e519",
+      "fullUrl": "Organization/1729354327561098000.bc7e40ff-e09a-498e-973c-e7d33d0bb25c",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292348002048000.3c407adc-893e-4fb5-b674-8e4cdfc1e519",
+        "id": "1729354327561098000.bc7e40ff-e09a-498e-973c-e7d33d0bb25c",
         "identifier": [
           {
             "extension": [
@@ -104,10 +104,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292348002385000.7264dea7-c5df-44c9-9c3f-5903d9bbea27",
+      "fullUrl": "Organization/1729354327561343000.d1433993-1b6e-4045-859c-c7eedd2e894a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292348002385000.7264dea7-c5df-44c9-9c3f-5903d9bbea27",
+        "id": "1729354327561343000.d1433993-1b6e-4045-859c-c7eedd2e894a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -128,73 +128,73 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292348003373000.c6be32b7-129c-4a81-b299-c3fae23b5919",
+      "fullUrl": "Provenance/1729354327562014000.ab517949-c07f-4f4d-b233-33d87ee0c819",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292348003373000.c6be32b7-129c-4a81-b299-c3fae23b5919",
+        "id": "1729354327562014000.ab517949-c07f-4f4d-b233-33d87ee0c819",
         "target": [
           {
-            "reference": "MessageHeader/1729292348002485000.bc245c3f-2b57-4b1b-a644-9ea49b71e9ff"
+            "reference": "MessageHeader/1729354327561418000.c8db502a-5de1-44ab-a3b4-b2502f659f17"
           },
           {
-            "reference": "DiagnosticReport/1729292348247831000.60ffa699-5ad9-4124-af27-6a64151adec8"
+            "reference": "DiagnosticReport/1729354327766853000.56ec6cc7-d748-413c-ae55-55ea8362cccb"
           },
           {
-            "reference": "DiagnosticReport/1729292348249980000.fadc3cc3-7b98-4041-bc2b-8d409b57e952"
+            "reference": "DiagnosticReport/1729354327768321000.a389c970-8a6b-413c-8b19-857119680896"
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           {
-            "reference": "DiagnosticReport/1729292348251788000.c7c55fa4-7e11-4d2a-9bae-c0729b38cdfc"
+            "reference": "DiagnosticReport/1729354327769839000.8f07aa50-7a70-4c6e-916c-e2013f979247"
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           {
-            "reference": "DiagnosticReport/1729292348253312000.edfb2f08-b77f-4095-8497-170eeb15762f"
+            "reference": "DiagnosticReport/1729354327771139000.8bb56d16-1fe7-47a7-b914-12f492b3c444"
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           {
-            "reference": "DiagnosticReport/1729292348255409000.f9e36222-6fe9-45b5-af97-19fce88806ae"
+            "reference": "DiagnosticReport/1729354327772956000.66f3398f-3056-465f-8231-caabd75ae0e9"
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-            "reference": "DiagnosticReport/1729292348256927000.1b7cefb7-771d-404d-b954-ff669a7cd519"
+            "reference": "DiagnosticReport/1729354327774334000.00a0dece-a450-4cc4-b1e7-3bb251b98f20"
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-            "reference": "DiagnosticReport/1729292348259230000.5f05c937-30ed-434c-8eba-4cb25e5002b8"
+            "reference": "DiagnosticReport/1729354327776358000.218ba141-c648-4b14-9f12-6fc33a720bb6"
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           {
-            "reference": "DiagnosticReport/1729292348261416000.62223c28-5acf-4fdf-95f8-4b2721837050"
+            "reference": "DiagnosticReport/1729354327777928000.fdd8f1df-cd66-4787-847b-9a3a0919ba4a"
           },
           {
-            "reference": "DiagnosticReport/1729292348263586000.052d25c4-138a-4599-8331-ced7d1044db5"
+            "reference": "DiagnosticReport/1729354327779262000.5902753a-8eaf-4075-94d5-5388a491bbaf"
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           {
-            "reference": "DiagnosticReport/1729292348265718000.c2d795ff-4371-40dd-a6b4-66e7cf5f2333"
+            "reference": "DiagnosticReport/1729354327780608000.19c6e208-a20c-45fa-8a22-a47e96cd3297"
           },
           {
-            "reference": "DiagnosticReport/1729292348267355000.dad9d4c7-8582-4258-8cc8-024abf86da5d"
+            "reference": "DiagnosticReport/1729354327781968000.8e34dbd9-9b07-4145-9307-411ae0d3f588"
           },
           {
-            "reference": "DiagnosticReport/1729292348268984000.174e0353-6b00-465b-917f-58adc7c98418"
+            "reference": "DiagnosticReport/1729354327783319000.83e2b38c-1c71-4011-86f1-9d18032be796"
           },
           {
-            "reference": "DiagnosticReport/1729292348270531000.37caf9c5-d5fe-40c3-8da2-c3f9dbabff99"
+            "reference": "DiagnosticReport/1729354327784633000.c73fdead-df3c-44a1-931a-134d256df7e2"
           },
           {
-            "reference": "DiagnosticReport/1729292348275456000.978f6593-eb21-408b-9e55-a6c4e8140ae4"
+            "reference": "DiagnosticReport/1729354327785999000.19de83a0-67aa-482b-8be4-66e9891dea01"
           },
           {
-            "reference": "DiagnosticReport/1729292348278783000.16c1ee1f-aba0-4efd-8972-993223d98c46"
+            "reference": "DiagnosticReport/1729354327787364000.4796e32c-794c-4660-a09a-2bb707cdb3f0"
           },
           {
-            "reference": "DiagnosticReport/1729292348282155000.5ca0061e-e36c-48ee-af4e-5d3890adb71b"
+            "reference": "DiagnosticReport/1729354327788801000.7344b660-0f60-4989-b842-6a253abd8b84"
           },
           {
-            "reference": "DiagnosticReport/1729292348285126000.e3022996-7306-41c3-896a-cf715cf100c8"
+            "reference": "DiagnosticReport/1729354327790224000.9cdc945c-3ff4-4cc5-8701-5e22e05d46a5"
           },
           {
-            "reference": "DiagnosticReport/1729292348294196000.11df5fe3-6b79-4e11-9450-d56979a896c6"
+            "reference": "DiagnosticReport/1729354327791635000.a38f31a0-6926-49c7-aba1-14f3f13c3502"
           },
           {
-            "reference": "DiagnosticReport/1729292348295898000.f9014c78-f8c5-4b6d-9551-b7ffe9f14999"
+            "reference": "DiagnosticReport/1729354327793089000.a861b721-7faa-4212-8246-2cae7e0c9e5d"
           },
           {
-            "reference": "DiagnosticReport/1729292348297900000.4ec94a21-f56e-4f50-974e-78d9513c2be5"
+            "reference": "DiagnosticReport/1729354327794486000.deb33394-4371-4c8b-ad48-32d1592c80b1"
           }
         ],
         "recorded": "2024-07-11T03:49:13Z",
@@ -216,17 +216,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729292348003267000.8f0ec976-3579-4bf5-959b-bb3d111bda4d"
+              "reference": "Organization/1729354327561934000.9855c177-1bd9-4f56-a155-b6836198eeba"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729292348003267000.8f0ec976-3579-4bf5-959b-bb3d111bda4d",
+      "fullUrl": "Organization/1729354327561934000.9855c177-1bd9-4f56-a155-b6836198eeba",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292348003267000.8f0ec976-3579-4bf5-959b-bb3d111bda4d",
+        "id": "1729354327561934000.9855c177-1bd9-4f56-a155-b6836198eeba",
         "identifier": [
           {
             "extension": [
@@ -241,11 +241,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292348003762000.3fc4d40f-3dfe-43d0-a6d6-3debdcf9d324",
+      "fullUrl": "Provenance/1729354327562276000.7aab63c0-a29f-43a9-b0ed-0c80e3c60b9b",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292348003762000.3fc4d40f-3dfe-43d0-a6d6-3debdcf9d324",
-        "recorded": "2024-10-18T15:59:08Z",
+        "id": "1729354327562276000.7aab63c0-a29f-43a9-b0ed-0c80e3c60b9b",
+        "recorded": "2024-10-19T09:12:07Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -267,17 +267,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729292348003683000.23dd4aa9-53f6-42a4-922e-5ee5f99c859c"
+              "reference": "Organization/1729354327562210000.2e53537d-025f-4c7f-9200-32a1ad66cb01"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729292348003683000.23dd4aa9-53f6-42a4-922e-5ee5f99c859c",
+      "fullUrl": "Organization/1729354327562210000.2e53537d-025f-4c7f-9200-32a1ad66cb01",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292348003683000.23dd4aa9-53f6-42a4-922e-5ee5f99c859c",
+        "id": "1729354327562210000.2e53537d-025f-4c7f-9200-32a1ad66cb01",
         "identifier": [
           {
             "value": "CDC PRIME - Atlanta"
@@ -297,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59",
+      "fullUrl": "Patient/1729354327565104000.65f00cef-db4c-4646-a734-e0f189146f3b",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59",
+        "id": "1729354327565104000.65f00cef-db4c-4646-a734-e0f189146f3b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -387,7 +387,7 @@
             },
             "value": "80009197",
             "assigner": {
-              "reference": "Organization/1729292348004139000.664c2f8f-e5fa-4c1e-92d6-68a7d1b5c6d9"
+              "reference": "Organization/1729354327562558000.e3ff6e7d-310a-4316-a7d7-6fa5323b61fb"
             }
           }
         ],
@@ -454,10 +454,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292348004139000.664c2f8f-e5fa-4c1e-92d6-68a7d1b5c6d9",
+      "fullUrl": "Organization/1729354327562558000.e3ff6e7d-310a-4316-a7d7-6fa5323b61fb",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292348004139000.664c2f8f-e5fa-4c1e-92d6-68a7d1b5c6d9",
+        "id": "1729354327562558000.e3ff6e7d-310a-4316-a7d7-6fa5323b61fb",
         "identifier": [
           {
             "extension": [
@@ -478,16 +478,16 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292348007323000.fd7d1386-edc4-47da-8d33-51d0874ce254",
+      "fullUrl": "Provenance/1729354327565274000.e9e9653d-1c0a-4b42-a58a-0a20f4326274",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292348007323000.fd7d1386-edc4-47da-8d33-51d0874ce254",
+        "id": "1729354327565274000.e9e9653d-1c0a-4b42-a58a-0a20f4326274",
         "target": [
           {
-            "reference": "Patient/1729292348007064000.5a92a119-228a-46a2-982a-e3a317455d59"
+            "reference": "Patient/1729354327565104000.65f00cef-db4c-4646-a734-e0f189146f3b"
           }
         ],
-        "recorded": "2024-10-18T15:59:08Z",
+        "recorded": "2024-10-19T09:12:07Z",
         "activity": {
           "coding": [
             {
@@ -499,10 +499,10 @@
       }
     },
     {
-      "fullUrl": "RelatedPerson/1729292348007812000.61488a6a-30b6-4865-8196-c1a682eceded",
+      "fullUrl": "RelatedPerson/1729354327565679000.a8a33b42-203d-41aa-9f8a-def926c1c03c",
       "resource": {
         "resourceType": "RelatedPerson",
-        "id": "1729292348007812000.61488a6a-30b6-4865-8196-c1a682eceded",
+        "id": "1729354327565679000.a8a33b42-203d-41aa-9f8a-def926c1c03c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -510,7 +510,7 @@
           }
         ],
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@@ -5534,7 +5534,7 @@
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@@ -5632,7 +5632,7 @@
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@@ -9654,10 +9654,10 @@
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@@ -9698,7 +9698,7 @@
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@@ -9746,10 +9746,10 @@
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@@ -9790,7 +9790,7 @@
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@@ -9820,10 +9820,10 @@
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@@ -9879,7 +9879,7 @@
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@@ -9927,10 +9927,10 @@
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@@ -9986,7 +9986,7 @@
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@@ -10016,10 +10016,10 @@
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@@ -10076,7 +10076,7 @@
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@@ -10114,10 +10114,10 @@
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@@ -10127,10 +10127,10 @@
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@@ -10140,10 +10140,10 @@
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@@ -10153,10 +10153,10 @@
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@@ -10166,10 +10166,10 @@
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@@ -10179,10 +10179,10 @@
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@@ -10192,10 +10192,10 @@
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@@ -10205,10 +10205,10 @@
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@@ -10218,10 +10218,10 @@
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@@ -10231,10 +10231,10 @@
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@@ -10244,10 +10244,10 @@
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@@ -10257,10 +10257,10 @@
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@@ -10270,10 +10270,10 @@
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@@ -10283,10 +10283,10 @@
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@@ -10296,10 +10296,10 @@
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@@ -10309,10 +10309,10 @@
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@@ -10322,10 +10322,10 @@
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@@ -10335,10 +10335,10 @@
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@@ -10348,10 +10348,10 @@
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@@ -10361,10 +10361,10 @@
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@@ -10374,10 +10374,10 @@
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@@ -10389,7 +10389,7 @@
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@@ -10422,7 +10422,7 @@
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@@ -10458,7 +10458,7 @@
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@@ -10564,18 +10564,18 @@
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@@ -10611,10 +10611,10 @@
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@@ -10672,23 +10672,23 @@
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@@ -10708,10 +10708,10 @@
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@@ -10743,10 +10743,10 @@
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@@ -10769,10 +10769,10 @@
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@@ -10799,10 +10799,10 @@
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@@ -10825,10 +10825,10 @@
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@@ -10855,10 +10855,10 @@
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@@ -10881,10 +10881,10 @@
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@@ -10911,10 +10911,10 @@
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@@ -10937,10 +10937,10 @@
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@@ -10967,10 +10967,10 @@
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@@ -10993,10 +10993,10 @@
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@@ -11023,10 +11023,10 @@
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@@ -11049,10 +11049,10 @@
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@@ -11079,10 +11079,10 @@
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@@ -11105,10 +11105,10 @@
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@@ -11135,10 +11135,10 @@
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@@ -11161,10 +11161,10 @@
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@@ -11191,10 +11191,10 @@
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@@ -11217,10 +11217,10 @@
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@@ -11247,10 +11247,10 @@
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@@ -11273,10 +11273,10 @@
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@@ -11303,10 +11303,10 @@
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@@ -11329,10 +11329,10 @@
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@@ -11359,10 +11359,10 @@
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@@ -11385,10 +11385,10 @@
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diff --git a/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_1_hl7_translation.fhir b/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_1_hl7_translation.fhir
index 32545975e..608537f37 100644
--- a/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_1_hl7_translation.fhir
+++ b/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
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@@ -89,10 +89,10 @@
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@@ -2686,7 +2686,7 @@
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@@ -3214,10 +3214,10 @@
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@@ -3759,7 +3759,7 @@
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@@ -3857,7 +3857,7 @@
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@@ -3955,7 +3955,7 @@
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@@ -4111,7 +4111,7 @@
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@@ -4391,7 +4391,7 @@
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@@ -4429,10 +4429,10 @@
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@@ -4489,7 +4489,7 @@
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@@ -4527,10 +4527,10 @@
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@@ -4587,7 +4587,7 @@
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@@ -4625,10 +4625,10 @@
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@@ -4685,7 +4685,7 @@
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@@ -4723,10 +4723,10 @@
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@@ -4783,7 +4783,7 @@
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@@ -4821,10 +4821,10 @@
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@@ -5110,10 +5110,10 @@
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@@ -5557,7 +5557,7 @@
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@@ -5655,7 +5655,7 @@
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@@ -5748,7 +5748,7 @@
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@@ -5841,7 +5841,7 @@
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@@ -5879,10 +5879,10 @@
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@@ -5939,7 +5939,7 @@
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@@ -6037,7 +6037,7 @@
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@@ -6135,7 +6135,7 @@
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@@ -6233,7 +6233,7 @@
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@@ -6331,7 +6331,7 @@
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@@ -6369,10 +6369,10 @@
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@@ -6429,7 +6429,7 @@
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@@ -6467,10 +6467,10 @@
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@@ -6527,7 +6527,7 @@
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@@ -6560,10 +6560,10 @@
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@@ -6620,7 +6620,7 @@
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@@ -6718,7 +6718,7 @@
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@@ -10347,7 +10347,7 @@
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@@ -10377,10 +10377,10 @@
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@@ -10437,7 +10437,7 @@
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@@ -10475,10 +10475,10 @@
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@@ -10488,10 +10488,10 @@
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@@ -10501,10 +10501,10 @@
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@@ -10514,10 +10514,10 @@
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@@ -10527,10 +10527,10 @@
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@@ -10540,10 +10540,10 @@
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@@ -10553,10 +10553,10 @@
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@@ -10566,10 +10566,10 @@
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@@ -10579,10 +10579,10 @@
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@@ -10592,10 +10592,10 @@
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@@ -10605,10 +10605,10 @@
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@@ -10618,10 +10618,10 @@
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@@ -10631,10 +10631,10 @@
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@@ -10644,10 +10644,10 @@
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@@ -10657,10 +10657,10 @@
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@@ -10670,10 +10670,10 @@
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@@ -10683,10 +10683,10 @@
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@@ -10696,10 +10696,10 @@
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@@ -10709,10 +10709,10 @@
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@@ -10722,10 +10722,10 @@
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@@ -10735,10 +10735,10 @@
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@@ -10750,7 +10750,7 @@
               {
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                 "valueReference": {
-                  "reference": "Organization/1729291863127745000.7560f7d0-c3ae-451e-bfb0-72cff5c6bcf4"
+                  "reference": "Organization/1729353845325086000.2abd6e69-0a38-4329-8f84-93f9a24bde1d"
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@@ -10783,7 +10783,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291863129079000.5271ea12-a2ad-4514-985d-2a9da8b0d727"
+                  "reference": "Practitioner/1729353845326084000.f8db70be-6336-4e09-8060-bc16e8c17076"
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@@ -10819,7 +10819,7 @@
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                 "valueReference": {
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+                  "reference": "Practitioner/1729353845327011000.2c1f1bcb-20cd-4d9e-a90a-83be95d81ef9"
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@@ -10921,18 +10921,18 @@
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@@ -10968,10 +10968,10 @@
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@@ -11030,23 +11030,23 @@
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@@ -11067,10 +11067,10 @@
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@@ -11102,10 +11102,10 @@
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         "extension": [
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@@ -11128,10 +11128,10 @@
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@@ -11147,7 +11147,7 @@
               {
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                 "valueReference": {
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@@ -11197,18 +11197,18 @@
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@@ -11235,10 +11235,10 @@
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@@ -11261,10 +11261,10 @@
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@@ -11280,7 +11280,7 @@
               {
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@@ -11330,18 +11330,18 @@
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@@ -11368,10 +11368,10 @@
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         "extension": [
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@@ -11394,10 +11394,10 @@
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@@ -11413,7 +11413,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291863147468000.ae514f39-8f34-456c-aa8a-3b0064a739c3"
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@@ -11463,18 +11463,18 @@
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@@ -11501,10 +11501,10 @@
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         "extension": [
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@@ -11527,10 +11527,10 @@
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+      "fullUrl": "ServiceRequest/1729353845342819000.dadd36b9-cd7b-4dfd-a53f-5d364d16dec1",
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+        "id": "1729353845342819000.dadd36b9-cd7b-4dfd-a53f-5d364d16dec1",
         "extension": [
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@@ -11546,7 +11546,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291863153834000.4acfe68b-7450-4457-95ea-13d0cb461ca5"
+                  "reference": "Practitioner/1729353845342338000.8b513e9b-de4f-4955-8bab-f197d79ed1e9"
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@@ -11596,18 +11596,18 @@
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+          "reference": "Practitioner/1729353845339798000.d3004e7d-8292-47cd-8efe-b91f0b64c708"
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@@ -11634,10 +11634,10 @@
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@@ -11660,10 +11660,10 @@
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@@ -11679,7 +11679,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291863159257000.0cce4bac-4c4a-4302-8cfc-21934a768611"
+                  "reference": "Practitioner/1729353845346172000.5e6fdc31-e235-4a61-9fd8-44fd6f6b20b2"
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@@ -11729,18 +11729,18 @@
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+          "reference": "Patient/1729353845180577000.af7988d8-5612-43a5-bff9-ca8c0c9c1923"
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+          "reference": "Practitioner/1729353845343672000.60d811fe-260c-4da1-b872-3f2c412bbeaa"
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+      "fullUrl": "Practitioner/1729353845343672000.60d811fe-260c-4da1-b872-3f2c412bbeaa",
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@@ -11767,10 +11767,10 @@
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@@ -11793,10 +11793,10 @@
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@@ -11812,7 +11812,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291863164432000.01c6645f-b98c-45d8-bb4b-d1aac9a4dcf8"
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@@ -11862,18 +11862,18 @@
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@@ -11900,10 +11900,10 @@
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@@ -11926,10 +11926,10 @@
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@@ -11945,7 +11945,7 @@
               {
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                 "valueReference": {
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@@ -11995,18 +11995,18 @@
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       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729291863166464000.ec602e9a-c302-4860-8fdd-d00872463be4",
+        "id": "1729353845351383000.2fcc276c-5365-4b86-acf3-78bae9b7bdc5",
         "extension": [
           {
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@@ -12033,10 +12033,10 @@
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     {
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+      "fullUrl": "Practitioner/1729353845353890000.1c4828d8-b816-4f85-8dd1-3d054d345dc5",
       "resource": {
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+        "id": "1729353845353890000.1c4828d8-b816-4f85-8dd1-3d054d345dc5",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -12059,10 +12059,10 @@
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-        "id": "1729291863176926000.fde894f0-8480-4a1b-ae34-d182891edbb1",
+        "id": "1729353845358159000.267010d2-7507-4e5d-b16a-412ad4130012",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
@@ -12078,7 +12078,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729291863176313000.e8887115-f7e6-41d8-b0b4-a46b17b98131"
+                  "reference": "Practitioner/1729353845357700000.aab29c30-a81f-49e9-b761-5d73c64c9d3d"
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@@ -12128,18 +12128,18 @@
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+          "reference": "Patient/1729353845180577000.af7988d8-5612-43a5-bff9-ca8c0c9c1923"
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+          "reference": "Practitioner/1729353845355215000.baddc5ca-c406-4d4e-be2b-7de681d8962a"
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         "extension": [
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@@ -12166,10 +12166,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729291863176313000.e8887115-f7e6-41d8-b0b4-a46b17b98131",
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         "extension": [
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@@ -12192,10 +12192,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729353845361965000.efee45b1-5c87-409b-9bec-aa30de920c6f",
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+        "id": "1729353845361965000.efee45b1-5c87-409b-9bec-aa30de920c6f",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
@@ -12211,7 +12211,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729291863181981000.306e717d-ee96-44da-9e7a-c542b6fde070"
+                  "reference": "Practitioner/1729353845361502000.70b4de22-447a-43cf-b701-f5c9428908f4"
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@@ -12261,18 +12261,18 @@
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+          "reference": "Practitioner/1729353845359021000.874ea520-214c-4511-896c-ca0d6594bef0"
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+      "fullUrl": "Practitioner/1729353845359021000.874ea520-214c-4511-896c-ca0d6594bef0",
       "resource": {
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-        "id": "1729291863178101000.3207fb01-9691-4321-b941-c7a31967821d",
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         "extension": [
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@@ -12299,10 +12299,10 @@
       }
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     {
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+      "fullUrl": "Practitioner/1729353845361502000.70b4de22-447a-43cf-b701-f5c9428908f4",
       "resource": {
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-        "id": "1729291863181981000.306e717d-ee96-44da-9e7a-c542b6fde070",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -12325,10 +12325,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729353845365787000.5184c879-70be-40b1-bf58-0f03101cb589",
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+        "id": "1729353845365787000.5184c879-70be-40b1-bf58-0f03101cb589",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
@@ -12344,7 +12344,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729291863187921000.978508ad-b0f7-4202-ac4b-e8849273bfe9"
+                  "reference": "Practitioner/1729353845365328000.e34be258-0573-489b-9c45-3a4b11947d6c"
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@@ -12394,18 +12394,18 @@
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         "subject": {
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+          "reference": "Patient/1729353845180577000.af7988d8-5612-43a5-bff9-ca8c0c9c1923"
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-          "reference": "Practitioner/1729291863183988000.c7bb2216-f4b1-49c9-b029-6689c18f9e8d"
+          "reference": "Practitioner/1729353845362811000.64e7b075-3113-4961-a143-457548a14bc9"
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-      "fullUrl": "Practitioner/1729291863183988000.c7bb2216-f4b1-49c9-b029-6689c18f9e8d",
+      "fullUrl": "Practitioner/1729353845362811000.64e7b075-3113-4961-a143-457548a14bc9",
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         "extension": [
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@@ -12432,10 +12432,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729291863187921000.978508ad-b0f7-4202-ac4b-e8849273bfe9",
+      "fullUrl": "Practitioner/1729353845365328000.e34be258-0573-489b-9c45-3a4b11947d6c",
       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -12458,10 +12458,10 @@
       }
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-      "fullUrl": "ServiceRequest/1729291863194972000.464e3726-bd86-40df-a0a6-b405a4c774ca",
+      "fullUrl": "ServiceRequest/1729353845369613000.be64c563-8e19-4b3e-92b9-0f9675feb965",
       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
@@ -12477,7 +12477,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729291863193097000.d13b7828-41b1-484d-a918-ce677243572d"
+                  "reference": "Practitioner/1729353845369153000.ea31bf89-a30b-4c97-b73b-a9b386fc803b"
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@@ -12527,18 +12527,18 @@
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+          "reference": "Patient/1729353845180577000.af7988d8-5612-43a5-bff9-ca8c0c9c1923"
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         "requester": {
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+          "reference": "Practitioner/1729353845366645000.bd75f6da-cb79-4b6e-9b44-0216754ce1a5"
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-      "fullUrl": "Practitioner/1729291863189871000.7866567b-0dec-4641-a207-c9912e02c9f0",
+      "fullUrl": "Practitioner/1729353845366645000.bd75f6da-cb79-4b6e-9b44-0216754ce1a5",
       "resource": {
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-        "id": "1729291863189871000.7866567b-0dec-4641-a207-c9912e02c9f0",
+        "id": "1729353845366645000.bd75f6da-cb79-4b6e-9b44-0216754ce1a5",
         "extension": [
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@@ -12565,10 +12565,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729291863193097000.d13b7828-41b1-484d-a918-ce677243572d",
+      "fullUrl": "Practitioner/1729353845369153000.ea31bf89-a30b-4c97-b73b-a9b386fc803b",
       "resource": {
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         "extension": [
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@@ -12591,10 +12591,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729353845373398000.6a10193b-2014-400b-8cb3-6cd6b614b3bc",
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+        "id": "1729353845373398000.6a10193b-2014-400b-8cb3-6cd6b614b3bc",
         "extension": [
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@@ -12610,7 +12610,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729291863199027000.a64904a2-e8f0-4df3-ad32-e0ca76dde041"
+                  "reference": "Practitioner/1729353845372942000.466b898f-4ceb-48b8-911c-ce0b434249ce"
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@@ -12660,18 +12660,18 @@
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+          "reference": "Patient/1729353845180577000.af7988d8-5612-43a5-bff9-ca8c0c9c1923"
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-          "reference": "Practitioner/1729291863196036000.2e98f4a9-c111-43a5-b8f2-01c61d931fa4"
+          "reference": "Practitioner/1729353845370474000.c5eba620-4beb-4824-b064-3ea58a904831"
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-      "fullUrl": "Practitioner/1729291863196036000.2e98f4a9-c111-43a5-b8f2-01c61d931fa4",
+      "fullUrl": "Practitioner/1729353845370474000.c5eba620-4beb-4824-b064-3ea58a904831",
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         "extension": [
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@@ -12698,10 +12698,10 @@
       }
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-      "fullUrl": "Practitioner/1729291863199027000.a64904a2-e8f0-4df3-ad32-e0ca76dde041",
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       "resource": {
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         "extension": [
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@@ -12724,10 +12724,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729353845377207000.27407609-cfc7-40ac-90bb-de2bc81ed6ff",
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+        "id": "1729353845377207000.27407609-cfc7-40ac-90bb-de2bc81ed6ff",
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@@ -12743,7 +12743,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729291863203706000.6690e128-c988-46e4-8007-d9604b9a2ede"
+                  "reference": "Practitioner/1729353845376736000.cd6cbea8-9063-4adb-b92c-7ad579bc3407"
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@@ -12793,18 +12793,18 @@
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+          "reference": "Patient/1729353845180577000.af7988d8-5612-43a5-bff9-ca8c0c9c1923"
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+          "reference": "Practitioner/1729353845374249000.9a613feb-96fa-43d9-8dbd-acc5a88b332a"
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@@ -12831,10 +12831,10 @@
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         "extension": [
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@@ -12857,10 +12857,10 @@
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@@ -12876,7 +12876,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291863208380000.9179be7e-1edb-4613-b10b-4155e6e9a466"
+                  "reference": "Practitioner/1729353845380565000.669ab55f-32ec-474e-a495-ee0954fdd09f"
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@@ -12926,18 +12926,18 @@
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+          "reference": "Practitioner/1729353845378052000.db15555e-03e1-45ae-9357-b92e8b0e1d83"
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@@ -12964,10 +12964,10 @@
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@@ -12990,10 +12990,10 @@
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@@ -13009,7 +13009,7 @@
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@@ -13059,18 +13059,18 @@
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@@ -13097,10 +13097,10 @@
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@@ -13123,10 +13123,10 @@
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@@ -13142,7 +13142,7 @@
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@@ -13192,18 +13192,18 @@
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@@ -13230,10 +13230,10 @@
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@@ -13256,10 +13256,10 @@
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@@ -13275,7 +13275,7 @@
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@@ -13325,18 +13325,18 @@
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@@ -13363,10 +13363,10 @@
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@@ -13389,10 +13389,10 @@
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@@ -13408,7 +13408,7 @@
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@@ -13463,18 +13463,18 @@
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@@ -13501,10 +13501,10 @@
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@@ -13527,10 +13527,10 @@
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@@ -13546,7 +13546,7 @@
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@@ -13601,18 +13601,18 @@
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@@ -13639,10 +13639,10 @@
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@@ -13665,10 +13665,10 @@
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@@ -13743,7 +13743,7 @@
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@@ -13762,7 +13762,7 @@
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@@ -13784,16 +13784,16 @@
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@@ -13824,7 +13824,7 @@
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@@ -13843,7 +13843,7 @@
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@@ -13865,39 +13865,39 @@
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@@ -15177,7 +15177,7 @@
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@@ -15196,7 +15196,7 @@
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@@ -15218,27 +15218,27 @@
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@@ -15269,7 +15269,7 @@
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@@ -15288,7 +15288,7 @@
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@@ -15310,27 +15310,27 @@
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@@ -15361,7 +15361,7 @@
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@@ -15380,7 +15380,7 @@
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@@ -15402,27 +15402,27 @@
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@@ -15453,7 +15453,7 @@
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@@ -15472,7 +15472,7 @@
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@@ -15494,27 +15494,27 @@
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+            "reference": "Specimen/1729353845320618000.e3037544-5271-40ee-a1c2-a27d2d4f01a2"
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     {
-      "fullUrl": "DiagnosticReport/1729291863267782000.f16f0edb-7d3e-45ed-9e05-e43c61822c6e",
+      "fullUrl": "DiagnosticReport/1729353845431374000.25bd7d6f-5eb3-4bf7-96b6-d5d360830697",
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@@ -15545,7 +15545,7 @@
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+            "reference": "ServiceRequest/1729353845396792000.72cf25f7-7cff-41d2-bf73-8330421da0fd"
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@@ -15569,7 +15569,7 @@
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+          "reference": "Patient/1729353845180577000.af7988d8-5612-43a5-bff9-ca8c0c9c1923"
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@@ -15591,24 +15591,24 @@
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+            "reference": "Observation/1729353845305568000.919c36d2-23ca-4d9b-ae7f-68bf269733f6"
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-            "reference": "Observation/1729291863106612000.d131ba4e-3f82-49d5-9e7e-a1155ec5eb1b"
+            "reference": "Observation/1729353845306549000.e073dfa4-0116-47d8-8c16-8d136bea1b6e"
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     {
-      "fullUrl": "DiagnosticReport/1729291863269439000.5c76fb62-be9f-48ea-b735-f12c92eb64ec",
+      "fullUrl": "DiagnosticReport/1729353845432768000.55a2a25d-660f-4fd7-a43b-bb4cf31e504f",
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-        "id": "1729291863269439000.5c76fb62-be9f-48ea-b735-f12c92eb64ec",
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@@ -15639,7 +15639,7 @@
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+            "reference": "ServiceRequest/1729353845400767000.5885bf33-bf93-46a0-be83-3dd5a4022b42"
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@@ -15663,7 +15663,7 @@
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+          "reference": "Patient/1729353845180577000.af7988d8-5612-43a5-bff9-ca8c0c9c1923"
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@@ -15685,12 +15685,12 @@
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-            "reference": "Specimen/1729291863121578000.494d55aa-e52f-4220-a523-984c87d7568b"
+            "reference": "Specimen/1729353845321303000.f7a7fb84-d729-4e11-8a30-158bb2537854"
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+            "reference": "Observation/1729353845307708000.63bd9b12-4d1c-4e20-b585-8a5ff5b6921d"
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diff --git a/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_2_fhir_transformation.fhir b/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_2_fhir_transformation.fhir
index 709a6726f..413a24ffa 100644
--- a/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_2_fhir_transformation.fhir
+++ b/examples/CA/010_CA_ORU_R01_CDPH_produced_from_UCSD_order_189556932_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729291862952487000.d21a4e14-69b4-4f0b-9e08-edb761f2c028",
+  "id": "1729353845169474000.b6e4052e-c179-4ee7-a922-ba235ac0e22e",
   "meta": {
-    "lastUpdated": "2024-10-18T15:51:02.952-07:00"
+    "lastUpdated": "2024-10-19T09:04:05.169-07:00"
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@@ -12,10 +12,10 @@
   "timestamp": "2024-07-22T10:35:44.000-07:00",
   "entry": [
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+        "id": "1729353845171267000.1b204ea2-a008-4057-beda-cac92f04aedf",
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@@ -55,12 +55,12 @@
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             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1729291862954324000.6bafa13a-dd18-442a-a596-821cdda9114c"
+              "reference": "Organization/1729353845170905000.29070b0c-314d-42d9-82cc-d1ca33d84e75"
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         "sender": {
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+          "reference": "Organization/1729353845170197000.684bad05-838f-4037-afc9-b59e46b8954b"
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@@ -86,10 +86,10 @@
       }
     },
     {
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+      "fullUrl": "Organization/1729353845170197000.684bad05-838f-4037-afc9-b59e46b8954b",
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+        "id": "1729353845170197000.684bad05-838f-4037-afc9-b59e46b8954b",
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@@ -104,10 +104,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291862954324000.6bafa13a-dd18-442a-a596-821cdda9114c",
+      "fullUrl": "Organization/1729353845170905000.29070b0c-314d-42d9-82cc-d1ca33d84e75",
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+        "id": "1729353845170905000.29070b0c-314d-42d9-82cc-d1ca33d84e75",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -128,73 +128,73 @@
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     {
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@@ -1287,7 +1287,7 @@
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@@ -6145,7 +6145,7 @@
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@@ -8882,7 +8882,7 @@
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@@ -9492,7 +9492,7 @@
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@@ -9584,7 +9584,7 @@
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@@ -9674,7 +9674,7 @@
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@@ -9756,7 +9756,7 @@
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@@ -10107,7 +10107,7 @@
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@@ -10483,10 +10483,10 @@
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@@ -10496,10 +10496,10 @@
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@@ -10509,10 +10509,10 @@
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@@ -10522,10 +10522,10 @@
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@@ -10535,10 +10535,10 @@
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@@ -10548,10 +10548,10 @@
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@@ -10561,10 +10561,10 @@
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@@ -10574,10 +10574,10 @@
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@@ -10587,10 +10587,10 @@
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@@ -10600,10 +10600,10 @@
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@@ -10613,10 +10613,10 @@
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@@ -10626,10 +10626,10 @@
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@@ -10639,10 +10639,10 @@
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@@ -10652,10 +10652,10 @@
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@@ -10665,10 +10665,10 @@
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@@ -10678,10 +10678,10 @@
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@@ -10691,10 +10691,10 @@
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@@ -10706,7 +10706,7 @@
               {
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                 "valueReference": {
-                  "reference": "Organization/1729291863127745000.7560f7d0-c3ae-451e-bfb0-72cff5c6bcf4"
+                  "reference": "Organization/1729353845325086000.2abd6e69-0a38-4329-8f84-93f9a24bde1d"
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@@ -10739,7 +10739,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291863129079000.5271ea12-a2ad-4514-985d-2a9da8b0d727"
+                  "reference": "Practitioner/1729353845326084000.f8db70be-6336-4e09-8060-bc16e8c17076"
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@@ -10775,7 +10775,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291863124376000.7300b61e-28b9-49b1-904d-78186c5f02a5"
+                  "reference": "Practitioner/1729353845322511000.50dedb2a-e786-4b8f-8333-72d9a32b5ea3"
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@@ -10881,18 +10881,18 @@
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+          "reference": "Patient/1729353845180577000.af7988d8-5612-43a5-bff9-ca8c0c9c1923"
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+          "reference": "PractitionerRole/1729353845321876000.31fb6726-1234-4d7c-b283-803aa522ad4d"
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@@ -10928,10 +10928,10 @@
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@@ -10990,23 +10990,23 @@
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+          "reference": "Organization/1729353845323468000.695692b1-37c3-410f-8c4a-acc67a7b8e03"
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@@ -11027,10 +11027,10 @@
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@@ -11062,10 +11062,10 @@
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@@ -11088,10 +11088,10 @@
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@@ -11118,10 +11118,10 @@
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@@ -11144,10 +11144,10 @@
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@@ -11174,10 +11174,10 @@
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@@ -11200,10 +11200,10 @@
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@@ -11230,10 +11230,10 @@
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@@ -11256,10 +11256,10 @@
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@@ -11286,10 +11286,10 @@
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@@ -11312,10 +11312,10 @@
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@@ -11342,10 +11342,10 @@
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@@ -11368,10 +11368,10 @@
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@@ -11398,10 +11398,10 @@
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@@ -11424,10 +11424,10 @@
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@@ -11454,10 +11454,10 @@
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@@ -11480,10 +11480,10 @@
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@@ -11510,10 +11510,10 @@
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@@ -11536,10 +11536,10 @@
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@@ -11566,10 +11566,10 @@
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@@ -11592,10 +11592,10 @@
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@@ -11622,10 +11622,10 @@
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@@ -11648,10 +11648,10 @@
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@@ -11678,10 +11678,10 @@
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@@ -11704,10 +11704,10 @@
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@@ -11734,10 +11734,10 @@
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@@ -11760,10 +11760,10 @@
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@@ -11790,10 +11790,10 @@
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@@ -11816,10 +11816,10 @@
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@@ -11846,10 +11846,10 @@
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@@ -11872,10 +11872,10 @@
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@@ -11902,10 +11902,10 @@
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@@ -11928,10 +11928,10 @@
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@@ -11958,10 +11958,10 @@
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@@ -11984,10 +11984,10 @@
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@@ -12014,10 +12014,10 @@
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@@ -12040,10 +12040,10 @@
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diff --git a/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_1_hl7_translation.fhir b/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_1_hl7_translation.fhir
index fade85488..e20136d22 100644
--- a/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_1_hl7_translation.fhir
+++ b/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
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@@ -233,11 +233,11 @@
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@@ -259,17 +259,17 @@
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@@ -289,10 +289,10 @@
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@@ -380,7 +380,7 @@
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@@ -466,10 +466,10 @@
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@@ -491,16 +491,16 @@
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@@ -512,10 +512,10 @@
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@@ -523,7 +523,7 @@
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@@ -573,10 +573,10 @@
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@@ -617,7 +617,7 @@
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@@ -665,10 +665,10 @@
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@@ -709,7 +709,7 @@
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@@ -757,10 +757,10 @@
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@@ -801,7 +801,7 @@
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@@ -849,10 +849,10 @@
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@@ -893,7 +893,7 @@
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@@ -941,10 +941,10 @@
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@@ -985,7 +985,7 @@
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@@ -1033,10 +1033,10 @@
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@@ -1077,7 +1077,7 @@
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@@ -1107,10 +1107,10 @@
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@@ -1151,7 +1151,7 @@
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@@ -1180,10 +1180,10 @@
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@@ -1224,7 +1224,7 @@
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@@ -1254,10 +1254,10 @@
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@@ -1314,7 +1314,7 @@
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@@ -1347,10 +1347,10 @@
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@@ -1391,7 +1391,7 @@
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@@ -1429,10 +1429,10 @@
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@@ -1473,7 +1473,7 @@
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@@ -1521,10 +1521,10 @@
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@@ -1581,7 +1581,7 @@
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@@ -1614,10 +1614,10 @@
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@@ -1658,7 +1658,7 @@
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@@ -1706,10 +1706,10 @@
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@@ -1750,7 +1750,7 @@
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@@ -1798,10 +1798,10 @@
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@@ -2080,7 +2080,7 @@
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@@ -2113,10 +2113,10 @@
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@@ -2462,7 +2462,7 @@
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@@ -2560,7 +2560,7 @@
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@@ -2658,7 +2658,7 @@
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@@ -2756,7 +2756,7 @@
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@@ -2854,7 +2854,7 @@
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@@ -3050,7 +3050,7 @@
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@@ -3246,7 +3246,7 @@
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@@ -3344,7 +3344,7 @@
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@@ -3633,7 +3633,7 @@
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@@ -3671,10 +3671,10 @@
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@@ -3769,10 +3769,10 @@
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@@ -3813,7 +3813,7 @@
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@@ -3843,10 +3843,10 @@
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@@ -3887,7 +3887,7 @@
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@@ -3935,10 +3935,10 @@
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@@ -3979,7 +3979,7 @@
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@@ -4009,10 +4009,10 @@
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@@ -4069,7 +4069,7 @@
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@@ -4107,10 +4107,10 @@
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@@ -4167,7 +4167,7 @@
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@@ -4205,10 +4205,10 @@
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@@ -4265,7 +4265,7 @@
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@@ -4303,10 +4303,10 @@
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@@ -4363,7 +4363,7 @@
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@@ -4401,10 +4401,10 @@
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@@ -4461,7 +4461,7 @@
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@@ -4499,10 +4499,10 @@
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@@ -4559,7 +4559,7 @@
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@@ -4597,10 +4597,10 @@
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@@ -4657,7 +4657,7 @@
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@@ -4690,10 +4690,10 @@
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@@ -4750,7 +4750,7 @@
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@@ -4788,10 +4788,10 @@
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@@ -4848,7 +4848,7 @@
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@@ -4886,10 +4886,10 @@
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@@ -4946,7 +4946,7 @@
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@@ -4984,10 +4984,10 @@
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@@ -5044,7 +5044,7 @@
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@@ -5082,10 +5082,10 @@
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@@ -5142,7 +5142,7 @@
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@@ -5175,10 +5175,10 @@
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@@ -5235,7 +5235,7 @@
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@@ -5273,10 +5273,10 @@
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@@ -5333,7 +5333,7 @@
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@@ -5371,10 +5371,10 @@
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@@ -5464,10 +5464,10 @@
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@@ -6984,7 +6984,7 @@
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@@ -8746,7 +8746,7 @@
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@@ -8784,10 +8784,10 @@
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@@ -8950,10 +8950,10 @@
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@@ -9140,10 +9140,10 @@
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@@ -9274,7 +9274,7 @@
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@@ -9356,7 +9356,7 @@
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@@ -9404,10 +9404,10 @@
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@@ -9448,7 +9448,7 @@
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@@ -9478,10 +9478,10 @@
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@@ -9538,7 +9538,7 @@
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@@ -9576,10 +9576,10 @@
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@@ -9620,7 +9620,7 @@
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@@ -9668,10 +9668,10 @@
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@@ -9712,7 +9712,7 @@
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@@ -9742,10 +9742,10 @@
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@@ -9786,7 +9786,7 @@
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@@ -9821,10 +9821,10 @@
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@@ -9865,7 +9865,7 @@
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@@ -9913,10 +9913,10 @@
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@@ -9957,7 +9957,7 @@
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@@ -9987,10 +9987,10 @@
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@@ -10031,7 +10031,7 @@
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@@ -10079,10 +10079,10 @@
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@@ -10123,7 +10123,7 @@
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@@ -10153,10 +10153,10 @@
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@@ -10213,7 +10213,7 @@
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@@ -10251,10 +10251,10 @@
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@@ -10264,10 +10264,10 @@
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@@ -10277,10 +10277,10 @@
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@@ -10290,10 +10290,10 @@
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@@ -10303,10 +10303,10 @@
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@@ -10316,10 +10316,10 @@
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@@ -10329,10 +10329,10 @@
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@@ -10342,10 +10342,10 @@
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@@ -10355,10 +10355,10 @@
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@@ -10368,10 +10368,10 @@
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@@ -10381,10 +10381,10 @@
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@@ -10394,10 +10394,10 @@
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@@ -10407,10 +10407,10 @@
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@@ -10420,10 +10420,10 @@
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@@ -10433,10 +10433,10 @@
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@@ -10446,10 +10446,10 @@
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@@ -10459,10 +10459,10 @@
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@@ -10472,10 +10472,10 @@
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@@ -10485,10 +10485,10 @@
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@@ -10498,10 +10498,10 @@
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@@ -10511,10 +10511,10 @@
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@@ -10526,7 +10526,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Organization/1729353247707033000.fca0f4e3-0bbf-4567-a6e4-a3f4b08c179c"
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@@ -10559,7 +10559,7 @@
               {
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+                  "reference": "Practitioner/1729353247708135000.5a409c94-7fa8-44cc-83a5-954dae8c9dc5"
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@@ -10595,7 +10595,7 @@
               {
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@@ -10697,18 +10697,18 @@
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@@ -10744,10 +10744,10 @@
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@@ -10805,23 +10805,23 @@
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@@ -10841,10 +10841,10 @@
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@@ -10876,10 +10876,10 @@
       }
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@@ -10902,10 +10902,10 @@
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@@ -10921,7 +10921,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291295508978000.a63342cd-f5b0-4195-b70f-aee728eca0b7"
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@@ -10971,18 +10971,18 @@
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@@ -11009,10 +11009,10 @@
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@@ -11035,10 +11035,10 @@
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@@ -11054,7 +11054,7 @@
               {
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                 "valueReference": {
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@@ -11104,18 +11104,18 @@
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@@ -11142,10 +11142,10 @@
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@@ -11168,10 +11168,10 @@
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@@ -11187,7 +11187,7 @@
               {
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                 "valueReference": {
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@@ -11237,18 +11237,18 @@
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@@ -11275,10 +11275,10 @@
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@@ -11301,10 +11301,10 @@
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@@ -11320,7 +11320,7 @@
               {
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                 "valueReference": {
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@@ -11370,18 +11370,18 @@
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@@ -11408,10 +11408,10 @@
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         "extension": [
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@@ -11434,10 +11434,10 @@
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@@ -11453,7 +11453,7 @@
               {
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@@ -11503,18 +11503,18 @@
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@@ -11541,10 +11541,10 @@
       }
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@@ -11567,10 +11567,10 @@
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@@ -11586,7 +11586,7 @@
               {
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                 "valueReference": {
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@@ -11636,18 +11636,18 @@
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@@ -11674,10 +11674,10 @@
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@@ -11700,10 +11700,10 @@
       }
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@@ -11719,7 +11719,7 @@
               {
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                 "valueReference": {
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@@ -11769,18 +11769,18 @@
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@@ -11807,10 +11807,10 @@
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@@ -11833,10 +11833,10 @@
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@@ -11852,7 +11852,7 @@
               {
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                 "valueReference": {
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@@ -11902,18 +11902,18 @@
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@@ -11940,10 +11940,10 @@
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@@ -11966,10 +11966,10 @@
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@@ -11985,7 +11985,7 @@
               {
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                 "valueReference": {
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@@ -12035,18 +12035,18 @@
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@@ -12073,10 +12073,10 @@
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@@ -12099,10 +12099,10 @@
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@@ -12118,7 +12118,7 @@
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@@ -12168,18 +12168,18 @@
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@@ -12206,10 +12206,10 @@
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@@ -12232,10 +12232,10 @@
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@@ -12251,7 +12251,7 @@
               {
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                 "valueReference": {
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@@ -12301,18 +12301,18 @@
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@@ -12339,10 +12339,10 @@
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@@ -12365,10 +12365,10 @@
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@@ -12384,7 +12384,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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@@ -12434,18 +12434,18 @@
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@@ -12472,10 +12472,10 @@
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@@ -12498,10 +12498,10 @@
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@@ -12517,7 +12517,7 @@
               {
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                 "valueReference": {
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@@ -12567,18 +12567,18 @@
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@@ -12605,10 +12605,10 @@
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@@ -12631,10 +12631,10 @@
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@@ -12650,7 +12650,7 @@
               {
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                 "valueReference": {
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@@ -12700,18 +12700,18 @@
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@@ -12738,10 +12738,10 @@
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@@ -12764,10 +12764,10 @@
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@@ -12783,7 +12783,7 @@
               {
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                 "valueReference": {
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@@ -12833,18 +12833,18 @@
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@@ -12871,10 +12871,10 @@
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@@ -12897,10 +12897,10 @@
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@@ -12916,7 +12916,7 @@
               {
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@@ -12966,18 +12966,18 @@
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@@ -13004,10 +13004,10 @@
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@@ -13030,10 +13030,10 @@
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@@ -13049,7 +13049,7 @@
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@@ -13320,7 +13320,7 @@
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@@ -13439,10 +13439,10 @@
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@@ -13517,7 +13517,7 @@
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@@ -13558,16 +13558,16 @@
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@@ -13639,39 +13639,39 @@
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@@ -13743,48 +13743,48 @@
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@@ -13815,7 +13815,7 @@
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@@ -13937,75 +13937,75 @@
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-      "fullUrl": "DiagnosticReport/1729291295632237000.e4031dbf-75f9-4355-bc2d-ae271c594726",
+      "fullUrl": "DiagnosticReport/1729353247816011000.d7e1781b-d787-426c-b0ac-c5acec228a46",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729291295632237000.e4031dbf-75f9-4355-bc2d-ae271c594726",
+        "id": "1729353247816011000.d7e1781b-d787-426c-b0ac-c5acec228a46",
         "identifier": [
           {
             "extension": [
@@ -15224,7 +15224,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291295591674000.731b02ba-8300-4c51-9f28-c293bf3e5a37"
+            "reference": "ServiceRequest/1729353247779110000.1e8467b4-1dce-4eda-99cf-999a71fc1194"
           }
         ],
         "status": "final",
@@ -15243,7 +15243,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf"
+          "reference": "Patient/1729353247556007000.33341055-6ce5-4612-9444-9f3b5e08d6f7"
         },
         "effectiveDateTime": "2024-07-17T12:28:00Z",
         "_effectiveDateTime": {
@@ -15265,27 +15265,27 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291295489432000.4c5aba00-3ae3-458d-ab7c-051e28ac9923"
+            "reference": "Specimen/1729353247702203000.9dc006d7-8e32-429f-8e08-3bc0067ed3fc"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729291295471836000.67bf5e1c-4097-41b3-bafc-0eb224265d97"
+            "reference": "Observation/1729353247686281000.ea64ba6d-422d-4d49-b0cc-de66a1d3b946"
           },
           {
-            "reference": "Observation/1729291295473039000.3e38e192-72c1-414a-b2a8-0218fa787c00"
+            "reference": "Observation/1729353247687357000.b84c60dc-4746-4aec-b26c-865040ee5062"
           },
           {
-            "reference": "Observation/1729291295474097000.12a74700-76ef-445d-9d3d-b5041e441209"
+            "reference": "Observation/1729353247688314000.528c8fec-4552-4558-8be4-925f44d012bd"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729291295635009000.fd242864-d2b3-4610-8a96-bdf46067a3ca",
+      "fullUrl": "DiagnosticReport/1729353247817342000.097cebbc-d340-4420-bc48-88e92f692853",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729291295635009000.fd242864-d2b3-4610-8a96-bdf46067a3ca",
+        "id": "1729353247817342000.097cebbc-d340-4420-bc48-88e92f692853",
         "identifier": [
           {
             "extension": [
@@ -15316,7 +15316,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291295596127000.a7216c88-0a78-467f-8eb3-ca8ca24fe982"
+            "reference": "ServiceRequest/1729353247783121000.c9318a7a-17a8-4a25-b7c7-c918a92de08e"
           }
         ],
         "status": "final",
@@ -15340,7 +15340,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf"
+          "reference": "Patient/1729353247556007000.33341055-6ce5-4612-9444-9f3b5e08d6f7"
         },
         "effectiveDateTime": "2024-07-17T12:28:00Z",
         "_effectiveDateTime": {
@@ -15362,24 +15362,24 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291295489815000.0370cf6e-836b-4bb2-a0a2-0d64f2e0a6a3"
+            "reference": "Specimen/1729353247702540000.81978269-6620-4804-b5db-ad7247839490"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729291295475278000.407afb37-39ec-400f-b6a2-40422f4ce0f6"
+            "reference": "Observation/1729353247689379000.4924e234-3b32-4cab-86f7-044ad7d8e0bb"
           },
           {
-            "reference": "Observation/1729291295476328000.e4ef28b1-0f1d-4fe5-93c4-242ec094e7a2"
+            "reference": "Observation/1729353247690355000.db2258ff-9ad6-48f8-bfc3-280de1eaaab4"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729291295637863000.850a5878-c7fd-4b0d-9cb1-12098c317dd4",
+      "fullUrl": "DiagnosticReport/1729353247818685000.84992dd1-25c0-4c1e-9adb-0e7f526c5008",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729291295637863000.850a5878-c7fd-4b0d-9cb1-12098c317dd4",
+        "id": "1729353247818685000.84992dd1-25c0-4c1e-9adb-0e7f526c5008",
         "identifier": [
           {
             "extension": [
@@ -15410,7 +15410,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291295600584000.2340cce5-3422-48fc-9e73-1ff06e437756"
+            "reference": "ServiceRequest/1729353247787159000.033d99ba-ac9a-4e63-961e-ba37d0dbac05"
           }
         ],
         "status": "final",
@@ -15434,7 +15434,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf"
+          "reference": "Patient/1729353247556007000.33341055-6ce5-4612-9444-9f3b5e08d6f7"
         },
         "effectiveDateTime": "2024-07-17T12:28:00Z",
         "_effectiveDateTime": {
@@ -15456,12 +15456,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291295490210000.56b183e3-5b61-4de5-ad73-84d15c8a55c3"
+            "reference": "Specimen/1729353247702875000.080f5738-44d5-4c2f-b93d-aaf946bf04ce"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729291295477503000.1a0211e0-1e7e-45d4-aedb-fcbf6f2610a5"
+            "reference": "Observation/1729353247691407000.2b9cdec6-637a-4778-90f6-979b2bff3246"
           }
         ]
       }
diff --git a/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_2_fhir_transformation.fhir b/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_2_fhir_transformation.fhir
index 9c08d7231..4a5c92e0a 100644
--- a/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_2_fhir_transformation.fhir
+++ b/examples/CA/012_CA_ORU_R01_CDPH_produced_from_UCSD_order_189417053_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729291295299574000.a2c1571d-8ca1-4a1b-aa63-134ee2bfdce1",
+  "id": "1729353247542400000.ade43c8c-da27-4b06-b782-0b1d27297e9f",
   "meta": {
-    "lastUpdated": "2024-10-18T15:41:35.299-07:00"
+    "lastUpdated": "2024-10-19T08:54:07.542-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-07-22T01:02:05.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729291295302140000.d2861530-097d-414a-983a-7f0443ca3fec",
+      "fullUrl": "MessageHeader/1729353247544498000.2c3c663c-8e03-4f27-95ed-0ac3359c5f82",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729291295302140000.d2861530-097d-414a-983a-7f0443ca3fec",
+        "id": "1729353247544498000.2c3c663c-8e03-4f27-95ed-0ac3359c5f82",
         "meta": {
           "tag": [
             {
@@ -55,12 +55,12 @@
             ],
             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1729291295301945000.5ed62576-5ece-47b7-bfce-cd29b7b71499"
+              "reference": "Organization/1729353247544274000.726cbaad-6004-47b7-acda-87c1459322f0"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729291295301181000.5fbf4ba9-afb0-431e-bc42-d5e3bd798c06"
+          "reference": "Organization/1729353247543413000.5e1e16f2-131c-42dd-9896-960c29890f22"
         },
         "source": {
           "extension": [
@@ -86,10 +86,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291295301181000.5fbf4ba9-afb0-431e-bc42-d5e3bd798c06",
+      "fullUrl": "Organization/1729353247543413000.5e1e16f2-131c-42dd-9896-960c29890f22",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291295301181000.5fbf4ba9-afb0-431e-bc42-d5e3bd798c06",
+        "id": "1729353247543413000.5e1e16f2-131c-42dd-9896-960c29890f22",
         "identifier": [
           {
             "extension": [
@@ -104,10 +104,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291295301945000.5ed62576-5ece-47b7-bfce-cd29b7b71499",
+      "fullUrl": "Organization/1729353247544274000.726cbaad-6004-47b7-acda-87c1459322f0",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291295301945000.5ed62576-5ece-47b7-bfce-cd29b7b71499",
+        "id": "1729353247544274000.726cbaad-6004-47b7-acda-87c1459322f0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -128,73 +128,73 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729291295304544000.5dfda4f2-3e74-4648-bb87-def9ccbb033b",
+      "fullUrl": "Provenance/1729353247546378000.b550b3fe-304d-4d6d-9255-09e864f6c015",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729291295304544000.5dfda4f2-3e74-4648-bb87-def9ccbb033b",
+        "id": "1729353247546378000.b550b3fe-304d-4d6d-9255-09e864f6c015",
         "target": [
           {
-            "reference": "MessageHeader/1729291295302140000.d2861530-097d-414a-983a-7f0443ca3fec"
+            "reference": "MessageHeader/1729353247544498000.2c3c663c-8e03-4f27-95ed-0ac3359c5f82"
           },
           {
-            "reference": "DiagnosticReport/1729291295604198000.09ec9c93-c4d0-41ed-a4e2-f22fd9f820b0"
+            "reference": "DiagnosticReport/1729353247790326000.a92ece03-d50b-4a38-843f-589b207be2f0"
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           {
-            "reference": "DiagnosticReport/1729291295605925000.cef3cb42-aa2e-4cb0-bd09-818554e9fa0f"
+            "reference": "DiagnosticReport/1729353247791890000.03261a60-09e2-49d9-91b2-99cfe30da9cf"
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-            "reference": "DiagnosticReport/1729291295607769000.5ac12326-2d6c-4b50-b947-e3529f1559fd"
+            "reference": "DiagnosticReport/1729353247793643000.5f82676f-b185-4d03-8763-fff1093c412e"
           },
           {
-            "reference": "DiagnosticReport/1729291295609237000.a6d1b4c2-261c-4fd3-b065-242c7662863b"
+            "reference": "DiagnosticReport/1729353247795299000.968b9eb9-72e8-4e3f-8fdd-e106de86fcb4"
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-            "reference": "DiagnosticReport/1729291295611327000.2b5b9f2b-5c61-4c7d-8994-ab9ddb7ef945"
+            "reference": "DiagnosticReport/1729353247797428000.d2135272-cbca-4b61-b47d-ef92474d93c6"
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           {
-            "reference": "DiagnosticReport/1729291295612862000.c2c0abf4-a1c1-4eb0-93c6-a947818770b6"
+            "reference": "DiagnosticReport/1729353247798829000.3898d8bb-b99d-4b44-93eb-bd11effd81cb"
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-            "reference": "DiagnosticReport/1729291295615184000.27e12d15-1fd4-45e9-83ba-a546737cf90c"
+            "reference": "DiagnosticReport/1729353247800832000.98042912-01b3-429e-bb8f-a3a4b5b19c12"
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           {
-            "reference": "DiagnosticReport/1729291295616953000.4cc4e97e-eb3b-45e2-a1d5-8feab4a4fc05"
+            "reference": "DiagnosticReport/1729353247802372000.da6277ef-9589-466c-b7c7-320bfa8ec30a"
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           {
-            "reference": "DiagnosticReport/1729291295618494000.f29249de-1334-45a3-9a31-ae7fe6ba6c85"
+            "reference": "DiagnosticReport/1729353247803797000.5bccbab3-03bf-4b56-b357-b86fdb649a3e"
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-            "reference": "DiagnosticReport/1729291295620036000.34956397-3f7b-4003-a779-737989831100"
+            "reference": "DiagnosticReport/1729353247805224000.715f3aac-1771-4c85-be55-549eacc2d21f"
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-            "reference": "DiagnosticReport/1729291295621563000.1d424ad4-820a-4d4e-b126-f03e5bebbc7f"
+            "reference": "DiagnosticReport/1729353247806638000.d50476da-a18c-48c6-8e2c-32c1fce474df"
           },
           {
-            "reference": "DiagnosticReport/1729291295623087000.49857adb-fc9a-4320-9890-32be1492f1a5"
+            "reference": "DiagnosticReport/1729353247807986000.712f1ffb-497d-483c-831b-cea199f6563f"
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           {
-            "reference": "DiagnosticReport/1729291295624579000.6769fc61-08a7-4ee2-9462-b6ddd5aa0c47"
+            "reference": "DiagnosticReport/1729353247809321000.e1516ee8-c1b7-4e0d-a26a-36c767dd574f"
           },
           {
-            "reference": "DiagnosticReport/1729291295626106000.b3d89cab-24d4-4950-8c98-82f9efd1687a"
+            "reference": "DiagnosticReport/1729353247810695000.a4051246-897f-4ca6-bd29-909165be8103"
           },
           {
-            "reference": "DiagnosticReport/1729291295627640000.6572e5bf-1b74-4397-990f-e7de6379d265"
+            "reference": "DiagnosticReport/1729353247812033000.b4d2b8fd-5e58-4f05-8c2f-1785c0641f2d"
           },
           {
-            "reference": "DiagnosticReport/1729291295629177000.a15d563a-f686-437b-832c-b31a1a7294f0"
+            "reference": "DiagnosticReport/1729353247813352000.3131efb9-4687-4586-81af-d8cfd3cd5a00"
           },
           {
-            "reference": "DiagnosticReport/1729291295630709000.7bd76dd8-3d8b-4fc1-975f-ebc5a8e350ad"
+            "reference": "DiagnosticReport/1729353247814671000.0fa002c2-342d-42e7-82af-96ad4ed44d3d"
           },
           {
-            "reference": "DiagnosticReport/1729291295632237000.e4031dbf-75f9-4355-bc2d-ae271c594726"
+            "reference": "DiagnosticReport/1729353247816011000.d7e1781b-d787-426c-b0ac-c5acec228a46"
           },
           {
-            "reference": "DiagnosticReport/1729291295635009000.fd242864-d2b3-4610-8a96-bdf46067a3ca"
+            "reference": "DiagnosticReport/1729353247817342000.097cebbc-d340-4420-bc48-88e92f692853"
           },
           {
-            "reference": "DiagnosticReport/1729291295637863000.850a5878-c7fd-4b0d-9cb1-12098c317dd4"
+            "reference": "DiagnosticReport/1729353247818685000.84992dd1-25c0-4c1e-9adb-0e7f526c5008"
           }
         ],
         "recorded": "2024-07-22T01:02:05Z",
@@ -216,17 +216,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729291295304349000.fcf6e34e-cb7d-4d92-b636-085ca210f66b"
+              "reference": "Organization/1729353247546130000.2ed23384-2be9-4f8a-9b4e-7a88b6971b31"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729291295304349000.fcf6e34e-cb7d-4d92-b636-085ca210f66b",
+      "fullUrl": "Organization/1729353247546130000.2ed23384-2be9-4f8a-9b4e-7a88b6971b31",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291295304349000.fcf6e34e-cb7d-4d92-b636-085ca210f66b",
+        "id": "1729353247546130000.2ed23384-2be9-4f8a-9b4e-7a88b6971b31",
         "identifier": [
           {
             "extension": [
@@ -241,11 +241,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729291295305403000.268a5701-4d61-473a-9b8d-4ad9781b7fb0",
+      "fullUrl": "Provenance/1729353247547480000.9ed7952e-70e6-4253-a90d-2033560c08a6",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729291295305403000.268a5701-4d61-473a-9b8d-4ad9781b7fb0",
-        "recorded": "2024-10-18T15:41:35Z",
+        "id": "1729353247547480000.9ed7952e-70e6-4253-a90d-2033560c08a6",
+        "recorded": "2024-10-19T08:54:07Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -267,17 +267,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729291295305253000.c2e7d744-2e7a-4b83-a361-79d309134d26"
+              "reference": "Organization/1729353247547283000.899f2323-5552-4c0a-804e-344e44beaf91"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729291295305253000.c2e7d744-2e7a-4b83-a361-79d309134d26",
+      "fullUrl": "Organization/1729353247547283000.899f2323-5552-4c0a-804e-344e44beaf91",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291295305253000.c2e7d744-2e7a-4b83-a361-79d309134d26",
+        "id": "1729353247547283000.899f2323-5552-4c0a-804e-344e44beaf91",
         "identifier": [
           {
             "value": "CDC PRIME - Atlanta"
@@ -297,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf",
+      "fullUrl": "Patient/1729353247556007000.33341055-6ce5-4612-9444-9f3b5e08d6f7",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729291295311920000.4dc6d45a-c954-4334-9c1d-7d0f00eb2ddf",
+        "id": "1729353247556007000.33341055-6ce5-4612-9444-9f3b5e08d6f7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -387,7 +387,7 @@
             },
             "value": "80008766",
             "assigner": {
-              "reference": "Organization/1729291295306247000.fd765a5a-f50d-46e3-b09f-7740b21ba4d0"
+              "reference": "Organization/1729353247548859000.07d19723-fe64-4ac6-972f-d9097feccf13"
             }
           }
         ],
@@ -472,10 +472,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291295306247000.fd765a5a-f50d-46e3-b09f-7740b21ba4d0",
+      "fullUrl": "Organization/1729353247548859000.07d19723-fe64-4ac6-972f-d9097feccf13",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291295306247000.fd765a5a-f50d-46e3-b09f-7740b21ba4d0",
+        "id": "1729353247548859000.07d19723-fe64-4ac6-972f-d9097feccf13",
         "identifier": [
           {
             "extension": [
@@ -496,16 +496,16 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729291295312529000.a31d87a5-ad0b-45c2-af0b-e605ea2e474c",
+      "fullUrl": "Provenance/1729353247556680000.c1d468f6-0bf4-4153-9302-eb4a447a8ba1",
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@@ -1038,10 +1038,10 @@
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@@ -1156,7 +1156,7 @@
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@@ -1185,10 +1185,10 @@
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@@ -1229,7 +1229,7 @@
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@@ -1319,7 +1319,7 @@
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@@ -1352,10 +1352,10 @@
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@@ -1396,7 +1396,7 @@
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@@ -1478,7 +1478,7 @@
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@@ -1586,7 +1586,7 @@
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@@ -1663,7 +1663,7 @@
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@@ -1711,10 +1711,10 @@
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@@ -1755,7 +1755,7 @@
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@@ -1847,7 +1847,7 @@
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@@ -1877,10 +1877,10 @@
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@@ -1921,7 +1921,7 @@
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@@ -2011,7 +2011,7 @@
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@@ -2044,10 +2044,10 @@
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@@ -2104,7 +2104,7 @@
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@@ -3373,7 +3373,7 @@
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@@ -3466,7 +3466,7 @@
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@@ -3564,7 +3564,7 @@
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@@ -4000,7 +4000,7 @@
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@@ -4038,10 +4038,10 @@
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@@ -4136,10 +4136,10 @@
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@@ -4234,10 +4234,10 @@
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@@ -4294,7 +4294,7 @@
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@@ -4332,10 +4332,10 @@
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@@ -4392,7 +4392,7 @@
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@@ -4430,10 +4430,10 @@
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@@ -4490,7 +4490,7 @@
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@@ -4528,10 +4528,10 @@
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@@ -4588,7 +4588,7 @@
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@@ -4621,10 +4621,10 @@
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@@ -4681,7 +4681,7 @@
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@@ -4719,10 +4719,10 @@
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@@ -4779,7 +4779,7 @@
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@@ -4817,10 +4817,10 @@
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@@ -4877,7 +4877,7 @@
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@@ -4915,10 +4915,10 @@
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@@ -4975,7 +4975,7 @@
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@@ -5013,10 +5013,10 @@
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@@ -5073,7 +5073,7 @@
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@@ -5106,10 +5106,10 @@
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@@ -5166,7 +5166,7 @@
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@@ -5204,10 +5204,10 @@
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@@ -5264,7 +5264,7 @@
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@@ -5302,10 +5302,10 @@
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@@ -5362,7 +5362,7 @@
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@@ -5395,10 +5395,10 @@
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@@ -5455,7 +5455,7 @@
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@@ -5488,10 +5488,10 @@
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@@ -5548,7 +5548,7 @@
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@@ -5586,10 +5586,10 @@
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@@ -5646,7 +5646,7 @@
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@@ -5684,10 +5684,10 @@
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@@ -5744,7 +5744,7 @@
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@@ -5782,10 +5782,10 @@
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@@ -5842,7 +5842,7 @@
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@@ -5880,10 +5880,10 @@
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@@ -8377,7 +8377,7 @@
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@@ -8425,10 +8425,10 @@
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@@ -8677,7 +8677,7 @@
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@@ -8941,7 +8941,7 @@
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@@ -9115,7 +9115,7 @@
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@@ -9409,10 +9409,10 @@
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@@ -9469,7 +9469,7 @@
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@@ -9507,10 +9507,10 @@
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@@ -9551,7 +9551,7 @@
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@@ -9599,10 +9599,10 @@
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@@ -9643,7 +9643,7 @@
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@@ -9673,10 +9673,10 @@
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@@ -9731,7 +9731,7 @@
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@@ -9766,10 +9766,10 @@
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@@ -9810,7 +9810,7 @@
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@@ -9858,10 +9858,10 @@
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@@ -9902,7 +9902,7 @@
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@@ -9932,10 +9932,10 @@
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@@ -9991,7 +9991,7 @@
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@@ -10039,10 +10039,10 @@
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@@ -10098,7 +10098,7 @@
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@@ -10128,10 +10128,10 @@
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@@ -10188,7 +10188,7 @@
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@@ -10226,10 +10226,10 @@
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@@ -10239,10 +10239,10 @@
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@@ -10252,10 +10252,10 @@
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@@ -10265,10 +10265,10 @@
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@@ -10278,10 +10278,10 @@
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@@ -10291,10 +10291,10 @@
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@@ -10304,10 +10304,10 @@
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@@ -10317,10 +10317,10 @@
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@@ -10330,10 +10330,10 @@
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@@ -10343,10 +10343,10 @@
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@@ -10356,10 +10356,10 @@
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@@ -10369,10 +10369,10 @@
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@@ -10382,10 +10382,10 @@
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@@ -10395,10 +10395,10 @@
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@@ -10408,10 +10408,10 @@
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@@ -10421,10 +10421,10 @@
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@@ -10434,10 +10434,10 @@
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@@ -10447,10 +10447,10 @@
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@@ -10460,10 +10460,10 @@
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@@ -10473,10 +10473,10 @@
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@@ -10486,10 +10486,10 @@
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@@ -10501,7 +10501,7 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291295495404000.36452c71-0816-473a-9a5e-d12054333346"
+                  "reference": "Organization/1729353247707033000.fca0f4e3-0bbf-4567-a6e4-a3f4b08c179c"
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@@ -10534,7 +10534,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729291295498107000.029a72fd-a253-493b-8fe1-efc3042c1067"
+                  "reference": "Practitioner/1729353247708135000.5a409c94-7fa8-44cc-83a5-954dae8c9dc5"
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@@ -10570,7 +10570,7 @@
               {
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+                  "reference": "Practitioner/1729353247704131000.12bfd11f-8743-4282-b1be-7ef40dbf45d4"
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@@ -10676,18 +10676,18 @@
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@@ -10723,10 +10723,10 @@
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         "extension": [
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@@ -10784,23 +10784,23 @@
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     {
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         "extension": [
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@@ -10820,10 +10820,10 @@
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@@ -10855,10 +10855,10 @@
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@@ -10881,10 +10881,10 @@
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@@ -10911,10 +10911,10 @@
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@@ -10937,10 +10937,10 @@
       }
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@@ -10967,10 +10967,10 @@
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@@ -10993,10 +10993,10 @@
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@@ -11023,10 +11023,10 @@
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@@ -11049,10 +11049,10 @@
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@@ -11079,10 +11079,10 @@
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@@ -11105,10 +11105,10 @@
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@@ -11135,10 +11135,10 @@
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@@ -11161,10 +11161,10 @@
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@@ -11191,10 +11191,10 @@
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@@ -11217,10 +11217,10 @@
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@@ -11247,10 +11247,10 @@
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@@ -11273,10 +11273,10 @@
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@@ -11303,10 +11303,10 @@
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@@ -11329,10 +11329,10 @@
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@@ -11359,10 +11359,10 @@
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diff --git a/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_1_hl7_translation.fhir b/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_1_hl7_translation.fhir
index 6de8cf898..389f88452 100644
--- a/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_1_hl7_translation.fhir
+++ b/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729292473762840000.6a08be9a-72cb-4fd5-b005-065ec4c7366f",
+  "id": "1729354451718918000.6d8b4b7b-b2d7-4bfe-aa16-15b9d5f9ba3f",
   "meta": {
-    "lastUpdated": "2024-10-18T16:01:13.763-07:00"
+    "lastUpdated": "2024-10-19T09:14:11.718-07:00"
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     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-07-22T02:17:21.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729292473773890000.8d49428f-6963-4991-9abd-a148adecd18e",
+      "fullUrl": "MessageHeader/1729354451720570000.d11ffd7f-69f1-4846-b40d-d3e317ecf503",
       "resource": {
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-        "id": "1729292473773890000.8d49428f-6963-4991-9abd-a148adecd18e",
+        "id": "1729354451720570000.d11ffd7f-69f1-4846-b40d-d3e317ecf503",
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@@ -58,12 +58,12 @@
             ],
             "name": "SISHIERECEIVER",
             "receiver": {
-              "reference": "Organization/1729292473773794000.4c58f585-7a46-484b-9027-88a97fe0ca32"
+              "reference": "Organization/1729354451720362000.d32c07e8-5540-4d22-bc02-2656b3566519"
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         "sender": {
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+          "reference": "Organization/1729354451719656000.8014a144-0d8f-4a6e-95fc-1f22ee1445df"
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@@ -89,10 +89,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729354451719656000.8014a144-0d8f-4a6e-95fc-1f22ee1445df",
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@@ -107,10 +107,10 @@
       }
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+      "fullUrl": "Organization/1729354451720362000.d32c07e8-5540-4d22-bc02-2656b3566519",
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@@ -120,73 +120,73 @@
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@@ -208,17 +208,17 @@
               ]
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+              "reference": "Organization/1729354451721831000.cb4f6d33-96e3-42d7-bbb0-ecf7ac137ce9"
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@@ -233,11 +233,11 @@
       }
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+      "fullUrl": "Provenance/1729354451722751000.d88b913f-b289-428d-b6ff-a6a996af96b9",
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+        "id": "1729354451722751000.d88b913f-b289-428d-b6ff-a6a996af96b9",
+        "recorded": "2024-10-19T09:14:11Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
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@@ -259,17 +259,17 @@
               ]
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             "who": {
-              "reference": "Organization/1729292473788084000.4361372b-883e-4bf7-a05a-b24154cc3b09"
+              "reference": "Organization/1729354451722575000.e9072c37-79be-4018-b95b-9334f98696a2"
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-      "fullUrl": "Organization/1729292473788084000.4361372b-883e-4bf7-a05a-b24154cc3b09",
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@@ -289,10 +289,10 @@
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+      "fullUrl": "Patient/1729354451729481000.c73df7a1-4587-4d1d-b985-6aa4e788096c",
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@@ -380,7 +380,7 @@
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             "value": "80008667",
             "assigner": {
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+              "reference": "Organization/1729354451723350000.b95f2692-eb74-48c6-97ce-2b2f222bb1ab"
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@@ -466,10 +466,10 @@
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@@ -491,16 +491,16 @@
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-        "recorded": "2024-10-18T16:01:13Z",
+        "recorded": "2024-10-19T09:14:11Z",
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@@ -512,10 +512,10 @@
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+      "fullUrl": "RelatedPerson/1729354451730798000.6bd6817d-b90c-4f49-88f0-44a95f7b3f06",
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+        "id": "1729354451730798000.6bd6817d-b90c-4f49-88f0-44a95f7b3f06",
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@@ -523,7 +523,7 @@
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         "patient": {
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+          "reference": "Patient/1729354451729481000.c73df7a1-4587-4d1d-b985-6aa4e788096c"
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@@ -573,10 +573,10 @@
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+        "id": "1729354451733557000.c1466a19-e719-454c-bed8-fd28c83f581a",
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@@ -617,7 +617,7 @@
           ]
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@@ -665,10 +665,10 @@
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@@ -709,7 +709,7 @@
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@@ -757,10 +757,10 @@
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@@ -801,7 +801,7 @@
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@@ -849,10 +849,10 @@
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@@ -893,7 +893,7 @@
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@@ -9865,7 +9865,7 @@
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@@ -9913,10 +9913,10 @@
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@@ -9957,7 +9957,7 @@
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@@ -9987,10 +9987,10 @@
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@@ -10031,7 +10031,7 @@
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@@ -10079,10 +10079,10 @@
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@@ -10123,7 +10123,7 @@
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@@ -10153,10 +10153,10 @@
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@@ -10213,7 +10213,7 @@
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@@ -10251,10 +10251,10 @@
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@@ -10264,10 +10264,10 @@
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@@ -10277,10 +10277,10 @@
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@@ -10290,10 +10290,10 @@
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@@ -10303,10 +10303,10 @@
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@@ -10316,10 +10316,10 @@
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@@ -10329,10 +10329,10 @@
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@@ -10342,10 +10342,10 @@
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@@ -10355,10 +10355,10 @@
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@@ -10368,10 +10368,10 @@
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@@ -10381,10 +10381,10 @@
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@@ -10394,10 +10394,10 @@
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@@ -10407,10 +10407,10 @@
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@@ -10420,10 +10420,10 @@
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@@ -10433,10 +10433,10 @@
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@@ -10446,10 +10446,10 @@
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@@ -10459,10 +10459,10 @@
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@@ -10472,10 +10472,10 @@
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@@ -10485,10 +10485,10 @@
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@@ -10498,10 +10498,10 @@
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@@ -10511,10 +10511,10 @@
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@@ -10526,7 +10526,7 @@
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@@ -10559,7 +10559,7 @@
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@@ -10595,7 +10595,7 @@
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@@ -10697,18 +10697,18 @@
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@@ -10744,10 +10744,10 @@
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         "extension": [
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@@ -10805,23 +10805,23 @@
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@@ -10841,10 +10841,10 @@
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@@ -10876,10 +10876,10 @@
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@@ -10902,10 +10902,10 @@
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@@ -10921,7 +10921,7 @@
               {
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                 "valueReference": {
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@@ -10971,18 +10971,18 @@
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@@ -11009,10 +11009,10 @@
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@@ -11035,10 +11035,10 @@
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@@ -11054,7 +11054,7 @@
               {
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@@ -11104,18 +11104,18 @@
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@@ -11142,10 +11142,10 @@
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@@ -11168,10 +11168,10 @@
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@@ -11187,7 +11187,7 @@
               {
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@@ -11237,18 +11237,18 @@
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@@ -11275,10 +11275,10 @@
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@@ -11301,10 +11301,10 @@
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@@ -11320,7 +11320,7 @@
               {
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@@ -11370,18 +11370,18 @@
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@@ -11408,10 +11408,10 @@
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@@ -11434,10 +11434,10 @@
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@@ -11453,7 +11453,7 @@
               {
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@@ -11503,18 +11503,18 @@
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@@ -11541,10 +11541,10 @@
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@@ -11567,10 +11567,10 @@
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@@ -11586,7 +11586,7 @@
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@@ -11636,18 +11636,18 @@
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@@ -11674,10 +11674,10 @@
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         "extension": [
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@@ -11700,10 +11700,10 @@
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@@ -11719,7 +11719,7 @@
               {
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                 "valueReference": {
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@@ -11769,18 +11769,18 @@
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@@ -11807,10 +11807,10 @@
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@@ -11833,10 +11833,10 @@
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@@ -11852,7 +11852,7 @@
               {
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@@ -11902,18 +11902,18 @@
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@@ -11940,10 +11940,10 @@
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@@ -11966,10 +11966,10 @@
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@@ -11985,7 +11985,7 @@
               {
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                 "valueReference": {
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@@ -12035,18 +12035,18 @@
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@@ -12073,10 +12073,10 @@
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@@ -12099,10 +12099,10 @@
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@@ -12118,7 +12118,7 @@
               {
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                 "valueReference": {
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@@ -12168,18 +12168,18 @@
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@@ -12206,10 +12206,10 @@
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@@ -12232,10 +12232,10 @@
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@@ -12251,7 +12251,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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@@ -12301,18 +12301,18 @@
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@@ -12339,10 +12339,10 @@
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@@ -12365,10 +12365,10 @@
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@@ -12384,7 +12384,7 @@
               {
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@@ -12434,18 +12434,18 @@
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@@ -12472,10 +12472,10 @@
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@@ -12498,10 +12498,10 @@
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@@ -12517,7 +12517,7 @@
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@@ -12567,18 +12567,18 @@
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@@ -12605,10 +12605,10 @@
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@@ -12631,10 +12631,10 @@
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@@ -12650,7 +12650,7 @@
               {
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@@ -12700,18 +12700,18 @@
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@@ -12738,10 +12738,10 @@
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@@ -12764,10 +12764,10 @@
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@@ -12783,7 +12783,7 @@
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@@ -12833,18 +12833,18 @@
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@@ -12871,10 +12871,10 @@
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@@ -12897,10 +12897,10 @@
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@@ -12916,7 +12916,7 @@
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@@ -12966,18 +12966,18 @@
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@@ -13004,10 +13004,10 @@
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@@ -13030,10 +13030,10 @@
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@@ -13049,7 +13049,7 @@
               {
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@@ -13099,18 +13099,18 @@
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@@ -13137,10 +13137,10 @@
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@@ -13163,10 +13163,10 @@
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@@ -13182,7 +13182,7 @@
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@@ -13237,18 +13237,18 @@
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@@ -13275,10 +13275,10 @@
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@@ -13301,10 +13301,10 @@
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@@ -13320,7 +13320,7 @@
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@@ -13375,18 +13375,18 @@
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@@ -13413,10 +13413,10 @@
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@@ -13439,10 +13439,10 @@
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@@ -13517,7 +13517,7 @@
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@@ -13536,7 +13536,7 @@
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@@ -13558,16 +13558,16 @@
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@@ -14856,7 +14856,7 @@
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@@ -14875,7 +14875,7 @@
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@@ -14897,27 +14897,27 @@
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@@ -14948,7 +14948,7 @@
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@@ -14967,7 +14967,7 @@
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@@ -14989,27 +14989,27 @@
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@@ -15040,7 +15040,7 @@
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@@ -15059,7 +15059,7 @@
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@@ -15081,27 +15081,27 @@
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@@ -15132,7 +15132,7 @@
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@@ -15151,7 +15151,7 @@
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@@ -15173,27 +15173,27 @@
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@@ -15224,7 +15224,7 @@
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@@ -15243,7 +15243,7 @@
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@@ -15265,27 +15265,27 @@
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@@ -15316,7 +15316,7 @@
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@@ -15340,7 +15340,7 @@
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@@ -15362,24 +15362,24 @@
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@@ -15410,7 +15410,7 @@
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@@ -15434,7 +15434,7 @@
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@@ -15456,12 +15456,12 @@
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diff --git a/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_2_fhir_transformation.fhir b/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_2_fhir_transformation.fhir
index 660172880..e5fbad5ea 100644
--- a/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_2_fhir_transformation.fhir
+++ b/examples/CA/014_CA_ORU_R01_CDPH_produced_from_UCSD_order_189394505_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
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+    "lastUpdated": "2024-10-19T09:14:11.718-07:00"
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@@ -12,10 +12,10 @@
   "timestamp": "2024-07-22T02:17:21.000-07:00",
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@@ -55,12 +55,12 @@
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+              "reference": "Organization/1729354451720362000.d32c07e8-5540-4d22-bc02-2656b3566519"
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@@ -86,10 +86,10 @@
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@@ -104,10 +104,10 @@
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@@ -2011,7 +2011,7 @@
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@@ -10239,10 +10239,10 @@
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@@ -10252,10 +10252,10 @@
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@@ -10265,10 +10265,10 @@
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@@ -10278,10 +10278,10 @@
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@@ -10291,10 +10291,10 @@
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@@ -10304,10 +10304,10 @@
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@@ -10317,10 +10317,10 @@
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@@ -10330,10 +10330,10 @@
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@@ -10343,10 +10343,10 @@
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@@ -10356,10 +10356,10 @@
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@@ -10369,10 +10369,10 @@
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@@ -10382,10 +10382,10 @@
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@@ -10395,10 +10395,10 @@
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@@ -10408,10 +10408,10 @@
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@@ -10421,10 +10421,10 @@
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@@ -10434,10 +10434,10 @@
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@@ -10447,10 +10447,10 @@
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@@ -10460,10 +10460,10 @@
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@@ -10473,10 +10473,10 @@
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@@ -10486,10 +10486,10 @@
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@@ -10501,7 +10501,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Organization/1729354451879657000.d90f2726-de30-471a-b6ed-925be3dcd185"
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@@ -10534,7 +10534,7 @@
               {
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+                  "reference": "Practitioner/1729354451880669000.a924bb37-be9b-457a-88e8-dd4e8dc26125"
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@@ -10570,7 +10570,7 @@
               {
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+                  "reference": "Practitioner/1729354451876776000.fd54a9d1-5451-48c1-8212-5caf456f91e4"
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@@ -10676,18 +10676,18 @@
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@@ -10723,10 +10723,10 @@
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@@ -10784,23 +10784,23 @@
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@@ -10820,10 +10820,10 @@
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@@ -10855,10 +10855,10 @@
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@@ -10881,10 +10881,10 @@
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@@ -10911,10 +10911,10 @@
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@@ -11527,10 +11527,10 @@
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@@ -11583,10 +11583,10 @@
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@@ -11609,10 +11609,10 @@
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@@ -11639,10 +11639,10 @@
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@@ -11665,10 +11665,10 @@
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diff --git a/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_1_hl7_translation.fhir b/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_1_hl7_translation.fhir
index 2f01f2052..66f551577 100644
--- a/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_1_hl7_translation.fhir
+++ b/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
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@@ -89,10 +89,10 @@
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@@ -107,10 +107,10 @@
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@@ -208,17 +208,17 @@
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@@ -233,11 +233,11 @@
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@@ -289,10 +289,10 @@
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@@ -380,7 +380,7 @@
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@@ -473,16 +473,16 @@
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@@ -505,7 +505,7 @@
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@@ -635,10 +635,10 @@
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@@ -863,7 +863,7 @@
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@@ -955,7 +955,7 @@
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@@ -1003,10 +1003,10 @@
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@@ -1047,7 +1047,7 @@
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@@ -1077,10 +1077,10 @@
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@@ -1121,7 +1121,7 @@
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@@ -1150,10 +1150,10 @@
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@@ -1194,7 +1194,7 @@
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@@ -1224,10 +1224,10 @@
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@@ -1284,7 +1284,7 @@
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@@ -1317,10 +1317,10 @@
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@@ -1361,7 +1361,7 @@
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@@ -1409,10 +1409,10 @@
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@@ -1469,7 +1469,7 @@
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@@ -1502,10 +1502,10 @@
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@@ -1546,7 +1546,7 @@
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@@ -1594,10 +1594,10 @@
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@@ -1638,7 +1638,7 @@
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@@ -2061,7 +2061,7 @@
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@@ -2448,7 +2448,7 @@
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@@ -2546,7 +2546,7 @@
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@@ -2644,7 +2644,7 @@
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@@ -2840,7 +2840,7 @@
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@@ -2938,7 +2938,7 @@
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@@ -3036,7 +3036,7 @@
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@@ -4736,7 +4736,7 @@
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@@ -4834,7 +4834,7 @@
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@@ -4932,7 +4932,7 @@
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@@ -10269,10 +10269,10 @@
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@@ -10282,10 +10282,10 @@
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@@ -10295,10 +10295,10 @@
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@@ -10308,10 +10308,10 @@
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@@ -10321,10 +10321,10 @@
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@@ -10334,10 +10334,10 @@
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@@ -10347,10 +10347,10 @@
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@@ -10360,10 +10360,10 @@
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@@ -10373,10 +10373,10 @@
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@@ -10386,10 +10386,10 @@
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@@ -10399,10 +10399,10 @@
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@@ -10414,7 +10414,7 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292585942660000.37cc1e01-3296-47a1-9bef-66784bc0eba5"
+                  "reference": "Organization/1729354566029198000.92616284-e84c-47b2-a000-464a91cce319"
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@@ -10447,7 +10447,7 @@
               {
                 "url": "orc-12-ordering-provider",
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-                  "reference": "Practitioner/1729292585943846000.12f1b156-5788-4fc0-8fb3-0b0d03f53b4f"
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@@ -10483,7 +10483,7 @@
               {
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+                  "reference": "Practitioner/1729354566032020000.448e6de2-2aec-4438-b528-167633f48982"
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@@ -10585,18 +10585,18 @@
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+          "reference": "Patient/1729354565852369000.1c4b2754-34a7-442a-b907-8ccc1ec34d02"
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@@ -10632,10 +10632,10 @@
       }
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         "extension": [
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@@ -10693,23 +10693,23 @@
       }
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+          "reference": "Practitioner/1729354566025732000.f53bd087-2219-4838-83aa-9a0dc89930b0"
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+          "reference": "Organization/1729354566027038000.9327d92c-61e1-466b-b9a2-366429fb532c"
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         "extension": [
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@@ -10729,10 +10729,10 @@
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         "extension": [
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@@ -10764,10 +10764,10 @@
       }
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         "extension": [
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@@ -10790,10 +10790,10 @@
       }
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         "extension": [
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@@ -10809,7 +10809,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292585948931000.59bc5406-d09e-4356-80fc-dbbf8f6d469b"
+                  "reference": "Practitioner/1729354566036708000.9840dc08-a7e6-467b-afeb-702334016aef"
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@@ -10859,18 +10859,18 @@
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+          "reference": "Patient/1729354565852369000.1c4b2754-34a7-442a-b907-8ccc1ec34d02"
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+          "reference": "Practitioner/1729354566033558000.31beab01-cf50-4be2-8dd3-1ab12a1b9cf5"
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+      "fullUrl": "Practitioner/1729354566033558000.31beab01-cf50-4be2-8dd3-1ab12a1b9cf5",
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         "extension": [
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@@ -10897,10 +10897,10 @@
       }
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         "extension": [
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@@ -10923,10 +10923,10 @@
       }
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@@ -10942,7 +10942,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292585953018000.1d9e69e8-4385-4688-a21b-05809a183638"
+                  "reference": "Practitioner/1729354566043301000.43d05e0f-f755-44b4-888d-55f341ec1e14"
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@@ -10992,18 +10992,18 @@
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+          "reference": "Patient/1729354565852369000.1c4b2754-34a7-442a-b907-8ccc1ec34d02"
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+          "reference": "Practitioner/1729354566038789000.41bcba9b-ca10-426a-a6bf-1496b50de0e8"
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         "extension": [
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@@ -11030,10 +11030,10 @@
       }
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-      "fullUrl": "Practitioner/1729292585953018000.1d9e69e8-4385-4688-a21b-05809a183638",
+      "fullUrl": "Practitioner/1729354566043301000.43d05e0f-f755-44b4-888d-55f341ec1e14",
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         "extension": [
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@@ -11056,10 +11056,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729354566050681000.96813dba-d674-446f-b94b-d8209183fbcf",
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         "extension": [
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@@ -11075,7 +11075,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292585957121000.ebfbfc74-f71d-49a3-afb6-5200ecd1aa1c"
+                  "reference": "Practitioner/1729354566049967000.df46b5a9-d510-4a86-bb06-94ac60ce700f"
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@@ -11125,18 +11125,18 @@
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@@ -11163,10 +11163,10 @@
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@@ -11189,10 +11189,10 @@
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@@ -11208,7 +11208,7 @@
               {
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@@ -11258,18 +11258,18 @@
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@@ -11296,10 +11296,10 @@
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@@ -11322,10 +11322,10 @@
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@@ -11341,7 +11341,7 @@
               {
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@@ -11391,18 +11391,18 @@
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@@ -11429,10 +11429,10 @@
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@@ -11455,10 +11455,10 @@
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@@ -11474,7 +11474,7 @@
               {
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                 "valueReference": {
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@@ -11524,18 +11524,18 @@
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@@ -11562,10 +11562,10 @@
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@@ -11588,10 +11588,10 @@
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@@ -11607,7 +11607,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729354566071371000.0753274f-a5ae-494b-bdc2-5bfeb3d58ff8"
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@@ -11657,18 +11657,18 @@
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         "extension": [
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@@ -11695,10 +11695,10 @@
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         "extension": [
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@@ -11721,10 +11721,10 @@
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         "extension": [
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@@ -11740,7 +11740,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729354566076725000.c12031d0-6ff9-48c2-849b-838353c1833e"
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@@ -11790,18 +11790,18 @@
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+          "reference": "Practitioner/1729354566073087000.5acc1580-1e26-4e01-b3b8-b6259976c1da"
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@@ -11828,10 +11828,10 @@
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@@ -11854,10 +11854,10 @@
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@@ -11873,7 +11873,7 @@
               {
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@@ -11923,18 +11923,18 @@
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@@ -11961,10 +11961,10 @@
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@@ -11987,10 +11987,10 @@
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@@ -12006,7 +12006,7 @@
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                 "valueReference": {
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@@ -12056,18 +12056,18 @@
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@@ -12094,10 +12094,10 @@
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@@ -12120,10 +12120,10 @@
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@@ -12139,7 +12139,7 @@
               {
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@@ -12189,18 +12189,18 @@
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@@ -12227,10 +12227,10 @@
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@@ -12253,10 +12253,10 @@
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@@ -12272,7 +12272,7 @@
               {
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@@ -12322,18 +12322,18 @@
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@@ -12360,10 +12360,10 @@
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@@ -12386,10 +12386,10 @@
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@@ -12405,7 +12405,7 @@
               {
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@@ -12455,18 +12455,18 @@
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@@ -12493,10 +12493,10 @@
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@@ -12519,10 +12519,10 @@
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@@ -12538,7 +12538,7 @@
               {
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                 "valueReference": {
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@@ -12588,18 +12588,18 @@
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@@ -12626,10 +12626,10 @@
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@@ -12652,10 +12652,10 @@
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@@ -12671,7 +12671,7 @@
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                 "valueReference": {
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@@ -12721,18 +12721,18 @@
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@@ -12759,10 +12759,10 @@
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@@ -12785,10 +12785,10 @@
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@@ -12804,7 +12804,7 @@
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@@ -12854,18 +12854,18 @@
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@@ -12892,10 +12892,10 @@
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@@ -12918,10 +12918,10 @@
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@@ -12937,7 +12937,7 @@
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                 "valueReference": {
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@@ -13781,7 +13781,7 @@
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           }
         ],
         "status": "final",
@@ -15128,7 +15128,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292585794022000.8fceeebd-7b26-4cc8-ab01-503065b0ea25"
+          "reference": "Patient/1729354565852369000.1c4b2754-34a7-442a-b907-8ccc1ec34d02"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -15150,27 +15150,27 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292585937684000.843e8dc4-d71f-472d-a750-7cae4e212edc"
+            "reference": "Specimen/1729354566022419000.017ca598-7b45-4b44-a30f-a836ad5a2fff"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729292585921760000.ab994851-eb95-43ef-be35-0a6320983647"
+            "reference": "Observation/1729354566002157000.4d4c5949-7de4-4d36-a521-b312eebfc53d"
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           {
-            "reference": "Observation/1729292585922844000.df7b89e9-dfcf-478c-acf0-86e8a6d38fe0"
+            "reference": "Observation/1729354566003312000.c2ce9837-bf10-4c06-9790-97ed1592e3ec"
           },
           {
-            "reference": "Observation/1729292585923779000.dbca5804-4719-4622-ab22-31747fe44ca0"
+            "reference": "Observation/1729354566004347000.9501f9f6-5085-4d0e-acef-811a4c526871"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292586056409000.e39c2e8e-0fce-45cf-8c62-5ba1045025a5",
+      "fullUrl": "DiagnosticReport/1729354566165277000.8584d146-96e6-40e3-839c-f78f6edb0487",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292586056409000.e39c2e8e-0fce-45cf-8c62-5ba1045025a5",
+        "id": "1729354566165277000.8584d146-96e6-40e3-839c-f78f6edb0487",
         "identifier": [
           {
             "extension": [
@@ -15201,7 +15201,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292586019067000.7e252ed7-1a63-444e-a947-4ddec1575f0b"
+            "reference": "ServiceRequest/1729354566124201000.5cff3ab7-61c6-4bdf-add1-351379073f16"
           }
         ],
         "status": "final",
@@ -15225,7 +15225,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292585794022000.8fceeebd-7b26-4cc8-ab01-503065b0ea25"
+          "reference": "Patient/1729354565852369000.1c4b2754-34a7-442a-b907-8ccc1ec34d02"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -15247,24 +15247,24 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292585938037000.394343af-1b12-4cb1-bd1c-831c35987aa1"
+            "reference": "Specimen/1729354566022900000.a80cb09f-a320-4c25-abb1-a2bce2c2fb02"
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         ],
         "result": [
           {
-            "reference": "Observation/1729292585924830000.e40044c7-527a-4f0d-97e4-139912342b40"
+            "reference": "Observation/1729354566005713000.f5f8e60e-c60a-4903-83a7-3df467454246"
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           {
-            "reference": "Observation/1729292585925762000.32f384cd-1e58-48a3-8c9a-beb6009d8183"
+            "reference": "Observation/1729354566006801000.983f80b0-6a92-4d1c-9142-ba93e2a64552"
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       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292586057853000.f713be7a-c5ec-4f28-9503-ef7f20ac74a7",
+      "fullUrl": "DiagnosticReport/1729354566166896000.5a7295cb-568e-488c-b1a2-471968de23a5",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292586057853000.f713be7a-c5ec-4f28-9503-ef7f20ac74a7",
+        "id": "1729354566166896000.5a7295cb-568e-488c-b1a2-471968de23a5",
         "identifier": [
           {
             "extension": [
@@ -15295,7 +15295,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292586023164000.4d852c6c-ae85-4b55-b9d7-338edb6b4d5e"
+            "reference": "ServiceRequest/1729354566129118000.d14763fe-d305-414a-a882-9e58c185e9a4"
           }
         ],
         "status": "final",
@@ -15319,7 +15319,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292585794022000.8fceeebd-7b26-4cc8-ab01-503065b0ea25"
+          "reference": "Patient/1729354565852369000.1c4b2754-34a7-442a-b907-8ccc1ec34d02"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -15341,12 +15341,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292585938390000.e7c018e8-77ff-419c-9d8c-7c4cf85f9438"
+            "reference": "Specimen/1729354566023313000.55e0a9ed-2ee1-4afe-8f9a-44b9432d34eb"
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         ],
         "result": [
           {
-            "reference": "Observation/1729292585926820000.6a356ec2-7916-4f9b-b616-96e2c99aa0c4"
+            "reference": "Observation/1729354566007955000.2ec90803-cdc0-4dfe-8cc6-e6a74c6fb4b8"
           }
         ]
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diff --git a/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_2_fhir_transformation.fhir b/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_2_fhir_transformation.fhir
index 4df14d0b0..92edc9f79 100644
--- a/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_2_fhir_transformation.fhir
+++ b/examples/CA/016_CA_ORU_R01_CDPH_produced_from_UCSD_order_189609160_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729292585784729000.e5f6d5dd-cd3c-4cbc-84a4-89e7c80a6340",
+  "id": "1729354565839674000.6f20c625-0747-4d38-808c-686bfa5840e6",
   "meta": {
-    "lastUpdated": "2024-10-18T16:03:05.784-07:00"
+    "lastUpdated": "2024-10-19T09:16:05.839-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-07-11T03:49:13.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729292585786249000.8c980a6f-9b04-4344-bd03-c2e26a056983",
+      "fullUrl": "MessageHeader/1729354565841844000.ed29dac8-c947-4a65-b579-af41a3b3fbfb",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729292585786249000.8c980a6f-9b04-4344-bd03-c2e26a056983",
+        "id": "1729354565841844000.ed29dac8-c947-4a65-b579-af41a3b3fbfb",
         "meta": {
           "tag": [
             {
@@ -55,12 +55,12 @@
             ],
             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1729292585786088000.29d75606-bbd1-4683-8cc0-748ffc633afa"
+              "reference": "Organization/1729354565841629000.aabb9cd6-dcc0-431e-9d26-f9e56053a888"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729292585785509000.dd41e1db-00d4-4f55-ae20-aa8c2d66b816"
+          "reference": "Organization/1729354565840825000.2d870fd3-558b-4da1-a520-112ddb57d816"
         },
         "source": {
           "extension": [
@@ -86,10 +86,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292585785509000.dd41e1db-00d4-4f55-ae20-aa8c2d66b816",
+      "fullUrl": "Organization/1729354565840825000.2d870fd3-558b-4da1-a520-112ddb57d816",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292585785509000.dd41e1db-00d4-4f55-ae20-aa8c2d66b816",
+        "id": "1729354565840825000.2d870fd3-558b-4da1-a520-112ddb57d816",
         "identifier": [
           {
             "extension": [
@@ -104,10 +104,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292585786088000.29d75606-bbd1-4683-8cc0-748ffc633afa",
+      "fullUrl": "Organization/1729354565841629000.aabb9cd6-dcc0-431e-9d26-f9e56053a888",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292585786088000.29d75606-bbd1-4683-8cc0-748ffc633afa",
+        "id": "1729354565841629000.aabb9cd6-dcc0-431e-9d26-f9e56053a888",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -128,73 +128,73 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292585787837000.624877d5-153c-4727-8bcf-39fac2e2147f",
+      "fullUrl": "Provenance/1729354565844172000.c0c15cb9-30e5-42a0-9f46-568fd2c28959",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292585787837000.624877d5-153c-4727-8bcf-39fac2e2147f",
+        "id": "1729354565844172000.c0c15cb9-30e5-42a0-9f46-568fd2c28959",
         "target": [
           {
-            "reference": "MessageHeader/1729292585786249000.8c980a6f-9b04-4344-bd03-c2e26a056983"
+            "reference": "MessageHeader/1729354565841844000.ed29dac8-c947-4a65-b579-af41a3b3fbfb"
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-            "reference": "DiagnosticReport/1729292586026374000.46e4f419-c98a-438b-a5a6-cbf8251725af"
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+            "reference": "DiagnosticReport/1729354566134832000.46634b6a-5de0-4d0d-b05e-aa0a30965006"
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+            "reference": "DiagnosticReport/1729354566136611000.a56760d6-6e84-40e3-9d36-105c2975b3d1"
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-            "reference": "DiagnosticReport/1729292586052004000.c36c2d73-7491-4ef4-8315-dd90349ee940"
+            "reference": "DiagnosticReport/1729354566160203000.0780df60-a052-41f9-b0c4-7b680d38ca33"
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           {
-            "reference": "DiagnosticReport/1729292586053452000.6d8a8547-57b8-4656-ba8a-4244d3909415"
+            "reference": "DiagnosticReport/1729354566161938000.4442bce1-5637-41ff-8cfa-476f1e1788ee"
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-            "reference": "DiagnosticReport/1729292586054928000.d17f9df9-0b3b-4733-b2c3-76f0b4010dd0"
+            "reference": "DiagnosticReport/1729354566163648000.2c520966-7090-4856-a71b-23c1857b0359"
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           {
-            "reference": "DiagnosticReport/1729292586056409000.e39c2e8e-0fce-45cf-8c62-5ba1045025a5"
+            "reference": "DiagnosticReport/1729354566165277000.8584d146-96e6-40e3-839c-f78f6edb0487"
           },
           {
-            "reference": "DiagnosticReport/1729292586057853000.f713be7a-c5ec-4f28-9503-ef7f20ac74a7"
+            "reference": "DiagnosticReport/1729354566166896000.5a7295cb-568e-488c-b1a2-471968de23a5"
           }
         ],
         "recorded": "2024-07-11T03:49:13Z",
@@ -216,17 +216,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729292585787648000.74eea74f-8d24-4e9f-9fee-d31e5f2ade88"
+              "reference": "Organization/1729354565843902000.41238ead-a730-4112-8589-2376f1fdf2c1"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729292585787648000.74eea74f-8d24-4e9f-9fee-d31e5f2ade88",
+      "fullUrl": "Organization/1729354565843902000.41238ead-a730-4112-8589-2376f1fdf2c1",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292585787648000.74eea74f-8d24-4e9f-9fee-d31e5f2ade88",
+        "id": "1729354565843902000.41238ead-a730-4112-8589-2376f1fdf2c1",
         "identifier": [
           {
             "extension": [
@@ -241,11 +241,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292585788553000.1fa1a22f-779d-4742-8599-0076e5606984",
+      "fullUrl": "Provenance/1729354565845330000.14964560-125d-42a8-b407-2a43522b4d1d",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292585788553000.1fa1a22f-779d-4742-8599-0076e5606984",
-        "recorded": "2024-10-18T16:03:05Z",
+        "id": "1729354565845330000.14964560-125d-42a8-b407-2a43522b4d1d",
+        "recorded": "2024-10-19T09:16:05Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -267,17 +267,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729292585788402000.89483f95-ddea-4f9f-9d2e-956b5d521f44"
+              "reference": "Organization/1729354565845137000.c2137209-17dd-4ee9-b6ec-0226da0d3c4f"
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       }
     },
     {
-      "fullUrl": "Organization/1729292585788402000.89483f95-ddea-4f9f-9d2e-956b5d521f44",
+      "fullUrl": "Organization/1729354565845137000.c2137209-17dd-4ee9-b6ec-0226da0d3c4f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292585788402000.89483f95-ddea-4f9f-9d2e-956b5d521f44",
+        "id": "1729354565845137000.c2137209-17dd-4ee9-b6ec-0226da0d3c4f",
         "identifier": [
           {
             "value": "CDC PRIME - Atlanta"
@@ -297,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729292585794022000.8fceeebd-7b26-4cc8-ab01-503065b0ea25",
+      "fullUrl": "Patient/1729354565852369000.1c4b2754-34a7-442a-b907-8ccc1ec34d02",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729292585794022000.8fceeebd-7b26-4cc8-ab01-503065b0ea25",
+        "id": "1729354565852369000.1c4b2754-34a7-442a-b907-8ccc1ec34d02",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -387,7 +387,7 @@
             },
             "value": "80009197",
             "assigner": {
-              "reference": "Organization/1729292585789137000.35202dcd-2ad9-4b86-906c-d74748e64c34"
+              "reference": "Organization/1729354565846667000.3f97a1f9-3868-435d-a1f3-528a30dc90e5"
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@@ -454,10 +454,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292585789137000.35202dcd-2ad9-4b86-906c-d74748e64c34",
+      "fullUrl": "Organization/1729354565846667000.3f97a1f9-3868-435d-a1f3-528a30dc90e5",
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-        "id": "1729292585789137000.35202dcd-2ad9-4b86-906c-d74748e64c34",
+        "id": "1729354565846667000.3f97a1f9-3868-435d-a1f3-528a30dc90e5",
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@@ -478,16 +478,16 @@
       }
     },
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-      "fullUrl": "Provenance/1729292585794433000.d7f50236-5ebb-407e-879c-0e1291cd6148",
+      "fullUrl": "Provenance/1729354565853103000.a857e6dc-d98a-4728-af67-c7fd031684c4",
       "resource": {
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+        "id": "1729354565853103000.a857e6dc-d98a-4728-af67-c7fd031684c4",
         "target": [
           {
-            "reference": "Patient/1729292585794022000.8fceeebd-7b26-4cc8-ab01-503065b0ea25"
+            "reference": "Patient/1729354565852369000.1c4b2754-34a7-442a-b907-8ccc1ec34d02"
           }
         ],
-        "recorded": "2024-10-18T16:03:05Z",
+        "recorded": "2024-10-19T09:16:05Z",
         "activity": {
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@@ -510,7 +510,7 @@
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@@ -592,7 +592,7 @@
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@@ -640,10 +640,10 @@
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@@ -732,10 +732,10 @@
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@@ -776,7 +776,7 @@
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@@ -824,10 +824,10 @@
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@@ -868,7 +868,7 @@
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@@ -916,10 +916,10 @@
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@@ -960,7 +960,7 @@
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@@ -1008,10 +1008,10 @@
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@@ -1052,7 +1052,7 @@
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@@ -1082,10 +1082,10 @@
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@@ -1126,7 +1126,7 @@
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@@ -1155,10 +1155,10 @@
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@@ -1199,7 +1199,7 @@
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@@ -1229,10 +1229,10 @@
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@@ -1289,7 +1289,7 @@
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@@ -1322,10 +1322,10 @@
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@@ -1366,7 +1366,7 @@
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@@ -1414,10 +1414,10 @@
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@@ -1474,7 +1474,7 @@
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@@ -1507,10 +1507,10 @@
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@@ -1551,7 +1551,7 @@
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@@ -1599,10 +1599,10 @@
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@@ -1643,7 +1643,7 @@
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@@ -1691,10 +1691,10 @@
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@@ -1735,7 +1735,7 @@
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@@ -1765,10 +1765,10 @@
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@@ -1809,7 +1809,7 @@
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@@ -1839,10 +1839,10 @@
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@@ -1899,7 +1899,7 @@
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@@ -1932,10 +1932,10 @@
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@@ -1992,7 +1992,7 @@
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@@ -2030,10 +2030,10 @@
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@@ -2090,7 +2090,7 @@
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@@ -2123,10 +2123,10 @@
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@@ -2183,7 +2183,7 @@
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@@ -5632,7 +5632,7 @@
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@@ -5730,7 +5730,7 @@
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@@ -8313,10 +8313,10 @@
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@@ -8431,7 +8431,7 @@
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@@ -8490,7 +8490,7 @@
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@@ -8911,7 +8911,7 @@
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@@ -9093,7 +9093,7 @@
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@@ -9175,7 +9175,7 @@
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@@ -9267,7 +9267,7 @@
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@@ -9531,7 +9531,7 @@
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@@ -9561,10 +9561,10 @@
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@@ -9619,7 +9619,7 @@
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@@ -9654,10 +9654,10 @@
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@@ -9698,7 +9698,7 @@
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@@ -9746,10 +9746,10 @@
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@@ -9790,7 +9790,7 @@
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@@ -9820,10 +9820,10 @@
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@@ -9879,7 +9879,7 @@
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@@ -9927,10 +9927,10 @@
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@@ -9986,7 +9986,7 @@
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@@ -10016,10 +10016,10 @@
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@@ -10076,7 +10076,7 @@
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@@ -10114,10 +10114,10 @@
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@@ -10127,10 +10127,10 @@
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@@ -10140,10 +10140,10 @@
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@@ -10153,10 +10153,10 @@
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@@ -10166,10 +10166,10 @@
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@@ -10179,10 +10179,10 @@
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@@ -10192,10 +10192,10 @@
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@@ -10205,10 +10205,10 @@
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@@ -10218,10 +10218,10 @@
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@@ -10231,10 +10231,10 @@
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@@ -10244,10 +10244,10 @@
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@@ -10257,10 +10257,10 @@
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@@ -10270,10 +10270,10 @@
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@@ -10283,10 +10283,10 @@
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@@ -10296,10 +10296,10 @@
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@@ -10309,10 +10309,10 @@
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@@ -10322,10 +10322,10 @@
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@@ -10335,10 +10335,10 @@
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@@ -10348,10 +10348,10 @@
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@@ -10361,10 +10361,10 @@
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@@ -10374,10 +10374,10 @@
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -10389,7 +10389,7 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292585942660000.37cc1e01-3296-47a1-9bef-66784bc0eba5"
+                  "reference": "Organization/1729354566029198000.92616284-e84c-47b2-a000-464a91cce319"
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               {
@@ -10422,7 +10422,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292585943846000.12f1b156-5788-4fc0-8fb3-0b0d03f53b4f"
+                  "reference": "Practitioner/1729354566030780000.cded3ec4-3f37-444b-b2f7-b0b12d147883"
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@@ -10458,7 +10458,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292585939672000.3e7ab130-d49c-46a7-9b6e-c5307d206a50"
+                  "reference": "Practitioner/1729354566025732000.f53bd087-2219-4838-83aa-9a0dc89930b0"
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@@ -10564,18 +10564,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292585794022000.8fceeebd-7b26-4cc8-ab01-503065b0ea25"
+          "reference": "Patient/1729354565852369000.1c4b2754-34a7-442a-b907-8ccc1ec34d02"
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         "requester": {
-          "reference": "PractitionerRole/1729292585938982000.1914d5b7-276e-45d1-a633-98fb6f9010d9"
+          "reference": "PractitionerRole/1729354566024737000.773a8452-d4d9-44ef-b719-60cfa48bcce6"
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-      "fullUrl": "Practitioner/1729292585939672000.3e7ab130-d49c-46a7-9b6e-c5307d206a50",
+      "fullUrl": "Practitioner/1729354566025732000.f53bd087-2219-4838-83aa-9a0dc89930b0",
       "resource": {
         "resourceType": "Practitioner",
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+        "id": "1729354566025732000.f53bd087-2219-4838-83aa-9a0dc89930b0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -10611,10 +10611,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292585940758000.2d048de9-f991-4152-96ba-db0a377ce74c",
+      "fullUrl": "Organization/1729354566027038000.9327d92c-61e1-466b-b9a2-366429fb532c",
       "resource": {
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+        "id": "1729354566027038000.9327d92c-61e1-466b-b9a2-366429fb532c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xon-organization",
@@ -10672,23 +10672,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292585938982000.1914d5b7-276e-45d1-a633-98fb6f9010d9",
+      "fullUrl": "PractitionerRole/1729354566024737000.773a8452-d4d9-44ef-b719-60cfa48bcce6",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292585938982000.1914d5b7-276e-45d1-a633-98fb6f9010d9",
+        "id": "1729354566024737000.773a8452-d4d9-44ef-b719-60cfa48bcce6",
         "practitioner": {
-          "reference": "Practitioner/1729292585939672000.3e7ab130-d49c-46a7-9b6e-c5307d206a50"
+          "reference": "Practitioner/1729354566025732000.f53bd087-2219-4838-83aa-9a0dc89930b0"
         },
         "organization": {
-          "reference": "Organization/1729292585940758000.2d048de9-f991-4152-96ba-db0a377ce74c"
+          "reference": "Organization/1729354566027038000.9327d92c-61e1-466b-b9a2-366429fb532c"
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     {
-      "fullUrl": "Organization/1729292585942660000.37cc1e01-3296-47a1-9bef-66784bc0eba5",
+      "fullUrl": "Organization/1729354566029198000.92616284-e84c-47b2-a000-464a91cce319",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292585942660000.37cc1e01-3296-47a1-9bef-66784bc0eba5",
+        "id": "1729354566029198000.92616284-e84c-47b2-a000-464a91cce319",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xon-organization",
@@ -10708,10 +10708,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292585943846000.12f1b156-5788-4fc0-8fb3-0b0d03f53b4f",
+      "fullUrl": "Practitioner/1729354566030780000.cded3ec4-3f37-444b-b2f7-b0b12d147883",
       "resource": {
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-        "id": "1729292585943846000.12f1b156-5788-4fc0-8fb3-0b0d03f53b4f",
+        "id": "1729354566030780000.cded3ec4-3f37-444b-b2f7-b0b12d147883",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -10743,10 +10743,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292585944868000.9ab6422f-1497-4886-8cec-c062e9c1bbe4",
+      "fullUrl": "Practitioner/1729354566032020000.448e6de2-2aec-4438-b528-167633f48982",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292585944868000.9ab6422f-1497-4886-8cec-c062e9c1bbe4",
+        "id": "1729354566032020000.448e6de2-2aec-4438-b528-167633f48982",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -10769,10 +10769,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292585946217000.6055b1fa-b8d9-427d-a1f2-d8b119e584b5",
+      "fullUrl": "Practitioner/1729354566033558000.31beab01-cf50-4be2-8dd3-1ab12a1b9cf5",
       "resource": {
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-        "id": "1729292585946217000.6055b1fa-b8d9-427d-a1f2-d8b119e584b5",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -10799,10 +10799,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292585948931000.59bc5406-d09e-4356-80fc-dbbf8f6d469b",
+      "fullUrl": "Practitioner/1729354566036708000.9840dc08-a7e6-467b-afeb-702334016aef",
       "resource": {
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-        "id": "1729292585948931000.59bc5406-d09e-4356-80fc-dbbf8f6d469b",
+        "id": "1729354566036708000.9840dc08-a7e6-467b-afeb-702334016aef",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -10825,10 +10825,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292585950344000.96e7489a-5a3f-4b77-ac16-c51b0a61d511",
+      "fullUrl": "Practitioner/1729354566038789000.41bcba9b-ca10-426a-a6bf-1496b50de0e8",
       "resource": {
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         "extension": [
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@@ -10855,10 +10855,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292585953018000.1d9e69e8-4385-4688-a21b-05809a183638",
+      "fullUrl": "Practitioner/1729354566043301000.43d05e0f-f755-44b4-888d-55f341ec1e14",
       "resource": {
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+        "id": "1729354566043301000.43d05e0f-f755-44b4-888d-55f341ec1e14",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -10881,10 +10881,10 @@
       }
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-      "fullUrl": "Practitioner/1729292585954434000.1aeef8c5-9668-4258-822b-a543a3174ab4",
+      "fullUrl": "Practitioner/1729354566045810000.a8c45a3a-3bb3-421e-a7ee-587526fc9c8a",
       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -10911,10 +10911,10 @@
       }
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-      "fullUrl": "Practitioner/1729292585957121000.ebfbfc74-f71d-49a3-afb6-5200ecd1aa1c",
+      "fullUrl": "Practitioner/1729354566049967000.df46b5a9-d510-4a86-bb06-94ac60ce700f",
       "resource": {
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         "extension": [
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@@ -10937,10 +10937,10 @@
       }
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-      "fullUrl": "Practitioner/1729292585958548000.c3391fb2-2a80-41df-9c80-35cb1a8bc2b5",
+      "fullUrl": "Practitioner/1729354566052002000.54974ad8-4a41-403b-8d8b-39e4035238f2",
       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -10967,10 +10967,10 @@
       }
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-      "fullUrl": "Practitioner/1729292585961228000.0263e827-24e2-4e0a-9e81-4f23bc7091a0",
+      "fullUrl": "Practitioner/1729354566055423000.da9b4766-964d-4cf8-8602-649bbb074f4b",
       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
@@ -10993,10 +10993,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292585962654000.39741121-a80b-4d5f-bad8-109bf406125c",
+      "fullUrl": "Practitioner/1729354566057041000.a1715d5b-24cf-4fc8-9b88-4e97361f6c5a",
       "resource": {
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-        "id": "1729292585962654000.39741121-a80b-4d5f-bad8-109bf406125c",
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         "extension": [
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@@ -11023,10 +11023,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292585965326000.005e2cb7-d009-4717-8f33-bcf81cc98904",
+      "fullUrl": "Practitioner/1729354566060422000.e1aa21da-6053-4a1e-8e09-6082727c9316",
       "resource": {
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         "extension": [
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@@ -11049,10 +11049,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292585966733000.cb180105-1b59-4566-bca0-cd6b7f40f987",
+      "fullUrl": "Practitioner/1729354566062375000.eac413d2-2d63-4f8a-90f6-60be3cc8303d",
       "resource": {
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         "extension": [
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@@ -11079,10 +11079,10 @@
       }
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+      "fullUrl": "Practitioner/1729354566066163000.66bb80bc-b162-4fba-b532-e5a5de7e25e3",
       "resource": {
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         "extension": [
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@@ -11105,10 +11105,10 @@
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+      "fullUrl": "Practitioner/1729354566067931000.fab779ba-5137-49c9-a2b2-bc830e2ef82e",
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         "extension": [
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@@ -11135,10 +11135,10 @@
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-      "fullUrl": "Practitioner/1729292585973521000.42a17f9a-24f9-425f-aa33-ca3738e88f60",
+      "fullUrl": "Practitioner/1729354566071371000.0753274f-a5ae-494b-bdc2-5bfeb3d58ff8",
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         "extension": [
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@@ -11161,10 +11161,10 @@
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@@ -11191,10 +11191,10 @@
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@@ -11217,10 +11217,10 @@
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@@ -11247,10 +11247,10 @@
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@@ -11273,10 +11273,10 @@
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@@ -11303,10 +11303,10 @@
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@@ -11329,10 +11329,10 @@
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@@ -11359,10 +11359,10 @@
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diff --git a/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir b/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
index 8ca53a3a7..61ef75374 100644
--- a/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
+++ b/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
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@@ -58,12 +58,12 @@
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@@ -89,10 +89,10 @@
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@@ -208,17 +208,17 @@
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@@ -233,11 +233,11 @@
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@@ -259,17 +259,17 @@
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@@ -289,10 +289,10 @@
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@@ -380,7 +380,7 @@
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@@ -448,10 +448,10 @@
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@@ -473,16 +473,16 @@
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@@ -494,10 +494,10 @@
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@@ -505,7 +505,7 @@
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@@ -543,10 +543,10 @@
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@@ -587,7 +587,7 @@
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@@ -635,10 +635,10 @@
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@@ -679,7 +679,7 @@
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@@ -727,10 +727,10 @@
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@@ -771,7 +771,7 @@
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@@ -819,10 +819,10 @@
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@@ -863,7 +863,7 @@
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@@ -911,10 +911,10 @@
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@@ -955,7 +955,7 @@
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@@ -1003,10 +1003,10 @@
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@@ -1047,7 +1047,7 @@
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@@ -1150,10 +1150,10 @@
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@@ -1194,7 +1194,7 @@
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@@ -1361,7 +1361,7 @@
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@@ -1409,10 +1409,10 @@
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@@ -1469,7 +1469,7 @@
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@@ -1638,7 +1638,7 @@
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@@ -1730,7 +1730,7 @@
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@@ -1760,10 +1760,10 @@
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@@ -1804,7 +1804,7 @@
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@@ -1878,7 +1878,7 @@
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@@ -1968,7 +1968,7 @@
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@@ -2001,10 +2001,10 @@
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@@ -2061,7 +2061,7 @@
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@@ -2159,7 +2159,7 @@
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@@ -2252,7 +2252,7 @@
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@@ -2290,10 +2290,10 @@
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@@ -2350,7 +2350,7 @@
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@@ -2388,10 +2388,10 @@
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@@ -2448,7 +2448,7 @@
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@@ -2486,10 +2486,10 @@
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@@ -2546,7 +2546,7 @@
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@@ -2584,10 +2584,10 @@
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@@ -2644,7 +2644,7 @@
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@@ -2682,10 +2682,10 @@
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@@ -2742,7 +2742,7 @@
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@@ -10101,7 +10101,7 @@
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@@ -10139,10 +10139,10 @@
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@@ -10152,10 +10152,10 @@
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@@ -10165,10 +10165,10 @@
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@@ -10178,10 +10178,10 @@
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@@ -10191,10 +10191,10 @@
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@@ -10204,10 +10204,10 @@
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@@ -10217,10 +10217,10 @@
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@@ -10230,10 +10230,10 @@
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@@ -10243,10 +10243,10 @@
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@@ -10256,10 +10256,10 @@
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@@ -10269,10 +10269,10 @@
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@@ -10282,10 +10282,10 @@
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@@ -10295,10 +10295,10 @@
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@@ -10308,10 +10308,10 @@
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@@ -10321,10 +10321,10 @@
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@@ -10334,10 +10334,10 @@
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@@ -10347,10 +10347,10 @@
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@@ -10360,10 +10360,10 @@
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@@ -10373,10 +10373,10 @@
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@@ -10386,10 +10386,10 @@
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@@ -10399,10 +10399,10 @@
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@@ -10414,7 +10414,7 @@
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@@ -10447,7 +10447,7 @@
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@@ -10579,18 +10579,18 @@
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@@ -10635,10 +10635,10 @@
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@@ -10696,23 +10696,23 @@
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@@ -10732,10 +10732,10 @@
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@@ -10776,10 +10776,10 @@
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@@ -10839,15 +10839,15 @@
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@@ -10907,15 +10907,15 @@
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@@ -10975,15 +10975,15 @@
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@@ -11043,15 +11043,15 @@
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@@ -11111,15 +11111,15 @@
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@@ -11179,15 +11179,15 @@
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@@ -11247,15 +11247,15 @@
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@@ -11315,15 +11315,15 @@
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@@ -11383,15 +11383,15 @@
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@@ -11451,15 +11451,15 @@
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@@ -11519,15 +11519,15 @@
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@@ -11587,15 +11587,15 @@
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@@ -11655,15 +11655,15 @@
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@@ -11723,15 +11723,15 @@
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@@ -11791,15 +11791,15 @@
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@@ -11859,15 +11859,15 @@
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@@ -11927,15 +11927,15 @@
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@@ -12000,15 +12000,15 @@
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@@ -12073,15 +12073,15 @@
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@@ -12156,7 +12156,7 @@
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@@ -12175,7 +12175,7 @@
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@@ -12197,16 +12197,16 @@
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@@ -12237,7 +12237,7 @@
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@@ -12256,7 +12256,7 @@
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@@ -12278,39 +12278,39 @@
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@@ -13533,27 +13533,27 @@
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@@ -13584,7 +13584,7 @@
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@@ -13603,7 +13603,7 @@
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@@ -13625,27 +13625,27 @@
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@@ -13676,7 +13676,7 @@
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@@ -13695,7 +13695,7 @@
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@@ -13717,27 +13717,27 @@
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@@ -13768,7 +13768,7 @@
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@@ -13787,7 +13787,7 @@
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@@ -13809,27 +13809,27 @@
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@@ -13860,7 +13860,7 @@
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@@ -13879,7 +13879,7 @@
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@@ -13901,27 +13901,27 @@
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@@ -13952,7 +13952,7 @@
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@@ -13976,7 +13976,7 @@
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@@ -13998,24 +13998,24 @@
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@@ -14046,7 +14046,7 @@
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@@ -14070,7 +14070,7 @@
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@@ -14092,12 +14092,12 @@
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diff --git a/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir b/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
index a1d880a1e..9da14c80b 100644
--- a/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
+++ b/examples/CA/017_CA_ORU_R01_CDPH_empty_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
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+  "id": "1729353370015166000.db419ab3-5dcc-4766-be69-ca0065cb7bd7",
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-    "lastUpdated": "2024-10-18T15:43:07.602-07:00"
+    "lastUpdated": "2024-10-19T08:56:10.015-07:00"
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@@ -12,10 +12,10 @@
   "timestamp": "2024-07-11T03:49:13.000-07:00",
   "entry": [
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+        "id": "1729353370016623000.b55b41bc-eceb-4830-8dfe-edc4490d8070",
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@@ -55,12 +55,12 @@
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             "receiver": {
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+              "reference": "Organization/1729353370016500000.6d36250a-6944-4eb1-a6a3-b4dc6ed42cb4"
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+          "reference": "Organization/1729353370016009000.c8ef9bed-c26a-47a6-8525-92a995c60e24"
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@@ -86,10 +86,10 @@
       }
     },
     {
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+      "fullUrl": "Organization/1729353370016009000.c8ef9bed-c26a-47a6-8525-92a995c60e24",
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@@ -104,10 +104,10 @@
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     {
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+      "fullUrl": "Organization/1729353370016500000.6d36250a-6944-4eb1-a6a3-b4dc6ed42cb4",
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@@ -128,73 +128,73 @@
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@@ -1414,10 +1414,10 @@
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@@ -1735,7 +1735,7 @@
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@@ -1992,7 +1992,7 @@
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@@ -2090,7 +2090,7 @@
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@@ -2123,10 +2123,10 @@
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@@ -2183,7 +2183,7 @@
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@@ -2281,7 +2281,7 @@
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@@ -2379,7 +2379,7 @@
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@@ -2417,10 +2417,10 @@
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@@ -2477,7 +2477,7 @@
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@@ -2515,10 +2515,10 @@
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@@ -2575,7 +2575,7 @@
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@@ -2673,7 +2673,7 @@
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@@ -2711,10 +2711,10 @@
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@@ -2771,7 +2771,7 @@
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@@ -2809,10 +2809,10 @@
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@@ -2869,7 +2869,7 @@
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@@ -2907,10 +2907,10 @@
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@@ -2967,7 +2967,7 @@
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@@ -3065,7 +3065,7 @@
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@@ -8431,7 +8431,7 @@
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@@ -8490,7 +8490,7 @@
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@@ -9531,7 +9531,7 @@
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@@ -9619,7 +9619,7 @@
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@@ -10076,7 +10076,7 @@
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@@ -10192,10 +10192,10 @@
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@@ -10205,10 +10205,10 @@
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@@ -10218,10 +10218,10 @@
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@@ -10231,10 +10231,10 @@
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@@ -10270,10 +10270,10 @@
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@@ -10283,10 +10283,10 @@
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@@ -10296,10 +10296,10 @@
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@@ -10309,10 +10309,10 @@
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@@ -10322,10 +10322,10 @@
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@@ -10335,10 +10335,10 @@
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@@ -10348,10 +10348,10 @@
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@@ -10361,10 +10361,10 @@
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@@ -10374,10 +10374,10 @@
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@@ -10389,7 +10389,7 @@
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@@ -10422,7 +10422,7 @@
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@@ -10458,7 +10458,7 @@
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@@ -10564,18 +10564,18 @@
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@@ -10620,10 +10620,10 @@
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@@ -10681,23 +10681,23 @@
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@@ -10717,10 +10717,10 @@
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@@ -10761,10 +10761,10 @@
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@@ -10858,7 +10858,7 @@
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@@ -10880,324 +10880,324 @@
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diff --git a/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir b/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
index 7f9962a29..0aa276da9 100644
--- a/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
+++ b/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
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+  "id": "1729354091006562000.30a9f330-6eae-460e-b278-b2a6634c93a5",
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-    "lastUpdated": "2024-10-18T15:55:11.581-07:00"
+    "lastUpdated": "2024-10-19T09:08:11.006-07:00"
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@@ -12,10 +12,10 @@
   "timestamp": "2024-07-11T03:49:13.000-07:00",
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@@ -58,12 +58,12 @@
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@@ -89,10 +89,10 @@
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@@ -107,10 +107,10 @@
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@@ -120,73 +120,73 @@
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@@ -208,17 +208,17 @@
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@@ -233,11 +233,11 @@
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@@ -259,17 +259,17 @@
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+              "reference": "Organization/1729354091010160000.111875ec-1b1a-4242-aca7-c482717f107e"
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@@ -289,10 +289,10 @@
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@@ -380,7 +380,7 @@
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@@ -448,10 +448,10 @@
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@@ -473,16 +473,16 @@
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@@ -494,10 +494,10 @@
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@@ -505,7 +505,7 @@
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@@ -543,10 +543,10 @@
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@@ -587,7 +587,7 @@
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@@ -635,10 +635,10 @@
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@@ -679,7 +679,7 @@
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@@ -771,7 +771,7 @@
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@@ -3619,7 +3619,7 @@
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@@ -9967,10 +9967,10 @@
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@@ -10011,7 +10011,7 @@
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@@ -10041,10 +10041,10 @@
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@@ -10101,7 +10101,7 @@
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@@ -10139,10 +10139,10 @@
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@@ -10152,10 +10152,10 @@
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@@ -10165,10 +10165,10 @@
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@@ -10178,10 +10178,10 @@
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@@ -10191,10 +10191,10 @@
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@@ -10204,10 +10204,10 @@
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@@ -10217,10 +10217,10 @@
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@@ -10230,10 +10230,10 @@
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@@ -10243,10 +10243,10 @@
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@@ -10256,10 +10256,10 @@
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@@ -10269,10 +10269,10 @@
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@@ -10282,10 +10282,10 @@
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@@ -10295,10 +10295,10 @@
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@@ -10308,10 +10308,10 @@
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@@ -10321,10 +10321,10 @@
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@@ -10334,10 +10334,10 @@
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@@ -10347,10 +10347,10 @@
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@@ -10360,10 +10360,10 @@
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@@ -10373,10 +10373,10 @@
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@@ -10386,10 +10386,10 @@
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@@ -10399,10 +10399,10 @@
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@@ -10414,7 +10414,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Organization/1729354091168784000.582de035-a364-425e-9e2f-17db355f4008"
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@@ -10477,7 +10477,7 @@
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@@ -10579,18 +10579,18 @@
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@@ -10617,10 +10617,10 @@
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@@ -10678,23 +10678,23 @@
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@@ -10714,10 +10714,10 @@
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@@ -10740,10 +10740,10 @@
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@@ -10759,7 +10759,7 @@
               {
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                 "valueReference": {
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@@ -10809,18 +10809,18 @@
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@@ -10847,10 +10847,10 @@
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@@ -10873,10 +10873,10 @@
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@@ -10892,7 +10892,7 @@
               {
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@@ -10942,18 +10942,18 @@
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@@ -10980,10 +10980,10 @@
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@@ -11006,10 +11006,10 @@
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@@ -11025,7 +11025,7 @@
               {
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@@ -11075,18 +11075,18 @@
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@@ -11113,10 +11113,10 @@
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@@ -11139,10 +11139,10 @@
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@@ -11158,7 +11158,7 @@
               {
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@@ -11208,18 +11208,18 @@
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@@ -11246,10 +11246,10 @@
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@@ -11272,10 +11272,10 @@
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@@ -11291,7 +11291,7 @@
               {
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@@ -11341,18 +11341,18 @@
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@@ -11379,10 +11379,10 @@
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@@ -11405,10 +11405,10 @@
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@@ -11424,7 +11424,7 @@
               {
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@@ -11474,18 +11474,18 @@
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@@ -11512,10 +11512,10 @@
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@@ -11538,10 +11538,10 @@
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@@ -11557,7 +11557,7 @@
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@@ -11607,18 +11607,18 @@
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@@ -11645,10 +11645,10 @@
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@@ -11671,10 +11671,10 @@
       }
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         "extension": [
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@@ -11690,7 +11690,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292111772253000.4e17ff71-2f0a-4e48-b788-7abfc1200007"
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@@ -11740,18 +11740,18 @@
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@@ -11778,10 +11778,10 @@
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@@ -11804,10 +11804,10 @@
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@@ -11823,7 +11823,7 @@
               {
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                 "valueReference": {
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@@ -11873,18 +11873,18 @@
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@@ -11911,10 +11911,10 @@
       }
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         "extension": [
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@@ -11937,10 +11937,10 @@
       }
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@@ -11956,7 +11956,7 @@
               {
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                 "valueReference": {
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@@ -12006,18 +12006,18 @@
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+          "reference": "Practitioner/1729354091208922000.f3766f52-2741-40f0-a63c-ee0ff2a3d16c"
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         "extension": [
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@@ -12044,10 +12044,10 @@
       }
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         "extension": [
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@@ -12070,10 +12070,10 @@
       }
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@@ -12089,7 +12089,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292111784155000.18dab597-0502-42fa-acaf-3fad26735e37"
+                  "reference": "Practitioner/1729354091215739000.45ca024d-59c9-438e-bf5a-0234698d7d66"
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@@ -12139,18 +12139,18 @@
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@@ -12177,10 +12177,10 @@
       }
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         "extension": [
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@@ -12203,10 +12203,10 @@
       }
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       "resource": {
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         "extension": [
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@@ -12222,7 +12222,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292111788116000.bcf3cb2a-586f-4648-b069-a8c1e4d9539c"
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@@ -12272,18 +12272,18 @@
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+          "reference": "Patient/1729354091015813000.049352af-7755-406d-a52a-36abaed14ad7"
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+          "reference": "Practitioner/1729354091217148000.40c15e83-251c-4f2a-a5bd-334c6a0d5188"
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         "extension": [
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@@ -12310,10 +12310,10 @@
       }
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         "extension": [
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@@ -12336,10 +12336,10 @@
       }
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@@ -12355,7 +12355,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292111792124000.3c0c0daf-9b62-43e5-8a05-dcdbbf41a78c"
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@@ -12405,18 +12405,18 @@
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@@ -12443,10 +12443,10 @@
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@@ -12469,10 +12469,10 @@
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@@ -12488,7 +12488,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292111796120000.74bac5b7-c3db-4cc2-b6e6-65176bbbbc77"
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@@ -12538,18 +12538,18 @@
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+          "reference": "Practitioner/1729354091225363000.ad66802e-f322-44ec-b10f-42bee77584fa"
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@@ -12576,10 +12576,10 @@
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@@ -12602,10 +12602,10 @@
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@@ -12621,7 +12621,7 @@
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@@ -12671,18 +12671,18 @@
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@@ -12709,10 +12709,10 @@
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@@ -12735,10 +12735,10 @@
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@@ -12754,7 +12754,7 @@
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@@ -12804,18 +12804,18 @@
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@@ -12842,10 +12842,10 @@
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@@ -12868,10 +12868,10 @@
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@@ -12887,7 +12887,7 @@
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@@ -12937,18 +12937,18 @@
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@@ -12975,10 +12975,10 @@
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@@ -13001,10 +13001,10 @@
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@@ -13020,7 +13020,7 @@
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@@ -13075,18 +13075,18 @@
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@@ -13113,10 +13113,10 @@
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@@ -13139,10 +13139,10 @@
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@@ -13158,7 +13158,7 @@
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@@ -13213,18 +13213,18 @@
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@@ -13251,10 +13251,10 @@
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@@ -13277,10 +13277,10 @@
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@@ -13355,7 +13355,7 @@
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@@ -13374,7 +13374,7 @@
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@@ -13396,16 +13396,16 @@
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@@ -13436,7 +13436,7 @@
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@@ -13455,7 +13455,7 @@
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@@ -13477,39 +13477,39 @@
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@@ -13540,7 +13540,7 @@
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@@ -14875,7 +14875,7 @@
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@@ -14894,7 +14894,7 @@
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@@ -14916,27 +14916,27 @@
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@@ -14967,7 +14967,7 @@
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@@ -14986,7 +14986,7 @@
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@@ -15008,27 +15008,27 @@
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@@ -15059,7 +15059,7 @@
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@@ -15078,7 +15078,7 @@
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@@ -15100,27 +15100,27 @@
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@@ -15151,7 +15151,7 @@
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@@ -15175,7 +15175,7 @@
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@@ -15197,24 +15197,24 @@
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@@ -15245,7 +15245,7 @@
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@@ -15269,7 +15269,7 @@
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@@ -15291,12 +15291,12 @@
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diff --git a/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir b/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
index eb707dca2..8c9466541 100644
--- a/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
+++ b/examples/CA/018_CA_ORU_R01_CDPH_empty_orc12_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
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+  "id": "1729354091006562000.30a9f330-6eae-460e-b278-b2a6634c93a5",
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+    "lastUpdated": "2024-10-19T09:08:11.006-07:00"
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@@ -12,10 +12,10 @@
   "timestamp": "2024-07-11T03:49:13.000-07:00",
   "entry": [
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@@ -55,12 +55,12 @@
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+              "reference": "Organization/1729354091008110000.075750f2-298b-4f8e-901c-f4005934f570"
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+          "reference": "Organization/1729354091007514000.65209274-e8a4-4032-a0a2-4d04b2cdda5e"
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@@ -86,10 +86,10 @@
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     {
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+      "fullUrl": "Organization/1729354091007514000.65209274-e8a4-4032-a0a2-4d04b2cdda5e",
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@@ -104,10 +104,10 @@
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@@ -128,73 +128,73 @@
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@@ -4863,7 +4863,7 @@
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@@ -4961,7 +4961,7 @@
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@@ -5152,7 +5152,7 @@
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@@ -5250,7 +5250,7 @@
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@@ -5343,7 +5343,7 @@
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@@ -5436,7 +5436,7 @@
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@@ -9531,7 +9531,7 @@
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@@ -9561,10 +9561,10 @@
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@@ -9619,7 +9619,7 @@
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@@ -9654,10 +9654,10 @@
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@@ -9698,7 +9698,7 @@
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@@ -9746,10 +9746,10 @@
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@@ -9790,7 +9790,7 @@
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@@ -9879,7 +9879,7 @@
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@@ -9927,10 +9927,10 @@
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@@ -9986,7 +9986,7 @@
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@@ -10076,7 +10076,7 @@
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@@ -10127,10 +10127,10 @@
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@@ -10166,10 +10166,10 @@
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@@ -10179,10 +10179,10 @@
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@@ -10192,10 +10192,10 @@
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@@ -10205,10 +10205,10 @@
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@@ -10231,10 +10231,10 @@
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@@ -10257,10 +10257,10 @@
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@@ -10309,10 +10309,10 @@
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@@ -10322,10 +10322,10 @@
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@@ -10335,10 +10335,10 @@
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@@ -10348,10 +10348,10 @@
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@@ -10361,10 +10361,10 @@
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@@ -10374,10 +10374,10 @@
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@@ -10389,7 +10389,7 @@
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                 "valueReference": {
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@@ -10452,7 +10452,7 @@
               {
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@@ -10558,18 +10558,18 @@
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@@ -10596,10 +10596,10 @@
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@@ -10657,23 +10657,23 @@
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@@ -10693,10 +10693,10 @@
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@@ -10719,10 +10719,10 @@
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@@ -10749,10 +10749,10 @@
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@@ -10775,10 +10775,10 @@
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@@ -10805,10 +10805,10 @@
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@@ -10831,10 +10831,10 @@
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@@ -10861,10 +10861,10 @@
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@@ -10887,10 +10887,10 @@
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@@ -10917,10 +10917,10 @@
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@@ -10943,10 +10943,10 @@
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@@ -10973,10 +10973,10 @@
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@@ -10999,10 +10999,10 @@
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@@ -11029,10 +11029,10 @@
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@@ -11055,10 +11055,10 @@
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@@ -11085,10 +11085,10 @@
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@@ -11111,10 +11111,10 @@
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@@ -11141,10 +11141,10 @@
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@@ -11167,10 +11167,10 @@
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diff --git a/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir b/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
index 6131c569b..75082f069 100644
--- a/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
+++ b/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
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+    "lastUpdated": "2024-10-19T09:00:07.824-07:00"
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@@ -12,10 +12,10 @@
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@@ -58,12 +58,12 @@
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@@ -89,10 +89,10 @@
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@@ -107,10 +107,10 @@
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@@ -120,73 +120,73 @@
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@@ -208,17 +208,17 @@
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@@ -233,11 +233,11 @@
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@@ -259,17 +259,17 @@
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@@ -289,10 +289,10 @@
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@@ -380,7 +380,7 @@
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@@ -448,10 +448,10 @@
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@@ -473,16 +473,16 @@
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@@ -494,10 +494,10 @@
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@@ -505,7 +505,7 @@
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@@ -543,10 +543,10 @@
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@@ -587,7 +587,7 @@
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@@ -635,10 +635,10 @@
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@@ -679,7 +679,7 @@
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@@ -771,7 +771,7 @@
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@@ -1968,7 +1968,7 @@
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@@ -5319,7 +5319,7 @@
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@@ -7634,7 +7634,7 @@
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@@ -9919,7 +9919,7 @@
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@@ -9967,10 +9967,10 @@
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@@ -10011,7 +10011,7 @@
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@@ -10041,10 +10041,10 @@
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@@ -10101,7 +10101,7 @@
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@@ -10139,10 +10139,10 @@
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@@ -10152,10 +10152,10 @@
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@@ -10165,10 +10165,10 @@
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@@ -10178,10 +10178,10 @@
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@@ -10191,10 +10191,10 @@
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@@ -10204,10 +10204,10 @@
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@@ -10217,10 +10217,10 @@
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@@ -10230,10 +10230,10 @@
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@@ -10243,10 +10243,10 @@
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@@ -10256,10 +10256,10 @@
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@@ -10269,10 +10269,10 @@
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@@ -10282,10 +10282,10 @@
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@@ -10295,10 +10295,10 @@
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@@ -10308,10 +10308,10 @@
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@@ -10321,10 +10321,10 @@
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@@ -10334,10 +10334,10 @@
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@@ -10347,10 +10347,10 @@
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@@ -10360,10 +10360,10 @@
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@@ -10373,10 +10373,10 @@
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@@ -10386,10 +10386,10 @@
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@@ -10399,10 +10399,10 @@
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@@ -10414,7 +10414,7 @@
               {
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                 "valueReference": {
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@@ -10573,18 +10573,18 @@
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@@ -10642,20 +10642,20 @@
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@@ -10675,10 +10675,10 @@
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@@ -10738,15 +10738,15 @@
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@@ -10942,15 +10942,15 @@
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@@ -11010,15 +11010,15 @@
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@@ -11078,15 +11078,15 @@
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@@ -11146,15 +11146,15 @@
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@@ -11214,15 +11214,15 @@
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@@ -11282,15 +11282,15 @@
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@@ -11350,15 +11350,15 @@
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@@ -11418,15 +11418,15 @@
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@@ -11486,15 +11486,15 @@
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@@ -11554,15 +11554,15 @@
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@@ -11622,15 +11622,15 @@
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@@ -11690,15 +11690,15 @@
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@@ -11758,15 +11758,15 @@
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@@ -11826,15 +11826,15 @@
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@@ -11899,15 +11899,15 @@
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@@ -11972,15 +11972,15 @@
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@@ -12055,7 +12055,7 @@
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@@ -12096,16 +12096,16 @@
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@@ -12136,7 +12136,7 @@
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@@ -12177,39 +12177,39 @@
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@@ -13483,7 +13483,7 @@
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@@ -13502,7 +13502,7 @@
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@@ -13524,27 +13524,27 @@
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@@ -13575,7 +13575,7 @@
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@@ -13594,7 +13594,7 @@
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@@ -13616,27 +13616,27 @@
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@@ -13667,7 +13667,7 @@
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@@ -13686,7 +13686,7 @@
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@@ -13708,27 +13708,27 @@
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@@ -13759,7 +13759,7 @@
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@@ -13778,7 +13778,7 @@
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@@ -13800,27 +13800,27 @@
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@@ -13851,7 +13851,7 @@
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@@ -13875,7 +13875,7 @@
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@@ -13897,24 +13897,24 @@
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@@ -13945,7 +13945,7 @@
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@@ -13969,7 +13969,7 @@
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@@ -13991,12 +13991,12 @@
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diff --git a/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir b/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
index 6fefeee4a..c899620b1 100644
--- a/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
+++ b/examples/CA/019_CA_ORU_R01_CDPH_empty_orc12_obr16_UCSD2024-07-11-16-02-17-749_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
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+  "id": "1729353607824191000.23268d0e-73c1-421c-a55a-7cd15b3bae1a",
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-    "lastUpdated": "2024-10-18T15:47:05.257-07:00"
+    "lastUpdated": "2024-10-19T09:00:07.824-07:00"
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@@ -12,10 +12,10 @@
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@@ -55,12 +55,12 @@
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@@ -86,10 +86,10 @@
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@@ -104,10 +104,10 @@
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@@ -128,73 +128,73 @@
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@@ -4280,7 +4280,7 @@
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@@ -4765,7 +4765,7 @@
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@@ -6215,7 +6215,7 @@
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@@ -8431,7 +8431,7 @@
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@@ -9879,7 +9879,7 @@
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diff --git a/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_1_hl7_translation.fhir b/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_1_hl7_translation.fhir
index 9ca4f8102..4b2ae06d3 100644
--- a/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_1_hl7_translation.fhir
+++ b/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
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@@ -89,10 +89,10 @@
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@@ -2546,7 +2546,7 @@
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@@ -10307,7 +10307,7 @@
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@@ -10381,7 +10381,7 @@
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@@ -10411,10 +10411,10 @@
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@@ -10455,7 +10455,7 @@
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@@ -10485,10 +10485,10 @@
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@@ -10529,7 +10529,7 @@
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@@ -10559,10 +10559,10 @@
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@@ -10603,7 +10603,7 @@
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@@ -10633,10 +10633,10 @@
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@@ -10677,7 +10677,7 @@
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@@ -10707,10 +10707,10 @@
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@@ -10767,7 +10767,7 @@
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@@ -10805,10 +10805,10 @@
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@@ -10818,10 +10818,10 @@
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@@ -10831,10 +10831,10 @@
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@@ -10844,10 +10844,10 @@
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@@ -10857,10 +10857,10 @@
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@@ -10870,10 +10870,10 @@
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@@ -10883,10 +10883,10 @@
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@@ -10896,10 +10896,10 @@
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@@ -10909,10 +10909,10 @@
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@@ -10922,10 +10922,10 @@
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@@ -10935,10 +10935,10 @@
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@@ -10948,10 +10948,10 @@
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@@ -10961,10 +10961,10 @@
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@@ -10974,10 +10974,10 @@
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@@ -10987,10 +10987,10 @@
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@@ -11000,10 +11000,10 @@
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@@ -11013,10 +11013,10 @@
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@@ -11026,10 +11026,10 @@
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@@ -11039,10 +11039,10 @@
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@@ -11065,10 +11065,10 @@
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@@ -11080,7 +11080,7 @@
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@@ -11239,18 +11239,18 @@
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@@ -11308,20 +11308,20 @@
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@@ -11341,10 +11341,10 @@
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@@ -11404,15 +11404,15 @@
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@@ -11472,15 +11472,15 @@
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@@ -11540,15 +11540,15 @@
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@@ -11608,15 +11608,15 @@
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@@ -11676,15 +11676,15 @@
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@@ -11744,15 +11744,15 @@
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@@ -11812,15 +11812,15 @@
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@@ -11880,15 +11880,15 @@
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@@ -11948,15 +11948,15 @@
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@@ -12016,15 +12016,15 @@
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@@ -12084,15 +12084,15 @@
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@@ -12152,15 +12152,15 @@
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@@ -12220,15 +12220,15 @@
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@@ -12288,15 +12288,15 @@
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@@ -12356,15 +12356,15 @@
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@@ -12424,15 +12424,15 @@
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@@ -12492,15 +12492,15 @@
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         "subject": {
-          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
+          "reference": "Patient/1729353731107720000.e17dc602-b9ea-4b20-9cd4-864dbe3cf166"
         },
         "effectiveDateTime": "2024-07-11T13:46:00Z",
         "_effectiveDateTime": {
@@ -14684,12 +14684,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291749580456000.1fcc01d0-a672-4d36-b83e-7f70a42be9ec"
+            "reference": "Specimen/1729353731259477000.72eb1605-822b-4616-83a1-b68989fdd682"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729291749565780000.bf10a594-8b98-481e-8f63-9bc6e75b7dff"
+            "reference": "Observation/1729353731247582000.84981616-f9fa-4325-8df5-7f1a926e8591"
           }
         ]
       }
diff --git a/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_2_fhir_transformation.fhir b/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_2_fhir_transformation.fhir
index 6e32cda45..fac3a8970 100644
--- a/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_2_fhir_transformation.fhir
+++ b/examples/CA/020_CA_ORU_R01_CDPH_OBX_to_LOINC_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729291749380438000.489b3095-a78c-41a8-ad34-5f67e90c7a90",
+  "id": "1729353731098064000.a15fb5bb-941c-44ee-8d75-36ea5c981acb",
   "meta": {
-    "lastUpdated": "2024-10-18T15:49:09.380-07:00"
+    "lastUpdated": "2024-10-19T09:02:11.098-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-07-11T03:49:13.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729291749383345000.5891632c-bc50-48dc-9f25-4c55cd363363",
+      "fullUrl": "MessageHeader/1729353731099157000.ba755a60-6d7c-4590-bf6d-01a5021988da",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729291749383345000.5891632c-bc50-48dc-9f25-4c55cd363363",
+        "id": "1729353731099157000.ba755a60-6d7c-4590-bf6d-01a5021988da",
         "meta": {
           "tag": [
             {
@@ -55,12 +55,12 @@
             ],
             "name": "EPIC",
             "receiver": {
-              "reference": "Organization/1729291749383072000.f76eb5c0-9161-43db-9c02-01d81fdad790"
+              "reference": "Organization/1729353731099017000.892cdbca-89ec-43e5-bba6-859f4098f45d"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729291749381955000.e38ba077-ffbd-4b4f-80c5-f95b54d97c80"
+          "reference": "Organization/1729353731098525000.64c6b3db-b7f1-419c-8c2e-c7408ddc5491"
         },
         "source": {
           "extension": [
@@ -86,10 +86,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291749381955000.e38ba077-ffbd-4b4f-80c5-f95b54d97c80",
+      "fullUrl": "Organization/1729353731098525000.64c6b3db-b7f1-419c-8c2e-c7408ddc5491",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291749381955000.e38ba077-ffbd-4b4f-80c5-f95b54d97c80",
+        "id": "1729353731098525000.64c6b3db-b7f1-419c-8c2e-c7408ddc5491",
         "identifier": [
           {
             "extension": [
@@ -104,10 +104,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291749383072000.f76eb5c0-9161-43db-9c02-01d81fdad790",
+      "fullUrl": "Organization/1729353731099017000.892cdbca-89ec-43e5-bba6-859f4098f45d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291749383072000.f76eb5c0-9161-43db-9c02-01d81fdad790",
+        "id": "1729353731099017000.892cdbca-89ec-43e5-bba6-859f4098f45d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -128,73 +128,73 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729291749385306000.9842e381-6d0d-42fe-a4a6-c0b8c2dbaba3",
+      "fullUrl": "Provenance/1729353731100703000.57d06647-b024-4703-9e26-12be4fcf7465",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729291749385306000.9842e381-6d0d-42fe-a4a6-c0b8c2dbaba3",
+        "id": "1729353731100703000.57d06647-b024-4703-9e26-12be4fcf7465",
         "target": [
           {
-            "reference": "MessageHeader/1729291749383345000.5891632c-bc50-48dc-9f25-4c55cd363363"
+            "reference": "MessageHeader/1729353731099157000.ba755a60-6d7c-4590-bf6d-01a5021988da"
           },
           {
-            "reference": "DiagnosticReport/1729291749651361000.e2d2e58c-1049-4620-9ed3-ab6ad7427d74"
+            "reference": "DiagnosticReport/1729353731321275000.17a70ca3-6160-41f2-a710-1010ed68d893"
           },
           {
-            "reference": "DiagnosticReport/1729291749653369000.07945c19-0279-414c-a7a7-8dc83b5a83f7"
+            "reference": "DiagnosticReport/1729353731322887000.f574ea24-84a7-4ba5-a47b-3940f58d80d3"
           },
           {
-            "reference": "DiagnosticReport/1729291749655221000.cb959ee9-f472-4a5c-a8ab-4f7c8f2ce048"
+            "reference": "DiagnosticReport/1729353731324540000.3335caea-c5d8-4e82-ae4a-38d98e95bd09"
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           {
-            "reference": "DiagnosticReport/1729291749656755000.03969b86-e046-4b21-9e65-c65e29b60824"
+            "reference": "DiagnosticReport/1729353731325921000.4808be2c-d70a-438c-b300-51ff63250d53"
           },
           {
-            "reference": "DiagnosticReport/1729291749658920000.bd5f3be6-d2b6-409d-9194-5fb98c0fb3d9"
+            "reference": "DiagnosticReport/1729353731327913000.5a959fbe-5cbc-4121-8107-13a8470fbf15"
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           {
-            "reference": "DiagnosticReport/1729291749660506000.e0dd8057-6f27-4c19-838b-54fd302a0470"
+            "reference": "DiagnosticReport/1729353731329364000.afb60235-f123-496d-97c5-7ee32dccdebb"
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           {
-            "reference": "DiagnosticReport/1729291749662866000.c6cd4a56-9c9d-4bba-90c8-dc60ea851c9f"
+            "reference": "DiagnosticReport/1729353731331576000.1999adfa-9f92-4607-89f2-545e2c85aa10"
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           {
-            "reference": "DiagnosticReport/1729291749665068000.7f7684d0-af55-4400-9c17-e2abf4314553"
+            "reference": "DiagnosticReport/1729353731333331000.57614e26-939c-4c0c-a9a9-0cbdb9dd6894"
           },
           {
-            "reference": "DiagnosticReport/1729291749666783000.0389c43e-cc5f-42de-a37a-904f6259a974"
+            "reference": "DiagnosticReport/1729353731334797000.7c740839-1505-4f7b-a4e7-8f197f9c3fbb"
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-            "reference": "DiagnosticReport/1729291749668680000.10825df5-c68d-49d6-bb69-c4299fe5f240"
+            "reference": "DiagnosticReport/1729353731336287000.f78aecec-4d56-428c-954e-5606cd17ff59"
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           {
-            "reference": "DiagnosticReport/1729291749670237000.45e682b3-5c37-436f-9e5f-ae7b17767a6c"
+            "reference": "DiagnosticReport/1729353731337748000.a033e074-d1da-4b26-ac95-5f9ab297de13"
           },
           {
-            "reference": "DiagnosticReport/1729291749671794000.91b6b7cf-7297-4f68-9b40-88ee87a60f63"
+            "reference": "DiagnosticReport/1729353731339215000.2ab9052a-d5d2-4fbd-9e2a-16666c6e832a"
           },
           {
-            "reference": "DiagnosticReport/1729291749673341000.7c63a221-70b0-4032-897e-9f86b7afca4d"
+            "reference": "DiagnosticReport/1729353731340646000.0af3e7e3-405f-4273-bb7b-6b2ec88db94a"
           },
           {
-            "reference": "DiagnosticReport/1729291749674951000.967f0101-bb46-48da-88b5-ae83f8df0487"
+            "reference": "DiagnosticReport/1729353731342179000.a0c6f05f-79f7-4786-af69-c3f178f6e37e"
           },
           {
-            "reference": "DiagnosticReport/1729291749677056000.4119005e-3ec7-4476-b805-4a5b27b466be"
+            "reference": "DiagnosticReport/1729353731343640000.9fad5045-2bbf-4504-baeb-febd87c48f88"
           },
           {
-            "reference": "DiagnosticReport/1729291749680334000.23deec80-1a25-44c3-9687-cf097574ffb9"
+            "reference": "DiagnosticReport/1729353731345146000.752dc782-a1a8-471f-818b-4bbff94b84ff"
           },
           {
-            "reference": "DiagnosticReport/1729291749682216000.f7def470-a4ff-44f7-8b4f-967d6f480503"
+            "reference": "DiagnosticReport/1729353731346582000.fec1e77f-c38c-4337-82e1-9fc980c0e520"
           },
           {
-            "reference": "DiagnosticReport/1729291749683803000.f3fe6412-7fd3-4ac0-acf3-d90895a5586b"
+            "reference": "DiagnosticReport/1729353731348047000.e699ac43-7044-4cc6-98c0-9ba6b75a4512"
           },
           {
-            "reference": "DiagnosticReport/1729291749685711000.c24eb62c-ddea-4ebf-ab9d-1a9ff00d6bd1"
+            "reference": "DiagnosticReport/1729353731349787000.dfe77bd2-96de-4306-8cba-6f159682023d"
           },
           {
-            "reference": "DiagnosticReport/1729291749687266000.58dc2ce2-63ec-4550-a3f4-604c608bd784"
+            "reference": "DiagnosticReport/1729353731351203000.a4c4df59-87d9-43bc-8b2f-57b5abb278be"
           }
         ],
         "recorded": "2024-07-11T03:49:13Z",
@@ -216,17 +216,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729291749385045000.68565ed7-c462-4ba6-81c7-7fa3e0b9b0a9"
+              "reference": "Organization/1729353731100498000.ea52e7f3-ed50-499e-95bb-0fada21f64b7"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729291749385045000.68565ed7-c462-4ba6-81c7-7fa3e0b9b0a9",
+      "fullUrl": "Organization/1729353731100498000.ea52e7f3-ed50-499e-95bb-0fada21f64b7",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291749385045000.68565ed7-c462-4ba6-81c7-7fa3e0b9b0a9",
+        "id": "1729353731100498000.ea52e7f3-ed50-499e-95bb-0fada21f64b7",
         "identifier": [
           {
             "extension": [
@@ -241,11 +241,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729291749390769000.60615142-1e17-443c-9f3c-d526291d450a",
+      "fullUrl": "Provenance/1729353731101327000.58ff3bea-2377-4a4c-ae14-e65db6058b28",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729291749390769000.60615142-1e17-443c-9f3c-d526291d450a",
-        "recorded": "2024-10-18T15:49:09Z",
+        "id": "1729353731101327000.58ff3bea-2377-4a4c-ae14-e65db6058b28",
+        "recorded": "2024-10-19T09:02:11Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -267,17 +267,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729291749390543000.20c42f97-d668-4d48-ac73-6314b9658a94"
+              "reference": "Organization/1729353731101148000.7d4f291f-5f4a-4067-b41e-deabfef57d04"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729291749390543000.20c42f97-d668-4d48-ac73-6314b9658a94",
+      "fullUrl": "Organization/1729353731101148000.7d4f291f-5f4a-4067-b41e-deabfef57d04",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291749390543000.20c42f97-d668-4d48-ac73-6314b9658a94",
+        "id": "1729353731101148000.7d4f291f-5f4a-4067-b41e-deabfef57d04",
         "identifier": [
           {
             "value": "CDC PRIME - Atlanta"
@@ -297,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52",
+      "fullUrl": "Patient/1729353731107720000.e17dc602-b9ea-4b20-9cd4-864dbe3cf166",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52",
+        "id": "1729353731107720000.e17dc602-b9ea-4b20-9cd4-864dbe3cf166",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -387,7 +387,7 @@
             },
             "value": "80009197",
             "assigner": {
-              "reference": "Organization/1729291749391695000.11799206-723a-4540-8a61-629951842f87"
+              "reference": "Organization/1729353731102088000.2cb4f52a-cc3a-451a-8d12-9637fe0bfaca"
             }
           }
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@@ -454,10 +454,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291749391695000.11799206-723a-4540-8a61-629951842f87",
+      "fullUrl": "Organization/1729353731102088000.2cb4f52a-cc3a-451a-8d12-9637fe0bfaca",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291749391695000.11799206-723a-4540-8a61-629951842f87",
+        "id": "1729353731102088000.2cb4f52a-cc3a-451a-8d12-9637fe0bfaca",
         "identifier": [
           {
             "extension": [
@@ -478,16 +478,16 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729291749398716000.8bccc4e1-f3c9-4d79-bec6-c0f9d915c578",
+      "fullUrl": "Provenance/1729353731108095000.63e42333-1378-4847-b3da-6f830abeb367",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729291749398716000.8bccc4e1-f3c9-4d79-bec6-c0f9d915c578",
+        "id": "1729353731108095000.63e42333-1378-4847-b3da-6f830abeb367",
         "target": [
           {
-            "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
+            "reference": "Patient/1729353731107720000.e17dc602-b9ea-4b20-9cd4-864dbe3cf166"
           }
         ],
-        "recorded": "2024-10-18T15:49:09Z",
+        "recorded": "2024-10-19T09:02:11Z",
         "activity": {
           "coding": [
             {
@@ -499,10 +499,10 @@
       }
     },
     {
-      "fullUrl": "RelatedPerson/1729291749399695000.c6507a22-8a79-4945-8b96-fd6f2239f827",
+      "fullUrl": "RelatedPerson/1729353731108842000.67a241ca-d8fc-4d24-a6bf-72e72b749164",
       "resource": {
         "resourceType": "RelatedPerson",
-        "id": "1729291749399695000.c6507a22-8a79-4945-8b96-fd6f2239f827",
+        "id": "1729353731108842000.67a241ca-d8fc-4d24-a6bf-72e72b749164",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -510,7 +510,7 @@
           }
         ],
         "patient": {
-          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
+          "reference": "Patient/1729353731107720000.e17dc602-b9ea-4b20-9cd4-864dbe3cf166"
         },
         "relationship": [
           {
@@ -548,10 +548,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729291749402918000.8e17ef87-d43c-43af-8096-e5b191868eb2",
+      "fullUrl": "Observation/1729353731111537000.054437c3-8796-4414-90ae-28a75ee56d14",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729291749402918000.8e17ef87-d43c-43af-8096-e5b191868eb2",
+        "id": "1729353731111537000.054437c3-8796-4414-90ae-28a75ee56d14",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
@@ -592,7 +592,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
+          "reference": "Patient/1729353731107720000.e17dc602-b9ea-4b20-9cd4-864dbe3cf166"
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         "effectiveDateTime": "2024-07-11T03:49:13Z",
         "_effectiveDateTime": {
@@ -640,10 +640,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729291749405331000.918cbd1e-0f01-46ed-8136-f38a91ff53ca",
+      "fullUrl": "Observation/1729353731113759000.7f906662-3f5d-48df-9bfd-bec1d8d523db",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729291749405331000.918cbd1e-0f01-46ed-8136-f38a91ff53ca",
+        "id": "1729353731113759000.7f906662-3f5d-48df-9bfd-bec1d8d523db",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
@@ -684,7 +684,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
+          "reference": "Patient/1729353731107720000.e17dc602-b9ea-4b20-9cd4-864dbe3cf166"
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         "_effectiveDateTime": {
@@ -732,10 +732,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729291749407514000.0d1701f5-cd50-4225-85ad-387384eb793e",
+      "fullUrl": "Observation/1729353731115704000.1cd66167-e7e3-4b66-87be-5b2fb781c86f",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729291749407514000.0d1701f5-cd50-4225-85ad-387384eb793e",
+        "id": "1729353731115704000.1cd66167-e7e3-4b66-87be-5b2fb781c86f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
@@ -776,7 +776,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
+          "reference": "Patient/1729353731107720000.e17dc602-b9ea-4b20-9cd4-864dbe3cf166"
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         "effectiveDateTime": "2024-07-11T03:49:13Z",
         "_effectiveDateTime": {
@@ -824,10 +824,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729291749409522000.fa27aa9a-608b-47b8-a575-269d5ada3218",
+      "fullUrl": "Observation/1729353731117588000.30f46868-935b-43b9-bdd3-9cff75b96083",
       "resource": {
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-        "id": "1729291749409522000.fa27aa9a-608b-47b8-a575-269d5ada3218",
+        "id": "1729353731117588000.30f46868-935b-43b9-bdd3-9cff75b96083",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sub-id",
@@ -868,7 +868,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291749398101000.8942505b-7afc-4b80-bb23-3b8c1496cd52"
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diff --git a/examples/MN/004_MN_ORU_R01_NBS_1_hl7_translation.fhir b/examples/MN/004_MN_ORU_R01_NBS_1_hl7_translation.fhir
index 146824bf8..adf1cb475 100644
--- a/examples/MN/004_MN_ORU_R01_NBS_1_hl7_translation.fhir
+++ b/examples/MN/004_MN_ORU_R01_NBS_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729291107444872000.e40ac070-1e5e-4cd6-832f-5b53bf1c4e86",
+  "id": "1729353134037405000.e9b8d650-dbc5-4607-af94-81d9e76af5ee",
   "meta": {
-    "lastUpdated": "2024-10-18T15:38:27.444-07:00"
+    "lastUpdated": "2024-10-19T08:52:14.037-07:00"
   },
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     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2023-06-06T17:28:49.000-07:00",
   "entry": [
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+      "fullUrl": "MessageHeader/1729353134039122000.096ac48a-3aad-4ced-8fae-d3bfae5021c7",
       "resource": {
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+        "id": "1729353134039122000.096ac48a-3aad-4ced-8fae-d3bfae5021c7",
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@@ -151,12 +151,12 @@
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             "receiver": {
-              "reference": "Organization/1729291107447084000.5391ba51-9dad-4f2e-9936-54c7a452bd60"
+              "reference": "Organization/1729353134038792000.982a6307-89f0-4ee9-9d81-74d9c423a06a"
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+          "reference": "Organization/1729353134038051000.5bddf162-dcd7-4141-8bcb-39a4ac7c84d0"
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@@ -182,10 +182,10 @@
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     },
     {
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+      "fullUrl": "Organization/1729353134038051000.5bddf162-dcd7-4141-8bcb-39a4ac7c84d0",
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@@ -218,10 +218,10 @@
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+      "fullUrl": "Organization/1729353134038792000.982a6307-89f0-4ee9-9d81-74d9c423a06a",
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@@ -259,58 +259,58 @@
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@@ -2349,7 +2349,7 @@
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@@ -2517,7 +2517,7 @@
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@@ -2530,7 +2530,7 @@
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@@ -2698,7 +2698,7 @@
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@@ -2711,7 +2711,7 @@
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@@ -2762,10 +2762,10 @@
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@@ -2879,7 +2879,7 @@
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@@ -2943,10 +2943,10 @@
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@@ -3060,7 +3060,7 @@
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@@ -3073,7 +3073,7 @@
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@@ -3124,10 +3124,10 @@
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@@ -3241,7 +3241,7 @@
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@@ -3254,7 +3254,7 @@
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@@ -3422,7 +3422,7 @@
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@@ -3435,7 +3435,7 @@
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@@ -3486,10 +3486,10 @@
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@@ -3603,7 +3603,7 @@
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@@ -3616,7 +3616,7 @@
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@@ -3667,10 +3667,10 @@
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@@ -3784,7 +3784,7 @@
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@@ -3848,10 +3848,10 @@
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@@ -3965,7 +3965,7 @@
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@@ -3978,7 +3978,7 @@
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@@ -4029,10 +4029,10 @@
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@@ -4146,7 +4146,7 @@
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@@ -4210,10 +4210,10 @@
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@@ -4327,7 +4327,7 @@
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@@ -4340,7 +4340,7 @@
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@@ -4508,7 +4508,7 @@
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@@ -4521,7 +4521,7 @@
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@@ -4572,10 +4572,10 @@
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@@ -4689,7 +4689,7 @@
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@@ -4753,10 +4753,10 @@
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@@ -4870,7 +4870,7 @@
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@@ -4934,10 +4934,10 @@
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@@ -5051,7 +5051,7 @@
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@@ -5064,7 +5064,7 @@
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@@ -5115,10 +5115,10 @@
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@@ -5413,7 +5413,7 @@
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@@ -5426,7 +5426,7 @@
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@@ -5477,10 +5477,10 @@
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@@ -5511,15 +5511,15 @@
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@@ -5594,7 +5594,7 @@
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@@ -5607,7 +5607,7 @@
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@@ -5658,10 +5658,10 @@
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@@ -5775,7 +5775,7 @@
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@@ -5788,7 +5788,7 @@
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@@ -5813,10 +5813,10 @@
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@@ -5839,10 +5839,10 @@
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@@ -5873,15 +5873,15 @@
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@@ -5956,7 +5956,7 @@
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@@ -5969,7 +5969,7 @@
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@@ -5994,10 +5994,10 @@
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@@ -6020,10 +6020,10 @@
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@@ -6054,15 +6054,15 @@
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@@ -6137,7 +6137,7 @@
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@@ -6150,7 +6150,7 @@
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@@ -6318,7 +6318,7 @@
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@@ -6499,7 +6499,7 @@
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@@ -6512,7 +6512,7 @@
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@@ -6563,10 +6563,10 @@
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@@ -6680,7 +6680,7 @@
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@@ -6693,7 +6693,7 @@
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@@ -6744,10 +6744,10 @@
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@@ -6861,7 +6861,7 @@
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@@ -6874,7 +6874,7 @@
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@@ -6925,10 +6925,10 @@
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@@ -7042,7 +7042,7 @@
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@@ -7055,7 +7055,7 @@
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@@ -7106,10 +7106,10 @@
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@@ -7585,7 +7585,7 @@
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@@ -7766,7 +7766,7 @@
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@@ -7779,7 +7779,7 @@
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@@ -7830,10 +7830,10 @@
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@@ -7947,7 +7947,7 @@
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@@ -7960,7 +7960,7 @@
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@@ -8490,7 +8490,7 @@
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@@ -8671,7 +8671,7 @@
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@@ -8735,10 +8735,10 @@
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@@ -8852,7 +8852,7 @@
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@@ -8865,7 +8865,7 @@
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@@ -8916,10 +8916,10 @@
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@@ -9046,7 +9046,7 @@
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@@ -9395,7 +9395,7 @@
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@@ -9576,7 +9576,7 @@
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@@ -9757,7 +9757,7 @@
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@@ -9770,7 +9770,7 @@
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@@ -9821,10 +9821,10 @@
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@@ -9938,7 +9938,7 @@
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@@ -9951,7 +9951,7 @@
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@@ -10002,10 +10002,10 @@
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@@ -19334,10 +19334,10 @@
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@@ -19347,10 +19347,10 @@
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@@ -19360,10 +19360,10 @@
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@@ -19373,10 +19373,10 @@
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@@ -19386,10 +19386,10 @@
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@@ -19399,10 +19399,10 @@
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@@ -19412,10 +19412,10 @@
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@@ -19425,10 +19425,10 @@
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@@ -19438,10 +19438,10 @@
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@@ -19451,10 +19451,10 @@
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@@ -19464,10 +19464,10 @@
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@@ -19477,10 +19477,10 @@
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@@ -19642,10 +19642,10 @@
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@@ -19657,13 +19657,13 @@
               {
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@@ -19691,7 +19691,7 @@
               {
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@@ -19835,7 +19835,7 @@
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@@ -19933,18 +19933,18 @@
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@@ -19959,10 +19959,10 @@
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@@ -20014,7 +20014,7 @@
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@@ -20030,10 +20030,10 @@
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@@ -20121,23 +20121,23 @@
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@@ -20213,10 +20213,10 @@
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@@ -20292,10 +20292,10 @@
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@@ -20310,10 +20310,10 @@
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@@ -20361,7 +20361,7 @@
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@@ -20377,10 +20377,10 @@
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@@ -20395,10 +20395,10 @@
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@@ -20446,7 +20446,7 @@
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@@ -20462,10 +20462,10 @@
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@@ -20612,7 +20612,7 @@
               {
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                 "valueReference": {
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@@ -20710,18 +20710,18 @@
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@@ -20736,10 +20736,10 @@
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@@ -20791,7 +20791,7 @@
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@@ -20807,10 +20807,10 @@
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@@ -20825,10 +20825,10 @@
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@@ -20876,7 +20876,7 @@
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@@ -20892,10 +20892,10 @@
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@@ -20907,13 +20907,13 @@
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@@ -20941,7 +20941,7 @@
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@@ -21085,7 +21085,7 @@
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@@ -21183,18 +21183,18 @@
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@@ -21209,10 +21209,10 @@
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@@ -21264,7 +21264,7 @@
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@@ -21280,10 +21280,10 @@
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@@ -21371,23 +21371,23 @@
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@@ -21463,10 +21463,10 @@
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@@ -21542,10 +21542,10 @@
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@@ -21560,10 +21560,10 @@
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@@ -21611,7 +21611,7 @@
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@@ -21627,10 +21627,10 @@
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@@ -21645,10 +21645,10 @@
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@@ -21696,7 +21696,7 @@
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@@ -21712,10 +21712,10 @@
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@@ -21727,13 +21727,13 @@
               {
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                 "valueReference": {
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@@ -21761,7 +21761,7 @@
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@@ -21905,7 +21905,7 @@
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@@ -22003,18 +22003,18 @@
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@@ -22029,10 +22029,10 @@
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@@ -22084,7 +22084,7 @@
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@@ -22100,10 +22100,10 @@
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@@ -22191,23 +22191,23 @@
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@@ -22283,10 +22283,10 @@
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@@ -22362,10 +22362,10 @@
       }
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@@ -22380,10 +22380,10 @@
       }
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@@ -22431,7 +22431,7 @@
             },
             "value": "1174911127",
             "assigner": {
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@@ -22447,10 +22447,10 @@
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@@ -22465,10 +22465,10 @@
       }
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@@ -22516,7 +22516,7 @@
             },
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             "assigner": {
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@@ -22532,10 +22532,10 @@
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@@ -22547,13 +22547,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107787984000.7292f507-4a2c-409b-b719-c810926832bf"
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@@ -22581,7 +22581,7 @@
               {
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@@ -22725,7 +22725,7 @@
               {
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@@ -22823,18 +22823,18 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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@@ -22849,10 +22849,10 @@
       }
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@@ -22904,7 +22904,7 @@
             },
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             "assigner": {
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@@ -22920,10 +22920,10 @@
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         "extension": [
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@@ -23011,23 +23011,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729291107780618000.c45b4f76-4123-47a5-b4d9-b87adf3f07f1",
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+          "reference": "Practitioner/1729353134368595000.c4c69f1f-d099-4c0b-a040-85200ab51ebe"
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         "extension": [
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@@ -23103,10 +23103,10 @@
       }
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         "extension": [
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@@ -23182,10 +23182,10 @@
       }
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@@ -23200,10 +23200,10 @@
       }
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         "extension": [
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@@ -23251,7 +23251,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729291107792021000.e2b3d2c7-c111-44ba-b5ca-e9b0285ee48e"
+              "reference": "Organization/1729353134386410000.9a6f779e-a79f-4d33-ad62-10df8deccc8a"
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@@ -23267,10 +23267,10 @@
       }
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@@ -23285,10 +23285,10 @@
       }
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       "resource": {
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         "extension": [
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@@ -23336,7 +23336,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729291107796638000.38c113e7-a2f7-47d2-8c86-734c46e58a84"
+              "reference": "Organization/1729353134388780000.9c5c062f-0dcd-4d93-ae59-b6615da32352"
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@@ -23352,10 +23352,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729353134399644000.a36d3292-7206-4325-9a17-b8a605720119",
       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -23367,13 +23367,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107813573000.8d16dba9-a7c5-431d-bd7b-44c3991d215c"
+                  "reference": "Organization/1729353134394792000.de1654c4-16d9-44c4-bc33-c82aee4971e2"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107816300000.9e29ae56-363e-4d3d-b3bf-f590c1deffc5"
+                  "reference": "Organization/1729353134395621000.5a1312bf-e508-49e1-96f5-e40866035a07"
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@@ -23401,7 +23401,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729291107818165000.2e635ad0-f76f-41b5-abd4-99f42a1734c3"
+                  "reference": "Practitioner/1729353134396912000.88f53c49-1eee-4f92-9888-7092ff01fd41"
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@@ -23545,7 +23545,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729353134399172000.cd52b87e-4fd2-4bdf-aab5-4485998ae51f"
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@@ -23643,18 +23643,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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         "requester": {
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@@ -23669,10 +23669,10 @@
       }
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         "extension": [
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@@ -23724,7 +23724,7 @@
             },
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             "assigner": {
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@@ -23740,10 +23740,10 @@
       }
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         "extension": [
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@@ -23831,23 +23831,23 @@
       }
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@@ -23923,10 +23923,10 @@
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@@ -24002,10 +24002,10 @@
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@@ -24020,10 +24020,10 @@
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@@ -24071,7 +24071,7 @@
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@@ -24087,10 +24087,10 @@
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@@ -24105,10 +24105,10 @@
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@@ -24156,7 +24156,7 @@
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@@ -24172,10 +24172,10 @@
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@@ -24187,13 +24187,13 @@
               {
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                 "valueReference": {
-                  "reference": "Organization/1729291107825998000.7b87572a-2922-4634-8fda-4e2043b87904"
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@@ -24221,7 +24221,7 @@
               {
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@@ -24365,7 +24365,7 @@
               {
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@@ -24463,18 +24463,18 @@
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@@ -24489,10 +24489,10 @@
       }
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@@ -24544,7 +24544,7 @@
             },
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             "assigner": {
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@@ -24560,10 +24560,10 @@
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@@ -24651,23 +24651,23 @@
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@@ -24743,10 +24743,10 @@
       }
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@@ -24822,10 +24822,10 @@
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@@ -24840,10 +24840,10 @@
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@@ -24891,7 +24891,7 @@
             },
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             "assigner": {
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@@ -24907,10 +24907,10 @@
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@@ -24925,10 +24925,10 @@
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@@ -24976,7 +24976,7 @@
             },
             "value": "1174911127",
             "assigner": {
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@@ -24992,10 +24992,10 @@
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@@ -25007,13 +25007,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107835610000.2a09665a-190b-4d2b-88b2-6c506a255e59"
+                  "reference": "Organization/1729353134413824000.ce8982a3-978d-4172-8c78-46f72fcd007d"
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+                  "reference": "Organization/1729353134414648000.140edf20-33b2-482f-9970-1645a7b1f6ff"
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@@ -25041,7 +25041,7 @@
               {
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+                  "reference": "Practitioner/1729353134415936000.c61cb64a-6615-40c6-ba73-86d7400fa65c"
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@@ -25185,7 +25185,7 @@
               {
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@@ -25283,18 +25283,18 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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@@ -25309,10 +25309,10 @@
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@@ -25364,7 +25364,7 @@
             },
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@@ -25380,10 +25380,10 @@
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@@ -25471,23 +25471,23 @@
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@@ -25563,10 +25563,10 @@
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@@ -25642,10 +25642,10 @@
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@@ -25660,10 +25660,10 @@
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@@ -25711,7 +25711,7 @@
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@@ -25727,10 +25727,10 @@
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@@ -25745,10 +25745,10 @@
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@@ -25796,7 +25796,7 @@
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@@ -25812,10 +25812,10 @@
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@@ -25827,13 +25827,13 @@
               {
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@@ -25861,7 +25861,7 @@
               {
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@@ -26005,7 +26005,7 @@
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@@ -26103,18 +26103,18 @@
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@@ -26129,10 +26129,10 @@
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@@ -26184,7 +26184,7 @@
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             "assigner": {
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@@ -26200,10 +26200,10 @@
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@@ -26291,23 +26291,23 @@
       }
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@@ -26383,10 +26383,10 @@
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@@ -26462,10 +26462,10 @@
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@@ -26480,10 +26480,10 @@
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@@ -26531,7 +26531,7 @@
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             "assigner": {
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@@ -26547,10 +26547,10 @@
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@@ -26565,10 +26565,10 @@
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@@ -26616,7 +26616,7 @@
             },
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             "assigner": {
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@@ -26632,10 +26632,10 @@
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@@ -26647,13 +26647,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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@@ -26681,7 +26681,7 @@
               {
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@@ -26825,7 +26825,7 @@
               {
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@@ -26922,18 +26922,18 @@
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@@ -26948,10 +26948,10 @@
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@@ -27003,7 +27003,7 @@
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@@ -27019,10 +27019,10 @@
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@@ -27110,23 +27110,23 @@
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@@ -27202,10 +27202,10 @@
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@@ -27281,10 +27281,10 @@
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@@ -27299,10 +27299,10 @@
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@@ -27350,7 +27350,7 @@
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@@ -27366,10 +27366,10 @@
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@@ -27384,10 +27384,10 @@
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@@ -27435,7 +27435,7 @@
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@@ -27451,10 +27451,10 @@
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@@ -27466,13 +27466,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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@@ -27500,7 +27500,7 @@
               {
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@@ -27644,7 +27644,7 @@
               {
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@@ -27742,18 +27742,18 @@
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@@ -27768,10 +27768,10 @@
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@@ -27823,7 +27823,7 @@
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@@ -27839,10 +27839,10 @@
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@@ -27930,23 +27930,23 @@
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@@ -28022,10 +28022,10 @@
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@@ -28101,10 +28101,10 @@
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@@ -28119,10 +28119,10 @@
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@@ -28170,7 +28170,7 @@
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             "assigner": {
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@@ -28186,10 +28186,10 @@
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@@ -28204,10 +28204,10 @@
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@@ -28255,7 +28255,7 @@
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@@ -28271,10 +28271,10 @@
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@@ -28286,13 +28286,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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@@ -28320,7 +28320,7 @@
               {
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@@ -28464,7 +28464,7 @@
               {
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@@ -28562,18 +28562,18 @@
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@@ -28588,10 +28588,10 @@
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@@ -28643,7 +28643,7 @@
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             "assigner": {
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@@ -28659,10 +28659,10 @@
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@@ -28750,23 +28750,23 @@
       }
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+        "id": "1729353134447536000.e6e2459a-9876-4da9-8060-f8a67df927b6",
         "practitioner": {
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+          "reference": "Practitioner/1729353134455197000.d7499239-4b18-4e71-81e3-23db0c05cd43"
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         "extension": [
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@@ -28842,10 +28842,10 @@
       }
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     {
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         "extension": [
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@@ -28921,10 +28921,10 @@
       }
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@@ -28939,10 +28939,10 @@
       }
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@@ -28990,7 +28990,7 @@
             },
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             "assigner": {
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@@ -29006,10 +29006,10 @@
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@@ -29024,10 +29024,10 @@
       }
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@@ -29075,7 +29075,7 @@
             },
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             "assigner": {
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@@ -29091,10 +29091,10 @@
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@@ -29106,13 +29106,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107885687000.e668bf26-2a93-40a6-970d-535b4e8cf2df"
+                  "reference": "Organization/1729353134476306000.3e6e7fce-0985-4a1c-91a3-4a943eb0cab5"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107886764000.5a1c460c-f08d-4801-bd64-d2d2338eb078"
+                  "reference": "Organization/1729353134477148000.8035bd76-ba95-4818-ad85-51dc47b291f1"
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@@ -29140,7 +29140,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729291107888108000.1ebadded-e239-4931-8a94-9f033bd6fc02"
+                  "reference": "Practitioner/1729353134478459000.06aeeec8-15cd-4613-a06c-c13728bc20d3"
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@@ -29284,7 +29284,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291107890313000.ac26b3a9-330a-48ca-9937-fcd250763a41"
+                  "reference": "Practitioner/1729353134480673000.474a59ce-d58d-44bd-8c5d-67af2308a04a"
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@@ -29382,18 +29382,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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         "requester": {
-          "reference": "PractitionerRole/1729291107880438000.0ed18c71-abd4-4312-87b1-9e5a01b28016"
+          "reference": "PractitionerRole/1729353134471694000.64007a48-2d65-4e24-8696-30324e38074c"
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@@ -29408,10 +29408,10 @@
       }
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@@ -29463,7 +29463,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729291107880714000.07329767-5015-4e21-ad71-e2bd93ac7c32"
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@@ -29479,10 +29479,10 @@
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         "extension": [
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@@ -29570,23 +29570,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729291107880438000.0ed18c71-abd4-4312-87b1-9e5a01b28016",
+      "fullUrl": "PractitionerRole/1729353134471694000.64007a48-2d65-4e24-8696-30324e38074c",
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@@ -29662,10 +29662,10 @@
       }
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@@ -29741,10 +29741,10 @@
       }
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@@ -29759,10 +29759,10 @@
       }
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         "extension": [
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@@ -29810,7 +29810,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729291107887329000.e6131390-305a-489f-8bf8-def6273e247d"
+              "reference": "Organization/1729353134477707000.0a544f94-45f9-4875-b6b0-eb7c5d2b772c"
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@@ -29826,10 +29826,10 @@
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@@ -29844,10 +29844,10 @@
       }
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@@ -29895,7 +29895,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729291107889563000.6b139ae0-4038-4b25-b08e-1c399eb3439b"
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@@ -29911,10 +29911,10 @@
       }
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@@ -29926,13 +29926,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107896378000.f2e1fcb8-dea7-4d39-97fe-5b10517b7df8"
+                  "reference": "Organization/1729353134485917000.324ff264-daec-42c1-9441-76c7ac29f538"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729353134486748000.76c18fd2-8722-4d6b-84df-3f0d834ae671"
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@@ -29960,7 +29960,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291107899779000.048692aa-c53f-4b79-b758-4c35811a4067"
+                  "reference": "Practitioner/1729353134488051000.ed78ebee-4dce-4288-bd00-a58758ae0553"
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@@ -30104,7 +30104,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291107905027000.e5bbef14-3c35-4076-a9c0-2fa841aa5f35"
+                  "reference": "Practitioner/1729353134490282000.368beb51-3f31-4dd8-a6c0-53708662cd2c"
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@@ -30202,18 +30202,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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         "requester": {
-          "reference": "PractitionerRole/1729291107890963000.9de57c68-9be2-4e3a-af11-5a471141bab3"
+          "reference": "PractitionerRole/1729353134481300000.51a13d5c-d833-4a2c-b6e2-407061717f06"
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@@ -30228,10 +30228,10 @@
       }
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@@ -30283,7 +30283,7 @@
             },
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             "assigner": {
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@@ -30299,10 +30299,10 @@
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@@ -30390,23 +30390,23 @@
       }
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@@ -30482,10 +30482,10 @@
       }
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@@ -30561,10 +30561,10 @@
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@@ -30579,10 +30579,10 @@
       }
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@@ -30630,7 +30630,7 @@
             },
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             "assigner": {
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@@ -30646,10 +30646,10 @@
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@@ -30664,10 +30664,10 @@
       }
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@@ -30715,7 +30715,7 @@
             },
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             "assigner": {
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@@ -30731,10 +30731,10 @@
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@@ -30746,13 +30746,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107919534000.5eb8a255-a8d1-487d-99d7-dadb896ff39d"
+                  "reference": "Organization/1729353134495454000.e7741dfb-1e00-4b97-b6e2-c6a05ed11ef1"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729353134496294000.7db83b53-fe11-47ab-b214-18dc33d4f977"
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@@ -30780,7 +30780,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729291107925112000.78480cb9-7949-4525-93f5-50069d8a8599"
+                  "reference": "Practitioner/1729353134497596000.47ec9b5a-a45d-44bb-8a22-ac9f6f200350"
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@@ -30924,7 +30924,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729353134499841000.66ada9d1-1dbe-4302-af12-63a46d2ef6e6"
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@@ -31022,18 +31022,18 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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@@ -31048,10 +31048,10 @@
       }
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@@ -31103,7 +31103,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729291107907400000.d47581af-8d07-422b-852c-4428f0ab7c21"
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@@ -31119,10 +31119,10 @@
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@@ -31210,23 +31210,23 @@
       }
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@@ -31302,10 +31302,10 @@
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@@ -31381,10 +31381,10 @@
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@@ -31399,10 +31399,10 @@
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@@ -31450,7 +31450,7 @@
             },
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             "assigner": {
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@@ -31466,10 +31466,10 @@
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@@ -31484,10 +31484,10 @@
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@@ -31535,7 +31535,7 @@
             },
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             "assigner": {
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@@ -31551,10 +31551,10 @@
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@@ -31623,7 +31623,7 @@
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@@ -31647,7 +31647,7 @@
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@@ -31669,258 +31669,258 @@
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         "resourceType": "DiagnosticReport",
-        "id": "1729291107955355000.cf2de07a-f88c-438e-8266-40ab24628977",
+        "id": "1729353134527309000.f4216295-5b06-4632-9db3-b672c474a620",
         "identifier": [
           {
             "extension": [
@@ -33317,7 +33317,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291107880225000.b792767a-10c5-4557-8cca-e4d731bb1d38"
+            "reference": "ServiceRequest/1729353134471527000.01b92a4c-e98b-4067-8775-4cef7867d306"
           }
         ],
         "status": "final",
@@ -33341,7 +33341,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -33363,21 +33363,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291107727883000.ea92537f-b3f6-44ff-9ca7-ded63a5baafe"
+            "reference": "Specimen/1729353134325488000.e5b4b97c-770c-449e-aa40-395a209c8fca"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729291107707422000.2f64f1d0-508f-40ab-a0e0-ec67ed0dbe67"
+            "reference": "Observation/1729353134301154000.7dfaf4e3-84b7-4b7a-88e7-86a86e73d933"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729291107956904000.798dc2d6-a996-41a0-8cbd-9333700198e5",
+      "fullUrl": "DiagnosticReport/1729353134528870000.418fd1e1-00c9-4d06-9266-3744215e716a",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729291107956904000.798dc2d6-a996-41a0-8cbd-9333700198e5",
+        "id": "1729353134528870000.418fd1e1-00c9-4d06-9266-3744215e716a",
         "identifier": [
           {
             "extension": [
@@ -33446,7 +33446,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291107890794000.1b8d1c45-eb0d-41a0-91ea-676fedd7645b"
+            "reference": "ServiceRequest/1729353134481137000.5fd6cce4-521d-4b93-867e-542cfef42774"
           }
         ],
         "status": "final",
@@ -33470,7 +33470,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -33492,21 +33492,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291107728218000.67c82b8e-73a7-40d6-a0fb-45220ecc0fcf"
+            "reference": "Specimen/1729353134325841000.3dfa330d-a035-49ca-a7ff-77999759e05d"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729291107709363000.62bb89b3-e268-455d-aefa-f3ed9a1dfed0"
+            "reference": "Observation/1729353134304879000.a02d2279-592a-4de8-b744-da9fcd027904"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729291107958474000.1c09e264-b1c4-413a-ba4e-505e66f54641",
+      "fullUrl": "DiagnosticReport/1729353134530716000.4cd7b908-089a-4985-a9cf-ea6a70916f77",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729291107958474000.1c09e264-b1c4-413a-ba4e-505e66f54641",
+        "id": "1729353134530716000.4cd7b908-089a-4985-a9cf-ea6a70916f77",
         "identifier": [
           {
             "extension": [
@@ -33575,7 +33575,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291107906481000.02c14d41-3c3d-46e4-a4ce-b6f1c39d09c9"
+            "reference": "ServiceRequest/1729353134490753000.9fab3c92-c907-419b-b315-3263b6ca937d"
           }
         ],
         "status": "final",
@@ -33599,7 +33599,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -33621,21 +33621,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291107728560000.3662692a-c052-4811-b3bf-76cc239e1bda"
+            "reference": "Specimen/1729353134326209000.09acac12-769f-4bd5-91b5-475231f8adc5"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729291107711352000.bc7b5392-4460-43d2-8b01-dd6069a7fbca"
+            "reference": "Observation/1729353134309279000.a6754ada-22bc-4ce2-830f-baaebecd9307"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7",
+      "fullUrl": "DiagnosticReport/1729353134532388000.309d17c4-ca64-4560-b6af-ee14d84e85eb",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7",
+        "id": "1729353134532388000.309d17c4-ca64-4560-b6af-ee14d84e85eb",
         "identifier": [
           {
             "extension": [
@@ -33704,7 +33704,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291107928381000.393a5e55-bf48-4df3-9b33-0d5c0f319080"
+            "reference": "ServiceRequest/1729353134500320000.5f026c93-0116-4157-be5d-cd3d9e3ea2fc"
           }
         ],
         "status": "final",
@@ -33728,7 +33728,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -33750,12 +33750,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291107728890000.b65e0a21-8472-43c5-8186-c66a4167448e"
+            "reference": "Specimen/1729353134326568000.5d8e0017-ffaf-4bb3-b644-8833bd46ebf0"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729291107713347000.12695555-420d-4590-be82-8d646ab4b90b"
+            "reference": "Observation/1729353134311364000.4c2ecf63-8087-43aa-b484-fc33f1d63c64"
           }
         ]
       }
diff --git a/examples/MN/004_MN_ORU_R01_NBS_2_fhir_transformation.fhir b/examples/MN/004_MN_ORU_R01_NBS_2_fhir_transformation.fhir
index b3d077483..277c5a0dc 100644
--- a/examples/MN/004_MN_ORU_R01_NBS_2_fhir_transformation.fhir
+++ b/examples/MN/004_MN_ORU_R01_NBS_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729291107444872000.e40ac070-1e5e-4cd6-832f-5b53bf1c4e86",
+  "id": "1729353134037405000.e9b8d650-dbc5-4607-af94-81d9e76af5ee",
   "meta": {
-    "lastUpdated": "2024-10-18T15:38:27.444-07:00"
+    "lastUpdated": "2024-10-19T08:52:14.037-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2023-06-06T17:28:49.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729291107447411000.07549021-9f4c-4f23-8669-14729e53486e",
+      "fullUrl": "MessageHeader/1729353134039122000.096ac48a-3aad-4ced-8fae-d3bfae5021c7",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729291107447411000.07549021-9f4c-4f23-8669-14729e53486e",
+        "id": "1729353134039122000.096ac48a-3aad-4ced-8fae-d3bfae5021c7",
         "meta": {
           "tag": [
             {
@@ -156,12 +156,12 @@
             "name": "Epic",
             "endpoint": "urn:oid:1.2.840.114350.1.13.145.2.7.2.695071",
             "receiver": {
-              "reference": "Organization/1729291107447084000.5391ba51-9dad-4f2e-9936-54c7a452bd60"
+              "reference": "Organization/1729353134038792000.982a6307-89f0-4ee9-9d81-74d9c423a06a"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729291107446309000.dbc0897e-6bc9-4c22-95c6-68a6f42eb67f"
+          "reference": "Organization/1729353134038051000.5bddf162-dcd7-4141-8bcb-39a4ac7c84d0"
         },
         "source": {
           "extension": [
@@ -187,10 +187,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291107446309000.dbc0897e-6bc9-4c22-95c6-68a6f42eb67f",
+      "fullUrl": "Organization/1729353134038051000.5bddf162-dcd7-4141-8bcb-39a4ac7c84d0",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291107446309000.dbc0897e-6bc9-4c22-95c6-68a6f42eb67f",
+        "id": "1729353134038051000.5bddf162-dcd7-4141-8bcb-39a4ac7c84d0",
         "identifier": [
           {
             "extension": [
@@ -223,10 +223,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291107447084000.5391ba51-9dad-4f2e-9936-54c7a452bd60",
+      "fullUrl": "Organization/1729353134038792000.982a6307-89f0-4ee9-9d81-74d9c423a06a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291107447084000.5391ba51-9dad-4f2e-9936-54c7a452bd60",
+        "id": "1729353134038792000.982a6307-89f0-4ee9-9d81-74d9c423a06a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -264,58 +264,58 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729291107450218000.57b33bad-d132-409f-89c5-9ab0ffe7971a",
+      "fullUrl": "Provenance/1729353134041387000.b314ae8e-666e-4215-93b1-38efdaa5249f",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729291107450218000.57b33bad-d132-409f-89c5-9ab0ffe7971a",
+        "id": "1729353134041387000.b314ae8e-666e-4215-93b1-38efdaa5249f",
         "target": [
           {
-            "reference": "MessageHeader/1729291107447411000.07549021-9f4c-4f23-8669-14729e53486e"
+            "reference": "MessageHeader/1729353134039122000.096ac48a-3aad-4ced-8fae-d3bfae5021c7"
           },
           {
-            "reference": "DiagnosticReport/1729291107937451000.01c9892e-0be4-488a-bd55-5ac4a0c62705"
+            "reference": "DiagnosticReport/1729353134509225000.e2edee29-3923-46fd-a010-d6faf9244dca"
           },
           {
-            "reference": "DiagnosticReport/1729291107939388000.c3fb3626-141e-492c-8d16-d050d22670f0"
+            "reference": "DiagnosticReport/1729353134511093000.328be3bc-47fe-405e-be34-a7f7482c4c60"
           },
           {
-            "reference": "DiagnosticReport/1729291107940957000.28b9bf3c-8776-4d4a-ad5e-f581632c7829"
+            "reference": "DiagnosticReport/1729353134512671000.5b7056fe-b7cb-4bd4-88e8-0658a9b3352a"
           },
           {
-            "reference": "DiagnosticReport/1729291107942557000.48186f3e-a3e9-4e8a-ad18-112510ba96cd"
+            "reference": "DiagnosticReport/1729353134514248000.04edef8b-df64-4936-a226-9d7be3c77544"
           },
           {
-            "reference": "DiagnosticReport/1729291107944144000.04b557f0-d52c-4473-a0ee-5b59f1d23e55"
+            "reference": "DiagnosticReport/1729353134515821000.021fc95b-d434-4e9f-ab26-3b62208f392f"
           },
           {
-            "reference": "DiagnosticReport/1729291107945749000.25c447ac-7856-40d1-838f-2d2e5626363f"
+            "reference": "DiagnosticReport/1729353134517452000.5e226802-a1be-47ef-89fd-4bfeeb161788"
           },
           {
-            "reference": "DiagnosticReport/1729291107947373000.cf62a87d-7104-4a2b-bd6a-656228e26ffd"
+            "reference": "DiagnosticReport/1729353134519298000.f54b20e2-4f65-4c3e-8fe2-7e5b57991854"
           },
           {
-            "reference": "DiagnosticReport/1729291107949011000.3efd48d0-480d-4bbb-807d-bcd208d02163"
+            "reference": "DiagnosticReport/1729353134520906000.1a993cdd-608e-4322-a5d3-42c0737502af"
           },
           {
-            "reference": "DiagnosticReport/1729291107950608000.0b3b3d1a-b4b7-4d0b-a6f8-3a2edb165162"
+            "reference": "DiagnosticReport/1729353134522514000.eb765b40-82df-4884-8af6-87e6eed60359"
           },
           {
-            "reference": "DiagnosticReport/1729291107952193000.c589f522-e2f1-4328-8814-bf1fd3e59806"
+            "reference": "DiagnosticReport/1729353134524098000.6164b785-c790-445c-ab5c-bb23380e141a"
           },
           {
-            "reference": "DiagnosticReport/1729291107953799000.61d41968-e1fc-4a18-87e7-b48398ea1a00"
+            "reference": "DiagnosticReport/1729353134525731000.b5c75960-02e1-42d5-aed6-f1a01929f4e0"
           },
           {
-            "reference": "DiagnosticReport/1729291107955355000.cf2de07a-f88c-438e-8266-40ab24628977"
+            "reference": "DiagnosticReport/1729353134527309000.f4216295-5b06-4632-9db3-b672c474a620"
           },
           {
-            "reference": "DiagnosticReport/1729291107956904000.798dc2d6-a996-41a0-8cbd-9333700198e5"
+            "reference": "DiagnosticReport/1729353134528870000.418fd1e1-00c9-4d06-9266-3744215e716a"
           },
           {
-            "reference": "DiagnosticReport/1729291107958474000.1c09e264-b1c4-413a-ba4e-505e66f54641"
+            "reference": "DiagnosticReport/1729353134530716000.4cd7b908-089a-4985-a9cf-ea6a70916f77"
           },
           {
-            "reference": "DiagnosticReport/1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7"
+            "reference": "DiagnosticReport/1729353134532388000.309d17c4-ca64-4560-b6af-ee14d84e85eb"
           }
         ],
         "recorded": "2023-06-06T19:28:49-05:00",
@@ -337,17 +337,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729291107449935000.e4879612-05fc-4e40-9bc0-984157488f0a"
+              "reference": "Organization/1729353134041135000.1b34c6d9-1271-4242-8152-7fc89ed34f5a"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729291107449935000.e4879612-05fc-4e40-9bc0-984157488f0a",
+      "fullUrl": "Organization/1729353134041135000.1b34c6d9-1271-4242-8152-7fc89ed34f5a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291107449935000.e4879612-05fc-4e40-9bc0-984157488f0a",
+        "id": "1729353134041135000.1b34c6d9-1271-4242-8152-7fc89ed34f5a",
         "identifier": [
           {
             "extension": [
@@ -380,11 +380,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729291107450926000.8d3941f4-8bf9-4feb-815d-837dadda563b",
+      "fullUrl": "Provenance/1729353134042072000.3415c564-1979-48fe-83fd-d6c2a59c3c5c",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729291107450926000.8d3941f4-8bf9-4feb-815d-837dadda563b",
-        "recorded": "2024-10-18T15:38:27Z",
+        "id": "1729353134042072000.3415c564-1979-48fe-83fd-d6c2a59c3c5c",
+        "recorded": "2024-10-19T08:52:14Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -406,17 +406,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729291107450778000.b0477565-3b08-47de-93c1-03ddd13c0400"
+              "reference": "Organization/1729353134041934000.3e403251-d391-474c-b1a2-4e81fc0082a3"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729291107450778000.b0477565-3b08-47de-93c1-03ddd13c0400",
+      "fullUrl": "Organization/1729353134041934000.3e403251-d391-474c-b1a2-4e81fc0082a3",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291107450778000.b0477565-3b08-47de-93c1-03ddd13c0400",
+        "id": "1729353134041934000.3e403251-d391-474c-b1a2-4e81fc0082a3",
         "identifier": [
           {
             "value": "CDC PRIME - Atlanta"
@@ -436,10 +436,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70",
+      "fullUrl": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70",
+        "id": "1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -477,7 +477,7 @@
             },
             "value": "11102779",
             "assigner": {
-              "reference": "Organization/1729291107451677000.3dd864d6-5719-423e-bf17-d145b55f4528"
+              "reference": "Organization/1729353134042737000.566802a9-517a-40c6-929f-7d699b2cf27b"
             }
           }
         ],
@@ -677,10 +677,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729291107451677000.3dd864d6-5719-423e-bf17-d145b55f4528",
+      "fullUrl": "Organization/1729353134042737000.566802a9-517a-40c6-929f-7d699b2cf27b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729291107451677000.3dd864d6-5719-423e-bf17-d145b55f4528",
+        "id": "1729353134042737000.566802a9-517a-40c6-929f-7d699b2cf27b",
         "identifier": [
           {
             "extension": [
@@ -695,16 +695,16 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729291107458727000.23eb40ff-e623-42d6-ac3d-89390dff03b2",
+      "fullUrl": "Provenance/1729353134050795000.b24628a3-d45a-42b4-909d-69a9a1595c89",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729291107458727000.23eb40ff-e623-42d6-ac3d-89390dff03b2",
+        "id": "1729353134050795000.b24628a3-d45a-42b4-909d-69a9a1595c89",
         "target": [
           {
-            "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
+            "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
           }
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-        "recorded": "2024-10-18T15:38:27Z",
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@@ -929,7 +929,7 @@
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@@ -1110,7 +1110,7 @@
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@@ -1174,10 +1174,10 @@
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@@ -1291,7 +1291,7 @@
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@@ -1304,17 +1304,17 @@
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@@ -1337,10 +1337,10 @@
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@@ -1394,10 +1394,10 @@
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@@ -1454,7 +1454,7 @@
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@@ -1467,17 +1467,17 @@
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@@ -1500,10 +1500,10 @@
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@@ -1534,15 +1534,15 @@
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@@ -1557,10 +1557,10 @@
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@@ -1617,7 +1617,7 @@
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@@ -1630,7 +1630,7 @@
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@@ -1655,10 +1655,10 @@
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@@ -1681,10 +1681,10 @@
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@@ -1715,15 +1715,15 @@
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@@ -1811,7 +1811,7 @@
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@@ -1862,10 +1862,10 @@
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@@ -1979,7 +1979,7 @@
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@@ -1992,7 +1992,7 @@
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@@ -2043,10 +2043,10 @@
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@@ -2160,7 +2160,7 @@
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@@ -2173,7 +2173,7 @@
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@@ -2224,10 +2224,10 @@
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@@ -2258,15 +2258,15 @@
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@@ -2281,10 +2281,10 @@
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@@ -2341,7 +2341,7 @@
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@@ -2354,7 +2354,7 @@
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@@ -2379,10 +2379,10 @@
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@@ -2405,10 +2405,10 @@
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@@ -2439,15 +2439,15 @@
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@@ -2462,10 +2462,10 @@
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@@ -2522,7 +2522,7 @@
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@@ -2535,7 +2535,7 @@
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@@ -2560,10 +2560,10 @@
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@@ -2586,10 +2586,10 @@
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@@ -2620,15 +2620,15 @@
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@@ -2703,7 +2703,7 @@
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@@ -2716,7 +2716,7 @@
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@@ -3065,7 +3065,7 @@
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@@ -3078,7 +3078,7 @@
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@@ -3246,7 +3246,7 @@
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@@ -3310,10 +3310,10 @@
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@@ -3427,7 +3427,7 @@
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@@ -3440,7 +3440,7 @@
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@@ -3491,10 +3491,10 @@
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@@ -3525,15 +3525,15 @@
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@@ -3608,7 +3608,7 @@
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@@ -3621,7 +3621,7 @@
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@@ -3672,10 +3672,10 @@
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@@ -4332,7 +4332,7 @@
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@@ -4396,10 +4396,10 @@
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@@ -4513,7 +4513,7 @@
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@@ -4526,7 +4526,7 @@
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@@ -4577,10 +4577,10 @@
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@@ -4875,7 +4875,7 @@
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@@ -5056,7 +5056,7 @@
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@@ -5237,7 +5237,7 @@
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@@ -5250,7 +5250,7 @@
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@@ -5301,10 +5301,10 @@
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@@ -5418,7 +5418,7 @@
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@@ -5431,7 +5431,7 @@
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@@ -5482,10 +5482,10 @@
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@@ -5516,15 +5516,15 @@
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@@ -5599,7 +5599,7 @@
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@@ -5612,7 +5612,7 @@
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@@ -5637,10 +5637,10 @@
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@@ -5663,10 +5663,10 @@
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@@ -5780,7 +5780,7 @@
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@@ -5793,7 +5793,7 @@
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@@ -5844,10 +5844,10 @@
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@@ -5961,7 +5961,7 @@
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@@ -5974,7 +5974,7 @@
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@@ -6025,10 +6025,10 @@
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@@ -6142,7 +6142,7 @@
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@@ -6155,7 +6155,7 @@
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@@ -6206,10 +6206,10 @@
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@@ -6240,15 +6240,15 @@
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@@ -6263,10 +6263,10 @@
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@@ -6323,7 +6323,7 @@
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@@ -6336,7 +6336,7 @@
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@@ -6361,10 +6361,10 @@
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@@ -6387,10 +6387,10 @@
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@@ -6421,15 +6421,15 @@
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@@ -6504,7 +6504,7 @@
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@@ -6517,7 +6517,7 @@
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@@ -6542,10 +6542,10 @@
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@@ -6568,10 +6568,10 @@
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@@ -7228,7 +7228,7 @@
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@@ -7409,7 +7409,7 @@
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@@ -7473,10 +7473,10 @@
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@@ -8314,7 +8314,7 @@
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@@ -8495,7 +8495,7 @@
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@@ -8857,7 +8857,7 @@
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@@ -8921,10 +8921,10 @@
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@@ -9038,7 +9038,7 @@
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@@ -9051,7 +9051,7 @@
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@@ -9102,10 +9102,10 @@
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@@ -9219,7 +9219,7 @@
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@@ -9232,7 +9232,7 @@
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@@ -9257,10 +9257,10 @@
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@@ -9283,10 +9283,10 @@
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@@ -9317,15 +9317,15 @@
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@@ -9400,7 +9400,7 @@
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@@ -9413,7 +9413,7 @@
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@@ -9464,10 +9464,10 @@
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@@ -18869,10 +18869,10 @@
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@@ -18943,7 +18943,7 @@
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@@ -18956,7 +18956,7 @@
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@@ -18995,10 +18995,10 @@
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@@ -19021,10 +19021,10 @@
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@@ -19055,15 +19055,15 @@
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@@ -19078,10 +19078,10 @@
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@@ -19152,7 +19152,7 @@
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@@ -19165,7 +19165,7 @@
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@@ -19204,10 +19204,10 @@
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@@ -19230,10 +19230,10 @@
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@@ -19264,15 +19264,15 @@
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@@ -19287,10 +19287,10 @@
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@@ -19300,10 +19300,10 @@
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@@ -19313,10 +19313,10 @@
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@@ -19326,10 +19326,10 @@
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@@ -19339,10 +19339,10 @@
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@@ -19352,10 +19352,10 @@
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@@ -19365,10 +19365,10 @@
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@@ -19378,10 +19378,10 @@
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@@ -19391,10 +19391,10 @@
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@@ -19404,10 +19404,10 @@
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@@ -19417,10 +19417,10 @@
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@@ -19430,10 +19430,10 @@
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@@ -19443,10 +19443,10 @@
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@@ -19456,10 +19456,10 @@
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@@ -19469,10 +19469,10 @@
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@@ -19482,10 +19482,10 @@
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@@ -19647,10 +19647,10 @@
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@@ -19662,13 +19662,13 @@
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@@ -19696,7 +19696,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729353134336231000.b58cafeb-9060-4c15-b4ca-6789faeb3353"
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@@ -19840,7 +19840,7 @@
               {
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@@ -19938,18 +19938,18 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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@@ -19964,10 +19964,10 @@
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@@ -20019,7 +20019,7 @@
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@@ -20035,10 +20035,10 @@
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@@ -20126,23 +20126,23 @@
       }
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@@ -20218,10 +20218,10 @@
       }
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@@ -20297,10 +20297,10 @@
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@@ -20315,10 +20315,10 @@
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@@ -20366,7 +20366,7 @@
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             "assigner": {
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@@ -20382,10 +20382,10 @@
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@@ -20400,10 +20400,10 @@
       }
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@@ -20451,7 +20451,7 @@
             },
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             "assigner": {
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@@ -20467,10 +20467,10 @@
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@@ -20617,7 +20617,7 @@
               {
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                 "valueReference": {
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@@ -20715,18 +20715,18 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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@@ -20741,10 +20741,10 @@
       }
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@@ -20796,7 +20796,7 @@
             },
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@@ -20812,10 +20812,10 @@
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@@ -20830,10 +20830,10 @@
       }
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@@ -20881,7 +20881,7 @@
             },
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             "assigner": {
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@@ -20897,10 +20897,10 @@
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -20912,13 +20912,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107764497000.e3785359-51b7-4fa5-93ce-48e0f4c2f319"
+                  "reference": "Organization/1729353134349021000.cd4295a5-3ba8-4982-bc7f-8e4b75d4e730"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729353134349864000.ec8bdaf4-94db-4a77-8c77-adb1c425fc99"
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@@ -20946,7 +20946,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729291107767245000.789ca542-92e7-4238-936b-efc6a8f682fa"
+                  "reference": "Practitioner/1729353134351156000.b4c953a9-2726-4a5e-85db-b52226b10707"
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@@ -21090,7 +21090,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729353134353366000.bba88269-4cda-4655-9d37-ff4bc0abc626"
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@@ -21188,18 +21188,18 @@
           ]
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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@@ -21214,10 +21214,10 @@
       }
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@@ -21269,7 +21269,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729353134344666000.8bb78282-5d4e-42c7-86aa-b68a7a1eef17"
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@@ -21285,10 +21285,10 @@
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         "extension": [
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@@ -21376,23 +21376,23 @@
       }
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@@ -21468,10 +21468,10 @@
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@@ -21547,10 +21547,10 @@
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@@ -21565,10 +21565,10 @@
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@@ -21616,7 +21616,7 @@
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@@ -21632,10 +21632,10 @@
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@@ -21650,10 +21650,10 @@
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@@ -21701,7 +21701,7 @@
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@@ -21717,10 +21717,10 @@
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@@ -21732,13 +21732,13 @@
               {
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                 "valueReference": {
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@@ -21766,7 +21766,7 @@
               {
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@@ -21910,7 +21910,7 @@
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@@ -22008,18 +22008,18 @@
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@@ -22034,10 +22034,10 @@
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@@ -22089,7 +22089,7 @@
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@@ -22105,10 +22105,10 @@
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@@ -22196,23 +22196,23 @@
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@@ -22288,10 +22288,10 @@
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@@ -22367,10 +22367,10 @@
       }
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@@ -22385,10 +22385,10 @@
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@@ -22436,7 +22436,7 @@
             },
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             "assigner": {
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@@ -22452,10 +22452,10 @@
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@@ -22470,10 +22470,10 @@
       }
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@@ -22521,7 +22521,7 @@
             },
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             "assigner": {
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@@ -22537,10 +22537,10 @@
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@@ -22552,13 +22552,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107787984000.7292f507-4a2c-409b-b719-c810926832bf"
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                 "valueReference": {
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@@ -22586,7 +22586,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291107793664000.4e4ae246-74c7-44c4-ac6b-f5c95734cc6e"
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@@ -22730,7 +22730,7 @@
               {
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@@ -22828,18 +22828,18 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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@@ -22854,10 +22854,10 @@
       }
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@@ -22909,7 +22909,7 @@
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@@ -22925,10 +22925,10 @@
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@@ -23016,23 +23016,23 @@
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@@ -23108,10 +23108,10 @@
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@@ -23187,10 +23187,10 @@
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@@ -23205,10 +23205,10 @@
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@@ -23256,7 +23256,7 @@
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@@ -23272,10 +23272,10 @@
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@@ -23290,10 +23290,10 @@
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@@ -23341,7 +23341,7 @@
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@@ -23357,10 +23357,10 @@
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@@ -23372,13 +23372,13 @@
               {
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@@ -23406,7 +23406,7 @@
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@@ -23550,7 +23550,7 @@
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@@ -23648,18 +23648,18 @@
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@@ -23674,10 +23674,10 @@
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@@ -23729,7 +23729,7 @@
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@@ -23745,10 +23745,10 @@
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@@ -23836,23 +23836,23 @@
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@@ -23928,10 +23928,10 @@
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@@ -24007,10 +24007,10 @@
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@@ -24025,10 +24025,10 @@
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@@ -24076,7 +24076,7 @@
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             "assigner": {
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@@ -24092,10 +24092,10 @@
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@@ -24110,10 +24110,10 @@
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@@ -24161,7 +24161,7 @@
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@@ -24177,10 +24177,10 @@
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@@ -24192,13 +24192,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107825998000.7b87572a-2922-4634-8fda-4e2043b87904"
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@@ -24226,7 +24226,7 @@
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@@ -24370,7 +24370,7 @@
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@@ -24468,18 +24468,18 @@
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@@ -24494,10 +24494,10 @@
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@@ -24549,7 +24549,7 @@
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@@ -24565,10 +24565,10 @@
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@@ -24656,23 +24656,23 @@
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@@ -24748,10 +24748,10 @@
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@@ -24827,10 +24827,10 @@
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@@ -24845,10 +24845,10 @@
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@@ -24896,7 +24896,7 @@
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@@ -24912,10 +24912,10 @@
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@@ -24930,10 +24930,10 @@
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@@ -24981,7 +24981,7 @@
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@@ -24997,10 +24997,10 @@
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@@ -25012,13 +25012,13 @@
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@@ -25046,7 +25046,7 @@
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@@ -25190,7 +25190,7 @@
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@@ -25288,18 +25288,18 @@
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@@ -25314,10 +25314,10 @@
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@@ -25369,7 +25369,7 @@
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@@ -25385,10 +25385,10 @@
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@@ -25476,23 +25476,23 @@
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@@ -25568,10 +25568,10 @@
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@@ -25647,10 +25647,10 @@
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@@ -25665,10 +25665,10 @@
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@@ -25716,7 +25716,7 @@
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@@ -25732,10 +25732,10 @@
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@@ -25750,10 +25750,10 @@
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@@ -25801,7 +25801,7 @@
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@@ -25817,10 +25817,10 @@
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@@ -25832,13 +25832,13 @@
               {
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                 "valueReference": {
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@@ -25866,7 +25866,7 @@
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@@ -26010,7 +26010,7 @@
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@@ -26108,18 +26108,18 @@
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@@ -26134,10 +26134,10 @@
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@@ -26189,7 +26189,7 @@
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@@ -26205,10 +26205,10 @@
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@@ -26296,23 +26296,23 @@
       }
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-      "fullUrl": "PractitionerRole/1729291107840674000.fe6bf946-d060-498e-8caa-853c7d2bc4b9",
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         "resourceType": "PractitionerRole",
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+        "id": "1729353134418814000.4f4e1f07-0b4a-4e69-a385-f013b5a8167f",
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+          "reference": "Practitioner/1729353134419896000.5b30b926-bad7-45ac-abfd-ff4233587fbd"
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@@ -26388,10 +26388,10 @@
       }
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         "extension": [
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@@ -26467,10 +26467,10 @@
       }
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@@ -26485,10 +26485,10 @@
       }
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@@ -26536,7 +26536,7 @@
             },
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             "assigner": {
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@@ -26552,10 +26552,10 @@
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@@ -26570,10 +26570,10 @@
       }
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@@ -26621,7 +26621,7 @@
             },
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             "assigner": {
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@@ -26637,10 +26637,10 @@
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@@ -26652,13 +26652,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729353134432989000.a4a484c6-668e-4100-bd98-6a75ad97d387"
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                 "valueReference": {
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+                  "reference": "Organization/1729353134433833000.846bd57c-d36a-4917-9d8b-46f7ddf4065d"
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@@ -26686,7 +26686,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291107857094000.abdd62cc-ad5c-4c70-a3f9-d27040942d02"
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@@ -26830,7 +26830,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291107859266000.eab0f3e9-89e2-4d12-b7a5-333f94666f38"
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@@ -26927,18 +26927,18 @@
           ]
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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         "requester": {
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@@ -26953,10 +26953,10 @@
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@@ -27008,7 +27008,7 @@
             },
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             "assigner": {
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@@ -27024,10 +27024,10 @@
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@@ -27115,23 +27115,23 @@
       }
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@@ -27207,10 +27207,10 @@
       }
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@@ -27286,10 +27286,10 @@
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@@ -27304,10 +27304,10 @@
       }
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@@ -27355,7 +27355,7 @@
             },
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             "assigner": {
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@@ -27371,10 +27371,10 @@
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@@ -27389,10 +27389,10 @@
       }
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         "extension": [
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@@ -27440,7 +27440,7 @@
             },
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             "assigner": {
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@@ -27456,10 +27456,10 @@
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@@ -27471,13 +27471,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107864617000.0292e56c-ec5d-4b7a-9588-89740d97b1aa"
+                  "reference": "Organization/1729353134442547000.f810eb42-7423-4e5a-a3ae-398845a8c582"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729353134443391000.f7055837-6b99-4ca1-9ba1-58aef1473fb3"
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@@ -27505,7 +27505,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729291107867107000.d907dcba-3008-4ba0-9664-9f7781c8a351"
+                  "reference": "Practitioner/1729353134444700000.492f6a39-49d0-464b-a11b-737f3f5eed84"
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@@ -27649,7 +27649,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729291107869359000.b1ced12d-8834-45e3-aed3-872bd0ff0931"
+                  "reference": "Practitioner/1729353134446907000.b476f7c4-6ec8-4f8a-bb3e-036624aa000a"
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@@ -27747,18 +27747,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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         "requester": {
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+          "reference": "PractitionerRole/1729353134437975000.4d507f63-d0d9-4e2b-bd11-fc5fd33ccdfe"
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@@ -27773,10 +27773,10 @@
       }
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@@ -27828,7 +27828,7 @@
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@@ -27844,10 +27844,10 @@
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@@ -27935,23 +27935,23 @@
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@@ -28027,10 +28027,10 @@
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@@ -28106,10 +28106,10 @@
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@@ -28124,10 +28124,10 @@
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@@ -28175,7 +28175,7 @@
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@@ -28191,10 +28191,10 @@
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@@ -28209,10 +28209,10 @@
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@@ -28260,7 +28260,7 @@
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@@ -28276,10 +28276,10 @@
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@@ -28291,13 +28291,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107875021000.15df78c9-6e7e-415b-9bd8-7c31af26b642"
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                 "valueReference": {
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@@ -28325,7 +28325,7 @@
               {
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@@ -28469,7 +28469,7 @@
               {
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@@ -28567,18 +28567,18 @@
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@@ -28593,10 +28593,10 @@
       }
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@@ -28648,7 +28648,7 @@
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@@ -28664,10 +28664,10 @@
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@@ -28755,23 +28755,23 @@
       }
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@@ -28847,10 +28847,10 @@
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@@ -28926,10 +28926,10 @@
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@@ -28944,10 +28944,10 @@
       }
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@@ -28995,7 +28995,7 @@
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             "assigner": {
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@@ -29011,10 +29011,10 @@
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@@ -29029,10 +29029,10 @@
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@@ -29080,7 +29080,7 @@
             },
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@@ -29096,10 +29096,10 @@
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@@ -29111,13 +29111,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107885687000.e668bf26-2a93-40a6-970d-535b4e8cf2df"
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@@ -29145,7 +29145,7 @@
               {
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-                  "reference": "Practitioner/1729291107888108000.1ebadded-e239-4931-8a94-9f033bd6fc02"
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@@ -29289,7 +29289,7 @@
               {
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@@ -29387,18 +29387,18 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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@@ -29413,10 +29413,10 @@
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@@ -29468,7 +29468,7 @@
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@@ -29484,10 +29484,10 @@
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@@ -29575,23 +29575,23 @@
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@@ -29667,10 +29667,10 @@
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@@ -29746,10 +29746,10 @@
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@@ -29764,10 +29764,10 @@
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@@ -29815,7 +29815,7 @@
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@@ -29831,10 +29831,10 @@
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@@ -29849,10 +29849,10 @@
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@@ -29900,7 +29900,7 @@
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@@ -29916,10 +29916,10 @@
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@@ -29931,13 +29931,13 @@
               {
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                 "valueReference": {
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@@ -29965,7 +29965,7 @@
               {
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@@ -30109,7 +30109,7 @@
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@@ -30207,18 +30207,18 @@
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@@ -30233,10 +30233,10 @@
       }
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@@ -30288,7 +30288,7 @@
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             "assigner": {
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@@ -30304,10 +30304,10 @@
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@@ -30395,23 +30395,23 @@
       }
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@@ -30487,10 +30487,10 @@
       }
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@@ -30566,10 +30566,10 @@
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@@ -30584,10 +30584,10 @@
       }
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@@ -30635,7 +30635,7 @@
             },
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             "assigner": {
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@@ -30651,10 +30651,10 @@
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@@ -30669,10 +30669,10 @@
       }
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@@ -30720,7 +30720,7 @@
             },
             "value": "1174911127",
             "assigner": {
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@@ -30736,10 +30736,10 @@
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@@ -30751,13 +30751,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729291107919534000.5eb8a255-a8d1-487d-99d7-dadb896ff39d"
+                  "reference": "Organization/1729353134495454000.e7741dfb-1e00-4b97-b6e2-c6a05ed11ef1"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729353134496294000.7db83b53-fe11-47ab-b214-18dc33d4f977"
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@@ -30785,7 +30785,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729353134497596000.47ec9b5a-a45d-44bb-8a22-ac9f6f200350"
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@@ -30929,7 +30929,7 @@
               {
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                 "valueReference": {
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@@ -31027,18 +31027,18 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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@@ -32586,24 +32586,24 @@
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@@ -32672,7 +32672,7 @@
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@@ -32696,7 +32696,7 @@
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@@ -32718,27 +32718,27 @@
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@@ -32807,7 +32807,7 @@
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@@ -32831,7 +32831,7 @@
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@@ -32853,21 +32853,21 @@
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@@ -32936,7 +32936,7 @@
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@@ -32960,7 +32960,7 @@
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@@ -32982,21 +32982,21 @@
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-        "id": "1729291107952193000.c589f522-e2f1-4328-8814-bf1fd3e59806",
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@@ -33065,7 +33065,7 @@
         ],
         "basedOn": [
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+            "reference": "ServiceRequest/1729353134437811000.b8229405-c2a0-4db4-8ebb-9ad6f2e649f2"
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@@ -33088,7 +33088,7 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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         "_effectiveDateTime": {
@@ -33110,21 +33110,21 @@
         },
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           {
-            "reference": "Specimen/1729291107727202000.ced69d25-92c6-467c-a6d0-cde0c1d7f484"
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         "result": [
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-            "reference": "Observation/1729291107703549000.00f3fbde-74d0-4b33-be01-16aeac26d204"
+            "reference": "Observation/1729353134291289000.3fb62a76-2fbd-4b1d-8ca8-434f5b4d6125"
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-      "fullUrl": "DiagnosticReport/1729291107953799000.61d41968-e1fc-4a18-87e7-b48398ea1a00",
+      "fullUrl": "DiagnosticReport/1729353134525731000.b5c75960-02e1-42d5-aed6-f1a01929f4e0",
       "resource": {
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-        "id": "1729291107953799000.61d41968-e1fc-4a18-87e7-b48398ea1a00",
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@@ -33193,7 +33193,7 @@
         ],
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+            "reference": "ServiceRequest/1729353134447373000.257299e5-b0b2-4a56-bf19-276f51974795"
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@@ -33217,7 +33217,7 @@
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         "subject": {
-          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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@@ -33239,21 +33239,21 @@
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           {
-            "reference": "Specimen/1729291107727537000.667e2c73-26b6-4235-8950-a039f8db88b3"
+            "reference": "Specimen/1729353134325135000.f82fe3ae-a3b9-4827-9219-06f77d9740f4"
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         "result": [
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+            "reference": "Observation/1729353134297410000.e7add66c-17c1-4e9e-b838-05a15dcd3761"
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-      "fullUrl": "DiagnosticReport/1729291107955355000.cf2de07a-f88c-438e-8266-40ab24628977",
+      "fullUrl": "DiagnosticReport/1729353134527309000.f4216295-5b06-4632-9db3-b672c474a620",
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-        "id": "1729291107955355000.cf2de07a-f88c-438e-8266-40ab24628977",
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@@ -33322,7 +33322,7 @@
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+            "reference": "ServiceRequest/1729353134471527000.01b92a4c-e98b-4067-8775-4cef7867d306"
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@@ -33346,7 +33346,7 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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         "_effectiveDateTime": {
@@ -33368,21 +33368,21 @@
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         "specimen": [
           {
-            "reference": "Specimen/1729291107727883000.ea92537f-b3f6-44ff-9ca7-ded63a5baafe"
+            "reference": "Specimen/1729353134325488000.e5b4b97c-770c-449e-aa40-395a209c8fca"
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+            "reference": "Observation/1729353134301154000.7dfaf4e3-84b7-4b7a-88e7-86a86e73d933"
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     },
     {
-      "fullUrl": "DiagnosticReport/1729291107956904000.798dc2d6-a996-41a0-8cbd-9333700198e5",
+      "fullUrl": "DiagnosticReport/1729353134528870000.418fd1e1-00c9-4d06-9266-3744215e716a",
       "resource": {
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-        "id": "1729291107956904000.798dc2d6-a996-41a0-8cbd-9333700198e5",
+        "id": "1729353134528870000.418fd1e1-00c9-4d06-9266-3744215e716a",
         "identifier": [
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             "extension": [
@@ -33451,7 +33451,7 @@
         ],
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           {
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+            "reference": "ServiceRequest/1729353134481137000.5fd6cce4-521d-4b93-867e-542cfef42774"
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@@ -33475,7 +33475,7 @@
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         "subject": {
-          "reference": "Patient/1729291107458018000.56b6e970-1c74-4883-ade4-e8e4bc92be70"
+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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         "_effectiveDateTime": {
@@ -33497,21 +33497,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291107728218000.67c82b8e-73a7-40d6-a0fb-45220ecc0fcf"
+            "reference": "Specimen/1729353134325841000.3dfa330d-a035-49ca-a7ff-77999759e05d"
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+            "reference": "Observation/1729353134304879000.a02d2279-592a-4de8-b744-da9fcd027904"
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     },
     {
-      "fullUrl": "DiagnosticReport/1729291107958474000.1c09e264-b1c4-413a-ba4e-505e66f54641",
+      "fullUrl": "DiagnosticReport/1729353134530716000.4cd7b908-089a-4985-a9cf-ea6a70916f77",
       "resource": {
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-        "id": "1729291107958474000.1c09e264-b1c4-413a-ba4e-505e66f54641",
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             "extension": [
@@ -33580,7 +33580,7 @@
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         "basedOn": [
           {
-            "reference": "ServiceRequest/1729291107906481000.02c14d41-3c3d-46e4-a4ce-b6f1c39d09c9"
+            "reference": "ServiceRequest/1729353134490753000.9fab3c92-c907-419b-b315-3263b6ca937d"
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@@ -33604,7 +33604,7 @@
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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         "_effectiveDateTime": {
@@ -33626,21 +33626,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291107728560000.3662692a-c052-4811-b3bf-76cc239e1bda"
+            "reference": "Specimen/1729353134326209000.09acac12-769f-4bd5-91b5-475231f8adc5"
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         "result": [
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+            "reference": "Observation/1729353134309279000.a6754ada-22bc-4ce2-830f-baaebecd9307"
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     {
-      "fullUrl": "DiagnosticReport/1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7",
+      "fullUrl": "DiagnosticReport/1729353134532388000.309d17c4-ca64-4560-b6af-ee14d84e85eb",
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-        "id": "1729291107960067000.240ec4da-2f7b-445e-8434-66f68dc5bec7",
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             "extension": [
@@ -33709,7 +33709,7 @@
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+            "reference": "ServiceRequest/1729353134500320000.5f026c93-0116-4157-be5d-cd3d9e3ea2fc"
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@@ -33733,7 +33733,7 @@
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         "subject": {
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+          "reference": "Patient/1729353134050347000.dfde0f9d-059b-484e-9b23-b328addf7b81"
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         "_effectiveDateTime": {
@@ -33755,12 +33755,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729291107728890000.b65e0a21-8472-43c5-8186-c66a4167448e"
+            "reference": "Specimen/1729353134326568000.5d8e0017-ffaf-4bb3-b644-8833bd46ebf0"
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         "result": [
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+            "reference": "Observation/1729353134311364000.4c2ecf63-8087-43aa-b484-fc33f1d63c64"
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diff --git a/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_1_hl7_translation.fhir b/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_1_hl7_translation.fhir
index c7618150a..836bf8dea 100644
--- a/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_1_hl7_translation.fhir
+++ b/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_1_hl7_translation.fhir
@@ -1,21 +1,29 @@
 {
   "resourceType": "Bundle",
-  "id": "1710179686294436144.63a1f4a3-b61c-4db3-a2fd-77ab0568c038",
+  "id": "1729351928336593000.360cb35c-e380-4c0e-b238-50ae92b04d64",
   "meta": {
-    "lastUpdated": "2024-03-11T17:54:46.294+00:00"
+    "lastUpdated": "2024-10-19T08:32:08.336-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
     "value": "Q1960841872T2476960690"
   },
   "type": "message",
-  "timestamp": "2024-02-24T13:40:09.000+00:00",
+  "timestamp": "2024-02-24T13:40:09.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "fullUrl": "MessageHeader/1729351928338755000.84b1cadb-a0a4-4080-a138-883e5dfaec2e",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "id": "1729351928338755000.84b1cadb-a0a4-4080-a138-883e5dfaec2e",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
@@ -55,12 +63,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1710179686296973645.7983aa33-57ec-49c6-a173-d12bd592bbb1"
+              "reference": "Organization/1729351928338347000.edb67c09-d0d2-476b-956d-d4c05f6e7930"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1710179686296048958.8d83dc6e-d3a1-4521-b53d-0dcc2017165a"
+          "reference": "Organization/1729351928337397000.0008a387-27c0-4b77-95e8-dcacf81f2934"
         },
         "source": {
           "extension": [
@@ -86,10 +94,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710179686296048958.8d83dc6e-d3a1-4521-b53d-0dcc2017165a",
+      "fullUrl": "Organization/1729351928337397000.0008a387-27c0-4b77-95e8-dcacf81f2934",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710179686296048958.8d83dc6e-d3a1-4521-b53d-0dcc2017165a",
+        "id": "1729351928337397000.0008a387-27c0-4b77-95e8-dcacf81f2934",
         "identifier": [
           {
             "extension": [
@@ -122,10 +130,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710179686296973645.7983aa33-57ec-49c6-a173-d12bd592bbb1",
+      "fullUrl": "Organization/1729351928338347000.edb67c09-d0d2-476b-956d-d4c05f6e7930",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710179686296973645.7983aa33-57ec-49c6-a173-d12bd592bbb1",
+        "id": "1729351928338347000.edb67c09-d0d2-476b-956d-d4c05f6e7930",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -164,10 +172,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f",
+      "fullUrl": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f",
       "resource": {
         "resourceType": "Patient",
-        "id": "1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f",
+        "id": "1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -216,7 +224,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1710179686302231143.c3898cb4-07b1-4574-9346-805f0069aafe"
+              "reference": "Organization/1729351928340631000.2309fc85-0dc5-4a09-a30e-a91eaaf68514"
             }
           }
         ],
@@ -233,7 +241,6 @@
                 ]
               }
             ],
-            "text": "TestValue",
             "family": "ONE",
             "given": [
               "TESTCASE"
@@ -290,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710179686302231143.c3898cb4-07b1-4574-9346-805f0069aafe",
+      "fullUrl": "Organization/1729351928340631000.2309fc85-0dc5-4a09-a30e-a91eaaf68514",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710179686302231143.c3898cb4-07b1-4574-9346-805f0069aafe",
+        "id": "1729351928340631000.2309fc85-0dc5-4a09-a30e-a91eaaf68514",
         "identifier": [
           {
             "extension": [
@@ -308,10 +315,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1710179686323438391.245a6921-2664-4491-bc22-ba6267dd21b7",
+      "fullUrl": "ServiceRequest/1729351928353148000.ee20a4bf-8f33-49d2-86b7-b718eb65cf0b",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1710179686323438391.245a6921-2664-4491-bc22-ba6267dd21b7",
+        "id": "1729351928353148000.ee20a4bf-8f33-49d2-86b7-b718eb65cf0b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -323,7 +330,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1710179686319303517.2fba8016-9b3d-4822-939d-359911b40245"
+                  "reference": "Practitioner/1729351928351389000.cd3d3daf-d25c-4cf7-846a-205abce23e61"
                 }
               }
             ]
@@ -351,7 +358,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1710179686320969024.4d7bd8ba-6430-450e-b221-7d2c705f22a8"
+                  "reference": "Practitioner/1729351928352664000.3f98c026-7689-4197-a477-96122800e4be"
                 }
               }
             ]
@@ -387,18 +394,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "requester": {
-          "reference": "Practitioner/1710179686315009240.0afe59c0-6361-45ca-9be4-cf9dad2f69d6"
+          "reference": "Practitioner/1729351928348529000.ec6129ab-d1aa-4693-a1d9-6ddb1130638c"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1710179686315009240.0afe59c0-6361-45ca-9be4-cf9dad2f69d6",
+      "fullUrl": "Practitioner/1729351928348529000.ec6129ab-d1aa-4693-a1d9-6ddb1130638c",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710179686315009240.0afe59c0-6361-45ca-9be4-cf9dad2f69d6",
+        "id": "1729351928348529000.ec6129ab-d1aa-4693-a1d9-6ddb1130638c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -445,10 +452,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710179686319303517.2fba8016-9b3d-4822-939d-359911b40245",
+      "fullUrl": "Practitioner/1729351928351389000.cd3d3daf-d25c-4cf7-846a-205abce23e61",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710179686319303517.2fba8016-9b3d-4822-939d-359911b40245",
+        "id": "1729351928351389000.cd3d3daf-d25c-4cf7-846a-205abce23e61",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -491,10 +498,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710179686320969024.4d7bd8ba-6430-450e-b221-7d2c705f22a8",
+      "fullUrl": "Practitioner/1729351928352664000.3f98c026-7689-4197-a477-96122800e4be",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710179686320969024.4d7bd8ba-6430-450e-b221-7d2c705f22a8",
+        "id": "1729351928352664000.3f98c026-7689-4197-a477-96122800e4be",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -537,10 +544,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710179686326166283.bb3806d1-e358-4aaa-b8d2-7eef92a9a3e9",
+      "fullUrl": "Observation/1729351928354752000.062a6470-e2de-47ad-84a8-23056968d055",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710179686326166283.bb3806d1-e358-4aaa-b8d2-7eef92a9a3e9",
+        "id": "1729351928354752000.062a6470-e2de-47ad-84a8-23056968d055",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -558,7 +565,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -573,10 +580,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710179686329269566.8424b31d-c67c-449b-936e-8bfb9dc44bc0",
+      "fullUrl": "Observation/1729351928356918000.af164e21-d2f2-4630-884c-a6532a47aa5e",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710179686329269566.8424b31d-c67c-449b-936e-8bfb9dc44bc0",
+        "id": "1729351928356918000.af164e21-d2f2-4630-884c-a6532a47aa5e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -597,7 +604,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -617,10 +624,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710179686333047303.acf700c4-a57b-4011-b56b-7d7f596009bc",
+      "fullUrl": "Observation/1729351928359451000.314ca6a7-8254-48c2-a8ff-6ad72fed0109",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710179686333047303.acf700c4-a57b-4011-b56b-7d7f596009bc",
+        "id": "1729351928359451000.314ca6a7-8254-48c2-a8ff-6ad72fed0109",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -638,7 +645,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -671,10 +678,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710179686335951843.72a42d24-fb7b-4729-bd35-2dafbcdb60cb",
+      "fullUrl": "Observation/1729351928361496000.ce0e0448-c07c-402f-aca3-f2b6299c5ad0",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710179686335951843.72a42d24-fb7b-4729-bd35-2dafbcdb60cb",
+        "id": "1729351928361496000.ce0e0448-c07c-402f-aca3-f2b6299c5ad0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -695,7 +702,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -715,10 +722,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710179686338900486.6b5dcf95-9250-46ea-aef4-a62f34941505",
+      "fullUrl": "Observation/1729351928363347000.d5a90ea8-55a1-4ba9-a805-5a398da78830",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710179686338900486.6b5dcf95-9250-46ea-aef4-a62f34941505",
+        "id": "1729351928363347000.d5a90ea8-55a1-4ba9-a805-5a398da78830",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -735,27 +742,8 @@
           }
         ],
         "status": "final",
-        "code": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "67704-7",
-              "display": "Feeding types"
-            }
-          ]
-        },
         "subject": {
-          "reference": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -765,33 +753,14 @@
               "valueString": "202402221854-0500"
             }
           ]
-        },
-        "valueCodeableConcept": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "LA16914-6",
-              "display": "Breast milk"
-            }
-          ]
         }
       }
     },
     {
-      "fullUrl": "Observation/1710179686344189289.382a1cd4-f201-4548-84cd-6a9a8c075f81",
+      "fullUrl": "Observation/1729351928365013000.0e8991d6-0e5b-4b29-9261-2f3e8f6a717e",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710179686344189289.382a1cd4-f201-4548-84cd-6a9a8c075f81",
+        "id": "1729351928365013000.0e8991d6-0e5b-4b29-9261-2f3e8f6a717e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -809,7 +778,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -832,10 +801,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710179686347385514.bb1cf9fb-22c4-442f-8160-43cb90092584",
+      "fullUrl": "Observation/1729351928366661000.88a07ef9-7d12-461f-923d-b80da63c5755",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710179686347385514.bb1cf9fb-22c4-442f-8160-43cb90092584",
+        "id": "1729351928366661000.88a07ef9-7d12-461f-923d-b80da63c5755",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -853,7 +822,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -868,10 +837,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710179686350238800.ee756ec7-c51d-4bc9-8325-e6b71f74a493",
+      "fullUrl": "Observation/1729351928368241000.ee32f93a-636f-4368-b016-cbf0e86be181",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710179686350238800.ee756ec7-c51d-4bc9-8325-e6b71f74a493",
+        "id": "1729351928368241000.ee32f93a-636f-4368-b016-cbf0e86be181",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -889,7 +858,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -903,10 +872,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710179686353072003.95c5ea0c-ab3c-4f43-9954-d007c9570b27",
+      "fullUrl": "Observation/1729351928369714000.40c0c9cd-60ed-47ff-b9b6-8e18c0eb6170",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710179686353072003.95c5ea0c-ab3c-4f43-9954-d007c9570b27",
+        "id": "1729351928369714000.40c0c9cd-60ed-47ff-b9b6-8e18c0eb6170",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -924,7 +893,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710179686310875021.8e4af6d8-5c8e-4c06-82c5-0636f1ff033f"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -959,10 +928,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1710179686362277827.67942af9-6d45-4d65-8b2a-b3dc0db59703",
+      "fullUrl": "Specimen/1729351928372823000.d93d04da-5767-426e-8eae-f5b57cfb9362",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1710179686362277827.67942af9-6d45-4d65-8b2a-b3dc0db59703",
+        "id": "1729351928372823000.d93d04da-5767-426e-8eae-f5b57cfb9362",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_2_fhir_transformation.fhir b/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_2_fhir_transformation.fhir
index 3c5a0aad9..95f2e9daf 100644
--- a/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/003_AL_ORM_O01_NBS_Fully_Populated_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729293731960903000.d6c5211b-4b66-42ea-9c55-109a209eaa5f",
+  "id": "1729351928336593000.360cb35c-e380-4c0e-b238-50ae92b04d64",
   "meta": {
-    "lastUpdated": "2024-10-18T16:22:11.960-07:00"
+    "lastUpdated": "2024-10-19T08:32:08.336-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-24T13:40:09.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729293731963240000.f8113b10-512c-45b9-b6ba-8d29615908cf",
+      "fullUrl": "MessageHeader/1729351928338755000.84b1cadb-a0a4-4080-a138-883e5dfaec2e",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729293731963240000.f8113b10-512c-45b9-b6ba-8d29615908cf",
+        "id": "1729351928338755000.84b1cadb-a0a4-4080-a138-883e5dfaec2e",
         "meta": {
           "tag": [
             {
@@ -68,12 +68,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1729293731962786000.b1837cad-0d4b-4656-baa7-8abc7b373595"
+              "reference": "Organization/1729351928338347000.edb67c09-d0d2-476b-956d-d4c05f6e7930"
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           }
         ],
         "sender": {
-          "reference": "Organization/1729293731961700000.96b7dd93-722d-454a-8463-30ed7cce400f"
+          "reference": "Organization/1729351928337397000.0008a387-27c0-4b77-95e8-dcacf81f2934"
         },
         "source": {
           "extension": [
@@ -99,10 +99,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293731961700000.96b7dd93-722d-454a-8463-30ed7cce400f",
+      "fullUrl": "Organization/1729351928337397000.0008a387-27c0-4b77-95e8-dcacf81f2934",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293731961700000.96b7dd93-722d-454a-8463-30ed7cce400f",
+        "id": "1729351928337397000.0008a387-27c0-4b77-95e8-dcacf81f2934",
         "identifier": [
           {
             "extension": [
@@ -135,10 +135,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293731962786000.b1837cad-0d4b-4656-baa7-8abc7b373595",
+      "fullUrl": "Organization/1729351928338347000.edb67c09-d0d2-476b-956d-d4c05f6e7930",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293731962786000.b1837cad-0d4b-4656-baa7-8abc7b373595",
+        "id": "1729351928338347000.edb67c09-d0d2-476b-956d-d4c05f6e7930",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -177,10 +177,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e",
+      "fullUrl": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e",
+        "id": "1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -229,7 +229,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1729293731965462000.3b6f3bfe-59f9-482d-9937-004f225a2eb5"
+              "reference": "Organization/1729351928340631000.2309fc85-0dc5-4a09-a30e-a91eaaf68514"
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@@ -347,10 +347,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293731965462000.3b6f3bfe-59f9-482d-9937-004f225a2eb5",
+      "fullUrl": "Organization/1729351928340631000.2309fc85-0dc5-4a09-a30e-a91eaaf68514",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293731965462000.3b6f3bfe-59f9-482d-9937-004f225a2eb5",
+        "id": "1729351928340631000.2309fc85-0dc5-4a09-a30e-a91eaaf68514",
         "identifier": [
           {
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@@ -365,10 +365,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293731980765000.f54ae30f-97d0-4262-9a19-d16d1ed7e0b0",
+      "fullUrl": "ServiceRequest/1729351928353148000.ee20a4bf-8f33-49d2-86b7-b718eb65cf0b",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293731980765000.f54ae30f-97d0-4262-9a19-d16d1ed7e0b0",
+        "id": "1729351928353148000.ee20a4bf-8f33-49d2-86b7-b718eb65cf0b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -380,7 +380,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293731978655000.f740a9a7-2bf1-40ef-b0b5-e75a02c1659e"
+                  "reference": "Practitioner/1729351928351389000.cd3d3daf-d25c-4cf7-846a-205abce23e61"
                 }
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@@ -408,7 +408,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293731980203000.eb4d08b4-cfb5-4ec0-b902-434755b385e9"
+                  "reference": "Practitioner/1729351928352664000.3f98c026-7689-4197-a477-96122800e4be"
                 }
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@@ -444,18 +444,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "requester": {
-          "reference": "Practitioner/1729293731975407000.b401f294-ea62-4089-abd0-b0026726f5be"
+          "reference": "Practitioner/1729351928348529000.ec6129ab-d1aa-4693-a1d9-6ddb1130638c"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729293731975407000.b401f294-ea62-4089-abd0-b0026726f5be",
+      "fullUrl": "Practitioner/1729351928348529000.ec6129ab-d1aa-4693-a1d9-6ddb1130638c",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293731975407000.b401f294-ea62-4089-abd0-b0026726f5be",
+        "id": "1729351928348529000.ec6129ab-d1aa-4693-a1d9-6ddb1130638c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -502,10 +502,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293731978655000.f740a9a7-2bf1-40ef-b0b5-e75a02c1659e",
+      "fullUrl": "Practitioner/1729351928351389000.cd3d3daf-d25c-4cf7-846a-205abce23e61",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293731978655000.f740a9a7-2bf1-40ef-b0b5-e75a02c1659e",
+        "id": "1729351928351389000.cd3d3daf-d25c-4cf7-846a-205abce23e61",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -548,10 +548,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293731980203000.eb4d08b4-cfb5-4ec0-b902-434755b385e9",
+      "fullUrl": "Practitioner/1729351928352664000.3f98c026-7689-4197-a477-96122800e4be",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293731980203000.eb4d08b4-cfb5-4ec0-b902-434755b385e9",
+        "id": "1729351928352664000.3f98c026-7689-4197-a477-96122800e4be",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -594,10 +594,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293731982704000.935cc663-9da6-4473-98f6-0aeda7488796",
+      "fullUrl": "Observation/1729351928354752000.062a6470-e2de-47ad-84a8-23056968d055",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293731982704000.935cc663-9da6-4473-98f6-0aeda7488796",
+        "id": "1729351928354752000.062a6470-e2de-47ad-84a8-23056968d055",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -615,7 +615,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -630,10 +630,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293731985311000.98a932df-bb12-45ff-88ff-ef31847012c8",
+      "fullUrl": "Observation/1729351928356918000.af164e21-d2f2-4630-884c-a6532a47aa5e",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293731985311000.98a932df-bb12-45ff-88ff-ef31847012c8",
+        "id": "1729351928356918000.af164e21-d2f2-4630-884c-a6532a47aa5e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -654,7 +654,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -674,10 +674,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293731988467000.097bc81d-fbfe-483a-96ed-158320f469d0",
+      "fullUrl": "Observation/1729351928359451000.314ca6a7-8254-48c2-a8ff-6ad72fed0109",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293731988467000.097bc81d-fbfe-483a-96ed-158320f469d0",
+        "id": "1729351928359451000.314ca6a7-8254-48c2-a8ff-6ad72fed0109",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -695,7 +695,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -728,10 +728,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293731990654000.1cca21a9-4a4c-46ff-b2c8-9048b8c41dd7",
+      "fullUrl": "Observation/1729351928361496000.ce0e0448-c07c-402f-aca3-f2b6299c5ad0",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293731990654000.1cca21a9-4a4c-46ff-b2c8-9048b8c41dd7",
+        "id": "1729351928361496000.ce0e0448-c07c-402f-aca3-f2b6299c5ad0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -752,7 +752,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -772,10 +772,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293731992590000.65e76307-1ee4-4455-8f32-2e869637bcac",
+      "fullUrl": "Observation/1729351928363347000.d5a90ea8-55a1-4ba9-a805-5a398da78830",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293731992590000.65e76307-1ee4-4455-8f32-2e869637bcac",
+        "id": "1729351928363347000.d5a90ea8-55a1-4ba9-a805-5a398da78830",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -793,7 +793,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -807,10 +807,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293731994321000.0d6eb55f-fd91-4964-a252-220c381b85f4",
+      "fullUrl": "Observation/1729351928365013000.0e8991d6-0e5b-4b29-9261-2f3e8f6a717e",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293731994321000.0d6eb55f-fd91-4964-a252-220c381b85f4",
+        "id": "1729351928365013000.0e8991d6-0e5b-4b29-9261-2f3e8f6a717e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -828,7 +828,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -851,10 +851,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293732001953000.7631bc65-33b0-4a8f-a00c-607ffccb23b8",
+      "fullUrl": "Observation/1729351928366661000.88a07ef9-7d12-461f-923d-b80da63c5755",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293732001953000.7631bc65-33b0-4a8f-a00c-607ffccb23b8",
+        "id": "1729351928366661000.88a07ef9-7d12-461f-923d-b80da63c5755",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -872,7 +872,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -887,10 +887,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293732003589000.5aab4cb3-ac54-4679-90c1-9405d0dfe0e3",
+      "fullUrl": "Observation/1729351928368241000.ee32f93a-636f-4368-b016-cbf0e86be181",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293732003589000.5aab4cb3-ac54-4679-90c1-9405d0dfe0e3",
+        "id": "1729351928368241000.ee32f93a-636f-4368-b016-cbf0e86be181",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -908,7 +908,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -922,10 +922,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293732005089000.6837b6e0-3d49-41ab-9031-5b6276cd2bdf",
+      "fullUrl": "Observation/1729351928369714000.40c0c9cd-60ed-47ff-b9b6-8e18c0eb6170",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293732005089000.6837b6e0-3d49-41ab-9031-5b6276cd2bdf",
+        "id": "1729351928369714000.40c0c9cd-60ed-47ff-b9b6-8e18c0eb6170",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -943,7 +943,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293731973034000.f9da8cca-e762-4198-af78-b5ad4656737e"
+          "reference": "Patient/1729351928346939000.8c1bf873-73a8-4ca3-a43e-e0854cb1c42f"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -978,10 +978,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293732008494000.c8ae3d11-e219-43df-b5cb-48f367131e67",
+      "fullUrl": "Specimen/1729351928372823000.d93d04da-5767-426e-8eae-f5b57cfb9362",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293732008494000.c8ae3d11-e219-43df-b5cb-48f367131e67",
+        "id": "1729351928372823000.d93d04da-5767-426e-8eae-f5b57cfb9362",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_1_hl7_translation.fhir b/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_1_hl7_translation.fhir
index a99ce37aa..a373100c2 100644
--- a/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_1_hl7_translation.fhir
+++ b/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_1_hl7_translation.fhir
@@ -1,21 +1,29 @@
 {
   "resourceType": "Bundle",
-  "id": "1710185434144159506.5d4aa0cb-449d-42ee-9ef0-fa4969f0e475",
+  "id": "1729352052541160000.20e72d3a-65d6-463b-8f4c-c91bac45e1ab",
   "meta": {
-    "lastUpdated": "2024-03-11T19:30:34.156+00:00"
+    "lastUpdated": "2024-10-19T08:34:12.541-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
     "value": "Q1960841872T2476960690"
   },
   "type": "message",
-  "timestamp": "2024-01-18T01:52:00.000+00:00",
+  "timestamp": "2024-01-18T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "fullUrl": "MessageHeader/1729352052543419000.e494b59e-40a9-4c11-801e-aa32aa72bf42",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "id": "1729352052543419000.e494b59e-40a9-4c11-801e-aa32aa72bf42",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
@@ -55,12 +63,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1710185434295205215.917ef1f8-1a60-4af0-903e-6a4b68c2765b"
+              "reference": "Organization/1729352052542960000.702f2c9d-574e-4acb-a828-bd66185b7f5b"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1710185434235689715.bff2bbbc-6580-4f99-94ee-b84f93fc4496"
+          "reference": "Organization/1729352052541940000.2741f02e-6c07-470f-a43e-9b4cb2953f0a"
         },
         "source": {
           "extension": [
@@ -86,10 +94,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710185434235689715.bff2bbbc-6580-4f99-94ee-b84f93fc4496",
+      "fullUrl": "Organization/1729352052541940000.2741f02e-6c07-470f-a43e-9b4cb2953f0a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710185434235689715.bff2bbbc-6580-4f99-94ee-b84f93fc4496",
+        "id": "1729352052541940000.2741f02e-6c07-470f-a43e-9b4cb2953f0a",
         "identifier": [
           {
             "extension": [
@@ -122,10 +130,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710185434295205215.917ef1f8-1a60-4af0-903e-6a4b68c2765b",
+      "fullUrl": "Organization/1729352052542960000.702f2c9d-574e-4acb-a828-bd66185b7f5b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710185434295205215.917ef1f8-1a60-4af0-903e-6a4b68c2765b",
+        "id": "1729352052542960000.702f2c9d-574e-4acb-a828-bd66185b7f5b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -164,10 +172,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26",
+      "fullUrl": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0",
       "resource": {
         "resourceType": "Patient",
-        "id": "1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26",
+        "id": "1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -216,7 +224,7 @@
             },
             "value": "1256872",
             "assigner": {
-              "reference": "Organization/1710185434749364132.b4ab280f-c511-4eb2-b87b-404081e422be"
+              "reference": "Organization/1729352052545600000.c7eaea70-6b3e-44a7-8821-7e57b3b19764"
             }
           }
         ],
@@ -233,7 +241,6 @@
                 ]
               }
             ],
-            "text": "TestValue",
             "family": "TWO",
             "given": [
               "TESTCASE"
@@ -290,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710185434749364132.b4ab280f-c511-4eb2-b87b-404081e422be",
+      "fullUrl": "Organization/1729352052545600000.c7eaea70-6b3e-44a7-8821-7e57b3b19764",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710185434749364132.b4ab280f-c511-4eb2-b87b-404081e422be",
+        "id": "1729352052545600000.c7eaea70-6b3e-44a7-8821-7e57b3b19764",
         "identifier": [
           {
             "extension": [
@@ -308,10 +315,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1710185434870283340.cdaaf370-2b61-464d-940b-657b1d855298",
+      "fullUrl": "ServiceRequest/1729352052558844000.24cf896c-2253-4b33-a0d9-328ea0355994",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1710185434870283340.cdaaf370-2b61-464d-940b-657b1d855298",
+        "id": "1729352052558844000.24cf896c-2253-4b33-a0d9-328ea0355994",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -323,7 +330,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1710185434862617173.6edbbe57-e65f-4674-8273-6e7ebc1ac751"
+                  "reference": "Practitioner/1729352052557075000.039df086-b45c-4354-9c17-6dd516fae546"
                 }
               }
             ]
@@ -351,7 +358,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1710185434868105673.bce46f6b-cec5-4b94-bc12-854a14b2c7cd"
+                  "reference": "Practitioner/1729352052558346000.0b828a53-6119-460a-8a48-687dd44f2303"
                 }
               }
             ]
@@ -387,18 +394,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "requester": {
-          "reference": "Practitioner/1710185434852273548.54aef7cb-e199-4e3d-890d-fff83f630288"
+          "reference": "Practitioner/1729352052554441000.72e258b2-e1e1-4b42-b283-77ac997a3758"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1710185434852273548.54aef7cb-e199-4e3d-890d-fff83f630288",
+      "fullUrl": "Practitioner/1729352052554441000.72e258b2-e1e1-4b42-b283-77ac997a3758",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710185434852273548.54aef7cb-e199-4e3d-890d-fff83f630288",
+        "id": "1729352052554441000.72e258b2-e1e1-4b42-b283-77ac997a3758",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -445,10 +452,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710185434862617173.6edbbe57-e65f-4674-8273-6e7ebc1ac751",
+      "fullUrl": "Practitioner/1729352052557075000.039df086-b45c-4354-9c17-6dd516fae546",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710185434862617173.6edbbe57-e65f-4674-8273-6e7ebc1ac751",
+        "id": "1729352052557075000.039df086-b45c-4354-9c17-6dd516fae546",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -491,10 +498,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710185434868105673.bce46f6b-cec5-4b94-bc12-854a14b2c7cd",
+      "fullUrl": "Practitioner/1729352052558346000.0b828a53-6119-460a-8a48-687dd44f2303",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710185434868105673.bce46f6b-cec5-4b94-bc12-854a14b2c7cd",
+        "id": "1729352052558346000.0b828a53-6119-460a-8a48-687dd44f2303",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -537,10 +544,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710185435280264465.6e9ab6f4-ba7d-48bc-8167-d614bfe566a9",
+      "fullUrl": "Observation/1729352052560333000.8ab31685-9747-4357-9169-45ebc6aa2a41",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710185435280264465.6e9ab6f4-ba7d-48bc-8167-d614bfe566a9",
+        "id": "1729352052560333000.8ab31685-9747-4357-9169-45ebc6aa2a41",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -558,7 +565,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -573,10 +580,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710185435294860590.03a7d8d8-1282-4dc8-a263-b9ba960e0f83",
+      "fullUrl": "Observation/1729352052562548000.290f05d2-489a-43ed-87ea-9987671517e6",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710185435294860590.03a7d8d8-1282-4dc8-a263-b9ba960e0f83",
+        "id": "1729352052562548000.290f05d2-489a-43ed-87ea-9987671517e6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -597,7 +604,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -617,10 +624,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710185435304914882.856dfe0b-49a4-4c24-bcaf-3acb62a9451b",
+      "fullUrl": "Observation/1729352052565175000.a99368ef-e539-4b93-9e70-7522893b5f1b",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710185435304914882.856dfe0b-49a4-4c24-bcaf-3acb62a9451b",
+        "id": "1729352052565175000.a99368ef-e539-4b93-9e70-7522893b5f1b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -638,7 +645,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -671,10 +678,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710185435309391924.5a682f34-a1c4-4c0d-9758-dc88b9cb80e9",
+      "fullUrl": "Observation/1729352052567207000.e0a3c3b5-1adc-4595-9925-6fd18bed7794",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710185435309391924.5a682f34-a1c4-4c0d-9758-dc88b9cb80e9",
+        "id": "1729352052567207000.e0a3c3b5-1adc-4595-9925-6fd18bed7794",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -695,7 +702,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -715,10 +722,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710185435314613049.a1dc362a-0a0c-4d41-8165-07beb516c170",
+      "fullUrl": "Observation/1729352052569206000.ce9f219d-b450-4f8a-95ac-0aae7f411852",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710185435314613049.a1dc362a-0a0c-4d41-8165-07beb516c170",
+        "id": "1729352052569206000.ce9f219d-b450-4f8a-95ac-0aae7f411852",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -735,27 +742,8 @@
           }
         ],
         "status": "final",
-        "code": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "67704-7",
-              "display": "Feeding types"
-            }
-          ]
-        },
         "subject": {
-          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -765,33 +753,14 @@
               "valueString": "202401161500-0500"
             }
           ]
-        },
-        "valueCodeableConcept": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "LA12418-2",
-              "display": "TPN"
-            }
-          ]
         }
       }
     },
     {
-      "fullUrl": "Observation/1710185435319816049.c4b4c049-cfe8-42dc-87da-5f8cefe5af5a",
+      "fullUrl": "Observation/1729352052570924000.5fda657c-fadd-4850-8070-cac52dc50dd7",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710185435319816049.c4b4c049-cfe8-42dc-87da-5f8cefe5af5a",
+        "id": "1729352052570924000.5fda657c-fadd-4850-8070-cac52dc50dd7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -809,7 +778,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -832,10 +801,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710185435322851090.24acdf7e-5971-41ec-adab-37c27bcbb009",
+      "fullUrl": "Observation/1729352052572647000.fd7cfa1e-0ede-4859-bcda-de883f189ba4",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710185435322851090.24acdf7e-5971-41ec-adab-37c27bcbb009",
+        "id": "1729352052572647000.fd7cfa1e-0ede-4859-bcda-de883f189ba4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -853,7 +822,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -868,10 +837,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710185435331423007.5e7510bf-3478-41e8-ad1e-609a92f6ff45",
+      "fullUrl": "Observation/1729352052574161000.3c285c5f-a237-4bed-8b67-69b63c7ee1d2",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710185435331423007.5e7510bf-3478-41e8-ad1e-609a92f6ff45",
+        "id": "1729352052574161000.3c285c5f-a237-4bed-8b67-69b63c7ee1d2",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -889,7 +858,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -903,10 +872,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710185435335532549.c370f515-22e3-4556-b705-5211d9a92d03",
+      "fullUrl": "Observation/1729352052575744000.cbc75275-6d2a-41c4-a4df-7086ead85f95",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710185435335532549.c370f515-22e3-4556-b705-5211d9a92d03",
+        "id": "1729352052575744000.cbc75275-6d2a-41c4-a4df-7086ead85f95",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -924,7 +893,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710185434836110090.088f3639-4903-46e9-838f-fc84ef480a26"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -950,10 +919,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1710185435351469382.9f7fad5b-c5f7-40bc-95a5-6d7c5beebb98",
+      "fullUrl": "Specimen/1729352052578890000.cea7f016-f936-45d3-9981-21aa65b36839",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1710185435351469382.9f7fad5b-c5f7-40bc-95a5-6d7c5beebb98",
+        "id": "1729352052578890000.cea7f016-f936-45d3-9981-21aa65b36839",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_2_fhir_transformation.fhir b/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_2_fhir_transformation.fhir
index 7db5b1280..de88ff4cd 100644
--- a/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/004_AL_ORM_O01_NBS_Multiple_Races_Multiple_Births_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729293853790916000.80623fde-9bbf-412a-8720-35bdab98e6cd",
+  "id": "1729352052541160000.20e72d3a-65d6-463b-8f4c-c91bac45e1ab",
   "meta": {
-    "lastUpdated": "2024-10-18T16:24:13.790-07:00"
+    "lastUpdated": "2024-10-19T08:34:12.541-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-01-18T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729293853793366000.c38c2fd3-b4de-4fa5-9f56-a8b48c32d26e",
+      "fullUrl": "MessageHeader/1729352052543419000.e494b59e-40a9-4c11-801e-aa32aa72bf42",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729293853793366000.c38c2fd3-b4de-4fa5-9f56-a8b48c32d26e",
+        "id": "1729352052543419000.e494b59e-40a9-4c11-801e-aa32aa72bf42",
         "meta": {
           "tag": [
             {
@@ -68,12 +68,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1729293853792881000.89f064a3-563c-4934-a252-ae006d8e4190"
+              "reference": "Organization/1729352052542960000.702f2c9d-574e-4acb-a828-bd66185b7f5b"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729293853791814000.2b838ef1-ef68-4536-bb83-8b1660c60ec6"
+          "reference": "Organization/1729352052541940000.2741f02e-6c07-470f-a43e-9b4cb2953f0a"
         },
         "source": {
           "extension": [
@@ -99,10 +99,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293853791814000.2b838ef1-ef68-4536-bb83-8b1660c60ec6",
+      "fullUrl": "Organization/1729352052541940000.2741f02e-6c07-470f-a43e-9b4cb2953f0a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293853791814000.2b838ef1-ef68-4536-bb83-8b1660c60ec6",
+        "id": "1729352052541940000.2741f02e-6c07-470f-a43e-9b4cb2953f0a",
         "identifier": [
           {
             "extension": [
@@ -135,10 +135,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293853792881000.89f064a3-563c-4934-a252-ae006d8e4190",
+      "fullUrl": "Organization/1729352052542960000.702f2c9d-574e-4acb-a828-bd66185b7f5b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293853792881000.89f064a3-563c-4934-a252-ae006d8e4190",
+        "id": "1729352052542960000.702f2c9d-574e-4acb-a828-bd66185b7f5b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -177,10 +177,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32",
+      "fullUrl": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32",
+        "id": "1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -229,7 +229,7 @@
             },
             "value": "1256872",
             "assigner": {
-              "reference": "Organization/1729293853795527000.f74ce8de-ba3f-47f7-96b9-8479fd5d0c73"
+              "reference": "Organization/1729352052545600000.c7eaea70-6b3e-44a7-8821-7e57b3b19764"
             }
           }
         ],
@@ -347,10 +347,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293853795527000.f74ce8de-ba3f-47f7-96b9-8479fd5d0c73",
+      "fullUrl": "Organization/1729352052545600000.c7eaea70-6b3e-44a7-8821-7e57b3b19764",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293853795527000.f74ce8de-ba3f-47f7-96b9-8479fd5d0c73",
+        "id": "1729352052545600000.c7eaea70-6b3e-44a7-8821-7e57b3b19764",
         "identifier": [
           {
             "extension": [
@@ -365,10 +365,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293853810094000.de978df6-baca-4cf7-972c-685322af21a4",
+      "fullUrl": "ServiceRequest/1729352052558844000.24cf896c-2253-4b33-a0d9-328ea0355994",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293853810094000.de978df6-baca-4cf7-972c-685322af21a4",
+        "id": "1729352052558844000.24cf896c-2253-4b33-a0d9-328ea0355994",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -380,7 +380,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293853808046000.4765e90f-3c15-4e07-9e25-eb4abec65131"
+                  "reference": "Practitioner/1729352052557075000.039df086-b45c-4354-9c17-6dd516fae546"
                 }
               }
             ]
@@ -408,7 +408,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293853809451000.e6be8591-29a2-47aa-bf76-e1778da9c288"
+                  "reference": "Practitioner/1729352052558346000.0b828a53-6119-460a-8a48-687dd44f2303"
                 }
               }
             ]
@@ -444,18 +444,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "requester": {
-          "reference": "Practitioner/1729293853805215000.42e73b28-901b-40bf-9183-5f97a4ebfd40"
+          "reference": "Practitioner/1729352052554441000.72e258b2-e1e1-4b42-b283-77ac997a3758"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729293853805215000.42e73b28-901b-40bf-9183-5f97a4ebfd40",
+      "fullUrl": "Practitioner/1729352052554441000.72e258b2-e1e1-4b42-b283-77ac997a3758",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293853805215000.42e73b28-901b-40bf-9183-5f97a4ebfd40",
+        "id": "1729352052554441000.72e258b2-e1e1-4b42-b283-77ac997a3758",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -502,10 +502,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293853808046000.4765e90f-3c15-4e07-9e25-eb4abec65131",
+      "fullUrl": "Practitioner/1729352052557075000.039df086-b45c-4354-9c17-6dd516fae546",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293853808046000.4765e90f-3c15-4e07-9e25-eb4abec65131",
+        "id": "1729352052557075000.039df086-b45c-4354-9c17-6dd516fae546",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -548,10 +548,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293853809451000.e6be8591-29a2-47aa-bf76-e1778da9c288",
+      "fullUrl": "Practitioner/1729352052558346000.0b828a53-6119-460a-8a48-687dd44f2303",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293853809451000.e6be8591-29a2-47aa-bf76-e1778da9c288",
+        "id": "1729352052558346000.0b828a53-6119-460a-8a48-687dd44f2303",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -594,10 +594,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293853811937000.a364bf26-c61e-43be-b6f4-77e017cf99ca",
+      "fullUrl": "Observation/1729352052560333000.8ab31685-9747-4357-9169-45ebc6aa2a41",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293853811937000.a364bf26-c61e-43be-b6f4-77e017cf99ca",
+        "id": "1729352052560333000.8ab31685-9747-4357-9169-45ebc6aa2a41",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -615,7 +615,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -630,10 +630,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293853814471000.c7f6cc2f-af45-4d2b-aea1-e42837ef8a21",
+      "fullUrl": "Observation/1729352052562548000.290f05d2-489a-43ed-87ea-9987671517e6",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293853814471000.c7f6cc2f-af45-4d2b-aea1-e42837ef8a21",
+        "id": "1729352052562548000.290f05d2-489a-43ed-87ea-9987671517e6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -654,7 +654,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -674,10 +674,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293853817121000.d147ddac-17db-4bf1-80bf-1d9050ada53f",
+      "fullUrl": "Observation/1729352052565175000.a99368ef-e539-4b93-9e70-7522893b5f1b",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293853817121000.d147ddac-17db-4bf1-80bf-1d9050ada53f",
+        "id": "1729352052565175000.a99368ef-e539-4b93-9e70-7522893b5f1b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -695,7 +695,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -728,10 +728,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293853819287000.4ba0dcb4-7107-4740-8cf7-09d8dcc924b3",
+      "fullUrl": "Observation/1729352052567207000.e0a3c3b5-1adc-4595-9925-6fd18bed7794",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293853819287000.4ba0dcb4-7107-4740-8cf7-09d8dcc924b3",
+        "id": "1729352052567207000.e0a3c3b5-1adc-4595-9925-6fd18bed7794",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -752,7 +752,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -772,10 +772,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293853821382000.7b2fdc78-bfda-4077-bf9b-fd785906f413",
+      "fullUrl": "Observation/1729352052569206000.ce9f219d-b450-4f8a-95ac-0aae7f411852",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293853821382000.7b2fdc78-bfda-4077-bf9b-fd785906f413",
+        "id": "1729352052569206000.ce9f219d-b450-4f8a-95ac-0aae7f411852",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -793,7 +793,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -807,10 +807,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293853823084000.e98188cb-a86b-4fbe-8c09-587750cfcb5f",
+      "fullUrl": "Observation/1729352052570924000.5fda657c-fadd-4850-8070-cac52dc50dd7",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293853823084000.e98188cb-a86b-4fbe-8c09-587750cfcb5f",
+        "id": "1729352052570924000.5fda657c-fadd-4850-8070-cac52dc50dd7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -828,7 +828,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -851,10 +851,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293853824778000.787201f1-ac04-443a-a193-c836eb392dbb",
+      "fullUrl": "Observation/1729352052572647000.fd7cfa1e-0ede-4859-bcda-de883f189ba4",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293853824778000.787201f1-ac04-443a-a193-c836eb392dbb",
+        "id": "1729352052572647000.fd7cfa1e-0ede-4859-bcda-de883f189ba4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -872,7 +872,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -887,10 +887,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293853826439000.5341ad2a-63a5-4a6a-8831-50219d1bb870",
+      "fullUrl": "Observation/1729352052574161000.3c285c5f-a237-4bed-8b67-69b63c7ee1d2",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293853826439000.5341ad2a-63a5-4a6a-8831-50219d1bb870",
+        "id": "1729352052574161000.3c285c5f-a237-4bed-8b67-69b63c7ee1d2",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -908,7 +908,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -922,10 +922,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293853828066000.59e5034f-7833-4ac7-9dbd-97124aae8add",
+      "fullUrl": "Observation/1729352052575744000.cbc75275-6d2a-41c4-a4df-7086ead85f95",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293853828066000.59e5034f-7833-4ac7-9dbd-97124aae8add",
+        "id": "1729352052575744000.cbc75275-6d2a-41c4-a4df-7086ead85f95",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -943,7 +943,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293853803231000.3eaf261b-5b51-4de6-9f60-26ed4f568b32"
+          "reference": "Patient/1729352052552657000.02057dcb-83b2-4624-9e2b-f2d00193d8b0"
         },
         "effectiveDateTime": "2024-01-16T15:00:00-05:00",
         "_effectiveDateTime": {
@@ -969,10 +969,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293853831104000.1dd383c1-b636-4f84-9c70-1d8509335178",
+      "fullUrl": "Specimen/1729352052578890000.cea7f016-f936-45d3-9981-21aa65b36839",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293853831104000.1dd383c1-b636-4f84-9c70-1d8509335178",
+        "id": "1729352052578890000.cea7f016-f936-45d3-9981-21aa65b36839",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_1_hl7_translation.fhir b/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_1_hl7_translation.fhir
index 9cea481e3..320d5f1fa 100644
--- a/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_1_hl7_translation.fhir
+++ b/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_1_hl7_translation.fhir
@@ -1,21 +1,29 @@
 {
   "resourceType": "Bundle",
-  "id": "1710187328184689466.6792c5b6-280f-4052-b1fa-289e7c96ec26",
+  "id": "1729353009788950000.049bc674-412c-4551-b9bb-3aa554164e6f",
   "meta": {
-    "lastUpdated": "2024-03-11T20:02:08.185+00:00"
+    "lastUpdated": "2024-10-19T08:50:09.789-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
     "value": "Q1960841872T2476960690"
   },
   "type": "message",
-  "timestamp": "2024-01-20T01:52:00.000+00:00",
+  "timestamp": "2024-01-20T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "fullUrl": "MessageHeader/1729353009792061000.12da643d-b222-4e0e-bbda-e684208f522d",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "id": "1729353009792061000.12da643d-b222-4e0e-bbda-e684208f522d",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
@@ -55,12 +63,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1710187328197640716.85de1353-17a0-4e08-b3c7-3b3ae4e2391e"
+              "reference": "Organization/1729353009791538000.c47e12e8-03ff-47fe-a4e0-2da44a630afb"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1710187328194283716.9bb519dd-b70e-4131-bd65-45f846df241a"
+          "reference": "Organization/1729353009790348000.2889be21-6c8c-4e5d-85ad-8daa7f82443a"
         },
         "source": {
           "extension": [
@@ -86,10 +94,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710187328194283716.9bb519dd-b70e-4131-bd65-45f846df241a",
+      "fullUrl": "Organization/1729353009790348000.2889be21-6c8c-4e5d-85ad-8daa7f82443a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710187328194283716.9bb519dd-b70e-4131-bd65-45f846df241a",
+        "id": "1729353009790348000.2889be21-6c8c-4e5d-85ad-8daa7f82443a",
         "identifier": [
           {
             "extension": [
@@ -122,10 +130,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710187328197640716.85de1353-17a0-4e08-b3c7-3b3ae4e2391e",
+      "fullUrl": "Organization/1729353009791538000.c47e12e8-03ff-47fe-a4e0-2da44a630afb",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710187328197640716.85de1353-17a0-4e08-b3c7-3b3ae4e2391e",
+        "id": "1729353009791538000.c47e12e8-03ff-47fe-a4e0-2da44a630afb",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -164,10 +172,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011",
+      "fullUrl": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1",
       "resource": {
         "resourceType": "Patient",
-        "id": "1710187328223907300.98bea26e-6738-4c96-8072-142639689011",
+        "id": "1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -216,7 +224,7 @@
             },
             "value": "1256872",
             "assigner": {
-              "reference": "Organization/1710187328209494258.e2902c30-d2ab-4941-a97d-0b2606045bb7"
+              "reference": "Organization/1729353009796132000.b2d63382-67b4-47c3-830f-b003c915ebb7"
             }
           }
         ],
@@ -233,7 +241,6 @@
                 ]
               }
             ],
-            "text": "TestValue",
             "family": "THREE",
             "given": [
               "TESTCASE"
@@ -290,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710187328209494258.e2902c30-d2ab-4941-a97d-0b2606045bb7",
+      "fullUrl": "Organization/1729353009796132000.b2d63382-67b4-47c3-830f-b003c915ebb7",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710187328209494258.e2902c30-d2ab-4941-a97d-0b2606045bb7",
+        "id": "1729353009796132000.b2d63382-67b4-47c3-830f-b003c915ebb7",
         "identifier": [
           {
             "extension": [
@@ -308,10 +315,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1710187328245046050.e765350c-5b6f-4596-a980-e2b2a983deb8",
+      "fullUrl": "ServiceRequest/1729353009810800000.eb46f6d8-5c82-454a-8c6a-9fd43dd5f763",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1710187328245046050.e765350c-5b6f-4596-a980-e2b2a983deb8",
+        "id": "1729353009810800000.eb46f6d8-5c82-454a-8c6a-9fd43dd5f763",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -323,7 +330,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1710187328240259341.299749c1-81ae-4a96-8efa-5aa679a02ccf"
+                  "reference": "Practitioner/1729353009808804000.2c727cd7-5391-4038-ae32-1970c1475a9e"
                 }
               }
             ]
@@ -351,7 +358,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1710187328243754008.68f1d467-53a6-4e4e-a30d-4366be63984d"
+                  "reference": "Practitioner/1729353009810277000.6c615d83-820c-4fc9-8eee-19f0408d48c2"
                 }
               }
             ]
@@ -387,18 +394,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "requester": {
-          "reference": "Practitioner/1710187328231700883.d449defb-c8cb-41df-9ee6-068bd5713886"
+          "reference": "Practitioner/1729353009805834000.3847d324-7e3c-4749-a450-b856c43695fd"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1710187328231700883.d449defb-c8cb-41df-9ee6-068bd5713886",
+      "fullUrl": "Practitioner/1729353009805834000.3847d324-7e3c-4749-a450-b856c43695fd",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710187328231700883.d449defb-c8cb-41df-9ee6-068bd5713886",
+        "id": "1729353009805834000.3847d324-7e3c-4749-a450-b856c43695fd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -445,10 +452,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710187328240259341.299749c1-81ae-4a96-8efa-5aa679a02ccf",
+      "fullUrl": "Practitioner/1729353009808804000.2c727cd7-5391-4038-ae32-1970c1475a9e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710187328240259341.299749c1-81ae-4a96-8efa-5aa679a02ccf",
+        "id": "1729353009808804000.2c727cd7-5391-4038-ae32-1970c1475a9e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -491,10 +498,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710187328243754008.68f1d467-53a6-4e4e-a30d-4366be63984d",
+      "fullUrl": "Practitioner/1729353009810277000.6c615d83-820c-4fc9-8eee-19f0408d48c2",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710187328243754008.68f1d467-53a6-4e4e-a30d-4366be63984d",
+        "id": "1729353009810277000.6c615d83-820c-4fc9-8eee-19f0408d48c2",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -537,10 +544,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187328252081466.5afcb825-d14a-4c7b-8cf6-23330fce85a8",
+      "fullUrl": "Observation/1729353009812666000.f9cf6e31-9066-426f-a7c0-c3fc9bf3fca0",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187328252081466.5afcb825-d14a-4c7b-8cf6-23330fce85a8",
+        "id": "1729353009812666000.f9cf6e31-9066-426f-a7c0-c3fc9bf3fca0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -558,7 +565,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -573,10 +580,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187328256523216.595a3c22-ceac-4f6b-a106-50a5451d7119",
+      "fullUrl": "Observation/1729353009814975000.1502adb9-f5c6-41c0-a5ec-e5d92acfb3f0",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187328256523216.595a3c22-ceac-4f6b-a106-50a5451d7119",
+        "id": "1729353009814975000.1502adb9-f5c6-41c0-a5ec-e5d92acfb3f0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -597,7 +604,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -617,10 +624,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187328260967341.f0e16339-ef00-4273-85ae-727bb65a7e8f",
+      "fullUrl": "Observation/1729353009817430000.0442b1d8-e292-435d-97b6-b11721ab4fa5",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187328260967341.f0e16339-ef00-4273-85ae-727bb65a7e8f",
+        "id": "1729353009817430000.0442b1d8-e292-435d-97b6-b11721ab4fa5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -638,7 +645,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -671,10 +678,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187328264144841.98fc3976-9930-4c86-9e76-b4ff04cfdc13",
+      "fullUrl": "Observation/1729353009819430000.05b6995d-4c12-48d9-94eb-5e38af22e6bd",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187328264144841.98fc3976-9930-4c86-9e76-b4ff04cfdc13",
+        "id": "1729353009819430000.05b6995d-4c12-48d9-94eb-5e38af22e6bd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -695,7 +702,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -715,10 +722,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187328269353341.b1d23e3c-5769-47cc-8321-7ff5d337937e",
+      "fullUrl": "Observation/1729353009821493000.563d1fa0-3372-4fe2-861b-70c063bd2642",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187328269353341.b1d23e3c-5769-47cc-8321-7ff5d337937e",
+        "id": "1729353009821493000.563d1fa0-3372-4fe2-861b-70c063bd2642",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -735,27 +742,8 @@
           }
         ],
         "status": "final",
-        "code": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "67704-7",
-              "display": "Feeding types"
-            }
-          ]
-        },
         "subject": {
-          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -765,33 +753,14 @@
               "valueString": "202401170152-0500"
             }
           ]
-        },
-        "valueCodeableConcept": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "LA16915-3",
-              "display": "Lactose formula"
-            }
-          ]
         }
       }
     },
     {
-      "fullUrl": "Observation/1710187328272616466.34e6cb78-1106-4789-80a2-d6dd5f0c6f85",
+      "fullUrl": "Observation/1729353009823166000.d883cb4a-8096-4929-8b1c-a8ba06992f30",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187328272616466.34e6cb78-1106-4789-80a2-d6dd5f0c6f85",
+        "id": "1729353009823166000.d883cb4a-8096-4929-8b1c-a8ba06992f30",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -809,7 +778,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -832,10 +801,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187328276760425.feec07f0-b05f-4a63-8370-fe64aee99b7c",
+      "fullUrl": "Observation/1729353009824905000.645f7bba-31f8-4a43-a4f4-12317bc1b7d7",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187328276760425.feec07f0-b05f-4a63-8370-fe64aee99b7c",
+        "id": "1729353009824905000.645f7bba-31f8-4a43-a4f4-12317bc1b7d7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -853,7 +822,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -868,10 +837,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187328280783258.0bd9eedb-1207-4d65-b53c-2bb066760111",
+      "fullUrl": "Observation/1729353009826574000.5a5b0cbb-fe68-4481-ac08-025ab89376ba",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187328280783258.0bd9eedb-1207-4d65-b53c-2bb066760111",
+        "id": "1729353009826574000.5a5b0cbb-fe68-4481-ac08-025ab89376ba",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -889,7 +858,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -903,10 +872,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187328284601050.ce5f15de-b77d-4010-b462-e06f5e6b244a",
+      "fullUrl": "Observation/1729353009828404000.be282496-bd0a-4d38-9530-ea935e09e292",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187328284601050.ce5f15de-b77d-4010-b462-e06f5e6b244a",
+        "id": "1729353009828404000.be282496-bd0a-4d38-9530-ea935e09e292",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -924,7 +893,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187328223907300.98bea26e-6738-4c96-8072-142639689011"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -950,10 +919,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1710187328294739883.876c658c-c76e-4f81-8271-79d5497b8cd6",
+      "fullUrl": "Specimen/1729353009831789000.7b253b7f-0f7b-4948-8b01-7a6b29167268",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1710187328294739883.876c658c-c76e-4f81-8271-79d5497b8cd6",
+        "id": "1729353009831789000.7b253b7f-0f7b-4948-8b01-7a6b29167268",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_2_fhir_transformation.fhir b/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_2_fhir_transformation.fhir
index fb9af291f..379779b80 100644
--- a/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/005_AL_ORM_O01_NBS_Incorrect_Units_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729294809541500000.7bdeaa4d-fec7-4805-bd8c-bf7605a4693c",
+  "id": "1729353009788950000.049bc674-412c-4551-b9bb-3aa554164e6f",
   "meta": {
-    "lastUpdated": "2024-10-18T16:40:09.541-07:00"
+    "lastUpdated": "2024-10-19T08:50:09.789-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-01-20T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729294809544209000.690b4763-fb98-4c3a-a352-64d107c2057d",
+      "fullUrl": "MessageHeader/1729353009792061000.12da643d-b222-4e0e-bbda-e684208f522d",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729294809544209000.690b4763-fb98-4c3a-a352-64d107c2057d",
+        "id": "1729353009792061000.12da643d-b222-4e0e-bbda-e684208f522d",
         "meta": {
           "tag": [
             {
@@ -68,12 +68,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1729294809543576000.e922401a-5225-403c-b8f0-9b122fbbb225"
+              "reference": "Organization/1729353009791538000.c47e12e8-03ff-47fe-a4e0-2da44a630afb"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729294809542255000.bde757d3-c43c-416a-87cf-3d481bae0e9d"
+          "reference": "Organization/1729353009790348000.2889be21-6c8c-4e5d-85ad-8daa7f82443a"
         },
         "source": {
           "extension": [
@@ -99,10 +99,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294809542255000.bde757d3-c43c-416a-87cf-3d481bae0e9d",
+      "fullUrl": "Organization/1729353009790348000.2889be21-6c8c-4e5d-85ad-8daa7f82443a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294809542255000.bde757d3-c43c-416a-87cf-3d481bae0e9d",
+        "id": "1729353009790348000.2889be21-6c8c-4e5d-85ad-8daa7f82443a",
         "identifier": [
           {
             "extension": [
@@ -135,10 +135,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294809543576000.e922401a-5225-403c-b8f0-9b122fbbb225",
+      "fullUrl": "Organization/1729353009791538000.c47e12e8-03ff-47fe-a4e0-2da44a630afb",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294809543576000.e922401a-5225-403c-b8f0-9b122fbbb225",
+        "id": "1729353009791538000.c47e12e8-03ff-47fe-a4e0-2da44a630afb",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -177,10 +177,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8",
+      "fullUrl": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8",
+        "id": "1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -229,7 +229,7 @@
             },
             "value": "1256872",
             "assigner": {
-              "reference": "Organization/1729294809546485000.18e3d38d-06df-4e8d-b1ee-294cebcb22e1"
+              "reference": "Organization/1729353009796132000.b2d63382-67b4-47c3-830f-b003c915ebb7"
             }
           }
         ],
@@ -347,10 +347,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294809546485000.18e3d38d-06df-4e8d-b1ee-294cebcb22e1",
+      "fullUrl": "Organization/1729353009796132000.b2d63382-67b4-47c3-830f-b003c915ebb7",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294809546485000.18e3d38d-06df-4e8d-b1ee-294cebcb22e1",
+        "id": "1729353009796132000.b2d63382-67b4-47c3-830f-b003c915ebb7",
         "identifier": [
           {
             "extension": [
@@ -365,10 +365,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729294809561023000.784a311f-6eb1-466e-b366-7b17e080f4b6",
+      "fullUrl": "ServiceRequest/1729353009810800000.eb46f6d8-5c82-454a-8c6a-9fd43dd5f763",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729294809561023000.784a311f-6eb1-466e-b366-7b17e080f4b6",
+        "id": "1729353009810800000.eb46f6d8-5c82-454a-8c6a-9fd43dd5f763",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -380,7 +380,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729294809559156000.5ad8fa13-86f1-4be4-abfb-795ac55fc36d"
+                  "reference": "Practitioner/1729353009808804000.2c727cd7-5391-4038-ae32-1970c1475a9e"
                 }
               }
             ]
@@ -408,7 +408,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729294809560516000.d9b7e859-e66c-4c97-a8a6-68afa6619b8e"
+                  "reference": "Practitioner/1729353009810277000.6c615d83-820c-4fc9-8eee-19f0408d48c2"
                 }
               }
             ]
@@ -444,18 +444,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "requester": {
-          "reference": "Practitioner/1729294809556139000.8c72b9ec-722e-498d-980d-76861ec60094"
+          "reference": "Practitioner/1729353009805834000.3847d324-7e3c-4749-a450-b856c43695fd"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729294809556139000.8c72b9ec-722e-498d-980d-76861ec60094",
+      "fullUrl": "Practitioner/1729353009805834000.3847d324-7e3c-4749-a450-b856c43695fd",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294809556139000.8c72b9ec-722e-498d-980d-76861ec60094",
+        "id": "1729353009805834000.3847d324-7e3c-4749-a450-b856c43695fd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -502,10 +502,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294809559156000.5ad8fa13-86f1-4be4-abfb-795ac55fc36d",
+      "fullUrl": "Practitioner/1729353009808804000.2c727cd7-5391-4038-ae32-1970c1475a9e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294809559156000.5ad8fa13-86f1-4be4-abfb-795ac55fc36d",
+        "id": "1729353009808804000.2c727cd7-5391-4038-ae32-1970c1475a9e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -548,10 +548,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294809560516000.d9b7e859-e66c-4c97-a8a6-68afa6619b8e",
+      "fullUrl": "Practitioner/1729353009810277000.6c615d83-820c-4fc9-8eee-19f0408d48c2",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294809560516000.d9b7e859-e66c-4c97-a8a6-68afa6619b8e",
+        "id": "1729353009810277000.6c615d83-820c-4fc9-8eee-19f0408d48c2",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -594,10 +594,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294809562796000.9e182b2d-d925-412a-b6c5-792b418b0ceb",
+      "fullUrl": "Observation/1729353009812666000.f9cf6e31-9066-426f-a7c0-c3fc9bf3fca0",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294809562796000.9e182b2d-d925-412a-b6c5-792b418b0ceb",
+        "id": "1729353009812666000.f9cf6e31-9066-426f-a7c0-c3fc9bf3fca0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -615,7 +615,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -630,10 +630,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294809565346000.a2aa645a-d837-4439-b7e7-02f8af647e31",
+      "fullUrl": "Observation/1729353009814975000.1502adb9-f5c6-41c0-a5ec-e5d92acfb3f0",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294809565346000.a2aa645a-d837-4439-b7e7-02f8af647e31",
+        "id": "1729353009814975000.1502adb9-f5c6-41c0-a5ec-e5d92acfb3f0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -654,7 +654,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -674,10 +674,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294809568237000.9ad90f44-e4a3-4aa4-8f9c-398fd40f7d22",
+      "fullUrl": "Observation/1729353009817430000.0442b1d8-e292-435d-97b6-b11721ab4fa5",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294809568237000.9ad90f44-e4a3-4aa4-8f9c-398fd40f7d22",
+        "id": "1729353009817430000.0442b1d8-e292-435d-97b6-b11721ab4fa5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -695,7 +695,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -728,10 +728,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294809570515000.531df2d1-6a03-49e1-a89b-f4d00ffd10d2",
+      "fullUrl": "Observation/1729353009819430000.05b6995d-4c12-48d9-94eb-5e38af22e6bd",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294809570515000.531df2d1-6a03-49e1-a89b-f4d00ffd10d2",
+        "id": "1729353009819430000.05b6995d-4c12-48d9-94eb-5e38af22e6bd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -752,7 +752,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -772,10 +772,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294809572641000.e529a29d-a38d-4f59-aa8b-8121f825b367",
+      "fullUrl": "Observation/1729353009821493000.563d1fa0-3372-4fe2-861b-70c063bd2642",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294809572641000.e529a29d-a38d-4f59-aa8b-8121f825b367",
+        "id": "1729353009821493000.563d1fa0-3372-4fe2-861b-70c063bd2642",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -793,7 +793,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -807,10 +807,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294809574625000.ff2a82fc-1d93-4a93-83dd-eee540848267",
+      "fullUrl": "Observation/1729353009823166000.d883cb4a-8096-4929-8b1c-a8ba06992f30",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294809574625000.ff2a82fc-1d93-4a93-83dd-eee540848267",
+        "id": "1729353009823166000.d883cb4a-8096-4929-8b1c-a8ba06992f30",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -828,7 +828,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -851,10 +851,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294809576514000.41de17f4-3eb3-4412-9198-a25c4ac176d9",
+      "fullUrl": "Observation/1729353009824905000.645f7bba-31f8-4a43-a4f4-12317bc1b7d7",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294809576514000.41de17f4-3eb3-4412-9198-a25c4ac176d9",
+        "id": "1729353009824905000.645f7bba-31f8-4a43-a4f4-12317bc1b7d7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -872,7 +872,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -887,10 +887,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294809578164000.dbdb8a85-4a9a-4fc4-b679-e9ead5085bcf",
+      "fullUrl": "Observation/1729353009826574000.5a5b0cbb-fe68-4481-ac08-025ab89376ba",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294809578164000.dbdb8a85-4a9a-4fc4-b679-e9ead5085bcf",
+        "id": "1729353009826574000.5a5b0cbb-fe68-4481-ac08-025ab89376ba",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -908,7 +908,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -922,10 +922,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294809579839000.6e914907-83d6-4b8b-b181-17fa9b964dd5",
+      "fullUrl": "Observation/1729353009828404000.be282496-bd0a-4d38-9530-ea935e09e292",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294809579839000.6e914907-83d6-4b8b-b181-17fa9b964dd5",
+        "id": "1729353009828404000.be282496-bd0a-4d38-9530-ea935e09e292",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -943,7 +943,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294809554431000.59b1f7b1-25e8-4d0e-a7b0-5fffe3821cd8"
+          "reference": "Patient/1729353009803583000.0f7d09c7-d7f8-4e04-9df4-395d6c0832e1"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -969,10 +969,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729294809583150000.41fcd698-d0a8-4864-af74-ef53f36bbc8c",
+      "fullUrl": "Specimen/1729353009831789000.7b253b7f-0f7b-4948-8b01-7a6b29167268",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729294809583150000.41fcd698-d0a8-4864-af74-ef53f36bbc8c",
+        "id": "1729353009831789000.7b253b7f-0f7b-4948-8b01-7a6b29167268",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_1_hl7_translation.fhir b/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_1_hl7_translation.fhir
index 9af72ea56..d62594904 100644
--- a/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_1_hl7_translation.fhir
+++ b/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_1_hl7_translation.fhir
@@ -1,21 +1,29 @@
 {
   "resourceType": "Bundle",
-  "id": "1710188792313526755.af8d823f-4e1f-4f27-8d60-fb1b91cf9de6",
+  "id": "1729352164513952000.f4f5d3b8-4438-4e57-a867-c3f751802001",
   "meta": {
-    "lastUpdated": "2024-03-11T20:26:32.314+00:00"
+    "lastUpdated": "2024-10-19T08:36:04.514-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
     "value": "Q1960841872T2476960690"
   },
   "type": "message",
-  "timestamp": "2024-01-20T01:52:00.000+00:00",
+  "timestamp": "2024-01-20T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "fullUrl": "MessageHeader/1729352164515538000.1eb3ade3-b401-4c3a-ad54-4191d3eba7cb",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "id": "1729352164515538000.1eb3ade3-b401-4c3a-ad54-4191d3eba7cb",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
@@ -55,12 +63,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1710188792357600922.a7033f6b-7622-456d-9811-0fd982dc9dd0"
+              "reference": "Organization/1729352164515276000.60bd2929-fd5f-43df-9bcb-e288b389275b"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1710188792344011880.b62bcab8-ed28-4f5d-a49b-aca0cab603fd"
+          "reference": "Organization/1729352164514718000.aaca69b8-9d2d-473a-80c3-29d59aaccefb"
         },
         "source": {
           "extension": [
@@ -86,10 +94,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710188792344011880.b62bcab8-ed28-4f5d-a49b-aca0cab603fd",
+      "fullUrl": "Organization/1729352164514718000.aaca69b8-9d2d-473a-80c3-29d59aaccefb",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710188792344011880.b62bcab8-ed28-4f5d-a49b-aca0cab603fd",
+        "id": "1729352164514718000.aaca69b8-9d2d-473a-80c3-29d59aaccefb",
         "identifier": [
           {
             "extension": [
@@ -122,10 +130,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710188792357600922.a7033f6b-7622-456d-9811-0fd982dc9dd0",
+      "fullUrl": "Organization/1729352164515276000.60bd2929-fd5f-43df-9bcb-e288b389275b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710188792357600922.a7033f6b-7622-456d-9811-0fd982dc9dd0",
+        "id": "1729352164515276000.60bd2929-fd5f-43df-9bcb-e288b389275b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -164,10 +172,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b",
+      "fullUrl": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b",
       "resource": {
         "resourceType": "Patient",
-        "id": "1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b",
+        "id": "1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -216,7 +224,7 @@
             },
             "value": "1256872",
             "assigner": {
-              "reference": "Organization/1710188792367587505.cabbc41c-b5fa-4c27-94d6-5392ed4be1fa"
+              "reference": "Organization/1729352164517996000.09e7109d-f5bd-4f80-9b83-1c6be8acc624"
             }
           }
         ],
@@ -233,7 +241,6 @@
                 ]
               }
             ],
-            "text": "TestValue",
             "family": "FOUR",
             "given": [
               "TESTCASE"
@@ -290,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710188792367587505.cabbc41c-b5fa-4c27-94d6-5392ed4be1fa",
+      "fullUrl": "Organization/1729352164517996000.09e7109d-f5bd-4f80-9b83-1c6be8acc624",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710188792367587505.cabbc41c-b5fa-4c27-94d6-5392ed4be1fa",
+        "id": "1729352164517996000.09e7109d-f5bd-4f80-9b83-1c6be8acc624",
         "identifier": [
           {
             "extension": [
@@ -308,10 +315,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1710188792427888547.7a0249e3-d1f5-4b2b-b4da-b2cc46d025f6",
+      "fullUrl": "ServiceRequest/1729352164528030000.f17da6f5-d547-4852-b44f-2b5d8a463c15",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1710188792427888547.7a0249e3-d1f5-4b2b-b4da-b2cc46d025f6",
+        "id": "1729352164528030000.f17da6f5-d547-4852-b44f-2b5d8a463c15",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -323,7 +330,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1710188792422870922.40a539db-08d3-43ae-9fdd-51ef62420bc5"
+                  "reference": "Practitioner/1729352164526562000.82d22e24-866a-4317-8d4b-ae60b75a8924"
                 }
               }
             ]
@@ -351,7 +358,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1710188792426594422.8e5b250e-486e-4da3-9dfc-ed7c238cce61"
+                  "reference": "Practitioner/1729352164527538000.9dbd2481-a659-4197-bd7e-5a9d3241be03"
                 }
               }
             ]
@@ -387,18 +394,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "requester": {
-          "reference": "Practitioner/1710188792416147172.59bd2eae-c136-4dea-bf0f-ddfa88310de3"
+          "reference": "Practitioner/1729352164524655000.5239490c-3f7e-4601-895d-09146d59309e"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1710188792416147172.59bd2eae-c136-4dea-bf0f-ddfa88310de3",
+      "fullUrl": "Practitioner/1729352164524655000.5239490c-3f7e-4601-895d-09146d59309e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710188792416147172.59bd2eae-c136-4dea-bf0f-ddfa88310de3",
+        "id": "1729352164524655000.5239490c-3f7e-4601-895d-09146d59309e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -445,10 +452,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710188792422870922.40a539db-08d3-43ae-9fdd-51ef62420bc5",
+      "fullUrl": "Practitioner/1729352164526562000.82d22e24-866a-4317-8d4b-ae60b75a8924",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710188792422870922.40a539db-08d3-43ae-9fdd-51ef62420bc5",
+        "id": "1729352164526562000.82d22e24-866a-4317-8d4b-ae60b75a8924",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -491,10 +498,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710188792426594422.8e5b250e-486e-4da3-9dfc-ed7c238cce61",
+      "fullUrl": "Practitioner/1729352164527538000.9dbd2481-a659-4197-bd7e-5a9d3241be03",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710188792426594422.8e5b250e-486e-4da3-9dfc-ed7c238cce61",
+        "id": "1729352164527538000.9dbd2481-a659-4197-bd7e-5a9d3241be03",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -537,10 +544,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710188792432517088.07203720-e38c-47e3-b2d0-34399895a6a6",
+      "fullUrl": "Observation/1729352164529830000.2104f376-eb32-4c1c-ada8-121d0405505c",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710188792432517088.07203720-e38c-47e3-b2d0-34399895a6a6",
+        "id": "1729352164529830000.2104f376-eb32-4c1c-ada8-121d0405505c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -558,7 +565,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -573,10 +580,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710188792436107713.1fd14e08-182c-4af6-93fb-ea110fe2777f",
+      "fullUrl": "Observation/1729352164531615000.ffc13062-95cd-47d4-aacb-d24faecec34b",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710188792436107713.1fd14e08-182c-4af6-93fb-ea110fe2777f",
+        "id": "1729352164531615000.ffc13062-95cd-47d4-aacb-d24faecec34b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -594,7 +601,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -611,10 +618,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710188792440963880.796631cd-63ec-4328-acc1-0c2f24f8a0a9",
+      "fullUrl": "Observation/1729352164534200000.7806bf05-9641-4a6b-a5cd-c4e3bffc9aaf",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710188792440963880.796631cd-63ec-4328-acc1-0c2f24f8a0a9",
+        "id": "1729352164534200000.7806bf05-9641-4a6b-a5cd-c4e3bffc9aaf",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -632,7 +639,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -665,10 +672,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710188792443907422.41f0e63a-6bb4-4a37-b8ba-a9cf068c35b5",
+      "fullUrl": "Observation/1729352164536594000.76741fcc-24ae-4a64-ab1b-0b6ea3c5504b",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710188792443907422.41f0e63a-6bb4-4a37-b8ba-a9cf068c35b5",
+        "id": "1729352164536594000.76741fcc-24ae-4a64-ab1b-0b6ea3c5504b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -689,7 +696,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -709,10 +716,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710188792446528713.ce82ac6e-f6b0-4e1d-a318-5ab0a6f1ba45",
+      "fullUrl": "Observation/1729352164538451000.73986ec3-04bc-4283-a1ba-002238fc5dd9",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710188792446528713.ce82ac6e-f6b0-4e1d-a318-5ab0a6f1ba45",
+        "id": "1729352164538451000.73986ec3-04bc-4283-a1ba-002238fc5dd9",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -729,27 +736,8 @@
           }
         ],
         "status": "final",
-        "code": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "67704-7",
-              "display": "Feeding types"
-            }
-          ]
-        },
         "subject": {
-          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -759,33 +747,14 @@
               "valueString": "202401170152-0500"
             }
           ]
-        },
-        "valueCodeableConcept": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "LA16915-3",
-              "display": "Lactose formula"
-            }
-          ]
         }
       }
     },
     {
-      "fullUrl": "Observation/1710188792451528172.69385ef0-1e3a-4fdd-bc33-9c01ce8b1488",
+      "fullUrl": "Observation/1729352164539850000.70fddf7d-7380-4806-8eb3-cd96775b78c7",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710188792451528172.69385ef0-1e3a-4fdd-bc33-9c01ce8b1488",
+        "id": "1729352164539850000.70fddf7d-7380-4806-8eb3-cd96775b78c7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -803,7 +772,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -826,10 +795,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710188792454420172.dbc7c418-53c1-407a-9364-e39118a5006e",
+      "fullUrl": "Observation/1729352164541389000.84a0fb1e-a4bb-455c-a579-eab510438fdc",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710188792454420172.dbc7c418-53c1-407a-9364-e39118a5006e",
+        "id": "1729352164541389000.84a0fb1e-a4bb-455c-a579-eab510438fdc",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -847,7 +816,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -862,10 +831,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710188792458448547.ff760483-c087-4e97-8d15-3d032987ea7e",
+      "fullUrl": "Observation/1729352164542784000.cca8cbf8-cb06-47fa-99fc-c08743827b60",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710188792458448547.ff760483-c087-4e97-8d15-3d032987ea7e",
+        "id": "1729352164542784000.cca8cbf8-cb06-47fa-99fc-c08743827b60",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -883,7 +852,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -897,10 +866,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710188792462730005.014df8ff-3f96-41da-9756-e1af82df3e7d",
+      "fullUrl": "Observation/1729352164544325000.4b6ad7f4-58b6-475b-b470-ebc3fa858fc6",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710188792462730005.014df8ff-3f96-41da-9756-e1af82df3e7d",
+        "id": "1729352164544325000.4b6ad7f4-58b6-475b-b470-ebc3fa858fc6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -918,7 +887,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710188792407871213.add055ca-5c42-4aef-8959-ad61132a5c5b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -944,10 +913,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1710188792472506172.8a25fc36-3a7c-474e-b7e2-156b2df5fccf",
+      "fullUrl": "Specimen/1729352164547186000.bf1e15a4-ece5-4124-8efa-8539fb9e6405",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1710188792472506172.8a25fc36-3a7c-474e-b7e2-156b2df5fccf",
+        "id": "1729352164547186000.bf1e15a4-ece5-4124-8efa-8539fb9e6405",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_2_fhir_transformation.fhir b/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_2_fhir_transformation.fhir
index f4f38963a..49452d46b 100644
--- a/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/006_AL_ORM_O01_NBS_Incorrect_Data_Types_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729293968076765000.608ef3ae-4f32-43f5-8e5c-be0869c445e3",
+  "id": "1729352164513952000.f4f5d3b8-4438-4e57-a867-c3f751802001",
   "meta": {
-    "lastUpdated": "2024-10-18T16:26:08.076-07:00"
+    "lastUpdated": "2024-10-19T08:36:04.514-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-01-20T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729293968079747000.71b6ecf2-dbc8-4e26-bff5-28f89d17785c",
+      "fullUrl": "MessageHeader/1729352164515538000.1eb3ade3-b401-4c3a-ad54-4191d3eba7cb",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729293968079747000.71b6ecf2-dbc8-4e26-bff5-28f89d17785c",
+        "id": "1729352164515538000.1eb3ade3-b401-4c3a-ad54-4191d3eba7cb",
         "meta": {
           "tag": [
             {
@@ -68,12 +68,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1729293968079272000.3ffbf2b1-d7a0-4b4b-b5fd-15e79375277d"
+              "reference": "Organization/1729352164515276000.60bd2929-fd5f-43df-9bcb-e288b389275b"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729293968078004000.503923e6-23d5-48f4-a0e9-8371af498405"
+          "reference": "Organization/1729352164514718000.aaca69b8-9d2d-473a-80c3-29d59aaccefb"
         },
         "source": {
           "extension": [
@@ -99,10 +99,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293968078004000.503923e6-23d5-48f4-a0e9-8371af498405",
+      "fullUrl": "Organization/1729352164514718000.aaca69b8-9d2d-473a-80c3-29d59aaccefb",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293968078004000.503923e6-23d5-48f4-a0e9-8371af498405",
+        "id": "1729352164514718000.aaca69b8-9d2d-473a-80c3-29d59aaccefb",
         "identifier": [
           {
             "extension": [
@@ -135,10 +135,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293968079272000.3ffbf2b1-d7a0-4b4b-b5fd-15e79375277d",
+      "fullUrl": "Organization/1729352164515276000.60bd2929-fd5f-43df-9bcb-e288b389275b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293968079272000.3ffbf2b1-d7a0-4b4b-b5fd-15e79375277d",
+        "id": "1729352164515276000.60bd2929-fd5f-43df-9bcb-e288b389275b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -177,10 +177,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b",
+      "fullUrl": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b",
+        "id": "1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -229,7 +229,7 @@
             },
             "value": "1256872",
             "assigner": {
-              "reference": "Organization/1729293968082174000.5d7b0bbc-3da5-4d5b-9b13-9cbb589074f8"
+              "reference": "Organization/1729352164517996000.09e7109d-f5bd-4f80-9b83-1c6be8acc624"
             }
           }
         ],
@@ -347,10 +347,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293968082174000.5d7b0bbc-3da5-4d5b-9b13-9cbb589074f8",
+      "fullUrl": "Organization/1729352164517996000.09e7109d-f5bd-4f80-9b83-1c6be8acc624",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293968082174000.5d7b0bbc-3da5-4d5b-9b13-9cbb589074f8",
+        "id": "1729352164517996000.09e7109d-f5bd-4f80-9b83-1c6be8acc624",
         "identifier": [
           {
             "extension": [
@@ -365,10 +365,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293968096553000.3153478d-c9a7-4936-b47b-c80b41887a97",
+      "fullUrl": "ServiceRequest/1729352164528030000.f17da6f5-d547-4852-b44f-2b5d8a463c15",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293968096553000.3153478d-c9a7-4936-b47b-c80b41887a97",
+        "id": "1729352164528030000.f17da6f5-d547-4852-b44f-2b5d8a463c15",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -380,7 +380,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293968094542000.45a2fbbe-dc50-4816-bede-7e5780638115"
+                  "reference": "Practitioner/1729352164526562000.82d22e24-866a-4317-8d4b-ae60b75a8924"
                 }
               }
             ]
@@ -408,7 +408,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293968096038000.6f4bbc32-4c91-432d-b1d2-d6ce76620124"
+                  "reference": "Practitioner/1729352164527538000.9dbd2481-a659-4197-bd7e-5a9d3241be03"
                 }
               }
             ]
@@ -444,18 +444,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "requester": {
-          "reference": "Practitioner/1729293968091641000.9ebe0e4f-3f90-4f2a-9878-d6ce0e94f12d"
+          "reference": "Practitioner/1729352164524655000.5239490c-3f7e-4601-895d-09146d59309e"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729293968091641000.9ebe0e4f-3f90-4f2a-9878-d6ce0e94f12d",
+      "fullUrl": "Practitioner/1729352164524655000.5239490c-3f7e-4601-895d-09146d59309e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293968091641000.9ebe0e4f-3f90-4f2a-9878-d6ce0e94f12d",
+        "id": "1729352164524655000.5239490c-3f7e-4601-895d-09146d59309e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -502,10 +502,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293968094542000.45a2fbbe-dc50-4816-bede-7e5780638115",
+      "fullUrl": "Practitioner/1729352164526562000.82d22e24-866a-4317-8d4b-ae60b75a8924",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293968094542000.45a2fbbe-dc50-4816-bede-7e5780638115",
+        "id": "1729352164526562000.82d22e24-866a-4317-8d4b-ae60b75a8924",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -548,10 +548,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293968096038000.6f4bbc32-4c91-432d-b1d2-d6ce76620124",
+      "fullUrl": "Practitioner/1729352164527538000.9dbd2481-a659-4197-bd7e-5a9d3241be03",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293968096038000.6f4bbc32-4c91-432d-b1d2-d6ce76620124",
+        "id": "1729352164527538000.9dbd2481-a659-4197-bd7e-5a9d3241be03",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -594,10 +594,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293968098331000.12f11a48-31a4-41a4-bc5c-6fdbccb63bfd",
+      "fullUrl": "Observation/1729352164529830000.2104f376-eb32-4c1c-ada8-121d0405505c",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293968098331000.12f11a48-31a4-41a4-bc5c-6fdbccb63bfd",
+        "id": "1729352164529830000.2104f376-eb32-4c1c-ada8-121d0405505c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -615,7 +615,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -630,10 +630,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293968100475000.912e5c66-fb54-421f-8dc7-ad40c1efc89c",
+      "fullUrl": "Observation/1729352164531615000.ffc13062-95cd-47d4-aacb-d24faecec34b",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293968100475000.912e5c66-fb54-421f-8dc7-ad40c1efc89c",
+        "id": "1729352164531615000.ffc13062-95cd-47d4-aacb-d24faecec34b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -651,7 +651,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -668,10 +668,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293968103086000.e0833afd-91cb-462c-bec2-874fdf12d119",
+      "fullUrl": "Observation/1729352164534200000.7806bf05-9641-4a6b-a5cd-c4e3bffc9aaf",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293968103086000.e0833afd-91cb-462c-bec2-874fdf12d119",
+        "id": "1729352164534200000.7806bf05-9641-4a6b-a5cd-c4e3bffc9aaf",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -689,7 +689,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -722,10 +722,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293968105195000.7314069d-19e2-4519-b384-4f9aaeb2b88a",
+      "fullUrl": "Observation/1729352164536594000.76741fcc-24ae-4a64-ab1b-0b6ea3c5504b",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293968105195000.7314069d-19e2-4519-b384-4f9aaeb2b88a",
+        "id": "1729352164536594000.76741fcc-24ae-4a64-ab1b-0b6ea3c5504b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -746,7 +746,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -766,10 +766,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293968107310000.e37067c8-1cfd-458b-a655-95e2fb864680",
+      "fullUrl": "Observation/1729352164538451000.73986ec3-04bc-4283-a1ba-002238fc5dd9",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293968107310000.e37067c8-1cfd-458b-a655-95e2fb864680",
+        "id": "1729352164538451000.73986ec3-04bc-4283-a1ba-002238fc5dd9",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -787,7 +787,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -801,10 +801,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293968109145000.4348831f-f44a-4418-b193-1118486015b7",
+      "fullUrl": "Observation/1729352164539850000.70fddf7d-7380-4806-8eb3-cd96775b78c7",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293968109145000.4348831f-f44a-4418-b193-1118486015b7",
+        "id": "1729352164539850000.70fddf7d-7380-4806-8eb3-cd96775b78c7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -822,7 +822,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -845,10 +845,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293968110860000.62b013e8-cde1-4159-98b0-69a8f51bbd19",
+      "fullUrl": "Observation/1729352164541389000.84a0fb1e-a4bb-455c-a579-eab510438fdc",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293968110860000.62b013e8-cde1-4159-98b0-69a8f51bbd19",
+        "id": "1729352164541389000.84a0fb1e-a4bb-455c-a579-eab510438fdc",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -866,7 +866,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -881,10 +881,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293968112474000.93cfcf7e-4239-4887-803c-b8236d849474",
+      "fullUrl": "Observation/1729352164542784000.cca8cbf8-cb06-47fa-99fc-c08743827b60",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293968112474000.93cfcf7e-4239-4887-803c-b8236d849474",
+        "id": "1729352164542784000.cca8cbf8-cb06-47fa-99fc-c08743827b60",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -902,7 +902,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -916,10 +916,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293968114037000.908bcca7-7193-441e-870b-90c204884141",
+      "fullUrl": "Observation/1729352164544325000.4b6ad7f4-58b6-475b-b470-ebc3fa858fc6",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293968114037000.908bcca7-7193-441e-870b-90c204884141",
+        "id": "1729352164544325000.4b6ad7f4-58b6-475b-b470-ebc3fa858fc6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -937,7 +937,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293968089463000.17424b81-5797-4119-900b-33bc25e3df4b"
+          "reference": "Patient/1729352164523214000.c9367afc-b98a-42ba-9809-5a295bfbfc6b"
         },
         "effectiveDateTime": "2024-01-17T01:52:00-05:00",
         "_effectiveDateTime": {
@@ -963,10 +963,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293968117226000.bbfd1112-0fc8-457a-953e-31d6a877df05",
+      "fullUrl": "Specimen/1729352164547186000.bf1e15a4-ece5-4124-8efa-8539fb9e6405",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293968117226000.bbfd1112-0fc8-457a-953e-31d6a877df05",
+        "id": "1729352164547186000.bf1e15a4-ece5-4124-8efa-8539fb9e6405",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_1_hl7_translation.fhir b/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_1_hl7_translation.fhir
index b83243eed..dcc659359 100644
--- a/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_1_hl7_translation.fhir
+++ b/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_1_hl7_translation.fhir
@@ -1,21 +1,29 @@
 {
   "resourceType": "Bundle",
-  "id": "1710186529252016178.407daa03-859d-44fa-bd0c-b9e40c80c50a",
+  "id": "1729352886081697000.7007bea5-10c1-4deb-818f-a0299c9e2ecd",
   "meta": {
-    "lastUpdated": "2024-03-11T19:48:49.252+00:00"
+    "lastUpdated": "2024-10-19T08:48:06.081-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
     "value": "Q1960841872T2476960690"
   },
   "type": "message",
-  "timestamp": "2024-02-24T01:52:00.000+00:00",
+  "timestamp": "2024-02-24T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "fullUrl": "MessageHeader/1729352886084623000.1ba6f40c-cf4a-44f9-97af-41824d37b787",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "id": "1729352886084623000.1ba6f40c-cf4a-44f9-97af-41824d37b787",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
@@ -35,24 +43,14 @@
           "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
           "code": "O01",
           "display": "ORM^O01^ORM_O01"
-        },
-        "source": {
-          "_endpoint": {
-            "extension": [
-              {
-                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
-                "valueCode": "unknown"
-              }
-            ]
-          }
         }
       }
     },
     {
-      "fullUrl": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e",
+      "fullUrl": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b",
       "resource": {
         "resourceType": "Patient",
-        "id": "1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e",
+        "id": "1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -101,7 +99,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1710186529263312720.05c21bf7-33e7-42dc-bfa8-4d537e6d725d"
+              "reference": "Organization/1729352886086535000.7561d95b-b09c-4a43-baa2-b51cb3586d43"
             }
           }
         ],
@@ -118,7 +116,6 @@
                 ]
               }
             ],
-            "text": "TestValue",
             "family": "FIVE",
             "given": [
               "TESTCASE"
@@ -175,10 +172,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710186529263312720.05c21bf7-33e7-42dc-bfa8-4d537e6d725d",
+      "fullUrl": "Organization/1729352886086535000.7561d95b-b09c-4a43-baa2-b51cb3586d43",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710186529263312720.05c21bf7-33e7-42dc-bfa8-4d537e6d725d",
+        "id": "1729352886086535000.7561d95b-b09c-4a43-baa2-b51cb3586d43",
         "identifier": [
           {
             "extension": [
@@ -193,10 +190,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1710186529287796345.ceece9e3-a9aa-42cb-bde6-cf4f0a914ef7",
+      "fullUrl": "ServiceRequest/1729352886107351000.2a38e610-d125-407e-ab17-14fd6b2f0f59",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1710186529287796345.ceece9e3-a9aa-42cb-bde6-cf4f0a914ef7",
+        "id": "1729352886107351000.2a38e610-d125-407e-ab17-14fd6b2f0f59",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -208,7 +205,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1710186529284684220.50dd7980-a356-44dc-8d38-8f8b283e7da7"
+                  "reference": "Practitioner/1729352886104819000.4c62a505-b61a-40f3-b298-34d28db9f9f5"
                 }
               }
             ]
@@ -236,7 +233,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1710186529286808428.92df7c7f-161b-4eb8-9a06-b919d63ba459"
+                  "reference": "Practitioner/1729352886106626000.f792f03c-b12b-4fc0-b693-fa766c2850f0"
                 }
               }
             ]
@@ -272,18 +269,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "requester": {
-          "reference": "Practitioner/1710186529281201887.309da9e7-b486-4c6b-b635-bde371e17015"
+          "reference": "Practitioner/1729352886100878000.ae211cc4-a544-47a8-b888-424102039454"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1710186529281201887.309da9e7-b486-4c6b-b635-bde371e17015",
+      "fullUrl": "Practitioner/1729352886100878000.ae211cc4-a544-47a8-b888-424102039454",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710186529281201887.309da9e7-b486-4c6b-b635-bde371e17015",
+        "id": "1729352886100878000.ae211cc4-a544-47a8-b888-424102039454",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -330,10 +327,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710186529284684220.50dd7980-a356-44dc-8d38-8f8b283e7da7",
+      "fullUrl": "Practitioner/1729352886104819000.4c62a505-b61a-40f3-b298-34d28db9f9f5",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710186529284684220.50dd7980-a356-44dc-8d38-8f8b283e7da7",
+        "id": "1729352886104819000.4c62a505-b61a-40f3-b298-34d28db9f9f5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -376,10 +373,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710186529286808428.92df7c7f-161b-4eb8-9a06-b919d63ba459",
+      "fullUrl": "Practitioner/1729352886106626000.f792f03c-b12b-4fc0-b693-fa766c2850f0",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710186529286808428.92df7c7f-161b-4eb8-9a06-b919d63ba459",
+        "id": "1729352886106626000.f792f03c-b12b-4fc0-b693-fa766c2850f0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -422,10 +419,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710186529293146178.6d6aa8ce-4715-4b65-aba6-50f6d16e19e3",
+      "fullUrl": "Observation/1729352886110031000.6df7bb96-16bd-4ce8-a903-887ed418f1f4",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710186529293146178.6d6aa8ce-4715-4b65-aba6-50f6d16e19e3",
+        "id": "1729352886110031000.6df7bb96-16bd-4ce8-a903-887ed418f1f4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -443,7 +440,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -458,10 +455,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710186529297185137.04e7ba79-9171-4685-b32f-77ad8c425661",
+      "fullUrl": "Observation/1729352886112981000.7e8c018c-cf09-4060-b959-952340195ae3",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710186529297185137.04e7ba79-9171-4685-b32f-77ad8c425661",
+        "id": "1729352886112981000.7e8c018c-cf09-4060-b959-952340195ae3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -482,7 +479,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -502,10 +499,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710186529300168678.1eabc935-168c-4fc3-b0e8-9ff026c6b935",
+      "fullUrl": "Observation/1729352886116260000.f2d59863-6d71-4ae9-93b0-c346a8c358bf",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710186529300168678.1eabc935-168c-4fc3-b0e8-9ff026c6b935",
+        "id": "1729352886116260000.f2d59863-6d71-4ae9-93b0-c346a8c358bf",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -523,7 +520,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -556,10 +553,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710186529302653678.26d446fe-e57f-4b4b-880c-efd8fe952d23",
+      "fullUrl": "Observation/1729352886118736000.a053c739-294f-41af-8228-92d36342a98c",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710186529302653678.26d446fe-e57f-4b4b-880c-efd8fe952d23",
+        "id": "1729352886118736000.a053c739-294f-41af-8228-92d36342a98c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -580,7 +577,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -600,10 +597,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710186529305251470.14cf135b-fc2b-4ec3-88a2-d2d5c55244ba",
+      "fullUrl": "Observation/1729352886121191000.0b2166c3-fabe-4862-b2c2-3e9422064b9c",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710186529305251470.14cf135b-fc2b-4ec3-88a2-d2d5c55244ba",
+        "id": "1729352886121191000.0b2166c3-fabe-4862-b2c2-3e9422064b9c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -620,27 +617,8 @@
           }
         ],
         "status": "final",
-        "code": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "67704-7",
-              "display": "Feeding types"
-            }
-          ]
-        },
         "subject": {
-          "reference": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -650,33 +628,14 @@
               "valueString": "202402221854-0500"
             }
           ]
-        },
-        "valueCodeableConcept": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "LA16914-6",
-              "display": "Breast milk"
-            }
-          ]
         }
       }
     },
     {
-      "fullUrl": "Observation/1710186529308706137.1f4ea3f4-53a2-4c4a-8cce-ec69831a7b43",
+      "fullUrl": "Observation/1729352886123026000.0fa1bfaa-850d-43ae-a995-166248bac858",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710186529308706137.1f4ea3f4-53a2-4c4a-8cce-ec69831a7b43",
+        "id": "1729352886123026000.0fa1bfaa-850d-43ae-a995-166248bac858",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -694,7 +653,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -717,10 +676,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710186529312183304.58c03a2c-35ea-460e-a13c-83ea155e4c37",
+      "fullUrl": "Observation/1729352886125165000.f52b6d6d-175f-43bf-9229-395be4982a50",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710186529312183304.58c03a2c-35ea-460e-a13c-83ea155e4c37",
+        "id": "1729352886125165000.f52b6d6d-175f-43bf-9229-395be4982a50",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -738,7 +697,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -753,10 +712,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710186529314314262.68d1ca9e-1141-4ab6-b5de-dfef7ecc217f",
+      "fullUrl": "Observation/1729352886127035000.8a91512d-5fc3-4991-95d3-d67b8b697ef6",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710186529314314262.68d1ca9e-1141-4ab6-b5de-dfef7ecc217f",
+        "id": "1729352886127035000.8a91512d-5fc3-4991-95d3-d67b8b697ef6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -774,7 +733,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -788,10 +747,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710186529316420054.8267e65b-f844-46b7-9a44-bffd4ac05c69",
+      "fullUrl": "Observation/1729352886128870000.657301de-af4d-4497-88bd-225d4128021e",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710186529316420054.8267e65b-f844-46b7-9a44-bffd4ac05c69",
+        "id": "1729352886128870000.657301de-af4d-4497-88bd-225d4128021e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -809,7 +768,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710186529273742595.c84df0b3-f15f-4919-b6b5-9a201dfa154e"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -835,10 +794,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1710186529323789054.13cfee1d-dd7f-484d-afa6-a9522b31ed60",
+      "fullUrl": "Specimen/1729352886132732000.73592920-fb65-4293-b957-8a6c25986364",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1710186529323789054.13cfee1d-dd7f-484d-afa6-a9522b31ed60",
+        "id": "1729352886132732000.73592920-fb65-4293-b957-8a6c25986364",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_2_fhir_transformation.fhir b/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_2_fhir_transformation.fhir
index 2eacd9aa9..b332fb418 100644
--- a/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/007_AL_ORM_O01_NBS_Missing_Required_Fields_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729294687049336000.830fb29a-6626-4978-a3c4-813fbe79be28",
+  "id": "1729352886081697000.7007bea5-10c1-4deb-818f-a0299c9e2ecd",
   "meta": {
-    "lastUpdated": "2024-10-18T16:38:07.049-07:00"
+    "lastUpdated": "2024-10-19T08:48:06.081-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-24T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729294687050648000.0b249881-d561-4700-bfdc-2d5f49ca3ef9",
+      "fullUrl": "MessageHeader/1729352886084623000.1ba6f40c-cf4a-44f9-97af-41824d37b787",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729294687050648000.0b249881-d561-4700-bfdc-2d5f49ca3ef9",
+        "id": "1729352886084623000.1ba6f40c-cf4a-44f9-97af-41824d37b787",
         "meta": {
           "tag": [
             {
@@ -52,10 +52,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a",
+      "fullUrl": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a",
+        "id": "1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -104,7 +104,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1729294687052552000.c875e5c5-e898-4b31-ac86-a341ae352bd8"
+              "reference": "Organization/1729352886086535000.7561d95b-b09c-4a43-baa2-b51cb3586d43"
             }
           }
         ],
@@ -222,10 +222,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294687052552000.c875e5c5-e898-4b31-ac86-a341ae352bd8",
+      "fullUrl": "Organization/1729352886086535000.7561d95b-b09c-4a43-baa2-b51cb3586d43",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294687052552000.c875e5c5-e898-4b31-ac86-a341ae352bd8",
+        "id": "1729352886086535000.7561d95b-b09c-4a43-baa2-b51cb3586d43",
         "identifier": [
           {
             "extension": [
@@ -240,10 +240,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729294687068496000.54bfcfab-e6c1-4b84-9191-50ef21263b3f",
+      "fullUrl": "ServiceRequest/1729352886107351000.2a38e610-d125-407e-ab17-14fd6b2f0f59",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729294687068496000.54bfcfab-e6c1-4b84-9191-50ef21263b3f",
+        "id": "1729352886107351000.2a38e610-d125-407e-ab17-14fd6b2f0f59",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -255,7 +255,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729294687066333000.b0a5fc75-d743-4d64-98aa-99dbcd1df413"
+                  "reference": "Practitioner/1729352886104819000.4c62a505-b61a-40f3-b298-34d28db9f9f5"
                 }
               }
             ]
@@ -283,7 +283,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729294687067909000.abbf6e99-3c45-4428-bdf8-9178f40990d2"
+                  "reference": "Practitioner/1729352886106626000.f792f03c-b12b-4fc0-b693-fa766c2850f0"
                 }
               }
             ]
@@ -319,18 +319,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "requester": {
-          "reference": "Practitioner/1729294687063473000.f1ddded0-19f0-402b-a086-f512b210b42c"
+          "reference": "Practitioner/1729352886100878000.ae211cc4-a544-47a8-b888-424102039454"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729294687063473000.f1ddded0-19f0-402b-a086-f512b210b42c",
+      "fullUrl": "Practitioner/1729352886100878000.ae211cc4-a544-47a8-b888-424102039454",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294687063473000.f1ddded0-19f0-402b-a086-f512b210b42c",
+        "id": "1729352886100878000.ae211cc4-a544-47a8-b888-424102039454",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -377,10 +377,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294687066333000.b0a5fc75-d743-4d64-98aa-99dbcd1df413",
+      "fullUrl": "Practitioner/1729352886104819000.4c62a505-b61a-40f3-b298-34d28db9f9f5",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294687066333000.b0a5fc75-d743-4d64-98aa-99dbcd1df413",
+        "id": "1729352886104819000.4c62a505-b61a-40f3-b298-34d28db9f9f5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -423,10 +423,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294687067909000.abbf6e99-3c45-4428-bdf8-9178f40990d2",
+      "fullUrl": "Practitioner/1729352886106626000.f792f03c-b12b-4fc0-b693-fa766c2850f0",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294687067909000.abbf6e99-3c45-4428-bdf8-9178f40990d2",
+        "id": "1729352886106626000.f792f03c-b12b-4fc0-b693-fa766c2850f0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -469,10 +469,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294687070464000.e6f3dc8e-04a4-48a1-8341-8a3ce881b18c",
+      "fullUrl": "Observation/1729352886110031000.6df7bb96-16bd-4ce8-a903-887ed418f1f4",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294687070464000.e6f3dc8e-04a4-48a1-8341-8a3ce881b18c",
+        "id": "1729352886110031000.6df7bb96-16bd-4ce8-a903-887ed418f1f4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -490,7 +490,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -505,10 +505,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294687073337000.1d8d84a9-76e0-4a8a-9400-f6b4f1805825",
+      "fullUrl": "Observation/1729352886112981000.7e8c018c-cf09-4060-b959-952340195ae3",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294687073337000.1d8d84a9-76e0-4a8a-9400-f6b4f1805825",
+        "id": "1729352886112981000.7e8c018c-cf09-4060-b959-952340195ae3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -529,7 +529,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -549,10 +549,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294687076289000.63742533-d66d-4716-a022-947b1e754df8",
+      "fullUrl": "Observation/1729352886116260000.f2d59863-6d71-4ae9-93b0-c346a8c358bf",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294687076289000.63742533-d66d-4716-a022-947b1e754df8",
+        "id": "1729352886116260000.f2d59863-6d71-4ae9-93b0-c346a8c358bf",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -570,7 +570,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -603,10 +603,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294687078506000.eb94dbda-f1ba-40a5-92af-86a5591a0afe",
+      "fullUrl": "Observation/1729352886118736000.a053c739-294f-41af-8228-92d36342a98c",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294687078506000.eb94dbda-f1ba-40a5-92af-86a5591a0afe",
+        "id": "1729352886118736000.a053c739-294f-41af-8228-92d36342a98c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -627,7 +627,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -647,10 +647,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294687080583000.78361666-0875-48aa-af14-10d338fbef20",
+      "fullUrl": "Observation/1729352886121191000.0b2166c3-fabe-4862-b2c2-3e9422064b9c",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294687080583000.78361666-0875-48aa-af14-10d338fbef20",
+        "id": "1729352886121191000.0b2166c3-fabe-4862-b2c2-3e9422064b9c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -668,7 +668,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -682,10 +682,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294687082494000.a7641311-d8f9-424a-a5a5-9a60d1ff3612",
+      "fullUrl": "Observation/1729352886123026000.0fa1bfaa-850d-43ae-a995-166248bac858",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294687082494000.a7641311-d8f9-424a-a5a5-9a60d1ff3612",
+        "id": "1729352886123026000.0fa1bfaa-850d-43ae-a995-166248bac858",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -703,7 +703,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -726,10 +726,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294687084372000.e0198319-8f0d-498d-8dbf-1804a32f7b3f",
+      "fullUrl": "Observation/1729352886125165000.f52b6d6d-175f-43bf-9229-395be4982a50",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294687084372000.e0198319-8f0d-498d-8dbf-1804a32f7b3f",
+        "id": "1729352886125165000.f52b6d6d-175f-43bf-9229-395be4982a50",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -747,7 +747,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -762,10 +762,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294687086164000.e1ee3893-5b32-4094-bac8-b7a79da5a5f2",
+      "fullUrl": "Observation/1729352886127035000.8a91512d-5fc3-4991-95d3-d67b8b697ef6",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294687086164000.e1ee3893-5b32-4094-bac8-b7a79da5a5f2",
+        "id": "1729352886127035000.8a91512d-5fc3-4991-95d3-d67b8b697ef6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -783,7 +783,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -797,10 +797,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294687087828000.8e0843da-2401-48dd-96e3-fffa0de5f3b4",
+      "fullUrl": "Observation/1729352886128870000.657301de-af4d-4497-88bd-225d4128021e",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294687087828000.8e0843da-2401-48dd-96e3-fffa0de5f3b4",
+        "id": "1729352886128870000.657301de-af4d-4497-88bd-225d4128021e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -818,7 +818,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294687060834000.e7600a52-1336-4a10-92b7-c143eddf4d8a"
+          "reference": "Patient/1729352886096877000.280ec18b-5e7e-49ed-a239-6823564ee10b"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -844,10 +844,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729294687091120000.285018b8-6689-41ea-a44f-62725c5264f7",
+      "fullUrl": "Specimen/1729352886132732000.73592920-fb65-4293-b957-8a6c25986364",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729294687091120000.285018b8-6689-41ea-a44f-62725c5264f7",
+        "id": "1729352886132732000.73592920-fb65-4293-b957-8a6c25986364",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_1_hl7_translation.fhir b/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_1_hl7_translation.fhir
index e9000e112..d0667f0ab 100644
--- a/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_1_hl7_translation.fhir
+++ b/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_1_hl7_translation.fhir
@@ -1,21 +1,29 @@
 {
   "resourceType": "Bundle",
-  "id": "1710187586384798542.c6ddaf55-a4bd-4018-b870-42da5c91a205",
+  "id": "1729352525194732000.0b7b226d-3288-430a-87a3-b34e2fdf1ee9",
   "meta": {
-    "lastUpdated": "2024-03-11T20:06:26.385+00:00"
+    "lastUpdated": "2024-10-19T08:42:05.194-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
     "value": "Q1960841872T2476960690"
   },
   "type": "message",
-  "timestamp": "2024-02-24T01:52:00.000+00:00",
+  "timestamp": "2024-02-24T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "fullUrl": "MessageHeader/1729352525195792000.444036cf-4ce5-46ec-be6f-2b1d0c288e37",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "id": "1729352525195792000.444036cf-4ce5-46ec-be6f-2b1d0c288e37",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
@@ -55,12 +63,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1710187586392287292.7c0df14b-70cb-4381-9840-4eec43a26c7e"
+              "reference": "Organization/1729352525195581000.40768489-f24b-49c6-957d-1e734d1f5e3c"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1710187586389586126.65780795-9f9e-469c-9598-1e5b8d85e1bc"
+          "reference": "Organization/1729352525195144000.f50f4672-8437-4ec1-aa2d-ffd2de42603d"
         },
         "source": {
           "extension": [
@@ -86,10 +94,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710187586389586126.65780795-9f9e-469c-9598-1e5b8d85e1bc",
+      "fullUrl": "Organization/1729352525195144000.f50f4672-8437-4ec1-aa2d-ffd2de42603d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710187586389586126.65780795-9f9e-469c-9598-1e5b8d85e1bc",
+        "id": "1729352525195144000.f50f4672-8437-4ec1-aa2d-ffd2de42603d",
         "identifier": [
           {
             "extension": [
@@ -122,10 +130,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710187586392287292.7c0df14b-70cb-4381-9840-4eec43a26c7e",
+      "fullUrl": "Organization/1729352525195581000.40768489-f24b-49c6-957d-1e734d1f5e3c",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710187586392287292.7c0df14b-70cb-4381-9840-4eec43a26c7e",
+        "id": "1729352525195581000.40768489-f24b-49c6-957d-1e734d1f5e3c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -164,10 +172,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9",
+      "fullUrl": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3",
       "resource": {
         "resourceType": "Patient",
-        "id": "1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9",
+        "id": "1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -216,7 +224,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1710187586400045709.1f02069d-181a-4637-b3a9-7fe68805c657"
+              "reference": "Organization/1729352525196783000.bc8be9c3-1b5a-4261-8e38-cf977df9e515"
             }
           }
         ],
@@ -233,7 +241,6 @@
                 ]
               }
             ],
-            "text": "TestValue",
             "family": "SIX",
             "given": [
               "TESTCASE"
@@ -290,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710187586400045709.1f02069d-181a-4637-b3a9-7fe68805c657",
+      "fullUrl": "Organization/1729352525196783000.bc8be9c3-1b5a-4261-8e38-cf977df9e515",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710187586400045709.1f02069d-181a-4637-b3a9-7fe68805c657",
+        "id": "1729352525196783000.bc8be9c3-1b5a-4261-8e38-cf977df9e515",
         "identifier": [
           {
             "extension": [
@@ -308,10 +315,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1710187586429742751.b52e02dc-f812-4856-9144-04367ca58356",
+      "fullUrl": "ServiceRequest/1729352525206277000.e8a6deb9-8ee0-45c7-a578-a5c049377b91",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1710187586429742751.b52e02dc-f812-4856-9144-04367ca58356",
+        "id": "1729352525206277000.e8a6deb9-8ee0-45c7-a578-a5c049377b91",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -323,7 +330,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1710187586421641501.bae98cde-514b-4fd8-9879-a142e78f2f47"
+                  "reference": "Practitioner/1729352525204823000.46c6e182-e931-41ed-90d6-2f2c05ef3efa"
                 }
               }
             ]
@@ -351,7 +358,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1710187586427369209.5ede2c35-6409-4da4-bbb9-a401e30369a1"
+                  "reference": "Practitioner/1729352525205887000.4ff3d433-b394-49dc-8b7e-6094495bb480"
                 }
               }
             ]
@@ -387,18 +394,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "requester": {
-          "reference": "Practitioner/1710187586417673501.b072a40e-a5fc-46a1-a6fc-80d63a3c2c98"
+          "reference": "Practitioner/1729352525202803000.073cf4a6-60d3-44c4-817b-086eb9e20988"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1710187586417673501.b072a40e-a5fc-46a1-a6fc-80d63a3c2c98",
+      "fullUrl": "Practitioner/1729352525202803000.073cf4a6-60d3-44c4-817b-086eb9e20988",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710187586417673501.b072a40e-a5fc-46a1-a6fc-80d63a3c2c98",
+        "id": "1729352525202803000.073cf4a6-60d3-44c4-817b-086eb9e20988",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -445,10 +452,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710187586421641501.bae98cde-514b-4fd8-9879-a142e78f2f47",
+      "fullUrl": "Practitioner/1729352525204823000.46c6e182-e931-41ed-90d6-2f2c05ef3efa",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710187586421641501.bae98cde-514b-4fd8-9879-a142e78f2f47",
+        "id": "1729352525204823000.46c6e182-e931-41ed-90d6-2f2c05ef3efa",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -491,10 +498,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710187586427369209.5ede2c35-6409-4da4-bbb9-a401e30369a1",
+      "fullUrl": "Practitioner/1729352525205887000.4ff3d433-b394-49dc-8b7e-6094495bb480",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710187586427369209.5ede2c35-6409-4da4-bbb9-a401e30369a1",
+        "id": "1729352525205887000.4ff3d433-b394-49dc-8b7e-6094495bb480",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -537,10 +544,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187586440164876.e9d45837-db45-4a67-8bd6-99564832a29b",
+      "fullUrl": "Observation/1729352525207508000.5f5d9219-167e-4b46-8ad2-3737fead8b79",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187586440164876.e9d45837-db45-4a67-8bd6-99564832a29b",
+        "id": "1729352525207508000.5f5d9219-167e-4b46-8ad2-3737fead8b79",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -558,7 +565,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -573,10 +580,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187586450130376.573b1b4c-085a-4c73-8996-65bd0b374461",
+      "fullUrl": "Observation/1729352525209497000.52f32acd-55f7-4e6a-abc1-93a9d1c1440e",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187586450130376.573b1b4c-085a-4c73-8996-65bd0b374461",
+        "id": "1729352525209497000.52f32acd-55f7-4e6a-abc1-93a9d1c1440e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -597,7 +604,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -617,10 +624,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187586454373126.2417f92b-28fe-4187-ab38-ea10a4b2090c",
+      "fullUrl": "Observation/1729352525211521000.094b0c1c-06a4-4798-8510-0794850a3c3d",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187586454373126.2417f92b-28fe-4187-ab38-ea10a4b2090c",
+        "id": "1729352525211521000.094b0c1c-06a4-4798-8510-0794850a3c3d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -638,7 +645,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -671,10 +678,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187586458953918.ca9c872b-6b31-49ff-9618-6a21066aff97",
+      "fullUrl": "Observation/1729352525213331000.4f9dbc78-f934-4c37-9310-d50bdc9788c4",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187586458953918.ca9c872b-6b31-49ff-9618-6a21066aff97",
+        "id": "1729352525213331000.4f9dbc78-f934-4c37-9310-d50bdc9788c4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -695,7 +702,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -715,10 +722,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187586462961418.810b7974-8280-4cf1-9f9c-f884f5efb6ee",
+      "fullUrl": "Observation/1729352525215181000.0804fdd4-455e-4ab9-9b51-73e49eedbc9a",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187586462961418.810b7974-8280-4cf1-9f9c-f884f5efb6ee",
+        "id": "1729352525215181000.0804fdd4-455e-4ab9-9b51-73e49eedbc9a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -735,27 +742,8 @@
           }
         ],
         "status": "final",
-        "code": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "67704-7",
-              "display": "Feeding types"
-            }
-          ]
-        },
         "subject": {
-          "reference": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -765,33 +753,14 @@
               "valueString": "202402221854-0500"
             }
           ]
-        },
-        "valueCodeableConcept": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "LA16914-6",
-              "display": "Breast milk"
-            }
-          ]
         }
       }
     },
     {
-      "fullUrl": "Observation/1710187586465499209.1ef3e71c-d8da-4349-b2fd-6c09173eb42e",
+      "fullUrl": "Observation/1729352525216834000.f6a323ac-e2e8-4bac-9bee-c61cfb6c185d",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187586465499209.1ef3e71c-d8da-4349-b2fd-6c09173eb42e",
+        "id": "1729352525216834000.f6a323ac-e2e8-4bac-9bee-c61cfb6c185d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -809,7 +778,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -832,10 +801,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187586472141751.9146d40f-ab7c-43f6-b1c9-1894f8644f66",
+      "fullUrl": "Observation/1729352525218360000.d142bef0-4e05-4358-8437-3acc60571956",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187586472141751.9146d40f-ab7c-43f6-b1c9-1894f8644f66",
+        "id": "1729352525218360000.d142bef0-4e05-4358-8437-3acc60571956",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -853,7 +822,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -868,10 +837,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187586478304334.4e00ca8c-5385-4c97-a4b9-b6f56b028c40",
+      "fullUrl": "Observation/1729352525219858000.8794398d-e0d7-4e2e-8733-2a624ddf3ab3",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187586478304334.4e00ca8c-5385-4c97-a4b9-b6f56b028c40",
+        "id": "1729352525219858000.8794398d-e0d7-4e2e-8733-2a624ddf3ab3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -889,7 +858,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -903,10 +872,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710187586482671209.6f0190f3-8f81-4268-a89d-5b0e900d40d2",
+      "fullUrl": "Observation/1729352525221317000.e52b75bc-5b48-4c61-861b-c9228434c2b5",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710187586482671209.6f0190f3-8f81-4268-a89d-5b0e900d40d2",
+        "id": "1729352525221317000.e52b75bc-5b48-4c61-861b-c9228434c2b5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -924,7 +893,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710187586412227751.276c3564-6fc2-405f-8155-667a1316fcf9"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -950,10 +919,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1710187586496406418.28bb8af6-ff22-40c7-b01b-18de3c7a6612",
+      "fullUrl": "Specimen/1729352525224087000.69351c9e-08c5-42d4-9fa6-9b47030ed19e",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1710187586496406418.28bb8af6-ff22-40c7-b01b-18de3c7a6612",
+        "id": "1729352525224087000.69351c9e-08c5-42d4-9fa6-9b47030ed19e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_2_fhir_transformation.fhir b/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_2_fhir_transformation.fhir
index 2ec134064..0a05aff38 100644
--- a/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/008_AL_ORM_O01_NBS_Incorrect_Code_System_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729294326497307000.76fe46a3-9ad3-4ef5-a524-30bcf116d656",
+  "id": "1729352525194732000.0b7b226d-3288-430a-87a3-b34e2fdf1ee9",
   "meta": {
-    "lastUpdated": "2024-10-18T16:32:06.497-07:00"
+    "lastUpdated": "2024-10-19T08:42:05.194-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-24T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729294326499346000.1f10f807-390c-43a5-a13e-14e84e342811",
+      "fullUrl": "MessageHeader/1729352525195792000.444036cf-4ce5-46ec-be6f-2b1d0c288e37",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729294326499346000.1f10f807-390c-43a5-a13e-14e84e342811",
+        "id": "1729352525195792000.444036cf-4ce5-46ec-be6f-2b1d0c288e37",
         "meta": {
           "tag": [
             {
@@ -68,12 +68,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1729294326498759000.5f884252-2e8a-413d-9ab9-8f11b8ac21f6"
+              "reference": "Organization/1729352525195581000.40768489-f24b-49c6-957d-1e734d1f5e3c"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729294326497869000.020c15da-5ce4-44b4-b99b-f3941b9cf6d9"
+          "reference": "Organization/1729352525195144000.f50f4672-8437-4ec1-aa2d-ffd2de42603d"
         },
         "source": {
           "extension": [
@@ -99,10 +99,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294326497869000.020c15da-5ce4-44b4-b99b-f3941b9cf6d9",
+      "fullUrl": "Organization/1729352525195144000.f50f4672-8437-4ec1-aa2d-ffd2de42603d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294326497869000.020c15da-5ce4-44b4-b99b-f3941b9cf6d9",
+        "id": "1729352525195144000.f50f4672-8437-4ec1-aa2d-ffd2de42603d",
         "identifier": [
           {
             "extension": [
@@ -135,10 +135,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294326498759000.5f884252-2e8a-413d-9ab9-8f11b8ac21f6",
+      "fullUrl": "Organization/1729352525195581000.40768489-f24b-49c6-957d-1e734d1f5e3c",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294326498759000.5f884252-2e8a-413d-9ab9-8f11b8ac21f6",
+        "id": "1729352525195581000.40768489-f24b-49c6-957d-1e734d1f5e3c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -177,10 +177,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359",
+      "fullUrl": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359",
+        "id": "1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -229,7 +229,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1729294326501094000.d99a9273-b572-4db5-975f-b6272132e4c2"
+              "reference": "Organization/1729352525196783000.bc8be9c3-1b5a-4261-8e38-cf977df9e515"
             }
           }
         ],
@@ -347,10 +347,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294326501094000.d99a9273-b572-4db5-975f-b6272132e4c2",
+      "fullUrl": "Organization/1729352525196783000.bc8be9c3-1b5a-4261-8e38-cf977df9e515",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294326501094000.d99a9273-b572-4db5-975f-b6272132e4c2",
+        "id": "1729352525196783000.bc8be9c3-1b5a-4261-8e38-cf977df9e515",
         "identifier": [
           {
             "extension": [
@@ -365,10 +365,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729294326513120000.881147d1-a989-4518-a2e8-7e706b3edad4",
+      "fullUrl": "ServiceRequest/1729352525206277000.e8a6deb9-8ee0-45c7-a578-a5c049377b91",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729294326513120000.881147d1-a989-4518-a2e8-7e706b3edad4",
+        "id": "1729352525206277000.e8a6deb9-8ee0-45c7-a578-a5c049377b91",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -380,7 +380,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729294326511396000.3b0cb3ef-6d0b-4f66-8d8b-c9f67b56f974"
+                  "reference": "Practitioner/1729352525204823000.46c6e182-e931-41ed-90d6-2f2c05ef3efa"
                 }
               }
             ]
@@ -408,7 +408,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729294326512632000.6f8b8c0d-6f5d-498c-8365-70713ad1b378"
+                  "reference": "Practitioner/1729352525205887000.4ff3d433-b394-49dc-8b7e-6094495bb480"
                 }
               }
             ]
@@ -444,18 +444,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "requester": {
-          "reference": "Practitioner/1729294326509484000.290413a2-8cd7-4095-ba2b-3142174bef15"
+          "reference": "Practitioner/1729352525202803000.073cf4a6-60d3-44c4-817b-086eb9e20988"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729294326509484000.290413a2-8cd7-4095-ba2b-3142174bef15",
+      "fullUrl": "Practitioner/1729352525202803000.073cf4a6-60d3-44c4-817b-086eb9e20988",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294326509484000.290413a2-8cd7-4095-ba2b-3142174bef15",
+        "id": "1729352525202803000.073cf4a6-60d3-44c4-817b-086eb9e20988",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -502,10 +502,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294326511396000.3b0cb3ef-6d0b-4f66-8d8b-c9f67b56f974",
+      "fullUrl": "Practitioner/1729352525204823000.46c6e182-e931-41ed-90d6-2f2c05ef3efa",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294326511396000.3b0cb3ef-6d0b-4f66-8d8b-c9f67b56f974",
+        "id": "1729352525204823000.46c6e182-e931-41ed-90d6-2f2c05ef3efa",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -548,10 +548,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294326512632000.6f8b8c0d-6f5d-498c-8365-70713ad1b378",
+      "fullUrl": "Practitioner/1729352525205887000.4ff3d433-b394-49dc-8b7e-6094495bb480",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294326512632000.6f8b8c0d-6f5d-498c-8365-70713ad1b378",
+        "id": "1729352525205887000.4ff3d433-b394-49dc-8b7e-6094495bb480",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -594,10 +594,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294326514062000.4440497a-374c-4083-9d81-80abf8c1dd8b",
+      "fullUrl": "Observation/1729352525207508000.5f5d9219-167e-4b46-8ad2-3737fead8b79",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294326514062000.4440497a-374c-4083-9d81-80abf8c1dd8b",
+        "id": "1729352525207508000.5f5d9219-167e-4b46-8ad2-3737fead8b79",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -615,7 +615,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -630,10 +630,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294326515397000.4db74cd3-011f-4743-af9f-e42e69898efe",
+      "fullUrl": "Observation/1729352525209497000.52f32acd-55f7-4e6a-abc1-93a9d1c1440e",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294326515397000.4db74cd3-011f-4743-af9f-e42e69898efe",
+        "id": "1729352525209497000.52f32acd-55f7-4e6a-abc1-93a9d1c1440e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -654,7 +654,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -674,10 +674,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294326516932000.f115dfb9-302d-4a9f-84f0-58c17775ce5f",
+      "fullUrl": "Observation/1729352525211521000.094b0c1c-06a4-4798-8510-0794850a3c3d",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294326516932000.f115dfb9-302d-4a9f-84f0-58c17775ce5f",
+        "id": "1729352525211521000.094b0c1c-06a4-4798-8510-0794850a3c3d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -695,7 +695,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -728,10 +728,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294326518187000.b4369dfb-9729-458c-8f48-e4bf0fb74a16",
+      "fullUrl": "Observation/1729352525213331000.4f9dbc78-f934-4c37-9310-d50bdc9788c4",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294326518187000.b4369dfb-9729-458c-8f48-e4bf0fb74a16",
+        "id": "1729352525213331000.4f9dbc78-f934-4c37-9310-d50bdc9788c4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -752,7 +752,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -772,10 +772,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294326519449000.3d68245d-fb04-4da4-b585-0c4192616514",
+      "fullUrl": "Observation/1729352525215181000.0804fdd4-455e-4ab9-9b51-73e49eedbc9a",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294326519449000.3d68245d-fb04-4da4-b585-0c4192616514",
+        "id": "1729352525215181000.0804fdd4-455e-4ab9-9b51-73e49eedbc9a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -793,7 +793,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -807,10 +807,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294326520592000.0cedec4d-185f-487f-b34e-2369fceb3aae",
+      "fullUrl": "Observation/1729352525216834000.f6a323ac-e2e8-4bac-9bee-c61cfb6c185d",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294326520592000.0cedec4d-185f-487f-b34e-2369fceb3aae",
+        "id": "1729352525216834000.f6a323ac-e2e8-4bac-9bee-c61cfb6c185d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -828,7 +828,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -851,10 +851,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294326522319000.452ec804-1b69-4d03-9b43-b5e5e014541b",
+      "fullUrl": "Observation/1729352525218360000.d142bef0-4e05-4358-8437-3acc60571956",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294326522319000.452ec804-1b69-4d03-9b43-b5e5e014541b",
+        "id": "1729352525218360000.d142bef0-4e05-4358-8437-3acc60571956",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -872,7 +872,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -887,10 +887,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294326524228000.36090798-67cd-4d9a-8356-22c9391d6fc5",
+      "fullUrl": "Observation/1729352525219858000.8794398d-e0d7-4e2e-8733-2a624ddf3ab3",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294326524228000.36090798-67cd-4d9a-8356-22c9391d6fc5",
+        "id": "1729352525219858000.8794398d-e0d7-4e2e-8733-2a624ddf3ab3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -908,7 +908,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -922,10 +922,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294326525987000.90b2cb4f-76ea-4b12-a553-7c4a3a340d58",
+      "fullUrl": "Observation/1729352525221317000.e52b75bc-5b48-4c61-861b-c9228434c2b5",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294326525987000.90b2cb4f-76ea-4b12-a553-7c4a3a340d58",
+        "id": "1729352525221317000.e52b75bc-5b48-4c61-861b-c9228434c2b5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -943,7 +943,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294326507454000.3270cfc0-2f4d-46b0-b675-7a91a5a63359"
+          "reference": "Patient/1729352525201632000.abdf941d-0421-4daa-a7b2-439b11807eb3"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -969,10 +969,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729294326529308000.00f493b9-8ff1-4a76-bd77-a360a78cc923",
+      "fullUrl": "Specimen/1729352525224087000.69351c9e-08c5-42d4-9fa6-9b47030ed19e",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729294326529308000.00f493b9-8ff1-4a76-bd77-a360a78cc923",
+        "id": "1729352525224087000.69351c9e-08c5-42d4-9fa6-9b47030ed19e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_1_hl7_translation.fhir b/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_1_hl7_translation.fhir
index 4855f1239..545d87d24 100644
--- a/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_1_hl7_translation.fhir
+++ b/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_1_hl7_translation.fhir
@@ -1,21 +1,29 @@
 {
   "resourceType": "Bundle",
-  "id": "1710191037028009502.d4e6f24d-44ea-4a60-a678-b5424456dd1d",
+  "id": "1729352411690224000.7171886c-fe3b-4b47-9cfd-2b18ed164048",
   "meta": {
-    "lastUpdated": "2024-03-11T21:03:57.028+00:00"
+    "lastUpdated": "2024-10-19T08:40:11.690-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
     "value": "Q1960841872T2476960690"
   },
   "type": "message",
-  "timestamp": "2024-02-24T01:52:00.000+00:00",
+  "timestamp": "2024-02-24T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "fullUrl": "MessageHeader/1729352411691718000.703e768e-9518-4dc8-8bf7-75d0281b1a9a",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "id": "1729352411691718000.703e768e-9518-4dc8-8bf7-75d0281b1a9a",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
@@ -55,12 +63,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1710191037059476044.4e40b3f3-3d8d-44af-a4e1-1e0a17a1719b"
+              "reference": "Organization/1729352411691493000.e8ce9e41-c30f-4eed-907d-6cd0f5d284b6"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1710191037056103336.450a74ae-29bb-43aa-902b-105e6158f174"
+          "reference": "Organization/1729352411690943000.87b96254-0dc3-43d2-9534-141e912f4805"
         },
         "source": {
           "extension": [
@@ -86,10 +94,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710191037056103336.450a74ae-29bb-43aa-902b-105e6158f174",
+      "fullUrl": "Organization/1729352411690943000.87b96254-0dc3-43d2-9534-141e912f4805",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710191037056103336.450a74ae-29bb-43aa-902b-105e6158f174",
+        "id": "1729352411690943000.87b96254-0dc3-43d2-9534-141e912f4805",
         "identifier": [
           {
             "extension": [
@@ -122,10 +130,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710191037059476044.4e40b3f3-3d8d-44af-a4e1-1e0a17a1719b",
+      "fullUrl": "Organization/1729352411691493000.e8ce9e41-c30f-4eed-907d-6cd0f5d284b6",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710191037059476044.4e40b3f3-3d8d-44af-a4e1-1e0a17a1719b",
+        "id": "1729352411691493000.e8ce9e41-c30f-4eed-907d-6cd0f5d284b6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -164,10 +172,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220",
+      "fullUrl": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37",
       "resource": {
         "resourceType": "Patient",
-        "id": "1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220",
+        "id": "1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -216,7 +224,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1710191037067151961.b55938eb-97ca-4807-a6d6-2e5ea969e1ff"
+              "reference": "Organization/1729352411693002000.ed99c2c8-e13d-4a2f-a845-2646190ac9cf"
             }
           }
         ],
@@ -233,7 +241,6 @@
                 ]
               }
             ],
-            "text": "TestValue",
             "given": [
               "TESTCASE"
             ]
@@ -276,10 +283,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710191037067151961.b55938eb-97ca-4807-a6d6-2e5ea969e1ff",
+      "fullUrl": "Organization/1729352411693002000.ed99c2c8-e13d-4a2f-a845-2646190ac9cf",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710191037067151961.b55938eb-97ca-4807-a6d6-2e5ea969e1ff",
+        "id": "1729352411693002000.ed99c2c8-e13d-4a2f-a845-2646190ac9cf",
         "identifier": [
           {
             "extension": [
@@ -294,10 +301,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1710191037091112502.b3edb4bc-e347-47f0-9054-087311f7024b",
+      "fullUrl": "ServiceRequest/1729352411700477000.38e4afbb-d8df-4625-93c6-b7aad2643b8d",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1710191037091112502.b3edb4bc-e347-47f0-9054-087311f7024b",
+        "id": "1729352411700477000.38e4afbb-d8df-4625-93c6-b7aad2643b8d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -309,7 +316,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1710191037086937377.5564fbc6-f6f0-4bd0-9570-c423a819ee85"
+                  "reference": "Practitioner/1729352411699249000.2176d665-2308-4058-9980-1a197be28bfb"
                 }
               }
             ]
@@ -337,7 +344,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1710191037090084169.cd75129d-3b41-4d00-b046-69b6a8403fc4"
+                  "reference": "Practitioner/1729352411700159000.d37d2205-adc2-4e7f-b68b-a5baaf737262"
                 }
               }
             ]
@@ -373,18 +380,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "requester": {
-          "reference": "Practitioner/1710191037081491586.95218aac-c8b0-46c8-8ab6-dc08af441f8c"
+          "reference": "Practitioner/1729352411697622000.70e110bc-7032-4b21-a4a8-f3694f6bf922"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1710191037081491586.95218aac-c8b0-46c8-8ab6-dc08af441f8c",
+      "fullUrl": "Practitioner/1729352411697622000.70e110bc-7032-4b21-a4a8-f3694f6bf922",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710191037081491586.95218aac-c8b0-46c8-8ab6-dc08af441f8c",
+        "id": "1729352411697622000.70e110bc-7032-4b21-a4a8-f3694f6bf922",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -431,10 +438,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710191037086937377.5564fbc6-f6f0-4bd0-9570-c423a819ee85",
+      "fullUrl": "Practitioner/1729352411699249000.2176d665-2308-4058-9980-1a197be28bfb",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710191037086937377.5564fbc6-f6f0-4bd0-9570-c423a819ee85",
+        "id": "1729352411699249000.2176d665-2308-4058-9980-1a197be28bfb",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -477,10 +484,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710191037090084169.cd75129d-3b41-4d00-b046-69b6a8403fc4",
+      "fullUrl": "Practitioner/1729352411700159000.d37d2205-adc2-4e7f-b68b-a5baaf737262",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710191037090084169.cd75129d-3b41-4d00-b046-69b6a8403fc4",
+        "id": "1729352411700159000.d37d2205-adc2-4e7f-b68b-a5baaf737262",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -523,10 +530,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710191037096056752.0966c1de-c36a-4cf4-bea9-ff9146325da0",
+      "fullUrl": "Observation/1729352411701561000.d5fa11be-fb94-4d92-b6f5-6734f1db8be3",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710191037096056752.0966c1de-c36a-4cf4-bea9-ff9146325da0",
+        "id": "1729352411701561000.d5fa11be-fb94-4d92-b6f5-6734f1db8be3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -544,7 +551,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -559,10 +566,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710191037101958002.5cd00381-e908-4802-b4ab-11d0c3ed9edc",
+      "fullUrl": "Observation/1729352411703101000.6d763f23-9250-4108-8a2e-a37bd32e9799",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710191037101958002.5cd00381-e908-4802-b4ab-11d0c3ed9edc",
+        "id": "1729352411703101000.6d763f23-9250-4108-8a2e-a37bd32e9799",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -583,7 +590,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -603,10 +610,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710191037105947961.44f5fbe3-145e-4666-8b17-55044e6743bb",
+      "fullUrl": "Observation/1729352411704760000.4644799c-4879-4924-b5a1-8e75ac79633b",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710191037105947961.44f5fbe3-145e-4666-8b17-55044e6743bb",
+        "id": "1729352411704760000.4644799c-4879-4924-b5a1-8e75ac79633b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -624,7 +631,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -657,10 +664,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710191037109255127.10607d95-b889-4e34-af00-a66950a6287c",
+      "fullUrl": "Observation/1729352411706099000.294e52b1-b8b8-40f5-8de4-6edb8a5957ee",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710191037109255127.10607d95-b889-4e34-af00-a66950a6287c",
+        "id": "1729352411706099000.294e52b1-b8b8-40f5-8de4-6edb8a5957ee",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -681,7 +688,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -701,10 +708,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710191037113508919.70f8c453-900b-47a5-bbc2-a5359d0657b3",
+      "fullUrl": "Observation/1729352411707472000.bc747f23-e0c9-490f-835c-9b6e46d30bf4",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710191037113508919.70f8c453-900b-47a5-bbc2-a5359d0657b3",
+        "id": "1729352411707472000.bc747f23-e0c9-490f-835c-9b6e46d30bf4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -721,27 +728,8 @@
           }
         ],
         "status": "final",
-        "code": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "67704-7",
-              "display": "Feeding types"
-            }
-          ]
-        },
         "subject": {
-          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -751,33 +739,14 @@
               "valueString": "202402221854-0500"
             }
           ]
-        },
-        "valueCodeableConcept": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "LA16914-6",
-              "display": "Breast milk"
-            }
-          ]
         }
       }
     },
     {
-      "fullUrl": "Observation/1710191037118169252.d810fc88-2f38-4df8-af06-288c6b9c8a2d",
+      "fullUrl": "Observation/1729352411708669000.bb844841-b1af-4977-b760-bf2313b74050",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710191037118169252.d810fc88-2f38-4df8-af06-288c6b9c8a2d",
+        "id": "1729352411708669000.bb844841-b1af-4977-b760-bf2313b74050",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -795,7 +764,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -818,10 +787,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710191037120499752.0d38982e-9048-413c-b278-a39dabf85aad",
+      "fullUrl": "Observation/1729352411709857000.3fe8c328-9109-4e1f-a034-7d644cbb9953",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710191037120499752.0d38982e-9048-413c-b278-a39dabf85aad",
+        "id": "1729352411709857000.3fe8c328-9109-4e1f-a034-7d644cbb9953",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -839,7 +808,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -854,10 +823,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710191037123117169.b41587bc-4743-46e5-bfd1-e6e87a01912d",
+      "fullUrl": "Observation/1729352411711116000.1412b026-c4f8-4bb7-90eb-941f421e9a96",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710191037123117169.b41587bc-4743-46e5-bfd1-e6e87a01912d",
+        "id": "1729352411711116000.1412b026-c4f8-4bb7-90eb-941f421e9a96",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -875,7 +844,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710191037076469627.79d1caf0-04b3-4d5d-be31-a8ecb7814220"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -900,10 +869,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1710191037132924919.617b66b1-3e6b-4ec0-948b-01058778d5e0",
+      "fullUrl": "Specimen/1729352411713871000.5e849f20-b423-41ff-80a9-b0adf6953bc0",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1710191037132924919.617b66b1-3e6b-4ec0-948b-01058778d5e0",
+        "id": "1729352411713871000.5e849f20-b423-41ff-80a9-b0adf6953bc0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_2_fhir_transformation.fhir b/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_2_fhir_transformation.fhir
index 1517bef76..3ca71bbbd 100644
--- a/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/009_AL_ORM_O01_NBS_Missing_Non_Required_Fields_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729294204218212000.92c86202-5999-4f88-84ce-dfd32b3f6a22",
+  "id": "1729352411690224000.7171886c-fe3b-4b47-9cfd-2b18ed164048",
   "meta": {
-    "lastUpdated": "2024-10-18T16:30:04.218-07:00"
+    "lastUpdated": "2024-10-19T08:40:11.690-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-24T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729294204220840000.663d2b20-ed0b-4016-84a1-bc9e08457d60",
+      "fullUrl": "MessageHeader/1729352411691718000.703e768e-9518-4dc8-8bf7-75d0281b1a9a",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729294204220840000.663d2b20-ed0b-4016-84a1-bc9e08457d60",
+        "id": "1729352411691718000.703e768e-9518-4dc8-8bf7-75d0281b1a9a",
         "meta": {
           "tag": [
             {
@@ -68,12 +68,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1729294204220331000.16ce3211-c181-42b4-94d9-c6741ea2d172"
+              "reference": "Organization/1729352411691493000.e8ce9e41-c30f-4eed-907d-6cd0f5d284b6"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729294204219263000.d3227467-255e-4de1-9d35-4397466cfbe4"
+          "reference": "Organization/1729352411690943000.87b96254-0dc3-43d2-9534-141e912f4805"
         },
         "source": {
           "extension": [
@@ -99,10 +99,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294204219263000.d3227467-255e-4de1-9d35-4397466cfbe4",
+      "fullUrl": "Organization/1729352411690943000.87b96254-0dc3-43d2-9534-141e912f4805",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294204219263000.d3227467-255e-4de1-9d35-4397466cfbe4",
+        "id": "1729352411690943000.87b96254-0dc3-43d2-9534-141e912f4805",
         "identifier": [
           {
             "extension": [
@@ -135,10 +135,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294204220331000.16ce3211-c181-42b4-94d9-c6741ea2d172",
+      "fullUrl": "Organization/1729352411691493000.e8ce9e41-c30f-4eed-907d-6cd0f5d284b6",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294204220331000.16ce3211-c181-42b4-94d9-c6741ea2d172",
+        "id": "1729352411691493000.e8ce9e41-c30f-4eed-907d-6cd0f5d284b6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -177,10 +177,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf",
+      "fullUrl": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf",
+        "id": "1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -229,7 +229,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1729294204222999000.87ea7414-bee5-41a9-97f1-be3b7f461102"
+              "reference": "Organization/1729352411693002000.ed99c2c8-e13d-4a2f-a845-2646190ac9cf"
             }
           }
         ],
@@ -333,10 +333,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294204222999000.87ea7414-bee5-41a9-97f1-be3b7f461102",
+      "fullUrl": "Organization/1729352411693002000.ed99c2c8-e13d-4a2f-a845-2646190ac9cf",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294204222999000.87ea7414-bee5-41a9-97f1-be3b7f461102",
+        "id": "1729352411693002000.ed99c2c8-e13d-4a2f-a845-2646190ac9cf",
         "identifier": [
           {
             "extension": [
@@ -351,10 +351,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729294204235823000.f15326e7-64f3-480f-818d-03ab91e9e2af",
+      "fullUrl": "ServiceRequest/1729352411700477000.38e4afbb-d8df-4625-93c6-b7aad2643b8d",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729294204235823000.f15326e7-64f3-480f-818d-03ab91e9e2af",
+        "id": "1729352411700477000.38e4afbb-d8df-4625-93c6-b7aad2643b8d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -366,7 +366,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729294204233805000.46797c8f-bdfd-4bdd-a57f-830d777522db"
+                  "reference": "Practitioner/1729352411699249000.2176d665-2308-4058-9980-1a197be28bfb"
                 }
               }
             ]
@@ -394,7 +394,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729294204235211000.1b93c17d-3f46-45b9-aea7-3ade53f9142b"
+                  "reference": "Practitioner/1729352411700159000.d37d2205-adc2-4e7f-b68b-a5baaf737262"
                 }
               }
             ]
@@ -430,18 +430,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "requester": {
-          "reference": "Practitioner/1729294204231287000.8cb242c8-d39a-46c2-81ca-a702a51ac42a"
+          "reference": "Practitioner/1729352411697622000.70e110bc-7032-4b21-a4a8-f3694f6bf922"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729294204231287000.8cb242c8-d39a-46c2-81ca-a702a51ac42a",
+      "fullUrl": "Practitioner/1729352411697622000.70e110bc-7032-4b21-a4a8-f3694f6bf922",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294204231287000.8cb242c8-d39a-46c2-81ca-a702a51ac42a",
+        "id": "1729352411697622000.70e110bc-7032-4b21-a4a8-f3694f6bf922",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -488,10 +488,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294204233805000.46797c8f-bdfd-4bdd-a57f-830d777522db",
+      "fullUrl": "Practitioner/1729352411699249000.2176d665-2308-4058-9980-1a197be28bfb",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294204233805000.46797c8f-bdfd-4bdd-a57f-830d777522db",
+        "id": "1729352411699249000.2176d665-2308-4058-9980-1a197be28bfb",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -534,10 +534,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294204235211000.1b93c17d-3f46-45b9-aea7-3ade53f9142b",
+      "fullUrl": "Practitioner/1729352411700159000.d37d2205-adc2-4e7f-b68b-a5baaf737262",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294204235211000.1b93c17d-3f46-45b9-aea7-3ade53f9142b",
+        "id": "1729352411700159000.d37d2205-adc2-4e7f-b68b-a5baaf737262",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -580,10 +580,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294204237631000.8a28383b-ef99-4641-b937-f41b1a36733f",
+      "fullUrl": "Observation/1729352411701561000.d5fa11be-fb94-4d92-b6f5-6734f1db8be3",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294204237631000.8a28383b-ef99-4641-b937-f41b1a36733f",
+        "id": "1729352411701561000.d5fa11be-fb94-4d92-b6f5-6734f1db8be3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -601,7 +601,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -616,10 +616,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294204240234000.0be393a9-2a9e-437d-b033-7cd7bb597ea0",
+      "fullUrl": "Observation/1729352411703101000.6d763f23-9250-4108-8a2e-a37bd32e9799",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294204240234000.0be393a9-2a9e-437d-b033-7cd7bb597ea0",
+        "id": "1729352411703101000.6d763f23-9250-4108-8a2e-a37bd32e9799",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -640,7 +640,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -660,10 +660,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294204242950000.8ee6be78-5b22-4aa8-af8a-5293da5b1e9f",
+      "fullUrl": "Observation/1729352411704760000.4644799c-4879-4924-b5a1-8e75ac79633b",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294204242950000.8ee6be78-5b22-4aa8-af8a-5293da5b1e9f",
+        "id": "1729352411704760000.4644799c-4879-4924-b5a1-8e75ac79633b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -681,7 +681,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -714,10 +714,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294204245028000.41c069f0-552d-435e-aeaa-e12adc347167",
+      "fullUrl": "Observation/1729352411706099000.294e52b1-b8b8-40f5-8de4-6edb8a5957ee",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294204245028000.41c069f0-552d-435e-aeaa-e12adc347167",
+        "id": "1729352411706099000.294e52b1-b8b8-40f5-8de4-6edb8a5957ee",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -738,7 +738,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -758,10 +758,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294204247114000.47fda705-c2fa-41fa-8f4d-c77373a557b9",
+      "fullUrl": "Observation/1729352411707472000.bc747f23-e0c9-490f-835c-9b6e46d30bf4",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294204247114000.47fda705-c2fa-41fa-8f4d-c77373a557b9",
+        "id": "1729352411707472000.bc747f23-e0c9-490f-835c-9b6e46d30bf4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -779,7 +779,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -793,10 +793,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294204248955000.0c670aa1-e5fd-425f-ac69-02e5cd4daefa",
+      "fullUrl": "Observation/1729352411708669000.bb844841-b1af-4977-b760-bf2313b74050",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294204248955000.0c670aa1-e5fd-425f-ac69-02e5cd4daefa",
+        "id": "1729352411708669000.bb844841-b1af-4977-b760-bf2313b74050",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -814,7 +814,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -837,10 +837,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294204250787000.a002c395-23af-40fa-90b4-4c71ae4dbbc6",
+      "fullUrl": "Observation/1729352411709857000.3fe8c328-9109-4e1f-a034-7d644cbb9953",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294204250787000.a002c395-23af-40fa-90b4-4c71ae4dbbc6",
+        "id": "1729352411709857000.3fe8c328-9109-4e1f-a034-7d644cbb9953",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -858,7 +858,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -873,10 +873,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294204252413000.9850bbd9-5178-49c7-b19b-038b9befa4b6",
+      "fullUrl": "Observation/1729352411711116000.1412b026-c4f8-4bb7-90eb-941f421e9a96",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294204252413000.9850bbd9-5178-49c7-b19b-038b9befa4b6",
+        "id": "1729352411711116000.1412b026-c4f8-4bb7-90eb-941f421e9a96",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -894,7 +894,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294204229415000.e3db4ed5-dac7-43ed-a0c2-6635db86cbaf"
+          "reference": "Patient/1729352411696573000.806042e5-467f-4b94-b21e-5ca0cbd97f37"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -919,10 +919,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729294204255603000.7a939287-597f-41a7-811f-2d79971be327",
+      "fullUrl": "Specimen/1729352411713871000.5e849f20-b423-41ff-80a9-b0adf6953bc0",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729294204255603000.7a939287-597f-41a7-811f-2d79971be327",
+        "id": "1729352411713871000.5e849f20-b423-41ff-80a9-b0adf6953bc0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_1_hl7_translation.fhir b/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_1_hl7_translation.fhir
index 9e893553d..2b0682bf8 100644
--- a/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_1_hl7_translation.fhir
+++ b/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_1_hl7_translation.fhir
@@ -1,21 +1,29 @@
 {
   "resourceType": "Bundle",
-  "id": "1710273861575958264.575537a7-2c27-4b0f-9d5d-c748cd2b6d06",
+  "id": "1729352648767306000.db795365-520d-41a9-a135-786ece28de7a",
   "meta": {
-    "lastUpdated": "2024-03-12T20:04:21.576+00:00"
+    "lastUpdated": "2024-10-19T08:44:08.767-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
     "value": "Q1960841872T2476960690"
   },
   "type": "message",
-  "timestamp": "2024-02-24T01:52:00.000+00:00",
+  "timestamp": "2024-02-24T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/677145f7-c59e-381e-8f62-a29fb68719cf",
+      "fullUrl": "MessageHeader/1729352648769739000.0f0cdbb3-d938-44f9-8b52-4bb3a0406314",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "677145f7-c59e-381e-8f62-a29fb68719cf",
+        "id": "1729352648769739000.0f0cdbb3-d938-44f9-8b52-4bb3a0406314",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
@@ -55,12 +63,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1710273861592012639.3634a113-9a76-4df9-b949-fc5b922e7002"
+              "reference": "Organization/1729352648769379000.848b6b33-c795-450a-bdb6-3ae868861195"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1710273861586960097.bb302017-f586-456e-9def-13dba4450796"
+          "reference": "Organization/1729352648768528000.5a8ecbbf-c129-459f-b085-52cec6104a5f"
         },
         "source": {
           "extension": [
@@ -86,10 +94,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710273861586960097.bb302017-f586-456e-9def-13dba4450796",
+      "fullUrl": "Organization/1729352648768528000.5a8ecbbf-c129-459f-b085-52cec6104a5f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710273861586960097.bb302017-f586-456e-9def-13dba4450796",
+        "id": "1729352648768528000.5a8ecbbf-c129-459f-b085-52cec6104a5f",
         "identifier": [
           {
             "extension": [
@@ -122,10 +130,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710273861592012639.3634a113-9a76-4df9-b949-fc5b922e7002",
+      "fullUrl": "Organization/1729352648769379000.848b6b33-c795-450a-bdb6-3ae868861195",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710273861592012639.3634a113-9a76-4df9-b949-fc5b922e7002",
+        "id": "1729352648769379000.848b6b33-c795-450a-bdb6-3ae868861195",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -164,10 +172,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1",
+      "fullUrl": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350",
       "resource": {
         "resourceType": "Patient",
-        "id": "1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1",
+        "id": "1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -216,7 +224,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1710273861607587722.c55e84d4-8611-4ee4-94bb-191791e25a1e"
+              "reference": "Organization/1729352648771438000.4ac78013-f4e8-4115-a612-485c9b662763"
             }
           }
         ],
@@ -233,7 +241,6 @@
                 ]
               }
             ],
-            "text": "TestValue",
             "family": "SIX",
             "given": [
               "TESTCASE"
@@ -290,10 +297,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1710273861607587722.c55e84d4-8611-4ee4-94bb-191791e25a1e",
+      "fullUrl": "Organization/1729352648771438000.4ac78013-f4e8-4115-a612-485c9b662763",
       "resource": {
         "resourceType": "Organization",
-        "id": "1710273861607587722.c55e84d4-8611-4ee4-94bb-191791e25a1e",
+        "id": "1729352648771438000.4ac78013-f4e8-4115-a612-485c9b662763",
         "identifier": [
           {
             "extension": [
@@ -308,10 +315,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1710273861654764972.b8ac85eb-d8a1-4b8e-9440-21bd770ae903",
+      "fullUrl": "ServiceRequest/1729352648782711000.c21daa91-25ef-4a0e-9ef7-fe30b744b079",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1710273861654764972.b8ac85eb-d8a1-4b8e-9440-21bd770ae903",
+        "id": "1729352648782711000.c21daa91-25ef-4a0e-9ef7-fe30b744b079",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -323,7 +330,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1710273861649437930.96a0c030-f235-4969-a046-3141938d7370"
+                  "reference": "Practitioner/1729352648780723000.9b054902-79eb-4e51-b0b4-e14dcc796f1a"
                 }
               }
             ]
@@ -351,7 +358,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1710273861653642014.6b9253a8-dd82-4b9d-b0bc-d11676ee6b60"
+                  "reference": "Practitioner/1729352648782145000.4b86e7eb-b177-428f-b25e-8b689cc87e29"
                 }
               }
             ]
@@ -387,18 +394,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "requester": {
-          "reference": "Practitioner/1710273861638624097.e47e001b-3f58-46ea-8e58-ba638ed16e22"
+          "reference": "Practitioner/1729352648778197000.63e63ebf-3cc5-4e8b-9b1c-49a759f03258"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1710273861638624097.e47e001b-3f58-46ea-8e58-ba638ed16e22",
+      "fullUrl": "Practitioner/1729352648778197000.63e63ebf-3cc5-4e8b-9b1c-49a759f03258",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710273861638624097.e47e001b-3f58-46ea-8e58-ba638ed16e22",
+        "id": "1729352648778197000.63e63ebf-3cc5-4e8b-9b1c-49a759f03258",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -445,10 +452,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710273861649437930.96a0c030-f235-4969-a046-3141938d7370",
+      "fullUrl": "Practitioner/1729352648780723000.9b054902-79eb-4e51-b0b4-e14dcc796f1a",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710273861649437930.96a0c030-f235-4969-a046-3141938d7370",
+        "id": "1729352648780723000.9b054902-79eb-4e51-b0b4-e14dcc796f1a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -491,10 +498,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1710273861653642014.6b9253a8-dd82-4b9d-b0bc-d11676ee6b60",
+      "fullUrl": "Practitioner/1729352648782145000.4b86e7eb-b177-428f-b25e-8b689cc87e29",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1710273861653642014.6b9253a8-dd82-4b9d-b0bc-d11676ee6b60",
+        "id": "1729352648782145000.4b86e7eb-b177-428f-b25e-8b689cc87e29",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -537,10 +544,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710273861662574430.c98eaf95-f5ef-4904-a3b1-18b83a2cd9d6",
+      "fullUrl": "Observation/1729352648784214000.b6581bca-872b-4946-86e5-90bd58865291",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710273861662574430.c98eaf95-f5ef-4904-a3b1-18b83a2cd9d6",
+        "id": "1729352648784214000.b6581bca-872b-4946-86e5-90bd58865291",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -558,7 +565,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -573,10 +580,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710273861667534264.fd31fb63-2886-42a9-b02d-23b6d623941f",
+      "fullUrl": "Observation/1729352648786980000.931d72c4-a142-4e9d-9a85-e307a77053bc",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710273861667534264.fd31fb63-2886-42a9-b02d-23b6d623941f",
+        "id": "1729352648786980000.931d72c4-a142-4e9d-9a85-e307a77053bc",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -597,7 +604,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -617,10 +624,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710273861671580097.a13dafd8-4e67-46b6-ba35-1a1cfe38f44c",
+      "fullUrl": "Observation/1729352648789952000.245fdd9f-4b75-4486-abd9-0695e194eb52",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710273861671580097.a13dafd8-4e67-46b6-ba35-1a1cfe38f44c",
+        "id": "1729352648789952000.245fdd9f-4b75-4486-abd9-0695e194eb52",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -638,7 +645,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -671,10 +678,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710273861675006430.d0561e98-8496-44ff-bf43-b5c6676b92b3",
+      "fullUrl": "Observation/1729352648792231000.e36619ef-113a-4675-87b7-2e67257ab632",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710273861675006430.d0561e98-8496-44ff-bf43-b5c6676b92b3",
+        "id": "1729352648792231000.e36619ef-113a-4675-87b7-2e67257ab632",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -695,7 +702,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -715,10 +722,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710273861679088639.dff78382-7841-415a-9a7d-388ad63fb3de",
+      "fullUrl": "Observation/1729352648794524000.c03ab761-064a-4ba1-8066-a7f26695e2a7",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710273861679088639.dff78382-7841-415a-9a7d-388ad63fb3de",
+        "id": "1729352648794524000.c03ab761-064a-4ba1-8066-a7f26695e2a7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -735,27 +742,8 @@
           }
         ],
         "status": "final",
-        "code": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "67704-7",
-              "display": "Feeding types"
-            }
-          ]
-        },
         "subject": {
-          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -765,33 +753,14 @@
               "valueString": "202402221854-0500"
             }
           ]
-        },
-        "valueCodeableConcept": {
-          "coding": [
-            {
-              "extension": [
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding",
-                  "valueString": "coding"
-                },
-                {
-                  "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/ce-coding-system",
-                  "valueString": "LN"
-                }
-              ],
-              "system": "http://loinc.org",
-              "code": "LA16914-6",
-              "display": "Breast milk"
-            }
-          ]
         }
       }
     },
     {
-      "fullUrl": "Observation/1710273861682651889.32b23563-369f-4074-ad1e-b54147b29552",
+      "fullUrl": "Observation/1729352648796322000.4c20e111-4d1c-4f18-8daf-5d3af494d025",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710273861682651889.32b23563-369f-4074-ad1e-b54147b29552",
+        "id": "1729352648796322000.4c20e111-4d1c-4f18-8daf-5d3af494d025",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -809,7 +778,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -832,10 +801,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710273861686301722.8c3bd607-8066-42ed-ba3b-0332a4c4c5e0",
+      "fullUrl": "Observation/1729352648798196000.f8b5694f-d67e-4166-8348-2b269e63e026",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710273861686301722.8c3bd607-8066-42ed-ba3b-0332a4c4c5e0",
+        "id": "1729352648798196000.f8b5694f-d67e-4166-8348-2b269e63e026",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -853,7 +822,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -868,10 +837,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710273861690678555.107e5cd6-48f6-4e19-a424-882069bd899e",
+      "fullUrl": "Observation/1729352648800027000.5b01c97a-254b-42dc-ad2a-14035a12ab58",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710273861690678555.107e5cd6-48f6-4e19-a424-882069bd899e",
+        "id": "1729352648800027000.5b01c97a-254b-42dc-ad2a-14035a12ab58",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -889,7 +858,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -903,10 +872,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1710273861694267597.edd21da0-139c-41f5-9a02-b56b9690d528",
+      "fullUrl": "Observation/1729352648801887000.e5cfdbf5-07af-4056-8aa4-6544230cd3ae",
       "resource": {
         "resourceType": "Observation",
-        "id": "1710273861694267597.edd21da0-139c-41f5-9a02-b56b9690d528",
+        "id": "1729352648801887000.e5cfdbf5-07af-4056-8aa4-6544230cd3ae",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -924,7 +893,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1710273861627940014.334b408e-a29e-4050-8468-31489f8bd7e1"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -950,10 +919,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1710273861707690597.88a22055-ae5e-4a27-b2db-d3b41dd6e1ee",
+      "fullUrl": "Specimen/1729352648805400000.e7f93380-7ff0-4e03-8e85-915119bcb5c7",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1710273861707690597.88a22055-ae5e-4a27-b2db-d3b41dd6e1ee",
+        "id": "1729352648805400000.e7f93380-7ff0-4e03-8e85-915119bcb5c7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_2_fhir_transformation.fhir b/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_2_fhir_transformation.fhir
index 43913117e..def74e3f6 100644
--- a/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/010_AL_ORM_O01_NBS_Multiple_Parent_Contant_Phone_Numbers_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729294450742979000.d3a80d91-3072-483f-a1af-46b75335f232",
+  "id": "1729352648767306000.db795365-520d-41a9-a135-786ece28de7a",
   "meta": {
-    "lastUpdated": "2024-10-18T16:34:10.743-07:00"
+    "lastUpdated": "2024-10-19T08:44:08.767-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-24T01:52:00.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729294450745785000.1c4695d8-4e85-4960-850d-f65e3561b8f3",
+      "fullUrl": "MessageHeader/1729352648769739000.0f0cdbb3-d938-44f9-8b52-4bb3a0406314",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729294450745785000.1c4695d8-4e85-4960-850d-f65e3561b8f3",
+        "id": "1729352648769739000.0f0cdbb3-d938-44f9-8b52-4bb3a0406314",
         "meta": {
           "tag": [
             {
@@ -68,12 +68,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1729294450745325000.cb5220ed-63b7-4026-9e9f-18b4b9a9f9df"
+              "reference": "Organization/1729352648769379000.848b6b33-c795-450a-bdb6-3ae868861195"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729294450744258000.f2c3e36d-ae89-42e0-bee4-6eb6e41a27d3"
+          "reference": "Organization/1729352648768528000.5a8ecbbf-c129-459f-b085-52cec6104a5f"
         },
         "source": {
           "extension": [
@@ -99,10 +99,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294450744258000.f2c3e36d-ae89-42e0-bee4-6eb6e41a27d3",
+      "fullUrl": "Organization/1729352648768528000.5a8ecbbf-c129-459f-b085-52cec6104a5f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294450744258000.f2c3e36d-ae89-42e0-bee4-6eb6e41a27d3",
+        "id": "1729352648768528000.5a8ecbbf-c129-459f-b085-52cec6104a5f",
         "identifier": [
           {
             "extension": [
@@ -135,10 +135,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294450745325000.cb5220ed-63b7-4026-9e9f-18b4b9a9f9df",
+      "fullUrl": "Organization/1729352648769379000.848b6b33-c795-450a-bdb6-3ae868861195",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294450745325000.cb5220ed-63b7-4026-9e9f-18b4b9a9f9df",
+        "id": "1729352648769379000.848b6b33-c795-450a-bdb6-3ae868861195",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -177,10 +177,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484",
+      "fullUrl": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484",
+        "id": "1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -229,7 +229,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1729294450748570000.570df638-02c7-48d5-a098-825f1fd1cf99"
+              "reference": "Organization/1729352648771438000.4ac78013-f4e8-4115-a612-485c9b662763"
             }
           }
         ],
@@ -347,10 +347,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294450748570000.570df638-02c7-48d5-a098-825f1fd1cf99",
+      "fullUrl": "Organization/1729352648771438000.4ac78013-f4e8-4115-a612-485c9b662763",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294450748570000.570df638-02c7-48d5-a098-825f1fd1cf99",
+        "id": "1729352648771438000.4ac78013-f4e8-4115-a612-485c9b662763",
         "identifier": [
           {
             "extension": [
@@ -365,10 +365,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729294450760857000.44841786-81be-4d38-851c-92df3312304c",
+      "fullUrl": "ServiceRequest/1729352648782711000.c21daa91-25ef-4a0e-9ef7-fe30b744b079",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729294450760857000.44841786-81be-4d38-851c-92df3312304c",
+        "id": "1729352648782711000.c21daa91-25ef-4a0e-9ef7-fe30b744b079",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -380,7 +380,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729294450758383000.8d763590-690c-4d75-b770-348f018656c3"
+                  "reference": "Practitioner/1729352648780723000.9b054902-79eb-4e51-b0b4-e14dcc796f1a"
                 }
               }
             ]
@@ -408,7 +408,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729294450760260000.af0a3d2a-00b0-450c-8bfa-e9f8ca851a6d"
+                  "reference": "Practitioner/1729352648782145000.4b86e7eb-b177-428f-b25e-8b689cc87e29"
                 }
               }
             ]
@@ -444,18 +444,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "requester": {
-          "reference": "Practitioner/1729294450755719000.d69a0a12-c13f-4761-87b1-5f11c6be4829"
+          "reference": "Practitioner/1729352648778197000.63e63ebf-3cc5-4e8b-9b1c-49a759f03258"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729294450755719000.d69a0a12-c13f-4761-87b1-5f11c6be4829",
+      "fullUrl": "Practitioner/1729352648778197000.63e63ebf-3cc5-4e8b-9b1c-49a759f03258",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294450755719000.d69a0a12-c13f-4761-87b1-5f11c6be4829",
+        "id": "1729352648778197000.63e63ebf-3cc5-4e8b-9b1c-49a759f03258",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -502,10 +502,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294450758383000.8d763590-690c-4d75-b770-348f018656c3",
+      "fullUrl": "Practitioner/1729352648780723000.9b054902-79eb-4e51-b0b4-e14dcc796f1a",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294450758383000.8d763590-690c-4d75-b770-348f018656c3",
+        "id": "1729352648780723000.9b054902-79eb-4e51-b0b4-e14dcc796f1a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -548,10 +548,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294450760260000.af0a3d2a-00b0-450c-8bfa-e9f8ca851a6d",
+      "fullUrl": "Practitioner/1729352648782145000.4b86e7eb-b177-428f-b25e-8b689cc87e29",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294450760260000.af0a3d2a-00b0-450c-8bfa-e9f8ca851a6d",
+        "id": "1729352648782145000.4b86e7eb-b177-428f-b25e-8b689cc87e29",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -594,10 +594,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294450762840000.0ad3a3cc-e5e6-4498-9ede-adde30c1c06b",
+      "fullUrl": "Observation/1729352648784214000.b6581bca-872b-4946-86e5-90bd58865291",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294450762840000.0ad3a3cc-e5e6-4498-9ede-adde30c1c06b",
+        "id": "1729352648784214000.b6581bca-872b-4946-86e5-90bd58865291",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -615,7 +615,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -630,10 +630,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294450764606000.fde6cbcd-d10c-4a41-9ad6-220167fbd7eb",
+      "fullUrl": "Observation/1729352648786980000.931d72c4-a142-4e9d-9a85-e307a77053bc",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294450764606000.fde6cbcd-d10c-4a41-9ad6-220167fbd7eb",
+        "id": "1729352648786980000.931d72c4-a142-4e9d-9a85-e307a77053bc",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -654,7 +654,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -674,10 +674,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294450766657000.2e54569b-ed46-42f4-8c95-87c88e16f3a0",
+      "fullUrl": "Observation/1729352648789952000.245fdd9f-4b75-4486-abd9-0695e194eb52",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294450766657000.2e54569b-ed46-42f4-8c95-87c88e16f3a0",
+        "id": "1729352648789952000.245fdd9f-4b75-4486-abd9-0695e194eb52",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -695,7 +695,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -728,10 +728,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294450768186000.43f8be15-7683-4551-b43c-078f2b64987a",
+      "fullUrl": "Observation/1729352648792231000.e36619ef-113a-4675-87b7-2e67257ab632",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294450768186000.43f8be15-7683-4551-b43c-078f2b64987a",
+        "id": "1729352648792231000.e36619ef-113a-4675-87b7-2e67257ab632",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -752,7 +752,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -772,10 +772,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294450769659000.421c5990-892d-413d-a459-b1302b98a32b",
+      "fullUrl": "Observation/1729352648794524000.c03ab761-064a-4ba1-8066-a7f26695e2a7",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294450769659000.421c5990-892d-413d-a459-b1302b98a32b",
+        "id": "1729352648794524000.c03ab761-064a-4ba1-8066-a7f26695e2a7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -793,7 +793,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -807,10 +807,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294450771182000.87aa1626-9b0f-4f10-b438-b95c7fb3ebc9",
+      "fullUrl": "Observation/1729352648796322000.4c20e111-4d1c-4f18-8daf-5d3af494d025",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294450771182000.87aa1626-9b0f-4f10-b438-b95c7fb3ebc9",
+        "id": "1729352648796322000.4c20e111-4d1c-4f18-8daf-5d3af494d025",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -828,7 +828,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -851,10 +851,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294450772719000.19d40d0b-0d75-403a-8844-502b2a9d1e6c",
+      "fullUrl": "Observation/1729352648798196000.f8b5694f-d67e-4166-8348-2b269e63e026",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294450772719000.19d40d0b-0d75-403a-8844-502b2a9d1e6c",
+        "id": "1729352648798196000.f8b5694f-d67e-4166-8348-2b269e63e026",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -872,7 +872,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -887,10 +887,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294450774592000.02bb4fc9-ff03-45d1-b386-deacaf29caf9",
+      "fullUrl": "Observation/1729352648800027000.5b01c97a-254b-42dc-ad2a-14035a12ab58",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294450774592000.02bb4fc9-ff03-45d1-b386-deacaf29caf9",
+        "id": "1729352648800027000.5b01c97a-254b-42dc-ad2a-14035a12ab58",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -908,7 +908,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -922,10 +922,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294450776290000.d221ea95-61b6-4a20-81ca-c2d3f9175ce6",
+      "fullUrl": "Observation/1729352648801887000.e5cfdbf5-07af-4056-8aa4-6544230cd3ae",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294450776290000.d221ea95-61b6-4a20-81ca-c2d3f9175ce6",
+        "id": "1729352648801887000.e5cfdbf5-07af-4056-8aa4-6544230cd3ae",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -943,7 +943,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294450754214000.b724dfdc-073b-4cc9-8ff0-13bd2afad484"
+          "reference": "Patient/1729352648776693000.47b65873-bdc7-4b6d-9b80-75b8299f7350"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -969,10 +969,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729294450780065000.c1a186e8-d6e4-479d-b14f-e9635da3a8c3",
+      "fullUrl": "Specimen/1729352648805400000.e7f93380-7ff0-4e03-8e85-915119bcb5c7",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729294450780065000.c1a186e8-d6e4-479d-b14f-e9635da3a8c3",
+        "id": "1729352648805400000.e7f93380-7ff0-4e03-8e85-915119bcb5c7",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_1_hl7_translation.fhir b/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_1_hl7_translation.fhir
index e69de29bb..41014ee5b 100644
--- a/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_1_hl7_translation.fhir
+++ b/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_1_hl7_translation.fhir
@@ -0,0 +1,614 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729351806358208000.0166ff02-f452-4067-9e6c-ded369b13657",
+  "meta": {
+    "lastUpdated": "2024-10-19T08:30:06.358-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T13:40:09.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729351806360611000.4286857f-2fa4-43d7-b6fe-f665a8cd1907",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729351806360611000.4286857f-2fa4-43d7-b6fe-f665a8cd1907",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240224134009"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O01",
+          "display": "ORM^O01^ORM_O01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729351806360089000.ed2f9a91-8177-4b54-a46d-b693674f42b5"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729351806359137000.034a3738-b5f4-4932-b6bf-a454ca51ecfa"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729351806359137000.034a3738-b5f4-4932-b6bf-a454ca51ecfa",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729351806359137000.034a3738-b5f4-4932-b6bf-a454ca51ecfa",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729351806360089000.ed2f9a91-8177-4b54-a46d-b693674f42b5",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729351806360089000.ed2f9a91-8177-4b54-a46d-b693674f42b5",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729351806369678000.05fc561a-7da6-48cd-a3c0-98b08a50d5bb",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729351806369678000.05fc561a-7da6-48cd-a3c0-98b08a50d5bb",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729351806362875000.4f579b77-476d-4f3b-9aae-589fe2f63fd6"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
+            ],
+            "family": "ONE",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "birthDate": "2024-02-21",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402210152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-02-21T01:52:00-05:00"
+            }
+          ]
+        },
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1
+      }
+    },
+    {
+      "fullUrl": "Organization/1729351806362875000.4f579b77-476d-4f3b-9aae-589fe2f63fd6",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729351806362875000.4f579b77-476d-4f3b-9aae-589fe2f63fd6",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Baptist East"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "ServiceRequest/1729351806376110000.419ff517-abc1-4da5-a561-022830ac8557",
+      "resource": {
+        "resourceType": "ServiceRequest",
+        "id": "1729351806376110000.419ff517-abc1-4da5-a561-022830ac8557",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
+            "valueCode": "NW"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
+            "extension": [
+              {
+                "url": "orc-12-ordering-provider",
+                "valueReference": {
+                  "reference": "Practitioner/1729351806374139000.ecbccbd6-2ac9-4aba-abdc-38ec6c55870f"
+                }
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
+            "extension": [
+              {
+                "url": "OBR.2",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                          "valueString": "ORDERID"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "2801690163"
+                }
+              },
+              {
+                "url": "OBR.16",
+                "valueReference": {
+                  "reference": "Practitioner/1729351806375626000.c651c34a-b2c1-472a-85f2-5b477241de9f"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "2801690163"
+          }
+        ],
+        "status": "unknown",
+        "subject": {
+          "reference": "Patient/1729351806369678000.05fc561a-7da6-48cd-a3c0-98b08a50d5bb"
+        },
+        "requester": {
+          "reference": "Practitioner/1729351806371533000.3395b573-50d4-4368-b667-5568d5393c9e"
+        }
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729351806371533000.3395b573-50d4-4368-b667-5568d5393c9e",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729351806371533000.3395b573-50d4-4368-b667-5568d5393c9e",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "ORC.12"
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729351806374139000.ecbccbd6-2ac9-4aba-abdc-38ec6c55870f",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729351806374139000.ecbccbd6-2ac9-4aba-abdc-38ec6c55870f",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729351806375626000.c651c34a-b2c1-472a-85f2-5b477241de9f",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729351806375626000.c651c34a-b2c1-472a-85f2-5b477241de9f",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729351806377663000.a405e8dd-ec39-4faa-8b35-e94f36d6b2bd",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729351806377663000.a405e8dd-ec39-4faa-8b35-e94f36d6b2bd",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "DTM"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729351806369678000.05fc561a-7da6-48cd-a3c0-98b08a50d5bb"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "_valueDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "February 2 2024"
+            }
+          ]
+        },
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729351806381442000.bd100bd1-1229-4a64-9af1-2138e003e3dd",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729351806381442000.bd100bd1-1229-4a64-9af1-2138e003e3dd",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_2_fhir_transformation.fhir b/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_2_fhir_transformation.fhir
index d14d56ab2..91e1f7d12 100644
--- a/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/011_AL_ORM_O01_malformed_DTM_datatype_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729293608350739000.46215d0d-75f3-4171-9d19-aec9c5e0250b",
+  "id": "1729351806358208000.0166ff02-f452-4067-9e6c-ded369b13657",
   "meta": {
-    "lastUpdated": "2024-10-18T16:20:08.350-07:00"
+    "lastUpdated": "2024-10-19T08:30:06.358-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-24T13:40:09.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729293608352419000.bc3212d0-3e9c-4112-872c-beb43e74486c",
+      "fullUrl": "MessageHeader/1729351806360611000.4286857f-2fa4-43d7-b6fe-f665a8cd1907",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729293608352419000.bc3212d0-3e9c-4112-872c-beb43e74486c",
+        "id": "1729351806360611000.4286857f-2fa4-43d7-b6fe-f665a8cd1907",
         "meta": {
           "tag": [
             {
@@ -68,12 +68,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1729293608352204000.ec9949b4-07a5-4efe-9c2f-4c111bc6b1e4"
+              "reference": "Organization/1729351806360089000.ed2f9a91-8177-4b54-a46d-b693674f42b5"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729293608351547000.1622f176-4883-4e4f-9f87-c8540e417328"
+          "reference": "Organization/1729351806359137000.034a3738-b5f4-4932-b6bf-a454ca51ecfa"
         },
         "source": {
           "extension": [
@@ -99,10 +99,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293608351547000.1622f176-4883-4e4f-9f87-c8540e417328",
+      "fullUrl": "Organization/1729351806359137000.034a3738-b5f4-4932-b6bf-a454ca51ecfa",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293608351547000.1622f176-4883-4e4f-9f87-c8540e417328",
+        "id": "1729351806359137000.034a3738-b5f4-4932-b6bf-a454ca51ecfa",
         "identifier": [
           {
             "extension": [
@@ -135,10 +135,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293608352204000.ec9949b4-07a5-4efe-9c2f-4c111bc6b1e4",
+      "fullUrl": "Organization/1729351806360089000.ed2f9a91-8177-4b54-a46d-b693674f42b5",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293608352204000.ec9949b4-07a5-4efe-9c2f-4c111bc6b1e4",
+        "id": "1729351806360089000.ed2f9a91-8177-4b54-a46d-b693674f42b5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -177,10 +177,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729293608365060000.1a16b183-f641-4114-bb20-d27dfa39e493",
+      "fullUrl": "Patient/1729351806369678000.05fc561a-7da6-48cd-a3c0-98b08a50d5bb",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729293608365060000.1a16b183-f641-4114-bb20-d27dfa39e493",
+        "id": "1729351806369678000.05fc561a-7da6-48cd-a3c0-98b08a50d5bb",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -229,7 +229,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1729293608354147000.3cdc4c00-1624-41a5-aa53-631bd471ee19"
+              "reference": "Organization/1729351806362875000.4f579b77-476d-4f3b-9aae-589fe2f63fd6"
             }
           }
         ],
@@ -347,10 +347,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293608354147000.3cdc4c00-1624-41a5-aa53-631bd471ee19",
+      "fullUrl": "Organization/1729351806362875000.4f579b77-476d-4f3b-9aae-589fe2f63fd6",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293608354147000.3cdc4c00-1624-41a5-aa53-631bd471ee19",
+        "id": "1729351806362875000.4f579b77-476d-4f3b-9aae-589fe2f63fd6",
         "identifier": [
           {
             "extension": [
@@ -365,10 +365,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293608369053000.21a6a755-5a62-4bea-b247-64788dfb8f8b",
+      "fullUrl": "ServiceRequest/1729351806376110000.419ff517-abc1-4da5-a561-022830ac8557",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293608369053000.21a6a755-5a62-4bea-b247-64788dfb8f8b",
+        "id": "1729351806376110000.419ff517-abc1-4da5-a561-022830ac8557",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -380,7 +380,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293608367962000.4930df54-8bb2-4ebc-845e-9434d22b945e"
+                  "reference": "Practitioner/1729351806374139000.ecbccbd6-2ac9-4aba-abdc-38ec6c55870f"
                 }
               }
             ]
@@ -408,7 +408,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293608368799000.12ce891e-6c3f-40a8-b812-fe59dbbc7e71"
+                  "reference": "Practitioner/1729351806375626000.c651c34a-b2c1-472a-85f2-5b477241de9f"
                 }
               }
             ]
@@ -444,18 +444,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729293608365060000.1a16b183-f641-4114-bb20-d27dfa39e493"
+          "reference": "Patient/1729351806369678000.05fc561a-7da6-48cd-a3c0-98b08a50d5bb"
         },
         "requester": {
-          "reference": "Practitioner/1729293608366324000.e3b85302-d2ed-43a1-b44f-ad533af66b9e"
+          "reference": "Practitioner/1729351806371533000.3395b573-50d4-4368-b667-5568d5393c9e"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729293608366324000.e3b85302-d2ed-43a1-b44f-ad533af66b9e",
+      "fullUrl": "Practitioner/1729351806371533000.3395b573-50d4-4368-b667-5568d5393c9e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293608366324000.e3b85302-d2ed-43a1-b44f-ad533af66b9e",
+        "id": "1729351806371533000.3395b573-50d4-4368-b667-5568d5393c9e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -502,10 +502,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293608367962000.4930df54-8bb2-4ebc-845e-9434d22b945e",
+      "fullUrl": "Practitioner/1729351806374139000.ecbccbd6-2ac9-4aba-abdc-38ec6c55870f",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293608367962000.4930df54-8bb2-4ebc-845e-9434d22b945e",
+        "id": "1729351806374139000.ecbccbd6-2ac9-4aba-abdc-38ec6c55870f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -548,10 +548,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293608368799000.12ce891e-6c3f-40a8-b812-fe59dbbc7e71",
+      "fullUrl": "Practitioner/1729351806375626000.c651c34a-b2c1-472a-85f2-5b477241de9f",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293608368799000.12ce891e-6c3f-40a8-b812-fe59dbbc7e71",
+        "id": "1729351806375626000.c651c34a-b2c1-472a-85f2-5b477241de9f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -594,10 +594,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729293608370570000.25dd61cb-f071-409c-819c-1ded6cabc7ec",
+      "fullUrl": "Observation/1729351806377663000.a405e8dd-ec39-4faa-8b35-e94f36d6b2bd",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729293608370570000.25dd61cb-f071-409c-819c-1ded6cabc7ec",
+        "id": "1729351806377663000.a405e8dd-ec39-4faa-8b35-e94f36d6b2bd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -615,7 +615,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729293608365060000.1a16b183-f641-4114-bb20-d27dfa39e493"
+          "reference": "Patient/1729351806369678000.05fc561a-7da6-48cd-a3c0-98b08a50d5bb"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -648,10 +648,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293608373187000.28186737-a907-4e8c-9e99-ccdb44efbe7f",
+      "fullUrl": "Specimen/1729351806381442000.bd100bd1-1229-4a64-9af1-2138e003e3dd",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293608373187000.28186737-a907-4e8c-9e99-ccdb44efbe7f",
+        "id": "1729351806381442000.bd100bd1-1229-4a64-9af1-2138e003e3dd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_1_hl7_translation.fhir b/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_1_hl7_translation.fhir
index e69de29bb..e9e319e07 100644
--- a/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_1_hl7_translation.fhir
+++ b/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_1_hl7_translation.fhir
@@ -0,0 +1,606 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729352289898874000.2a52a35e-1512-448b-b58c-456b4fafd9cd",
+  "meta": {
+    "lastUpdated": "2024-10-19T08:38:09.898-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T13:40:09.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729352289904029000.e8aa4ae1-9c2e-4e5e-b05c-348567c99a6c",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729352289904029000.e8aa4ae1-9c2e-4e5e-b05c-348567c99a6c",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240224134009"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O01",
+          "display": "ORM^O01^ORM_O01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729352289903100000.14cbfc64-5bdc-4f86-a0be-cf830a6a8b15"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729352289901067000.de6b3a74-43d6-4dd6-902d-1f600c5849db"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729352289901067000.de6b3a74-43d6-4dd6-902d-1f600c5849db",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729352289901067000.de6b3a74-43d6-4dd6-902d-1f600c5849db",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729352289903100000.14cbfc64-5bdc-4f86-a0be-cf830a6a8b15",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729352289903100000.14cbfc64-5bdc-4f86-a0be-cf830a6a8b15",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729352289918467000.10b46d4e-e8b7-4fc7-bc8b-aa3e628746d2",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729352289918467000.10b46d4e-e8b7-4fc7-bc8b-aa3e628746d2",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729352289907357000.db8cdc39-bd7f-4911-9242-500cd08bca41"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
+            ],
+            "family": "ONE",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "birthDate": "2024-02-21",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402210152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-02-21T01:52:00-05:00"
+            }
+          ]
+        },
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1
+      }
+    },
+    {
+      "fullUrl": "Organization/1729352289907357000.db8cdc39-bd7f-4911-9242-500cd08bca41",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729352289907357000.db8cdc39-bd7f-4911-9242-500cd08bca41",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Baptist East"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "ServiceRequest/1729352289928013000.154434d7-fb6e-474c-a14b-f563ca3683fc",
+      "resource": {
+        "resourceType": "ServiceRequest",
+        "id": "1729352289928013000.154434d7-fb6e-474c-a14b-f563ca3683fc",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
+            "valueCode": "NW"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
+            "extension": [
+              {
+                "url": "orc-12-ordering-provider",
+                "valueReference": {
+                  "reference": "Practitioner/1729352289925615000.c19ee0c0-2dd4-4f84-9583-4262db0ca48d"
+                }
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
+            "extension": [
+              {
+                "url": "OBR.2",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                          "valueString": "ORDERID"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "2801690163"
+                }
+              },
+              {
+                "url": "OBR.16",
+                "valueReference": {
+                  "reference": "Practitioner/1729352289927295000.0df7d1aa-7035-42b0-b491-29aaf4387d2b"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "2801690163"
+          }
+        ],
+        "status": "unknown",
+        "subject": {
+          "reference": "Patient/1729352289918467000.10b46d4e-e8b7-4fc7-bc8b-aa3e628746d2"
+        },
+        "requester": {
+          "reference": "Practitioner/1729352289921726000.4d4df8c5-acf0-45e6-87b8-074268f9805e"
+        }
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729352289921726000.4d4df8c5-acf0-45e6-87b8-074268f9805e",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729352289921726000.4d4df8c5-acf0-45e6-87b8-074268f9805e",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "ORC.12"
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729352289925615000.c19ee0c0-2dd4-4f84-9583-4262db0ca48d",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729352289925615000.c19ee0c0-2dd4-4f84-9583-4262db0ca48d",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729352289927295000.0df7d1aa-7035-42b0-b491-29aaf4387d2b",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729352289927295000.0df7d1aa-7035-42b0-b491-29aaf4387d2b",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729352289930201000.dc4f0caf-19c8-45c8-a1d2-34345b55391e",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729352289930201000.dc4f0caf-19c8-45c8-a1d2-34345b55391e",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "XAD"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729352289918467000.10b46d4e-e8b7-4fc7-bc8b-aa3e628746d2"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729352289934651000.68fea759-da25-44b3-95a2-35c38a2a9e46",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729352289934651000.68fea759-da25-44b3-95a2-35c38a2a9e46",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_2_fhir_transformation.fhir b/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_2_fhir_transformation.fhir
index 1f5fcec2b..99516b583 100644
--- a/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/012_AL_ORM_O01_malformed_XAD_datatype_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729294090266383000.393650a3-2e9d-4481-a6b3-747ab47b55b6",
+  "id": "1729352289898874000.2a52a35e-1512-448b-b58c-456b4fafd9cd",
   "meta": {
-    "lastUpdated": "2024-10-18T16:28:10.266-07:00"
+    "lastUpdated": "2024-10-19T08:38:09.898-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-24T13:40:09.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729294090268769000.5bccb410-4ead-4558-a4f7-9a37e159c0df",
+      "fullUrl": "MessageHeader/1729352289904029000.e8aa4ae1-9c2e-4e5e-b05c-348567c99a6c",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729294090268769000.5bccb410-4ead-4558-a4f7-9a37e159c0df",
+        "id": "1729352289904029000.e8aa4ae1-9c2e-4e5e-b05c-348567c99a6c",
         "meta": {
           "tag": [
             {
@@ -68,12 +68,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1729294090268254000.aee5ade4-aed0-46fd-b8ab-3d15df2f17c1"
+              "reference": "Organization/1729352289903100000.14cbfc64-5bdc-4f86-a0be-cf830a6a8b15"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729294090267203000.6e025895-3cd5-4b6c-8650-9013316b92b9"
+          "reference": "Organization/1729352289901067000.de6b3a74-43d6-4dd6-902d-1f600c5849db"
         },
         "source": {
           "extension": [
@@ -99,10 +99,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294090267203000.6e025895-3cd5-4b6c-8650-9013316b92b9",
+      "fullUrl": "Organization/1729352289901067000.de6b3a74-43d6-4dd6-902d-1f600c5849db",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294090267203000.6e025895-3cd5-4b6c-8650-9013316b92b9",
+        "id": "1729352289901067000.de6b3a74-43d6-4dd6-902d-1f600c5849db",
         "identifier": [
           {
             "extension": [
@@ -135,10 +135,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294090268254000.aee5ade4-aed0-46fd-b8ab-3d15df2f17c1",
+      "fullUrl": "Organization/1729352289903100000.14cbfc64-5bdc-4f86-a0be-cf830a6a8b15",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294090268254000.aee5ade4-aed0-46fd-b8ab-3d15df2f17c1",
+        "id": "1729352289903100000.14cbfc64-5bdc-4f86-a0be-cf830a6a8b15",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -177,10 +177,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729294090278016000.aa64f3a7-b096-4ea5-8042-256c6da27e23",
+      "fullUrl": "Patient/1729352289918467000.10b46d4e-e8b7-4fc7-bc8b-aa3e628746d2",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729294090278016000.aa64f3a7-b096-4ea5-8042-256c6da27e23",
+        "id": "1729352289918467000.10b46d4e-e8b7-4fc7-bc8b-aa3e628746d2",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -229,7 +229,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1729294090271038000.4fd74fea-58f8-4ac2-bb27-8c355cd2cb8e"
+              "reference": "Organization/1729352289907357000.db8cdc39-bd7f-4911-9242-500cd08bca41"
             }
           }
         ],
@@ -347,10 +347,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294090271038000.4fd74fea-58f8-4ac2-bb27-8c355cd2cb8e",
+      "fullUrl": "Organization/1729352289907357000.db8cdc39-bd7f-4911-9242-500cd08bca41",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294090271038000.4fd74fea-58f8-4ac2-bb27-8c355cd2cb8e",
+        "id": "1729352289907357000.db8cdc39-bd7f-4911-9242-500cd08bca41",
         "identifier": [
           {
             "extension": [
@@ -365,10 +365,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729294090285006000.d08d8187-0595-408a-a8cc-838adc7ee523",
+      "fullUrl": "ServiceRequest/1729352289928013000.154434d7-fb6e-474c-a14b-f563ca3683fc",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729294090285006000.d08d8187-0595-408a-a8cc-838adc7ee523",
+        "id": "1729352289928013000.154434d7-fb6e-474c-a14b-f563ca3683fc",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -380,7 +380,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729294090282918000.3b80cfdd-4bc6-4bbb-88c0-3c57f8647540"
+                  "reference": "Practitioner/1729352289925615000.c19ee0c0-2dd4-4f84-9583-4262db0ca48d"
                 }
               }
             ]
@@ -408,7 +408,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729294090284424000.e912b324-0302-4d3d-a7cf-5a9ed33de2da"
+                  "reference": "Practitioner/1729352289927295000.0df7d1aa-7035-42b0-b491-29aaf4387d2b"
                 }
               }
             ]
@@ -444,18 +444,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729294090278016000.aa64f3a7-b096-4ea5-8042-256c6da27e23"
+          "reference": "Patient/1729352289918467000.10b46d4e-e8b7-4fc7-bc8b-aa3e628746d2"
         },
         "requester": {
-          "reference": "Practitioner/1729294090280103000.2b882880-a9b6-4172-a42c-6a89e9f0e790"
+          "reference": "Practitioner/1729352289921726000.4d4df8c5-acf0-45e6-87b8-074268f9805e"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729294090280103000.2b882880-a9b6-4172-a42c-6a89e9f0e790",
+      "fullUrl": "Practitioner/1729352289921726000.4d4df8c5-acf0-45e6-87b8-074268f9805e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294090280103000.2b882880-a9b6-4172-a42c-6a89e9f0e790",
+        "id": "1729352289921726000.4d4df8c5-acf0-45e6-87b8-074268f9805e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -502,10 +502,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294090282918000.3b80cfdd-4bc6-4bbb-88c0-3c57f8647540",
+      "fullUrl": "Practitioner/1729352289925615000.c19ee0c0-2dd4-4f84-9583-4262db0ca48d",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294090282918000.3b80cfdd-4bc6-4bbb-88c0-3c57f8647540",
+        "id": "1729352289925615000.c19ee0c0-2dd4-4f84-9583-4262db0ca48d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -548,10 +548,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294090284424000.e912b324-0302-4d3d-a7cf-5a9ed33de2da",
+      "fullUrl": "Practitioner/1729352289927295000.0df7d1aa-7035-42b0-b491-29aaf4387d2b",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294090284424000.e912b324-0302-4d3d-a7cf-5a9ed33de2da",
+        "id": "1729352289927295000.0df7d1aa-7035-42b0-b491-29aaf4387d2b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -594,10 +594,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294090286625000.8ee6599a-226b-4fe2-bdbd-71e463f04207",
+      "fullUrl": "Observation/1729352289930201000.dc4f0caf-19c8-45c8-a1d2-34345b55391e",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294090286625000.8ee6599a-226b-4fe2-bdbd-71e463f04207",
+        "id": "1729352289930201000.dc4f0caf-19c8-45c8-a1d2-34345b55391e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -615,7 +615,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294090278016000.aa64f3a7-b096-4ea5-8042-256c6da27e23"
+          "reference": "Patient/1729352289918467000.10b46d4e-e8b7-4fc7-bc8b-aa3e628746d2"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -640,10 +640,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729294090290469000.81457f28-afa8-459e-a4d5-f604ea512265",
+      "fullUrl": "Specimen/1729352289934651000.68fea759-da25-44b3-95a2-35c38a2a9e46",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729294090290469000.81457f28-afa8-459e-a4d5-f604ea512265",
+        "id": "1729352289934651000.68fea759-da25-44b3-95a2-35c38a2a9e46",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_1_hl7_translation.fhir b/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_1_hl7_translation.fhir
index e69de29bb..6d6fe5371 100644
--- a/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_1_hl7_translation.fhir
+++ b/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_1_hl7_translation.fhir
@@ -0,0 +1,607 @@
+{
+  "resourceType": "Bundle",
+  "id": "1729352772734523000.214bfc13-8444-49d2-bd25-1709ea4a371b",
+  "meta": {
+    "lastUpdated": "2024-10-19T08:46:12.734-07:00"
+  },
+  "identifier": {
+    "system": "https://reportstream.cdc.gov/prime-router",
+    "value": "Q1960841872T2476960690"
+  },
+  "type": "message",
+  "timestamp": "2024-02-24T13:40:09.000-08:00",
+  "entry": [
+    {
+      "fullUrl": "MessageHeader/1729352772739006000.dd8bbfea-684d-4f4f-ba66-e0fe213babcc",
+      "resource": {
+        "resourceType": "MessageHeader",
+        "id": "1729352772739006000.dd8bbfea-684d-4f4f-ba66-e0fe213babcc",
+        "meta": {
+          "tag": [
+            {
+              "system": "http://terminology.hl7.org/CodeSystem/v2-0103",
+              "code": "D"
+            }
+          ]
+        },
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/character-set",
+            "valueString": "8859/1"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/msh-message-header",
+            "extension": [
+              {
+                "url": "MSH.7",
+                "valueString": "20240224134009"
+              }
+            ]
+          }
+        ],
+        "eventCoding": {
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
+          "code": "O01",
+          "display": "ORM^O01^ORM_O01"
+        },
+        "destination": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.114222.4.1.181960.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueString": "ISO"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "MSH.5"
+              }
+            ],
+            "name": "ALlabNatus",
+            "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
+            "receiver": {
+              "reference": "Organization/1729352772738235000.bfbe2882-3060-4575-9029-12e52aa17e2a"
+            }
+          }
+        ],
+        "sender": {
+          "reference": "Organization/1729352772736367000.3089f032-4d2e-41bd-847b-8e6fc4272134"
+        },
+        "source": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+              "valueString": "BaptistOracle"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+              "valueString": "2.16.840.1.114222.4.1.000000"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+              "valueString": "ISO"
+            },
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+              "valueString": "MSH.3"
+            }
+          ],
+          "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000"
+        }
+      }
+    },
+    {
+      "fullUrl": "Organization/1729352772736367000.3089f032-4d2e-41bd-847b-8e6fc4272134",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729352772736367000.3089f032-4d2e-41bd-847b-8e6fc4272134",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "BaptistEast"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "2.16.840.1.114222.4.1.000001"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Organization/1729352772738235000.bfbe2882-3060-4575-9029-12e52aa17e2a",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729352772738235000.bfbe2882-3060-4575-9029-12e52aa17e2a",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "MSH.6"
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "ALlab"
+          },
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.2,HD.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0301",
+                  "code": "ISO"
+                }
+              ]
+            },
+            "system": "urn:ietf:rfc:3986",
+            "value": "simulated-lab-id"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Patient/1729352772752833000.b18422f2-260f-445c-b001-c677137d8cf1",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1729352772752833000.b18422f2-260f-445c-b001-c677137d8cf1",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
+            "extension": [
+              {
+                "url": "PID.8"
+              },
+              {
+                "url": "PID.18",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                      "valueString": "PID.18"
+                    }
+                  ],
+                  "value": "2227600015"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/cx-identifier",
+                "extension": [
+                  {
+                    "url": "CX.5",
+                    "valueString": "MR"
+                  }
+                ]
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "PID.3"
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "code": "MR"
+                }
+              ]
+            },
+            "value": "1300974",
+            "assigner": {
+              "reference": "Organization/1729352772742290000.90954376-8768-485f-bbb3-80eff57b32b7"
+            }
+          }
+        ],
+        "name": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xpn-human-name",
+                "extension": [
+                  {
+                    "url": "XPN.2",
+                    "valueString": "TESTCASE"
+                  }
+                ]
+              }
+            ],
+            "family": "ONE",
+            "given": [
+              "TESTCASE"
+            ]
+          }
+        ],
+        "gender": "female",
+        "birthDate": "2024-02-21",
+        "_birthDate": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402210152-0500"
+            },
+            {
+              "url": "http://hl7.org/fhir/StructureDefinition/patient-birthTime",
+              "valueDateTime": "2024-02-21T01:52:00-05:00"
+            }
+          ]
+        },
+        "address": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xad-address",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/sad-address-line",
+                    "extension": [
+                      {
+                        "url": "SAD.1",
+                        "valueString": "1234 GPCS WAY"
+                      }
+                    ]
+                  },
+                  {
+                    "url": "XAD.7",
+                    "valueCode": "home"
+                  }
+                ]
+              }
+            ],
+            "line": [
+              "1234 GPCS WAY"
+            ],
+            "city": "MONTGOMERY",
+            "district": "Montgomery",
+            "state": "Alabama",
+            "postalCode": "36117",
+            "country": "USA"
+          }
+        ],
+        "multipleBirthInteger": 1
+      }
+    },
+    {
+      "fullUrl": "Organization/1729352772742290000.90954376-8768-485f-bbb3-80eff57b32b7",
+      "resource": {
+        "resourceType": "Organization",
+        "id": "1729352772742290000.90954376-8768-485f-bbb3-80eff57b32b7",
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "HD.1"
+              }
+            ],
+            "value": "Baptist East"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "ServiceRequest/1729352772762090000.b3b94020-189c-4fdd-982a-3a7dce822261",
+      "resource": {
+        "resourceType": "ServiceRequest",
+        "id": "1729352772762090000.b3b94020-189c-4fdd-982a-3a7dce822261",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
+            "valueCode": "NW"
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/orc-common-order",
+            "extension": [
+              {
+                "url": "orc-12-ordering-provider",
+                "valueReference": {
+                  "reference": "Practitioner/1729352772759180000.ec86c527-409b-4a11-84c2-4c598a7c045a"
+                }
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obr-observation-request",
+            "extension": [
+              {
+                "url": "OBR.2",
+                "valueIdentifier": {
+                  "extension": [
+                    {
+                      "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                      "extension": [
+                        {
+                          "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                          "valueString": "ORDERID"
+                        }
+                      ]
+                    }
+                  ],
+                  "value": "2801690163"
+                }
+              },
+              {
+                "url": "OBR.16",
+                "valueReference": {
+                  "reference": "Practitioner/1729352772761336000.7a63cbbc-762d-4972-b271-5814383b9080"
+                }
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+                "valueString": "ORC.2"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+                "extension": [
+                  {
+                    "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                    "valueString": "ORDERID"
+                  }
+                ]
+              }
+            ],
+            "type": {
+              "coding": [
+                {
+                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
+                  "code": "PLAC"
+                }
+              ]
+            },
+            "value": "2801690163"
+          }
+        ],
+        "status": "unknown",
+        "subject": {
+          "reference": "Patient/1729352772752833000.b18422f2-260f-445c-b001-c677137d8cf1"
+        },
+        "requester": {
+          "reference": "Practitioner/1729352772755769000.8a7c1b9c-b4f3-4dfc-9234-d5f0891660df"
+        }
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729352772755769000.8a7c1b9c-b4f3-4dfc-9234-d5f0891660df",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729352772755769000.8a7c1b9c-b4f3-4dfc-9234-d5f0891660df",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
+            "valueString": "ORC.12"
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729352772759180000.ec86c527-409b-4a11-84c2-4c598a7c045a",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729352772759180000.ec86c527-409b-4a11-84c2-4c598a7c045a",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Practitioner/1729352772761336000.7a63cbbc-762d-4972-b271-5814383b9080",
+      "resource": {
+        "resourceType": "Practitioner",
+        "id": "1729352772761336000.7a63cbbc-762d-4972-b271-5814383b9080",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/namespace-id",
+                "valueString": "NPI"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id",
+                "valueString": "2.16.840.1.113883.4.6"
+              },
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/universal-id-type",
+                "valueCode": "ISO"
+              }
+            ]
+          },
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/xcn-practitioner",
+            "extension": [
+              {
+                "url": "XCN.10",
+                "valueString": "L"
+              }
+            ]
+          }
+        ],
+        "identifier": [
+          {
+            "system": "NPI",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "use": "official"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Observation/1729352772764364000.1dad9763-56a6-4556-b677-6e99d777fe6b",
+      "resource": {
+        "resourceType": "Observation",
+        "id": "1729352772764364000.1dad9763-56a6-4556-b677-6e99d777fe6b",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
+            "extension": [
+              {
+                "url": "OBX.2",
+                "valueId": "TX"
+              },
+              {
+                "url": "OBX.11",
+                "valueString": "F"
+              }
+            ]
+          }
+        ],
+        "status": "final",
+        "subject": {
+          "reference": "Patient/1729352772752833000.b18422f2-260f-445c-b001-c677137d8cf1"
+        },
+        "effectiveDateTime": "2024-02-22T18:54:00-05:00",
+        "_effectiveDateTime": {
+          "extension": [
+            {
+              "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2-date-time",
+              "valueString": "202402221854-0500"
+            }
+          ]
+        },
+        "valueString": "1234 GPCS WAY",
+        "note": [
+          {
+            "extension": [
+              {
+                "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/note-comment",
+                "valueId": "note 1"
+              }
+            ],
+            "text": "note 1"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "Specimen/1729352772769333000.9b0a69d4-40d5-4930-b015-a0f0fa57a2f4",
+      "resource": {
+        "resourceType": "Specimen",
+        "id": "1729352772769333000.9b0a69d4-40d5-4930-b015-a0f0fa57a2f4",
+        "extension": [
+          {
+            "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
+            "valueString": "SPM"
+          }
+        ]
+      }
+    }
+  ]
+}
diff --git a/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_2_fhir_transformation.fhir b/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_2_fhir_transformation.fhir
index f47e0f9ba..c1fce901e 100644
--- a/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_2_fhir_transformation.fhir
+++ b/examples/Test/Orders/013_AL_ORM_O01_invalid_text_as_txt_datatype_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729294572801182000.c051a6c6-ecf2-4f95-ba33-9ec5ccf22c39",
+  "id": "1729352772734523000.214bfc13-8444-49d2-bd25-1709ea4a371b",
   "meta": {
-    "lastUpdated": "2024-10-18T16:36:12.801-07:00"
+    "lastUpdated": "2024-10-19T08:46:12.734-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2024-02-24T13:40:09.000-08:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729294572803889000.0db4570e-894b-4ca2-8869-872cdf4ea17d",
+      "fullUrl": "MessageHeader/1729352772739006000.dd8bbfea-684d-4f4f-ba66-e0fe213babcc",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729294572803889000.0db4570e-894b-4ca2-8869-872cdf4ea17d",
+        "id": "1729352772739006000.dd8bbfea-684d-4f4f-ba66-e0fe213babcc",
         "meta": {
           "tag": [
             {
@@ -68,12 +68,12 @@
             "name": "ALlabNatus",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.181960.2",
             "receiver": {
-              "reference": "Organization/1729294572803383000.2fdf5530-fdca-4a16-93dd-d7715591ce9a"
+              "reference": "Organization/1729352772738235000.bfbe2882-3060-4575-9029-12e52aa17e2a"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729294572802106000.9362d963-1074-481c-94f8-ad209c2f04ff"
+          "reference": "Organization/1729352772736367000.3089f032-4d2e-41bd-847b-8e6fc4272134"
         },
         "source": {
           "extension": [
@@ -99,10 +99,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294572802106000.9362d963-1074-481c-94f8-ad209c2f04ff",
+      "fullUrl": "Organization/1729352772736367000.3089f032-4d2e-41bd-847b-8e6fc4272134",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294572802106000.9362d963-1074-481c-94f8-ad209c2f04ff",
+        "id": "1729352772736367000.3089f032-4d2e-41bd-847b-8e6fc4272134",
         "identifier": [
           {
             "extension": [
@@ -135,10 +135,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294572803383000.2fdf5530-fdca-4a16-93dd-d7715591ce9a",
+      "fullUrl": "Organization/1729352772738235000.bfbe2882-3060-4575-9029-12e52aa17e2a",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294572803383000.2fdf5530-fdca-4a16-93dd-d7715591ce9a",
+        "id": "1729352772738235000.bfbe2882-3060-4575-9029-12e52aa17e2a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -177,10 +177,10 @@
       }
     },
     {
-      "fullUrl": "Patient/1729294572812841000.7b03ccc8-f131-459c-95e6-8ebd0bdb1305",
+      "fullUrl": "Patient/1729352772752833000.b18422f2-260f-445c-b001-c677137d8cf1",
       "resource": {
         "resourceType": "Patient",
-        "id": "1729294572812841000.7b03ccc8-f131-459c-95e6-8ebd0bdb1305",
+        "id": "1729352772752833000.b18422f2-260f-445c-b001-c677137d8cf1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/pid-patient",
@@ -229,7 +229,7 @@
             },
             "value": "1300974",
             "assigner": {
-              "reference": "Organization/1729294572805815000.05679a1b-96f7-4d7a-968b-bb1053108b63"
+              "reference": "Organization/1729352772742290000.90954376-8768-485f-bbb3-80eff57b32b7"
             }
           }
         ],
@@ -347,10 +347,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729294572805815000.05679a1b-96f7-4d7a-968b-bb1053108b63",
+      "fullUrl": "Organization/1729352772742290000.90954376-8768-485f-bbb3-80eff57b32b7",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729294572805815000.05679a1b-96f7-4d7a-968b-bb1053108b63",
+        "id": "1729352772742290000.90954376-8768-485f-bbb3-80eff57b32b7",
         "identifier": [
           {
             "extension": [
@@ -365,10 +365,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729294572816353000.fc7e5055-c3e3-4c49-9278-d982ada7b351",
+      "fullUrl": "ServiceRequest/1729352772762090000.b3b94020-189c-4fdd-982a-3a7dce822261",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729294572816353000.fc7e5055-c3e3-4c49-9278-d982ada7b351",
+        "id": "1729352772762090000.b3b94020-189c-4fdd-982a-3a7dce822261",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -380,7 +380,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729294572815383000.2cf83374-13c7-4938-aae8-0d83050c87e8"
+                  "reference": "Practitioner/1729352772759180000.ec86c527-409b-4a11-84c2-4c598a7c045a"
                 }
               }
             ]
@@ -408,7 +408,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729294572816098000.a8781df2-1340-40e9-9d47-25456256b8a3"
+                  "reference": "Practitioner/1729352772761336000.7a63cbbc-762d-4972-b271-5814383b9080"
                 }
               }
             ]
@@ -444,18 +444,18 @@
         ],
         "status": "unknown",
         "subject": {
-          "reference": "Patient/1729294572812841000.7b03ccc8-f131-459c-95e6-8ebd0bdb1305"
+          "reference": "Patient/1729352772752833000.b18422f2-260f-445c-b001-c677137d8cf1"
         },
         "requester": {
-          "reference": "Practitioner/1729294572813967000.86ad03b0-cf2e-49d3-b6e7-2c3a9d52e025"
+          "reference": "Practitioner/1729352772755769000.8a7c1b9c-b4f3-4dfc-9234-d5f0891660df"
         }
       }
     },
     {
-      "fullUrl": "Practitioner/1729294572813967000.86ad03b0-cf2e-49d3-b6e7-2c3a9d52e025",
+      "fullUrl": "Practitioner/1729352772755769000.8a7c1b9c-b4f3-4dfc-9234-d5f0891660df",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294572813967000.86ad03b0-cf2e-49d3-b6e7-2c3a9d52e025",
+        "id": "1729352772755769000.8a7c1b9c-b4f3-4dfc-9234-d5f0891660df",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -502,10 +502,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294572815383000.2cf83374-13c7-4938-aae8-0d83050c87e8",
+      "fullUrl": "Practitioner/1729352772759180000.ec86c527-409b-4a11-84c2-4c598a7c045a",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294572815383000.2cf83374-13c7-4938-aae8-0d83050c87e8",
+        "id": "1729352772759180000.ec86c527-409b-4a11-84c2-4c598a7c045a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -548,10 +548,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729294572816098000.a8781df2-1340-40e9-9d47-25456256b8a3",
+      "fullUrl": "Practitioner/1729352772761336000.7a63cbbc-762d-4972-b271-5814383b9080",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729294572816098000.a8781df2-1340-40e9-9d47-25456256b8a3",
+        "id": "1729352772761336000.7a63cbbc-762d-4972-b271-5814383b9080",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -594,10 +594,10 @@
       }
     },
     {
-      "fullUrl": "Observation/1729294572817163000.816e6916-d6e3-4335-a219-b982f12648de",
+      "fullUrl": "Observation/1729352772764364000.1dad9763-56a6-4556-b677-6e99d777fe6b",
       "resource": {
         "resourceType": "Observation",
-        "id": "1729294572817163000.816e6916-d6e3-4335-a219-b982f12648de",
+        "id": "1729352772764364000.1dad9763-56a6-4556-b677-6e99d777fe6b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/obx-observation",
@@ -615,7 +615,7 @@
         ],
         "status": "final",
         "subject": {
-          "reference": "Patient/1729294572812841000.7b03ccc8-f131-459c-95e6-8ebd0bdb1305"
+          "reference": "Patient/1729352772752833000.b18422f2-260f-445c-b001-c677137d8cf1"
         },
         "effectiveDateTime": "2024-02-22T18:54:00-05:00",
         "_effectiveDateTime": {
@@ -641,10 +641,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729294572819226000.3dc17b63-d361-4613-8c4e-4141f9bddfd2",
+      "fullUrl": "Specimen/1729352772769333000.9b0a69d4-40d5-4930-b015-a0f0fa57a2f4",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729294572819226000.3dc17b63-d361-4613-8c4e-4141f9bddfd2",
+        "id": "1729352772769333000.9b0a69d4-40d5-4930-b015-a0f0fa57a2f4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
diff --git a/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_1_hl7_translation.fhir b/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_1_hl7_translation.fhir
index 449e00d98..0afdb4ba8 100644
--- a/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_1_hl7_translation.fhir
+++ b/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729293246229836000.a7c033db-c175-4683-8ff8-3b3e2b2e5523",
+  "id": "1729351568343493000.3b4ad6ac-1e7a-4fb6-aa0f-06dfd968545c",
   "meta": {
-    "lastUpdated": "2024-10-18T16:14:06.229-07:00"
+    "lastUpdated": "2024-10-19T08:26:08.343-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2023-06-06T17:28:49.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659",
+      "fullUrl": "MessageHeader/1729351568345776000.509f5c99-cf87-4099-be36-7115b7ef17bd",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659",
+        "id": "1729351568345776000.509f5c99-cf87-4099-be36-7115b7ef17bd",
         "meta": {
           "tag": [
             {
@@ -151,12 +151,12 @@
             "name": "BaptistOracle",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000",
             "receiver": {
-              "reference": "Organization/1729293246231738000.4579de5b-b509-4463-b5dd-b6310a8e3c0f"
+              "reference": "Organization/1729351568345265000.1bdaeaef-9431-4903-9a77-447221a4120f"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729293246230833000.cf643d8f-a03c-44bd-bb55-0e020b7d3e6b"
+          "reference": "Organization/1729351568344476000.0ad50fd5-3392-4e88-8614-72f80fdebb5d"
         },
         "source": {
           "extension": [
@@ -182,10 +182,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246230833000.cf643d8f-a03c-44bd-bb55-0e020b7d3e6b",
+      "fullUrl": "Organization/1729351568344476000.0ad50fd5-3392-4e88-8614-72f80fdebb5d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246230833000.cf643d8f-a03c-44bd-bb55-0e020b7d3e6b",
+        "id": "1729351568344476000.0ad50fd5-3392-4e88-8614-72f80fdebb5d",
         "identifier": [
           {
             "extension": [
@@ -218,10 +218,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246231738000.4579de5b-b509-4463-b5dd-b6310a8e3c0f",
+      "fullUrl": "Organization/1729351568345265000.1bdaeaef-9431-4903-9a77-447221a4120f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246231738000.4579de5b-b509-4463-b5dd-b6310a8e3c0f",
+        "id": "1729351568345265000.1bdaeaef-9431-4903-9a77-447221a4120f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -260,55 +260,55 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729293246235324000.86f10fe7-f0fd-4883-82d5-5498a77ae28d",
+      "fullUrl": "Provenance/1729351568348823000.f333529b-540a-4ccc-b4e7-281f5d370699",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729293246235324000.86f10fe7-f0fd-4883-82d5-5498a77ae28d",
+        "id": "1729351568348823000.f333529b-540a-4ccc-b4e7-281f5d370699",
         "target": [
           {
-            "reference": "MessageHeader/1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659"
+            "reference": "MessageHeader/1729351568345776000.509f5c99-cf87-4099-be36-7115b7ef17bd"
           },
           {
-            "reference": "DiagnosticReport/1729293246457454000.09c90ca0-5f1f-4f6c-ad36-cfd07beedb6c"
+            "reference": "DiagnosticReport/1729351568592672000.d7036f49-4afb-458e-a631-6818732da3cb"
           },
           {
-            "reference": "DiagnosticReport/1729293246459109000.6ecb3465-632d-4990-bd5a-21a1acd59543"
+            "reference": "DiagnosticReport/1729351568594190000.e227f615-496d-4590-a184-6cb33d5c920a"
           },
           {
-            "reference": "DiagnosticReport/1729293246460494000.41d40c15-e832-4ecd-9d92-9d19ce3a3fcb"
+            "reference": "DiagnosticReport/1729351568595471000.60375a92-deda-4145-97eb-3ccb1e07ba5b"
           },
           {
-            "reference": "DiagnosticReport/1729293246461882000.e6884d68-29a3-41d4-9fce-debf070c9c1f"
+            "reference": "DiagnosticReport/1729351568596795000.7b07077c-b9a5-450f-a7b6-9ea99a6953b0"
           },
           {
-            "reference": "DiagnosticReport/1729293246463338000.a175cd81-ba65-46f0-8e6e-67303327e1fe"
+            "reference": "DiagnosticReport/1729351568598084000.8c7658e0-fe28-47dc-acd5-e771d83f8037"
           },
           {
-            "reference": "DiagnosticReport/1729293246464712000.906ec640-0671-4dca-9bc2-94edd7a0eeab"
+            "reference": "DiagnosticReport/1729351568599400000.7902d852-c476-4a5c-bb3e-095aba461459"
           },
           {
-            "reference": "DiagnosticReport/1729293246466061000.0fb8eed7-87d5-4768-ae11-ac8bea2a5b94"
+            "reference": "DiagnosticReport/1729351568600666000.872f515b-a29b-46e2-b5d5-2496d72d93a5"
           },
           {
-            "reference": "DiagnosticReport/1729293246467495000.b7c5901b-d525-4c48-9dcc-135d9a86769e"
+            "reference": "DiagnosticReport/1729351568601938000.4943b9d9-57b0-427e-84fd-32482a485b8c"
           },
           {
-            "reference": "DiagnosticReport/1729293246468892000.8b00ef17-5538-42de-8cc5-3b60c0ede4c3"
+            "reference": "DiagnosticReport/1729351568603189000.51f58a0d-5e5d-4e6e-a540-7737963bde28"
           },
           {
-            "reference": "DiagnosticReport/1729293246470298000.6069a206-73c3-431d-acf4-ded8188d6217"
+            "reference": "DiagnosticReport/1729351568604423000.c63b06e7-dfe0-4405-953d-416576f280e8"
           },
           {
-            "reference": "DiagnosticReport/1729293246471762000.ff90458f-7e6e-4981-b2c1-80b2eaf49bc3"
+            "reference": "DiagnosticReport/1729351568605672000.c1986286-5c00-4bf8-aa9a-973192b66992"
           },
           {
-            "reference": "DiagnosticReport/1729293246473069000.6e05461f-2d84-4f47-b37a-5f2d32144e97"
+            "reference": "DiagnosticReport/1729351568606920000.183c09ff-9811-47c7-916d-e1ff9f78a0e6"
           },
           {
-            "reference": "DiagnosticReport/1729293246474425000.d1782e46-8a6f-4835-b81d-dc3a8f53c2cb"
+            "reference": "DiagnosticReport/1729351568608189000.af7f8e9d-00dd-4ccc-9f85-5317aef7c118"
           },
           {
-            "reference": "DiagnosticReport/1729293246475799000.095f2271-b0cc-486f-9096-b778a2548966"
+            "reference": "DiagnosticReport/1729351568609403000.89aa18d5-5526-4bf3-b96f-c87b50bac000"
           }
         ],
         "recorded": "2023-06-06T19:28:49-05:00",
@@ -330,17 +330,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729293246234923000.451c30f9-9a03-4f8a-98a5-03ee9e9eef61"
+              "reference": "Organization/1729351568348416000.2b876c9f-8036-4f12-ae88-a5197a1fa6fc"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729293246234923000.451c30f9-9a03-4f8a-98a5-03ee9e9eef61",
+      "fullUrl": "Organization/1729351568348416000.2b876c9f-8036-4f12-ae88-a5197a1fa6fc",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246234923000.451c30f9-9a03-4f8a-98a5-03ee9e9eef61",
+        "id": "1729351568348416000.2b876c9f-8036-4f12-ae88-a5197a1fa6fc",
         "identifier": [
           {
             "extension": [
@@ -373,11 +373,11 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729293246236211000.3a51aaf4-5046-4b4b-ae9a-ec293182dc1f",
+      "fullUrl": "Provenance/1729351568349554000.2fab3e01-0b9d-4a3c-aab4-82e3b5b1adb5",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729293246236211000.3a51aaf4-5046-4b4b-ae9a-ec293182dc1f",
-        "recorded": "2024-10-18T16:14:06Z",
+        "id": "1729351568349554000.2fab3e01-0b9d-4a3c-aab4-82e3b5b1adb5",
+        "recorded": "2024-10-19T08:26:08Z",
         "policy": [
           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
         ],
@@ -399,17 +399,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729293246236014000.5c24a510-e660-4b0b-98a7-4fb35c32ffce"
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@@ -429,10 +429,10 @@
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@@ -547,7 +547,7 @@
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@@ -697,10 +697,10 @@
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@@ -715,16 +715,16 @@
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-        "recorded": "2024-10-18T16:14:06Z",
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@@ -736,10 +736,10 @@
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@@ -795,7 +795,7 @@
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         "patient": {
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@@ -885,10 +885,10 @@
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@@ -945,7 +945,7 @@
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@@ -958,7 +958,7 @@
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@@ -983,10 +983,10 @@
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@@ -1009,10 +1009,10 @@
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@@ -1043,15 +1043,15 @@
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@@ -1066,10 +1066,10 @@
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@@ -1126,7 +1126,7 @@
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@@ -1139,7 +1139,7 @@
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@@ -1164,10 +1164,10 @@
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@@ -1190,10 +1190,10 @@
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@@ -1224,15 +1224,15 @@
       }
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+      "fullUrl": "PractitionerRole/1729351568367051000.6ce46521-e241-4b48-aea3-c64a2b3f1238",
       "resource": {
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-        "id": "1729293246252482000.57ffbe80-13a5-4467-a757-afa4f0de8ef5",
+        "id": "1729351568367051000.6ce46521-e241-4b48-aea3-c64a2b3f1238",
         "practitioner": {
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+          "reference": "Practitioner/1729351568367591000.754be278-9e00-4c53-b25c-1f7f699010db"
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@@ -1247,10 +1247,10 @@
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+      "fullUrl": "Observation/1729351568370193000.a79dd463-abd5-43f9-8c78-062ae6f3b690",
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@@ -1307,7 +1307,7 @@
           ]
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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@@ -1320,17 +1320,17 @@
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-            "reference": "PractitionerRole/1729293246255645000.6dbe171a-9812-4646-baf7-fe2f84a4e0ca"
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+      "fullUrl": "Practitioner/1729351568370835000.44d7fd6a-b12c-470a-8c34-f43f2bd90b11",
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@@ -1353,10 +1353,10 @@
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@@ -1387,15 +1387,15 @@
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+      "fullUrl": "PractitionerRole/1729351568370368000.9aed3d38-7d94-48b1-a966-ff6728d5c4b2",
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+        "id": "1729351568370368000.9aed3d38-7d94-48b1-a966-ff6728d5c4b2",
         "practitioner": {
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+          "reference": "Practitioner/1729351568370835000.44d7fd6a-b12c-470a-8c34-f43f2bd90b11"
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+          "reference": "Organization/1729351568371442000.2138686f-ae46-46c4-b6d8-c8787700f6a5"
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@@ -1410,10 +1410,10 @@
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@@ -1470,7 +1470,7 @@
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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@@ -1483,7 +1483,7 @@
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@@ -1508,10 +1508,10 @@
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@@ -1534,10 +1534,10 @@
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@@ -1568,15 +1568,15 @@
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@@ -1591,10 +1591,10 @@
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@@ -1651,7 +1651,7 @@
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@@ -1664,7 +1664,7 @@
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@@ -1689,10 +1689,10 @@
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@@ -1715,10 +1715,10 @@
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@@ -1749,15 +1749,15 @@
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@@ -1772,10 +1772,10 @@
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@@ -1832,7 +1832,7 @@
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@@ -1845,7 +1845,7 @@
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@@ -1870,10 +1870,10 @@
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@@ -1896,10 +1896,10 @@
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@@ -1930,15 +1930,15 @@
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@@ -1953,10 +1953,10 @@
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@@ -2013,7 +2013,7 @@
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@@ -2026,7 +2026,7 @@
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@@ -2051,10 +2051,10 @@
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@@ -2077,10 +2077,10 @@
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@@ -2111,15 +2111,15 @@
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@@ -2134,10 +2134,10 @@
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@@ -2194,7 +2194,7 @@
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@@ -2207,7 +2207,7 @@
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@@ -2232,10 +2232,10 @@
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@@ -2258,10 +2258,10 @@
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@@ -2292,15 +2292,15 @@
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@@ -2315,10 +2315,10 @@
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@@ -2411,7 +2411,7 @@
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@@ -2424,16 +2424,16 @@
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@@ -2456,10 +2456,10 @@
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@@ -2490,15 +2490,15 @@
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@@ -2513,10 +2513,10 @@
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@@ -2553,7 +2553,7 @@
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@@ -2568,10 +2568,10 @@
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@@ -2981,7 +2981,7 @@
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@@ -3036,7 +3036,7 @@
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@@ -3090,7 +3090,7 @@
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@@ -3105,10 +3105,10 @@
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@@ -3165,7 +3165,7 @@
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@@ -3178,7 +3178,7 @@
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@@ -3229,10 +3229,10 @@
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@@ -3263,15 +3263,15 @@
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@@ -3346,7 +3346,7 @@
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@@ -3359,7 +3359,7 @@
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@@ -3384,10 +3384,10 @@
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@@ -3410,10 +3410,10 @@
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@@ -3444,15 +3444,15 @@
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@@ -3467,10 +3467,10 @@
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@@ -3527,7 +3527,7 @@
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@@ -3540,7 +3540,7 @@
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@@ -3565,10 +3565,10 @@
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@@ -3591,10 +3591,10 @@
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@@ -3625,15 +3625,15 @@
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@@ -3648,10 +3648,10 @@
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@@ -3708,7 +3708,7 @@
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@@ -3721,7 +3721,7 @@
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@@ -3746,10 +3746,10 @@
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@@ -3772,10 +3772,10 @@
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@@ -3806,15 +3806,15 @@
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@@ -3829,10 +3829,10 @@
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@@ -3889,7 +3889,7 @@
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@@ -3902,7 +3902,7 @@
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@@ -3927,10 +3927,10 @@
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@@ -3953,10 +3953,10 @@
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@@ -3987,15 +3987,15 @@
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@@ -4010,10 +4010,10 @@
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@@ -4070,7 +4070,7 @@
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@@ -4083,7 +4083,7 @@
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@@ -4108,10 +4108,10 @@
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@@ -4134,10 +4134,10 @@
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@@ -4168,15 +4168,15 @@
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@@ -4191,10 +4191,10 @@
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@@ -4251,7 +4251,7 @@
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@@ -4264,7 +4264,7 @@
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@@ -4289,10 +4289,10 @@
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@@ -4315,10 +4315,10 @@
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@@ -4349,15 +4349,15 @@
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@@ -4372,10 +4372,10 @@
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@@ -4432,7 +4432,7 @@
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@@ -4445,7 +4445,7 @@
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@@ -4470,10 +4470,10 @@
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@@ -4496,10 +4496,10 @@
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@@ -4530,15 +4530,15 @@
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@@ -4553,10 +4553,10 @@
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@@ -4613,7 +4613,7 @@
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@@ -4626,7 +4626,7 @@
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@@ -4651,10 +4651,10 @@
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@@ -4677,10 +4677,10 @@
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@@ -4711,15 +4711,15 @@
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@@ -4734,10 +4734,10 @@
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@@ -4794,7 +4794,7 @@
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@@ -4807,7 +4807,7 @@
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@@ -4832,10 +4832,10 @@
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@@ -4858,10 +4858,10 @@
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@@ -4892,15 +4892,15 @@
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@@ -4915,10 +4915,10 @@
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@@ -4975,7 +4975,7 @@
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@@ -4988,7 +4988,7 @@
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@@ -5013,10 +5013,10 @@
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@@ -5039,10 +5039,10 @@
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@@ -5073,15 +5073,15 @@
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@@ -5096,10 +5096,10 @@
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@@ -5156,7 +5156,7 @@
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@@ -5169,7 +5169,7 @@
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@@ -5194,10 +5194,10 @@
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@@ -5220,10 +5220,10 @@
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@@ -5254,15 +5254,15 @@
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@@ -5277,10 +5277,10 @@
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@@ -5290,10 +5290,10 @@
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@@ -5303,10 +5303,10 @@
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@@ -5316,10 +5316,10 @@
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@@ -5329,10 +5329,10 @@
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@@ -5342,10 +5342,10 @@
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@@ -5355,10 +5355,10 @@
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@@ -5368,10 +5368,10 @@
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@@ -5381,10 +5381,10 @@
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@@ -5394,10 +5394,10 @@
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@@ -5407,10 +5407,10 @@
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@@ -5420,10 +5420,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293246320673000.85697ca7-b649-41cd-8e11-1d5629587351",
+      "fullUrl": "Specimen/1729351568453218000.d6ce5869-3ddf-4fda-9b11-7457424e4a93",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293246320673000.85697ca7-b649-41cd-8e11-1d5629587351",
+        "id": "1729351568453218000.d6ce5869-3ddf-4fda-9b11-7457424e4a93",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5433,10 +5433,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293246321055000.7bf4466c-50ff-40e1-9bd0-e6c4ce703cb7",
+      "fullUrl": "Specimen/1729351568453748000.49da3d8f-fa55-48a5-bbc5-165635d87ba8",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293246321055000.7bf4466c-50ff-40e1-9bd0-e6c4ce703cb7",
+        "id": "1729351568453748000.49da3d8f-fa55-48a5-bbc5-165635d87ba8",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5446,10 +5446,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293246321404000.88c5c40c-9df9-4753-96ff-835cc5064015",
+      "fullUrl": "Specimen/1729351568454085000.d178649e-0621-4d2b-9a35-48ba834a4785",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293246321404000.88c5c40c-9df9-4753-96ff-835cc5064015",
+        "id": "1729351568454085000.d178649e-0621-4d2b-9a35-48ba834a4785",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5459,10 +5459,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293246323590000.de842854-1a85-4031-a6e7-bd3e89156a4d",
+      "fullUrl": "Specimen/1729351568456364000.2b5bad34-855c-4dc0-97ea-f0a053932633",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293246323590000.de842854-1a85-4031-a6e7-bd3e89156a4d",
+        "id": "1729351568456364000.2b5bad34-855c-4dc0-97ea-f0a053932633",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5624,10 +5624,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293246332779000.a93e178a-ac40-4f9e-8590-da1359dc0b51",
+      "fullUrl": "ServiceRequest/1729351568465656000.7476c3e6-89bc-442e-bdb5-c10793c216a1",
       "resource": {
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-        "id": "1729293246332779000.a93e178a-ac40-4f9e-8590-da1359dc0b51",
+        "id": "1729351568465656000.7476c3e6-89bc-442e-bdb5-c10793c216a1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -5639,13 +5639,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246328162000.81ac06b5-7765-49e7-908d-dd08454ae63e"
+                  "reference": "Organization/1729351568461004000.964e2103-97cf-4a57-8947-f3b1b0305845"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246328968000.effa6adb-5933-4051-92f0-094bae647577"
+                  "reference": "Organization/1729351568461801000.a0f4fba3-68d5-49a5-b3d7-2fd83ae8e438"
                 }
               },
               {
@@ -5673,7 +5673,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246330222000.0dd52bef-81a4-4096-b295-f45e52a31f79"
+                  "reference": "Practitioner/1729351568463112000.86141ac5-925c-49a8-9f34-80f9efd61132"
                 }
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@@ -5801,7 +5801,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246332299000.556ed77c-83b1-43ae-9922-0886b0fe5c1a"
+                  "reference": "Practitioner/1729351568465177000.ebc684e0-b2ff-411e-97f1-0b879cb456cf"
                 }
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@@ -5883,18 +5883,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246323914000.dcea7a31-7d2e-4107-9b79-141d4def4cc4"
+          "reference": "PractitionerRole/1729351568456702000.7109dff6-ca30-484a-bd08-4b053f32474a"
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       }
     },
     {
-      "fullUrl": "Organization/1729293246324112000.e1240bb1-26f5-4ba4-84ec-1f9d6619fcc2",
+      "fullUrl": "Organization/1729351568456903000.d846f46c-7f7c-4b14-bd2f-39d93d639e8d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246324112000.e1240bb1-26f5-4ba4-84ec-1f9d6619fcc2",
+        "id": "1729351568456903000.d846f46c-7f7c-4b14-bd2f-39d93d639e8d",
         "identifier": [
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@@ -5909,10 +5909,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293246324949000.d72b1c7d-7257-42da-b956-2e0e2eb073f5",
+      "fullUrl": "Practitioner/1729351568457767000.edcafe5f-7a51-4c68-95ea-2e94b77091b2",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246324949000.d72b1c7d-7257-42da-b956-2e0e2eb073f5",
+        "id": "1729351568457767000.edcafe5f-7a51-4c68-95ea-2e94b77091b2",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -5964,7 +5964,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246324112000.e1240bb1-26f5-4ba4-84ec-1f9d6619fcc2"
+              "reference": "Organization/1729351568456903000.d846f46c-7f7c-4b14-bd2f-39d93d639e8d"
             }
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@@ -5980,10 +5980,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246326193000.dd7cb951-13b1-4165-9566-82220431ecf9",
+      "fullUrl": "Organization/1729351568459003000.76de488a-ae8d-43c4-9caf-3faa56a125fa",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246326193000.dd7cb951-13b1-4165-9566-82220431ecf9",
+        "id": "1729351568459003000.76de488a-ae8d-43c4-9caf-3faa56a125fa",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -6071,23 +6071,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246323914000.dcea7a31-7d2e-4107-9b79-141d4def4cc4",
+      "fullUrl": "PractitionerRole/1729351568456702000.7109dff6-ca30-484a-bd08-4b053f32474a",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246323914000.dcea7a31-7d2e-4107-9b79-141d4def4cc4",
+        "id": "1729351568456702000.7109dff6-ca30-484a-bd08-4b053f32474a",
         "practitioner": {
-          "reference": "Practitioner/1729293246324949000.d72b1c7d-7257-42da-b956-2e0e2eb073f5"
+          "reference": "Practitioner/1729351568457767000.edcafe5f-7a51-4c68-95ea-2e94b77091b2"
         },
         "organization": {
-          "reference": "Organization/1729293246326193000.dd7cb951-13b1-4165-9566-82220431ecf9"
+          "reference": "Organization/1729351568459003000.76de488a-ae8d-43c4-9caf-3faa56a125fa"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729293246328162000.81ac06b5-7765-49e7-908d-dd08454ae63e",
+      "fullUrl": "Organization/1729351568461004000.964e2103-97cf-4a57-8947-f3b1b0305845",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246328162000.81ac06b5-7765-49e7-908d-dd08454ae63e",
+        "id": "1729351568461004000.964e2103-97cf-4a57-8947-f3b1b0305845",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -6163,10 +6163,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246328968000.effa6adb-5933-4051-92f0-094bae647577",
+      "fullUrl": "Organization/1729351568461801000.a0f4fba3-68d5-49a5-b3d7-2fd83ae8e438",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246328968000.effa6adb-5933-4051-92f0-094bae647577",
+        "id": "1729351568461801000.a0f4fba3-68d5-49a5-b3d7-2fd83ae8e438",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -6242,10 +6242,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246329515000.f1848f41-5043-4589-9f2f-d92d564f9592",
+      "fullUrl": "Organization/1729351568462347000.b2beb90b-0b4e-437b-ab5b-0891e6d014c8",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246329515000.f1848f41-5043-4589-9f2f-d92d564f9592",
+        "id": "1729351568462347000.b2beb90b-0b4e-437b-ab5b-0891e6d014c8",
         "identifier": [
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@@ -6260,10 +6260,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246330222000.0dd52bef-81a4-4096-b295-f45e52a31f79",
+      "fullUrl": "Practitioner/1729351568463112000.86141ac5-925c-49a8-9f34-80f9efd61132",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246330222000.0dd52bef-81a4-4096-b295-f45e52a31f79",
+        "id": "1729351568463112000.86141ac5-925c-49a8-9f34-80f9efd61132",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6311,7 +6311,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246329515000.f1848f41-5043-4589-9f2f-d92d564f9592"
+              "reference": "Organization/1729351568462347000.b2beb90b-0b4e-437b-ab5b-0891e6d014c8"
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@@ -6327,10 +6327,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293246331572000.7c5ac254-6650-4692-8f54-8c5261064ffb",
+      "fullUrl": "Organization/1729351568464461000.32e12de2-2806-4e05-90ea-b4aadb6b347f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246331572000.7c5ac254-6650-4692-8f54-8c5261064ffb",
+        "id": "1729351568464461000.32e12de2-2806-4e05-90ea-b4aadb6b347f",
         "identifier": [
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@@ -6345,10 +6345,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246332299000.556ed77c-83b1-43ae-9922-0886b0fe5c1a",
+      "fullUrl": "Practitioner/1729351568465177000.ebc684e0-b2ff-411e-97f1-0b879cb456cf",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246332299000.556ed77c-83b1-43ae-9922-0886b0fe5c1a",
+        "id": "1729351568465177000.ebc684e0-b2ff-411e-97f1-0b879cb456cf",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6396,7 +6396,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246331572000.7c5ac254-6650-4692-8f54-8c5261064ffb"
+              "reference": "Organization/1729351568464461000.32e12de2-2806-4e05-90ea-b4aadb6b347f"
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@@ -6412,10 +6412,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293246337735000.ff20df51-ba4c-4efa-a0c9-56e95543caba",
+      "fullUrl": "ServiceRequest/1729351568470672000.0b738a38-1e22-4bea-aa9c-ce7ffa1319c3",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293246337735000.ff20df51-ba4c-4efa-a0c9-56e95543caba",
+        "id": "1729351568470672000.0b738a38-1e22-4bea-aa9c-ce7ffa1319c3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -6554,7 +6554,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246337273000.84a6369a-5ba0-47ad-97db-4da4bd87bb34"
+                  "reference": "Practitioner/1729351568470214000.114f256d-994d-4311-b9b2-8d780c52da02"
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@@ -6636,18 +6636,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "Practitioner/1729293246333875000.baaed4f2-296f-4247-ab5a-d93ac12c5051"
+          "reference": "Practitioner/1729351568466786000.8ed42bf9-ffab-40bf-8443-783e4ec58389"
         }
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     },
     {
-      "fullUrl": "Organization/1729293246333017000.ae5c1cad-6cf0-4ed3-85e5-d6208190e4aa",
+      "fullUrl": "Organization/1729351568465894000.65452ffe-52a5-40fa-8172-22e7b08e8ca1",
       "resource": {
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-        "id": "1729293246333017000.ae5c1cad-6cf0-4ed3-85e5-d6208190e4aa",
+        "id": "1729351568465894000.65452ffe-52a5-40fa-8172-22e7b08e8ca1",
         "identifier": [
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@@ -6662,10 +6662,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246333875000.baaed4f2-296f-4247-ab5a-d93ac12c5051",
+      "fullUrl": "Practitioner/1729351568466786000.8ed42bf9-ffab-40bf-8443-783e4ec58389",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246333875000.baaed4f2-296f-4247-ab5a-d93ac12c5051",
+        "id": "1729351568466786000.8ed42bf9-ffab-40bf-8443-783e4ec58389",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6717,7 +6717,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246333017000.ae5c1cad-6cf0-4ed3-85e5-d6208190e4aa"
+              "reference": "Organization/1729351568465894000.65452ffe-52a5-40fa-8172-22e7b08e8ca1"
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@@ -6733,10 +6733,10 @@
       }
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-      "fullUrl": "Organization/1729293246336567000.8a8a407c-85f0-43a5-943f-7387226ac845",
+      "fullUrl": "Organization/1729351568469494000.f32c91fe-af53-465d-9b19-47f01d4a6c5b",
       "resource": {
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-        "id": "1729293246336567000.8a8a407c-85f0-43a5-943f-7387226ac845",
+        "id": "1729351568469494000.f32c91fe-af53-465d-9b19-47f01d4a6c5b",
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@@ -6751,10 +6751,10 @@
       }
     },
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-      "fullUrl": "Practitioner/1729293246337273000.84a6369a-5ba0-47ad-97db-4da4bd87bb34",
+      "fullUrl": "Practitioner/1729351568470214000.114f256d-994d-4311-b9b2-8d780c52da02",
       "resource": {
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-        "id": "1729293246337273000.84a6369a-5ba0-47ad-97db-4da4bd87bb34",
+        "id": "1729351568470214000.114f256d-994d-4311-b9b2-8d780c52da02",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6802,7 +6802,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246336567000.8a8a407c-85f0-43a5-943f-7387226ac845"
+              "reference": "Organization/1729351568469494000.f32c91fe-af53-465d-9b19-47f01d4a6c5b"
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@@ -6818,10 +6818,10 @@
       }
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-      "fullUrl": "ServiceRequest/1729293246346814000.e03ec64a-96d7-40fc-b863-7fa3459bb5fd",
+      "fullUrl": "ServiceRequest/1729351568479703000.bbab943a-ad44-4765-9976-8099434e6d7b",
       "resource": {
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-        "id": "1729293246346814000.e03ec64a-96d7-40fc-b863-7fa3459bb5fd",
+        "id": "1729351568479703000.bbab943a-ad44-4765-9976-8099434e6d7b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -6833,13 +6833,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246342264000.8d9baffb-47ce-4415-b131-997c18e94757"
+                  "reference": "Organization/1729351568475160000.43332785-3c0a-4623-9a0f-51b867e01d5b"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246343028000.0e509c4c-af20-4ce8-8eb7-bcc74e73a17d"
+                  "reference": "Organization/1729351568475949000.2a56423b-1149-4496-824a-d1f162974dec"
                 }
               },
               {
@@ -6867,7 +6867,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246344245000.9a53d8e3-89ed-4f9c-9bd6-b38c3dd7ef17"
+                  "reference": "Practitioner/1729351568477165000.5a3aa70f-6288-45d9-a3b0-f62d29ce12f1"
                 }
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@@ -6995,7 +6995,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246346347000.e0810bfa-d4b9-47f2-a5c9-1001e47a7b57"
+                  "reference": "Practitioner/1729351568479245000.df0f3f2c-3418-4597-a511-f6ddcb16d093"
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@@ -7077,18 +7077,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
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+          "reference": "PractitionerRole/1729351568470839000.7b74e7be-fc5f-4a20-adfc-bc1cfb1f1ebb"
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-        "id": "1729293246338114000.51123485-6f49-436d-8979-d7cd5edf4539",
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@@ -7103,10 +7103,10 @@
       }
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@@ -7158,7 +7158,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246338114000.51123485-6f49-436d-8979-d7cd5edf4539"
+              "reference": "Organization/1729351568471032000.955db1e2-4adf-4665-866f-de77d33b7df3"
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@@ -7174,10 +7174,10 @@
       }
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-        "id": "1729293246340229000.4473ae24-31bf-48bc-b56a-4699b2870d86",
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         "extension": [
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@@ -7265,23 +7265,23 @@
       }
     },
     {
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+      "fullUrl": "PractitionerRole/1729351568470839000.7b74e7be-fc5f-4a20-adfc-bc1cfb1f1ebb",
       "resource": {
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-        "id": "1729293246337903000.40fb8126-47c2-43cd-a088-7dfdc3c7eb46",
+        "id": "1729351568470839000.7b74e7be-fc5f-4a20-adfc-bc1cfb1f1ebb",
         "practitioner": {
-          "reference": "Practitioner/1729293246339017000.d3fcc9a6-70a6-4d5a-8dea-4ab6e5745fed"
+          "reference": "Practitioner/1729351568471877000.9c2523a9-4f29-4b46-ac2e-fb877b45c890"
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         "organization": {
-          "reference": "Organization/1729293246340229000.4473ae24-31bf-48bc-b56a-4699b2870d86"
+          "reference": "Organization/1729351568473145000.93651296-1517-49bf-a631-9cc814af1cbb"
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       "resource": {
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-        "id": "1729293246342264000.8d9baffb-47ce-4415-b131-997c18e94757",
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         "extension": [
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@@ -7357,10 +7357,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729351568475949000.2a56423b-1149-4496-824a-d1f162974dec",
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         "extension": [
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@@ -7436,10 +7436,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729351568476462000.fec20681-820a-4294-918a-e4e18f5e19ef",
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@@ -7454,10 +7454,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568477165000.5a3aa70f-6288-45d9-a3b0-f62d29ce12f1",
       "resource": {
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-        "id": "1729293246344245000.9a53d8e3-89ed-4f9c-9bd6-b38c3dd7ef17",
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         "extension": [
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@@ -7505,7 +7505,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246343535000.f7f285b2-9ffa-4e8e-b02d-a197883661d4"
+              "reference": "Organization/1729351568476462000.fec20681-820a-4294-918a-e4e18f5e19ef"
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@@ -7521,10 +7521,10 @@
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       "resource": {
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@@ -7539,10 +7539,10 @@
       }
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         "extension": [
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@@ -7590,7 +7590,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246345615000.b2d2f8f7-ee9e-4078-aef0-c28dcff6d530"
+              "reference": "Organization/1729351568478501000.844add22-6c6a-4c95-a3ad-079cec484d29"
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@@ -7606,10 +7606,10 @@
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+      "fullUrl": "ServiceRequest/1729351568488784000.0262fad0-fa53-42d1-bc39-e8ed777fdf79",
       "resource": {
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-        "id": "1729293246358769000.150c6edf-bb7b-4220-8dbe-a45cb8139013",
+        "id": "1729351568488784000.0262fad0-fa53-42d1-bc39-e8ed777fdf79",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -7621,13 +7621,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246354193000.410afc88-9099-4411-8320-8379b77e5cd2"
+                  "reference": "Organization/1729351568484145000.b60969c5-e803-4acc-84c8-4ceee427f2ee"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246354992000.7a654b80-b123-47ed-8610-e048d23ba53d"
+                  "reference": "Organization/1729351568484956000.7a11f44e-5cf3-4e9b-9be5-11a4e085ca19"
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               {
@@ -7655,7 +7655,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246356258000.d2a34d18-7769-44a8-b466-aaa6fa79e686"
+                  "reference": "Practitioner/1729351568486200000.4f3d14a7-3b0c-4ffb-a400-262cd735e8b3"
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@@ -7783,7 +7783,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246358304000.6e4a02f3-a39c-46a4-b87b-e0cfd16f5658"
+                  "reference": "Practitioner/1729351568488297000.f05893d3-799e-44a9-a3e0-113d757ae305"
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@@ -7865,18 +7865,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246346970000.c5bf7794-ce10-4db7-ab70-027c1b084959"
+          "reference": "PractitionerRole/1729351568479863000.daf76a75-3a32-45de-960c-c8834b1c53c8"
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+      "fullUrl": "Organization/1729351568480055000.e77f04e3-7239-4b19-946f-000c397af6c3",
       "resource": {
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-        "id": "1729293246347161000.9e3cdbf8-b1de-436f-93ac-e5aa553ec0a4",
+        "id": "1729351568480055000.e77f04e3-7239-4b19-946f-000c397af6c3",
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@@ -7891,10 +7891,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568480932000.e78a1e91-80a0-4bd8-9fa0-ee4eeebeadf3",
       "resource": {
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-        "id": "1729293246348003000.b1450ebe-63d0-47c9-beac-04b990639829",
+        "id": "1729351568480932000.e78a1e91-80a0-4bd8-9fa0-ee4eeebeadf3",
         "extension": [
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@@ -7946,7 +7946,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246347161000.9e3cdbf8-b1de-436f-93ac-e5aa553ec0a4"
+              "reference": "Organization/1729351568480055000.e77f04e3-7239-4b19-946f-000c397af6c3"
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@@ -7962,10 +7962,10 @@
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+      "fullUrl": "Organization/1729351568482159000.1f0044da-72b2-4d77-9f4a-efd90f6cd16d",
       "resource": {
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-        "id": "1729293246352100000.903f5702-5344-46e6-a4f3-96d741671e4b",
+        "id": "1729351568482159000.1f0044da-72b2-4d77-9f4a-efd90f6cd16d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8053,23 +8053,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246346970000.c5bf7794-ce10-4db7-ab70-027c1b084959",
+      "fullUrl": "PractitionerRole/1729351568479863000.daf76a75-3a32-45de-960c-c8834b1c53c8",
       "resource": {
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+        "id": "1729351568479863000.daf76a75-3a32-45de-960c-c8834b1c53c8",
         "practitioner": {
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+          "reference": "Practitioner/1729351568480932000.e78a1e91-80a0-4bd8-9fa0-ee4eeebeadf3"
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         "organization": {
-          "reference": "Organization/1729293246352100000.903f5702-5344-46e6-a4f3-96d741671e4b"
+          "reference": "Organization/1729351568482159000.1f0044da-72b2-4d77-9f4a-efd90f6cd16d"
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-      "fullUrl": "Organization/1729293246354193000.410afc88-9099-4411-8320-8379b77e5cd2",
+      "fullUrl": "Organization/1729351568484145000.b60969c5-e803-4acc-84c8-4ceee427f2ee",
       "resource": {
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-        "id": "1729293246354193000.410afc88-9099-4411-8320-8379b77e5cd2",
+        "id": "1729351568484145000.b60969c5-e803-4acc-84c8-4ceee427f2ee",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8145,10 +8145,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246354992000.7a654b80-b123-47ed-8610-e048d23ba53d",
+      "fullUrl": "Organization/1729351568484956000.7a11f44e-5cf3-4e9b-9be5-11a4e085ca19",
       "resource": {
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-        "id": "1729293246354992000.7a654b80-b123-47ed-8610-e048d23ba53d",
+        "id": "1729351568484956000.7a11f44e-5cf3-4e9b-9be5-11a4e085ca19",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8224,10 +8224,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246355525000.9e6132de-2d49-4b84-a824-a1b5924d2496",
+      "fullUrl": "Organization/1729351568485477000.20244a2b-d8fa-4b6b-b17f-41645e17a595",
       "resource": {
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-        "id": "1729293246355525000.9e6132de-2d49-4b84-a824-a1b5924d2496",
+        "id": "1729351568485477000.20244a2b-d8fa-4b6b-b17f-41645e17a595",
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@@ -8242,10 +8242,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293246356258000.d2a34d18-7769-44a8-b466-aaa6fa79e686",
+      "fullUrl": "Practitioner/1729351568486200000.4f3d14a7-3b0c-4ffb-a400-262cd735e8b3",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246356258000.d2a34d18-7769-44a8-b466-aaa6fa79e686",
+        "id": "1729351568486200000.4f3d14a7-3b0c-4ffb-a400-262cd735e8b3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8293,7 +8293,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246355525000.9e6132de-2d49-4b84-a824-a1b5924d2496"
+              "reference": "Organization/1729351568485477000.20244a2b-d8fa-4b6b-b17f-41645e17a595"
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@@ -8309,10 +8309,10 @@
       }
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-      "fullUrl": "Organization/1729293246357603000.daf55445-3e3c-48ab-86e6-a116e205367f",
+      "fullUrl": "Organization/1729351568487543000.68374678-0cba-4682-bf34-1c56c39fe075",
       "resource": {
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-        "id": "1729293246357603000.daf55445-3e3c-48ab-86e6-a116e205367f",
+        "id": "1729351568487543000.68374678-0cba-4682-bf34-1c56c39fe075",
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@@ -8327,10 +8327,10 @@
       }
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-      "fullUrl": "Practitioner/1729293246358304000.6e4a02f3-a39c-46a4-b87b-e0cfd16f5658",
+      "fullUrl": "Practitioner/1729351568488297000.f05893d3-799e-44a9-a3e0-113d757ae305",
       "resource": {
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-        "id": "1729293246358304000.6e4a02f3-a39c-46a4-b87b-e0cfd16f5658",
+        "id": "1729351568488297000.f05893d3-799e-44a9-a3e0-113d757ae305",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8378,7 +8378,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246357603000.daf55445-3e3c-48ab-86e6-a116e205367f"
+              "reference": "Organization/1729351568487543000.68374678-0cba-4682-bf34-1c56c39fe075"
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@@ -8394,10 +8394,10 @@
       }
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     {
-      "fullUrl": "ServiceRequest/1729293246367631000.66c7a083-98bc-4f5c-93c9-c74242eec6ff",
+      "fullUrl": "ServiceRequest/1729351568497851000.90830430-92ca-41de-8cf5-c6665eec8b35",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293246367631000.66c7a083-98bc-4f5c-93c9-c74242eec6ff",
+        "id": "1729351568497851000.90830430-92ca-41de-8cf5-c6665eec8b35",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -8409,13 +8409,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246363202000.9e5d08f2-a54b-4d20-ab96-2a179d06d7c6"
+                  "reference": "Organization/1729351568493320000.6c176ae8-6d6a-49f8-a3d1-552c83c4840c"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246363976000.78f5d53b-02f2-4958-b975-458660057fc4"
+                  "reference": "Organization/1729351568494091000.24978ba1-2c42-4654-91d7-de9c0694fccf"
                 }
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@@ -8443,7 +8443,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246365184000.086fffe6-6c71-4f9f-8d8b-1a85066eba9e"
+                  "reference": "Practitioner/1729351568495347000.a192b06e-be35-46b5-94ad-e9ca5ad6322e"
                 }
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@@ -8571,7 +8571,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246367162000.6567d330-1edb-4d7f-9587-8490229fd568"
+                  "reference": "Practitioner/1729351568497396000.c778f467-f136-4168-a71b-13a492089f3c"
                 }
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@@ -8653,18 +8653,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246358926000.19b28c65-ea6b-4125-a2a6-dcf509787d49"
+          "reference": "PractitionerRole/1729351568488957000.c32c82e2-75e2-40a1-854c-a976b80af8f9"
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     {
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+      "fullUrl": "Organization/1729351568489155000.e7169c59-a37e-4bb0-a70b-e9c16d47a2c4",
       "resource": {
         "resourceType": "Organization",
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+        "id": "1729351568489155000.e7169c59-a37e-4bb0-a70b-e9c16d47a2c4",
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@@ -8679,10 +8679,10 @@
       }
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       "resource": {
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8734,7 +8734,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246359120000.74779224-3e63-4f7e-a155-49f9a12a15b9"
+              "reference": "Organization/1729351568489155000.e7169c59-a37e-4bb0-a70b-e9c16d47a2c4"
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@@ -8750,10 +8750,10 @@
       }
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+      "fullUrl": "Organization/1729351568491319000.8e927b1c-bedd-4f26-9666-f70fcdfe3830",
       "resource": {
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8841,23 +8841,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246358926000.19b28c65-ea6b-4125-a2a6-dcf509787d49",
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       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246358926000.19b28c65-ea6b-4125-a2a6-dcf509787d49",
+        "id": "1729351568488957000.c32c82e2-75e2-40a1-854c-a976b80af8f9",
         "practitioner": {
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+          "reference": "Practitioner/1729351568490052000.54b652ea-46bc-43b8-8f08-2d45b54ab31b"
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         "organization": {
-          "reference": "Organization/1729293246361184000.6c589bda-e87f-4996-bd16-5bedefe24761"
+          "reference": "Organization/1729351568491319000.8e927b1c-bedd-4f26-9666-f70fcdfe3830"
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-      "fullUrl": "Organization/1729293246363202000.9e5d08f2-a54b-4d20-ab96-2a179d06d7c6",
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       "resource": {
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8933,10 +8933,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246363976000.78f5d53b-02f2-4958-b975-458660057fc4",
+      "fullUrl": "Organization/1729351568494091000.24978ba1-2c42-4654-91d7-de9c0694fccf",
       "resource": {
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-        "id": "1729293246363976000.78f5d53b-02f2-4958-b975-458660057fc4",
+        "id": "1729351568494091000.24978ba1-2c42-4654-91d7-de9c0694fccf",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9012,10 +9012,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293246364489000.e54507e9-150e-4794-99b3-faf713e2e4b1",
+      "fullUrl": "Organization/1729351568494614000.52c8d10e-c098-405d-ba6d-b0bfd96115ac",
       "resource": {
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-        "id": "1729293246364489000.e54507e9-150e-4794-99b3-faf713e2e4b1",
+        "id": "1729351568494614000.52c8d10e-c098-405d-ba6d-b0bfd96115ac",
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@@ -9030,10 +9030,10 @@
       }
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-      "fullUrl": "Practitioner/1729293246365184000.086fffe6-6c71-4f9f-8d8b-1a85066eba9e",
+      "fullUrl": "Practitioner/1729351568495347000.a192b06e-be35-46b5-94ad-e9ca5ad6322e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246365184000.086fffe6-6c71-4f9f-8d8b-1a85066eba9e",
+        "id": "1729351568495347000.a192b06e-be35-46b5-94ad-e9ca5ad6322e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9081,7 +9081,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246364489000.e54507e9-150e-4794-99b3-faf713e2e4b1"
+              "reference": "Organization/1729351568494614000.52c8d10e-c098-405d-ba6d-b0bfd96115ac"
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@@ -9097,10 +9097,10 @@
       }
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-      "fullUrl": "Organization/1729293246366459000.67be5874-1b9a-422d-822c-79d8f9435c86",
+      "fullUrl": "Organization/1729351568496654000.b472ef1c-0cd7-4ed4-a14f-5ed300072d14",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246366459000.67be5874-1b9a-422d-822c-79d8f9435c86",
+        "id": "1729351568496654000.b472ef1c-0cd7-4ed4-a14f-5ed300072d14",
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@@ -9115,10 +9115,10 @@
       }
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     {
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+      "fullUrl": "Practitioner/1729351568497396000.c778f467-f136-4168-a71b-13a492089f3c",
       "resource": {
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-        "id": "1729293246367162000.6567d330-1edb-4d7f-9587-8490229fd568",
+        "id": "1729351568497396000.c778f467-f136-4168-a71b-13a492089f3c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9166,7 +9166,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246366459000.67be5874-1b9a-422d-822c-79d8f9435c86"
+              "reference": "Organization/1729351568496654000.b472ef1c-0cd7-4ed4-a14f-5ed300072d14"
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@@ -9182,10 +9182,10 @@
       }
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     {
-      "fullUrl": "ServiceRequest/1729293246376587000.74168d93-552d-4d58-b0e6-1e29f48869d6",
+      "fullUrl": "ServiceRequest/1729351568506784000.d687ad40-67bb-47d9-885e-dbec52cd6942",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293246376587000.74168d93-552d-4d58-b0e6-1e29f48869d6",
+        "id": "1729351568506784000.d687ad40-67bb-47d9-885e-dbec52cd6942",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -9197,13 +9197,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246372056000.75371672-f8aa-4d05-ad2b-9cb5df2276a1"
+                  "reference": "Organization/1729351568502289000.66c28621-0bf6-4920-8d1a-eeee9728a3de"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246372824000.83f1d808-4600-416c-a258-7aaa22543590"
+                  "reference": "Organization/1729351568503065000.6116ed3e-7eee-4e6a-94b8-0ca7d33c2714"
                 }
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               {
@@ -9231,7 +9231,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246374058000.bc845d3d-932e-42c1-a6bf-fde0640d4d6b"
+                  "reference": "Practitioner/1729351568504295000.95e0f72e-99f1-4f32-843f-a13f70d1fc3f"
                 }
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@@ -9359,7 +9359,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246376127000.38c89ae6-bb2e-4203-abaa-3005258d6b64"
+                  "reference": "Practitioner/1729351568506325000.1c61690e-9dba-4113-b517-c7242a88be9a"
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@@ -9441,18 +9441,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246367787000.ff34ef63-d83f-4747-8067-808dade1d2c5"
+          "reference": "PractitionerRole/1729351568498010000.b402c8d6-2f91-4215-a202-37434e10c091"
         }
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-      "fullUrl": "Organization/1729293246367978000.57feff62-a013-4349-bec6-8005e01a7b0b",
+      "fullUrl": "Organization/1729351568498195000.c173020d-9911-4829-91f7-100aba5635e4",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246367978000.57feff62-a013-4349-bec6-8005e01a7b0b",
+        "id": "1729351568498195000.c173020d-9911-4829-91f7-100aba5635e4",
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@@ -9467,10 +9467,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293246368846000.f74573d7-90fd-4786-94be-c3272caf6de5",
+      "fullUrl": "Practitioner/1729351568499039000.6683b3f2-c4da-48f0-b8ad-73a2f8476bed",
       "resource": {
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-        "id": "1729293246368846000.f74573d7-90fd-4786-94be-c3272caf6de5",
+        "id": "1729351568499039000.6683b3f2-c4da-48f0-b8ad-73a2f8476bed",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9522,7 +9522,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246367978000.57feff62-a013-4349-bec6-8005e01a7b0b"
+              "reference": "Organization/1729351568498195000.c173020d-9911-4829-91f7-100aba5635e4"
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@@ -9538,10 +9538,10 @@
       }
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-      "fullUrl": "Organization/1729293246370058000.fcc4dfa8-5f1f-4cad-a208-813d749b7b80",
+      "fullUrl": "Organization/1729351568500306000.a818591c-bfca-4eca-a1a7-fd516a8890db",
       "resource": {
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-        "id": "1729293246370058000.fcc4dfa8-5f1f-4cad-a208-813d749b7b80",
+        "id": "1729351568500306000.a818591c-bfca-4eca-a1a7-fd516a8890db",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9629,23 +9629,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246367787000.ff34ef63-d83f-4747-8067-808dade1d2c5",
+      "fullUrl": "PractitionerRole/1729351568498010000.b402c8d6-2f91-4215-a202-37434e10c091",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246367787000.ff34ef63-d83f-4747-8067-808dade1d2c5",
+        "id": "1729351568498010000.b402c8d6-2f91-4215-a202-37434e10c091",
         "practitioner": {
-          "reference": "Practitioner/1729293246368846000.f74573d7-90fd-4786-94be-c3272caf6de5"
+          "reference": "Practitioner/1729351568499039000.6683b3f2-c4da-48f0-b8ad-73a2f8476bed"
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         "organization": {
-          "reference": "Organization/1729293246370058000.fcc4dfa8-5f1f-4cad-a208-813d749b7b80"
+          "reference": "Organization/1729351568500306000.a818591c-bfca-4eca-a1a7-fd516a8890db"
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+      "fullUrl": "Organization/1729351568502289000.66c28621-0bf6-4920-8d1a-eeee9728a3de",
       "resource": {
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-        "id": "1729293246372056000.75371672-f8aa-4d05-ad2b-9cb5df2276a1",
+        "id": "1729351568502289000.66c28621-0bf6-4920-8d1a-eeee9728a3de",
         "extension": [
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@@ -9721,10 +9721,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246372824000.83f1d808-4600-416c-a258-7aaa22543590",
+      "fullUrl": "Organization/1729351568503065000.6116ed3e-7eee-4e6a-94b8-0ca7d33c2714",
       "resource": {
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-        "id": "1729293246372824000.83f1d808-4600-416c-a258-7aaa22543590",
+        "id": "1729351568503065000.6116ed3e-7eee-4e6a-94b8-0ca7d33c2714",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9800,10 +9800,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246373356000.9c255b7f-47a4-4add-989f-025a18a35869",
+      "fullUrl": "Organization/1729351568503581000.f2aac8be-bf78-4e40-9c88-29bcc0758e16",
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@@ -9818,10 +9818,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568504295000.95e0f72e-99f1-4f32-843f-a13f70d1fc3f",
       "resource": {
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-        "id": "1729293246374058000.bc845d3d-932e-42c1-a6bf-fde0640d4d6b",
+        "id": "1729351568504295000.95e0f72e-99f1-4f32-843f-a13f70d1fc3f",
         "extension": [
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@@ -9869,7 +9869,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246373356000.9c255b7f-47a4-4add-989f-025a18a35869"
+              "reference": "Organization/1729351568503581000.f2aac8be-bf78-4e40-9c88-29bcc0758e16"
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@@ -9885,10 +9885,10 @@
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-      "fullUrl": "Organization/1729293246375427000.ca8e27c6-3d4d-4c51-934c-3eb78592fb24",
+      "fullUrl": "Organization/1729351568505604000.008f3b3d-7c1a-4b4d-a0b9-322bb935abfd",
       "resource": {
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@@ -9903,10 +9903,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568506325000.1c61690e-9dba-4113-b517-c7242a88be9a",
       "resource": {
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-        "id": "1729293246376127000.38c89ae6-bb2e-4203-abaa-3005258d6b64",
+        "id": "1729351568506325000.1c61690e-9dba-4113-b517-c7242a88be9a",
         "extension": [
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@@ -9954,7 +9954,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246375427000.ca8e27c6-3d4d-4c51-934c-3eb78592fb24"
+              "reference": "Organization/1729351568505604000.008f3b3d-7c1a-4b4d-a0b9-322bb935abfd"
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@@ -9970,10 +9970,10 @@
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -9985,13 +9985,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246381080000.12daa83e-fd50-4a3f-a05d-0ccabad2b1d5"
+                  "reference": "Organization/1729351568511129000.d4610155-2958-45cf-bbcc-b5c1605b523d"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246381839000.61d3bc56-5174-4b41-acc3-d96a4a7c3bbb"
+                  "reference": "Organization/1729351568511891000.21dbd5b0-4301-4449-864e-1f308109591d"
                 }
               },
               {
@@ -10019,7 +10019,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246383077000.fc5d0ead-491e-422c-aa85-48e7a36d73e6"
+                  "reference": "Practitioner/1729351568513135000.1c068cfa-01e8-4209-bd84-46548839d2e4"
                 }
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@@ -10147,7 +10147,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246385154000.b96df541-a087-45b3-b153-a22920290a9a"
+                  "reference": "Practitioner/1729351568515151000.22d002ab-e8d8-465c-97fe-4a34470b4422"
                 }
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@@ -10229,18 +10229,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246376746000.b242965c-dfa5-42ef-89f6-1e31bf2c8ded"
+          "reference": "PractitionerRole/1729351568506939000.f4c844e6-acac-4b03-8c5d-d68551227c86"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729293246376942000.6af8f28c-0ed6-47dd-8618-bc4043031a1e",
+      "fullUrl": "Organization/1729351568507126000.7e912441-61a3-4fe8-8398-44ee712e0fe9",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246376942000.6af8f28c-0ed6-47dd-8618-bc4043031a1e",
+        "id": "1729351568507126000.7e912441-61a3-4fe8-8398-44ee712e0fe9",
         "identifier": [
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@@ -10255,10 +10255,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246377785000.1495c1e1-bd9e-4048-97f4-1dfd832526b6",
+      "fullUrl": "Practitioner/1729351568507957000.412f1086-ff92-45e8-bee1-598777c84a0b",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246377785000.1495c1e1-bd9e-4048-97f4-1dfd832526b6",
+        "id": "1729351568507957000.412f1086-ff92-45e8-bee1-598777c84a0b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -10310,7 +10310,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246376942000.6af8f28c-0ed6-47dd-8618-bc4043031a1e"
+              "reference": "Organization/1729351568507126000.7e912441-61a3-4fe8-8398-44ee712e0fe9"
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@@ -10326,10 +10326,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246379049000.5e5c4edf-5e60-4737-94a6-a899b787512a",
+      "fullUrl": "Organization/1729351568509167000.5a7816d7-49b6-482f-a300-78ee111e6519",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246379049000.5e5c4edf-5e60-4737-94a6-a899b787512a",
+        "id": "1729351568509167000.5a7816d7-49b6-482f-a300-78ee111e6519",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -10417,23 +10417,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246376746000.b242965c-dfa5-42ef-89f6-1e31bf2c8ded",
+      "fullUrl": "PractitionerRole/1729351568506939000.f4c844e6-acac-4b03-8c5d-d68551227c86",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246376746000.b242965c-dfa5-42ef-89f6-1e31bf2c8ded",
+        "id": "1729351568506939000.f4c844e6-acac-4b03-8c5d-d68551227c86",
         "practitioner": {
-          "reference": "Practitioner/1729293246377785000.1495c1e1-bd9e-4048-97f4-1dfd832526b6"
+          "reference": "Practitioner/1729351568507957000.412f1086-ff92-45e8-bee1-598777c84a0b"
         },
         "organization": {
-          "reference": "Organization/1729293246379049000.5e5c4edf-5e60-4737-94a6-a899b787512a"
+          "reference": "Organization/1729351568509167000.5a7816d7-49b6-482f-a300-78ee111e6519"
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     },
     {
-      "fullUrl": "Organization/1729293246381080000.12daa83e-fd50-4a3f-a05d-0ccabad2b1d5",
+      "fullUrl": "Organization/1729351568511129000.d4610155-2958-45cf-bbcc-b5c1605b523d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246381080000.12daa83e-fd50-4a3f-a05d-0ccabad2b1d5",
+        "id": "1729351568511129000.d4610155-2958-45cf-bbcc-b5c1605b523d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -10509,10 +10509,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246381839000.61d3bc56-5174-4b41-acc3-d96a4a7c3bbb",
+      "fullUrl": "Organization/1729351568511891000.21dbd5b0-4301-4449-864e-1f308109591d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246381839000.61d3bc56-5174-4b41-acc3-d96a4a7c3bbb",
+        "id": "1729351568511891000.21dbd5b0-4301-4449-864e-1f308109591d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -10588,10 +10588,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246382345000.aa6272bd-047b-456f-bee2-a0df2a55aaaa",
+      "fullUrl": "Organization/1729351568512412000.757b25ff-9056-4f54-8a82-c4fce26cbee4",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246382345000.aa6272bd-047b-456f-bee2-a0df2a55aaaa",
+        "id": "1729351568512412000.757b25ff-9056-4f54-8a82-c4fce26cbee4",
         "identifier": [
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@@ -10606,10 +10606,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246383077000.fc5d0ead-491e-422c-aa85-48e7a36d73e6",
+      "fullUrl": "Practitioner/1729351568513135000.1c068cfa-01e8-4209-bd84-46548839d2e4",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246383077000.fc5d0ead-491e-422c-aa85-48e7a36d73e6",
+        "id": "1729351568513135000.1c068cfa-01e8-4209-bd84-46548839d2e4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -10657,7 +10657,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246382345000.aa6272bd-047b-456f-bee2-a0df2a55aaaa"
+              "reference": "Organization/1729351568512412000.757b25ff-9056-4f54-8a82-c4fce26cbee4"
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@@ -10673,10 +10673,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293246384452000.e92c85aa-6999-4f66-9a04-eeedc37201eb",
+      "fullUrl": "Organization/1729351568514444000.77dc3dbf-7bd9-42c0-be89-8ce6dfe93a21",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246384452000.e92c85aa-6999-4f66-9a04-eeedc37201eb",
+        "id": "1729351568514444000.77dc3dbf-7bd9-42c0-be89-8ce6dfe93a21",
         "identifier": [
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@@ -10691,10 +10691,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246385154000.b96df541-a087-45b3-b153-a22920290a9a",
+      "fullUrl": "Practitioner/1729351568515151000.22d002ab-e8d8-465c-97fe-4a34470b4422",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246385154000.b96df541-a087-45b3-b153-a22920290a9a",
+        "id": "1729351568515151000.22d002ab-e8d8-465c-97fe-4a34470b4422",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -10742,7 +10742,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246384452000.e92c85aa-6999-4f66-9a04-eeedc37201eb"
+              "reference": "Organization/1729351568514444000.77dc3dbf-7bd9-42c0-be89-8ce6dfe93a21"
             }
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@@ -10758,10 +10758,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293246394657000.c20128c3-e77a-478a-88dc-4d78d4751030",
+      "fullUrl": "ServiceRequest/1729351568533716000.e88889bc-27d6-4f90-9666-d92f6a858e89",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293246394657000.c20128c3-e77a-478a-88dc-4d78d4751030",
+        "id": "1729351568533716000.e88889bc-27d6-4f90-9666-d92f6a858e89",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -10773,13 +10773,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246390086000.ca898dee-adfe-499f-ac23-3ce71d45fcbe"
+                  "reference": "Organization/1729351568526523000.4a29c083-e63c-4a93-aa7e-901bbef4fd30"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246390871000.8048c52a-f02a-432b-8a07-14efdca5460e"
+                  "reference": "Organization/1729351568528697000.a15f4d51-1b9a-47f1-960b-cefcc9fcceb1"
                 }
               },
               {
@@ -10807,7 +10807,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246392200000.67205715-ee7c-4953-9dda-3eedc03d0759"
+                  "reference": "Practitioner/1729351568531152000.93b48b35-e8ff-42b7-8335-b7424d2eeb7e"
                 }
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@@ -10935,7 +10935,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246394192000.da5b24c6-9253-43cf-9d84-5f3b5ea01617"
+                  "reference": "Practitioner/1729351568533249000.1684ef2a-8dca-42e5-9428-5ba5c115c548"
                 }
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@@ -11017,18 +11017,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246385751000.437cce6f-1bd4-4903-a885-82e946f59fee"
+          "reference": "PractitionerRole/1729351568516805000.b1850aee-3486-48cf-9de0-30a5e6cad3f1"
         }
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     },
     {
-      "fullUrl": "Organization/1729293246385943000.d77f29af-ea57-41e6-83bb-25aefe1a9b7c",
+      "fullUrl": "Organization/1729351568517234000.3ba65204-b8e0-4773-9a46-48dbeaff4a15",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246385943000.d77f29af-ea57-41e6-83bb-25aefe1a9b7c",
+        "id": "1729351568517234000.3ba65204-b8e0-4773-9a46-48dbeaff4a15",
         "identifier": [
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@@ -11043,10 +11043,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246386829000.0fd24ad2-0d6e-4537-8837-3d4e68779c3a",
+      "fullUrl": "Practitioner/1729351568518976000.9e06db0d-e846-4e54-bfc1-588bfa248152",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246386829000.0fd24ad2-0d6e-4537-8837-3d4e68779c3a",
+        "id": "1729351568518976000.9e06db0d-e846-4e54-bfc1-588bfa248152",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11098,7 +11098,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246385943000.d77f29af-ea57-41e6-83bb-25aefe1a9b7c"
+              "reference": "Organization/1729351568517234000.3ba65204-b8e0-4773-9a46-48dbeaff4a15"
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@@ -11114,10 +11114,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246388120000.c31405dc-69ba-4fb7-9765-746561739ab6",
+      "fullUrl": "Organization/1729351568522006000.ea73fddd-9cd4-4b16-9c80-ddaadf674d70",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246388120000.c31405dc-69ba-4fb7-9765-746561739ab6",
+        "id": "1729351568522006000.ea73fddd-9cd4-4b16-9c80-ddaadf674d70",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11205,23 +11205,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246385751000.437cce6f-1bd4-4903-a885-82e946f59fee",
+      "fullUrl": "PractitionerRole/1729351568516805000.b1850aee-3486-48cf-9de0-30a5e6cad3f1",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246385751000.437cce6f-1bd4-4903-a885-82e946f59fee",
+        "id": "1729351568516805000.b1850aee-3486-48cf-9de0-30a5e6cad3f1",
         "practitioner": {
-          "reference": "Practitioner/1729293246386829000.0fd24ad2-0d6e-4537-8837-3d4e68779c3a"
+          "reference": "Practitioner/1729351568518976000.9e06db0d-e846-4e54-bfc1-588bfa248152"
         },
         "organization": {
-          "reference": "Organization/1729293246388120000.c31405dc-69ba-4fb7-9765-746561739ab6"
+          "reference": "Organization/1729351568522006000.ea73fddd-9cd4-4b16-9c80-ddaadf674d70"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729293246390086000.ca898dee-adfe-499f-ac23-3ce71d45fcbe",
+      "fullUrl": "Organization/1729351568526523000.4a29c083-e63c-4a93-aa7e-901bbef4fd30",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246390086000.ca898dee-adfe-499f-ac23-3ce71d45fcbe",
+        "id": "1729351568526523000.4a29c083-e63c-4a93-aa7e-901bbef4fd30",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11297,10 +11297,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246390871000.8048c52a-f02a-432b-8a07-14efdca5460e",
+      "fullUrl": "Organization/1729351568528697000.a15f4d51-1b9a-47f1-960b-cefcc9fcceb1",
       "resource": {
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-        "id": "1729293246390871000.8048c52a-f02a-432b-8a07-14efdca5460e",
+        "id": "1729351568528697000.a15f4d51-1b9a-47f1-960b-cefcc9fcceb1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11376,10 +11376,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246391432000.77bcf2e8-954d-4fe5-b397-fc1df5820324",
+      "fullUrl": "Organization/1729351568530010000.0b97d72f-c35c-4014-9303-1c7371d44a65",
       "resource": {
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-        "id": "1729293246391432000.77bcf2e8-954d-4fe5-b397-fc1df5820324",
+        "id": "1729351568530010000.0b97d72f-c35c-4014-9303-1c7371d44a65",
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@@ -11394,10 +11394,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246392200000.67205715-ee7c-4953-9dda-3eedc03d0759",
+      "fullUrl": "Practitioner/1729351568531152000.93b48b35-e8ff-42b7-8335-b7424d2eeb7e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246392200000.67205715-ee7c-4953-9dda-3eedc03d0759",
+        "id": "1729351568531152000.93b48b35-e8ff-42b7-8335-b7424d2eeb7e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11445,7 +11445,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246391432000.77bcf2e8-954d-4fe5-b397-fc1df5820324"
+              "reference": "Organization/1729351568530010000.0b97d72f-c35c-4014-9303-1c7371d44a65"
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@@ -11461,10 +11461,10 @@
       }
     },
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-      "fullUrl": "Organization/1729293246393502000.b718f103-e008-4969-926c-737507779879",
+      "fullUrl": "Organization/1729351568532513000.77bed438-bcce-4bd8-9348-583641534608",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246393502000.b718f103-e008-4969-926c-737507779879",
+        "id": "1729351568532513000.77bed438-bcce-4bd8-9348-583641534608",
         "identifier": [
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@@ -11479,10 +11479,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246394192000.da5b24c6-9253-43cf-9d84-5f3b5ea01617",
+      "fullUrl": "Practitioner/1729351568533249000.1684ef2a-8dca-42e5-9428-5ba5c115c548",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246394192000.da5b24c6-9253-43cf-9d84-5f3b5ea01617",
+        "id": "1729351568533249000.1684ef2a-8dca-42e5-9428-5ba5c115c548",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11530,7 +11530,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246393502000.b718f103-e008-4969-926c-737507779879"
+              "reference": "Organization/1729351568532513000.77bed438-bcce-4bd8-9348-583641534608"
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@@ -11546,10 +11546,10 @@
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+      "fullUrl": "ServiceRequest/1729351568542887000.aaceff2e-97e2-4c94-bc85-e48189cf9951",
       "resource": {
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+        "id": "1729351568542887000.aaceff2e-97e2-4c94-bc85-e48189cf9951",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -11561,13 +11561,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246399137000.5f8192b1-6853-4005-8eea-aa58e1f194d9"
+                  "reference": "Organization/1729351568538318000.3751387a-4470-44c8-b7f8-63688d5fc406"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246399939000.fc93c1db-c0b1-44f1-96a3-e450169165e4"
+                  "reference": "Organization/1729351568539099000.3566a9f4-1cdf-450a-82de-bfed6cc4bfeb"
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               {
@@ -11595,7 +11595,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246401240000.f185df05-e477-4219-adef-25ac40985ed1"
+                  "reference": "Practitioner/1729351568540341000.9715362d-0fa0-4ad6-a760-410662d705d1"
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@@ -11723,7 +11723,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246403261000.e39dbe24-4dc4-4fce-82ab-bdae8bfc5115"
+                  "reference": "Practitioner/1729351568542415000.7eccce6b-0844-4a08-8d8f-b3f8f3cd9407"
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@@ -11805,18 +11805,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
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+          "reference": "PractitionerRole/1729351568533880000.ad22da6a-7631-4705-a983-5ad5bae37cfd"
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+      "fullUrl": "Organization/1729351568534086000.2f26a0cf-cddc-468e-996a-ff28aade40ac",
       "resource": {
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@@ -11831,10 +11831,10 @@
       }
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         "extension": [
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@@ -11886,7 +11886,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246395000000.99e7297a-109b-46f2-a057-48fd59748b4c"
+              "reference": "Organization/1729351568534086000.2f26a0cf-cddc-468e-996a-ff28aade40ac"
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@@ -11902,10 +11902,10 @@
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       "resource": {
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         "extension": [
           {
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@@ -11993,23 +11993,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246394810000.efdd064a-3572-4ad9-b438-80f17b8f2a23",
+      "fullUrl": "PractitionerRole/1729351568533880000.ad22da6a-7631-4705-a983-5ad5bae37cfd",
       "resource": {
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         "practitioner": {
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+          "reference": "Practitioner/1729351568534977000.13abe0aa-daf0-4284-a638-ceeb4c7b26b3"
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         "organization": {
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+          "reference": "Organization/1729351568536229000.9a3d8916-95eb-49e2-99ae-9232eb944281"
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         "extension": [
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@@ -12085,10 +12085,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729351568539099000.3566a9f4-1cdf-450a-82de-bfed6cc4bfeb",
       "resource": {
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+        "id": "1729351568539099000.3566a9f4-1cdf-450a-82de-bfed6cc4bfeb",
         "extension": [
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@@ -12164,10 +12164,10 @@
       }
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+      "fullUrl": "Organization/1729351568539626000.40224b24-d9e1-4b37-97ae-c42e54b05147",
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@@ -12182,10 +12182,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568540341000.9715362d-0fa0-4ad6-a760-410662d705d1",
       "resource": {
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-        "id": "1729293246401240000.f185df05-e477-4219-adef-25ac40985ed1",
+        "id": "1729351568540341000.9715362d-0fa0-4ad6-a760-410662d705d1",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12233,7 +12233,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246400511000.90bfaf58-3930-4fd5-84e5-428b8d29987f"
+              "reference": "Organization/1729351568539626000.40224b24-d9e1-4b37-97ae-c42e54b05147"
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@@ -12249,10 +12249,10 @@
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@@ -12267,10 +12267,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568542415000.7eccce6b-0844-4a08-8d8f-b3f8f3cd9407",
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         "extension": [
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@@ -12318,7 +12318,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729351568541694000.2716ae6f-e9fb-4956-b844-c86daf4938aa"
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@@ -12334,10 +12334,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729351568552141000.8d98b735-03af-4a27-9091-1683a09f072c",
       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -12349,13 +12349,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246408200000.78d63048-34b8-47d3-8c9a-be5ebea9d3bd"
+                  "reference": "Organization/1729351568547357000.cc6baad1-5af6-41c2-b5ce-62e2877e5030"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246408961000.648748f0-19ab-488f-891c-f813b3678ce5"
+                  "reference": "Organization/1729351568548229000.44bfea7d-cc59-4876-86f3-cbd12725fb61"
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@@ -12383,7 +12383,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246410251000.1ab200ac-a673-4d6b-a132-9b1d173c6269"
+                  "reference": "Practitioner/1729351568549500000.5faf4413-0fae-4282-84f6-f6d2375bb8f2"
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@@ -12511,7 +12511,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293246412299000.5d82c0b7-7045-426a-aa72-71e0ebc6d56c"
+                  "reference": "Practitioner/1729351568551663000.03126dd2-29fc-4dd8-9333-da61102ce8c0"
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@@ -12593,18 +12593,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
-          "reference": "PractitionerRole/1729293246403913000.aa2396bd-3a3b-440d-8259-a61ca7e189b8"
+          "reference": "PractitionerRole/1729351568543057000.5c0f7ec5-d7f4-490e-904d-f0f026177c80"
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+      "fullUrl": "Organization/1729351568543253000.347ac07a-3048-4c6c-82b7-1c4d959592cf",
       "resource": {
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@@ -12619,10 +12619,10 @@
       }
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-      "fullUrl": "Practitioner/1729293246404960000.217c2c88-c25b-446d-9e0c-552b9b3d84da",
+      "fullUrl": "Practitioner/1729351568544105000.0b84abd9-4a00-4256-a905-e2e84478670b",
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         "extension": [
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@@ -12674,7 +12674,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246404113000.9ee7cd14-370c-4dec-a2da-030ae898b557"
+              "reference": "Organization/1729351568543253000.347ac07a-3048-4c6c-82b7-1c4d959592cf"
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@@ -12690,10 +12690,10 @@
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@@ -12781,23 +12781,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729293246403913000.aa2396bd-3a3b-440d-8259-a61ca7e189b8",
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+        "id": "1729351568543057000.5c0f7ec5-d7f4-490e-904d-f0f026177c80",
         "practitioner": {
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+          "reference": "Practitioner/1729351568544105000.0b84abd9-4a00-4256-a905-e2e84478670b"
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+          "reference": "Organization/1729351568545348000.8393ab06-134f-44bd-9c68-b23b8ccd1814"
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+        "id": "1729351568547357000.cc6baad1-5af6-41c2-b5ce-62e2877e5030",
         "extension": [
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@@ -12873,10 +12873,10 @@
       }
     },
     {
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         "extension": [
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@@ -12952,10 +12952,10 @@
       }
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@@ -12970,10 +12970,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568549500000.5faf4413-0fae-4282-84f6-f6d2375bb8f2",
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@@ -13021,7 +13021,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246409508000.d91487f6-175c-4974-996f-374d7720447b"
+              "reference": "Organization/1729351568548781000.e3e56118-cdf0-4ce2-997d-96bdda605e1e"
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@@ -13037,10 +13037,10 @@
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@@ -13055,10 +13055,10 @@
       }
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@@ -13106,7 +13106,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729351568550879000.ef7a771a-c918-4487-b719-90c94d355add"
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@@ -13122,10 +13122,10 @@
       }
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       "resource": {
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -13137,13 +13137,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246419775000.85847b6e-e04d-4366-872b-674b87074229"
+                  "reference": "Organization/1729351568556742000.5cf1324b-89f9-401d-939a-cf126d737c6d"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351568557509000.8fa92ad7-54b6-4049-9f32-ae57cbd78b12"
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               {
@@ -13171,7 +13171,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246421851000.6d60cb66-c14e-4a4a-9506-776c9cf4ee0b"
+                  "reference": "Practitioner/1729351568558755000.0f0eb3e3-59a6-4663-8005-c79dac5a1923"
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@@ -13299,7 +13299,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293246423873000.675d05f7-b32e-4994-930d-21d17c27b289"
+                  "reference": "Practitioner/1729351568560812000.7ef40ae1-57c3-4ff7-b465-3aaa77fabe93"
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@@ -13381,18 +13381,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
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+          "reference": "PractitionerRole/1729351568552311000.0a5a7ff1-1b8c-4b38-8043-36a5875e935d"
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@@ -13407,10 +13407,10 @@
       }
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@@ -13462,7 +13462,7 @@
             },
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             "assigner": {
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@@ -13478,10 +13478,10 @@
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@@ -13569,23 +13569,23 @@
       }
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         "practitioner": {
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+          "reference": "Practitioner/1729351568553367000.386c12a9-0d48-44f6-921a-8883f56c4ec4"
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       "resource": {
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@@ -13661,10 +13661,10 @@
       }
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@@ -13740,10 +13740,10 @@
       }
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@@ -13758,10 +13758,10 @@
       }
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@@ -13809,7 +13809,7 @@
             },
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             "assigner": {
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@@ -13825,10 +13825,10 @@
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@@ -13843,10 +13843,10 @@
       }
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       "resource": {
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         "extension": [
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@@ -13894,7 +13894,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293246423171000.84d880ae-22a4-4197-8af9-25391ff9a9cb"
+              "reference": "Organization/1729351568560060000.335dc64f-0ca5-4927-98d7-9e5b06330077"
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@@ -13910,10 +13910,10 @@
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+      "fullUrl": "ServiceRequest/1729351568570174000.6cbf2e28-cbcc-4af3-b888-a797b9036fd3",
       "resource": {
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@@ -13925,13 +13925,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246428728000.5ec1f3ef-053f-4ad1-9333-587fbf0256d7"
+                  "reference": "Organization/1729351568565688000.c5fc4615-7364-401f-bd8b-81fefc2a7a88"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351568566456000.72104291-f98b-4a63-8351-7c486c34b20b"
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@@ -13959,7 +13959,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246430819000.8b0ca58d-5bba-4691-8231-433daacebe94"
+                  "reference": "Practitioner/1729351568567698000.6982f99d-667c-40aa-8ee9-8ce152ddaf0d"
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@@ -14087,7 +14087,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729351568569709000.a63ae7ac-b159-4aa6-aab8-70ff839f0e4b"
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@@ -14169,18 +14169,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
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+          "reference": "PractitionerRole/1729351568561430000.4e468a15-9e1f-47c9-b995-787cebbafecc"
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@@ -14195,10 +14195,10 @@
       }
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         "extension": [
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@@ -14250,7 +14250,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293246424680000.5b06a04a-e6da-4b92-a69e-f9ae4f031c2b"
+              "reference": "Organization/1729351568561616000.9950ccd8-f75a-4349-b11a-05791a4f0e9c"
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@@ -14266,10 +14266,10 @@
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@@ -14357,23 +14357,23 @@
       }
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+      "fullUrl": "PractitionerRole/1729351568561430000.4e468a15-9e1f-47c9-b995-787cebbafecc",
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+          "reference": "Practitioner/1729351568562457000.0a308fae-d529-4253-81cd-8c98b3280199"
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@@ -14449,10 +14449,10 @@
       }
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         "extension": [
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@@ -14528,10 +14528,10 @@
       }
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@@ -14546,10 +14546,10 @@
       }
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     {
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+      "fullUrl": "Practitioner/1729351568567698000.6982f99d-667c-40aa-8ee9-8ce152ddaf0d",
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         "extension": [
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@@ -14597,7 +14597,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293246430100000.0f4687bb-5b31-4e2b-b1ca-8beea1319102"
+              "reference": "Organization/1729351568566994000.eb2443b5-a0d2-454d-80b1-1d52dc0e6d04"
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@@ -14613,10 +14613,10 @@
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@@ -14631,10 +14631,10 @@
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@@ -14682,7 +14682,7 @@
             },
             "value": "1174911127",
             "assigner": {
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@@ -14698,10 +14698,10 @@
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -14713,13 +14713,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246437677000.95603c47-e7f3-42d2-875e-dd8a7044c1b3"
+                  "reference": "Organization/1729351568574269000.2be432dd-c98b-4087-984e-820661b08456"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351568575011000.f69b40f3-a818-4ec4-89b3-9bc5831872a8"
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@@ -14747,7 +14747,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246439753000.e5b21e7c-a69d-461e-9558-0d47247a58f7"
+                  "reference": "Practitioner/1729351568576145000.9b5d8abb-ed30-4801-a389-1f1355563c31"
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@@ -14875,7 +14875,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293246441731000.9c708f16-17e2-4db7-a953-29f9c0a6ffaa"
+                  "reference": "Practitioner/1729351568577954000.bb0e8c65-07b5-43b3-857c-f42466503f1b"
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@@ -14957,18 +14957,18 @@
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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@@ -14983,10 +14983,10 @@
       }
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@@ -15038,7 +15038,7 @@
             },
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             "assigner": {
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@@ -15054,10 +15054,10 @@
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@@ -15145,23 +15145,23 @@
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@@ -15237,10 +15237,10 @@
       }
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       "resource": {
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         "extension": [
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@@ -15316,10 +15316,10 @@
       }
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@@ -15334,10 +15334,10 @@
       }
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@@ -15385,7 +15385,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351568575515000.97f2668f-211e-4092-8b82-171f8a6a368a"
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@@ -15401,10 +15401,10 @@
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@@ -15419,10 +15419,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568577954000.bb0e8c65-07b5-43b3-857c-f42466503f1b",
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         "extension": [
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@@ -15470,7 +15470,7 @@
             },
             "value": "1174911127",
             "assigner": {
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@@ -15486,10 +15486,10 @@
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@@ -15501,13 +15501,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246446742000.09e9959a-fc49-4312-a637-7781895551ca"
+                  "reference": "Organization/1729351568582385000.0f6f2dd8-e849-4683-9149-cfd47d19cb3b"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246447510000.4f721624-afea-490e-8bfa-33313758a0a0"
+                  "reference": "Organization/1729351568583069000.69f6d16f-b673-4064-8d46-471d1b53525b"
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@@ -15535,7 +15535,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246448848000.33beeccd-929a-483d-ae36-4e1470eedf2c"
+                  "reference": "Practitioner/1729351568584177000.371ab20d-e747-4a2c-8f10-652060ebe51e"
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@@ -15663,7 +15663,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729351568586104000.b5b0e036-97fb-4750-822d-17525d3f9695"
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@@ -15745,18 +15745,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
-          "reference": "PractitionerRole/1729293246442394000.46a1e983-4f95-4bde-b480-640966bafe98"
+          "reference": "PractitionerRole/1729351568578528000.071e1e84-cddd-4680-9ac1-8322ff83ed9b"
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@@ -15771,10 +15771,10 @@
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@@ -15826,7 +15826,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293246442615000.9a9766d3-eca5-4640-8d4f-2e9ee1e34f7a"
+              "reference": "Organization/1729351568578704000.14301d84-0c45-4854-bcc3-3074e1ad6d48"
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@@ -15842,10 +15842,10 @@
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@@ -15933,23 +15933,23 @@
       }
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+      "fullUrl": "PractitionerRole/1729351568578528000.071e1e84-cddd-4680-9ac1-8322ff83ed9b",
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         "practitioner": {
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+          "reference": "Practitioner/1729351568579467000.743b72a6-d7b4-4a27-a972-d0f86f7871b2"
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@@ -16025,10 +16025,10 @@
       }
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@@ -16104,10 +16104,10 @@
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@@ -16122,10 +16122,10 @@
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@@ -16173,7 +16173,7 @@
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             "assigner": {
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@@ -16189,10 +16189,10 @@
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-            "reference": "Specimen/1729293246319220000.f5851634-597b-40d0-862f-774dd8ade3ba"
+            "reference": "Specimen/1729351568447151000.a3445551-ed03-41d2-a5af-9c9ab76e02dd"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293246300151000.7ca0a278-a768-4a8e-9386-e59203ea6313"
+            "reference": "Observation/1729351568412788000.2dfaa62d-8323-4c7a-8b65-65e23e2c1c26"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293246468892000.8b00ef17-5538-42de-8cc5-3b60c0ede4c3",
+      "fullUrl": "DiagnosticReport/1729351568603189000.51f58a0d-5e5d-4e6e-a540-7737963bde28",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293246468892000.8b00ef17-5538-42de-8cc5-3b60c0ede4c3",
+        "id": "1729351568603189000.51f58a0d-5e5d-4e6e-a540-7737963bde28",
         "identifier": [
           {
             "extension": [
@@ -17285,7 +17285,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293246403748000.1ece385c-45db-4fd4-ac6c-a5efcee08f52"
+            "reference": "ServiceRequest/1729351568542887000.aaceff2e-97e2-4c94-bc85-e48189cf9951"
           }
         ],
         "status": "final",
@@ -17309,7 +17309,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17331,21 +17331,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293246319579000.e1a0f661-732e-41cf-af6f-1b0426d14a85"
+            "reference": "Specimen/1729351568448394000.147af0c8-68e3-44b3-a837-921dd7c14f21"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293246302223000.5364f113-9472-4aba-9bc4-e296b1f9bab1"
+            "reference": "Observation/1729351568414907000.e8cda908-8f9c-40ee-bcc0-80a3f1af4845"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293246470298000.6069a206-73c3-431d-acf4-ded8188d6217",
+      "fullUrl": "DiagnosticReport/1729351568604423000.c63b06e7-dfe0-4405-953d-416576f280e8",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293246470298000.6069a206-73c3-431d-acf4-ded8188d6217",
+        "id": "1729351568604423000.c63b06e7-dfe0-4405-953d-416576f280e8",
         "identifier": [
           {
             "extension": [
@@ -17398,7 +17398,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293246412744000.264ca2ca-369c-4380-8d15-ff7ee7c4fbbd"
+            "reference": "ServiceRequest/1729351568552141000.8d98b735-03af-4a27-9091-1683a09f072c"
           }
         ],
         "status": "final",
@@ -17422,7 +17422,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17444,21 +17444,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293246319952000.f7ac0735-4613-4b27-8f2d-bdab2737de6e"
+            "reference": "Specimen/1729351568450126000.7689206a-6229-487f-a705-c1a8483d2d7c"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293246304321000.3c306565-fa1f-4361-9d24-3315a11ef1d5"
+            "reference": "Observation/1729351568417016000.df20a62c-ee0f-41ba-8cb3-49341ab04341"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293246471762000.ff90458f-7e6e-4981-b2c1-80b2eaf49bc3",
+      "fullUrl": "DiagnosticReport/1729351568605672000.c1986286-5c00-4bf8-aa9a-973192b66992",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293246471762000.ff90458f-7e6e-4981-b2c1-80b2eaf49bc3",
+        "id": "1729351568605672000.c1986286-5c00-4bf8-aa9a-973192b66992",
         "identifier": [
           {
             "extension": [
@@ -17511,7 +17511,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293246424328000.fbe3a99b-1646-4d11-990d-b83fb860296c"
+            "reference": "ServiceRequest/1729351568561276000.8cc50e19-acc1-49e2-b4b7-f4a0a4bec448"
           }
         ],
         "status": "final",
@@ -17535,7 +17535,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17557,21 +17557,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293246320310000.ece6d6f5-8f77-4b0b-a845-8e4af2fa4011"
+            "reference": "Specimen/1729351568451749000.6cb9f417-6631-4066-9c1f-68e93ff7f3a1"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293246306359000.1639c4e9-2b76-46e8-a517-31a666ee48ea"
+            "reference": "Observation/1729351568419098000.85e71cf3-1c21-4bb2-ad66-0c23be510987"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293246473069000.6e05461f-2d84-4f47-b37a-5f2d32144e97",
+      "fullUrl": "DiagnosticReport/1729351568606920000.183c09ff-9811-47c7-916d-e1ff9f78a0e6",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293246473069000.6e05461f-2d84-4f47-b37a-5f2d32144e97",
+        "id": "1729351568606920000.183c09ff-9811-47c7-916d-e1ff9f78a0e6",
         "identifier": [
           {
             "extension": [
@@ -17624,7 +17624,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293246433274000.63160a5a-e397-4d6b-a4ac-e1c196994c3d"
+            "reference": "ServiceRequest/1729351568570174000.6cbf2e28-cbcc-4af3-b888-a797b9036fd3"
           }
         ],
         "status": "final",
@@ -17648,7 +17648,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17670,21 +17670,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293246320673000.85697ca7-b649-41cd-8e11-1d5629587351"
+            "reference": "Specimen/1729351568453218000.d6ce5869-3ddf-4fda-9b11-7457424e4a93"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293246308542000.a417d638-b6a3-425f-a5f9-aaed64edb6b9"
+            "reference": "Observation/1729351568421155000.ce5ab467-69fc-49bd-8356-69e3c7608dcf"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293246474425000.d1782e46-8a6f-4835-b81d-dc3a8f53c2cb",
+      "fullUrl": "DiagnosticReport/1729351568608189000.af7f8e9d-00dd-4ccc-9f85-5317aef7c118",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293246474425000.d1782e46-8a6f-4835-b81d-dc3a8f53c2cb",
+        "id": "1729351568608189000.af7f8e9d-00dd-4ccc-9f85-5317aef7c118",
         "identifier": [
           {
             "extension": [
@@ -17737,7 +17737,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293246442222000.9d7eda09-3c55-49ac-99d4-6bce6f1285f4"
+            "reference": "ServiceRequest/1729351568578367000.cc0c55b2-fa9c-4959-8a8f-37d1a5fd2f47"
           }
         ],
         "status": "final",
@@ -17761,7 +17761,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17783,21 +17783,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293246321055000.7bf4466c-50ff-40e1-9bd0-e6c4ce703cb7"
+            "reference": "Specimen/1729351568453748000.49da3d8f-fa55-48a5-bbc5-165635d87ba8"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293246310603000.8e46b86c-f508-4b52-b8d3-f6c552dd5d9f"
+            "reference": "Observation/1729351568423190000.a0e10baf-8c19-4eac-b43c-5e9c59843bda"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293246475799000.095f2271-b0cc-486f-9096-b778a2548966",
+      "fullUrl": "DiagnosticReport/1729351568609403000.89aa18d5-5526-4bf3-b96f-c87b50bac000",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293246475799000.095f2271-b0cc-486f-9096-b778a2548966",
+        "id": "1729351568609403000.89aa18d5-5526-4bf3-b96f-c87b50bac000",
         "identifier": [
           {
             "extension": [
@@ -17850,7 +17850,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293246451331000.70b2af01-67dc-4fc5-a976-14e5eab579d4"
+            "reference": "ServiceRequest/1729351568586517000.bdb54487-7c11-417c-9590-0798d7907ffa"
           }
         ],
         "status": "final",
@@ -17874,7 +17874,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17896,12 +17896,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293246321404000.88c5c40c-9df9-4753-96ff-835cc5064015"
+            "reference": "Specimen/1729351568454085000.d178649e-0621-4d2b-9a35-48ba834a4785"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293246312631000.f9ced165-28e1-4839-94c2-800c7f81debc"
+            "reference": "Observation/1729351568425657000.cc002eb2-7f21-4fcc-8a2e-4e255db8d98a"
           }
         ]
       }
diff --git a/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_2_fhir_transformation.fhir b/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_2_fhir_transformation.fhir
index 2533f3479..5138e6792 100644
--- a/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_2_fhir_transformation.fhir
+++ b/examples/Test/Results/002_AL_ORU_R01_NBS_Fully_Populated_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729293246229836000.a7c033db-c175-4683-8ff8-3b3e2b2e5523",
+  "id": "1729351568343493000.3b4ad6ac-1e7a-4fb6-aa0f-06dfd968545c",
   "meta": {
-    "lastUpdated": "2024-10-18T16:14:06.229-07:00"
+    "lastUpdated": "2024-10-19T08:26:08.343-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2023-06-06T17:28:49.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659",
+      "fullUrl": "MessageHeader/1729351568345776000.509f5c99-cf87-4099-be36-7115b7ef17bd",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659",
+        "id": "1729351568345776000.509f5c99-cf87-4099-be36-7115b7ef17bd",
         "meta": {
           "tag": [
             {
@@ -156,12 +156,12 @@
             "name": "BaptistOracle",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000",
             "receiver": {
-              "reference": "Organization/1729293246231738000.4579de5b-b509-4463-b5dd-b6310a8e3c0f"
+              "reference": "Organization/1729351568345265000.1bdaeaef-9431-4903-9a77-447221a4120f"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729293246230833000.cf643d8f-a03c-44bd-bb55-0e020b7d3e6b"
+          "reference": "Organization/1729351568344476000.0ad50fd5-3392-4e88-8614-72f80fdebb5d"
         },
         "source": {
           "extension": [
@@ -187,10 +187,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246230833000.cf643d8f-a03c-44bd-bb55-0e020b7d3e6b",
+      "fullUrl": "Organization/1729351568344476000.0ad50fd5-3392-4e88-8614-72f80fdebb5d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246230833000.cf643d8f-a03c-44bd-bb55-0e020b7d3e6b",
+        "id": "1729351568344476000.0ad50fd5-3392-4e88-8614-72f80fdebb5d",
         "identifier": [
           {
             "extension": [
@@ -223,10 +223,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246231738000.4579de5b-b509-4463-b5dd-b6310a8e3c0f",
+      "fullUrl": "Organization/1729351568345265000.1bdaeaef-9431-4903-9a77-447221a4120f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246231738000.4579de5b-b509-4463-b5dd-b6310a8e3c0f",
+        "id": "1729351568345265000.1bdaeaef-9431-4903-9a77-447221a4120f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -265,55 +265,55 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729293246235324000.86f10fe7-f0fd-4883-82d5-5498a77ae28d",
+      "fullUrl": "Provenance/1729351568348823000.f333529b-540a-4ccc-b4e7-281f5d370699",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729293246235324000.86f10fe7-f0fd-4883-82d5-5498a77ae28d",
+        "id": "1729351568348823000.f333529b-540a-4ccc-b4e7-281f5d370699",
         "target": [
           {
-            "reference": "MessageHeader/1729293246232171000.1c21ce17-a146-4ebc-94f6-b95b8da44659"
+            "reference": "MessageHeader/1729351568345776000.509f5c99-cf87-4099-be36-7115b7ef17bd"
           },
           {
-            "reference": "DiagnosticReport/1729293246457454000.09c90ca0-5f1f-4f6c-ad36-cfd07beedb6c"
+            "reference": "DiagnosticReport/1729351568592672000.d7036f49-4afb-458e-a631-6818732da3cb"
           },
           {
-            "reference": "DiagnosticReport/1729293246459109000.6ecb3465-632d-4990-bd5a-21a1acd59543"
+            "reference": "DiagnosticReport/1729351568594190000.e227f615-496d-4590-a184-6cb33d5c920a"
           },
           {
-            "reference": "DiagnosticReport/1729293246460494000.41d40c15-e832-4ecd-9d92-9d19ce3a3fcb"
+            "reference": "DiagnosticReport/1729351568595471000.60375a92-deda-4145-97eb-3ccb1e07ba5b"
           },
           {
-            "reference": "DiagnosticReport/1729293246461882000.e6884d68-29a3-41d4-9fce-debf070c9c1f"
+            "reference": "DiagnosticReport/1729351568596795000.7b07077c-b9a5-450f-a7b6-9ea99a6953b0"
           },
           {
-            "reference": "DiagnosticReport/1729293246463338000.a175cd81-ba65-46f0-8e6e-67303327e1fe"
+            "reference": "DiagnosticReport/1729351568598084000.8c7658e0-fe28-47dc-acd5-e771d83f8037"
           },
           {
-            "reference": "DiagnosticReport/1729293246464712000.906ec640-0671-4dca-9bc2-94edd7a0eeab"
+            "reference": "DiagnosticReport/1729351568599400000.7902d852-c476-4a5c-bb3e-095aba461459"
           },
           {
-            "reference": "DiagnosticReport/1729293246466061000.0fb8eed7-87d5-4768-ae11-ac8bea2a5b94"
+            "reference": "DiagnosticReport/1729351568600666000.872f515b-a29b-46e2-b5d5-2496d72d93a5"
           },
           {
-            "reference": "DiagnosticReport/1729293246467495000.b7c5901b-d525-4c48-9dcc-135d9a86769e"
+            "reference": "DiagnosticReport/1729351568601938000.4943b9d9-57b0-427e-84fd-32482a485b8c"
           },
           {
-            "reference": "DiagnosticReport/1729293246468892000.8b00ef17-5538-42de-8cc5-3b60c0ede4c3"
+            "reference": "DiagnosticReport/1729351568603189000.51f58a0d-5e5d-4e6e-a540-7737963bde28"
           },
           {
-            "reference": "DiagnosticReport/1729293246470298000.6069a206-73c3-431d-acf4-ded8188d6217"
+            "reference": "DiagnosticReport/1729351568604423000.c63b06e7-dfe0-4405-953d-416576f280e8"
           },
           {
-            "reference": "DiagnosticReport/1729293246471762000.ff90458f-7e6e-4981-b2c1-80b2eaf49bc3"
+            "reference": "DiagnosticReport/1729351568605672000.c1986286-5c00-4bf8-aa9a-973192b66992"
           },
           {
-            "reference": "DiagnosticReport/1729293246473069000.6e05461f-2d84-4f47-b37a-5f2d32144e97"
+            "reference": "DiagnosticReport/1729351568606920000.183c09ff-9811-47c7-916d-e1ff9f78a0e6"
           },
           {
-            "reference": "DiagnosticReport/1729293246474425000.d1782e46-8a6f-4835-b81d-dc3a8f53c2cb"
+            "reference": "DiagnosticReport/1729351568608189000.af7f8e9d-00dd-4ccc-9f85-5317aef7c118"
           },
           {
-            "reference": "DiagnosticReport/1729293246475799000.095f2271-b0cc-486f-9096-b778a2548966"
+            "reference": "DiagnosticReport/1729351568609403000.89aa18d5-5526-4bf3-b96f-c87b50bac000"
           }
         ],
         "recorded": "2023-06-06T19:28:49-05:00",
@@ -335,17 +335,17 @@
               ]
             },
             "who": {
-              "reference": "Organization/1729293246234923000.451c30f9-9a03-4f8a-98a5-03ee9e9eef61"
+              "reference": "Organization/1729351568348416000.2b876c9f-8036-4f12-ae88-a5197a1fa6fc"
             }
           }
         ]
       }
     },
     {
-      "fullUrl": "Organization/1729293246234923000.451c30f9-9a03-4f8a-98a5-03ee9e9eef61",
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@@ -378,11 +378,11 @@
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+        "id": "1729351568349554000.2fab3e01-0b9d-4a3c-aab4-82e3b5b1adb5",
+        "recorded": "2024-10-19T08:26:08Z",
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           "http://hl7.org/fhir/uv/v2mappings/message-oru-r01-to-bundle"
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@@ -404,17 +404,17 @@
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@@ -434,10 +434,10 @@
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@@ -552,7 +552,7 @@
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             "assigner": {
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@@ -702,10 +702,10 @@
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@@ -720,16 +720,16 @@
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-        "recorded": "2024-10-18T16:14:06Z",
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@@ -741,10 +741,10 @@
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@@ -800,7 +800,7 @@
           }
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         "patient": {
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@@ -890,10 +890,10 @@
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@@ -950,7 +950,7 @@
           ]
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         "subject": {
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@@ -963,7 +963,7 @@
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@@ -988,10 +988,10 @@
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@@ -1014,10 +1014,10 @@
       }
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@@ -1048,15 +1048,15 @@
       }
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-      "fullUrl": "PractitionerRole/1729293246248800000.fe6796ce-b2b0-4dfa-beb7-61fa3cc29278",
+      "fullUrl": "PractitionerRole/1729351568363159000.93272677-066c-4f28-bccb-34b293294ff2",
       "resource": {
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-        "id": "1729293246248800000.fe6796ce-b2b0-4dfa-beb7-61fa3cc29278",
+        "id": "1729351568363159000.93272677-066c-4f28-bccb-34b293294ff2",
         "practitioner": {
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+          "reference": "Practitioner/1729351568363755000.cf8340da-2bce-426d-81ef-199732833c08"
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@@ -1071,10 +1071,10 @@
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@@ -1131,7 +1131,7 @@
           ]
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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@@ -1144,7 +1144,7 @@
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@@ -1169,10 +1169,10 @@
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+      "fullUrl": "Practitioner/1729351568367591000.754be278-9e00-4c53-b25c-1f7f699010db",
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+        "id": "1729351568367591000.754be278-9e00-4c53-b25c-1f7f699010db",
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@@ -1195,10 +1195,10 @@
       }
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+      "fullUrl": "Organization/1729351568368283000.5b9da7fe-18b6-473a-88b0-658927f5380f",
       "resource": {
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-        "id": "1729293246253723000.b821e0cd-17f9-4d08-ac76-01f5083dbdc2",
+        "id": "1729351568368283000.5b9da7fe-18b6-473a-88b0-658927f5380f",
         "name": "AL PHL Newborn Screening Laboratory",
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@@ -1229,15 +1229,15 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729293246252482000.57ffbe80-13a5-4467-a757-afa4f0de8ef5",
+      "fullUrl": "PractitionerRole/1729351568367051000.6ce46521-e241-4b48-aea3-c64a2b3f1238",
       "resource": {
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-        "id": "1729293246252482000.57ffbe80-13a5-4467-a757-afa4f0de8ef5",
+        "id": "1729351568367051000.6ce46521-e241-4b48-aea3-c64a2b3f1238",
         "practitioner": {
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+          "reference": "Practitioner/1729351568367591000.754be278-9e00-4c53-b25c-1f7f699010db"
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         "organization": {
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+          "reference": "Organization/1729351568368283000.5b9da7fe-18b6-473a-88b0-658927f5380f"
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@@ -1252,10 +1252,10 @@
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-      "fullUrl": "Observation/1729293246255468000.b12a988b-a136-44a0-a679-2402f2d3b1d9",
+      "fullUrl": "Observation/1729351568370193000.a79dd463-abd5-43f9-8c78-062ae6f3b690",
       "resource": {
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+        "id": "1729351568370193000.a79dd463-abd5-43f9-8c78-062ae6f3b690",
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@@ -1312,7 +1312,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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@@ -1325,17 +1325,17 @@
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-            "reference": "PractitionerRole/1729293246255645000.6dbe171a-9812-4646-baf7-fe2f84a4e0ca"
+            "reference": "PractitionerRole/1729351568370368000.9aed3d38-7d94-48b1-a966-ff6728d5c4b2"
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     {
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+      "fullUrl": "Practitioner/1729351568370835000.44d7fd6a-b12c-470a-8c34-f43f2bd90b11",
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+        "id": "1729351568370835000.44d7fd6a-b12c-470a-8c34-f43f2bd90b11",
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@@ -1358,10 +1358,10 @@
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+      "fullUrl": "Organization/1729351568371442000.2138686f-ae46-46c4-b6d8-c8787700f6a5",
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+        "id": "1729351568371442000.2138686f-ae46-46c4-b6d8-c8787700f6a5",
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@@ -1392,15 +1392,15 @@
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-      "fullUrl": "PractitionerRole/1729293246255645000.6dbe171a-9812-4646-baf7-fe2f84a4e0ca",
+      "fullUrl": "PractitionerRole/1729351568370368000.9aed3d38-7d94-48b1-a966-ff6728d5c4b2",
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-        "id": "1729293246255645000.6dbe171a-9812-4646-baf7-fe2f84a4e0ca",
+        "id": "1729351568370368000.9aed3d38-7d94-48b1-a966-ff6728d5c4b2",
         "practitioner": {
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+          "reference": "Practitioner/1729351568370835000.44d7fd6a-b12c-470a-8c34-f43f2bd90b11"
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-          "reference": "Organization/1729293246256693000.12004ca1-b805-4fbd-a80c-0b6ad4289077"
+          "reference": "Organization/1729351568371442000.2138686f-ae46-46c4-b6d8-c8787700f6a5"
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@@ -1415,10 +1415,10 @@
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@@ -1475,7 +1475,7 @@
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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@@ -1488,7 +1488,7 @@
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-            "reference": "PractitionerRole/1729293246260052000.93edb951-0d9a-40f1-81b7-cbbaf0344f25"
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@@ -1513,10 +1513,10 @@
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@@ -1539,10 +1539,10 @@
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@@ -1573,15 +1573,15 @@
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@@ -1596,10 +1596,10 @@
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@@ -1656,7 +1656,7 @@
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@@ -1669,7 +1669,7 @@
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@@ -1694,10 +1694,10 @@
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@@ -1720,10 +1720,10 @@
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@@ -1754,15 +1754,15 @@
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@@ -1777,10 +1777,10 @@
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@@ -1837,7 +1837,7 @@
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@@ -1850,7 +1850,7 @@
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@@ -1875,10 +1875,10 @@
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@@ -1901,10 +1901,10 @@
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@@ -1935,15 +1935,15 @@
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@@ -1958,10 +1958,10 @@
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@@ -2018,7 +2018,7 @@
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@@ -2031,7 +2031,7 @@
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@@ -2056,10 +2056,10 @@
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@@ -2082,10 +2082,10 @@
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@@ -2116,15 +2116,15 @@
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@@ -2139,10 +2139,10 @@
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@@ -2199,7 +2199,7 @@
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@@ -2212,7 +2212,7 @@
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@@ -2237,10 +2237,10 @@
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@@ -2263,10 +2263,10 @@
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@@ -2297,15 +2297,15 @@
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+      "fullUrl": "PractitionerRole/1729351568385336000.479cb82f-fc45-40fd-b079-3f3ea81b2bcd",
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@@ -2320,10 +2320,10 @@
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@@ -2416,7 +2416,7 @@
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@@ -2429,16 +2429,16 @@
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@@ -2461,10 +2461,10 @@
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@@ -2495,15 +2495,15 @@
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@@ -2518,10 +2518,10 @@
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@@ -2946,10 +2946,10 @@
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@@ -2986,7 +2986,7 @@
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@@ -3041,7 +3041,7 @@
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@@ -3095,7 +3095,7 @@
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@@ -3110,10 +3110,10 @@
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@@ -3170,7 +3170,7 @@
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@@ -3183,7 +3183,7 @@
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@@ -3234,10 +3234,10 @@
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@@ -3268,15 +3268,15 @@
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@@ -3351,7 +3351,7 @@
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@@ -3364,7 +3364,7 @@
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@@ -3389,10 +3389,10 @@
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@@ -3415,10 +3415,10 @@
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@@ -3449,15 +3449,15 @@
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@@ -3472,10 +3472,10 @@
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@@ -3532,7 +3532,7 @@
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@@ -3545,7 +3545,7 @@
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@@ -3570,10 +3570,10 @@
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@@ -3596,10 +3596,10 @@
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@@ -3630,15 +3630,15 @@
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@@ -3653,10 +3653,10 @@
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@@ -3713,7 +3713,7 @@
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@@ -3726,7 +3726,7 @@
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@@ -3751,10 +3751,10 @@
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@@ -3777,10 +3777,10 @@
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@@ -3811,15 +3811,15 @@
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@@ -3834,10 +3834,10 @@
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@@ -3894,7 +3894,7 @@
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@@ -3907,7 +3907,7 @@
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@@ -3932,10 +3932,10 @@
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@@ -3958,10 +3958,10 @@
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@@ -3992,15 +3992,15 @@
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@@ -4015,10 +4015,10 @@
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@@ -4075,7 +4075,7 @@
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@@ -4088,7 +4088,7 @@
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@@ -4113,10 +4113,10 @@
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@@ -4139,10 +4139,10 @@
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@@ -4173,15 +4173,15 @@
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@@ -4196,10 +4196,10 @@
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@@ -4256,7 +4256,7 @@
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@@ -4269,7 +4269,7 @@
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@@ -4294,10 +4294,10 @@
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@@ -4320,10 +4320,10 @@
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@@ -4354,15 +4354,15 @@
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@@ -4377,10 +4377,10 @@
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@@ -4437,7 +4437,7 @@
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@@ -4450,7 +4450,7 @@
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@@ -4475,10 +4475,10 @@
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@@ -4501,10 +4501,10 @@
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@@ -4535,15 +4535,15 @@
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@@ -4558,10 +4558,10 @@
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@@ -4618,7 +4618,7 @@
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@@ -4631,7 +4631,7 @@
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@@ -4656,10 +4656,10 @@
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@@ -4682,10 +4682,10 @@
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@@ -4716,15 +4716,15 @@
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@@ -4739,10 +4739,10 @@
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@@ -4799,7 +4799,7 @@
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@@ -4812,7 +4812,7 @@
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@@ -4837,10 +4837,10 @@
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@@ -4863,10 +4863,10 @@
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@@ -4897,15 +4897,15 @@
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@@ -4920,10 +4920,10 @@
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@@ -4980,7 +4980,7 @@
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@@ -4993,7 +4993,7 @@
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@@ -5018,10 +5018,10 @@
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@@ -5044,10 +5044,10 @@
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@@ -5078,15 +5078,15 @@
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+          "reference": "Organization/1729351568423958000.56f5b728-7c18-4d12-85e1-d491e41f2269"
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@@ -5101,10 +5101,10 @@
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@@ -5161,7 +5161,7 @@
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@@ -5174,7 +5174,7 @@
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@@ -5199,10 +5199,10 @@
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@@ -5225,10 +5225,10 @@
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@@ -5259,15 +5259,15 @@
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@@ -5282,10 +5282,10 @@
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@@ -5295,10 +5295,10 @@
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@@ -5308,10 +5308,10 @@
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@@ -5321,10 +5321,10 @@
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@@ -5334,10 +5334,10 @@
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@@ -5347,10 +5347,10 @@
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@@ -5360,10 +5360,10 @@
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@@ -5373,10 +5373,10 @@
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@@ -5386,10 +5386,10 @@
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@@ -5399,10 +5399,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293246319952000.f7ac0735-4613-4b27-8f2d-bdab2737de6e",
+      "fullUrl": "Specimen/1729351568450126000.7689206a-6229-487f-a705-c1a8483d2d7c",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293246319952000.f7ac0735-4613-4b27-8f2d-bdab2737de6e",
+        "id": "1729351568450126000.7689206a-6229-487f-a705-c1a8483d2d7c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5412,10 +5412,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293246320310000.ece6d6f5-8f77-4b0b-a845-8e4af2fa4011",
+      "fullUrl": "Specimen/1729351568451749000.6cb9f417-6631-4066-9c1f-68e93ff7f3a1",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293246320310000.ece6d6f5-8f77-4b0b-a845-8e4af2fa4011",
+        "id": "1729351568451749000.6cb9f417-6631-4066-9c1f-68e93ff7f3a1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5425,10 +5425,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293246320673000.85697ca7-b649-41cd-8e11-1d5629587351",
+      "fullUrl": "Specimen/1729351568453218000.d6ce5869-3ddf-4fda-9b11-7457424e4a93",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293246320673000.85697ca7-b649-41cd-8e11-1d5629587351",
+        "id": "1729351568453218000.d6ce5869-3ddf-4fda-9b11-7457424e4a93",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5438,10 +5438,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293246321055000.7bf4466c-50ff-40e1-9bd0-e6c4ce703cb7",
+      "fullUrl": "Specimen/1729351568453748000.49da3d8f-fa55-48a5-bbc5-165635d87ba8",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293246321055000.7bf4466c-50ff-40e1-9bd0-e6c4ce703cb7",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5451,10 +5451,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293246321404000.88c5c40c-9df9-4753-96ff-835cc5064015",
+      "fullUrl": "Specimen/1729351568454085000.d178649e-0621-4d2b-9a35-48ba834a4785",
       "resource": {
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-        "id": "1729293246321404000.88c5c40c-9df9-4753-96ff-835cc5064015",
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5464,10 +5464,10 @@
       }
     },
     {
-      "fullUrl": "Specimen/1729293246323590000.de842854-1a85-4031-a6e7-bd3e89156a4d",
+      "fullUrl": "Specimen/1729351568456364000.2b5bad34-855c-4dc0-97ea-f0a053932633",
       "resource": {
         "resourceType": "Specimen",
-        "id": "1729293246323590000.de842854-1a85-4031-a6e7-bd3e89156a4d",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5629,10 +5629,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293246332779000.a93e178a-ac40-4f9e-8590-da1359dc0b51",
+      "fullUrl": "ServiceRequest/1729351568465656000.7476c3e6-89bc-442e-bdb5-c10793c216a1",
       "resource": {
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-        "id": "1729293246332779000.a93e178a-ac40-4f9e-8590-da1359dc0b51",
+        "id": "1729351568465656000.7476c3e6-89bc-442e-bdb5-c10793c216a1",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -5644,13 +5644,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246328162000.81ac06b5-7765-49e7-908d-dd08454ae63e"
+                  "reference": "Organization/1729351568461004000.964e2103-97cf-4a57-8947-f3b1b0305845"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246328968000.effa6adb-5933-4051-92f0-094bae647577"
+                  "reference": "Organization/1729351568461801000.a0f4fba3-68d5-49a5-b3d7-2fd83ae8e438"
                 }
               },
               {
@@ -5678,7 +5678,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246330222000.0dd52bef-81a4-4096-b295-f45e52a31f79"
+                  "reference": "Practitioner/1729351568463112000.86141ac5-925c-49a8-9f34-80f9efd61132"
                 }
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@@ -5806,7 +5806,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246332299000.556ed77c-83b1-43ae-9922-0886b0fe5c1a"
+                  "reference": "Practitioner/1729351568465177000.ebc684e0-b2ff-411e-97f1-0b879cb456cf"
                 }
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@@ -5888,18 +5888,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246323914000.dcea7a31-7d2e-4107-9b79-141d4def4cc4"
+          "reference": "PractitionerRole/1729351568456702000.7109dff6-ca30-484a-bd08-4b053f32474a"
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       }
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     {
-      "fullUrl": "Organization/1729293246324112000.e1240bb1-26f5-4ba4-84ec-1f9d6619fcc2",
+      "fullUrl": "Organization/1729351568456903000.d846f46c-7f7c-4b14-bd2f-39d93d639e8d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246324112000.e1240bb1-26f5-4ba4-84ec-1f9d6619fcc2",
+        "id": "1729351568456903000.d846f46c-7f7c-4b14-bd2f-39d93d639e8d",
         "identifier": [
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@@ -5914,10 +5914,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293246324949000.d72b1c7d-7257-42da-b956-2e0e2eb073f5",
+      "fullUrl": "Practitioner/1729351568457767000.edcafe5f-7a51-4c68-95ea-2e94b77091b2",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246324949000.d72b1c7d-7257-42da-b956-2e0e2eb073f5",
+        "id": "1729351568457767000.edcafe5f-7a51-4c68-95ea-2e94b77091b2",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -5969,7 +5969,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246324112000.e1240bb1-26f5-4ba4-84ec-1f9d6619fcc2"
+              "reference": "Organization/1729351568456903000.d846f46c-7f7c-4b14-bd2f-39d93d639e8d"
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@@ -5985,10 +5985,10 @@
       }
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-      "fullUrl": "Organization/1729293246326193000.dd7cb951-13b1-4165-9566-82220431ecf9",
+      "fullUrl": "Organization/1729351568459003000.76de488a-ae8d-43c4-9caf-3faa56a125fa",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246326193000.dd7cb951-13b1-4165-9566-82220431ecf9",
+        "id": "1729351568459003000.76de488a-ae8d-43c4-9caf-3faa56a125fa",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -6076,23 +6076,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246323914000.dcea7a31-7d2e-4107-9b79-141d4def4cc4",
+      "fullUrl": "PractitionerRole/1729351568456702000.7109dff6-ca30-484a-bd08-4b053f32474a",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246323914000.dcea7a31-7d2e-4107-9b79-141d4def4cc4",
+        "id": "1729351568456702000.7109dff6-ca30-484a-bd08-4b053f32474a",
         "practitioner": {
-          "reference": "Practitioner/1729293246324949000.d72b1c7d-7257-42da-b956-2e0e2eb073f5"
+          "reference": "Practitioner/1729351568457767000.edcafe5f-7a51-4c68-95ea-2e94b77091b2"
         },
         "organization": {
-          "reference": "Organization/1729293246326193000.dd7cb951-13b1-4165-9566-82220431ecf9"
+          "reference": "Organization/1729351568459003000.76de488a-ae8d-43c4-9caf-3faa56a125fa"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729293246328162000.81ac06b5-7765-49e7-908d-dd08454ae63e",
+      "fullUrl": "Organization/1729351568461004000.964e2103-97cf-4a57-8947-f3b1b0305845",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246328162000.81ac06b5-7765-49e7-908d-dd08454ae63e",
+        "id": "1729351568461004000.964e2103-97cf-4a57-8947-f3b1b0305845",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -6168,10 +6168,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246328968000.effa6adb-5933-4051-92f0-094bae647577",
+      "fullUrl": "Organization/1729351568461801000.a0f4fba3-68d5-49a5-b3d7-2fd83ae8e438",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246328968000.effa6adb-5933-4051-92f0-094bae647577",
+        "id": "1729351568461801000.a0f4fba3-68d5-49a5-b3d7-2fd83ae8e438",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -6247,10 +6247,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246329515000.f1848f41-5043-4589-9f2f-d92d564f9592",
+      "fullUrl": "Organization/1729351568462347000.b2beb90b-0b4e-437b-ab5b-0891e6d014c8",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246329515000.f1848f41-5043-4589-9f2f-d92d564f9592",
+        "id": "1729351568462347000.b2beb90b-0b4e-437b-ab5b-0891e6d014c8",
         "identifier": [
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@@ -6265,10 +6265,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246330222000.0dd52bef-81a4-4096-b295-f45e52a31f79",
+      "fullUrl": "Practitioner/1729351568463112000.86141ac5-925c-49a8-9f34-80f9efd61132",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246330222000.0dd52bef-81a4-4096-b295-f45e52a31f79",
+        "id": "1729351568463112000.86141ac5-925c-49a8-9f34-80f9efd61132",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6316,7 +6316,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246329515000.f1848f41-5043-4589-9f2f-d92d564f9592"
+              "reference": "Organization/1729351568462347000.b2beb90b-0b4e-437b-ab5b-0891e6d014c8"
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@@ -6332,10 +6332,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293246331572000.7c5ac254-6650-4692-8f54-8c5261064ffb",
+      "fullUrl": "Organization/1729351568464461000.32e12de2-2806-4e05-90ea-b4aadb6b347f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246331572000.7c5ac254-6650-4692-8f54-8c5261064ffb",
+        "id": "1729351568464461000.32e12de2-2806-4e05-90ea-b4aadb6b347f",
         "identifier": [
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@@ -6350,10 +6350,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246332299000.556ed77c-83b1-43ae-9922-0886b0fe5c1a",
+      "fullUrl": "Practitioner/1729351568465177000.ebc684e0-b2ff-411e-97f1-0b879cb456cf",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246332299000.556ed77c-83b1-43ae-9922-0886b0fe5c1a",
+        "id": "1729351568465177000.ebc684e0-b2ff-411e-97f1-0b879cb456cf",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6401,7 +6401,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246331572000.7c5ac254-6650-4692-8f54-8c5261064ffb"
+              "reference": "Organization/1729351568464461000.32e12de2-2806-4e05-90ea-b4aadb6b347f"
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@@ -6417,10 +6417,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293246337735000.ff20df51-ba4c-4efa-a0c9-56e95543caba",
+      "fullUrl": "ServiceRequest/1729351568470672000.0b738a38-1e22-4bea-aa9c-ce7ffa1319c3",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293246337735000.ff20df51-ba4c-4efa-a0c9-56e95543caba",
+        "id": "1729351568470672000.0b738a38-1e22-4bea-aa9c-ce7ffa1319c3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -6559,7 +6559,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246337273000.84a6369a-5ba0-47ad-97db-4da4bd87bb34"
+                  "reference": "Practitioner/1729351568470214000.114f256d-994d-4311-b9b2-8d780c52da02"
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@@ -6641,18 +6641,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "Practitioner/1729293246333875000.baaed4f2-296f-4247-ab5a-d93ac12c5051"
+          "reference": "Practitioner/1729351568466786000.8ed42bf9-ffab-40bf-8443-783e4ec58389"
         }
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     {
-      "fullUrl": "Organization/1729293246333017000.ae5c1cad-6cf0-4ed3-85e5-d6208190e4aa",
+      "fullUrl": "Organization/1729351568465894000.65452ffe-52a5-40fa-8172-22e7b08e8ca1",
       "resource": {
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-        "id": "1729293246333017000.ae5c1cad-6cf0-4ed3-85e5-d6208190e4aa",
+        "id": "1729351568465894000.65452ffe-52a5-40fa-8172-22e7b08e8ca1",
         "identifier": [
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@@ -6667,10 +6667,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246333875000.baaed4f2-296f-4247-ab5a-d93ac12c5051",
+      "fullUrl": "Practitioner/1729351568466786000.8ed42bf9-ffab-40bf-8443-783e4ec58389",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246333875000.baaed4f2-296f-4247-ab5a-d93ac12c5051",
+        "id": "1729351568466786000.8ed42bf9-ffab-40bf-8443-783e4ec58389",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6722,7 +6722,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246333017000.ae5c1cad-6cf0-4ed3-85e5-d6208190e4aa"
+              "reference": "Organization/1729351568465894000.65452ffe-52a5-40fa-8172-22e7b08e8ca1"
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@@ -6738,10 +6738,10 @@
       }
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-      "fullUrl": "Organization/1729293246336567000.8a8a407c-85f0-43a5-943f-7387226ac845",
+      "fullUrl": "Organization/1729351568469494000.f32c91fe-af53-465d-9b19-47f01d4a6c5b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246336567000.8a8a407c-85f0-43a5-943f-7387226ac845",
+        "id": "1729351568469494000.f32c91fe-af53-465d-9b19-47f01d4a6c5b",
         "identifier": [
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@@ -6756,10 +6756,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246337273000.84a6369a-5ba0-47ad-97db-4da4bd87bb34",
+      "fullUrl": "Practitioner/1729351568470214000.114f256d-994d-4311-b9b2-8d780c52da02",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246337273000.84a6369a-5ba0-47ad-97db-4da4bd87bb34",
+        "id": "1729351568470214000.114f256d-994d-4311-b9b2-8d780c52da02",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6807,7 +6807,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246336567000.8a8a407c-85f0-43a5-943f-7387226ac845"
+              "reference": "Organization/1729351568469494000.f32c91fe-af53-465d-9b19-47f01d4a6c5b"
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@@ -6823,10 +6823,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293246346814000.e03ec64a-96d7-40fc-b863-7fa3459bb5fd",
+      "fullUrl": "ServiceRequest/1729351568479703000.bbab943a-ad44-4765-9976-8099434e6d7b",
       "resource": {
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-        "id": "1729293246346814000.e03ec64a-96d7-40fc-b863-7fa3459bb5fd",
+        "id": "1729351568479703000.bbab943a-ad44-4765-9976-8099434e6d7b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -6838,13 +6838,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246342264000.8d9baffb-47ce-4415-b131-997c18e94757"
+                  "reference": "Organization/1729351568475160000.43332785-3c0a-4623-9a0f-51b867e01d5b"
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               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246343028000.0e509c4c-af20-4ce8-8eb7-bcc74e73a17d"
+                  "reference": "Organization/1729351568475949000.2a56423b-1149-4496-824a-d1f162974dec"
                 }
               },
               {
@@ -6872,7 +6872,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246344245000.9a53d8e3-89ed-4f9c-9bd6-b38c3dd7ef17"
+                  "reference": "Practitioner/1729351568477165000.5a3aa70f-6288-45d9-a3b0-f62d29ce12f1"
                 }
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@@ -7000,7 +7000,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246346347000.e0810bfa-d4b9-47f2-a5c9-1001e47a7b57"
+                  "reference": "Practitioner/1729351568479245000.df0f3f2c-3418-4597-a511-f6ddcb16d093"
                 }
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@@ -7082,18 +7082,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246337903000.40fb8126-47c2-43cd-a088-7dfdc3c7eb46"
+          "reference": "PractitionerRole/1729351568470839000.7b74e7be-fc5f-4a20-adfc-bc1cfb1f1ebb"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729293246338114000.51123485-6f49-436d-8979-d7cd5edf4539",
+      "fullUrl": "Organization/1729351568471032000.955db1e2-4adf-4665-866f-de77d33b7df3",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246338114000.51123485-6f49-436d-8979-d7cd5edf4539",
+        "id": "1729351568471032000.955db1e2-4adf-4665-866f-de77d33b7df3",
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@@ -7108,10 +7108,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293246339017000.d3fcc9a6-70a6-4d5a-8dea-4ab6e5745fed",
+      "fullUrl": "Practitioner/1729351568471877000.9c2523a9-4f29-4b46-ac2e-fb877b45c890",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246339017000.d3fcc9a6-70a6-4d5a-8dea-4ab6e5745fed",
+        "id": "1729351568471877000.9c2523a9-4f29-4b46-ac2e-fb877b45c890",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7163,7 +7163,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246338114000.51123485-6f49-436d-8979-d7cd5edf4539"
+              "reference": "Organization/1729351568471032000.955db1e2-4adf-4665-866f-de77d33b7df3"
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@@ -7179,10 +7179,10 @@
       }
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-      "fullUrl": "Organization/1729293246340229000.4473ae24-31bf-48bc-b56a-4699b2870d86",
+      "fullUrl": "Organization/1729351568473145000.93651296-1517-49bf-a631-9cc814af1cbb",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246340229000.4473ae24-31bf-48bc-b56a-4699b2870d86",
+        "id": "1729351568473145000.93651296-1517-49bf-a631-9cc814af1cbb",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7270,23 +7270,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246337903000.40fb8126-47c2-43cd-a088-7dfdc3c7eb46",
+      "fullUrl": "PractitionerRole/1729351568470839000.7b74e7be-fc5f-4a20-adfc-bc1cfb1f1ebb",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246337903000.40fb8126-47c2-43cd-a088-7dfdc3c7eb46",
+        "id": "1729351568470839000.7b74e7be-fc5f-4a20-adfc-bc1cfb1f1ebb",
         "practitioner": {
-          "reference": "Practitioner/1729293246339017000.d3fcc9a6-70a6-4d5a-8dea-4ab6e5745fed"
+          "reference": "Practitioner/1729351568471877000.9c2523a9-4f29-4b46-ac2e-fb877b45c890"
         },
         "organization": {
-          "reference": "Organization/1729293246340229000.4473ae24-31bf-48bc-b56a-4699b2870d86"
+          "reference": "Organization/1729351568473145000.93651296-1517-49bf-a631-9cc814af1cbb"
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     {
-      "fullUrl": "Organization/1729293246342264000.8d9baffb-47ce-4415-b131-997c18e94757",
+      "fullUrl": "Organization/1729351568475160000.43332785-3c0a-4623-9a0f-51b867e01d5b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246342264000.8d9baffb-47ce-4415-b131-997c18e94757",
+        "id": "1729351568475160000.43332785-3c0a-4623-9a0f-51b867e01d5b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7362,10 +7362,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246343028000.0e509c4c-af20-4ce8-8eb7-bcc74e73a17d",
+      "fullUrl": "Organization/1729351568475949000.2a56423b-1149-4496-824a-d1f162974dec",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246343028000.0e509c4c-af20-4ce8-8eb7-bcc74e73a17d",
+        "id": "1729351568475949000.2a56423b-1149-4496-824a-d1f162974dec",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7441,10 +7441,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246343535000.f7f285b2-9ffa-4e8e-b02d-a197883661d4",
+      "fullUrl": "Organization/1729351568476462000.fec20681-820a-4294-918a-e4e18f5e19ef",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246343535000.f7f285b2-9ffa-4e8e-b02d-a197883661d4",
+        "id": "1729351568476462000.fec20681-820a-4294-918a-e4e18f5e19ef",
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@@ -7459,10 +7459,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293246344245000.9a53d8e3-89ed-4f9c-9bd6-b38c3dd7ef17",
+      "fullUrl": "Practitioner/1729351568477165000.5a3aa70f-6288-45d9-a3b0-f62d29ce12f1",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246344245000.9a53d8e3-89ed-4f9c-9bd6-b38c3dd7ef17",
+        "id": "1729351568477165000.5a3aa70f-6288-45d9-a3b0-f62d29ce12f1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7510,7 +7510,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246343535000.f7f285b2-9ffa-4e8e-b02d-a197883661d4"
+              "reference": "Organization/1729351568476462000.fec20681-820a-4294-918a-e4e18f5e19ef"
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@@ -7526,10 +7526,10 @@
       }
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-      "fullUrl": "Organization/1729293246345615000.b2d2f8f7-ee9e-4078-aef0-c28dcff6d530",
+      "fullUrl": "Organization/1729351568478501000.844add22-6c6a-4c95-a3ad-079cec484d29",
       "resource": {
         "resourceType": "Organization",
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+        "id": "1729351568478501000.844add22-6c6a-4c95-a3ad-079cec484d29",
         "identifier": [
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@@ -7544,10 +7544,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293246346347000.e0810bfa-d4b9-47f2-a5c9-1001e47a7b57",
+      "fullUrl": "Practitioner/1729351568479245000.df0f3f2c-3418-4597-a511-f6ddcb16d093",
       "resource": {
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-        "id": "1729293246346347000.e0810bfa-d4b9-47f2-a5c9-1001e47a7b57",
+        "id": "1729351568479245000.df0f3f2c-3418-4597-a511-f6ddcb16d093",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7595,7 +7595,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246345615000.b2d2f8f7-ee9e-4078-aef0-c28dcff6d530"
+              "reference": "Organization/1729351568478501000.844add22-6c6a-4c95-a3ad-079cec484d29"
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@@ -7611,10 +7611,10 @@
       }
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     {
-      "fullUrl": "ServiceRequest/1729293246358769000.150c6edf-bb7b-4220-8dbe-a45cb8139013",
+      "fullUrl": "ServiceRequest/1729351568488784000.0262fad0-fa53-42d1-bc39-e8ed777fdf79",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293246358769000.150c6edf-bb7b-4220-8dbe-a45cb8139013",
+        "id": "1729351568488784000.0262fad0-fa53-42d1-bc39-e8ed777fdf79",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -7626,13 +7626,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246354193000.410afc88-9099-4411-8320-8379b77e5cd2"
+                  "reference": "Organization/1729351568484145000.b60969c5-e803-4acc-84c8-4ceee427f2ee"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246354992000.7a654b80-b123-47ed-8610-e048d23ba53d"
+                  "reference": "Organization/1729351568484956000.7a11f44e-5cf3-4e9b-9be5-11a4e085ca19"
                 }
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               {
@@ -7660,7 +7660,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246356258000.d2a34d18-7769-44a8-b466-aaa6fa79e686"
+                  "reference": "Practitioner/1729351568486200000.4f3d14a7-3b0c-4ffb-a400-262cd735e8b3"
                 }
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@@ -7788,7 +7788,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246358304000.6e4a02f3-a39c-46a4-b87b-e0cfd16f5658"
+                  "reference": "Practitioner/1729351568488297000.f05893d3-799e-44a9-a3e0-113d757ae305"
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@@ -7870,18 +7870,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246346970000.c5bf7794-ce10-4db7-ab70-027c1b084959"
+          "reference": "PractitionerRole/1729351568479863000.daf76a75-3a32-45de-960c-c8834b1c53c8"
         }
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     },
     {
-      "fullUrl": "Organization/1729293246347161000.9e3cdbf8-b1de-436f-93ac-e5aa553ec0a4",
+      "fullUrl": "Organization/1729351568480055000.e77f04e3-7239-4b19-946f-000c397af6c3",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246347161000.9e3cdbf8-b1de-436f-93ac-e5aa553ec0a4",
+        "id": "1729351568480055000.e77f04e3-7239-4b19-946f-000c397af6c3",
         "identifier": [
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@@ -7896,10 +7896,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246348003000.b1450ebe-63d0-47c9-beac-04b990639829",
+      "fullUrl": "Practitioner/1729351568480932000.e78a1e91-80a0-4bd8-9fa0-ee4eeebeadf3",
       "resource": {
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-        "id": "1729293246348003000.b1450ebe-63d0-47c9-beac-04b990639829",
+        "id": "1729351568480932000.e78a1e91-80a0-4bd8-9fa0-ee4eeebeadf3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7951,7 +7951,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246347161000.9e3cdbf8-b1de-436f-93ac-e5aa553ec0a4"
+              "reference": "Organization/1729351568480055000.e77f04e3-7239-4b19-946f-000c397af6c3"
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@@ -7967,10 +7967,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293246352100000.903f5702-5344-46e6-a4f3-96d741671e4b",
+      "fullUrl": "Organization/1729351568482159000.1f0044da-72b2-4d77-9f4a-efd90f6cd16d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246352100000.903f5702-5344-46e6-a4f3-96d741671e4b",
+        "id": "1729351568482159000.1f0044da-72b2-4d77-9f4a-efd90f6cd16d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8058,23 +8058,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246346970000.c5bf7794-ce10-4db7-ab70-027c1b084959",
+      "fullUrl": "PractitionerRole/1729351568479863000.daf76a75-3a32-45de-960c-c8834b1c53c8",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246346970000.c5bf7794-ce10-4db7-ab70-027c1b084959",
+        "id": "1729351568479863000.daf76a75-3a32-45de-960c-c8834b1c53c8",
         "practitioner": {
-          "reference": "Practitioner/1729293246348003000.b1450ebe-63d0-47c9-beac-04b990639829"
+          "reference": "Practitioner/1729351568480932000.e78a1e91-80a0-4bd8-9fa0-ee4eeebeadf3"
         },
         "organization": {
-          "reference": "Organization/1729293246352100000.903f5702-5344-46e6-a4f3-96d741671e4b"
+          "reference": "Organization/1729351568482159000.1f0044da-72b2-4d77-9f4a-efd90f6cd16d"
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       }
     },
     {
-      "fullUrl": "Organization/1729293246354193000.410afc88-9099-4411-8320-8379b77e5cd2",
+      "fullUrl": "Organization/1729351568484145000.b60969c5-e803-4acc-84c8-4ceee427f2ee",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246354193000.410afc88-9099-4411-8320-8379b77e5cd2",
+        "id": "1729351568484145000.b60969c5-e803-4acc-84c8-4ceee427f2ee",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8150,10 +8150,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246354992000.7a654b80-b123-47ed-8610-e048d23ba53d",
+      "fullUrl": "Organization/1729351568484956000.7a11f44e-5cf3-4e9b-9be5-11a4e085ca19",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246354992000.7a654b80-b123-47ed-8610-e048d23ba53d",
+        "id": "1729351568484956000.7a11f44e-5cf3-4e9b-9be5-11a4e085ca19",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8229,10 +8229,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246355525000.9e6132de-2d49-4b84-a824-a1b5924d2496",
+      "fullUrl": "Organization/1729351568485477000.20244a2b-d8fa-4b6b-b17f-41645e17a595",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246355525000.9e6132de-2d49-4b84-a824-a1b5924d2496",
+        "id": "1729351568485477000.20244a2b-d8fa-4b6b-b17f-41645e17a595",
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@@ -8247,10 +8247,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246356258000.d2a34d18-7769-44a8-b466-aaa6fa79e686",
+      "fullUrl": "Practitioner/1729351568486200000.4f3d14a7-3b0c-4ffb-a400-262cd735e8b3",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246356258000.d2a34d18-7769-44a8-b466-aaa6fa79e686",
+        "id": "1729351568486200000.4f3d14a7-3b0c-4ffb-a400-262cd735e8b3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8298,7 +8298,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246355525000.9e6132de-2d49-4b84-a824-a1b5924d2496"
+              "reference": "Organization/1729351568485477000.20244a2b-d8fa-4b6b-b17f-41645e17a595"
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@@ -8314,10 +8314,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293246357603000.daf55445-3e3c-48ab-86e6-a116e205367f",
+      "fullUrl": "Organization/1729351568487543000.68374678-0cba-4682-bf34-1c56c39fe075",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246357603000.daf55445-3e3c-48ab-86e6-a116e205367f",
+        "id": "1729351568487543000.68374678-0cba-4682-bf34-1c56c39fe075",
         "identifier": [
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@@ -8332,10 +8332,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293246358304000.6e4a02f3-a39c-46a4-b87b-e0cfd16f5658",
+      "fullUrl": "Practitioner/1729351568488297000.f05893d3-799e-44a9-a3e0-113d757ae305",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246358304000.6e4a02f3-a39c-46a4-b87b-e0cfd16f5658",
+        "id": "1729351568488297000.f05893d3-799e-44a9-a3e0-113d757ae305",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8383,7 +8383,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246357603000.daf55445-3e3c-48ab-86e6-a116e205367f"
+              "reference": "Organization/1729351568487543000.68374678-0cba-4682-bf34-1c56c39fe075"
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@@ -8399,10 +8399,10 @@
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+      "fullUrl": "ServiceRequest/1729351568497851000.90830430-92ca-41de-8cf5-c6665eec8b35",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293246367631000.66c7a083-98bc-4f5c-93c9-c74242eec6ff",
+        "id": "1729351568497851000.90830430-92ca-41de-8cf5-c6665eec8b35",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -8414,13 +8414,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246363202000.9e5d08f2-a54b-4d20-ab96-2a179d06d7c6"
+                  "reference": "Organization/1729351568493320000.6c176ae8-6d6a-49f8-a3d1-552c83c4840c"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246363976000.78f5d53b-02f2-4958-b975-458660057fc4"
+                  "reference": "Organization/1729351568494091000.24978ba1-2c42-4654-91d7-de9c0694fccf"
                 }
               },
               {
@@ -8448,7 +8448,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246365184000.086fffe6-6c71-4f9f-8d8b-1a85066eba9e"
+                  "reference": "Practitioner/1729351568495347000.a192b06e-be35-46b5-94ad-e9ca5ad6322e"
                 }
               }
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@@ -8576,7 +8576,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246367162000.6567d330-1edb-4d7f-9587-8490229fd568"
+                  "reference": "Practitioner/1729351568497396000.c778f467-f136-4168-a71b-13a492089f3c"
                 }
               }
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@@ -8658,18 +8658,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246358926000.19b28c65-ea6b-4125-a2a6-dcf509787d49"
+          "reference": "PractitionerRole/1729351568488957000.c32c82e2-75e2-40a1-854c-a976b80af8f9"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729293246359120000.74779224-3e63-4f7e-a155-49f9a12a15b9",
+      "fullUrl": "Organization/1729351568489155000.e7169c59-a37e-4bb0-a70b-e9c16d47a2c4",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246359120000.74779224-3e63-4f7e-a155-49f9a12a15b9",
+        "id": "1729351568489155000.e7169c59-a37e-4bb0-a70b-e9c16d47a2c4",
         "identifier": [
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@@ -8684,10 +8684,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246359964000.4e9db5c6-8cbd-4487-bdf5-5c4312da0d6c",
+      "fullUrl": "Practitioner/1729351568490052000.54b652ea-46bc-43b8-8f08-2d45b54ab31b",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246359964000.4e9db5c6-8cbd-4487-bdf5-5c4312da0d6c",
+        "id": "1729351568490052000.54b652ea-46bc-43b8-8f08-2d45b54ab31b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8739,7 +8739,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246359120000.74779224-3e63-4f7e-a155-49f9a12a15b9"
+              "reference": "Organization/1729351568489155000.e7169c59-a37e-4bb0-a70b-e9c16d47a2c4"
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@@ -8755,10 +8755,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246361184000.6c589bda-e87f-4996-bd16-5bedefe24761",
+      "fullUrl": "Organization/1729351568491319000.8e927b1c-bedd-4f26-9666-f70fcdfe3830",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246361184000.6c589bda-e87f-4996-bd16-5bedefe24761",
+        "id": "1729351568491319000.8e927b1c-bedd-4f26-9666-f70fcdfe3830",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8846,23 +8846,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246358926000.19b28c65-ea6b-4125-a2a6-dcf509787d49",
+      "fullUrl": "PractitionerRole/1729351568488957000.c32c82e2-75e2-40a1-854c-a976b80af8f9",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246358926000.19b28c65-ea6b-4125-a2a6-dcf509787d49",
+        "id": "1729351568488957000.c32c82e2-75e2-40a1-854c-a976b80af8f9",
         "practitioner": {
-          "reference": "Practitioner/1729293246359964000.4e9db5c6-8cbd-4487-bdf5-5c4312da0d6c"
+          "reference": "Practitioner/1729351568490052000.54b652ea-46bc-43b8-8f08-2d45b54ab31b"
         },
         "organization": {
-          "reference": "Organization/1729293246361184000.6c589bda-e87f-4996-bd16-5bedefe24761"
+          "reference": "Organization/1729351568491319000.8e927b1c-bedd-4f26-9666-f70fcdfe3830"
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       }
     },
     {
-      "fullUrl": "Organization/1729293246363202000.9e5d08f2-a54b-4d20-ab96-2a179d06d7c6",
+      "fullUrl": "Organization/1729351568493320000.6c176ae8-6d6a-49f8-a3d1-552c83c4840c",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246363202000.9e5d08f2-a54b-4d20-ab96-2a179d06d7c6",
+        "id": "1729351568493320000.6c176ae8-6d6a-49f8-a3d1-552c83c4840c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8938,10 +8938,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246363976000.78f5d53b-02f2-4958-b975-458660057fc4",
+      "fullUrl": "Organization/1729351568494091000.24978ba1-2c42-4654-91d7-de9c0694fccf",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246363976000.78f5d53b-02f2-4958-b975-458660057fc4",
+        "id": "1729351568494091000.24978ba1-2c42-4654-91d7-de9c0694fccf",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9017,10 +9017,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246364489000.e54507e9-150e-4794-99b3-faf713e2e4b1",
+      "fullUrl": "Organization/1729351568494614000.52c8d10e-c098-405d-ba6d-b0bfd96115ac",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246364489000.e54507e9-150e-4794-99b3-faf713e2e4b1",
+        "id": "1729351568494614000.52c8d10e-c098-405d-ba6d-b0bfd96115ac",
         "identifier": [
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@@ -9035,10 +9035,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246365184000.086fffe6-6c71-4f9f-8d8b-1a85066eba9e",
+      "fullUrl": "Practitioner/1729351568495347000.a192b06e-be35-46b5-94ad-e9ca5ad6322e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246365184000.086fffe6-6c71-4f9f-8d8b-1a85066eba9e",
+        "id": "1729351568495347000.a192b06e-be35-46b5-94ad-e9ca5ad6322e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9086,7 +9086,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246364489000.e54507e9-150e-4794-99b3-faf713e2e4b1"
+              "reference": "Organization/1729351568494614000.52c8d10e-c098-405d-ba6d-b0bfd96115ac"
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@@ -9102,10 +9102,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293246366459000.67be5874-1b9a-422d-822c-79d8f9435c86",
+      "fullUrl": "Organization/1729351568496654000.b472ef1c-0cd7-4ed4-a14f-5ed300072d14",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246366459000.67be5874-1b9a-422d-822c-79d8f9435c86",
+        "id": "1729351568496654000.b472ef1c-0cd7-4ed4-a14f-5ed300072d14",
         "identifier": [
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@@ -9120,10 +9120,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246367162000.6567d330-1edb-4d7f-9587-8490229fd568",
+      "fullUrl": "Practitioner/1729351568497396000.c778f467-f136-4168-a71b-13a492089f3c",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246367162000.6567d330-1edb-4d7f-9587-8490229fd568",
+        "id": "1729351568497396000.c778f467-f136-4168-a71b-13a492089f3c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9171,7 +9171,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246366459000.67be5874-1b9a-422d-822c-79d8f9435c86"
+              "reference": "Organization/1729351568496654000.b472ef1c-0cd7-4ed4-a14f-5ed300072d14"
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@@ -9187,10 +9187,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293246376587000.74168d93-552d-4d58-b0e6-1e29f48869d6",
+      "fullUrl": "ServiceRequest/1729351568506784000.d687ad40-67bb-47d9-885e-dbec52cd6942",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293246376587000.74168d93-552d-4d58-b0e6-1e29f48869d6",
+        "id": "1729351568506784000.d687ad40-67bb-47d9-885e-dbec52cd6942",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -9202,13 +9202,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246372056000.75371672-f8aa-4d05-ad2b-9cb5df2276a1"
+                  "reference": "Organization/1729351568502289000.66c28621-0bf6-4920-8d1a-eeee9728a3de"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246372824000.83f1d808-4600-416c-a258-7aaa22543590"
+                  "reference": "Organization/1729351568503065000.6116ed3e-7eee-4e6a-94b8-0ca7d33c2714"
                 }
               },
               {
@@ -9236,7 +9236,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246374058000.bc845d3d-932e-42c1-a6bf-fde0640d4d6b"
+                  "reference": "Practitioner/1729351568504295000.95e0f72e-99f1-4f32-843f-a13f70d1fc3f"
                 }
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@@ -9364,7 +9364,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246376127000.38c89ae6-bb2e-4203-abaa-3005258d6b64"
+                  "reference": "Practitioner/1729351568506325000.1c61690e-9dba-4113-b517-c7242a88be9a"
                 }
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@@ -9446,18 +9446,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246367787000.ff34ef63-d83f-4747-8067-808dade1d2c5"
+          "reference": "PractitionerRole/1729351568498010000.b402c8d6-2f91-4215-a202-37434e10c091"
         }
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     {
-      "fullUrl": "Organization/1729293246367978000.57feff62-a013-4349-bec6-8005e01a7b0b",
+      "fullUrl": "Organization/1729351568498195000.c173020d-9911-4829-91f7-100aba5635e4",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246367978000.57feff62-a013-4349-bec6-8005e01a7b0b",
+        "id": "1729351568498195000.c173020d-9911-4829-91f7-100aba5635e4",
         "identifier": [
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@@ -9472,10 +9472,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246368846000.f74573d7-90fd-4786-94be-c3272caf6de5",
+      "fullUrl": "Practitioner/1729351568499039000.6683b3f2-c4da-48f0-b8ad-73a2f8476bed",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246368846000.f74573d7-90fd-4786-94be-c3272caf6de5",
+        "id": "1729351568499039000.6683b3f2-c4da-48f0-b8ad-73a2f8476bed",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9527,7 +9527,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246367978000.57feff62-a013-4349-bec6-8005e01a7b0b"
+              "reference": "Organization/1729351568498195000.c173020d-9911-4829-91f7-100aba5635e4"
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@@ -9543,10 +9543,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293246370058000.fcc4dfa8-5f1f-4cad-a208-813d749b7b80",
+      "fullUrl": "Organization/1729351568500306000.a818591c-bfca-4eca-a1a7-fd516a8890db",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246370058000.fcc4dfa8-5f1f-4cad-a208-813d749b7b80",
+        "id": "1729351568500306000.a818591c-bfca-4eca-a1a7-fd516a8890db",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9634,23 +9634,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246367787000.ff34ef63-d83f-4747-8067-808dade1d2c5",
+      "fullUrl": "PractitionerRole/1729351568498010000.b402c8d6-2f91-4215-a202-37434e10c091",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246367787000.ff34ef63-d83f-4747-8067-808dade1d2c5",
+        "id": "1729351568498010000.b402c8d6-2f91-4215-a202-37434e10c091",
         "practitioner": {
-          "reference": "Practitioner/1729293246368846000.f74573d7-90fd-4786-94be-c3272caf6de5"
+          "reference": "Practitioner/1729351568499039000.6683b3f2-c4da-48f0-b8ad-73a2f8476bed"
         },
         "organization": {
-          "reference": "Organization/1729293246370058000.fcc4dfa8-5f1f-4cad-a208-813d749b7b80"
+          "reference": "Organization/1729351568500306000.a818591c-bfca-4eca-a1a7-fd516a8890db"
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     },
     {
-      "fullUrl": "Organization/1729293246372056000.75371672-f8aa-4d05-ad2b-9cb5df2276a1",
+      "fullUrl": "Organization/1729351568502289000.66c28621-0bf6-4920-8d1a-eeee9728a3de",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246372056000.75371672-f8aa-4d05-ad2b-9cb5df2276a1",
+        "id": "1729351568502289000.66c28621-0bf6-4920-8d1a-eeee9728a3de",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9726,10 +9726,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246372824000.83f1d808-4600-416c-a258-7aaa22543590",
+      "fullUrl": "Organization/1729351568503065000.6116ed3e-7eee-4e6a-94b8-0ca7d33c2714",
       "resource": {
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-        "id": "1729293246372824000.83f1d808-4600-416c-a258-7aaa22543590",
+        "id": "1729351568503065000.6116ed3e-7eee-4e6a-94b8-0ca7d33c2714",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9805,10 +9805,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246373356000.9c255b7f-47a4-4add-989f-025a18a35869",
+      "fullUrl": "Organization/1729351568503581000.f2aac8be-bf78-4e40-9c88-29bcc0758e16",
       "resource": {
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-        "id": "1729293246373356000.9c255b7f-47a4-4add-989f-025a18a35869",
+        "id": "1729351568503581000.f2aac8be-bf78-4e40-9c88-29bcc0758e16",
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@@ -9823,10 +9823,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293246374058000.bc845d3d-932e-42c1-a6bf-fde0640d4d6b",
+      "fullUrl": "Practitioner/1729351568504295000.95e0f72e-99f1-4f32-843f-a13f70d1fc3f",
       "resource": {
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-        "id": "1729293246374058000.bc845d3d-932e-42c1-a6bf-fde0640d4d6b",
+        "id": "1729351568504295000.95e0f72e-99f1-4f32-843f-a13f70d1fc3f",
         "extension": [
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@@ -9874,7 +9874,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246373356000.9c255b7f-47a4-4add-989f-025a18a35869"
+              "reference": "Organization/1729351568503581000.f2aac8be-bf78-4e40-9c88-29bcc0758e16"
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@@ -9890,10 +9890,10 @@
       }
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-      "fullUrl": "Organization/1729293246375427000.ca8e27c6-3d4d-4c51-934c-3eb78592fb24",
+      "fullUrl": "Organization/1729351568505604000.008f3b3d-7c1a-4b4d-a0b9-322bb935abfd",
       "resource": {
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-        "id": "1729293246375427000.ca8e27c6-3d4d-4c51-934c-3eb78592fb24",
+        "id": "1729351568505604000.008f3b3d-7c1a-4b4d-a0b9-322bb935abfd",
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@@ -9908,10 +9908,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568506325000.1c61690e-9dba-4113-b517-c7242a88be9a",
       "resource": {
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+        "id": "1729351568506325000.1c61690e-9dba-4113-b517-c7242a88be9a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9959,7 +9959,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246375427000.ca8e27c6-3d4d-4c51-934c-3eb78592fb24"
+              "reference": "Organization/1729351568505604000.008f3b3d-7c1a-4b4d-a0b9-322bb935abfd"
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@@ -9975,10 +9975,10 @@
       }
     },
     {
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+      "fullUrl": "ServiceRequest/1729351568516487000.16c99b07-bbbf-4bc5-b246-f333d52ee173",
       "resource": {
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-        "id": "1729293246385596000.aa23ff49-6f24-4aaf-a747-eb6527fe32ba",
+        "id": "1729351568516487000.16c99b07-bbbf-4bc5-b246-f333d52ee173",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -9990,13 +9990,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246381080000.12daa83e-fd50-4a3f-a05d-0ccabad2b1d5"
+                  "reference": "Organization/1729351568511129000.d4610155-2958-45cf-bbcc-b5c1605b523d"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246381839000.61d3bc56-5174-4b41-acc3-d96a4a7c3bbb"
+                  "reference": "Organization/1729351568511891000.21dbd5b0-4301-4449-864e-1f308109591d"
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               {
@@ -10024,7 +10024,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246383077000.fc5d0ead-491e-422c-aa85-48e7a36d73e6"
+                  "reference": "Practitioner/1729351568513135000.1c068cfa-01e8-4209-bd84-46548839d2e4"
                 }
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@@ -10152,7 +10152,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246385154000.b96df541-a087-45b3-b153-a22920290a9a"
+                  "reference": "Practitioner/1729351568515151000.22d002ab-e8d8-465c-97fe-4a34470b4422"
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@@ -10234,18 +10234,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
-          "reference": "PractitionerRole/1729293246376746000.b242965c-dfa5-42ef-89f6-1e31bf2c8ded"
+          "reference": "PractitionerRole/1729351568506939000.f4c844e6-acac-4b03-8c5d-d68551227c86"
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+      "fullUrl": "Organization/1729351568507126000.7e912441-61a3-4fe8-8398-44ee712e0fe9",
       "resource": {
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-        "id": "1729293246376942000.6af8f28c-0ed6-47dd-8618-bc4043031a1e",
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@@ -10260,10 +10260,10 @@
       }
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       "resource": {
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -10315,7 +10315,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246376942000.6af8f28c-0ed6-47dd-8618-bc4043031a1e"
+              "reference": "Organization/1729351568507126000.7e912441-61a3-4fe8-8398-44ee712e0fe9"
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@@ -10331,10 +10331,10 @@
       }
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+      "fullUrl": "Organization/1729351568509167000.5a7816d7-49b6-482f-a300-78ee111e6519",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246379049000.5e5c4edf-5e60-4737-94a6-a899b787512a",
+        "id": "1729351568509167000.5a7816d7-49b6-482f-a300-78ee111e6519",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -10422,23 +10422,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246376746000.b242965c-dfa5-42ef-89f6-1e31bf2c8ded",
+      "fullUrl": "PractitionerRole/1729351568506939000.f4c844e6-acac-4b03-8c5d-d68551227c86",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293246376746000.b242965c-dfa5-42ef-89f6-1e31bf2c8ded",
+        "id": "1729351568506939000.f4c844e6-acac-4b03-8c5d-d68551227c86",
         "practitioner": {
-          "reference": "Practitioner/1729293246377785000.1495c1e1-bd9e-4048-97f4-1dfd832526b6"
+          "reference": "Practitioner/1729351568507957000.412f1086-ff92-45e8-bee1-598777c84a0b"
         },
         "organization": {
-          "reference": "Organization/1729293246379049000.5e5c4edf-5e60-4737-94a6-a899b787512a"
+          "reference": "Organization/1729351568509167000.5a7816d7-49b6-482f-a300-78ee111e6519"
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-      "fullUrl": "Organization/1729293246381080000.12daa83e-fd50-4a3f-a05d-0ccabad2b1d5",
+      "fullUrl": "Organization/1729351568511129000.d4610155-2958-45cf-bbcc-b5c1605b523d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246381080000.12daa83e-fd50-4a3f-a05d-0ccabad2b1d5",
+        "id": "1729351568511129000.d4610155-2958-45cf-bbcc-b5c1605b523d",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -10514,10 +10514,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246381839000.61d3bc56-5174-4b41-acc3-d96a4a7c3bbb",
+      "fullUrl": "Organization/1729351568511891000.21dbd5b0-4301-4449-864e-1f308109591d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246381839000.61d3bc56-5174-4b41-acc3-d96a4a7c3bbb",
+        "id": "1729351568511891000.21dbd5b0-4301-4449-864e-1f308109591d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -10593,10 +10593,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246382345000.aa6272bd-047b-456f-bee2-a0df2a55aaaa",
+      "fullUrl": "Organization/1729351568512412000.757b25ff-9056-4f54-8a82-c4fce26cbee4",
       "resource": {
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+        "id": "1729351568512412000.757b25ff-9056-4f54-8a82-c4fce26cbee4",
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@@ -10611,10 +10611,10 @@
       }
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-      "fullUrl": "Practitioner/1729293246383077000.fc5d0ead-491e-422c-aa85-48e7a36d73e6",
+      "fullUrl": "Practitioner/1729351568513135000.1c068cfa-01e8-4209-bd84-46548839d2e4",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246383077000.fc5d0ead-491e-422c-aa85-48e7a36d73e6",
+        "id": "1729351568513135000.1c068cfa-01e8-4209-bd84-46548839d2e4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -10662,7 +10662,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246382345000.aa6272bd-047b-456f-bee2-a0df2a55aaaa"
+              "reference": "Organization/1729351568512412000.757b25ff-9056-4f54-8a82-c4fce26cbee4"
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@@ -10678,10 +10678,10 @@
       }
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+      "fullUrl": "Organization/1729351568514444000.77dc3dbf-7bd9-42c0-be89-8ce6dfe93a21",
       "resource": {
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-        "id": "1729293246384452000.e92c85aa-6999-4f66-9a04-eeedc37201eb",
+        "id": "1729351568514444000.77dc3dbf-7bd9-42c0-be89-8ce6dfe93a21",
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@@ -10696,10 +10696,10 @@
       }
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     {
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+      "fullUrl": "Practitioner/1729351568515151000.22d002ab-e8d8-465c-97fe-4a34470b4422",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293246385154000.b96df541-a087-45b3-b153-a22920290a9a",
+        "id": "1729351568515151000.22d002ab-e8d8-465c-97fe-4a34470b4422",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -10747,7 +10747,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246384452000.e92c85aa-6999-4f66-9a04-eeedc37201eb"
+              "reference": "Organization/1729351568514444000.77dc3dbf-7bd9-42c0-be89-8ce6dfe93a21"
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@@ -10763,10 +10763,10 @@
       }
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     {
-      "fullUrl": "ServiceRequest/1729293246394657000.c20128c3-e77a-478a-88dc-4d78d4751030",
+      "fullUrl": "ServiceRequest/1729351568533716000.e88889bc-27d6-4f90-9666-d92f6a858e89",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293246394657000.c20128c3-e77a-478a-88dc-4d78d4751030",
+        "id": "1729351568533716000.e88889bc-27d6-4f90-9666-d92f6a858e89",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -10778,13 +10778,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246390086000.ca898dee-adfe-499f-ac23-3ce71d45fcbe"
+                  "reference": "Organization/1729351568526523000.4a29c083-e63c-4a93-aa7e-901bbef4fd30"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246390871000.8048c52a-f02a-432b-8a07-14efdca5460e"
+                  "reference": "Organization/1729351568528697000.a15f4d51-1b9a-47f1-960b-cefcc9fcceb1"
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               {
@@ -10812,7 +10812,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246392200000.67205715-ee7c-4953-9dda-3eedc03d0759"
+                  "reference": "Practitioner/1729351568531152000.93b48b35-e8ff-42b7-8335-b7424d2eeb7e"
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@@ -10940,7 +10940,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246394192000.da5b24c6-9253-43cf-9d84-5f3b5ea01617"
+                  "reference": "Practitioner/1729351568533249000.1684ef2a-8dca-42e5-9428-5ba5c115c548"
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@@ -11022,18 +11022,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293246385751000.437cce6f-1bd4-4903-a885-82e946f59fee"
+          "reference": "PractitionerRole/1729351568516805000.b1850aee-3486-48cf-9de0-30a5e6cad3f1"
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-      "fullUrl": "Organization/1729293246385943000.d77f29af-ea57-41e6-83bb-25aefe1a9b7c",
+      "fullUrl": "Organization/1729351568517234000.3ba65204-b8e0-4773-9a46-48dbeaff4a15",
       "resource": {
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-        "id": "1729293246385943000.d77f29af-ea57-41e6-83bb-25aefe1a9b7c",
+        "id": "1729351568517234000.3ba65204-b8e0-4773-9a46-48dbeaff4a15",
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@@ -11048,10 +11048,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293246386829000.0fd24ad2-0d6e-4537-8837-3d4e68779c3a",
+      "fullUrl": "Practitioner/1729351568518976000.9e06db0d-e846-4e54-bfc1-588bfa248152",
       "resource": {
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-        "id": "1729293246386829000.0fd24ad2-0d6e-4537-8837-3d4e68779c3a",
+        "id": "1729351568518976000.9e06db0d-e846-4e54-bfc1-588bfa248152",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11103,7 +11103,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246385943000.d77f29af-ea57-41e6-83bb-25aefe1a9b7c"
+              "reference": "Organization/1729351568517234000.3ba65204-b8e0-4773-9a46-48dbeaff4a15"
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@@ -11119,10 +11119,10 @@
       }
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-      "fullUrl": "Organization/1729293246388120000.c31405dc-69ba-4fb7-9765-746561739ab6",
+      "fullUrl": "Organization/1729351568522006000.ea73fddd-9cd4-4b16-9c80-ddaadf674d70",
       "resource": {
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-        "id": "1729293246388120000.c31405dc-69ba-4fb7-9765-746561739ab6",
+        "id": "1729351568522006000.ea73fddd-9cd4-4b16-9c80-ddaadf674d70",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11210,23 +11210,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293246385751000.437cce6f-1bd4-4903-a885-82e946f59fee",
+      "fullUrl": "PractitionerRole/1729351568516805000.b1850aee-3486-48cf-9de0-30a5e6cad3f1",
       "resource": {
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-        "id": "1729293246385751000.437cce6f-1bd4-4903-a885-82e946f59fee",
+        "id": "1729351568516805000.b1850aee-3486-48cf-9de0-30a5e6cad3f1",
         "practitioner": {
-          "reference": "Practitioner/1729293246386829000.0fd24ad2-0d6e-4537-8837-3d4e68779c3a"
+          "reference": "Practitioner/1729351568518976000.9e06db0d-e846-4e54-bfc1-588bfa248152"
         },
         "organization": {
-          "reference": "Organization/1729293246388120000.c31405dc-69ba-4fb7-9765-746561739ab6"
+          "reference": "Organization/1729351568522006000.ea73fddd-9cd4-4b16-9c80-ddaadf674d70"
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-      "fullUrl": "Organization/1729293246390086000.ca898dee-adfe-499f-ac23-3ce71d45fcbe",
+      "fullUrl": "Organization/1729351568526523000.4a29c083-e63c-4a93-aa7e-901bbef4fd30",
       "resource": {
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-        "id": "1729293246390086000.ca898dee-adfe-499f-ac23-3ce71d45fcbe",
+        "id": "1729351568526523000.4a29c083-e63c-4a93-aa7e-901bbef4fd30",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11302,10 +11302,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246390871000.8048c52a-f02a-432b-8a07-14efdca5460e",
+      "fullUrl": "Organization/1729351568528697000.a15f4d51-1b9a-47f1-960b-cefcc9fcceb1",
       "resource": {
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-        "id": "1729293246390871000.8048c52a-f02a-432b-8a07-14efdca5460e",
+        "id": "1729351568528697000.a15f4d51-1b9a-47f1-960b-cefcc9fcceb1",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11381,10 +11381,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293246391432000.77bcf2e8-954d-4fe5-b397-fc1df5820324",
+      "fullUrl": "Organization/1729351568530010000.0b97d72f-c35c-4014-9303-1c7371d44a65",
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+        "id": "1729351568530010000.0b97d72f-c35c-4014-9303-1c7371d44a65",
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@@ -11399,10 +11399,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293246392200000.67205715-ee7c-4953-9dda-3eedc03d0759",
+      "fullUrl": "Practitioner/1729351568531152000.93b48b35-e8ff-42b7-8335-b7424d2eeb7e",
       "resource": {
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-        "id": "1729293246392200000.67205715-ee7c-4953-9dda-3eedc03d0759",
+        "id": "1729351568531152000.93b48b35-e8ff-42b7-8335-b7424d2eeb7e",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11450,7 +11450,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246391432000.77bcf2e8-954d-4fe5-b397-fc1df5820324"
+              "reference": "Organization/1729351568530010000.0b97d72f-c35c-4014-9303-1c7371d44a65"
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@@ -11466,10 +11466,10 @@
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       "resource": {
         "resourceType": "Organization",
-        "id": "1729293246393502000.b718f103-e008-4969-926c-737507779879",
+        "id": "1729351568532513000.77bed438-bcce-4bd8-9348-583641534608",
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@@ -11484,10 +11484,10 @@
       }
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-      "fullUrl": "Practitioner/1729293246394192000.da5b24c6-9253-43cf-9d84-5f3b5ea01617",
+      "fullUrl": "Practitioner/1729351568533249000.1684ef2a-8dca-42e5-9428-5ba5c115c548",
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         "extension": [
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@@ -11535,7 +11535,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246393502000.b718f103-e008-4969-926c-737507779879"
+              "reference": "Organization/1729351568532513000.77bed438-bcce-4bd8-9348-583641534608"
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@@ -11551,10 +11551,10 @@
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+      "fullUrl": "ServiceRequest/1729351568542887000.aaceff2e-97e2-4c94-bc85-e48189cf9951",
       "resource": {
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-        "id": "1729293246403748000.1ece385c-45db-4fd4-ac6c-a5efcee08f52",
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -11566,13 +11566,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246399137000.5f8192b1-6853-4005-8eea-aa58e1f194d9"
+                  "reference": "Organization/1729351568538318000.3751387a-4470-44c8-b7f8-63688d5fc406"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246399939000.fc93c1db-c0b1-44f1-96a3-e450169165e4"
+                  "reference": "Organization/1729351568539099000.3566a9f4-1cdf-450a-82de-bfed6cc4bfeb"
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@@ -11600,7 +11600,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246401240000.f185df05-e477-4219-adef-25ac40985ed1"
+                  "reference": "Practitioner/1729351568540341000.9715362d-0fa0-4ad6-a760-410662d705d1"
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@@ -11728,7 +11728,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293246403261000.e39dbe24-4dc4-4fce-82ab-bdae8bfc5115"
+                  "reference": "Practitioner/1729351568542415000.7eccce6b-0844-4a08-8d8f-b3f8f3cd9407"
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@@ -11810,18 +11810,18 @@
           ]
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
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@@ -11836,10 +11836,10 @@
       }
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@@ -11891,7 +11891,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729351568534086000.2f26a0cf-cddc-468e-996a-ff28aade40ac"
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@@ -11907,10 +11907,10 @@
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       "resource": {
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@@ -11998,23 +11998,23 @@
       }
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         "practitioner": {
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+          "reference": "Practitioner/1729351568534977000.13abe0aa-daf0-4284-a638-ceeb4c7b26b3"
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         "organization": {
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+          "reference": "Organization/1729351568536229000.9a3d8916-95eb-49e2-99ae-9232eb944281"
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         "extension": [
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@@ -12090,10 +12090,10 @@
       }
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+      "fullUrl": "Organization/1729351568539099000.3566a9f4-1cdf-450a-82de-bfed6cc4bfeb",
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         "extension": [
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@@ -12169,10 +12169,10 @@
       }
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+      "fullUrl": "Organization/1729351568539626000.40224b24-d9e1-4b37-97ae-c42e54b05147",
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@@ -12187,10 +12187,10 @@
       }
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       "resource": {
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@@ -12238,7 +12238,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293246400511000.90bfaf58-3930-4fd5-84e5-428b8d29987f"
+              "reference": "Organization/1729351568539626000.40224b24-d9e1-4b37-97ae-c42e54b05147"
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@@ -12254,10 +12254,10 @@
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@@ -12272,10 +12272,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568542415000.7eccce6b-0844-4a08-8d8f-b3f8f3cd9407",
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         "extension": [
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@@ -12323,7 +12323,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351568541694000.2716ae6f-e9fb-4956-b844-c86daf4938aa"
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@@ -12339,10 +12339,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729351568552141000.8d98b735-03af-4a27-9091-1683a09f072c",
       "resource": {
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@@ -12354,13 +12354,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246408200000.78d63048-34b8-47d3-8c9a-be5ebea9d3bd"
+                  "reference": "Organization/1729351568547357000.cc6baad1-5af6-41c2-b5ce-62e2877e5030"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246408961000.648748f0-19ab-488f-891c-f813b3678ce5"
+                  "reference": "Organization/1729351568548229000.44bfea7d-cc59-4876-86f3-cbd12725fb61"
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@@ -12388,7 +12388,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246410251000.1ab200ac-a673-4d6b-a132-9b1d173c6269"
+                  "reference": "Practitioner/1729351568549500000.5faf4413-0fae-4282-84f6-f6d2375bb8f2"
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@@ -12516,7 +12516,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293246412299000.5d82c0b7-7045-426a-aa72-71e0ebc6d56c"
+                  "reference": "Practitioner/1729351568551663000.03126dd2-29fc-4dd8-9333-da61102ce8c0"
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@@ -12598,18 +12598,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
-          "reference": "PractitionerRole/1729293246403913000.aa2396bd-3a3b-440d-8259-a61ca7e189b8"
+          "reference": "PractitionerRole/1729351568543057000.5c0f7ec5-d7f4-490e-904d-f0f026177c80"
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+      "fullUrl": "Organization/1729351568543253000.347ac07a-3048-4c6c-82b7-1c4d959592cf",
       "resource": {
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@@ -12624,10 +12624,10 @@
       }
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+      "fullUrl": "Practitioner/1729351568544105000.0b84abd9-4a00-4256-a905-e2e84478670b",
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@@ -12679,7 +12679,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246404113000.9ee7cd14-370c-4dec-a2da-030ae898b557"
+              "reference": "Organization/1729351568543253000.347ac07a-3048-4c6c-82b7-1c4d959592cf"
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@@ -12695,10 +12695,10 @@
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@@ -12786,23 +12786,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729293246403913000.aa2396bd-3a3b-440d-8259-a61ca7e189b8",
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@@ -12878,10 +12878,10 @@
       }
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         "extension": [
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@@ -12957,10 +12957,10 @@
       }
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@@ -12975,10 +12975,10 @@
       }
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@@ -13026,7 +13026,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293246409508000.d91487f6-175c-4974-996f-374d7720447b"
+              "reference": "Organization/1729351568548781000.e3e56118-cdf0-4ce2-997d-96bdda605e1e"
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@@ -13042,10 +13042,10 @@
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@@ -13060,10 +13060,10 @@
       }
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@@ -13111,7 +13111,7 @@
             },
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@@ -13127,10 +13127,10 @@
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@@ -13142,13 +13142,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246419775000.85847b6e-e04d-4366-872b-674b87074229"
+                  "reference": "Organization/1729351568556742000.5cf1324b-89f9-401d-939a-cf126d737c6d"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351568557509000.8fa92ad7-54b6-4049-9f32-ae57cbd78b12"
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@@ -13176,7 +13176,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246421851000.6d60cb66-c14e-4a4a-9506-776c9cf4ee0b"
+                  "reference": "Practitioner/1729351568558755000.0f0eb3e3-59a6-4663-8005-c79dac5a1923"
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@@ -13304,7 +13304,7 @@
               {
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                 "valueReference": {
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@@ -13386,18 +13386,18 @@
           ]
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
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@@ -13412,10 +13412,10 @@
       }
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         "extension": [
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@@ -13467,7 +13467,7 @@
             },
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             "assigner": {
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@@ -13483,10 +13483,10 @@
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@@ -13574,23 +13574,23 @@
       }
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         "practitioner": {
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+          "reference": "Practitioner/1729351568553367000.386c12a9-0d48-44f6-921a-8883f56c4ec4"
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       "resource": {
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@@ -13666,10 +13666,10 @@
       }
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@@ -13745,10 +13745,10 @@
       }
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@@ -13763,10 +13763,10 @@
       }
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         "extension": [
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@@ -13814,7 +13814,7 @@
             },
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             "assigner": {
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@@ -13830,10 +13830,10 @@
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@@ -13848,10 +13848,10 @@
       }
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         "extension": [
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@@ -13899,7 +13899,7 @@
             },
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             "assigner": {
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@@ -13915,10 +13915,10 @@
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       "resource": {
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@@ -13930,13 +13930,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246428728000.5ec1f3ef-053f-4ad1-9333-587fbf0256d7"
+                  "reference": "Organization/1729351568565688000.c5fc4615-7364-401f-bd8b-81fefc2a7a88"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351568566456000.72104291-f98b-4a63-8351-7c486c34b20b"
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@@ -13964,7 +13964,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246430819000.8b0ca58d-5bba-4691-8231-433daacebe94"
+                  "reference": "Practitioner/1729351568567698000.6982f99d-667c-40aa-8ee9-8ce152ddaf0d"
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@@ -14092,7 +14092,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729351568569709000.a63ae7ac-b159-4aa6-aab8-70ff839f0e4b"
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@@ -14174,18 +14174,18 @@
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
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+          "reference": "PractitionerRole/1729351568561430000.4e468a15-9e1f-47c9-b995-787cebbafecc"
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@@ -14200,10 +14200,10 @@
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@@ -14255,7 +14255,7 @@
             },
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             "assigner": {
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@@ -14271,10 +14271,10 @@
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@@ -14362,23 +14362,23 @@
       }
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+          "reference": "Practitioner/1729351568562457000.0a308fae-d529-4253-81cd-8c98b3280199"
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@@ -14454,10 +14454,10 @@
       }
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@@ -14533,10 +14533,10 @@
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@@ -14551,10 +14551,10 @@
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@@ -14602,7 +14602,7 @@
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@@ -14618,10 +14618,10 @@
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@@ -14636,10 +14636,10 @@
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@@ -14687,7 +14687,7 @@
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             "value": "1174911127",
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@@ -14703,10 +14703,10 @@
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@@ -14718,13 +14718,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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@@ -14752,7 +14752,7 @@
               {
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@@ -14880,7 +14880,7 @@
               {
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@@ -14962,18 +14962,18 @@
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@@ -14988,10 +14988,10 @@
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@@ -15043,7 +15043,7 @@
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             "assigner": {
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@@ -15059,10 +15059,10 @@
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@@ -15150,23 +15150,23 @@
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@@ -15242,10 +15242,10 @@
       }
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         "extension": [
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@@ -15321,10 +15321,10 @@
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@@ -15339,10 +15339,10 @@
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@@ -15390,7 +15390,7 @@
             },
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             "assigner": {
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@@ -15406,10 +15406,10 @@
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@@ -15424,10 +15424,10 @@
       }
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         "extension": [
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@@ -15475,7 +15475,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729351568577323000.3fbca51a-1d0b-4272-b65c-82fede7d0dce"
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@@ -15491,10 +15491,10 @@
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@@ -15506,13 +15506,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246446742000.09e9959a-fc49-4312-a637-7781895551ca"
+                  "reference": "Organization/1729351568582385000.0f6f2dd8-e849-4683-9149-cfd47d19cb3b"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293246447510000.4f721624-afea-490e-8bfa-33313758a0a0"
+                  "reference": "Organization/1729351568583069000.69f6d16f-b673-4064-8d46-471d1b53525b"
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@@ -15540,7 +15540,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293246448848000.33beeccd-929a-483d-ae36-4e1470eedf2c"
+                  "reference": "Practitioner/1729351568584177000.371ab20d-e747-4a2c-8f10-652060ebe51e"
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@@ -15668,7 +15668,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293246450849000.45464441-0964-4428-a807-070290479091"
+                  "reference": "Practitioner/1729351568586104000.b5b0e036-97fb-4750-822d-17525d3f9695"
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@@ -15750,18 +15750,18 @@
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         "subject": {
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "requester": {
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+          "reference": "PractitionerRole/1729351568578528000.071e1e84-cddd-4680-9ac1-8322ff83ed9b"
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@@ -15776,10 +15776,10 @@
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@@ -15831,7 +15831,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293246442615000.9a9766d3-eca5-4640-8d4f-2e9ee1e34f7a"
+              "reference": "Organization/1729351568578704000.14301d84-0c45-4854-bcc3-3074e1ad6d48"
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@@ -15847,10 +15847,10 @@
       }
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@@ -15938,23 +15938,23 @@
       }
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+      "fullUrl": "PractitionerRole/1729351568578528000.071e1e84-cddd-4680-9ac1-8322ff83ed9b",
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         "practitioner": {
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+          "reference": "Practitioner/1729351568579467000.743b72a6-d7b4-4a27-a972-d0f86f7871b2"
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@@ -16030,10 +16030,10 @@
       }
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@@ -16109,10 +16109,10 @@
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@@ -17177,7 +17177,7 @@
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+            "reference": "ServiceRequest/1729351568533716000.e88889bc-27d6-4f90-9666-d92f6a858e89"
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@@ -17201,7 +17201,7 @@
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@@ -17223,21 +17223,21 @@
         },
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+            "reference": "Specimen/1729351568447151000.a3445551-ed03-41d2-a5af-9c9ab76e02dd"
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+      "fullUrl": "DiagnosticReport/1729351568603189000.51f58a0d-5e5d-4e6e-a540-7737963bde28",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293246468892000.8b00ef17-5538-42de-8cc5-3b60c0ede4c3",
+        "id": "1729351568603189000.51f58a0d-5e5d-4e6e-a540-7737963bde28",
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@@ -17290,7 +17290,7 @@
         ],
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+            "reference": "ServiceRequest/1729351568542887000.aaceff2e-97e2-4c94-bc85-e48189cf9951"
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@@ -17314,7 +17314,7 @@
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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@@ -17336,21 +17336,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293246319579000.e1a0f661-732e-41cf-af6f-1b0426d14a85"
+            "reference": "Specimen/1729351568448394000.147af0c8-68e3-44b3-a837-921dd7c14f21"
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         "result": [
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-            "reference": "Observation/1729293246302223000.5364f113-9472-4aba-9bc4-e296b1f9bab1"
+            "reference": "Observation/1729351568414907000.e8cda908-8f9c-40ee-bcc0-80a3f1af4845"
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-      "fullUrl": "DiagnosticReport/1729293246470298000.6069a206-73c3-431d-acf4-ded8188d6217",
+      "fullUrl": "DiagnosticReport/1729351568604423000.c63b06e7-dfe0-4405-953d-416576f280e8",
       "resource": {
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-        "id": "1729293246470298000.6069a206-73c3-431d-acf4-ded8188d6217",
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@@ -17403,7 +17403,7 @@
         ],
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-            "reference": "ServiceRequest/1729293246412744000.264ca2ca-369c-4380-8d15-ff7ee7c4fbbd"
+            "reference": "ServiceRequest/1729351568552141000.8d98b735-03af-4a27-9091-1683a09f072c"
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@@ -17427,7 +17427,7 @@
           ]
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-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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@@ -17449,21 +17449,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293246319952000.f7ac0735-4613-4b27-8f2d-bdab2737de6e"
+            "reference": "Specimen/1729351568450126000.7689206a-6229-487f-a705-c1a8483d2d7c"
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-            "reference": "Observation/1729293246304321000.3c306565-fa1f-4361-9d24-3315a11ef1d5"
+            "reference": "Observation/1729351568417016000.df20a62c-ee0f-41ba-8cb3-49341ab04341"
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-      "fullUrl": "DiagnosticReport/1729293246471762000.ff90458f-7e6e-4981-b2c1-80b2eaf49bc3",
+      "fullUrl": "DiagnosticReport/1729351568605672000.c1986286-5c00-4bf8-aa9a-973192b66992",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293246471762000.ff90458f-7e6e-4981-b2c1-80b2eaf49bc3",
+        "id": "1729351568605672000.c1986286-5c00-4bf8-aa9a-973192b66992",
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             "extension": [
@@ -17516,7 +17516,7 @@
         ],
         "basedOn": [
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+            "reference": "ServiceRequest/1729351568561276000.8cc50e19-acc1-49e2-b4b7-f4a0a4bec448"
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@@ -17540,7 +17540,7 @@
           ]
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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@@ -17562,21 +17562,21 @@
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         "specimen": [
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-            "reference": "Specimen/1729293246320310000.ece6d6f5-8f77-4b0b-a845-8e4af2fa4011"
+            "reference": "Specimen/1729351568451749000.6cb9f417-6631-4066-9c1f-68e93ff7f3a1"
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         "result": [
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-            "reference": "Observation/1729293246306359000.1639c4e9-2b76-46e8-a517-31a666ee48ea"
+            "reference": "Observation/1729351568419098000.85e71cf3-1c21-4bb2-ad66-0c23be510987"
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-      "fullUrl": "DiagnosticReport/1729293246473069000.6e05461f-2d84-4f47-b37a-5f2d32144e97",
+      "fullUrl": "DiagnosticReport/1729351568606920000.183c09ff-9811-47c7-916d-e1ff9f78a0e6",
       "resource": {
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-        "id": "1729293246473069000.6e05461f-2d84-4f47-b37a-5f2d32144e97",
+        "id": "1729351568606920000.183c09ff-9811-47c7-916d-e1ff9f78a0e6",
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             "extension": [
@@ -17629,7 +17629,7 @@
         ],
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+            "reference": "ServiceRequest/1729351568570174000.6cbf2e28-cbcc-4af3-b888-a797b9036fd3"
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@@ -17653,7 +17653,7 @@
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+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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@@ -17675,21 +17675,21 @@
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         "specimen": [
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-            "reference": "Specimen/1729293246320673000.85697ca7-b649-41cd-8e11-1d5629587351"
+            "reference": "Specimen/1729351568453218000.d6ce5869-3ddf-4fda-9b11-7457424e4a93"
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+            "reference": "Observation/1729351568421155000.ce5ab467-69fc-49bd-8356-69e3c7608dcf"
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     {
-      "fullUrl": "DiagnosticReport/1729293246474425000.d1782e46-8a6f-4835-b81d-dc3a8f53c2cb",
+      "fullUrl": "DiagnosticReport/1729351568608189000.af7f8e9d-00dd-4ccc-9f85-5317aef7c118",
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+        "id": "1729351568608189000.af7f8e9d-00dd-4ccc-9f85-5317aef7c118",
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             "extension": [
@@ -17742,7 +17742,7 @@
         ],
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+            "reference": "ServiceRequest/1729351568578367000.cc0c55b2-fa9c-4959-8a8f-37d1a5fd2f47"
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@@ -17766,7 +17766,7 @@
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-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "_effectiveDateTime": {
@@ -17788,21 +17788,21 @@
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         "specimen": [
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-            "reference": "Specimen/1729293246321055000.7bf4466c-50ff-40e1-9bd0-e6c4ce703cb7"
+            "reference": "Specimen/1729351568453748000.49da3d8f-fa55-48a5-bbc5-165635d87ba8"
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         "result": [
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-            "reference": "Observation/1729293246310603000.8e46b86c-f508-4b52-b8d3-f6c552dd5d9f"
+            "reference": "Observation/1729351568423190000.a0e10baf-8c19-4eac-b43c-5e9c59843bda"
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       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293246475799000.095f2271-b0cc-486f-9096-b778a2548966",
+      "fullUrl": "DiagnosticReport/1729351568609403000.89aa18d5-5526-4bf3-b96f-c87b50bac000",
       "resource": {
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-        "id": "1729293246475799000.095f2271-b0cc-486f-9096-b778a2548966",
+        "id": "1729351568609403000.89aa18d5-5526-4bf3-b96f-c87b50bac000",
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             "extension": [
@@ -17855,7 +17855,7 @@
         ],
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+            "reference": "ServiceRequest/1729351568586517000.bdb54487-7c11-417c-9590-0798d7907ffa"
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         "status": "final",
@@ -17879,7 +17879,7 @@
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         "subject": {
-          "reference": "Patient/1729293246244120000.b80e3b77-2ab0-4037-8b10-3838d55dc8a4"
+          "reference": "Patient/1729351568358158000.05dfb3c7-8686-41bf-b2a3-3b60658f3c11"
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         "_effectiveDateTime": {
@@ -17901,12 +17901,12 @@
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         "specimen": [
           {
-            "reference": "Specimen/1729293246321404000.88c5c40c-9df9-4753-96ff-835cc5064015"
+            "reference": "Specimen/1729351568454085000.d178649e-0621-4d2b-9a35-48ba834a4785"
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         "result": [
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-            "reference": "Observation/1729293246312631000.f9ced165-28e1-4839-94c2-800c7f81debc"
+            "reference": "Observation/1729351568425657000.cc002eb2-7f21-4fcc-8a2e-4e255db8d98a"
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diff --git a/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_1_hl7_translation.fhir b/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_1_hl7_translation.fhir
index 8e4bf325c..227787f3d 100644
--- a/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_1_hl7_translation.fhir
+++ b/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729292960519319000.0ecef2bb-80d6-4c8a-9e69-60b9e8569329",
+  "id": "1729351282444616000.48a4f85f-cbfd-4414-a22e-7249adb96ec8",
   "meta": {
-    "lastUpdated": "2024-10-18T16:09:20.519-07:00"
+    "lastUpdated": "2024-10-19T08:21:22.444-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2023-06-06T17:28:49.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729292960521914000.75f14dbb-1ae5-4720-837d-8725b1dffbfe",
+      "fullUrl": "MessageHeader/1729351282447821000.05ee23d7-b08f-409d-9bee-b60208918625",
       "resource": {
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-        "id": "1729292960521914000.75f14dbb-1ae5-4720-837d-8725b1dffbfe",
+        "id": "1729351282447821000.05ee23d7-b08f-409d-9bee-b60208918625",
         "meta": {
           "tag": [
             {
@@ -151,12 +151,12 @@
             "name": "BaptistOracle",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000",
             "receiver": {
-              "reference": "Organization/1729292960521456000.296f1ea7-b381-4d17-adc9-fd1cd11cd103"
+              "reference": "Organization/1729351282447438000.e0a62fa4-7e87-4343-bfa8-a388fae3d45c"
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           }
         ],
         "sender": {
-          "reference": "Organization/1729292960520446000.217de4fb-78a9-4675-a426-5c05fc7c608a"
+          "reference": "Organization/1729351282446520000.4d62c3d0-e995-42b6-ba91-952b10c338b3"
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         "source": {
           "extension": [
@@ -182,10 +182,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960520446000.217de4fb-78a9-4675-a426-5c05fc7c608a",
+      "fullUrl": "Organization/1729351282446520000.4d62c3d0-e995-42b6-ba91-952b10c338b3",
       "resource": {
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-        "id": "1729292960520446000.217de4fb-78a9-4675-a426-5c05fc7c608a",
+        "id": "1729351282446520000.4d62c3d0-e995-42b6-ba91-952b10c338b3",
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@@ -218,10 +218,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960521456000.296f1ea7-b381-4d17-adc9-fd1cd11cd103",
+      "fullUrl": "Organization/1729351282447438000.e0a62fa4-7e87-4343-bfa8-a388fae3d45c",
       "resource": {
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-        "id": "1729292960521456000.296f1ea7-b381-4d17-adc9-fd1cd11cd103",
+        "id": "1729351282447438000.e0a62fa4-7e87-4343-bfa8-a388fae3d45c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -260,55 +260,55 @@
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+      "fullUrl": "Provenance/1729351282452225000.2a062165-2bb6-4ceb-9c05-4945dfb013e6",
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+        "id": "1729351282452225000.2a062165-2bb6-4ceb-9c05-4945dfb013e6",
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@@ -330,17 +330,17 @@
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@@ -373,11 +373,11 @@
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@@ -399,17 +399,17 @@
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@@ -429,10 +429,10 @@
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@@ -547,7 +547,7 @@
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@@ -697,10 +697,10 @@
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@@ -715,16 +715,16 @@
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@@ -736,10 +736,10 @@
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@@ -795,7 +795,7 @@
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@@ -885,10 +885,10 @@
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@@ -945,7 +945,7 @@
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@@ -958,7 +958,7 @@
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@@ -983,10 +983,10 @@
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@@ -1009,10 +1009,10 @@
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@@ -1043,15 +1043,15 @@
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@@ -1066,10 +1066,10 @@
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@@ -1126,7 +1126,7 @@
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@@ -1139,7 +1139,7 @@
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@@ -1164,10 +1164,10 @@
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@@ -1190,10 +1190,10 @@
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@@ -1224,15 +1224,15 @@
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-      "fullUrl": "PractitionerRole/1729292960545568000.1cacc24c-9298-40d3-b225-8da8b8ebca9e",
+      "fullUrl": "PractitionerRole/1729351282485685000.de2d4847-8ce4-4d43-ac4e-393f77c77261",
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@@ -1247,10 +1247,10 @@
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@@ -1307,7 +1307,7 @@
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-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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@@ -1320,17 +1320,17 @@
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@@ -1353,10 +1353,10 @@
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@@ -1387,15 +1387,15 @@
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@@ -1410,10 +1410,10 @@
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@@ -1470,7 +1470,7 @@
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@@ -1483,7 +1483,7 @@
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@@ -1508,10 +1508,10 @@
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@@ -1534,10 +1534,10 @@
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@@ -1568,15 +1568,15 @@
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@@ -1591,10 +1591,10 @@
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@@ -1651,7 +1651,7 @@
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@@ -1664,7 +1664,7 @@
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@@ -1689,10 +1689,10 @@
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@@ -1715,10 +1715,10 @@
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@@ -1749,15 +1749,15 @@
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@@ -1772,10 +1772,10 @@
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@@ -1832,7 +1832,7 @@
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@@ -1845,7 +1845,7 @@
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@@ -1870,10 +1870,10 @@
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@@ -1896,10 +1896,10 @@
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@@ -1930,15 +1930,15 @@
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@@ -1953,10 +1953,10 @@
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@@ -2013,7 +2013,7 @@
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@@ -2026,7 +2026,7 @@
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@@ -2051,10 +2051,10 @@
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@@ -2077,10 +2077,10 @@
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@@ -2111,15 +2111,15 @@
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@@ -2134,10 +2134,10 @@
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@@ -2194,7 +2194,7 @@
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@@ -2207,7 +2207,7 @@
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@@ -2232,10 +2232,10 @@
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@@ -2258,10 +2258,10 @@
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@@ -2292,15 +2292,15 @@
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@@ -2315,10 +2315,10 @@
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@@ -2411,7 +2411,7 @@
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@@ -2424,16 +2424,16 @@
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@@ -2456,10 +2456,10 @@
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@@ -2490,15 +2490,15 @@
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@@ -2981,7 +2981,7 @@
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@@ -3036,7 +3036,7 @@
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@@ -3090,7 +3090,7 @@
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@@ -3165,7 +3165,7 @@
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@@ -3178,7 +3178,7 @@
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@@ -3229,10 +3229,10 @@
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@@ -3263,15 +3263,15 @@
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@@ -3346,7 +3346,7 @@
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@@ -3359,7 +3359,7 @@
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@@ -3384,10 +3384,10 @@
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@@ -3410,10 +3410,10 @@
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@@ -3527,7 +3527,7 @@
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@@ -3540,7 +3540,7 @@
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@@ -3565,10 +3565,10 @@
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@@ -3591,10 +3591,10 @@
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@@ -3625,15 +3625,15 @@
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@@ -3648,10 +3648,10 @@
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@@ -3708,7 +3708,7 @@
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@@ -3721,7 +3721,7 @@
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@@ -3746,10 +3746,10 @@
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@@ -3772,10 +3772,10 @@
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@@ -3806,15 +3806,15 @@
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@@ -3829,10 +3829,10 @@
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@@ -3889,7 +3889,7 @@
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@@ -3902,7 +3902,7 @@
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@@ -3927,10 +3927,10 @@
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@@ -3953,10 +3953,10 @@
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@@ -3987,15 +3987,15 @@
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@@ -4010,10 +4010,10 @@
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@@ -4070,7 +4070,7 @@
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@@ -4083,7 +4083,7 @@
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@@ -4108,10 +4108,10 @@
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@@ -4134,10 +4134,10 @@
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@@ -4168,15 +4168,15 @@
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@@ -4191,10 +4191,10 @@
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@@ -4251,7 +4251,7 @@
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@@ -4264,7 +4264,7 @@
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@@ -4289,10 +4289,10 @@
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@@ -4315,10 +4315,10 @@
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@@ -4349,15 +4349,15 @@
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@@ -4372,10 +4372,10 @@
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@@ -4432,7 +4432,7 @@
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@@ -4445,7 +4445,7 @@
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@@ -4470,10 +4470,10 @@
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@@ -4496,10 +4496,10 @@
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@@ -4530,15 +4530,15 @@
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@@ -4553,10 +4553,10 @@
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@@ -4613,7 +4613,7 @@
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@@ -4626,7 +4626,7 @@
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@@ -4651,10 +4651,10 @@
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@@ -4677,10 +4677,10 @@
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@@ -4711,15 +4711,15 @@
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@@ -4734,10 +4734,10 @@
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@@ -4794,7 +4794,7 @@
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@@ -4807,7 +4807,7 @@
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@@ -4832,10 +4832,10 @@
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@@ -4858,10 +4858,10 @@
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@@ -4892,15 +4892,15 @@
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@@ -4915,10 +4915,10 @@
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@@ -4975,7 +4975,7 @@
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@@ -4988,7 +4988,7 @@
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@@ -5013,10 +5013,10 @@
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@@ -5039,10 +5039,10 @@
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@@ -5073,15 +5073,15 @@
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@@ -5096,10 +5096,10 @@
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@@ -5156,7 +5156,7 @@
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@@ -5169,7 +5169,7 @@
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@@ -5194,10 +5194,10 @@
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@@ -5220,10 +5220,10 @@
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@@ -5254,15 +5254,15 @@
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@@ -5277,10 +5277,10 @@
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@@ -5290,10 +5290,10 @@
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@@ -5303,10 +5303,10 @@
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@@ -5316,10 +5316,10 @@
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@@ -5329,10 +5329,10 @@
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@@ -5342,10 +5342,10 @@
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@@ -5355,10 +5355,10 @@
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@@ -5368,10 +5368,10 @@
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@@ -5381,10 +5381,10 @@
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+        "id": "1729351282548040000.4dbcc4ae-cacc-4c49-9829-659b4748c0ae",
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@@ -5394,10 +5394,10 @@
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+      "fullUrl": "Specimen/1729351282548627000.755d869d-e7c4-4a50-aede-ddae64d77e11",
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+        "id": "1729351282548627000.755d869d-e7c4-4a50-aede-ddae64d77e11",
         "extension": [
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@@ -5407,10 +5407,10 @@
       }
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+      "fullUrl": "Specimen/1729351282549118000.db8226e4-9f3d-4fff-a25f-f863966f27ce",
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@@ -5420,10 +5420,10 @@
       }
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@@ -5433,10 +5433,10 @@
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@@ -5446,10 +5446,10 @@
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@@ -5459,10 +5459,10 @@
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@@ -5624,10 +5624,10 @@
       }
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@@ -5639,13 +5639,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960623165000.8be8ac66-ad4a-473f-8f4f-3db0b8d6c0fd"
+                  "reference": "Organization/1729351282563911000.7da79ebc-9367-4a16-a03c-e0aba4506254"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351282564775000.a7778ae0-25b7-4ef8-b07f-d6aaee63b803"
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@@ -5673,7 +5673,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960625477000.528c68a9-90ed-4b80-b898-20b6997746ba"
+                  "reference": "Practitioner/1729351282566168000.0501f719-6590-4bc6-8875-cb4aed215986"
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@@ -5801,7 +5801,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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+                  "reference": "Practitioner/1729351282568359000.9e07b1e5-51be-460b-ac33-a2ff22fe5391"
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@@ -5883,18 +5883,18 @@
           ]
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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+          "reference": "PractitionerRole/1729351282558229000.7008d5a9-c74a-4979-bca2-91effdfaea83"
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@@ -5909,10 +5909,10 @@
       }
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         "extension": [
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@@ -5964,7 +5964,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729351282558769000.0f09709d-ddd5-4fad-a99b-cde290d8d5fd"
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@@ -5980,10 +5980,10 @@
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         "extension": [
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@@ -6071,23 +6071,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729292960618455000.f527e374-3d9c-4983-8a84-975b3077e1d3",
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       "resource": {
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+        "id": "1729351282558229000.7008d5a9-c74a-4979-bca2-91effdfaea83",
         "practitioner": {
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+          "reference": "Practitioner/1729351282559920000.90b23f9f-39a8-47ce-9825-7b3c77f386f1"
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         "organization": {
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+          "reference": "Organization/1729351282561300000.f68607a8-2a4c-4cac-88e5-871e6edc37ef"
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+        "id": "1729351282563911000.7da79ebc-9367-4a16-a03c-e0aba4506254",
         "extension": [
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@@ -6163,10 +6163,10 @@
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+        "id": "1729351282564775000.a7778ae0-25b7-4ef8-b07f-d6aaee63b803",
         "extension": [
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@@ -6242,10 +6242,10 @@
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+      "fullUrl": "Organization/1729351282565401000.8f3551c5-59ad-459c-b135-8a9fbc41eb25",
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@@ -6260,10 +6260,10 @@
       }
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+      "fullUrl": "Practitioner/1729351282566168000.0501f719-6590-4bc6-8875-cb4aed215986",
       "resource": {
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-        "id": "1729292960625477000.528c68a9-90ed-4b80-b898-20b6997746ba",
+        "id": "1729351282566168000.0501f719-6590-4bc6-8875-cb4aed215986",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6311,7 +6311,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960624652000.7486fe8b-f9cf-4786-8d80-75e9cecf0bf5"
+              "reference": "Organization/1729351282565401000.8f3551c5-59ad-459c-b135-8a9fbc41eb25"
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@@ -6327,10 +6327,10 @@
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+      "fullUrl": "Organization/1729351282567625000.6a75053d-80aa-4478-b631-286f61e38c61",
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@@ -6345,10 +6345,10 @@
       }
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-      "fullUrl": "Practitioner/1729292960627695000.7611cf67-6d5f-4c6d-bf16-f140e0eb5258",
+      "fullUrl": "Practitioner/1729351282568359000.9e07b1e5-51be-460b-ac33-a2ff22fe5391",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960627695000.7611cf67-6d5f-4c6d-bf16-f140e0eb5258",
+        "id": "1729351282568359000.9e07b1e5-51be-460b-ac33-a2ff22fe5391",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6396,7 +6396,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729292960626930000.d3c61374-0a8c-4957-bc66-5280bc552401"
+              "reference": "Organization/1729351282567625000.6a75053d-80aa-4478-b631-286f61e38c61"
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@@ -6412,10 +6412,10 @@
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+        "id": "1729351282573937000.69a5f637-8225-4c84-b82f-ac83287ed445",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -6554,7 +6554,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960632718000.d412c570-6a8f-403e-b049-83dbcfe6c740"
+                  "reference": "Practitioner/1729351282573476000.4b5000a3-da12-449b-a663-951eb0f27f08"
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@@ -6636,18 +6636,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "requester": {
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+          "reference": "Practitioner/1729351282570018000.73539b52-c810-488c-bf56-4c51df9fa350"
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+        "id": "1729351282569118000.b47b6af9-b5dc-4532-a998-8e1836f3dd6d",
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@@ -6662,10 +6662,10 @@
       }
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+      "fullUrl": "Practitioner/1729351282570018000.73539b52-c810-488c-bf56-4c51df9fa350",
       "resource": {
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+        "id": "1729351282570018000.73539b52-c810-488c-bf56-4c51df9fa350",
         "extension": [
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@@ -6717,7 +6717,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351282569118000.b47b6af9-b5dc-4532-a998-8e1836f3dd6d"
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@@ -6733,10 +6733,10 @@
       }
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+      "fullUrl": "Organization/1729351282572754000.6b47d2cd-eea7-4a99-b7c0-14e65d7a0a59",
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@@ -6751,10 +6751,10 @@
       }
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6802,7 +6802,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729292960632011000.b454c336-b01e-41a2-b96b-a91feccdbc46"
+              "reference": "Organization/1729351282572754000.6b47d2cd-eea7-4a99-b7c0-14e65d7a0a59"
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@@ -6818,10 +6818,10 @@
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+      "fullUrl": "ServiceRequest/1729351282584024000.eeb85236-353f-4dd2-bd64-c2ca4600db0e",
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+        "id": "1729351282584024000.eeb85236-353f-4dd2-bd64-c2ca4600db0e",
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -6833,13 +6833,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960644062000.ee0bef0f-963c-490b-b7b9-bef0e9c9f732"
+                  "reference": "Organization/1729351282578540000.f02b579d-1e1d-43a5-a386-7c024bf2b101"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960646154000.6ceb595e-ef18-4669-ac94-6d49a642ea5f"
+                  "reference": "Organization/1729351282579324000.23115e3d-bd74-44c9-b993-4f0486dfac67"
                 }
               },
               {
@@ -6867,7 +6867,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960648895000.3e6bb8b6-10c7-4ecb-af01-341e490d36a0"
+                  "reference": "Practitioner/1729351282580601000.9e4759bd-1e61-4276-a6fe-5f2cb4e98320"
                 }
               }
             ]
@@ -6995,7 +6995,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960653389000.254a44ca-7642-46af-9328-5ec191f85a5b"
+                  "reference": "Practitioner/1729351282583554000.8ced7cb0-7cf3-483c-9b5a-631c63671ca4"
                 }
               }
             ]
@@ -7077,18 +7077,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "requester": {
-          "reference": "PractitionerRole/1729292960633352000.f8168c5b-aeb6-4f30-a7b8-aeb2628e9388"
+          "reference": "PractitionerRole/1729351282574107000.3c3aca8f-58d0-4b0b-a7d4-f6857ea1dd8f"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729292960634221000.d2e9881a-86eb-4bf4-ae57-c23eb2e03aa5",
+      "fullUrl": "Organization/1729351282574306000.0c570a71-055b-4164-8706-60086c771024",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960634221000.d2e9881a-86eb-4bf4-ae57-c23eb2e03aa5",
+        "id": "1729351282574306000.0c570a71-055b-4164-8706-60086c771024",
         "identifier": [
           {
             "extension": [
@@ -7103,10 +7103,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960636616000.b810c101-45d7-41ff-8156-80d766868536",
+      "fullUrl": "Practitioner/1729351282575173000.e3dcad2a-2e7d-4d2f-9855-5f4548ba9e64",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960636616000.b810c101-45d7-41ff-8156-80d766868536",
+        "id": "1729351282575173000.e3dcad2a-2e7d-4d2f-9855-5f4548ba9e64",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7158,7 +7158,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960634221000.d2e9881a-86eb-4bf4-ae57-c23eb2e03aa5"
+              "reference": "Organization/1729351282574306000.0c570a71-055b-4164-8706-60086c771024"
             }
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@@ -7174,10 +7174,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960639378000.430eda78-f03b-459b-a3c1-e3a3f05f2e36",
+      "fullUrl": "Organization/1729351282576474000.7ff6f314-5f62-444e-88ca-dfb7c123d9f8",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960639378000.430eda78-f03b-459b-a3c1-e3a3f05f2e36",
+        "id": "1729351282576474000.7ff6f314-5f62-444e-88ca-dfb7c123d9f8",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7265,23 +7265,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960633352000.f8168c5b-aeb6-4f30-a7b8-aeb2628e9388",
+      "fullUrl": "PractitionerRole/1729351282574107000.3c3aca8f-58d0-4b0b-a7d4-f6857ea1dd8f",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292960633352000.f8168c5b-aeb6-4f30-a7b8-aeb2628e9388",
+        "id": "1729351282574107000.3c3aca8f-58d0-4b0b-a7d4-f6857ea1dd8f",
         "practitioner": {
-          "reference": "Practitioner/1729292960636616000.b810c101-45d7-41ff-8156-80d766868536"
+          "reference": "Practitioner/1729351282575173000.e3dcad2a-2e7d-4d2f-9855-5f4548ba9e64"
         },
         "organization": {
-          "reference": "Organization/1729292960639378000.430eda78-f03b-459b-a3c1-e3a3f05f2e36"
+          "reference": "Organization/1729351282576474000.7ff6f314-5f62-444e-88ca-dfb7c123d9f8"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729292960644062000.ee0bef0f-963c-490b-b7b9-bef0e9c9f732",
+      "fullUrl": "Organization/1729351282578540000.f02b579d-1e1d-43a5-a386-7c024bf2b101",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960644062000.ee0bef0f-963c-490b-b7b9-bef0e9c9f732",
+        "id": "1729351282578540000.f02b579d-1e1d-43a5-a386-7c024bf2b101",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7357,10 +7357,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960646154000.6ceb595e-ef18-4669-ac94-6d49a642ea5f",
+      "fullUrl": "Organization/1729351282579324000.23115e3d-bd74-44c9-b993-4f0486dfac67",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960646154000.6ceb595e-ef18-4669-ac94-6d49a642ea5f",
+        "id": "1729351282579324000.23115e3d-bd74-44c9-b993-4f0486dfac67",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7436,10 +7436,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960647181000.07c1a022-3946-4afc-9db6-bd3d8482719a",
+      "fullUrl": "Organization/1729351282579886000.b6a9c813-1368-4ce3-ad68-2e3cdf3afa35",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960647181000.07c1a022-3946-4afc-9db6-bd3d8482719a",
+        "id": "1729351282579886000.b6a9c813-1368-4ce3-ad68-2e3cdf3afa35",
         "identifier": [
           {
             "extension": [
@@ -7454,10 +7454,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960648895000.3e6bb8b6-10c7-4ecb-af01-341e490d36a0",
+      "fullUrl": "Practitioner/1729351282580601000.9e4759bd-1e61-4276-a6fe-5f2cb4e98320",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960648895000.3e6bb8b6-10c7-4ecb-af01-341e490d36a0",
+        "id": "1729351282580601000.9e4759bd-1e61-4276-a6fe-5f2cb4e98320",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7505,7 +7505,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960647181000.07c1a022-3946-4afc-9db6-bd3d8482719a"
+              "reference": "Organization/1729351282579886000.b6a9c813-1368-4ce3-ad68-2e3cdf3afa35"
             }
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@@ -7521,10 +7521,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960652123000.dd28922e-6608-4c9f-9f8c-ae02135a8302",
+      "fullUrl": "Organization/1729351282582834000.f89a7000-ba24-4775-9fc7-2a0b82855873",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960652123000.dd28922e-6608-4c9f-9f8c-ae02135a8302",
+        "id": "1729351282582834000.f89a7000-ba24-4775-9fc7-2a0b82855873",
         "identifier": [
           {
             "extension": [
@@ -7539,10 +7539,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960653389000.254a44ca-7642-46af-9328-5ec191f85a5b",
+      "fullUrl": "Practitioner/1729351282583554000.8ced7cb0-7cf3-483c-9b5a-631c63671ca4",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960653389000.254a44ca-7642-46af-9328-5ec191f85a5b",
+        "id": "1729351282583554000.8ced7cb0-7cf3-483c-9b5a-631c63671ca4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7590,7 +7590,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960652123000.dd28922e-6608-4c9f-9f8c-ae02135a8302"
+              "reference": "Organization/1729351282582834000.f89a7000-ba24-4775-9fc7-2a0b82855873"
             }
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@@ -7606,10 +7606,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729292960663026000.c4fe6d84-8031-489e-ade3-b682c2843335",
+      "fullUrl": "ServiceRequest/1729351282592913000.21f790c8-0d3d-4ba6-82e2-ff366d24058e",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729292960663026000.c4fe6d84-8031-489e-ade3-b682c2843335",
+        "id": "1729351282592913000.21f790c8-0d3d-4ba6-82e2-ff366d24058e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -7621,13 +7621,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960658447000.ce47b803-a80d-4db7-927f-2731e24802a7"
+                  "reference": "Organization/1729351282588469000.d152cd08-af52-4997-9b97-f5aae58ca613"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960659235000.fcfe63ee-a3e0-40cf-b8a4-cf2e9d4a0d60"
+                  "reference": "Organization/1729351282589218000.2e1ce613-9962-4ea5-b3ee-ab7a02dbe4f9"
                 }
               },
               {
@@ -7655,7 +7655,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960660482000.ce0addce-129b-499b-a39b-b5833ce5741f"
+                  "reference": "Practitioner/1729351282590455000.32d424ea-0eca-44b3-b7d2-9b9c80fb675e"
                 }
               }
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@@ -7783,7 +7783,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960662563000.3c8a8055-249e-43a2-b99d-f9e4309bcc7f"
+                  "reference": "Practitioner/1729351282592455000.42c90818-03f1-4adc-858d-afd0253f1861"
                 }
               }
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@@ -7865,18 +7865,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "requester": {
-          "reference": "PractitionerRole/1729292960654026000.11356f86-e6f6-4b78-8e7c-a2ec8b7f5f9c"
+          "reference": "PractitionerRole/1729351282584182000.a9a046af-e5ec-4a1e-91b7-97642b126581"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729292960654235000.4b9893f2-42cc-49ab-8e5c-e1d362d4a9c6",
+      "fullUrl": "Organization/1729351282584378000.c8f36209-be17-42ca-9ac7-2e4b95547218",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960654235000.4b9893f2-42cc-49ab-8e5c-e1d362d4a9c6",
+        "id": "1729351282584378000.c8f36209-be17-42ca-9ac7-2e4b95547218",
         "identifier": [
           {
             "extension": [
@@ -7891,10 +7891,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960655123000.01cb178b-c33e-44a0-a0b0-2690b7e9b219",
+      "fullUrl": "Practitioner/1729351282585236000.84f3b21b-b4ca-41d3-bd9a-140f8f36d63e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960655123000.01cb178b-c33e-44a0-a0b0-2690b7e9b219",
+        "id": "1729351282585236000.84f3b21b-b4ca-41d3-bd9a-140f8f36d63e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7946,7 +7946,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960654235000.4b9893f2-42cc-49ab-8e5c-e1d362d4a9c6"
+              "reference": "Organization/1729351282584378000.c8f36209-be17-42ca-9ac7-2e4b95547218"
             }
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@@ -7962,10 +7962,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960656410000.33f861e6-988f-4b3e-be8b-5d12f71172c9",
+      "fullUrl": "Organization/1729351282586463000.96b11376-37ae-4f93-9f3d-c4c3ad6fe4a6",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960656410000.33f861e6-988f-4b3e-be8b-5d12f71172c9",
+        "id": "1729351282586463000.96b11376-37ae-4f93-9f3d-c4c3ad6fe4a6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8053,23 +8053,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960654026000.11356f86-e6f6-4b78-8e7c-a2ec8b7f5f9c",
+      "fullUrl": "PractitionerRole/1729351282584182000.a9a046af-e5ec-4a1e-91b7-97642b126581",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292960654026000.11356f86-e6f6-4b78-8e7c-a2ec8b7f5f9c",
+        "id": "1729351282584182000.a9a046af-e5ec-4a1e-91b7-97642b126581",
         "practitioner": {
-          "reference": "Practitioner/1729292960655123000.01cb178b-c33e-44a0-a0b0-2690b7e9b219"
+          "reference": "Practitioner/1729351282585236000.84f3b21b-b4ca-41d3-bd9a-140f8f36d63e"
         },
         "organization": {
-          "reference": "Organization/1729292960656410000.33f861e6-988f-4b3e-be8b-5d12f71172c9"
+          "reference": "Organization/1729351282586463000.96b11376-37ae-4f93-9f3d-c4c3ad6fe4a6"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729292960658447000.ce47b803-a80d-4db7-927f-2731e24802a7",
+      "fullUrl": "Organization/1729351282588469000.d152cd08-af52-4997-9b97-f5aae58ca613",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960658447000.ce47b803-a80d-4db7-927f-2731e24802a7",
+        "id": "1729351282588469000.d152cd08-af52-4997-9b97-f5aae58ca613",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8145,10 +8145,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960659235000.fcfe63ee-a3e0-40cf-b8a4-cf2e9d4a0d60",
+      "fullUrl": "Organization/1729351282589218000.2e1ce613-9962-4ea5-b3ee-ab7a02dbe4f9",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960659235000.fcfe63ee-a3e0-40cf-b8a4-cf2e9d4a0d60",
+        "id": "1729351282589218000.2e1ce613-9962-4ea5-b3ee-ab7a02dbe4f9",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8224,10 +8224,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960659760000.aa4e6bb7-8d14-4d67-bb6c-f0ac433e3658",
+      "fullUrl": "Organization/1729351282589728000.5a0f8969-896e-4698-a6ae-0916750ad11b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960659760000.aa4e6bb7-8d14-4d67-bb6c-f0ac433e3658",
+        "id": "1729351282589728000.5a0f8969-896e-4698-a6ae-0916750ad11b",
         "identifier": [
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@@ -8242,10 +8242,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960660482000.ce0addce-129b-499b-a39b-b5833ce5741f",
+      "fullUrl": "Practitioner/1729351282590455000.32d424ea-0eca-44b3-b7d2-9b9c80fb675e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960660482000.ce0addce-129b-499b-a39b-b5833ce5741f",
+        "id": "1729351282590455000.32d424ea-0eca-44b3-b7d2-9b9c80fb675e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8293,7 +8293,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960659760000.aa4e6bb7-8d14-4d67-bb6c-f0ac433e3658"
+              "reference": "Organization/1729351282589728000.5a0f8969-896e-4698-a6ae-0916750ad11b"
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@@ -8309,10 +8309,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960661820000.d2c0e170-f671-48b7-bf83-435d4eaad804",
+      "fullUrl": "Organization/1729351282591734000.7d15a934-d3d5-4703-8c0c-e305a3056728",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960661820000.d2c0e170-f671-48b7-bf83-435d4eaad804",
+        "id": "1729351282591734000.7d15a934-d3d5-4703-8c0c-e305a3056728",
         "identifier": [
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@@ -8327,10 +8327,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960662563000.3c8a8055-249e-43a2-b99d-f9e4309bcc7f",
+      "fullUrl": "Practitioner/1729351282592455000.42c90818-03f1-4adc-858d-afd0253f1861",
       "resource": {
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-        "id": "1729292960662563000.3c8a8055-249e-43a2-b99d-f9e4309bcc7f",
+        "id": "1729351282592455000.42c90818-03f1-4adc-858d-afd0253f1861",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8378,7 +8378,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960661820000.d2c0e170-f671-48b7-bf83-435d4eaad804"
+              "reference": "Organization/1729351282591734000.7d15a934-d3d5-4703-8c0c-e305a3056728"
             }
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@@ -8394,10 +8394,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729292960672182000.692679e3-c71d-4470-afa9-1c870df8dc6b",
+      "fullUrl": "ServiceRequest/1729351282601632000.b401d3e6-297f-4c53-8ba7-31d8ccbf9c23",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729292960672182000.692679e3-c71d-4470-afa9-1c870df8dc6b",
+        "id": "1729351282601632000.b401d3e6-297f-4c53-8ba7-31d8ccbf9c23",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -8409,13 +8409,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960667574000.a717c454-1517-451e-8e02-d71f1f6e7343"
+                  "reference": "Organization/1729351282597206000.3c04f9a8-87be-4a9d-9d22-318950e56d42"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960668376000.5d1b8e5d-2812-4b42-87e9-6deb597ced2b"
+                  "reference": "Organization/1729351282597987000.c66510a6-d5bf-4525-9305-05536f24312c"
                 }
               },
               {
@@ -8443,7 +8443,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960669623000.d0a7fdaa-4855-4614-9ebb-9d0f677b8f0b"
+                  "reference": "Practitioner/1729351282599191000.b2a2824b-ba87-4b6d-85cd-8b6beeae5051"
                 }
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@@ -8571,7 +8571,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960671710000.9e7090f4-fe47-4c04-8a15-8a0cde2ad273"
+                  "reference": "Practitioner/1729351282601169000.928187dd-22cb-488b-acee-9846e233eb0e"
                 }
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@@ -8653,18 +8653,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "requester": {
-          "reference": "PractitionerRole/1729292960663186000.31ed98c7-b2d2-4e5f-9a0f-ea6f08f23724"
+          "reference": "PractitionerRole/1729351282593070000.0ab4e3b2-333d-40ab-917e-94e44ec61209"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729292960663382000.90256941-ef52-4949-9c49-ffbccbb56945",
+      "fullUrl": "Organization/1729351282593260000.d7dc6b66-ee49-4b64-978f-05b40cee6046",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960663382000.90256941-ef52-4949-9c49-ffbccbb56945",
+        "id": "1729351282593260000.d7dc6b66-ee49-4b64-978f-05b40cee6046",
         "identifier": [
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@@ -8679,10 +8679,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960664299000.a8b83a0c-b962-4f23-8813-820ed13bf35a",
+      "fullUrl": "Practitioner/1729351282594080000.ccb317e5-3078-49da-a981-34b915611c47",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960664299000.a8b83a0c-b962-4f23-8813-820ed13bf35a",
+        "id": "1729351282594080000.ccb317e5-3078-49da-a981-34b915611c47",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8734,7 +8734,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960663382000.90256941-ef52-4949-9c49-ffbccbb56945"
+              "reference": "Organization/1729351282593260000.d7dc6b66-ee49-4b64-978f-05b40cee6046"
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@@ -8750,10 +8750,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960665549000.8ad32f5e-8b4b-4e61-afc5-8f0ad7223058",
+      "fullUrl": "Organization/1729351282595270000.3f215b18-d852-46a1-a2e8-8d8be159cec9",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960665549000.8ad32f5e-8b4b-4e61-afc5-8f0ad7223058",
+        "id": "1729351282595270000.3f215b18-d852-46a1-a2e8-8d8be159cec9",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8841,23 +8841,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960663186000.31ed98c7-b2d2-4e5f-9a0f-ea6f08f23724",
+      "fullUrl": "PractitionerRole/1729351282593070000.0ab4e3b2-333d-40ab-917e-94e44ec61209",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292960663186000.31ed98c7-b2d2-4e5f-9a0f-ea6f08f23724",
+        "id": "1729351282593070000.0ab4e3b2-333d-40ab-917e-94e44ec61209",
         "practitioner": {
-          "reference": "Practitioner/1729292960664299000.a8b83a0c-b962-4f23-8813-820ed13bf35a"
+          "reference": "Practitioner/1729351282594080000.ccb317e5-3078-49da-a981-34b915611c47"
         },
         "organization": {
-          "reference": "Organization/1729292960665549000.8ad32f5e-8b4b-4e61-afc5-8f0ad7223058"
+          "reference": "Organization/1729351282595270000.3f215b18-d852-46a1-a2e8-8d8be159cec9"
         }
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     },
     {
-      "fullUrl": "Organization/1729292960667574000.a717c454-1517-451e-8e02-d71f1f6e7343",
+      "fullUrl": "Organization/1729351282597206000.3c04f9a8-87be-4a9d-9d22-318950e56d42",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960667574000.a717c454-1517-451e-8e02-d71f1f6e7343",
+        "id": "1729351282597206000.3c04f9a8-87be-4a9d-9d22-318950e56d42",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8933,10 +8933,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960668376000.5d1b8e5d-2812-4b42-87e9-6deb597ced2b",
+      "fullUrl": "Organization/1729351282597987000.c66510a6-d5bf-4525-9305-05536f24312c",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960668376000.5d1b8e5d-2812-4b42-87e9-6deb597ced2b",
+        "id": "1729351282597987000.c66510a6-d5bf-4525-9305-05536f24312c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9012,10 +9012,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960668901000.6898a5da-09ba-4a46-a45f-26ddcf703701",
+      "fullUrl": "Organization/1729351282598501000.33a4e43d-0a8c-43a4-9d56-5f04eacd38c9",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960668901000.6898a5da-09ba-4a46-a45f-26ddcf703701",
+        "id": "1729351282598501000.33a4e43d-0a8c-43a4-9d56-5f04eacd38c9",
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@@ -9030,10 +9030,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960669623000.d0a7fdaa-4855-4614-9ebb-9d0f677b8f0b",
+      "fullUrl": "Practitioner/1729351282599191000.b2a2824b-ba87-4b6d-85cd-8b6beeae5051",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960669623000.d0a7fdaa-4855-4614-9ebb-9d0f677b8f0b",
+        "id": "1729351282599191000.b2a2824b-ba87-4b6d-85cd-8b6beeae5051",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9081,7 +9081,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960668901000.6898a5da-09ba-4a46-a45f-26ddcf703701"
+              "reference": "Organization/1729351282598501000.33a4e43d-0a8c-43a4-9d56-5f04eacd38c9"
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@@ -9097,10 +9097,10 @@
       }
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     {
-      "fullUrl": "Organization/1729292960670972000.9f5d5cbb-393b-4bc7-b546-c933dfb1f897",
+      "fullUrl": "Organization/1729351282600463000.8e856b14-b606-47b6-b29d-a44abb6c3e5f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960670972000.9f5d5cbb-393b-4bc7-b546-c933dfb1f897",
+        "id": "1729351282600463000.8e856b14-b606-47b6-b29d-a44abb6c3e5f",
         "identifier": [
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@@ -9115,10 +9115,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960671710000.9e7090f4-fe47-4c04-8a15-8a0cde2ad273",
+      "fullUrl": "Practitioner/1729351282601169000.928187dd-22cb-488b-acee-9846e233eb0e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960671710000.9e7090f4-fe47-4c04-8a15-8a0cde2ad273",
+        "id": "1729351282601169000.928187dd-22cb-488b-acee-9846e233eb0e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9166,7 +9166,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960670972000.9f5d5cbb-393b-4bc7-b546-c933dfb1f897"
+              "reference": "Organization/1729351282600463000.8e856b14-b606-47b6-b29d-a44abb6c3e5f"
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@@ -9182,10 +9182,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729292960681341000.f623864e-c40e-4a1f-8475-c86923839ea8",
+      "fullUrl": "ServiceRequest/1729351282610493000.da07e6c0-a832-4e3f-926d-9aa07e66810a",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729292960681341000.f623864e-c40e-4a1f-8475-c86923839ea8",
+        "id": "1729351282610493000.da07e6c0-a832-4e3f-926d-9aa07e66810a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -9197,13 +9197,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960676723000.68b10456-e9d1-4d29-a557-2a1d8fd9c77f"
+                  "reference": "Organization/1729351282606025000.ee0d11e5-80aa-4e4a-bc91-cd71f21a4ee4"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960677540000.071d7d82-47d2-4bf1-b33e-fde4330ea62d"
+                  "reference": "Organization/1729351282606806000.8ba32df0-0ee5-487d-9e47-60e4757d4a97"
                 }
               },
               {
@@ -9231,7 +9231,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960678797000.eb4eb268-7147-4173-88d7-3487ff6b92f2"
+                  "reference": "Practitioner/1729351282608007000.2e48ece5-fd98-4af2-8bff-00826cd0dc87"
                 }
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@@ -9359,7 +9359,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960680876000.192a3414-1213-483a-b93f-064bcb5fc619"
+                  "reference": "Practitioner/1729351282610027000.b30cde50-d638-4f6b-9404-095d70a54dfb"
                 }
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@@ -9441,18 +9441,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "requester": {
-          "reference": "PractitionerRole/1729292960672340000.fa7b38fe-9cc3-4773-98c8-0c954904e1d8"
+          "reference": "PractitionerRole/1729351282601795000.25da09f6-c201-4423-987d-95a138f8e84d"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729292960672538000.4b34062c-355d-4567-a587-28f7653b3d82",
+      "fullUrl": "Organization/1729351282601986000.f18e6ff3-3067-456c-adb5-1d525da21af4",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960672538000.4b34062c-355d-4567-a587-28f7653b3d82",
+        "id": "1729351282601986000.f18e6ff3-3067-456c-adb5-1d525da21af4",
         "identifier": [
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@@ -9467,10 +9467,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960673397000.83f711b2-e8e7-4f7f-8b7a-0e76c894d3fd",
+      "fullUrl": "Practitioner/1729351282602844000.0b01dd2c-b0e3-4438-bb6b-c8b310d34819",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960673397000.83f711b2-e8e7-4f7f-8b7a-0e76c894d3fd",
+        "id": "1729351282602844000.0b01dd2c-b0e3-4438-bb6b-c8b310d34819",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9522,7 +9522,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960672538000.4b34062c-355d-4567-a587-28f7653b3d82"
+              "reference": "Organization/1729351282601986000.f18e6ff3-3067-456c-adb5-1d525da21af4"
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@@ -9538,10 +9538,10 @@
       }
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     {
-      "fullUrl": "Organization/1729292960674678000.ac8751f8-c776-4c9a-bd5b-f4e3c360d22c",
+      "fullUrl": "Organization/1729351282604092000.fbb8c496-654b-440f-912e-a54f8cfdff1f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960674678000.ac8751f8-c776-4c9a-bd5b-f4e3c360d22c",
+        "id": "1729351282604092000.fbb8c496-654b-440f-912e-a54f8cfdff1f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9629,23 +9629,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960672340000.fa7b38fe-9cc3-4773-98c8-0c954904e1d8",
+      "fullUrl": "PractitionerRole/1729351282601795000.25da09f6-c201-4423-987d-95a138f8e84d",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292960672340000.fa7b38fe-9cc3-4773-98c8-0c954904e1d8",
+        "id": "1729351282601795000.25da09f6-c201-4423-987d-95a138f8e84d",
         "practitioner": {
-          "reference": "Practitioner/1729292960673397000.83f711b2-e8e7-4f7f-8b7a-0e76c894d3fd"
+          "reference": "Practitioner/1729351282602844000.0b01dd2c-b0e3-4438-bb6b-c8b310d34819"
         },
         "organization": {
-          "reference": "Organization/1729292960674678000.ac8751f8-c776-4c9a-bd5b-f4e3c360d22c"
+          "reference": "Organization/1729351282604092000.fbb8c496-654b-440f-912e-a54f8cfdff1f"
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     {
-      "fullUrl": "Organization/1729292960676723000.68b10456-e9d1-4d29-a557-2a1d8fd9c77f",
+      "fullUrl": "Organization/1729351282606025000.ee0d11e5-80aa-4e4a-bc91-cd71f21a4ee4",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960676723000.68b10456-e9d1-4d29-a557-2a1d8fd9c77f",
+        "id": "1729351282606025000.ee0d11e5-80aa-4e4a-bc91-cd71f21a4ee4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9721,10 +9721,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960677540000.071d7d82-47d2-4bf1-b33e-fde4330ea62d",
+      "fullUrl": "Organization/1729351282606806000.8ba32df0-0ee5-487d-9e47-60e4757d4a97",
       "resource": {
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-        "id": "1729292960677540000.071d7d82-47d2-4bf1-b33e-fde4330ea62d",
+        "id": "1729351282606806000.8ba32df0-0ee5-487d-9e47-60e4757d4a97",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9800,10 +9800,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960678071000.077225e3-de2c-4281-ace8-0bbf2a0124a8",
+      "fullUrl": "Organization/1729351282607316000.4344244f-02b8-491f-8721-fcfba19c2e69",
       "resource": {
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+        "id": "1729351282607316000.4344244f-02b8-491f-8721-fcfba19c2e69",
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@@ -9818,10 +9818,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960678797000.eb4eb268-7147-4173-88d7-3487ff6b92f2",
+      "fullUrl": "Practitioner/1729351282608007000.2e48ece5-fd98-4af2-8bff-00826cd0dc87",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960678797000.eb4eb268-7147-4173-88d7-3487ff6b92f2",
+        "id": "1729351282608007000.2e48ece5-fd98-4af2-8bff-00826cd0dc87",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9869,7 +9869,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960678071000.077225e3-de2c-4281-ace8-0bbf2a0124a8"
+              "reference": "Organization/1729351282607316000.4344244f-02b8-491f-8721-fcfba19c2e69"
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@@ -9885,10 +9885,10 @@
       }
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-      "fullUrl": "Organization/1729292960680135000.e2f1e78c-e629-43bd-ad51-95aed5bd0db7",
+      "fullUrl": "Organization/1729351282609331000.7dc6ab92-4794-4556-aa60-29eead122cef",
       "resource": {
         "resourceType": "Organization",
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@@ -9903,10 +9903,10 @@
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@@ -9954,7 +9954,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351282609331000.7dc6ab92-4794-4556-aa60-29eead122cef"
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@@ -9970,10 +9970,10 @@
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@@ -9985,13 +9985,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960685879000.61bde7c5-2846-4186-89d8-aa8a8c70a0f1"
+                  "reference": "Organization/1729351282614928000.248a1d6b-c846-44ae-8017-c7d5e1777edf"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351282615728000.11ee4ccc-727e-4a38-9d4d-7bde63195b39"
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@@ -10019,7 +10019,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960688008000.2b9bd956-e2fd-45b3-8e25-85a4cb4b4729"
+                  "reference": "Practitioner/1729351282616958000.275815df-df12-469c-a6a9-9cb78c76b984"
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@@ -10147,7 +10147,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729351282618976000.95ad05dd-c4a7-4b5e-9eed-a16d1f957058"
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@@ -10229,18 +10229,18 @@
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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@@ -10255,10 +10255,10 @@
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@@ -10310,7 +10310,7 @@
             },
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             "assigner": {
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@@ -10326,10 +10326,10 @@
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@@ -10417,23 +10417,23 @@
       }
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       "resource": {
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@@ -10509,10 +10509,10 @@
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         "extension": [
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@@ -10588,10 +10588,10 @@
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@@ -10606,10 +10606,10 @@
       }
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@@ -10657,7 +10657,7 @@
             },
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             "assigner": {
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@@ -10673,10 +10673,10 @@
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@@ -10691,10 +10691,10 @@
       }
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         "extension": [
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@@ -10742,7 +10742,7 @@
             },
             "value": "1174911127",
             "assigner": {
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@@ -10758,10 +10758,10 @@
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       "resource": {
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@@ -10773,13 +10773,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960699590000.0416e952-5bc9-49d5-b646-67d8bf22cdbf"
+                  "reference": "Organization/1729351282623870000.baaec27e-ad81-4fc8-b89d-604bf2dc77d4"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351282624666000.32981889-05b6-4883-8475-e0c287fa931d"
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@@ -10807,7 +10807,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960704604000.b69ea163-9a7c-45f6-8b2c-a8e86056d247"
+                  "reference": "Practitioner/1729351282625886000.95458a50-2bff-4e6e-8acd-c2b713906c54"
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@@ -10935,7 +10935,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960709449000.ffeaf742-007d-4eac-983e-a4331f0a323b"
+                  "reference": "Practitioner/1729351282627866000.830a6c1e-b160-4b27-add7-9f54df134631"
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@@ -11017,18 +11017,18 @@
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         "subject": {
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "requester": {
-          "reference": "PractitionerRole/1729292960690644000.56b9e829-b0e3-449d-be87-4b0244fd9308"
+          "reference": "PractitionerRole/1729351282619602000.89013f5f-bd25-4dbc-939a-2b64ff8ce7b2"
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@@ -11043,10 +11043,10 @@
       }
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+      "fullUrl": "Practitioner/1729351282620625000.63568ee3-aad7-4c8e-aa13-79a159f94422",
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         "extension": [
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@@ -11098,7 +11098,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960690840000.f8066797-dbdf-42e3-bf22-fb17e2fbf699"
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@@ -11114,10 +11114,10 @@
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@@ -11205,23 +11205,23 @@
       }
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+          "reference": "Practitioner/1729351282620625000.63568ee3-aad7-4c8e-aa13-79a159f94422"
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+          "reference": "Organization/1729351282621898000.f080b388-78f2-4170-ad0a-5b3750836c7e"
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@@ -11297,10 +11297,10 @@
       }
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@@ -11376,10 +11376,10 @@
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@@ -11394,10 +11394,10 @@
       }
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+      "fullUrl": "Practitioner/1729351282625886000.95458a50-2bff-4e6e-8acd-c2b713906c54",
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@@ -11445,7 +11445,7 @@
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+              "reference": "Organization/1729351282625184000.333229da-b32f-42c1-9445-b2c454849c2a"
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@@ -11461,10 +11461,10 @@
       }
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+      "fullUrl": "Organization/1729351282627165000.9fe93648-0e1a-4336-807b-87fcae0d05fa",
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+        "id": "1729351282627165000.9fe93648-0e1a-4336-807b-87fcae0d05fa",
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@@ -11479,10 +11479,10 @@
       }
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+      "fullUrl": "Practitioner/1729351282627866000.830a6c1e-b160-4b27-add7-9f54df134631",
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+        "id": "1729351282627866000.830a6c1e-b160-4b27-add7-9f54df134631",
         "extension": [
           {
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@@ -11530,7 +11530,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960707863000.beabade2-6da5-40ff-81b2-86e924d77d31"
+              "reference": "Organization/1729351282627165000.9fe93648-0e1a-4336-807b-87fcae0d05fa"
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@@ -11546,10 +11546,10 @@
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       "resource": {
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -11561,13 +11561,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960715024000.29fb6c13-8a1c-49d7-8264-659f7537758b"
+                  "reference": "Organization/1729351282632715000.d12f2d6c-5107-4e26-8b65-7eb6eac94c0e"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960715820000.b388cd49-7a5c-4631-b59f-6120485973a8"
+                  "reference": "Organization/1729351282633482000.7b1b680d-e773-4798-95f2-cd5e89a946b5"
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@@ -11595,7 +11595,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960717088000.2e90e0cf-340c-4591-b0ca-efffadc0cf99"
+                  "reference": "Practitioner/1729351282634718000.9e129482-1f82-4e7a-b81b-be3b35c32406"
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@@ -11723,7 +11723,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960719166000.7349a0df-d936-4503-9418-96ce2b1eb211"
+                  "reference": "Practitioner/1729351282638256000.4c88e211-fed3-492e-b7f5-92ccd56004a2"
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@@ -11805,18 +11805,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "requester": {
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+          "reference": "PractitionerRole/1729351282628495000.0351bcc4-bb41-4b83-a064-ba548d2940f1"
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@@ -11831,10 +11831,10 @@
       }
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         "extension": [
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@@ -11886,7 +11886,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729292960710774000.17ae4d1e-b7c8-476d-b319-d9dfa75cc8f3"
+              "reference": "Organization/1729351282628687000.a8f75bbd-a7a9-46da-8ae0-9f358475cf5d"
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@@ -11902,10 +11902,10 @@
       }
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       "resource": {
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+        "id": "1729351282630743000.90540bdf-d0d5-465f-83e9-aacd18f637e3",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11993,23 +11993,23 @@
       }
     },
     {
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+      "fullUrl": "PractitionerRole/1729351282628495000.0351bcc4-bb41-4b83-a064-ba548d2940f1",
       "resource": {
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-        "id": "1729292960710573000.75dc770a-65e5-4101-8fb7-238ce53d040c",
+        "id": "1729351282628495000.0351bcc4-bb41-4b83-a064-ba548d2940f1",
         "practitioner": {
-          "reference": "Practitioner/1729292960711629000.210a5d4a-af01-4de3-a3a5-2bc72e5a2314"
+          "reference": "Practitioner/1729351282629538000.7434bf1f-59e8-43be-8615-4f1b54ba64cf"
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         "organization": {
-          "reference": "Organization/1729292960712897000.4fa804f9-fe3a-48f4-92b0-ba3959aaac37"
+          "reference": "Organization/1729351282630743000.90540bdf-d0d5-465f-83e9-aacd18f637e3"
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-      "fullUrl": "Organization/1729292960715024000.29fb6c13-8a1c-49d7-8264-659f7537758b",
+      "fullUrl": "Organization/1729351282632715000.d12f2d6c-5107-4e26-8b65-7eb6eac94c0e",
       "resource": {
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-        "id": "1729292960715024000.29fb6c13-8a1c-49d7-8264-659f7537758b",
+        "id": "1729351282632715000.d12f2d6c-5107-4e26-8b65-7eb6eac94c0e",
         "extension": [
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@@ -12085,10 +12085,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960715820000.b388cd49-7a5c-4631-b59f-6120485973a8",
+      "fullUrl": "Organization/1729351282633482000.7b1b680d-e773-4798-95f2-cd5e89a946b5",
       "resource": {
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+        "id": "1729351282633482000.7b1b680d-e773-4798-95f2-cd5e89a946b5",
         "extension": [
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@@ -12164,10 +12164,10 @@
       }
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-      "fullUrl": "Organization/1729292960716359000.120b1f97-4b41-48b7-8454-a3d1a61ac1b1",
+      "fullUrl": "Organization/1729351282634009000.f99099e9-2d41-4288-8bcf-2b1ec20a733a",
       "resource": {
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+        "id": "1729351282634009000.f99099e9-2d41-4288-8bcf-2b1ec20a733a",
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@@ -12182,10 +12182,10 @@
       }
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-      "fullUrl": "Practitioner/1729292960717088000.2e90e0cf-340c-4591-b0ca-efffadc0cf99",
+      "fullUrl": "Practitioner/1729351282634718000.9e129482-1f82-4e7a-b81b-be3b35c32406",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960717088000.2e90e0cf-340c-4591-b0ca-efffadc0cf99",
+        "id": "1729351282634718000.9e129482-1f82-4e7a-b81b-be3b35c32406",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12233,7 +12233,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960716359000.120b1f97-4b41-48b7-8454-a3d1a61ac1b1"
+              "reference": "Organization/1729351282634009000.f99099e9-2d41-4288-8bcf-2b1ec20a733a"
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@@ -12249,10 +12249,10 @@
       }
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-      "fullUrl": "Organization/1729292960718429000.7c3bb40d-ca3e-490c-8901-d239cc745fac",
+      "fullUrl": "Organization/1729351282636025000.39c53e03-5887-4df4-a7de-da01d83f0786",
       "resource": {
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-        "id": "1729292960718429000.7c3bb40d-ca3e-490c-8901-d239cc745fac",
+        "id": "1729351282636025000.39c53e03-5887-4df4-a7de-da01d83f0786",
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@@ -12267,10 +12267,10 @@
       }
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     {
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+      "fullUrl": "Practitioner/1729351282638256000.4c88e211-fed3-492e-b7f5-92ccd56004a2",
       "resource": {
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-        "id": "1729292960719166000.7349a0df-d936-4503-9418-96ce2b1eb211",
+        "id": "1729351282638256000.4c88e211-fed3-492e-b7f5-92ccd56004a2",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12318,7 +12318,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960718429000.7c3bb40d-ca3e-490c-8901-d239cc745fac"
+              "reference": "Organization/1729351282636025000.39c53e03-5887-4df4-a7de-da01d83f0786"
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@@ -12334,10 +12334,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729351282655731000.527b6a72-3f4b-4eef-b198-10b3371d294c",
       "resource": {
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-        "id": "1729292960728779000.9585689a-a3bd-45ba-aed7-e46c1bf05ab4",
+        "id": "1729351282655731000.527b6a72-3f4b-4eef-b198-10b3371d294c",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -12349,13 +12349,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960724164000.4d08a169-acee-4491-b9c4-d6ef5713bc51"
+                  "reference": "Organization/1729351282650384000.f9db98c1-bf1c-4070-9a47-21debd77c830"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960724962000.d642a06e-02f4-4c35-9eb3-973bfa485e7b"
+                  "reference": "Organization/1729351282652055000.625dce7b-9cf0-435b-a510-40b6bdef88f2"
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@@ -12383,7 +12383,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960726209000.b4e9d8a6-1c93-4b16-a19f-e684f2c533e0"
+                  "reference": "Practitioner/1729351282653286000.f1d9e3fe-19fe-407e-b9de-5119dd3636f8"
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@@ -12511,7 +12511,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960728283000.039583d8-9c2d-4d25-9aef-aeb79974d891"
+                  "reference": "Practitioner/1729351282655280000.80c896d1-9407-4f0d-b70b-232214a31d83"
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@@ -12593,18 +12593,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "requester": {
-          "reference": "PractitionerRole/1729292960719820000.26992ee4-b509-425b-877c-fdb7acc680e3"
+          "reference": "PractitionerRole/1729351282639512000.95d2889e-0f37-451e-b8a3-bfad8decaaa8"
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-      "fullUrl": "Organization/1729292960720014000.4d35d12e-53b3-4c08-a049-9998fa8aca24",
+      "fullUrl": "Organization/1729351282639828000.db96b239-8329-485a-bb1f-9090315a8e6d",
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-        "id": "1729292960720014000.4d35d12e-53b3-4c08-a049-9998fa8aca24",
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@@ -12619,10 +12619,10 @@
       }
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+      "fullUrl": "Practitioner/1729351282642324000.eb9fd4ac-1eed-41df-923c-152ad6b94944",
       "resource": {
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         "extension": [
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@@ -12674,7 +12674,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729292960720014000.4d35d12e-53b3-4c08-a049-9998fa8aca24"
+              "reference": "Organization/1729351282639828000.db96b239-8329-485a-bb1f-9090315a8e6d"
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@@ -12690,10 +12690,10 @@
       }
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-      "fullUrl": "Organization/1729292960722144000.928c96c2-0352-4d01-9a2f-3fcc9b965bd0",
+      "fullUrl": "Organization/1729351282646007000.c38140ff-0019-40e3-8cf3-bb254748dfd8",
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         "extension": [
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@@ -12781,23 +12781,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960719820000.26992ee4-b509-425b-877c-fdb7acc680e3",
+      "fullUrl": "PractitionerRole/1729351282639512000.95d2889e-0f37-451e-b8a3-bfad8decaaa8",
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-        "id": "1729292960719820000.26992ee4-b509-425b-877c-fdb7acc680e3",
+        "id": "1729351282639512000.95d2889e-0f37-451e-b8a3-bfad8decaaa8",
         "practitioner": {
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+          "reference": "Practitioner/1729351282642324000.eb9fd4ac-1eed-41df-923c-152ad6b94944"
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         "organization": {
-          "reference": "Organization/1729292960722144000.928c96c2-0352-4d01-9a2f-3fcc9b965bd0"
+          "reference": "Organization/1729351282646007000.c38140ff-0019-40e3-8cf3-bb254748dfd8"
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         "extension": [
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@@ -12873,10 +12873,10 @@
       }
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         "extension": [
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@@ -12952,10 +12952,10 @@
       }
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-      "fullUrl": "Organization/1729292960725493000.f8f2d992-a1df-4434-96b3-6ce6eede09ab",
+      "fullUrl": "Organization/1729351282652577000.a83893c0-1da2-476b-a1fc-7a93dfd2fe99",
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@@ -12970,10 +12970,10 @@
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@@ -13021,7 +13021,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351282652577000.a83893c0-1da2-476b-a1fc-7a93dfd2fe99"
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@@ -13037,10 +13037,10 @@
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@@ -13055,10 +13055,10 @@
       }
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@@ -13106,7 +13106,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960727553000.9efffa41-d609-4bb9-9633-f8364977c02d"
+              "reference": "Organization/1729351282654573000.50ac200d-8cbb-4362-b3c4-baafe8717ab0"
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@@ -13122,10 +13122,10 @@
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -13137,13 +13137,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960733317000.ec556131-9f9a-4f4b-8f04-3501d5a23525"
+                  "reference": "Organization/1729351282660161000.725890bf-618b-4b74-934d-3ca558dee474"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351282660933000.0d58ef48-e360-49ea-8fdc-0607db9d3e2f"
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@@ -13171,7 +13171,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960735421000.e7e04ed9-7def-448e-a043-4822bd035f94"
+                  "reference": "Practitioner/1729351282662173000.379d479e-827e-4c81-ae70-265eba41222b"
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@@ -13299,7 +13299,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960737522000.5610ff0a-97dd-452d-bf65-a029773b467b"
+                  "reference": "Practitioner/1729351282664155000.d0c3e473-faeb-40b9-ad71-979198e41e23"
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@@ -13381,18 +13381,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "requester": {
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@@ -13407,10 +13407,10 @@
       }
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@@ -13462,7 +13462,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351282656089000.c91ee0e4-7b77-4855-bf1d-cd428668120f"
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@@ -13478,10 +13478,10 @@
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         "extension": [
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@@ -13569,23 +13569,23 @@
       }
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-      "fullUrl": "PractitionerRole/1729292960728962000.1736f59a-6146-4790-b650-d5e0b226ad27",
+      "fullUrl": "PractitionerRole/1729351282655893000.8e19d946-f77c-403d-a08d-dc0de4632632",
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+        "id": "1729351282655893000.8e19d946-f77c-403d-a08d-dc0de4632632",
         "practitioner": {
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+          "reference": "Practitioner/1729351282656956000.a1f76b43-ee5c-4255-a70a-ff27d54cbde1"
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         "organization": {
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@@ -13661,10 +13661,10 @@
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@@ -13740,10 +13740,10 @@
       }
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@@ -13758,10 +13758,10 @@
       }
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       "resource": {
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         "extension": [
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@@ -13809,7 +13809,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729292960734656000.30b3745a-3b32-4692-85c4-9690f4dc3830"
+              "reference": "Organization/1729351282661459000.7613fa82-2f39-4f8a-9fbf-4e5c78f3f905"
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@@ -13825,10 +13825,10 @@
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@@ -13843,10 +13843,10 @@
       }
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@@ -13894,7 +13894,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729292960736783000.6cf06ed1-79f4-4b28-b49f-4c71c8c941c5"
+              "reference": "Organization/1729351282663458000.cf698933-2ccd-4ffc-9e77-8690cf438c4e"
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@@ -13910,10 +13910,10 @@
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+      "fullUrl": "ServiceRequest/1729351282673715000.02e4c0e7-d30c-45f2-9805-bf7f74d453c5",
       "resource": {
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@@ -13925,13 +13925,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960742620000.37e573bb-01ef-4661-9c04-783432b9e08a"
+                  "reference": "Organization/1729351282669041000.7bb0e91c-e386-4030-a274-5fe4852d4094"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960743440000.15841523-250e-424a-9749-e7382a44de0a"
+                  "reference": "Organization/1729351282669832000.5332e3c7-c38c-436a-bc1b-b12592ef3412"
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@@ -13959,7 +13959,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960744701000.c5ffc999-9b13-41e8-8ab0-55c04d174139"
+                  "reference": "Practitioner/1729351282671098000.7b5c275e-f8cb-42cb-8e81-221d85de92ec"
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@@ -14087,7 +14087,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960746863000.6c8bb4e8-c0e7-4fec-b802-a0c13aa63149"
+                  "reference": "Practitioner/1729351282673179000.55a2e39d-603f-49da-8584-295601ec9941"
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@@ -14169,18 +14169,18 @@
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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-          "reference": "PractitionerRole/1729292960738149000.0d2b97f5-ec9d-4db0-9072-94c9f6eacd29"
+          "reference": "PractitionerRole/1729351282664775000.b9acd547-be5c-41ed-819f-a73149da7a66"
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@@ -14195,10 +14195,10 @@
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@@ -14250,7 +14250,7 @@
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             "assigner": {
-              "reference": "Organization/1729292960738345000.42ae2a95-b725-41e2-8763-3daf751911f7"
+              "reference": "Organization/1729351282664971000.ffac2a0c-860d-4c71-82ef-c4186fea9612"
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@@ -14266,10 +14266,10 @@
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@@ -14357,23 +14357,23 @@
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+          "reference": "Practitioner/1729351282665809000.9e3aa027-3ef2-4322-8815-19adda551efe"
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@@ -14449,10 +14449,10 @@
       }
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@@ -14528,10 +14528,10 @@
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@@ -14546,10 +14546,10 @@
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@@ -14597,7 +14597,7 @@
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             "assigner": {
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+              "reference": "Organization/1729351282670380000.249ae1af-8964-44a5-8e52-9930309c8744"
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@@ -14613,10 +14613,10 @@
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@@ -14631,10 +14631,10 @@
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@@ -14682,7 +14682,7 @@
             },
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             "assigner": {
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@@ -14698,10 +14698,10 @@
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@@ -14713,13 +14713,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960751907000.1667c020-039e-4bfe-8fab-fdf01da8cdc5"
+                  "reference": "Organization/1729351282678242000.49548e40-a8e4-446b-a79a-1cefeef16b0f"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960752684000.62567362-e46c-4e87-bb1e-aa081003d699"
+                  "reference": "Organization/1729351282679022000.7492b4ad-8b93-4f60-8150-89ea8efe1b50"
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@@ -14747,7 +14747,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960754007000.a7b79959-5efe-43d0-86ef-6940dba564a9"
+                  "reference": "Practitioner/1729351282680256000.0e5e5bf0-5949-4683-838e-432f05f56517"
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@@ -14875,7 +14875,7 @@
               {
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-                  "reference": "Practitioner/1729292960756033000.e96b71ad-5133-4fb7-931c-14a7c5a7f399"
+                  "reference": "Practitioner/1729351282682354000.2425a090-184a-4890-b7f3-c74147dda9bb"
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@@ -14957,18 +14957,18 @@
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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@@ -14983,10 +14983,10 @@
       }
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@@ -15038,7 +15038,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351282674102000.1cd96e92-843d-4664-b964-a19cd7bfe14c"
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@@ -15054,10 +15054,10 @@
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@@ -15145,23 +15145,23 @@
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+          "reference": "Practitioner/1729351282674951000.02dd2df1-b67f-4d6d-a9c4-399cf190f451"
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@@ -15237,10 +15237,10 @@
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@@ -15316,10 +15316,10 @@
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@@ -15334,10 +15334,10 @@
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@@ -15385,7 +15385,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351282679554000.ff090dd8-3abc-4a5f-90b6-ca7a61ae889b"
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@@ -15401,10 +15401,10 @@
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@@ -15419,10 +15419,10 @@
       }
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@@ -15470,7 +15470,7 @@
             },
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             "assigner": {
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@@ -15486,10 +15486,10 @@
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@@ -15501,13 +15501,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960761120000.56af5421-247f-48f7-b198-c5442a42dcbe"
+                  "reference": "Organization/1729351282687202000.9d51ca97-53a6-44f9-a116-ec34b0b27caa"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351282687965000.81ba21b2-06b9-4c95-8aae-5b0a16c41c32"
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@@ -15535,7 +15535,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960763357000.9bf6295b-00c6-4302-bb1f-f95c7d593da4"
+                  "reference": "Practitioner/1729351282689209000.08ca2621-e21a-4a53-bb7e-ebdb72f4ad6b"
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@@ -15663,7 +15663,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960768416000.8e425671-971c-4c19-b3c6-d0c701cd67b4"
+                  "reference": "Practitioner/1729351282691213000.0d775e6d-186a-41d9-9833-9e54d24c53b4"
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@@ -15745,18 +15745,18 @@
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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+          "reference": "PractitionerRole/1729351282682983000.8f94cf98-8345-4e50-8824-5b6e291d1a12"
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@@ -15771,10 +15771,10 @@
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@@ -15826,7 +15826,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960756919000.48144433-f634-42df-be17-f2e15080eda6"
+              "reference": "Organization/1729351282683179000.e7966ab6-613a-400e-be6e-4f504b5f7f44"
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@@ -15842,10 +15842,10 @@
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@@ -15933,23 +15933,23 @@
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+          "reference": "Practitioner/1729351282684016000.204bfb73-6207-4dd9-bc5f-2cd2c56c4467"
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@@ -16025,10 +16025,10 @@
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-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17105,21 +17105,21 @@
         },
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           {
-            "reference": "Specimen/1729292960613029000.03ecd02d-a0d8-4eb4-bf3b-9263b186c53b"
+            "reference": "Specimen/1729351282546219000.b22413f5-4380-47f3-b53c-b8a874ac7cad"
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+            "reference": "Observation/1729351282523772000.7101051c-460b-466b-981c-0c30b97d1462"
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     {
-      "fullUrl": "DiagnosticReport/1729292960791458000.1974a3d0-af9b-4b4c-b22b-2a19c833076f",
+      "fullUrl": "DiagnosticReport/1729351282707728000.18dab047-e03f-44ef-b538-fc9d034e2ff7",
       "resource": {
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-        "id": "1729292960791458000.1974a3d0-af9b-4b4c-b22b-2a19c833076f",
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@@ -17172,7 +17172,7 @@
         ],
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           {
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+            "reference": "ServiceRequest/1729351282628339000.8c32e27f-262c-4391-9aa5-0c1f8b5cd65e"
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@@ -17196,7 +17196,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17218,21 +17218,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960613389000.7927118b-2869-4833-83f2-be947087eebe"
+            "reference": "Specimen/1729351282547218000.c1935b83-445c-4a0c-9379-085457f37d4f"
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         "result": [
           {
-            "reference": "Observation/1729292960594362000.1ceff9e2-418b-485c-8896-084a0878196e"
+            "reference": "Observation/1729351282525744000.50fb89fd-d1b0-4c20-bd1e-6d89080166ed"
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     {
-      "fullUrl": "DiagnosticReport/1729292960792829000.19e7d02d-9bcd-4244-bb20-499669066cc5",
+      "fullUrl": "DiagnosticReport/1729351282711754000.27fb5804-0458-42c1-8d44-38ed4a5ff252",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292960792829000.19e7d02d-9bcd-4244-bb20-499669066cc5",
+        "id": "1729351282711754000.27fb5804-0458-42c1-8d44-38ed4a5ff252",
         "identifier": [
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             "extension": [
@@ -17285,7 +17285,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960719659000.c7032b8b-0c75-4368-94ad-9bd076955b6e"
+            "reference": "ServiceRequest/1729351282639248000.1d991564-64a7-4142-a946-f82e065f5d9f"
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         "status": "final",
@@ -17309,7 +17309,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17331,21 +17331,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960613737000.451cc298-4ec2-4cda-a6f1-3010758309d0"
+            "reference": "Specimen/1729351282548040000.4dbcc4ae-cacc-4c49-9829-659b4748c0ae"
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         ],
         "result": [
           {
-            "reference": "Observation/1729292960596419000.ae367932-cd33-4834-a247-5e8c55929c37"
+            "reference": "Observation/1729351282527840000.9f7134e3-b9c4-42c7-941d-6eaff11699f3"
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         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292960794258000.b71f93df-77ef-4b37-a134-5cdbc254ccd4",
+      "fullUrl": "DiagnosticReport/1729351282714826000.2cc773ab-edb1-45b5-ab1b-18a8a5219463",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292960794258000.b71f93df-77ef-4b37-a134-5cdbc254ccd4",
+        "id": "1729351282714826000.2cc773ab-edb1-45b5-ab1b-18a8a5219463",
         "identifier": [
           {
             "extension": [
@@ -17398,7 +17398,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960728779000.9585689a-a3bd-45ba-aed7-e46c1bf05ab4"
+            "reference": "ServiceRequest/1729351282655731000.527b6a72-3f4b-4eef-b198-10b3371d294c"
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         ],
         "status": "final",
@@ -17422,7 +17422,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17444,21 +17444,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960614082000.603140f0-5392-4f0a-af7c-7cb49dbef86d"
+            "reference": "Specimen/1729351282548627000.755d869d-e7c4-4a50-aede-ddae64d77e11"
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         ],
         "result": [
           {
-            "reference": "Observation/1729292960598461000.1de21530-6db6-44a5-9b59-c63617272d72"
+            "reference": "Observation/1729351282529856000.e8c7724c-4095-4ada-a529-d39c121c9dbd"
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         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292960795639000.62c88e2d-10b8-4aaa-94f6-cace410dd6c3",
+      "fullUrl": "DiagnosticReport/1729351282718550000.26ea1c91-207c-44b9-96e2-058cf5fe40ec",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292960795639000.62c88e2d-10b8-4aaa-94f6-cace410dd6c3",
+        "id": "1729351282718550000.26ea1c91-207c-44b9-96e2-058cf5fe40ec",
         "identifier": [
           {
             "extension": [
@@ -17511,7 +17511,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960737986000.647557fd-9965-4f8c-88ca-d97a13284fc3"
+            "reference": "ServiceRequest/1729351282664614000.09972dff-4ebb-48aa-91cc-cde49eeb717d"
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         ],
         "status": "final",
@@ -17535,7 +17535,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17557,21 +17557,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960614427000.3bbc7d98-7f15-4512-836d-646b714f8eff"
+            "reference": "Specimen/1729351282549118000.db8226e4-9f3d-4fff-a25f-f863966f27ce"
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         "result": [
           {
-            "reference": "Observation/1729292960600532000.d11f95ea-9e56-4e5b-805b-a56d009bc24a"
+            "reference": "Observation/1729351282531797000.a7372cf5-9e83-4de0-acf8-52619b7e1348"
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       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292960797049000.b7a29488-c86e-4d82-b78f-2a3ce72274d9",
+      "fullUrl": "DiagnosticReport/1729351282721733000.bce1ab6e-bc84-415e-8088-7fc5003add8d",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292960797049000.b7a29488-c86e-4d82-b78f-2a3ce72274d9",
+        "id": "1729351282721733000.bce1ab6e-bc84-415e-8088-7fc5003add8d",
         "identifier": [
           {
             "extension": [
@@ -17624,7 +17624,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960747334000.76edf288-2560-44e5-937f-60d398eb6434"
+            "reference": "ServiceRequest/1729351282673715000.02e4c0e7-d30c-45f2-9805-bf7f74d453c5"
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         ],
         "status": "final",
@@ -17648,7 +17648,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17670,21 +17670,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960614832000.72409220-1fed-4476-bf47-2d6f5006665c"
+            "reference": "Specimen/1729351282549857000.13027c09-31fe-46d2-9baf-e8d05c30f2f5"
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         ],
         "result": [
           {
-            "reference": "Observation/1729292960602651000.106430d0-e4bd-4214-a5d7-26229cf420a1"
+            "reference": "Observation/1729351282533740000.50d6e7c5-2bd5-474d-817e-c8eaf385e3f9"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292960798503000.11957d43-2f87-4226-a831-d3de6ca2de00",
+      "fullUrl": "DiagnosticReport/1729351282724482000.742e6965-279e-4728-9122-b2eaa1828179",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292960798503000.11957d43-2f87-4226-a831-d3de6ca2de00",
+        "id": "1729351282724482000.742e6965-279e-4728-9122-b2eaa1828179",
         "identifier": [
           {
             "extension": [
@@ -17737,7 +17737,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960756533000.0e296372-42f4-4627-9206-327e138f0431"
+            "reference": "ServiceRequest/1729351282682819000.5d23153b-ea77-484e-884a-0026a0437091"
           }
         ],
         "status": "final",
@@ -17761,7 +17761,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17783,21 +17783,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960615176000.0e296c27-4fef-4cc0-9b5b-2f795d6c5eb3"
+            "reference": "Specimen/1729351282550801000.066d8ce1-2f95-4176-a1db-bb81459a70b5"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729292960604735000.ebcfa323-3dc8-46a8-9df5-25f9a3bcca87"
+            "reference": "Observation/1729351282535655000.bba649fd-911f-4bae-8c25-f14913d191f0"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292960799953000.5b9dbcb3-1a3d-4c68-aa08-6b290f89a939",
+      "fullUrl": "DiagnosticReport/1729351282725974000.2f684db6-b0ab-4688-8f38-bb20580d7b1a",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292960799953000.5b9dbcb3-1a3d-4c68-aa08-6b290f89a939",
+        "id": "1729351282725974000.2f684db6-b0ab-4688-8f38-bb20580d7b1a",
         "identifier": [
           {
             "extension": [
@@ -17850,7 +17850,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960769148000.18eaed63-7c32-4e20-ab8e-2f517bb9f268"
+            "reference": "ServiceRequest/1729351282691682000.b014b742-6c5a-4cba-a34e-c261b7c712db"
           }
         ],
         "status": "final",
@@ -17874,7 +17874,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17896,12 +17896,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960615535000.7c1a5234-11fa-4b22-993f-9fff275b4635"
+            "reference": "Specimen/1729351282551957000.0e8624fd-5e3e-4fde-b404-39b297b1648a"
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         ],
         "result": [
           {
-            "reference": "Observation/1729292960606721000.7dbbab11-778d-4ec6-a1ca-aca5b49606eb"
+            "reference": "Observation/1729351282537570000.1b859cd3-3048-46c1-af1c-a67ed6e93864"
           }
         ]
       }
diff --git a/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_2_fhir_transformation.fhir b/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_2_fhir_transformation.fhir
index cd118187f..4e2c222b4 100644
--- a/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_2_fhir_transformation.fhir
+++ b/examples/Test/Results/003_AL_ORU_R01_NBS_Normal_And_Abnormal_Results_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729292960519319000.0ecef2bb-80d6-4c8a-9e69-60b9e8569329",
+  "id": "1729351282444616000.48a4f85f-cbfd-4414-a22e-7249adb96ec8",
   "meta": {
-    "lastUpdated": "2024-10-18T16:09:20.519-07:00"
+    "lastUpdated": "2024-10-19T08:21:22.444-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2023-06-06T17:28:49.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729292960521914000.75f14dbb-1ae5-4720-837d-8725b1dffbfe",
+      "fullUrl": "MessageHeader/1729351282447821000.05ee23d7-b08f-409d-9bee-b60208918625",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729292960521914000.75f14dbb-1ae5-4720-837d-8725b1dffbfe",
+        "id": "1729351282447821000.05ee23d7-b08f-409d-9bee-b60208918625",
         "meta": {
           "tag": [
             {
@@ -156,12 +156,12 @@
             "name": "BaptistOracle",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000",
             "receiver": {
-              "reference": "Organization/1729292960521456000.296f1ea7-b381-4d17-adc9-fd1cd11cd103"
+              "reference": "Organization/1729351282447438000.e0a62fa4-7e87-4343-bfa8-a388fae3d45c"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729292960520446000.217de4fb-78a9-4675-a426-5c05fc7c608a"
+          "reference": "Organization/1729351282446520000.4d62c3d0-e995-42b6-ba91-952b10c338b3"
         },
         "source": {
           "extension": [
@@ -187,10 +187,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960520446000.217de4fb-78a9-4675-a426-5c05fc7c608a",
+      "fullUrl": "Organization/1729351282446520000.4d62c3d0-e995-42b6-ba91-952b10c338b3",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960520446000.217de4fb-78a9-4675-a426-5c05fc7c608a",
+        "id": "1729351282446520000.4d62c3d0-e995-42b6-ba91-952b10c338b3",
         "identifier": [
           {
             "extension": [
@@ -223,10 +223,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960521456000.296f1ea7-b381-4d17-adc9-fd1cd11cd103",
+      "fullUrl": "Organization/1729351282447438000.e0a62fa4-7e87-4343-bfa8-a388fae3d45c",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960521456000.296f1ea7-b381-4d17-adc9-fd1cd11cd103",
+        "id": "1729351282447438000.e0a62fa4-7e87-4343-bfa8-a388fae3d45c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -265,55 +265,55 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729292960524945000.87685cf4-a0fb-4d66-803b-433c5af45810",
+      "fullUrl": "Provenance/1729351282452225000.2a062165-2bb6-4ceb-9c05-4945dfb013e6",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729292960524945000.87685cf4-a0fb-4d66-803b-433c5af45810",
+        "id": "1729351282452225000.2a062165-2bb6-4ceb-9c05-4945dfb013e6",
         "target": [
           {
-            "reference": "MessageHeader/1729292960521914000.75f14dbb-1ae5-4720-837d-8725b1dffbfe"
+            "reference": "MessageHeader/1729351282447821000.05ee23d7-b08f-409d-9bee-b60208918625"
           },
           {
-            "reference": "DiagnosticReport/1729292960779932000.0eeb7b2f-007d-4933-83cc-ee26678e40f5"
+            "reference": "DiagnosticReport/1729351282697937000.daa451f6-8238-4ff1-b3d7-c7f48673b67a"
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           {
-            "reference": "DiagnosticReport/1729292960783110000.cd959e7f-abba-4cb3-a84e-0494ddf57ac9"
+            "reference": "DiagnosticReport/1729351282699552000.db457a2d-1e22-49c2-9cc5-91cb70d069cd"
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-            "reference": "DiagnosticReport/1729292960784515000.3aee192e-6012-4f03-b876-745c0269a302"
+            "reference": "DiagnosticReport/1729351282700916000.607a1b03-77fb-4f64-88ea-22c9ce3b640b"
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-            "reference": "DiagnosticReport/1729292960785921000.e0952bd2-24fe-4fc3-9d38-23b19946a7e6"
+            "reference": "DiagnosticReport/1729351282702276000.1d734ccf-e738-4046-9d9e-3c25e0d8a27f"
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@@ -335,17 +335,17 @@
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@@ -378,11 +378,11 @@
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@@ -404,17 +404,17 @@
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@@ -434,10 +434,10 @@
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@@ -552,7 +552,7 @@
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@@ -702,10 +702,10 @@
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@@ -720,16 +720,16 @@
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@@ -741,10 +741,10 @@
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@@ -800,7 +800,7 @@
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@@ -890,10 +890,10 @@
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@@ -950,7 +950,7 @@
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@@ -963,7 +963,7 @@
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@@ -988,10 +988,10 @@
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@@ -1014,10 +1014,10 @@
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@@ -1048,15 +1048,15 @@
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@@ -1071,10 +1071,10 @@
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@@ -1131,7 +1131,7 @@
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@@ -1144,7 +1144,7 @@
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@@ -1169,10 +1169,10 @@
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@@ -1195,10 +1195,10 @@
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@@ -1229,15 +1229,15 @@
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+      "fullUrl": "PractitionerRole/1729351282485685000.de2d4847-8ce4-4d43-ac4e-393f77c77261",
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@@ -1252,10 +1252,10 @@
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@@ -1312,7 +1312,7 @@
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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@@ -1325,17 +1325,17 @@
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@@ -1358,10 +1358,10 @@
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@@ -1392,15 +1392,15 @@
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@@ -1415,10 +1415,10 @@
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@@ -1475,7 +1475,7 @@
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@@ -1488,7 +1488,7 @@
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@@ -1513,10 +1513,10 @@
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@@ -1539,10 +1539,10 @@
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@@ -1573,15 +1573,15 @@
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@@ -1596,10 +1596,10 @@
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@@ -1656,7 +1656,7 @@
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@@ -1669,7 +1669,7 @@
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@@ -1694,10 +1694,10 @@
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@@ -1720,10 +1720,10 @@
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@@ -1754,15 +1754,15 @@
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@@ -1777,10 +1777,10 @@
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@@ -1837,7 +1837,7 @@
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@@ -1850,7 +1850,7 @@
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@@ -1875,10 +1875,10 @@
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@@ -1901,10 +1901,10 @@
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@@ -1935,15 +1935,15 @@
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@@ -1958,10 +1958,10 @@
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@@ -2018,7 +2018,7 @@
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@@ -2031,7 +2031,7 @@
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@@ -2056,10 +2056,10 @@
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@@ -2082,10 +2082,10 @@
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@@ -2116,15 +2116,15 @@
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@@ -2139,10 +2139,10 @@
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@@ -2199,7 +2199,7 @@
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@@ -2212,7 +2212,7 @@
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@@ -2237,10 +2237,10 @@
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@@ -2263,10 +2263,10 @@
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@@ -2297,15 +2297,15 @@
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@@ -2320,10 +2320,10 @@
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@@ -2416,7 +2416,7 @@
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@@ -2429,16 +2429,16 @@
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@@ -2461,10 +2461,10 @@
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@@ -2495,15 +2495,15 @@
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@@ -2518,10 +2518,10 @@
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@@ -2558,7 +2558,7 @@
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@@ -2573,10 +2573,10 @@
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@@ -2635,7 +2635,7 @@
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@@ -2655,10 +2655,10 @@
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@@ -2695,7 +2695,7 @@
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@@ -2790,7 +2790,7 @@
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@@ -2810,10 +2810,10 @@
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@@ -2850,7 +2850,7 @@
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@@ -2883,10 +2883,10 @@
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@@ -2923,7 +2923,7 @@
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@@ -2946,10 +2946,10 @@
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@@ -2986,7 +2986,7 @@
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@@ -3001,10 +3001,10 @@
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@@ -3041,7 +3041,7 @@
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@@ -3095,7 +3095,7 @@
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@@ -3170,7 +3170,7 @@
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@@ -3183,7 +3183,7 @@
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@@ -3208,10 +3208,10 @@
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@@ -3234,10 +3234,10 @@
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@@ -3268,15 +3268,15 @@
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@@ -3291,10 +3291,10 @@
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@@ -3351,7 +3351,7 @@
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@@ -3364,7 +3364,7 @@
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@@ -3389,10 +3389,10 @@
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@@ -3415,10 +3415,10 @@
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@@ -3449,15 +3449,15 @@
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@@ -3532,7 +3532,7 @@
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@@ -3545,7 +3545,7 @@
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@@ -3570,10 +3570,10 @@
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@@ -3596,10 +3596,10 @@
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@@ -3630,15 +3630,15 @@
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@@ -3653,10 +3653,10 @@
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@@ -3713,7 +3713,7 @@
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@@ -3726,7 +3726,7 @@
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@@ -3777,10 +3777,10 @@
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@@ -3834,10 +3834,10 @@
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@@ -3894,7 +3894,7 @@
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@@ -3907,7 +3907,7 @@
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@@ -3958,10 +3958,10 @@
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@@ -4015,10 +4015,10 @@
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@@ -4075,7 +4075,7 @@
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@@ -4088,7 +4088,7 @@
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@@ -4113,10 +4113,10 @@
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@@ -4139,10 +4139,10 @@
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@@ -4173,15 +4173,15 @@
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@@ -4196,10 +4196,10 @@
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@@ -4256,7 +4256,7 @@
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@@ -4269,7 +4269,7 @@
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@@ -4294,10 +4294,10 @@
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@@ -4320,10 +4320,10 @@
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@@ -4354,15 +4354,15 @@
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@@ -4377,10 +4377,10 @@
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@@ -4437,7 +4437,7 @@
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@@ -4450,7 +4450,7 @@
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@@ -4475,10 +4475,10 @@
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@@ -4501,10 +4501,10 @@
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@@ -4535,15 +4535,15 @@
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@@ -4558,10 +4558,10 @@
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@@ -4618,7 +4618,7 @@
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@@ -4631,7 +4631,7 @@
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@@ -4656,10 +4656,10 @@
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@@ -4682,10 +4682,10 @@
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@@ -4716,15 +4716,15 @@
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@@ -4739,10 +4739,10 @@
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@@ -4799,7 +4799,7 @@
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@@ -4812,7 +4812,7 @@
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@@ -4837,10 +4837,10 @@
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@@ -4863,10 +4863,10 @@
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@@ -4897,15 +4897,15 @@
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@@ -4920,10 +4920,10 @@
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@@ -4980,7 +4980,7 @@
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@@ -4993,7 +4993,7 @@
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@@ -5018,10 +5018,10 @@
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@@ -5044,10 +5044,10 @@
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@@ -5078,15 +5078,15 @@
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@@ -5101,10 +5101,10 @@
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@@ -5161,7 +5161,7 @@
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@@ -5174,7 +5174,7 @@
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@@ -5199,10 +5199,10 @@
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@@ -5225,10 +5225,10 @@
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@@ -5259,15 +5259,15 @@
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@@ -5282,10 +5282,10 @@
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@@ -5295,10 +5295,10 @@
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@@ -5308,10 +5308,10 @@
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@@ -5321,10 +5321,10 @@
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@@ -5334,10 +5334,10 @@
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@@ -5347,10 +5347,10 @@
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@@ -5360,10 +5360,10 @@
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@@ -5373,10 +5373,10 @@
       }
     },
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-      "fullUrl": "Specimen/1729292960613389000.7927118b-2869-4833-83f2-be947087eebe",
+      "fullUrl": "Specimen/1729351282547218000.c1935b83-445c-4a0c-9379-085457f37d4f",
       "resource": {
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+        "id": "1729351282547218000.c1935b83-445c-4a0c-9379-085457f37d4f",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5386,10 +5386,10 @@
       }
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     {
-      "fullUrl": "Specimen/1729292960613737000.451cc298-4ec2-4cda-a6f1-3010758309d0",
+      "fullUrl": "Specimen/1729351282548040000.4dbcc4ae-cacc-4c49-9829-659b4748c0ae",
       "resource": {
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+        "id": "1729351282548040000.4dbcc4ae-cacc-4c49-9829-659b4748c0ae",
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5399,10 +5399,10 @@
       }
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     {
-      "fullUrl": "Specimen/1729292960614082000.603140f0-5392-4f0a-af7c-7cb49dbef86d",
+      "fullUrl": "Specimen/1729351282548627000.755d869d-e7c4-4a50-aede-ddae64d77e11",
       "resource": {
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+        "id": "1729351282548627000.755d869d-e7c4-4a50-aede-ddae64d77e11",
         "extension": [
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@@ -5412,10 +5412,10 @@
       }
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     {
-      "fullUrl": "Specimen/1729292960614427000.3bbc7d98-7f15-4512-836d-646b714f8eff",
+      "fullUrl": "Specimen/1729351282549118000.db8226e4-9f3d-4fff-a25f-f863966f27ce",
       "resource": {
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@@ -5425,10 +5425,10 @@
       }
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+      "fullUrl": "Specimen/1729351282549857000.13027c09-31fe-46d2-9baf-e8d05c30f2f5",
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@@ -5438,10 +5438,10 @@
       }
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@@ -5451,10 +5451,10 @@
       }
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+      "fullUrl": "Specimen/1729351282551957000.0e8624fd-5e3e-4fde-b404-39b297b1648a",
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@@ -5464,10 +5464,10 @@
       }
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+      "fullUrl": "Specimen/1729351282557236000.48c6cf90-a925-4da6-9d7b-d290d296618d",
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Segment",
@@ -5629,10 +5629,10 @@
       }
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     {
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+      "fullUrl": "ServiceRequest/1729351282568852000.6fda921c-b107-4d98-bbd0-e424e44f6bcf",
       "resource": {
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -5644,13 +5644,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960623165000.8be8ac66-ad4a-473f-8f4f-3db0b8d6c0fd"
+                  "reference": "Organization/1729351282563911000.7da79ebc-9367-4a16-a03c-e0aba4506254"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960624025000.2f0c0183-fb5e-4130-90be-ac1e5206c36f"
+                  "reference": "Organization/1729351282564775000.a7778ae0-25b7-4ef8-b07f-d6aaee63b803"
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               {
@@ -5678,7 +5678,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960625477000.528c68a9-90ed-4b80-b898-20b6997746ba"
+                  "reference": "Practitioner/1729351282566168000.0501f719-6590-4bc6-8875-cb4aed215986"
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@@ -5806,7 +5806,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960627695000.7611cf67-6d5f-4c6d-bf16-f140e0eb5258"
+                  "reference": "Practitioner/1729351282568359000.9e07b1e5-51be-460b-ac33-a2ff22fe5391"
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@@ -5888,18 +5888,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "requester": {
-          "reference": "PractitionerRole/1729292960618455000.f527e374-3d9c-4983-8a84-975b3077e1d3"
+          "reference": "PractitionerRole/1729351282558229000.7008d5a9-c74a-4979-bca2-91effdfaea83"
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+      "fullUrl": "Organization/1729351282558769000.0f09709d-ddd5-4fad-a99b-cde290d8d5fd",
       "resource": {
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-        "id": "1729292960618668000.3f377ced-9540-4993-8ad2-db506faacc1a",
+        "id": "1729351282558769000.0f09709d-ddd5-4fad-a99b-cde290d8d5fd",
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@@ -5914,10 +5914,10 @@
       }
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     {
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+      "fullUrl": "Practitioner/1729351282559920000.90b23f9f-39a8-47ce-9825-7b3c77f386f1",
       "resource": {
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+        "id": "1729351282559920000.90b23f9f-39a8-47ce-9825-7b3c77f386f1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -5969,7 +5969,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960618668000.3f377ced-9540-4993-8ad2-db506faacc1a"
+              "reference": "Organization/1729351282558769000.0f09709d-ddd5-4fad-a99b-cde290d8d5fd"
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@@ -5985,10 +5985,10 @@
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+      "fullUrl": "Organization/1729351282561300000.f68607a8-2a4c-4cac-88e5-871e6edc37ef",
       "resource": {
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+        "id": "1729351282561300000.f68607a8-2a4c-4cac-88e5-871e6edc37ef",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -6076,23 +6076,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960618455000.f527e374-3d9c-4983-8a84-975b3077e1d3",
+      "fullUrl": "PractitionerRole/1729351282558229000.7008d5a9-c74a-4979-bca2-91effdfaea83",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292960618455000.f527e374-3d9c-4983-8a84-975b3077e1d3",
+        "id": "1729351282558229000.7008d5a9-c74a-4979-bca2-91effdfaea83",
         "practitioner": {
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+          "reference": "Practitioner/1729351282559920000.90b23f9f-39a8-47ce-9825-7b3c77f386f1"
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         "organization": {
-          "reference": "Organization/1729292960620923000.3a104921-82e7-4448-8f9f-a00acac7c655"
+          "reference": "Organization/1729351282561300000.f68607a8-2a4c-4cac-88e5-871e6edc37ef"
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-      "fullUrl": "Organization/1729292960623165000.8be8ac66-ad4a-473f-8f4f-3db0b8d6c0fd",
+      "fullUrl": "Organization/1729351282563911000.7da79ebc-9367-4a16-a03c-e0aba4506254",
       "resource": {
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-        "id": "1729292960623165000.8be8ac66-ad4a-473f-8f4f-3db0b8d6c0fd",
+        "id": "1729351282563911000.7da79ebc-9367-4a16-a03c-e0aba4506254",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -6168,10 +6168,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960624025000.2f0c0183-fb5e-4130-90be-ac1e5206c36f",
+      "fullUrl": "Organization/1729351282564775000.a7778ae0-25b7-4ef8-b07f-d6aaee63b803",
       "resource": {
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-        "id": "1729292960624025000.2f0c0183-fb5e-4130-90be-ac1e5206c36f",
+        "id": "1729351282564775000.a7778ae0-25b7-4ef8-b07f-d6aaee63b803",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -6247,10 +6247,10 @@
       }
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     {
-      "fullUrl": "Organization/1729292960624652000.7486fe8b-f9cf-4786-8d80-75e9cecf0bf5",
+      "fullUrl": "Organization/1729351282565401000.8f3551c5-59ad-459c-b135-8a9fbc41eb25",
       "resource": {
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-        "id": "1729292960624652000.7486fe8b-f9cf-4786-8d80-75e9cecf0bf5",
+        "id": "1729351282565401000.8f3551c5-59ad-459c-b135-8a9fbc41eb25",
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@@ -6265,10 +6265,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292960625477000.528c68a9-90ed-4b80-b898-20b6997746ba",
+      "fullUrl": "Practitioner/1729351282566168000.0501f719-6590-4bc6-8875-cb4aed215986",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960625477000.528c68a9-90ed-4b80-b898-20b6997746ba",
+        "id": "1729351282566168000.0501f719-6590-4bc6-8875-cb4aed215986",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6316,7 +6316,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960624652000.7486fe8b-f9cf-4786-8d80-75e9cecf0bf5"
+              "reference": "Organization/1729351282565401000.8f3551c5-59ad-459c-b135-8a9fbc41eb25"
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@@ -6332,10 +6332,10 @@
       }
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     {
-      "fullUrl": "Organization/1729292960626930000.d3c61374-0a8c-4957-bc66-5280bc552401",
+      "fullUrl": "Organization/1729351282567625000.6a75053d-80aa-4478-b631-286f61e38c61",
       "resource": {
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-        "id": "1729292960626930000.d3c61374-0a8c-4957-bc66-5280bc552401",
+        "id": "1729351282567625000.6a75053d-80aa-4478-b631-286f61e38c61",
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@@ -6350,10 +6350,10 @@
       }
     },
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-      "fullUrl": "Practitioner/1729292960627695000.7611cf67-6d5f-4c6d-bf16-f140e0eb5258",
+      "fullUrl": "Practitioner/1729351282568359000.9e07b1e5-51be-460b-ac33-a2ff22fe5391",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960627695000.7611cf67-6d5f-4c6d-bf16-f140e0eb5258",
+        "id": "1729351282568359000.9e07b1e5-51be-460b-ac33-a2ff22fe5391",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6401,7 +6401,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960626930000.d3c61374-0a8c-4957-bc66-5280bc552401"
+              "reference": "Organization/1729351282567625000.6a75053d-80aa-4478-b631-286f61e38c61"
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@@ -6417,10 +6417,10 @@
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+      "fullUrl": "ServiceRequest/1729351282573937000.69a5f637-8225-4c84-b82f-ac83287ed445",
       "resource": {
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-        "id": "1729292960633185000.60b095a1-50a5-4abb-9a99-1e5710ea6c33",
+        "id": "1729351282573937000.69a5f637-8225-4c84-b82f-ac83287ed445",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -6559,7 +6559,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960632718000.d412c570-6a8f-403e-b049-83dbcfe6c740"
+                  "reference": "Practitioner/1729351282573476000.4b5000a3-da12-449b-a663-951eb0f27f08"
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@@ -6641,18 +6641,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "requester": {
-          "reference": "Practitioner/1729292960629343000.4f8ccab7-476c-45e7-8a4c-ee42d190ba75"
+          "reference": "Practitioner/1729351282570018000.73539b52-c810-488c-bf56-4c51df9fa350"
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+      "fullUrl": "Organization/1729351282569118000.b47b6af9-b5dc-4532-a998-8e1836f3dd6d",
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-        "id": "1729292960628452000.7bb8089d-3eb0-4ab1-be26-41d730a0705d",
+        "id": "1729351282569118000.b47b6af9-b5dc-4532-a998-8e1836f3dd6d",
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@@ -6667,10 +6667,10 @@
       }
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-      "fullUrl": "Practitioner/1729292960629343000.4f8ccab7-476c-45e7-8a4c-ee42d190ba75",
+      "fullUrl": "Practitioner/1729351282570018000.73539b52-c810-488c-bf56-4c51df9fa350",
       "resource": {
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-        "id": "1729292960629343000.4f8ccab7-476c-45e7-8a4c-ee42d190ba75",
+        "id": "1729351282570018000.73539b52-c810-488c-bf56-4c51df9fa350",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6722,7 +6722,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960628452000.7bb8089d-3eb0-4ab1-be26-41d730a0705d"
+              "reference": "Organization/1729351282569118000.b47b6af9-b5dc-4532-a998-8e1836f3dd6d"
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@@ -6738,10 +6738,10 @@
       }
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-      "fullUrl": "Organization/1729292960632011000.b454c336-b01e-41a2-b96b-a91feccdbc46",
+      "fullUrl": "Organization/1729351282572754000.6b47d2cd-eea7-4a99-b7c0-14e65d7a0a59",
       "resource": {
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-        "id": "1729292960632011000.b454c336-b01e-41a2-b96b-a91feccdbc46",
+        "id": "1729351282572754000.6b47d2cd-eea7-4a99-b7c0-14e65d7a0a59",
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@@ -6756,10 +6756,10 @@
       }
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-      "fullUrl": "Practitioner/1729292960632718000.d412c570-6a8f-403e-b049-83dbcfe6c740",
+      "fullUrl": "Practitioner/1729351282573476000.4b5000a3-da12-449b-a663-951eb0f27f08",
       "resource": {
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+        "id": "1729351282573476000.4b5000a3-da12-449b-a663-951eb0f27f08",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6807,7 +6807,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960632011000.b454c336-b01e-41a2-b96b-a91feccdbc46"
+              "reference": "Organization/1729351282572754000.6b47d2cd-eea7-4a99-b7c0-14e65d7a0a59"
             }
           }
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@@ -6823,10 +6823,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729292960653862000.d263b6dc-0ac0-4c98-bed1-1b270f8cb305",
+      "fullUrl": "ServiceRequest/1729351282584024000.eeb85236-353f-4dd2-bd64-c2ca4600db0e",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729292960653862000.d263b6dc-0ac0-4c98-bed1-1b270f8cb305",
+        "id": "1729351282584024000.eeb85236-353f-4dd2-bd64-c2ca4600db0e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -6838,13 +6838,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960644062000.ee0bef0f-963c-490b-b7b9-bef0e9c9f732"
+                  "reference": "Organization/1729351282578540000.f02b579d-1e1d-43a5-a386-7c024bf2b101"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960646154000.6ceb595e-ef18-4669-ac94-6d49a642ea5f"
+                  "reference": "Organization/1729351282579324000.23115e3d-bd74-44c9-b993-4f0486dfac67"
                 }
               },
               {
@@ -6872,7 +6872,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960648895000.3e6bb8b6-10c7-4ecb-af01-341e490d36a0"
+                  "reference": "Practitioner/1729351282580601000.9e4759bd-1e61-4276-a6fe-5f2cb4e98320"
                 }
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@@ -7000,7 +7000,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960653389000.254a44ca-7642-46af-9328-5ec191f85a5b"
+                  "reference": "Practitioner/1729351282583554000.8ced7cb0-7cf3-483c-9b5a-631c63671ca4"
                 }
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@@ -7082,18 +7082,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "requester": {
-          "reference": "PractitionerRole/1729292960633352000.f8168c5b-aeb6-4f30-a7b8-aeb2628e9388"
+          "reference": "PractitionerRole/1729351282574107000.3c3aca8f-58d0-4b0b-a7d4-f6857ea1dd8f"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729292960634221000.d2e9881a-86eb-4bf4-ae57-c23eb2e03aa5",
+      "fullUrl": "Organization/1729351282574306000.0c570a71-055b-4164-8706-60086c771024",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960634221000.d2e9881a-86eb-4bf4-ae57-c23eb2e03aa5",
+        "id": "1729351282574306000.0c570a71-055b-4164-8706-60086c771024",
         "identifier": [
           {
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@@ -7108,10 +7108,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960636616000.b810c101-45d7-41ff-8156-80d766868536",
+      "fullUrl": "Practitioner/1729351282575173000.e3dcad2a-2e7d-4d2f-9855-5f4548ba9e64",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960636616000.b810c101-45d7-41ff-8156-80d766868536",
+        "id": "1729351282575173000.e3dcad2a-2e7d-4d2f-9855-5f4548ba9e64",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7163,7 +7163,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960634221000.d2e9881a-86eb-4bf4-ae57-c23eb2e03aa5"
+              "reference": "Organization/1729351282574306000.0c570a71-055b-4164-8706-60086c771024"
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@@ -7179,10 +7179,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960639378000.430eda78-f03b-459b-a3c1-e3a3f05f2e36",
+      "fullUrl": "Organization/1729351282576474000.7ff6f314-5f62-444e-88ca-dfb7c123d9f8",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960639378000.430eda78-f03b-459b-a3c1-e3a3f05f2e36",
+        "id": "1729351282576474000.7ff6f314-5f62-444e-88ca-dfb7c123d9f8",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7270,23 +7270,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960633352000.f8168c5b-aeb6-4f30-a7b8-aeb2628e9388",
+      "fullUrl": "PractitionerRole/1729351282574107000.3c3aca8f-58d0-4b0b-a7d4-f6857ea1dd8f",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292960633352000.f8168c5b-aeb6-4f30-a7b8-aeb2628e9388",
+        "id": "1729351282574107000.3c3aca8f-58d0-4b0b-a7d4-f6857ea1dd8f",
         "practitioner": {
-          "reference": "Practitioner/1729292960636616000.b810c101-45d7-41ff-8156-80d766868536"
+          "reference": "Practitioner/1729351282575173000.e3dcad2a-2e7d-4d2f-9855-5f4548ba9e64"
         },
         "organization": {
-          "reference": "Organization/1729292960639378000.430eda78-f03b-459b-a3c1-e3a3f05f2e36"
+          "reference": "Organization/1729351282576474000.7ff6f314-5f62-444e-88ca-dfb7c123d9f8"
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       }
     },
     {
-      "fullUrl": "Organization/1729292960644062000.ee0bef0f-963c-490b-b7b9-bef0e9c9f732",
+      "fullUrl": "Organization/1729351282578540000.f02b579d-1e1d-43a5-a386-7c024bf2b101",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960644062000.ee0bef0f-963c-490b-b7b9-bef0e9c9f732",
+        "id": "1729351282578540000.f02b579d-1e1d-43a5-a386-7c024bf2b101",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7362,10 +7362,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960646154000.6ceb595e-ef18-4669-ac94-6d49a642ea5f",
+      "fullUrl": "Organization/1729351282579324000.23115e3d-bd74-44c9-b993-4f0486dfac67",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960646154000.6ceb595e-ef18-4669-ac94-6d49a642ea5f",
+        "id": "1729351282579324000.23115e3d-bd74-44c9-b993-4f0486dfac67",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7441,10 +7441,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960647181000.07c1a022-3946-4afc-9db6-bd3d8482719a",
+      "fullUrl": "Organization/1729351282579886000.b6a9c813-1368-4ce3-ad68-2e3cdf3afa35",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960647181000.07c1a022-3946-4afc-9db6-bd3d8482719a",
+        "id": "1729351282579886000.b6a9c813-1368-4ce3-ad68-2e3cdf3afa35",
         "identifier": [
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@@ -7459,10 +7459,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960648895000.3e6bb8b6-10c7-4ecb-af01-341e490d36a0",
+      "fullUrl": "Practitioner/1729351282580601000.9e4759bd-1e61-4276-a6fe-5f2cb4e98320",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960648895000.3e6bb8b6-10c7-4ecb-af01-341e490d36a0",
+        "id": "1729351282580601000.9e4759bd-1e61-4276-a6fe-5f2cb4e98320",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7510,7 +7510,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960647181000.07c1a022-3946-4afc-9db6-bd3d8482719a"
+              "reference": "Organization/1729351282579886000.b6a9c813-1368-4ce3-ad68-2e3cdf3afa35"
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@@ -7526,10 +7526,10 @@
       }
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     {
-      "fullUrl": "Organization/1729292960652123000.dd28922e-6608-4c9f-9f8c-ae02135a8302",
+      "fullUrl": "Organization/1729351282582834000.f89a7000-ba24-4775-9fc7-2a0b82855873",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960652123000.dd28922e-6608-4c9f-9f8c-ae02135a8302",
+        "id": "1729351282582834000.f89a7000-ba24-4775-9fc7-2a0b82855873",
         "identifier": [
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@@ -7544,10 +7544,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960653389000.254a44ca-7642-46af-9328-5ec191f85a5b",
+      "fullUrl": "Practitioner/1729351282583554000.8ced7cb0-7cf3-483c-9b5a-631c63671ca4",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960653389000.254a44ca-7642-46af-9328-5ec191f85a5b",
+        "id": "1729351282583554000.8ced7cb0-7cf3-483c-9b5a-631c63671ca4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7595,7 +7595,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960652123000.dd28922e-6608-4c9f-9f8c-ae02135a8302"
+              "reference": "Organization/1729351282582834000.f89a7000-ba24-4775-9fc7-2a0b82855873"
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@@ -7611,10 +7611,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729292960663026000.c4fe6d84-8031-489e-ade3-b682c2843335",
+      "fullUrl": "ServiceRequest/1729351282592913000.21f790c8-0d3d-4ba6-82e2-ff366d24058e",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729292960663026000.c4fe6d84-8031-489e-ade3-b682c2843335",
+        "id": "1729351282592913000.21f790c8-0d3d-4ba6-82e2-ff366d24058e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -7626,13 +7626,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960658447000.ce47b803-a80d-4db7-927f-2731e24802a7"
+                  "reference": "Organization/1729351282588469000.d152cd08-af52-4997-9b97-f5aae58ca613"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960659235000.fcfe63ee-a3e0-40cf-b8a4-cf2e9d4a0d60"
+                  "reference": "Organization/1729351282589218000.2e1ce613-9962-4ea5-b3ee-ab7a02dbe4f9"
                 }
               },
               {
@@ -7660,7 +7660,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960660482000.ce0addce-129b-499b-a39b-b5833ce5741f"
+                  "reference": "Practitioner/1729351282590455000.32d424ea-0eca-44b3-b7d2-9b9c80fb675e"
                 }
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@@ -7788,7 +7788,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960662563000.3c8a8055-249e-43a2-b99d-f9e4309bcc7f"
+                  "reference": "Practitioner/1729351282592455000.42c90818-03f1-4adc-858d-afd0253f1861"
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@@ -7870,18 +7870,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "requester": {
-          "reference": "PractitionerRole/1729292960654026000.11356f86-e6f6-4b78-8e7c-a2ec8b7f5f9c"
+          "reference": "PractitionerRole/1729351282584182000.a9a046af-e5ec-4a1e-91b7-97642b126581"
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       }
     },
     {
-      "fullUrl": "Organization/1729292960654235000.4b9893f2-42cc-49ab-8e5c-e1d362d4a9c6",
+      "fullUrl": "Organization/1729351282584378000.c8f36209-be17-42ca-9ac7-2e4b95547218",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960654235000.4b9893f2-42cc-49ab-8e5c-e1d362d4a9c6",
+        "id": "1729351282584378000.c8f36209-be17-42ca-9ac7-2e4b95547218",
         "identifier": [
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@@ -7896,10 +7896,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960655123000.01cb178b-c33e-44a0-a0b0-2690b7e9b219",
+      "fullUrl": "Practitioner/1729351282585236000.84f3b21b-b4ca-41d3-bd9a-140f8f36d63e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960655123000.01cb178b-c33e-44a0-a0b0-2690b7e9b219",
+        "id": "1729351282585236000.84f3b21b-b4ca-41d3-bd9a-140f8f36d63e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7951,7 +7951,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960654235000.4b9893f2-42cc-49ab-8e5c-e1d362d4a9c6"
+              "reference": "Organization/1729351282584378000.c8f36209-be17-42ca-9ac7-2e4b95547218"
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@@ -7967,10 +7967,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960656410000.33f861e6-988f-4b3e-be8b-5d12f71172c9",
+      "fullUrl": "Organization/1729351282586463000.96b11376-37ae-4f93-9f3d-c4c3ad6fe4a6",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960656410000.33f861e6-988f-4b3e-be8b-5d12f71172c9",
+        "id": "1729351282586463000.96b11376-37ae-4f93-9f3d-c4c3ad6fe4a6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8058,23 +8058,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729292960654026000.11356f86-e6f6-4b78-8e7c-a2ec8b7f5f9c",
+      "fullUrl": "PractitionerRole/1729351282584182000.a9a046af-e5ec-4a1e-91b7-97642b126581",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292960654026000.11356f86-e6f6-4b78-8e7c-a2ec8b7f5f9c",
+        "id": "1729351282584182000.a9a046af-e5ec-4a1e-91b7-97642b126581",
         "practitioner": {
-          "reference": "Practitioner/1729292960655123000.01cb178b-c33e-44a0-a0b0-2690b7e9b219"
+          "reference": "Practitioner/1729351282585236000.84f3b21b-b4ca-41d3-bd9a-140f8f36d63e"
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         "organization": {
-          "reference": "Organization/1729292960656410000.33f861e6-988f-4b3e-be8b-5d12f71172c9"
+          "reference": "Organization/1729351282586463000.96b11376-37ae-4f93-9f3d-c4c3ad6fe4a6"
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     },
     {
-      "fullUrl": "Organization/1729292960658447000.ce47b803-a80d-4db7-927f-2731e24802a7",
+      "fullUrl": "Organization/1729351282588469000.d152cd08-af52-4997-9b97-f5aae58ca613",
       "resource": {
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-        "id": "1729292960658447000.ce47b803-a80d-4db7-927f-2731e24802a7",
+        "id": "1729351282588469000.d152cd08-af52-4997-9b97-f5aae58ca613",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8150,10 +8150,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960659235000.fcfe63ee-a3e0-40cf-b8a4-cf2e9d4a0d60",
+      "fullUrl": "Organization/1729351282589218000.2e1ce613-9962-4ea5-b3ee-ab7a02dbe4f9",
       "resource": {
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-        "id": "1729292960659235000.fcfe63ee-a3e0-40cf-b8a4-cf2e9d4a0d60",
+        "id": "1729351282589218000.2e1ce613-9962-4ea5-b3ee-ab7a02dbe4f9",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8229,10 +8229,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960659760000.aa4e6bb7-8d14-4d67-bb6c-f0ac433e3658",
+      "fullUrl": "Organization/1729351282589728000.5a0f8969-896e-4698-a6ae-0916750ad11b",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960659760000.aa4e6bb7-8d14-4d67-bb6c-f0ac433e3658",
+        "id": "1729351282589728000.5a0f8969-896e-4698-a6ae-0916750ad11b",
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@@ -8247,10 +8247,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960660482000.ce0addce-129b-499b-a39b-b5833ce5741f",
+      "fullUrl": "Practitioner/1729351282590455000.32d424ea-0eca-44b3-b7d2-9b9c80fb675e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960660482000.ce0addce-129b-499b-a39b-b5833ce5741f",
+        "id": "1729351282590455000.32d424ea-0eca-44b3-b7d2-9b9c80fb675e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8298,7 +8298,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960659760000.aa4e6bb7-8d14-4d67-bb6c-f0ac433e3658"
+              "reference": "Organization/1729351282589728000.5a0f8969-896e-4698-a6ae-0916750ad11b"
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@@ -8314,10 +8314,10 @@
       }
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-      "fullUrl": "Organization/1729292960661820000.d2c0e170-f671-48b7-bf83-435d4eaad804",
+      "fullUrl": "Organization/1729351282591734000.7d15a934-d3d5-4703-8c0c-e305a3056728",
       "resource": {
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-        "id": "1729292960661820000.d2c0e170-f671-48b7-bf83-435d4eaad804",
+        "id": "1729351282591734000.7d15a934-d3d5-4703-8c0c-e305a3056728",
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@@ -8332,10 +8332,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960662563000.3c8a8055-249e-43a2-b99d-f9e4309bcc7f",
+      "fullUrl": "Practitioner/1729351282592455000.42c90818-03f1-4adc-858d-afd0253f1861",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960662563000.3c8a8055-249e-43a2-b99d-f9e4309bcc7f",
+        "id": "1729351282592455000.42c90818-03f1-4adc-858d-afd0253f1861",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8383,7 +8383,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960661820000.d2c0e170-f671-48b7-bf83-435d4eaad804"
+              "reference": "Organization/1729351282591734000.7d15a934-d3d5-4703-8c0c-e305a3056728"
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@@ -8399,10 +8399,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729292960672182000.692679e3-c71d-4470-afa9-1c870df8dc6b",
+      "fullUrl": "ServiceRequest/1729351282601632000.b401d3e6-297f-4c53-8ba7-31d8ccbf9c23",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729292960672182000.692679e3-c71d-4470-afa9-1c870df8dc6b",
+        "id": "1729351282601632000.b401d3e6-297f-4c53-8ba7-31d8ccbf9c23",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -8414,13 +8414,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960667574000.a717c454-1517-451e-8e02-d71f1f6e7343"
+                  "reference": "Organization/1729351282597206000.3c04f9a8-87be-4a9d-9d22-318950e56d42"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960668376000.5d1b8e5d-2812-4b42-87e9-6deb597ced2b"
+                  "reference": "Organization/1729351282597987000.c66510a6-d5bf-4525-9305-05536f24312c"
                 }
               },
               {
@@ -8448,7 +8448,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960669623000.d0a7fdaa-4855-4614-9ebb-9d0f677b8f0b"
+                  "reference": "Practitioner/1729351282599191000.b2a2824b-ba87-4b6d-85cd-8b6beeae5051"
                 }
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@@ -8576,7 +8576,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960671710000.9e7090f4-fe47-4c04-8a15-8a0cde2ad273"
+                  "reference": "Practitioner/1729351282601169000.928187dd-22cb-488b-acee-9846e233eb0e"
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@@ -8658,18 +8658,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "requester": {
-          "reference": "PractitionerRole/1729292960663186000.31ed98c7-b2d2-4e5f-9a0f-ea6f08f23724"
+          "reference": "PractitionerRole/1729351282593070000.0ab4e3b2-333d-40ab-917e-94e44ec61209"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729292960663382000.90256941-ef52-4949-9c49-ffbccbb56945",
+      "fullUrl": "Organization/1729351282593260000.d7dc6b66-ee49-4b64-978f-05b40cee6046",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960663382000.90256941-ef52-4949-9c49-ffbccbb56945",
+        "id": "1729351282593260000.d7dc6b66-ee49-4b64-978f-05b40cee6046",
         "identifier": [
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@@ -8684,10 +8684,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960664299000.a8b83a0c-b962-4f23-8813-820ed13bf35a",
+      "fullUrl": "Practitioner/1729351282594080000.ccb317e5-3078-49da-a981-34b915611c47",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960664299000.a8b83a0c-b962-4f23-8813-820ed13bf35a",
+        "id": "1729351282594080000.ccb317e5-3078-49da-a981-34b915611c47",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8739,7 +8739,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960663382000.90256941-ef52-4949-9c49-ffbccbb56945"
+              "reference": "Organization/1729351282593260000.d7dc6b66-ee49-4b64-978f-05b40cee6046"
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@@ -8755,10 +8755,10 @@
       }
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     {
-      "fullUrl": "Organization/1729292960665549000.8ad32f5e-8b4b-4e61-afc5-8f0ad7223058",
+      "fullUrl": "Organization/1729351282595270000.3f215b18-d852-46a1-a2e8-8d8be159cec9",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960665549000.8ad32f5e-8b4b-4e61-afc5-8f0ad7223058",
+        "id": "1729351282595270000.3f215b18-d852-46a1-a2e8-8d8be159cec9",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8846,23 +8846,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960663186000.31ed98c7-b2d2-4e5f-9a0f-ea6f08f23724",
+      "fullUrl": "PractitionerRole/1729351282593070000.0ab4e3b2-333d-40ab-917e-94e44ec61209",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292960663186000.31ed98c7-b2d2-4e5f-9a0f-ea6f08f23724",
+        "id": "1729351282593070000.0ab4e3b2-333d-40ab-917e-94e44ec61209",
         "practitioner": {
-          "reference": "Practitioner/1729292960664299000.a8b83a0c-b962-4f23-8813-820ed13bf35a"
+          "reference": "Practitioner/1729351282594080000.ccb317e5-3078-49da-a981-34b915611c47"
         },
         "organization": {
-          "reference": "Organization/1729292960665549000.8ad32f5e-8b4b-4e61-afc5-8f0ad7223058"
+          "reference": "Organization/1729351282595270000.3f215b18-d852-46a1-a2e8-8d8be159cec9"
         }
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     },
     {
-      "fullUrl": "Organization/1729292960667574000.a717c454-1517-451e-8e02-d71f1f6e7343",
+      "fullUrl": "Organization/1729351282597206000.3c04f9a8-87be-4a9d-9d22-318950e56d42",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960667574000.a717c454-1517-451e-8e02-d71f1f6e7343",
+        "id": "1729351282597206000.3c04f9a8-87be-4a9d-9d22-318950e56d42",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8938,10 +8938,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960668376000.5d1b8e5d-2812-4b42-87e9-6deb597ced2b",
+      "fullUrl": "Organization/1729351282597987000.c66510a6-d5bf-4525-9305-05536f24312c",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960668376000.5d1b8e5d-2812-4b42-87e9-6deb597ced2b",
+        "id": "1729351282597987000.c66510a6-d5bf-4525-9305-05536f24312c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9017,10 +9017,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960668901000.6898a5da-09ba-4a46-a45f-26ddcf703701",
+      "fullUrl": "Organization/1729351282598501000.33a4e43d-0a8c-43a4-9d56-5f04eacd38c9",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960668901000.6898a5da-09ba-4a46-a45f-26ddcf703701",
+        "id": "1729351282598501000.33a4e43d-0a8c-43a4-9d56-5f04eacd38c9",
         "identifier": [
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@@ -9035,10 +9035,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292960669623000.d0a7fdaa-4855-4614-9ebb-9d0f677b8f0b",
+      "fullUrl": "Practitioner/1729351282599191000.b2a2824b-ba87-4b6d-85cd-8b6beeae5051",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960669623000.d0a7fdaa-4855-4614-9ebb-9d0f677b8f0b",
+        "id": "1729351282599191000.b2a2824b-ba87-4b6d-85cd-8b6beeae5051",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9086,7 +9086,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960668901000.6898a5da-09ba-4a46-a45f-26ddcf703701"
+              "reference": "Organization/1729351282598501000.33a4e43d-0a8c-43a4-9d56-5f04eacd38c9"
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@@ -9102,10 +9102,10 @@
       }
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     {
-      "fullUrl": "Organization/1729292960670972000.9f5d5cbb-393b-4bc7-b546-c933dfb1f897",
+      "fullUrl": "Organization/1729351282600463000.8e856b14-b606-47b6-b29d-a44abb6c3e5f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960670972000.9f5d5cbb-393b-4bc7-b546-c933dfb1f897",
+        "id": "1729351282600463000.8e856b14-b606-47b6-b29d-a44abb6c3e5f",
         "identifier": [
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@@ -9120,10 +9120,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960671710000.9e7090f4-fe47-4c04-8a15-8a0cde2ad273",
+      "fullUrl": "Practitioner/1729351282601169000.928187dd-22cb-488b-acee-9846e233eb0e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960671710000.9e7090f4-fe47-4c04-8a15-8a0cde2ad273",
+        "id": "1729351282601169000.928187dd-22cb-488b-acee-9846e233eb0e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9171,7 +9171,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960670972000.9f5d5cbb-393b-4bc7-b546-c933dfb1f897"
+              "reference": "Organization/1729351282600463000.8e856b14-b606-47b6-b29d-a44abb6c3e5f"
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@@ -9187,10 +9187,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729292960681341000.f623864e-c40e-4a1f-8475-c86923839ea8",
+      "fullUrl": "ServiceRequest/1729351282610493000.da07e6c0-a832-4e3f-926d-9aa07e66810a",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729292960681341000.f623864e-c40e-4a1f-8475-c86923839ea8",
+        "id": "1729351282610493000.da07e6c0-a832-4e3f-926d-9aa07e66810a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -9202,13 +9202,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960676723000.68b10456-e9d1-4d29-a557-2a1d8fd9c77f"
+                  "reference": "Organization/1729351282606025000.ee0d11e5-80aa-4e4a-bc91-cd71f21a4ee4"
                 }
               },
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960677540000.071d7d82-47d2-4bf1-b33e-fde4330ea62d"
+                  "reference": "Organization/1729351282606806000.8ba32df0-0ee5-487d-9e47-60e4757d4a97"
                 }
               },
               {
@@ -9236,7 +9236,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960678797000.eb4eb268-7147-4173-88d7-3487ff6b92f2"
+                  "reference": "Practitioner/1729351282608007000.2e48ece5-fd98-4af2-8bff-00826cd0dc87"
                 }
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@@ -9364,7 +9364,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960680876000.192a3414-1213-483a-b93f-064bcb5fc619"
+                  "reference": "Practitioner/1729351282610027000.b30cde50-d638-4f6b-9404-095d70a54dfb"
                 }
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@@ -9446,18 +9446,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "requester": {
-          "reference": "PractitionerRole/1729292960672340000.fa7b38fe-9cc3-4773-98c8-0c954904e1d8"
+          "reference": "PractitionerRole/1729351282601795000.25da09f6-c201-4423-987d-95a138f8e84d"
         }
       }
     },
     {
-      "fullUrl": "Organization/1729292960672538000.4b34062c-355d-4567-a587-28f7653b3d82",
+      "fullUrl": "Organization/1729351282601986000.f18e6ff3-3067-456c-adb5-1d525da21af4",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960672538000.4b34062c-355d-4567-a587-28f7653b3d82",
+        "id": "1729351282601986000.f18e6ff3-3067-456c-adb5-1d525da21af4",
         "identifier": [
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@@ -9472,10 +9472,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960673397000.83f711b2-e8e7-4f7f-8b7a-0e76c894d3fd",
+      "fullUrl": "Practitioner/1729351282602844000.0b01dd2c-b0e3-4438-bb6b-c8b310d34819",
       "resource": {
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-        "id": "1729292960673397000.83f711b2-e8e7-4f7f-8b7a-0e76c894d3fd",
+        "id": "1729351282602844000.0b01dd2c-b0e3-4438-bb6b-c8b310d34819",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9527,7 +9527,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960672538000.4b34062c-355d-4567-a587-28f7653b3d82"
+              "reference": "Organization/1729351282601986000.f18e6ff3-3067-456c-adb5-1d525da21af4"
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@@ -9543,10 +9543,10 @@
       }
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     {
-      "fullUrl": "Organization/1729292960674678000.ac8751f8-c776-4c9a-bd5b-f4e3c360d22c",
+      "fullUrl": "Organization/1729351282604092000.fbb8c496-654b-440f-912e-a54f8cfdff1f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960674678000.ac8751f8-c776-4c9a-bd5b-f4e3c360d22c",
+        "id": "1729351282604092000.fbb8c496-654b-440f-912e-a54f8cfdff1f",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9634,23 +9634,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960672340000.fa7b38fe-9cc3-4773-98c8-0c954904e1d8",
+      "fullUrl": "PractitionerRole/1729351282601795000.25da09f6-c201-4423-987d-95a138f8e84d",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292960672340000.fa7b38fe-9cc3-4773-98c8-0c954904e1d8",
+        "id": "1729351282601795000.25da09f6-c201-4423-987d-95a138f8e84d",
         "practitioner": {
-          "reference": "Practitioner/1729292960673397000.83f711b2-e8e7-4f7f-8b7a-0e76c894d3fd"
+          "reference": "Practitioner/1729351282602844000.0b01dd2c-b0e3-4438-bb6b-c8b310d34819"
         },
         "organization": {
-          "reference": "Organization/1729292960674678000.ac8751f8-c776-4c9a-bd5b-f4e3c360d22c"
+          "reference": "Organization/1729351282604092000.fbb8c496-654b-440f-912e-a54f8cfdff1f"
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     {
-      "fullUrl": "Organization/1729292960676723000.68b10456-e9d1-4d29-a557-2a1d8fd9c77f",
+      "fullUrl": "Organization/1729351282606025000.ee0d11e5-80aa-4e4a-bc91-cd71f21a4ee4",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960676723000.68b10456-e9d1-4d29-a557-2a1d8fd9c77f",
+        "id": "1729351282606025000.ee0d11e5-80aa-4e4a-bc91-cd71f21a4ee4",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9726,10 +9726,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960677540000.071d7d82-47d2-4bf1-b33e-fde4330ea62d",
+      "fullUrl": "Organization/1729351282606806000.8ba32df0-0ee5-487d-9e47-60e4757d4a97",
       "resource": {
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-        "id": "1729292960677540000.071d7d82-47d2-4bf1-b33e-fde4330ea62d",
+        "id": "1729351282606806000.8ba32df0-0ee5-487d-9e47-60e4757d4a97",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9805,10 +9805,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960678071000.077225e3-de2c-4281-ace8-0bbf2a0124a8",
+      "fullUrl": "Organization/1729351282607316000.4344244f-02b8-491f-8721-fcfba19c2e69",
       "resource": {
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-        "id": "1729292960678071000.077225e3-de2c-4281-ace8-0bbf2a0124a8",
+        "id": "1729351282607316000.4344244f-02b8-491f-8721-fcfba19c2e69",
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@@ -9823,10 +9823,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729292960678797000.eb4eb268-7147-4173-88d7-3487ff6b92f2",
+      "fullUrl": "Practitioner/1729351282608007000.2e48ece5-fd98-4af2-8bff-00826cd0dc87",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960678797000.eb4eb268-7147-4173-88d7-3487ff6b92f2",
+        "id": "1729351282608007000.2e48ece5-fd98-4af2-8bff-00826cd0dc87",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9874,7 +9874,7 @@
             },
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@@ -9890,10 +9890,10 @@
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@@ -9908,10 +9908,10 @@
       }
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@@ -9959,7 +9959,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351282609331000.7dc6ab92-4794-4556-aa60-29eead122cef"
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@@ -9975,10 +9975,10 @@
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@@ -9990,13 +9990,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960685879000.61bde7c5-2846-4186-89d8-aa8a8c70a0f1"
+                  "reference": "Organization/1729351282614928000.248a1d6b-c846-44ae-8017-c7d5e1777edf"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351282615728000.11ee4ccc-727e-4a38-9d4d-7bde63195b39"
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@@ -10024,7 +10024,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960688008000.2b9bd956-e2fd-45b3-8e25-85a4cb4b4729"
+                  "reference": "Practitioner/1729351282616958000.275815df-df12-469c-a6a9-9cb78c76b984"
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@@ -10152,7 +10152,7 @@
               {
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@@ -10234,18 +10234,18 @@
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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@@ -10260,10 +10260,10 @@
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@@ -10315,7 +10315,7 @@
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             "assigner": {
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@@ -10331,10 +10331,10 @@
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@@ -10422,23 +10422,23 @@
       }
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-      "fullUrl": "PractitionerRole/1729292960681501000.5e2b7f01-3156-4309-be36-172637da718b",
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+        "id": "1729351282610654000.3e991ece-e385-4b7a-bf24-e81c531684ad",
         "practitioner": {
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+          "reference": "Practitioner/1729351282611707000.7f7e7a8f-94c4-4fda-acae-fc0d0768fcb4"
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@@ -10514,10 +10514,10 @@
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         "extension": [
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@@ -10593,10 +10593,10 @@
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@@ -10611,10 +10611,10 @@
       }
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@@ -10662,7 +10662,7 @@
             },
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             "assigner": {
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@@ -10678,10 +10678,10 @@
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@@ -10696,10 +10696,10 @@
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@@ -10747,7 +10747,7 @@
             },
             "value": "1174911127",
             "assigner": {
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@@ -10763,10 +10763,10 @@
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@@ -10778,13 +10778,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960699590000.0416e952-5bc9-49d5-b646-67d8bf22cdbf"
+                  "reference": "Organization/1729351282623870000.baaec27e-ad81-4fc8-b89d-604bf2dc77d4"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351282624666000.32981889-05b6-4883-8475-e0c287fa931d"
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@@ -10812,7 +10812,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960704604000.b69ea163-9a7c-45f6-8b2c-a8e86056d247"
+                  "reference": "Practitioner/1729351282625886000.95458a50-2bff-4e6e-8acd-c2b713906c54"
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@@ -10940,7 +10940,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729351282627866000.830a6c1e-b160-4b27-add7-9f54df134631"
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@@ -11022,18 +11022,18 @@
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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+          "reference": "PractitionerRole/1729351282619602000.89013f5f-bd25-4dbc-939a-2b64ff8ce7b2"
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@@ -11048,10 +11048,10 @@
       }
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@@ -11103,7 +11103,7 @@
             },
             "value": "1174911127",
             "assigner": {
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@@ -11119,10 +11119,10 @@
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@@ -11210,23 +11210,23 @@
       }
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+          "reference": "Practitioner/1729351282620625000.63568ee3-aad7-4c8e-aa13-79a159f94422"
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@@ -11302,10 +11302,10 @@
       }
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@@ -11381,10 +11381,10 @@
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@@ -11399,10 +11399,10 @@
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+      "fullUrl": "Practitioner/1729351282625886000.95458a50-2bff-4e6e-8acd-c2b713906c54",
       "resource": {
         "resourceType": "Practitioner",
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11450,7 +11450,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960702726000.7adab4c9-730b-483b-a5a0-03ee8b7602c3"
+              "reference": "Organization/1729351282625184000.333229da-b32f-42c1-9445-b2c454849c2a"
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@@ -11466,10 +11466,10 @@
       }
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+      "fullUrl": "Organization/1729351282627165000.9fe93648-0e1a-4336-807b-87fcae0d05fa",
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-        "id": "1729292960707863000.beabade2-6da5-40ff-81b2-86e924d77d31",
+        "id": "1729351282627165000.9fe93648-0e1a-4336-807b-87fcae0d05fa",
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@@ -11484,10 +11484,10 @@
       }
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+      "fullUrl": "Practitioner/1729351282627866000.830a6c1e-b160-4b27-add7-9f54df134631",
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+        "id": "1729351282627866000.830a6c1e-b160-4b27-add7-9f54df134631",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11535,7 +11535,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960707863000.beabade2-6da5-40ff-81b2-86e924d77d31"
+              "reference": "Organization/1729351282627165000.9fe93648-0e1a-4336-807b-87fcae0d05fa"
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@@ -11551,10 +11551,10 @@
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+      "fullUrl": "ServiceRequest/1729351282639248000.1d991564-64a7-4142-a946-f82e065f5d9f",
       "resource": {
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-        "id": "1729292960719659000.c7032b8b-0c75-4368-94ad-9bd076955b6e",
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         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -11566,13 +11566,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960715024000.29fb6c13-8a1c-49d7-8264-659f7537758b"
+                  "reference": "Organization/1729351282632715000.d12f2d6c-5107-4e26-8b65-7eb6eac94c0e"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960715820000.b388cd49-7a5c-4631-b59f-6120485973a8"
+                  "reference": "Organization/1729351282633482000.7b1b680d-e773-4798-95f2-cd5e89a946b5"
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@@ -11600,7 +11600,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960717088000.2e90e0cf-340c-4591-b0ca-efffadc0cf99"
+                  "reference": "Practitioner/1729351282634718000.9e129482-1f82-4e7a-b81b-be3b35c32406"
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@@ -11728,7 +11728,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960719166000.7349a0df-d936-4503-9418-96ce2b1eb211"
+                  "reference": "Practitioner/1729351282638256000.4c88e211-fed3-492e-b7f5-92ccd56004a2"
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@@ -11810,18 +11810,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "requester": {
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+          "reference": "PractitionerRole/1729351282628495000.0351bcc4-bb41-4b83-a064-ba548d2940f1"
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       "resource": {
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@@ -11836,10 +11836,10 @@
       }
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-      "fullUrl": "Practitioner/1729292960711629000.210a5d4a-af01-4de3-a3a5-2bc72e5a2314",
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         "extension": [
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@@ -11891,7 +11891,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960710774000.17ae4d1e-b7c8-476d-b319-d9dfa75cc8f3"
+              "reference": "Organization/1729351282628687000.a8f75bbd-a7a9-46da-8ae0-9f358475cf5d"
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@@ -11907,10 +11907,10 @@
       }
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+      "fullUrl": "Organization/1729351282630743000.90540bdf-d0d5-465f-83e9-aacd18f637e3",
       "resource": {
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-        "id": "1729292960712897000.4fa804f9-fe3a-48f4-92b0-ba3959aaac37",
+        "id": "1729351282630743000.90540bdf-d0d5-465f-83e9-aacd18f637e3",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11998,23 +11998,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960710573000.75dc770a-65e5-4101-8fb7-238ce53d040c",
+      "fullUrl": "PractitionerRole/1729351282628495000.0351bcc4-bb41-4b83-a064-ba548d2940f1",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729292960710573000.75dc770a-65e5-4101-8fb7-238ce53d040c",
+        "id": "1729351282628495000.0351bcc4-bb41-4b83-a064-ba548d2940f1",
         "practitioner": {
-          "reference": "Practitioner/1729292960711629000.210a5d4a-af01-4de3-a3a5-2bc72e5a2314"
+          "reference": "Practitioner/1729351282629538000.7434bf1f-59e8-43be-8615-4f1b54ba64cf"
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         "organization": {
-          "reference": "Organization/1729292960712897000.4fa804f9-fe3a-48f4-92b0-ba3959aaac37"
+          "reference": "Organization/1729351282630743000.90540bdf-d0d5-465f-83e9-aacd18f637e3"
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     {
-      "fullUrl": "Organization/1729292960715024000.29fb6c13-8a1c-49d7-8264-659f7537758b",
+      "fullUrl": "Organization/1729351282632715000.d12f2d6c-5107-4e26-8b65-7eb6eac94c0e",
       "resource": {
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-        "id": "1729292960715024000.29fb6c13-8a1c-49d7-8264-659f7537758b",
+        "id": "1729351282632715000.d12f2d6c-5107-4e26-8b65-7eb6eac94c0e",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12090,10 +12090,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960715820000.b388cd49-7a5c-4631-b59f-6120485973a8",
+      "fullUrl": "Organization/1729351282633482000.7b1b680d-e773-4798-95f2-cd5e89a946b5",
       "resource": {
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+        "id": "1729351282633482000.7b1b680d-e773-4798-95f2-cd5e89a946b5",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12169,10 +12169,10 @@
       }
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     {
-      "fullUrl": "Organization/1729292960716359000.120b1f97-4b41-48b7-8454-a3d1a61ac1b1",
+      "fullUrl": "Organization/1729351282634009000.f99099e9-2d41-4288-8bcf-2b1ec20a733a",
       "resource": {
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-        "id": "1729292960716359000.120b1f97-4b41-48b7-8454-a3d1a61ac1b1",
+        "id": "1729351282634009000.f99099e9-2d41-4288-8bcf-2b1ec20a733a",
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@@ -12187,10 +12187,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292960717088000.2e90e0cf-340c-4591-b0ca-efffadc0cf99",
+      "fullUrl": "Practitioner/1729351282634718000.9e129482-1f82-4e7a-b81b-be3b35c32406",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960717088000.2e90e0cf-340c-4591-b0ca-efffadc0cf99",
+        "id": "1729351282634718000.9e129482-1f82-4e7a-b81b-be3b35c32406",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12238,7 +12238,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960716359000.120b1f97-4b41-48b7-8454-a3d1a61ac1b1"
+              "reference": "Organization/1729351282634009000.f99099e9-2d41-4288-8bcf-2b1ec20a733a"
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@@ -12254,10 +12254,10 @@
       }
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-      "fullUrl": "Organization/1729292960718429000.7c3bb40d-ca3e-490c-8901-d239cc745fac",
+      "fullUrl": "Organization/1729351282636025000.39c53e03-5887-4df4-a7de-da01d83f0786",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729292960718429000.7c3bb40d-ca3e-490c-8901-d239cc745fac",
+        "id": "1729351282636025000.39c53e03-5887-4df4-a7de-da01d83f0786",
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@@ -12272,10 +12272,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729292960719166000.7349a0df-d936-4503-9418-96ce2b1eb211",
+      "fullUrl": "Practitioner/1729351282638256000.4c88e211-fed3-492e-b7f5-92ccd56004a2",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729292960719166000.7349a0df-d936-4503-9418-96ce2b1eb211",
+        "id": "1729351282638256000.4c88e211-fed3-492e-b7f5-92ccd56004a2",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12323,7 +12323,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960718429000.7c3bb40d-ca3e-490c-8901-d239cc745fac"
+              "reference": "Organization/1729351282636025000.39c53e03-5887-4df4-a7de-da01d83f0786"
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@@ -12339,10 +12339,10 @@
       }
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     {
-      "fullUrl": "ServiceRequest/1729292960728779000.9585689a-a3bd-45ba-aed7-e46c1bf05ab4",
+      "fullUrl": "ServiceRequest/1729351282655731000.527b6a72-3f4b-4eef-b198-10b3371d294c",
       "resource": {
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-        "id": "1729292960728779000.9585689a-a3bd-45ba-aed7-e46c1bf05ab4",
+        "id": "1729351282655731000.527b6a72-3f4b-4eef-b198-10b3371d294c",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -12354,13 +12354,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960724164000.4d08a169-acee-4491-b9c4-d6ef5713bc51"
+                  "reference": "Organization/1729351282650384000.f9db98c1-bf1c-4070-9a47-21debd77c830"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960724962000.d642a06e-02f4-4c35-9eb3-973bfa485e7b"
+                  "reference": "Organization/1729351282652055000.625dce7b-9cf0-435b-a510-40b6bdef88f2"
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@@ -12388,7 +12388,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960726209000.b4e9d8a6-1c93-4b16-a19f-e684f2c533e0"
+                  "reference": "Practitioner/1729351282653286000.f1d9e3fe-19fe-407e-b9de-5119dd3636f8"
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@@ -12516,7 +12516,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960728283000.039583d8-9c2d-4d25-9aef-aeb79974d891"
+                  "reference": "Practitioner/1729351282655280000.80c896d1-9407-4f0d-b70b-232214a31d83"
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@@ -12598,18 +12598,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "requester": {
-          "reference": "PractitionerRole/1729292960719820000.26992ee4-b509-425b-877c-fdb7acc680e3"
+          "reference": "PractitionerRole/1729351282639512000.95d2889e-0f37-451e-b8a3-bfad8decaaa8"
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-      "fullUrl": "Organization/1729292960720014000.4d35d12e-53b3-4c08-a049-9998fa8aca24",
+      "fullUrl": "Organization/1729351282639828000.db96b239-8329-485a-bb1f-9090315a8e6d",
       "resource": {
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-        "id": "1729292960720014000.4d35d12e-53b3-4c08-a049-9998fa8aca24",
+        "id": "1729351282639828000.db96b239-8329-485a-bb1f-9090315a8e6d",
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@@ -12624,10 +12624,10 @@
       }
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-      "fullUrl": "Practitioner/1729292960720894000.22b20ede-d503-4179-b949-fac287c6f8a9",
+      "fullUrl": "Practitioner/1729351282642324000.eb9fd4ac-1eed-41df-923c-152ad6b94944",
       "resource": {
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-        "id": "1729292960720894000.22b20ede-d503-4179-b949-fac287c6f8a9",
+        "id": "1729351282642324000.eb9fd4ac-1eed-41df-923c-152ad6b94944",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12679,7 +12679,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960720014000.4d35d12e-53b3-4c08-a049-9998fa8aca24"
+              "reference": "Organization/1729351282639828000.db96b239-8329-485a-bb1f-9090315a8e6d"
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@@ -12695,10 +12695,10 @@
       }
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-      "fullUrl": "Organization/1729292960722144000.928c96c2-0352-4d01-9a2f-3fcc9b965bd0",
+      "fullUrl": "Organization/1729351282646007000.c38140ff-0019-40e3-8cf3-bb254748dfd8",
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+        "id": "1729351282646007000.c38140ff-0019-40e3-8cf3-bb254748dfd8",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12786,23 +12786,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729292960719820000.26992ee4-b509-425b-877c-fdb7acc680e3",
+      "fullUrl": "PractitionerRole/1729351282639512000.95d2889e-0f37-451e-b8a3-bfad8decaaa8",
       "resource": {
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-        "id": "1729292960719820000.26992ee4-b509-425b-877c-fdb7acc680e3",
+        "id": "1729351282639512000.95d2889e-0f37-451e-b8a3-bfad8decaaa8",
         "practitioner": {
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+          "reference": "Practitioner/1729351282642324000.eb9fd4ac-1eed-41df-923c-152ad6b94944"
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         "organization": {
-          "reference": "Organization/1729292960722144000.928c96c2-0352-4d01-9a2f-3fcc9b965bd0"
+          "reference": "Organization/1729351282646007000.c38140ff-0019-40e3-8cf3-bb254748dfd8"
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-      "fullUrl": "Organization/1729292960724164000.4d08a169-acee-4491-b9c4-d6ef5713bc51",
+      "fullUrl": "Organization/1729351282650384000.f9db98c1-bf1c-4070-9a47-21debd77c830",
       "resource": {
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-        "id": "1729292960724164000.4d08a169-acee-4491-b9c4-d6ef5713bc51",
+        "id": "1729351282650384000.f9db98c1-bf1c-4070-9a47-21debd77c830",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12878,10 +12878,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729292960724962000.d642a06e-02f4-4c35-9eb3-973bfa485e7b",
+      "fullUrl": "Organization/1729351282652055000.625dce7b-9cf0-435b-a510-40b6bdef88f2",
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+        "id": "1729351282652055000.625dce7b-9cf0-435b-a510-40b6bdef88f2",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12957,10 +12957,10 @@
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@@ -12975,10 +12975,10 @@
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@@ -13026,7 +13026,7 @@
             },
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             "assigner": {
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@@ -13042,10 +13042,10 @@
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@@ -13060,10 +13060,10 @@
       }
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@@ -13111,7 +13111,7 @@
             },
             "value": "1174911127",
             "assigner": {
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@@ -13127,10 +13127,10 @@
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@@ -13142,13 +13142,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960733317000.ec556131-9f9a-4f4b-8f04-3501d5a23525"
+                  "reference": "Organization/1729351282660161000.725890bf-618b-4b74-934d-3ca558dee474"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351282660933000.0d58ef48-e360-49ea-8fdc-0607db9d3e2f"
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@@ -13176,7 +13176,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
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+                  "reference": "Practitioner/1729351282662173000.379d479e-827e-4c81-ae70-265eba41222b"
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@@ -13304,7 +13304,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960737522000.5610ff0a-97dd-452d-bf65-a029773b467b"
+                  "reference": "Practitioner/1729351282664155000.d0c3e473-faeb-40b9-ad71-979198e41e23"
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@@ -13386,18 +13386,18 @@
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "requester": {
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@@ -13412,10 +13412,10 @@
       }
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@@ -13467,7 +13467,7 @@
             },
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             "assigner": {
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@@ -13483,10 +13483,10 @@
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@@ -13574,23 +13574,23 @@
       }
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         "practitioner": {
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+          "reference": "Practitioner/1729351282656956000.a1f76b43-ee5c-4255-a70a-ff27d54cbde1"
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@@ -13666,10 +13666,10 @@
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@@ -13745,10 +13745,10 @@
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@@ -13763,10 +13763,10 @@
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@@ -13814,7 +13814,7 @@
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             "assigner": {
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@@ -13830,10 +13830,10 @@
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@@ -13848,10 +13848,10 @@
       }
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@@ -13899,7 +13899,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729292960736783000.6cf06ed1-79f4-4b28-b49f-4c71c8c941c5"
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@@ -13915,10 +13915,10 @@
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@@ -13930,13 +13930,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960742620000.37e573bb-01ef-4661-9c04-783432b9e08a"
+                  "reference": "Organization/1729351282669041000.7bb0e91c-e386-4030-a274-5fe4852d4094"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960743440000.15841523-250e-424a-9749-e7382a44de0a"
+                  "reference": "Organization/1729351282669832000.5332e3c7-c38c-436a-bc1b-b12592ef3412"
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@@ -13964,7 +13964,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960744701000.c5ffc999-9b13-41e8-8ab0-55c04d174139"
+                  "reference": "Practitioner/1729351282671098000.7b5c275e-f8cb-42cb-8e81-221d85de92ec"
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@@ -14092,7 +14092,7 @@
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@@ -14174,18 +14174,18 @@
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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@@ -14200,10 +14200,10 @@
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@@ -14255,7 +14255,7 @@
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             "assigner": {
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@@ -14271,10 +14271,10 @@
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@@ -14362,23 +14362,23 @@
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@@ -14454,10 +14454,10 @@
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+        "id": "1729351282669832000.5332e3c7-c38c-436a-bc1b-b12592ef3412",
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@@ -14533,10 +14533,10 @@
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-      "fullUrl": "Organization/1729292960743973000.ae7c98b3-26d0-4b15-98c1-b8de19c4ff92",
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@@ -14551,10 +14551,10 @@
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       "resource": {
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         "extension": [
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@@ -14602,7 +14602,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729292960743973000.ae7c98b3-26d0-4b15-98c1-b8de19c4ff92"
+              "reference": "Organization/1729351282670380000.249ae1af-8964-44a5-8e52-9930309c8744"
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@@ -14618,10 +14618,10 @@
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@@ -14636,10 +14636,10 @@
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@@ -14687,7 +14687,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729292960746098000.339ae739-7435-4269-b825-bec2ab8fdf7d"
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@@ -14703,10 +14703,10 @@
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@@ -14718,13 +14718,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960751907000.1667c020-039e-4bfe-8fab-fdf01da8cdc5"
+                  "reference": "Organization/1729351282678242000.49548e40-a8e4-446b-a79a-1cefeef16b0f"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960752684000.62567362-e46c-4e87-bb1e-aa081003d699"
+                  "reference": "Organization/1729351282679022000.7492b4ad-8b93-4f60-8150-89ea8efe1b50"
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@@ -14752,7 +14752,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729292960754007000.a7b79959-5efe-43d0-86ef-6940dba564a9"
+                  "reference": "Practitioner/1729351282680256000.0e5e5bf0-5949-4683-838e-432f05f56517"
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@@ -14880,7 +14880,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960756033000.e96b71ad-5133-4fb7-931c-14a7c5a7f399"
+                  "reference": "Practitioner/1729351282682354000.2425a090-184a-4890-b7f3-c74147dda9bb"
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@@ -14962,18 +14962,18 @@
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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@@ -14988,10 +14988,10 @@
       }
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@@ -15043,7 +15043,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729351282674102000.1cd96e92-843d-4664-b964-a19cd7bfe14c"
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@@ -15059,10 +15059,10 @@
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         "extension": [
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@@ -15150,23 +15150,23 @@
       }
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-      "fullUrl": "PractitionerRole/1729292960747490000.47b2c9ff-2ac1-41d6-a139-83179475a846",
+      "fullUrl": "PractitionerRole/1729351282673875000.342930cb-17c1-4bfe-855f-d86be05ec372",
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+        "id": "1729351282673875000.342930cb-17c1-4bfe-855f-d86be05ec372",
         "practitioner": {
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+          "reference": "Practitioner/1729351282674951000.02dd2df1-b67f-4d6d-a9c4-399cf190f451"
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         "organization": {
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+          "reference": "Organization/1729351282676176000.8ef8ea1a-a5f8-40e3-a465-a88e22b79149"
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-        "id": "1729292960751907000.1667c020-039e-4bfe-8fab-fdf01da8cdc5",
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         "extension": [
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@@ -15242,10 +15242,10 @@
       }
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         "extension": [
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@@ -15321,10 +15321,10 @@
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@@ -15339,10 +15339,10 @@
       }
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       "resource": {
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+        "id": "1729351282680256000.0e5e5bf0-5949-4683-838e-432f05f56517",
         "extension": [
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@@ -15390,7 +15390,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960753248000.4e9490fe-4537-4ed9-ae48-8a52ce7ef725"
+              "reference": "Organization/1729351282679554000.ff090dd8-3abc-4a5f-90b6-ca7a61ae889b"
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@@ -15406,10 +15406,10 @@
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@@ -15424,10 +15424,10 @@
       }
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         "extension": [
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@@ -15475,7 +15475,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960755327000.08187d8c-fb72-4d9a-9431-204f5e37fcb4"
+              "reference": "Organization/1729351282681629000.01d01dd3-e4d9-4210-a006-eec9d1893451"
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@@ -15491,10 +15491,10 @@
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@@ -15506,13 +15506,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960761120000.56af5421-247f-48f7-b198-c5442a42dcbe"
+                  "reference": "Organization/1729351282687202000.9d51ca97-53a6-44f9-a116-ec34b0b27caa"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729292960761888000.e61c2f15-508c-4edc-96b9-d1568a0f93eb"
+                  "reference": "Organization/1729351282687965000.81ba21b2-06b9-4c95-8aae-5b0a16c41c32"
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@@ -15540,7 +15540,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960763357000.9bf6295b-00c6-4302-bb1f-f95c7d593da4"
+                  "reference": "Practitioner/1729351282689209000.08ca2621-e21a-4a53-bb7e-ebdb72f4ad6b"
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@@ -15668,7 +15668,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729292960768416000.8e425671-971c-4c19-b3c6-d0c701cd67b4"
+                  "reference": "Practitioner/1729351282691213000.0d775e6d-186a-41d9-9833-9e54d24c53b4"
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@@ -15750,18 +15750,18 @@
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "requester": {
-          "reference": "PractitionerRole/1729292960756704000.53c24ca4-96ed-4e8d-8410-2ad98c2de024"
+          "reference": "PractitionerRole/1729351282682983000.8f94cf98-8345-4e50-8824-5b6e291d1a12"
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@@ -15776,10 +15776,10 @@
       }
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+      "fullUrl": "Practitioner/1729351282684016000.204bfb73-6207-4dd9-bc5f-2cd2c56c4467",
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@@ -15831,7 +15831,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729292960756919000.48144433-f634-42df-be17-f2e15080eda6"
+              "reference": "Organization/1729351282683179000.e7966ab6-613a-400e-be6e-4f504b5f7f44"
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@@ -15847,10 +15847,10 @@
       }
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@@ -15938,23 +15938,23 @@
       }
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@@ -17064,7 +17064,7 @@
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@@ -17088,7 +17088,7 @@
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@@ -17110,21 +17110,21 @@
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@@ -17177,7 +17177,7 @@
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@@ -17201,7 +17201,7 @@
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+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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@@ -17223,21 +17223,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960613389000.7927118b-2869-4833-83f2-be947087eebe"
+            "reference": "Specimen/1729351282547218000.c1935b83-445c-4a0c-9379-085457f37d4f"
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-            "reference": "Observation/1729292960594362000.1ceff9e2-418b-485c-8896-084a0878196e"
+            "reference": "Observation/1729351282525744000.50fb89fd-d1b0-4c20-bd1e-6d89080166ed"
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+      "fullUrl": "DiagnosticReport/1729351282711754000.27fb5804-0458-42c1-8d44-38ed4a5ff252",
       "resource": {
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-        "id": "1729292960792829000.19e7d02d-9bcd-4244-bb20-499669066cc5",
+        "id": "1729351282711754000.27fb5804-0458-42c1-8d44-38ed4a5ff252",
         "identifier": [
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             "extension": [
@@ -17290,7 +17290,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960719659000.c7032b8b-0c75-4368-94ad-9bd076955b6e"
+            "reference": "ServiceRequest/1729351282639248000.1d991564-64a7-4142-a946-f82e065f5d9f"
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         "status": "final",
@@ -17314,7 +17314,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17336,21 +17336,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960613737000.451cc298-4ec2-4cda-a6f1-3010758309d0"
+            "reference": "Specimen/1729351282548040000.4dbcc4ae-cacc-4c49-9829-659b4748c0ae"
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         "result": [
           {
-            "reference": "Observation/1729292960596419000.ae367932-cd33-4834-a247-5e8c55929c37"
+            "reference": "Observation/1729351282527840000.9f7134e3-b9c4-42c7-941d-6eaff11699f3"
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       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292960794258000.b71f93df-77ef-4b37-a134-5cdbc254ccd4",
+      "fullUrl": "DiagnosticReport/1729351282714826000.2cc773ab-edb1-45b5-ab1b-18a8a5219463",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292960794258000.b71f93df-77ef-4b37-a134-5cdbc254ccd4",
+        "id": "1729351282714826000.2cc773ab-edb1-45b5-ab1b-18a8a5219463",
         "identifier": [
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             "extension": [
@@ -17403,7 +17403,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960728779000.9585689a-a3bd-45ba-aed7-e46c1bf05ab4"
+            "reference": "ServiceRequest/1729351282655731000.527b6a72-3f4b-4eef-b198-10b3371d294c"
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         "status": "final",
@@ -17427,7 +17427,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17449,21 +17449,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960614082000.603140f0-5392-4f0a-af7c-7cb49dbef86d"
+            "reference": "Specimen/1729351282548627000.755d869d-e7c4-4a50-aede-ddae64d77e11"
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         "result": [
           {
-            "reference": "Observation/1729292960598461000.1de21530-6db6-44a5-9b59-c63617272d72"
+            "reference": "Observation/1729351282529856000.e8c7724c-4095-4ada-a529-d39c121c9dbd"
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     },
     {
-      "fullUrl": "DiagnosticReport/1729292960795639000.62c88e2d-10b8-4aaa-94f6-cace410dd6c3",
+      "fullUrl": "DiagnosticReport/1729351282718550000.26ea1c91-207c-44b9-96e2-058cf5fe40ec",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292960795639000.62c88e2d-10b8-4aaa-94f6-cace410dd6c3",
+        "id": "1729351282718550000.26ea1c91-207c-44b9-96e2-058cf5fe40ec",
         "identifier": [
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             "extension": [
@@ -17516,7 +17516,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960737986000.647557fd-9965-4f8c-88ca-d97a13284fc3"
+            "reference": "ServiceRequest/1729351282664614000.09972dff-4ebb-48aa-91cc-cde49eeb717d"
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         "status": "final",
@@ -17540,7 +17540,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17562,21 +17562,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960614427000.3bbc7d98-7f15-4512-836d-646b714f8eff"
+            "reference": "Specimen/1729351282549118000.db8226e4-9f3d-4fff-a25f-f863966f27ce"
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         "result": [
           {
-            "reference": "Observation/1729292960600532000.d11f95ea-9e56-4e5b-805b-a56d009bc24a"
+            "reference": "Observation/1729351282531797000.a7372cf5-9e83-4de0-acf8-52619b7e1348"
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     {
-      "fullUrl": "DiagnosticReport/1729292960797049000.b7a29488-c86e-4d82-b78f-2a3ce72274d9",
+      "fullUrl": "DiagnosticReport/1729351282721733000.bce1ab6e-bc84-415e-8088-7fc5003add8d",
       "resource": {
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-        "id": "1729292960797049000.b7a29488-c86e-4d82-b78f-2a3ce72274d9",
+        "id": "1729351282721733000.bce1ab6e-bc84-415e-8088-7fc5003add8d",
         "identifier": [
           {
             "extension": [
@@ -17629,7 +17629,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960747334000.76edf288-2560-44e5-937f-60d398eb6434"
+            "reference": "ServiceRequest/1729351282673715000.02e4c0e7-d30c-45f2-9805-bf7f74d453c5"
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         "status": "final",
@@ -17653,7 +17653,7 @@
           ]
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         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17675,21 +17675,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960614832000.72409220-1fed-4476-bf47-2d6f5006665c"
+            "reference": "Specimen/1729351282549857000.13027c09-31fe-46d2-9baf-e8d05c30f2f5"
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         "result": [
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-            "reference": "Observation/1729292960602651000.106430d0-e4bd-4214-a5d7-26229cf420a1"
+            "reference": "Observation/1729351282533740000.50d6e7c5-2bd5-474d-817e-c8eaf385e3f9"
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     },
     {
-      "fullUrl": "DiagnosticReport/1729292960798503000.11957d43-2f87-4226-a831-d3de6ca2de00",
+      "fullUrl": "DiagnosticReport/1729351282724482000.742e6965-279e-4728-9122-b2eaa1828179",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292960798503000.11957d43-2f87-4226-a831-d3de6ca2de00",
+        "id": "1729351282724482000.742e6965-279e-4728-9122-b2eaa1828179",
         "identifier": [
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             "extension": [
@@ -17742,7 +17742,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960756533000.0e296372-42f4-4627-9206-327e138f0431"
+            "reference": "ServiceRequest/1729351282682819000.5d23153b-ea77-484e-884a-0026a0437091"
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         "status": "final",
@@ -17766,7 +17766,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
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         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17788,21 +17788,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960615176000.0e296c27-4fef-4cc0-9b5b-2f795d6c5eb3"
+            "reference": "Specimen/1729351282550801000.066d8ce1-2f95-4176-a1db-bb81459a70b5"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729292960604735000.ebcfa323-3dc8-46a8-9df5-25f9a3bcca87"
+            "reference": "Observation/1729351282535655000.bba649fd-911f-4bae-8c25-f14913d191f0"
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       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729292960799953000.5b9dbcb3-1a3d-4c68-aa08-6b290f89a939",
+      "fullUrl": "DiagnosticReport/1729351282725974000.2f684db6-b0ab-4688-8f38-bb20580d7b1a",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729292960799953000.5b9dbcb3-1a3d-4c68-aa08-6b290f89a939",
+        "id": "1729351282725974000.2f684db6-b0ab-4688-8f38-bb20580d7b1a",
         "identifier": [
           {
             "extension": [
@@ -17855,7 +17855,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729292960769148000.18eaed63-7c32-4e20-ab8e-2f517bb9f268"
+            "reference": "ServiceRequest/1729351282691682000.b014b742-6c5a-4cba-a34e-c261b7c712db"
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         ],
         "status": "final",
@@ -17879,7 +17879,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729292960534540000.2bc7a97a-bced-4459-8fba-8b8934637319"
+          "reference": "Patient/1729351282472755000.ddf934e3-fd92-40ec-897e-c69fc1316c23"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17901,12 +17901,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729292960615535000.7c1a5234-11fa-4b22-993f-9fff275b4635"
+            "reference": "Specimen/1729351282551957000.0e8624fd-5e3e-4fde-b404-39b297b1648a"
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         "result": [
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-            "reference": "Observation/1729292960606721000.7dbbab11-778d-4ec6-a1ca-aca5b49606eb"
+            "reference": "Observation/1729351282537570000.1b859cd3-3048-46c1-af1c-a67ed6e93864"
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         ]
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diff --git a/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_1_hl7_translation.fhir b/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_1_hl7_translation.fhir
index 5a68d67b4..7c4f4e92e 100644
--- a/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_1_hl7_translation.fhir
+++ b/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_1_hl7_translation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729293370398334000.2a393687-0862-412f-8529-077241d85208",
+  "id": "1729351692323352000.041e9d8d-7cda-4cf4-bdb3-bbf0fc5d87dd",
   "meta": {
-    "lastUpdated": "2024-10-18T16:16:10.398-07:00"
+    "lastUpdated": "2024-10-19T08:28:12.323-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2023-06-06T17:28:49.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835",
+      "fullUrl": "MessageHeader/1729351692324713000.0b4a1fd1-45ec-4d55-807c-cc562d015eb3",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835",
+        "id": "1729351692324713000.0b4a1fd1-45ec-4d55-807c-cc562d015eb3",
         "meta": {
           "tag": [
             {
@@ -151,12 +151,12 @@
             "name": "BaptistOracle",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000",
             "receiver": {
-              "reference": "Organization/1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93"
+              "reference": "Organization/1729351692324439000.9a1799b3-12c6-4fd7-a1fe-e230a3e50098"
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           }
         ],
         "sender": {
-          "reference": "Organization/1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2"
+          "reference": "Organization/1729351692323850000.2fe6cd6d-e791-4b98-9b8b-0b26dbe2e5de"
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         "source": {
           "extension": [
@@ -182,10 +182,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2",
+      "fullUrl": "Organization/1729351692323850000.2fe6cd6d-e791-4b98-9b8b-0b26dbe2e5de",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2",
+        "id": "1729351692323850000.2fe6cd6d-e791-4b98-9b8b-0b26dbe2e5de",
         "identifier": [
           {
             "extension": [
@@ -218,10 +218,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93",
+      "fullUrl": "Organization/1729351692324439000.9a1799b3-12c6-4fd7-a1fe-e230a3e50098",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93",
+        "id": "1729351692324439000.9a1799b3-12c6-4fd7-a1fe-e230a3e50098",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -260,55 +260,55 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729293370416105000.3f4b5e28-ebb1-4a26-857f-19b8077b2b8f",
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-        "id": "1729293370416105000.3f4b5e28-ebb1-4a26-857f-19b8077b2b8f",
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         "target": [
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-            "reference": "MessageHeader/1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835"
+            "reference": "MessageHeader/1729351692324713000.0b4a1fd1-45ec-4d55-807c-cc562d015eb3"
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-            "reference": "DiagnosticReport/1729293370608814000.e3661cfd-5e37-4f8d-a673-8efa91e7ece5"
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@@ -330,17 +330,17 @@
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@@ -373,11 +373,11 @@
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@@ -399,17 +399,17 @@
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@@ -547,7 +547,7 @@
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@@ -697,10 +697,10 @@
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@@ -715,16 +715,16 @@
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@@ -736,10 +736,10 @@
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@@ -795,7 +795,7 @@
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@@ -885,10 +885,10 @@
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@@ -945,7 +945,7 @@
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@@ -958,7 +958,7 @@
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@@ -983,10 +983,10 @@
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@@ -1009,10 +1009,10 @@
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@@ -1043,15 +1043,15 @@
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@@ -1066,10 +1066,10 @@
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@@ -1126,7 +1126,7 @@
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@@ -1139,7 +1139,7 @@
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@@ -1164,10 +1164,10 @@
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@@ -1190,10 +1190,10 @@
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@@ -1224,15 +1224,15 @@
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@@ -1247,10 +1247,10 @@
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@@ -1307,7 +1307,7 @@
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@@ -1320,17 +1320,17 @@
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@@ -1353,10 +1353,10 @@
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@@ -1387,15 +1387,15 @@
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@@ -1410,10 +1410,10 @@
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@@ -1470,7 +1470,7 @@
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@@ -1483,7 +1483,7 @@
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@@ -1508,10 +1508,10 @@
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@@ -1534,10 +1534,10 @@
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@@ -1568,15 +1568,15 @@
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@@ -1591,10 +1591,10 @@
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@@ -1651,7 +1651,7 @@
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@@ -1664,7 +1664,7 @@
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@@ -1689,10 +1689,10 @@
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@@ -1715,10 +1715,10 @@
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@@ -1749,15 +1749,15 @@
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@@ -1772,10 +1772,10 @@
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@@ -1832,7 +1832,7 @@
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@@ -1845,7 +1845,7 @@
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@@ -1870,10 +1870,10 @@
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@@ -1896,10 +1896,10 @@
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@@ -1930,15 +1930,15 @@
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@@ -1953,10 +1953,10 @@
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@@ -2013,7 +2013,7 @@
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@@ -2026,7 +2026,7 @@
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@@ -2051,10 +2051,10 @@
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@@ -2077,10 +2077,10 @@
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@@ -2111,15 +2111,15 @@
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@@ -2134,10 +2134,10 @@
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@@ -2194,7 +2194,7 @@
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@@ -2207,7 +2207,7 @@
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@@ -2232,10 +2232,10 @@
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@@ -2258,10 +2258,10 @@
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@@ -2292,15 +2292,15 @@
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@@ -2315,10 +2315,10 @@
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@@ -2411,7 +2411,7 @@
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@@ -2424,16 +2424,16 @@
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@@ -2553,7 +2553,7 @@
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@@ -2845,7 +2845,7 @@
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@@ -2918,7 +2918,7 @@
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@@ -2981,7 +2981,7 @@
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@@ -3036,7 +3036,7 @@
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@@ -3090,7 +3090,7 @@
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@@ -3105,10 +3105,10 @@
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@@ -3165,7 +3165,7 @@
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@@ -3178,7 +3178,7 @@
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@@ -3229,10 +3229,10 @@
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@@ -3263,15 +3263,15 @@
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@@ -3286,10 +3286,10 @@
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@@ -3346,7 +3346,7 @@
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@@ -3359,7 +3359,7 @@
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@@ -3410,10 +3410,10 @@
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@@ -3527,7 +3527,7 @@
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@@ -3540,7 +3540,7 @@
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@@ -3565,10 +3565,10 @@
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@@ -3591,10 +3591,10 @@
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@@ -3625,15 +3625,15 @@
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@@ -3648,10 +3648,10 @@
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@@ -3708,7 +3708,7 @@
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@@ -3721,7 +3721,7 @@
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@@ -3746,10 +3746,10 @@
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@@ -3772,10 +3772,10 @@
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@@ -3806,15 +3806,15 @@
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@@ -3829,10 +3829,10 @@
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@@ -3889,7 +3889,7 @@
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@@ -3902,7 +3902,7 @@
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@@ -3927,10 +3927,10 @@
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@@ -3953,10 +3953,10 @@
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@@ -3987,15 +3987,15 @@
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@@ -4010,10 +4010,10 @@
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@@ -4070,7 +4070,7 @@
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@@ -4083,7 +4083,7 @@
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@@ -4108,10 +4108,10 @@
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@@ -4134,10 +4134,10 @@
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@@ -4168,15 +4168,15 @@
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@@ -4191,10 +4191,10 @@
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@@ -4251,7 +4251,7 @@
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@@ -4264,7 +4264,7 @@
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@@ -4289,10 +4289,10 @@
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@@ -4315,10 +4315,10 @@
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@@ -4349,15 +4349,15 @@
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@@ -4372,10 +4372,10 @@
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@@ -4432,7 +4432,7 @@
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@@ -4445,7 +4445,7 @@
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@@ -4470,10 +4470,10 @@
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@@ -4496,10 +4496,10 @@
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@@ -4530,15 +4530,15 @@
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@@ -4553,10 +4553,10 @@
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@@ -4613,7 +4613,7 @@
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@@ -4626,7 +4626,7 @@
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@@ -4651,10 +4651,10 @@
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@@ -4677,10 +4677,10 @@
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@@ -4711,15 +4711,15 @@
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@@ -4734,10 +4734,10 @@
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@@ -4794,7 +4794,7 @@
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@@ -4807,7 +4807,7 @@
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@@ -4832,10 +4832,10 @@
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@@ -4858,10 +4858,10 @@
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@@ -4892,15 +4892,15 @@
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@@ -4915,10 +4915,10 @@
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@@ -4975,7 +4975,7 @@
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@@ -4988,7 +4988,7 @@
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@@ -5013,10 +5013,10 @@
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@@ -5039,10 +5039,10 @@
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@@ -5073,15 +5073,15 @@
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@@ -5096,10 +5096,10 @@
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@@ -5156,7 +5156,7 @@
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@@ -5169,7 +5169,7 @@
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@@ -5194,10 +5194,10 @@
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@@ -5220,10 +5220,10 @@
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@@ -5254,15 +5254,15 @@
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@@ -5277,10 +5277,10 @@
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@@ -5290,10 +5290,10 @@
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@@ -5303,10 +5303,10 @@
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@@ -5316,10 +5316,10 @@
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@@ -5329,10 +5329,10 @@
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@@ -5342,10 +5342,10 @@
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@@ -5355,10 +5355,10 @@
       }
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@@ -5368,10 +5368,10 @@
       }
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@@ -5381,10 +5381,10 @@
       }
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@@ -5394,10 +5394,10 @@
       }
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+      "fullUrl": "Specimen/1729351692399228000.95bfbb88-5dbe-413a-87fc-1370862eb764",
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@@ -5407,10 +5407,10 @@
       }
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@@ -5420,10 +5420,10 @@
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@@ -5433,10 +5433,10 @@
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@@ -5446,10 +5446,10 @@
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@@ -5459,10 +5459,10 @@
       }
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@@ -5624,10 +5624,10 @@
       }
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@@ -5639,13 +5639,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370502495000.7c5b41d7-f8d5-495b-a533-131ebc83c5ad"
+                  "reference": "Organization/1729351692406562000.8f580b1f-437c-488c-9152-542e079c2fb7"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351692407216000.84766b3a-7bef-40f5-afdb-77b1da566d69"
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@@ -5673,7 +5673,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370504286000.7329e47c-df43-4e49-8fb8-723458996e08"
+                  "reference": "Practitioner/1729351692408312000.7e6a2b1a-b9fc-4f40-b30e-b4cad501ac09"
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@@ -5801,7 +5801,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370506052000.1995a1b9-531e-4496-aa15-c9d81d55bce0"
+                  "reference": "Practitioner/1729351692410105000.f7afe0cd-3006-4a05-8aba-7244e5b4c202"
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@@ -5883,18 +5883,18 @@
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+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
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@@ -5909,10 +5909,10 @@
       }
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         "extension": [
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@@ -5964,7 +5964,7 @@
             },
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             "assigner": {
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@@ -5980,10 +5980,10 @@
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         "extension": [
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@@ -6071,23 +6071,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729293370498751000.e20f6a21-84ff-45aa-be33-e3c42bd6ec81",
+      "fullUrl": "PractitionerRole/1729351692402742000.2b78fdee-9db1-4d1b-97f5-86f2922d830c",
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         "practitioner": {
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+          "reference": "Practitioner/1729351692403678000.49942331-2e45-4d4d-8e46-cdddaa35c90b"
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+          "reference": "Organization/1729351692404766000.66f59be9-25e3-475f-b9ae-e95f4d7b973e"
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@@ -6163,10 +6163,10 @@
       }
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+        "id": "1729351692407216000.84766b3a-7bef-40f5-afdb-77b1da566d69",
         "extension": [
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@@ -6242,10 +6242,10 @@
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@@ -6260,10 +6260,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692408312000.7e6a2b1a-b9fc-4f40-b30e-b4cad501ac09",
       "resource": {
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-        "id": "1729293370504286000.7329e47c-df43-4e49-8fb8-723458996e08",
+        "id": "1729351692408312000.7e6a2b1a-b9fc-4f40-b30e-b4cad501ac09",
         "extension": [
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@@ -6311,7 +6311,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729351692407682000.85e90f79-9861-4cce-bbdb-5693ce164435"
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@@ -6327,10 +6327,10 @@
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@@ -6345,10 +6345,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692410105000.f7afe0cd-3006-4a05-8aba-7244e5b4c202",
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         "extension": [
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@@ -6396,7 +6396,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370505427000.7af6bbd8-daad-4e43-9e77-d9fbb34c300b"
+              "reference": "Organization/1729351692409478000.32291df2-4c22-4bb9-ad8a-8cb3b4080971"
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@@ -6412,10 +6412,10 @@
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+        "id": "1729351692414735000.1566dab6-52ca-4f0c-b1df-755ed01338d0",
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@@ -6554,7 +6554,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370510370000.94c63971-ab6e-4eed-bfe4-461374c09e0b"
+                  "reference": "Practitioner/1729351692414350000.d519d3a7-a9f8-4f5d-a168-3ccefb0f9279"
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@@ -6636,18 +6636,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "Practitioner/1729293370507458000.be2d86e1-c9f4-483d-a33a-e4bbacc355a0"
+          "reference": "Practitioner/1729351692411459000.b40ab972-8153-4054-90ef-fc24c6429bbb"
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-      "fullUrl": "Organization/1729293370506709000.2a643936-925d-41c9-bb3a-1a3b4b5c2f07",
+      "fullUrl": "Organization/1729351692410721000.4fb5d374-d92e-4e30-b6e3-3fee412a24f0",
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@@ -6662,10 +6662,10 @@
       }
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-      "fullUrl": "Practitioner/1729293370507458000.be2d86e1-c9f4-483d-a33a-e4bbacc355a0",
+      "fullUrl": "Practitioner/1729351692411459000.b40ab972-8153-4054-90ef-fc24c6429bbb",
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@@ -6717,7 +6717,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370506709000.2a643936-925d-41c9-bb3a-1a3b4b5c2f07"
+              "reference": "Organization/1729351692410721000.4fb5d374-d92e-4e30-b6e3-3fee412a24f0"
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@@ -6733,10 +6733,10 @@
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@@ -6751,10 +6751,10 @@
       }
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6802,7 +6802,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370509775000.2aec9b9f-7a93-4e31-b146-c5377b127bde"
+              "reference": "Organization/1729351692413751000.49a340c4-d42b-4d4d-b792-e0d31fa6e905"
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@@ -6818,10 +6818,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729351692422252000.4763f7f5-703e-4a13-8201-3091a7e1ce6e",
       "resource": {
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -6833,13 +6833,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370514545000.94f6e26a-5a73-4eb8-b78e-29d202542c89"
+                  "reference": "Organization/1729351692418430000.22d68980-09df-4778-b4d0-7289cda21059"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351692419083000.73a31cc3-39a2-4e40-aef2-1e9623a0a5b5"
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               {
@@ -6867,7 +6867,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370516264000.ec1e3eb0-30c9-401d-8675-1f87db9db0f0"
+                  "reference": "Practitioner/1729351692420166000.43868496-0e04-47c6-9968-d46542c45514"
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@@ -6995,7 +6995,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729351692421846000.d5bcff35-a19d-45fb-99c0-a256e38193ca"
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@@ -7077,18 +7077,18 @@
           ]
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         "subject": {
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+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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+          "reference": "PractitionerRole/1729351692414870000.89c8678c-5a0b-44c0-812f-d84876b594e0"
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@@ -7103,10 +7103,10 @@
       }
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         "extension": [
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@@ -7158,7 +7158,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351692415033000.c020102b-fa2a-41b1-98bd-d83a1880db31"
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@@ -7174,10 +7174,10 @@
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+      "fullUrl": "Organization/1729351692416783000.6e16ed7d-7eac-46c9-b256-d2d3e86718ad",
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         "extension": [
           {
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@@ -7265,23 +7265,23 @@
       }
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     {
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+      "fullUrl": "PractitionerRole/1729351692414870000.89c8678c-5a0b-44c0-812f-d84876b594e0",
       "resource": {
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+        "id": "1729351692414870000.89c8678c-5a0b-44c0-812f-d84876b594e0",
         "practitioner": {
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+          "reference": "Practitioner/1729351692415775000.011641e3-bcb3-4c4c-a441-449450daa3f6"
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         "organization": {
-          "reference": "Organization/1729293370512860000.14fbc6a1-8423-41d2-bdff-f06580c03154"
+          "reference": "Organization/1729351692416783000.6e16ed7d-7eac-46c9-b256-d2d3e86718ad"
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+      "fullUrl": "Organization/1729351692418430000.22d68980-09df-4778-b4d0-7289cda21059",
       "resource": {
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+        "id": "1729351692418430000.22d68980-09df-4778-b4d0-7289cda21059",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7357,10 +7357,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729351692419083000.73a31cc3-39a2-4e40-aef2-1e9623a0a5b5",
       "resource": {
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+        "id": "1729351692419083000.73a31cc3-39a2-4e40-aef2-1e9623a0a5b5",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7436,10 +7436,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293370515659000.6c1d15d4-dd5f-461b-b5ce-a6c5b64f63ad",
+      "fullUrl": "Organization/1729351692419523000.18f96c4a-8ad0-47d0-ac42-74a1fe475893",
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+        "id": "1729351692419523000.18f96c4a-8ad0-47d0-ac42-74a1fe475893",
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@@ -7454,10 +7454,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692420166000.43868496-0e04-47c6-9968-d46542c45514",
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+        "id": "1729351692420166000.43868496-0e04-47c6-9968-d46542c45514",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7505,7 +7505,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370515659000.6c1d15d4-dd5f-461b-b5ce-a6c5b64f63ad"
+              "reference": "Organization/1729351692419523000.18f96c4a-8ad0-47d0-ac42-74a1fe475893"
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@@ -7521,10 +7521,10 @@
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+      "fullUrl": "Organization/1729351692421249000.922d2b4c-1ee5-4dfa-b17d-739d7186e713",
       "resource": {
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+        "id": "1729351692421249000.922d2b4c-1ee5-4dfa-b17d-739d7186e713",
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@@ -7539,10 +7539,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692421846000.d5bcff35-a19d-45fb-99c0-a256e38193ca",
       "resource": {
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+        "id": "1729351692421846000.d5bcff35-a19d-45fb-99c0-a256e38193ca",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7590,7 +7590,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370517391000.7c3b7c57-6614-4fad-ad03-aee9e44e5374"
+              "reference": "Organization/1729351692421249000.922d2b4c-1ee5-4dfa-b17d-739d7186e713"
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@@ -7606,10 +7606,10 @@
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+      "fullUrl": "ServiceRequest/1729351692429662000.9d2fc68b-50cb-4900-86cc-585d9a718c45",
       "resource": {
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+        "id": "1729351692429662000.9d2fc68b-50cb-4900-86cc-585d9a718c45",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -7621,13 +7621,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370522227000.855413d7-444e-476e-a0dc-c949ed4e93f4"
+                  "reference": "Organization/1729351692425942000.60606cb3-e95e-423e-a7b5-6b219226373f"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370522890000.e33627aa-0e5c-40ad-a0b6-5479cf9edd9d"
+                  "reference": "Organization/1729351692426590000.b33af589-6db3-40e6-b44e-e5544f15ae65"
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@@ -7655,7 +7655,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370523920000.b90b834f-9e78-4a08-a725-f26768af2f0b"
+                  "reference": "Practitioner/1729351692427614000.24629bb8-2bb6-4044-87a9-5220aa3cd287"
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@@ -7783,7 +7783,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370525598000.bd2f67fd-0760-445d-bd77-bff82c10786b"
+                  "reference": "Practitioner/1729351692429278000.763d6dbd-e2f3-4cfe-98dc-98e3fc00334e"
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@@ -7865,18 +7865,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370518536000.27f22b6c-e3bc-4ea6-bafd-73be44d05eb3"
+          "reference": "PractitionerRole/1729351692422386000.520b10ab-0163-4b61-854c-f4d4f8f996ac"
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+      "fullUrl": "Organization/1729351692422548000.805e151c-cd3d-4994-b81b-9f569deb5bec",
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+        "id": "1729351692422548000.805e151c-cd3d-4994-b81b-9f569deb5bec",
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@@ -7891,10 +7891,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692423237000.4daac0c2-43a1-439b-a78f-1938a6657164",
       "resource": {
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+        "id": "1729351692423237000.4daac0c2-43a1-439b-a78f-1938a6657164",
         "extension": [
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@@ -7946,7 +7946,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370518709000.cd6cde25-3f1b-4bd9-a7ca-bb6eefb82bfd"
+              "reference": "Organization/1729351692422548000.805e151c-cd3d-4994-b81b-9f569deb5bec"
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@@ -7962,10 +7962,10 @@
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+      "fullUrl": "Organization/1729351692424282000.7322633f-cafb-41b9-b615-145438a65ed2",
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+        "id": "1729351692424282000.7322633f-cafb-41b9-b615-145438a65ed2",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8053,23 +8053,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729293370518536000.27f22b6c-e3bc-4ea6-bafd-73be44d05eb3",
+      "fullUrl": "PractitionerRole/1729351692422386000.520b10ab-0163-4b61-854c-f4d4f8f996ac",
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+        "id": "1729351692422386000.520b10ab-0163-4b61-854c-f4d4f8f996ac",
         "practitioner": {
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+          "reference": "Practitioner/1729351692423237000.4daac0c2-43a1-439b-a78f-1938a6657164"
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         "organization": {
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+          "reference": "Organization/1729351692424282000.7322633f-cafb-41b9-b615-145438a65ed2"
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+      "fullUrl": "Organization/1729351692425942000.60606cb3-e95e-423e-a7b5-6b219226373f",
       "resource": {
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-        "id": "1729293370522227000.855413d7-444e-476e-a0dc-c949ed4e93f4",
+        "id": "1729351692425942000.60606cb3-e95e-423e-a7b5-6b219226373f",
         "extension": [
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@@ -8145,10 +8145,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293370522890000.e33627aa-0e5c-40ad-a0b6-5479cf9edd9d",
+      "fullUrl": "Organization/1729351692426590000.b33af589-6db3-40e6-b44e-e5544f15ae65",
       "resource": {
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+        "id": "1729351692426590000.b33af589-6db3-40e6-b44e-e5544f15ae65",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8224,10 +8224,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293370523331000.d5a8648a-acee-40b2-8a5e-2a774895fc69",
+      "fullUrl": "Organization/1729351692427024000.caa0253f-cdbf-4786-8d8f-50e63d244fc2",
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@@ -8242,10 +8242,10 @@
       }
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-      "fullUrl": "Practitioner/1729293370523920000.b90b834f-9e78-4a08-a725-f26768af2f0b",
+      "fullUrl": "Practitioner/1729351692427614000.24629bb8-2bb6-4044-87a9-5220aa3cd287",
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+        "id": "1729351692427614000.24629bb8-2bb6-4044-87a9-5220aa3cd287",
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@@ -8293,7 +8293,7 @@
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             "assigner": {
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+              "reference": "Organization/1729351692427024000.caa0253f-cdbf-4786-8d8f-50e63d244fc2"
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@@ -8309,10 +8309,10 @@
       }
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+      "fullUrl": "Organization/1729351692428683000.43edcc13-7037-4ba2-8a2d-3c6368aff983",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370524998000.ce092f5f-02b2-4cf0-80c6-ac344d6c1704",
+        "id": "1729351692428683000.43edcc13-7037-4ba2-8a2d-3c6368aff983",
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@@ -8327,10 +8327,10 @@
       }
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     {
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+      "fullUrl": "Practitioner/1729351692429278000.763d6dbd-e2f3-4cfe-98dc-98e3fc00334e",
       "resource": {
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-        "id": "1729293370525598000.bd2f67fd-0760-445d-bd77-bff82c10786b",
+        "id": "1729351692429278000.763d6dbd-e2f3-4cfe-98dc-98e3fc00334e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8378,7 +8378,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370524998000.ce092f5f-02b2-4cf0-80c6-ac344d6c1704"
+              "reference": "Organization/1729351692428683000.43edcc13-7037-4ba2-8a2d-3c6368aff983"
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@@ -8394,10 +8394,10 @@
       }
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     {
-      "fullUrl": "ServiceRequest/1729293370533546000.ce4cdcd2-29fd-41d9-8d95-efa07fca5aca",
+      "fullUrl": "ServiceRequest/1729351692437084000.022bd0d3-59c5-4826-a784-c06500a2f3ff",
       "resource": {
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-        "id": "1729293370533546000.ce4cdcd2-29fd-41d9-8d95-efa07fca5aca",
+        "id": "1729351692437084000.022bd0d3-59c5-4826-a784-c06500a2f3ff",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -8409,13 +8409,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370529740000.b9afa1b2-a896-4a73-87b2-3e16181a506a"
+                  "reference": "Organization/1729351692433332000.8a108ba9-080d-44d9-9870-993ea3ee36dd"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370530385000.a3a7df8e-d038-47be-963b-b045b70b8d24"
+                  "reference": "Organization/1729351692433972000.211a2cad-e9ad-42f4-a300-bcfc843945c6"
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               {
@@ -8443,7 +8443,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370531448000.da555f25-8bb3-4c7e-887b-e7bda417a366"
+                  "reference": "Practitioner/1729351692435018000.cd5bdbda-f154-4c4e-8534-3f52d0d56180"
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@@ -8571,7 +8571,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370533137000.63d678d2-0d75-4fb2-a030-0db3a0c75e59"
+                  "reference": "Practitioner/1729351692436702000.1c49adf0-9039-40f9-9139-ca47360c2793"
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@@ -8653,18 +8653,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370526126000.e54bb504-19f0-400b-b72b-9305a9740c5b"
+          "reference": "PractitionerRole/1729351692429796000.756c20b6-5459-4299-8f88-44392acf268c"
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       "resource": {
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-        "id": "1729293370526294000.dec68d46-fb79-4a60-bdbe-4b1c4c21eb95",
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@@ -8679,10 +8679,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692430657000.d29fdf30-6a61-49fa-bd2b-96bc5ea2505c",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370527013000.d3040ad5-3243-4892-88e8-55f8b4f61a18",
+        "id": "1729351692430657000.d29fdf30-6a61-49fa-bd2b-96bc5ea2505c",
         "extension": [
           {
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@@ -8734,7 +8734,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370526294000.dec68d46-fb79-4a60-bdbe-4b1c4c21eb95"
+              "reference": "Organization/1729351692429956000.2e6ffaa1-006c-470d-852c-030cfadd09b0"
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@@ -8750,10 +8750,10 @@
       }
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+      "fullUrl": "Organization/1729351692431668000.da49a27e-f546-4536-addd-b290364c0edd",
       "resource": {
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+        "id": "1729351692431668000.da49a27e-f546-4536-addd-b290364c0edd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8841,23 +8841,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293370526126000.e54bb504-19f0-400b-b72b-9305a9740c5b",
+      "fullUrl": "PractitionerRole/1729351692429796000.756c20b6-5459-4299-8f88-44392acf268c",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293370526126000.e54bb504-19f0-400b-b72b-9305a9740c5b",
+        "id": "1729351692429796000.756c20b6-5459-4299-8f88-44392acf268c",
         "practitioner": {
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+          "reference": "Practitioner/1729351692430657000.d29fdf30-6a61-49fa-bd2b-96bc5ea2505c"
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         "organization": {
-          "reference": "Organization/1729293370528086000.bedd1052-3ffd-4ce0-9179-928a304d1b07"
+          "reference": "Organization/1729351692431668000.da49a27e-f546-4536-addd-b290364c0edd"
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-      "fullUrl": "Organization/1729293370529740000.b9afa1b2-a896-4a73-87b2-3e16181a506a",
+      "fullUrl": "Organization/1729351692433332000.8a108ba9-080d-44d9-9870-993ea3ee36dd",
       "resource": {
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-        "id": "1729293370529740000.b9afa1b2-a896-4a73-87b2-3e16181a506a",
+        "id": "1729351692433332000.8a108ba9-080d-44d9-9870-993ea3ee36dd",
         "extension": [
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@@ -8933,10 +8933,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370530385000.a3a7df8e-d038-47be-963b-b045b70b8d24",
+      "fullUrl": "Organization/1729351692433972000.211a2cad-e9ad-42f4-a300-bcfc843945c6",
       "resource": {
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-        "id": "1729293370530385000.a3a7df8e-d038-47be-963b-b045b70b8d24",
+        "id": "1729351692433972000.211a2cad-e9ad-42f4-a300-bcfc843945c6",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9012,10 +9012,10 @@
       }
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-      "fullUrl": "Organization/1729293370530857000.c44ed2d0-3fb2-4649-8c3e-c66ef69bf1d9",
+      "fullUrl": "Organization/1729351692434406000.13b9f9e3-4c95-4851-9f14-cf544c501ff4",
       "resource": {
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-        "id": "1729293370530857000.c44ed2d0-3fb2-4649-8c3e-c66ef69bf1d9",
+        "id": "1729351692434406000.13b9f9e3-4c95-4851-9f14-cf544c501ff4",
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@@ -9030,10 +9030,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692435018000.cd5bdbda-f154-4c4e-8534-3f52d0d56180",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370531448000.da555f25-8bb3-4c7e-887b-e7bda417a366",
+        "id": "1729351692435018000.cd5bdbda-f154-4c4e-8534-3f52d0d56180",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9081,7 +9081,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370530857000.c44ed2d0-3fb2-4649-8c3e-c66ef69bf1d9"
+              "reference": "Organization/1729351692434406000.13b9f9e3-4c95-4851-9f14-cf544c501ff4"
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@@ -9097,10 +9097,10 @@
       }
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-      "fullUrl": "Organization/1729293370532531000.dc611144-79ea-454a-b977-01dcc7edb432",
+      "fullUrl": "Organization/1729351692436113000.e588ffd9-e7e2-4855-a56d-215216847166",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370532531000.dc611144-79ea-454a-b977-01dcc7edb432",
+        "id": "1729351692436113000.e588ffd9-e7e2-4855-a56d-215216847166",
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@@ -9115,10 +9115,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293370533137000.63d678d2-0d75-4fb2-a030-0db3a0c75e59",
+      "fullUrl": "Practitioner/1729351692436702000.1c49adf0-9039-40f9-9139-ca47360c2793",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370533137000.63d678d2-0d75-4fb2-a030-0db3a0c75e59",
+        "id": "1729351692436702000.1c49adf0-9039-40f9-9139-ca47360c2793",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9166,7 +9166,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370532531000.dc611144-79ea-454a-b977-01dcc7edb432"
+              "reference": "Organization/1729351692436113000.e588ffd9-e7e2-4855-a56d-215216847166"
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@@ -9182,10 +9182,10 @@
       }
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     {
-      "fullUrl": "ServiceRequest/1729293370541304000.52dac68e-31e0-4467-a032-a880702141ee",
+      "fullUrl": "ServiceRequest/1729351692445516000.6396566f-ca10-4e30-8397-95757bb10dfa",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293370541304000.52dac68e-31e0-4467-a032-a880702141ee",
+        "id": "1729351692445516000.6396566f-ca10-4e30-8397-95757bb10dfa",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -9197,13 +9197,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370537522000.4af5319d-51fb-49de-962e-3e0a024c5e08"
+                  "reference": "Organization/1729351692441396000.073f4f68-9ce8-4bee-879f-4804dbc752f4"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370538193000.b8e648f5-0ba1-43af-8e2e-863140abbc3f"
+                  "reference": "Organization/1729351692442153000.1c41bb35-7833-4f61-bbe3-62e759366c22"
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               {
@@ -9231,7 +9231,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370539231000.3680d367-faac-4b60-a4bb-8cca68f80f6b"
+                  "reference": "Practitioner/1729351692443267000.bb63f9eb-771c-41d0-b0df-194ed909089b"
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@@ -9359,7 +9359,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370540911000.6e137b35-5571-4362-bbae-512092a98a94"
+                  "reference": "Practitioner/1729351692445101000.6f815bf0-85e6-46a8-9bab-e6979032bd64"
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@@ -9441,18 +9441,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293370533684000.128dda99-c3dc-49c6-abcd-c4a5d1b61b18"
+          "reference": "PractitionerRole/1729351692437217000.f14f44c0-1c0e-437b-b37c-9a355a968b38"
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     {
-      "fullUrl": "Organization/1729293370533852000.dca0289b-1f0e-4459-9865-0797a6974170",
+      "fullUrl": "Organization/1729351692437379000.73535cab-c3a1-49a0-beda-573aced36854",
       "resource": {
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-        "id": "1729293370533852000.dca0289b-1f0e-4459-9865-0797a6974170",
+        "id": "1729351692437379000.73535cab-c3a1-49a0-beda-573aced36854",
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@@ -9467,10 +9467,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293370534709000.61427778-d0e6-4e45-a5ea-caf223cd8f01",
+      "fullUrl": "Practitioner/1729351692438226000.5d821a75-fd6d-4cba-a4f4-539ac653ba6d",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370534709000.61427778-d0e6-4e45-a5ea-caf223cd8f01",
+        "id": "1729351692438226000.5d821a75-fd6d-4cba-a4f4-539ac653ba6d",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9522,7 +9522,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370533852000.dca0289b-1f0e-4459-9865-0797a6974170"
+              "reference": "Organization/1729351692437379000.73535cab-c3a1-49a0-beda-573aced36854"
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@@ -9538,10 +9538,10 @@
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+      "fullUrl": "Organization/1729351692439437000.41b185b1-1ac4-45b5-a9b8-8d4eabb2d048",
       "resource": {
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-        "id": "1729293370535767000.f24f6b2f-369c-4734-98bf-d12c745a7088",
+        "id": "1729351692439437000.41b185b1-1ac4-45b5-a9b8-8d4eabb2d048",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9629,23 +9629,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293370533684000.128dda99-c3dc-49c6-abcd-c4a5d1b61b18",
+      "fullUrl": "PractitionerRole/1729351692437217000.f14f44c0-1c0e-437b-b37c-9a355a968b38",
       "resource": {
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+        "id": "1729351692437217000.f14f44c0-1c0e-437b-b37c-9a355a968b38",
         "practitioner": {
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+          "reference": "Practitioner/1729351692438226000.5d821a75-fd6d-4cba-a4f4-539ac653ba6d"
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-          "reference": "Organization/1729293370535767000.f24f6b2f-369c-4734-98bf-d12c745a7088"
+          "reference": "Organization/1729351692439437000.41b185b1-1ac4-45b5-a9b8-8d4eabb2d048"
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+      "fullUrl": "Organization/1729351692441396000.073f4f68-9ce8-4bee-879f-4804dbc752f4",
       "resource": {
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-        "id": "1729293370537522000.4af5319d-51fb-49de-962e-3e0a024c5e08",
+        "id": "1729351692441396000.073f4f68-9ce8-4bee-879f-4804dbc752f4",
         "extension": [
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@@ -9721,10 +9721,10 @@
       }
     },
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+      "fullUrl": "Organization/1729351692442153000.1c41bb35-7833-4f61-bbe3-62e759366c22",
       "resource": {
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+        "id": "1729351692442153000.1c41bb35-7833-4f61-bbe3-62e759366c22",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9800,10 +9800,10 @@
       }
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-      "fullUrl": "Organization/1729293370538636000.e546e04e-a869-479b-b0db-9c6e9c92d3a6",
+      "fullUrl": "Organization/1729351692442621000.a15aa813-dffc-482e-9010-ff021c4ba7d8",
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@@ -9818,10 +9818,10 @@
       }
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       "resource": {
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         "extension": [
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@@ -9869,7 +9869,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370538636000.e546e04e-a869-479b-b0db-9c6e9c92d3a6"
+              "reference": "Organization/1729351692442621000.a15aa813-dffc-482e-9010-ff021c4ba7d8"
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@@ -9885,10 +9885,10 @@
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-        "id": "1729293370540321000.a5be6f85-1231-4b0b-a5ac-7fe331956569",
+        "id": "1729351692444437000.496f011f-ca2f-444e-bcda-c7959dd8449b",
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@@ -9903,10 +9903,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692445101000.6f815bf0-85e6-46a8-9bab-e6979032bd64",
       "resource": {
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-        "id": "1729293370540911000.6e137b35-5571-4362-bbae-512092a98a94",
+        "id": "1729351692445101000.6f815bf0-85e6-46a8-9bab-e6979032bd64",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9954,7 +9954,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370540321000.a5be6f85-1231-4b0b-a5ac-7fe331956569"
+              "reference": "Organization/1729351692444437000.496f011f-ca2f-444e-bcda-c7959dd8449b"
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@@ -9970,10 +9970,10 @@
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+      "fullUrl": "ServiceRequest/1729351692453273000.bb54f821-9255-4bcd-a1f7-8ff31f92ee90",
       "resource": {
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-        "id": "1729293370548857000.04937421-45d1-496e-b708-795471ce6e07",
+        "id": "1729351692453273000.bb54f821-9255-4bcd-a1f7-8ff31f92ee90",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -9985,13 +9985,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370545084000.df323123-0707-41a8-b8fb-cd27ba5f4c4a"
+                  "reference": "Organization/1729351692449522000.5023174b-0aec-455b-ab07-c06467d6f0ba"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370545749000.c1f1c0b9-179d-4042-870f-09b610100064"
+                  "reference": "Organization/1729351692450186000.bf713f7c-c516-424a-9f07-b5543672b8c8"
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@@ -10019,7 +10019,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370546783000.7dbcaba6-923f-426f-9e44-0610dc709ddc"
+                  "reference": "Practitioner/1729351692451209000.bb0ac022-1d31-48e4-9a8e-064d0a8c3d4e"
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@@ -10147,7 +10147,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729351692452889000.085a97b5-2e13-4bdf-ad01-42d32379a793"
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@@ -10229,18 +10229,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370541442000.3c6545eb-7522-4e7c-9f75-286d4b5591ab"
+          "reference": "PractitionerRole/1729351692445659000.58d46215-be32-42dd-8c17-425bfdbfc656"
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       "resource": {
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-        "id": "1729293370541609000.62313409-ed6a-46f8-b229-f06a8ee3afb9",
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@@ -10255,10 +10255,10 @@
       }
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         "extension": [
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@@ -10310,7 +10310,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370541609000.62313409-ed6a-46f8-b229-f06a8ee3afb9"
+              "reference": "Organization/1729351692445834000.ab069ef5-ea7b-4d83-a2db-f8569590d4e5"
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@@ -10326,10 +10326,10 @@
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       "resource": {
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+        "id": "1729351692447748000.83db6dc1-ebc1-4e02-9274-19544000ad71",
         "extension": [
           {
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@@ -10417,23 +10417,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293370541442000.3c6545eb-7522-4e7c-9f75-286d4b5591ab",
+      "fullUrl": "PractitionerRole/1729351692445659000.58d46215-be32-42dd-8c17-425bfdbfc656",
       "resource": {
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+        "id": "1729351692445659000.58d46215-be32-42dd-8c17-425bfdbfc656",
         "practitioner": {
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+          "reference": "Practitioner/1729351692446619000.d8cf22b7-f3d3-4ad5-9ef0-a6dd348d6b9a"
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         "organization": {
-          "reference": "Organization/1729293370543381000.522c5ae9-8b84-44e9-b50c-efa624a42198"
+          "reference": "Organization/1729351692447748000.83db6dc1-ebc1-4e02-9274-19544000ad71"
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+      "fullUrl": "Organization/1729351692449522000.5023174b-0aec-455b-ab07-c06467d6f0ba",
       "resource": {
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-        "id": "1729293370545084000.df323123-0707-41a8-b8fb-cd27ba5f4c4a",
+        "id": "1729351692449522000.5023174b-0aec-455b-ab07-c06467d6f0ba",
         "extension": [
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@@ -10509,10 +10509,10 @@
       }
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-        "id": "1729293370545749000.c1f1c0b9-179d-4042-870f-09b610100064",
+        "id": "1729351692450186000.bf713f7c-c516-424a-9f07-b5543672b8c8",
         "extension": [
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@@ -10588,10 +10588,10 @@
       }
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+      "fullUrl": "Organization/1729351692450620000.ab7de672-7a61-4d30-8a3d-cf2101ef7b9d",
       "resource": {
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-        "id": "1729293370546199000.aca21840-6441-42ab-b802-671cb3553c3c",
+        "id": "1729351692450620000.ab7de672-7a61-4d30-8a3d-cf2101ef7b9d",
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@@ -10606,10 +10606,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692451209000.bb0ac022-1d31-48e4-9a8e-064d0a8c3d4e",
       "resource": {
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-        "id": "1729293370546783000.7dbcaba6-923f-426f-9e44-0610dc709ddc",
+        "id": "1729351692451209000.bb0ac022-1d31-48e4-9a8e-064d0a8c3d4e",
         "extension": [
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@@ -10657,7 +10657,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370546199000.aca21840-6441-42ab-b802-671cb3553c3c"
+              "reference": "Organization/1729351692450620000.ab7de672-7a61-4d30-8a3d-cf2101ef7b9d"
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@@ -10673,10 +10673,10 @@
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+      "fullUrl": "Organization/1729351692452298000.da90a056-432c-450e-95f1-90ec7ba0e1bc",
       "resource": {
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-        "id": "1729293370547870000.c1db8f1a-b0ab-488f-ac8d-7617a619aeae",
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@@ -10691,10 +10691,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692452889000.085a97b5-2e13-4bdf-ad01-42d32379a793",
       "resource": {
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-        "id": "1729293370548457000.e4cb45c6-e782-4111-ae84-5e8442263550",
+        "id": "1729351692452889000.085a97b5-2e13-4bdf-ad01-42d32379a793",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -10742,7 +10742,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370547870000.c1db8f1a-b0ab-488f-ac8d-7617a619aeae"
+              "reference": "Organization/1729351692452298000.da90a056-432c-450e-95f1-90ec7ba0e1bc"
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@@ -10758,10 +10758,10 @@
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-      "fullUrl": "ServiceRequest/1729293370556418000.2b8ab7f1-edcb-42b5-9bfb-bea7e0e99164",
+      "fullUrl": "ServiceRequest/1729351692461366000.7b049d53-b94b-4810-a4ac-ab5c75f5a11b",
       "resource": {
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+        "id": "1729351692461366000.7b049d53-b94b-4810-a4ac-ab5c75f5a11b",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -10773,13 +10773,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370552574000.cc71e62f-ecb9-4396-ba35-ec603b65b7f7"
+                  "reference": "Organization/1729351692457294000.fb5ac4e7-157c-416d-94f7-3b6f5d9e286b"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370553226000.a9a3b7c4-3081-4697-9b66-8c96167cbcfd"
+                  "reference": "Organization/1729351692458001000.d7a54ceb-19ea-4a11-9f04-a3156fa81dde"
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@@ -10807,7 +10807,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370554277000.4a8ce38c-7d5f-4976-b8bb-0d7071db7e51"
+                  "reference": "Practitioner/1729351692459114000.d955ab56-b637-4e1f-9893-d9d633de4da5"
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@@ -10935,7 +10935,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370556006000.4e694806-5563-4d56-be88-21baa1cc383a"
+                  "reference": "Practitioner/1729351692460918000.f351abe2-0909-4b5a-b753-fe28ded785f0"
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@@ -11017,18 +11017,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370548996000.a6a1e9e8-d0e2-4944-a507-188ff08d7ffa"
+          "reference": "PractitionerRole/1729351692453417000.ca7e777e-e00a-45d8-a88b-27580ceafda8"
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-      "fullUrl": "Organization/1729293370549165000.5fdc8f3f-35f5-4f2d-86f7-3afff9344b13",
+      "fullUrl": "Organization/1729351692453593000.555cc3f0-59ee-4a1a-b29f-e511466a3f97",
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@@ -11043,10 +11043,10 @@
       }
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+        "id": "1729351692454369000.0653a888-9871-46e5-a2b3-8f5124ea6210",
         "extension": [
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@@ -11098,7 +11098,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370549165000.5fdc8f3f-35f5-4f2d-86f7-3afff9344b13"
+              "reference": "Organization/1729351692453593000.555cc3f0-59ee-4a1a-b29f-e511466a3f97"
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@@ -11114,10 +11114,10 @@
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       "resource": {
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+        "id": "1729351692455469000.eba75a92-8145-42ed-be80-f77a1f768a05",
         "extension": [
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@@ -11205,23 +11205,23 @@
       }
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-      "fullUrl": "PractitionerRole/1729293370548996000.a6a1e9e8-d0e2-4944-a507-188ff08d7ffa",
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-        "id": "1729293370548996000.a6a1e9e8-d0e2-4944-a507-188ff08d7ffa",
+        "id": "1729351692453417000.ca7e777e-e00a-45d8-a88b-27580ceafda8",
         "practitioner": {
-          "reference": "Practitioner/1729293370549874000.3efe7bb1-a011-4fc9-b33f-a9e0e8fb7cbe"
+          "reference": "Practitioner/1729351692454369000.0653a888-9871-46e5-a2b3-8f5124ea6210"
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         "organization": {
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+        "id": "1729351692457294000.fb5ac4e7-157c-416d-94f7-3b6f5d9e286b",
         "extension": [
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@@ -11297,10 +11297,10 @@
       }
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-      "fullUrl": "Organization/1729293370553226000.a9a3b7c4-3081-4697-9b66-8c96167cbcfd",
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         "extension": [
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@@ -11376,10 +11376,10 @@
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@@ -11394,10 +11394,10 @@
       }
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@@ -11445,7 +11445,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370553680000.d8a581e3-56ef-48bc-a3b9-1cab419ac562"
+              "reference": "Organization/1729351692458473000.fef234a4-9b0c-4a98-8105-e073c6db1b9f"
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@@ -11461,10 +11461,10 @@
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@@ -11479,10 +11479,10 @@
       }
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         "extension": [
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@@ -11530,7 +11530,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370555419000.9151ca57-b460-4ffb-b1f1-ba99cf40d885"
+              "reference": "Organization/1729351692460292000.227ef3e8-0a5c-413d-9bf2-f7d1e4893eee"
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@@ -11546,10 +11546,10 @@
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       "resource": {
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -11561,13 +11561,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370561029000.031d7ab2-acb1-403d-a265-2f31461143e3"
+                  "reference": "Organization/1729351692465338000.e5ec1648-5167-4431-9011-ec90d1f39da9"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370561746000.05132d5c-d80b-4b62-9949-ca574d0cb9c3"
+                  "reference": "Organization/1729351692466036000.3b6ebcc4-458e-47a8-98fa-34e0c56d5d54"
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@@ -11595,7 +11595,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370562836000.7eda87a0-275a-41be-8ab4-11c3d848bc5d"
+                  "reference": "Practitioner/1729351692467152000.05fc9d60-43ba-43eb-abdb-e6afd4031e82"
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@@ -11723,7 +11723,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370564570000.37bd92af-ae1d-471d-a8c0-835cd1cef9e8"
+                  "reference": "Practitioner/1729351692468999000.924f99fc-44db-4fed-a4eb-e8099e47700b"
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@@ -11805,18 +11805,18 @@
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370556593000.d2c89c77-17c9-4f36-877f-013f7364a7e0"
+          "reference": "PractitionerRole/1729351692461508000.18d8761b-c126-4fb2-a7d8-da8257d4a1db"
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@@ -11831,10 +11831,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692462437000.e42f5f80-8183-4692-ae19-26756ee2c863",
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+        "id": "1729351692462437000.e42f5f80-8183-4692-ae19-26756ee2c863",
         "extension": [
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@@ -11886,7 +11886,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351692461680000.dcf120f2-6e19-45ac-aed8-8ef9f6accc4d"
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@@ -11902,10 +11902,10 @@
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       "resource": {
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+        "id": "1729351692463549000.3090ed2b-6306-47fe-bf8a-c3f14b544d87",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11993,23 +11993,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729293370556593000.d2c89c77-17c9-4f36-877f-013f7364a7e0",
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-        "id": "1729293370556593000.d2c89c77-17c9-4f36-877f-013f7364a7e0",
+        "id": "1729351692461508000.18d8761b-c126-4fb2-a7d8-da8257d4a1db",
         "practitioner": {
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+          "reference": "Practitioner/1729351692462437000.e42f5f80-8183-4692-ae19-26756ee2c863"
         },
         "organization": {
-          "reference": "Organization/1729293370559029000.345401c8-393d-4705-a178-ae1aa5cf2fe9"
+          "reference": "Organization/1729351692463549000.3090ed2b-6306-47fe-bf8a-c3f14b544d87"
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+      "fullUrl": "Organization/1729351692465338000.e5ec1648-5167-4431-9011-ec90d1f39da9",
       "resource": {
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-        "id": "1729293370561029000.031d7ab2-acb1-403d-a265-2f31461143e3",
+        "id": "1729351692465338000.e5ec1648-5167-4431-9011-ec90d1f39da9",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12085,10 +12085,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729351692466036000.3b6ebcc4-458e-47a8-98fa-34e0c56d5d54",
       "resource": {
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-        "id": "1729293370561746000.05132d5c-d80b-4b62-9949-ca574d0cb9c3",
+        "id": "1729351692466036000.3b6ebcc4-458e-47a8-98fa-34e0c56d5d54",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12164,10 +12164,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729351692466507000.eb735866-9c90-4225-90aa-04a6acb66efe",
       "resource": {
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-        "id": "1729293370562216000.44f28bba-1f10-4a88-aaf5-3153c20edb07",
+        "id": "1729351692466507000.eb735866-9c90-4225-90aa-04a6acb66efe",
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@@ -12182,10 +12182,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692467152000.05fc9d60-43ba-43eb-abdb-e6afd4031e82",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370562836000.7eda87a0-275a-41be-8ab4-11c3d848bc5d",
+        "id": "1729351692467152000.05fc9d60-43ba-43eb-abdb-e6afd4031e82",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12233,7 +12233,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370562216000.44f28bba-1f10-4a88-aaf5-3153c20edb07"
+              "reference": "Organization/1729351692466507000.eb735866-9c90-4225-90aa-04a6acb66efe"
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@@ -12249,10 +12249,10 @@
       }
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+      "fullUrl": "Organization/1729351692468351000.f2785e55-0485-447c-ab3c-bd04ef58b0b1",
       "resource": {
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-        "id": "1729293370563972000.37e08b99-448f-4deb-b09d-e329ddd8bf94",
+        "id": "1729351692468351000.f2785e55-0485-447c-ab3c-bd04ef58b0b1",
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@@ -12267,10 +12267,10 @@
       }
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-      "fullUrl": "Practitioner/1729293370564570000.37bd92af-ae1d-471d-a8c0-835cd1cef9e8",
+      "fullUrl": "Practitioner/1729351692468999000.924f99fc-44db-4fed-a4eb-e8099e47700b",
       "resource": {
         "resourceType": "Practitioner",
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+        "id": "1729351692468999000.924f99fc-44db-4fed-a4eb-e8099e47700b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12318,7 +12318,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370563972000.37e08b99-448f-4deb-b09d-e329ddd8bf94"
+              "reference": "Organization/1729351692468351000.f2785e55-0485-447c-ab3c-bd04ef58b0b1"
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@@ -12334,10 +12334,10 @@
       }
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-      "fullUrl": "ServiceRequest/1729293370572799000.6eb041e2-9308-4af8-802a-7aa8313e7242",
+      "fullUrl": "ServiceRequest/1729351692477598000.70b2b6c6-00ba-475b-95ea-02e28bb20c99",
       "resource": {
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-        "id": "1729293370572799000.6eb041e2-9308-4af8-802a-7aa8313e7242",
+        "id": "1729351692477598000.70b2b6c6-00ba-475b-95ea-02e28bb20c99",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -12349,13 +12349,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370568837000.c23b7ba6-aacd-4327-b266-391d52da4c7e"
+                  "reference": "Organization/1729351692473452000.1d5038a5-e40d-4357-aea0-6e88eb3a7902"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370569639000.1dbe5d9f-f11a-43a7-a3ad-940b98808a90"
+                  "reference": "Organization/1729351692474163000.89cd0d88-dec0-4409-a82c-365208f65145"
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@@ -12383,7 +12383,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370570704000.80f1a9f8-b14e-4a91-8d0f-d6023ed3cd01"
+                  "reference": "Practitioner/1729351692475310000.2ce2b8ea-a61c-48af-b848-b0731f2e3b9b"
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@@ -12511,7 +12511,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370572411000.f9917c46-dcb3-4913-8abd-1358e73aeb02"
+                  "reference": "Practitioner/1729351692477184000.d7e80073-eb92-4520-8d90-6af17f8acccb"
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@@ -12593,18 +12593,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370565116000.5095d6d6-89e7-45f1-94e9-b0cc63b7c3fa"
+          "reference": "PractitionerRole/1729351692469579000.15f735f5-22e6-4f39-887d-c07dc14df39d"
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-      "fullUrl": "Organization/1729293370565283000.f92ca226-9778-4051-ae95-42d854c58320",
+      "fullUrl": "Organization/1729351692469756000.b4fef0a6-fc0e-4449-8ae9-ce32cca3f648",
       "resource": {
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-        "id": "1729293370565283000.f92ca226-9778-4051-ae95-42d854c58320",
+        "id": "1729351692469756000.b4fef0a6-fc0e-4449-8ae9-ce32cca3f648",
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@@ -12619,10 +12619,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692470521000.1fc8ceeb-858c-42eb-aa48-a45c08f0cdf1",
       "resource": {
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         "extension": [
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@@ -12674,7 +12674,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370565283000.f92ca226-9778-4051-ae95-42d854c58320"
+              "reference": "Organization/1729351692469756000.b4fef0a6-fc0e-4449-8ae9-ce32cca3f648"
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@@ -12690,10 +12690,10 @@
       }
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+      "fullUrl": "Organization/1729351692471629000.3b293395-4c8e-40ed-9825-4e623d0c6683",
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+        "id": "1729351692471629000.3b293395-4c8e-40ed-9825-4e623d0c6683",
         "extension": [
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@@ -12781,23 +12781,23 @@
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-      "fullUrl": "PractitionerRole/1729293370565116000.5095d6d6-89e7-45f1-94e9-b0cc63b7c3fa",
+      "fullUrl": "PractitionerRole/1729351692469579000.15f735f5-22e6-4f39-887d-c07dc14df39d",
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+        "id": "1729351692469579000.15f735f5-22e6-4f39-887d-c07dc14df39d",
         "practitioner": {
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+          "reference": "Practitioner/1729351692470521000.1fc8ceeb-858c-42eb-aa48-a45c08f0cdf1"
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         "organization": {
-          "reference": "Organization/1729293370567007000.36f93bad-a041-4632-bdaf-dcaf0eabeb88"
+          "reference": "Organization/1729351692471629000.3b293395-4c8e-40ed-9825-4e623d0c6683"
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+      "fullUrl": "Organization/1729351692473452000.1d5038a5-e40d-4357-aea0-6e88eb3a7902",
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+        "id": "1729351692473452000.1d5038a5-e40d-4357-aea0-6e88eb3a7902",
         "extension": [
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@@ -12873,10 +12873,10 @@
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       "resource": {
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-        "id": "1729293370569639000.1dbe5d9f-f11a-43a7-a3ad-940b98808a90",
+        "id": "1729351692474163000.89cd0d88-dec0-4409-a82c-365208f65145",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12952,10 +12952,10 @@
       }
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     {
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+        "id": "1729351692474642000.fa524655-5e8f-47b3-aba1-2ba12009c91e",
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@@ -12970,10 +12970,10 @@
       }
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     {
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         "extension": [
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@@ -13021,7 +13021,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370570118000.a345606c-c5ba-4f93-8cc4-c30b2fd4f766"
+              "reference": "Organization/1729351692474642000.fa524655-5e8f-47b3-aba1-2ba12009c91e"
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@@ -13037,10 +13037,10 @@
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-        "id": "1729293370571819000.f75bedf3-872f-4637-9553-22d2458a4187",
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@@ -13055,10 +13055,10 @@
       }
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       "resource": {
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-        "id": "1729293370572411000.f9917c46-dcb3-4913-8abd-1358e73aeb02",
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -13106,7 +13106,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370571819000.f75bedf3-872f-4637-9553-22d2458a4187"
+              "reference": "Organization/1729351692476529000.2948c1c8-ef3f-4fad-8c40-77aabc00c4f0"
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@@ -13122,10 +13122,10 @@
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       "resource": {
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-        "id": "1729293370580291000.8a89fbe6-9348-4d68-96b2-a65b4436fc3c",
+        "id": "1729351692485670000.3d9376ac-a290-4119-b113-e0ae49320178",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -13137,13 +13137,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370576576000.8193f176-dad4-4696-b153-92a8eac042d2"
+                  "reference": "Organization/1729351692481519000.f3c8adeb-dbb3-4790-9fd6-3ee010379b45"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370577221000.3b5bf30f-100c-4361-b220-cdc9ce0bdcdd"
+                  "reference": "Organization/1729351692482262000.f57244d4-ac08-4978-b5fb-42e66cb7849a"
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@@ -13171,7 +13171,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370578245000.3b25a13d-9158-4dcc-a9df-79e81b401795"
+                  "reference": "Practitioner/1729351692483401000.72866769-9dc7-46b9-b69a-3867beb19ac3"
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@@ -13299,7 +13299,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370579906000.f06d9073-7782-4810-9a86-e72d7e94f806"
+                  "reference": "Practitioner/1729351692485261000.657389b4-16eb-46b5-9f3d-f2f368943d67"
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@@ -13381,18 +13381,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370572944000.c49009f0-5e20-4492-abac-95eac1fc4606"
+          "reference": "PractitionerRole/1729351692477743000.b873a7fe-4f63-4041-b4ea-cd9105090e69"
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+      "fullUrl": "Organization/1729351692477916000.6f4927ff-81ec-4069-870a-9fe92ba469ec",
       "resource": {
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-        "id": "1729293370573109000.5ff1ace1-805f-41a9-bd94-3ef2f972cffb",
+        "id": "1729351692477916000.6f4927ff-81ec-4069-870a-9fe92ba469ec",
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@@ -13407,10 +13407,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692478687000.7c7cc05d-2265-401b-8fa2-31f77678bdd3",
       "resource": {
         "resourceType": "Practitioner",
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+        "id": "1729351692478687000.7c7cc05d-2265-401b-8fa2-31f77678bdd3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -13462,7 +13462,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370573109000.5ff1ace1-805f-41a9-bd94-3ef2f972cffb"
+              "reference": "Organization/1729351692477916000.6f4927ff-81ec-4069-870a-9fe92ba469ec"
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@@ -13478,10 +13478,10 @@
       }
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+      "fullUrl": "Organization/1729351692479754000.f2de98e5-c8c6-430f-ad25-403c5aefb447",
       "resource": {
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-        "id": "1729293370574884000.4d9338dc-239b-4ef0-acbb-c65a994ed7ea",
+        "id": "1729351692479754000.f2de98e5-c8c6-430f-ad25-403c5aefb447",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -13569,23 +13569,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293370572944000.c49009f0-5e20-4492-abac-95eac1fc4606",
+      "fullUrl": "PractitionerRole/1729351692477743000.b873a7fe-4f63-4041-b4ea-cd9105090e69",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293370572944000.c49009f0-5e20-4492-abac-95eac1fc4606",
+        "id": "1729351692477743000.b873a7fe-4f63-4041-b4ea-cd9105090e69",
         "practitioner": {
-          "reference": "Practitioner/1729293370573828000.cc741e05-cdc4-4c27-a5c4-78fb45afc672"
+          "reference": "Practitioner/1729351692478687000.7c7cc05d-2265-401b-8fa2-31f77678bdd3"
         },
         "organization": {
-          "reference": "Organization/1729293370574884000.4d9338dc-239b-4ef0-acbb-c65a994ed7ea"
+          "reference": "Organization/1729351692479754000.f2de98e5-c8c6-430f-ad25-403c5aefb447"
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-      "fullUrl": "Organization/1729293370576576000.8193f176-dad4-4696-b153-92a8eac042d2",
+      "fullUrl": "Organization/1729351692481519000.f3c8adeb-dbb3-4790-9fd6-3ee010379b45",
       "resource": {
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-        "id": "1729293370576576000.8193f176-dad4-4696-b153-92a8eac042d2",
+        "id": "1729351692481519000.f3c8adeb-dbb3-4790-9fd6-3ee010379b45",
         "extension": [
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@@ -13661,10 +13661,10 @@
       }
     },
     {
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+      "fullUrl": "Organization/1729351692482262000.f57244d4-ac08-4978-b5fb-42e66cb7849a",
       "resource": {
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-        "id": "1729293370577221000.3b5bf30f-100c-4361-b220-cdc9ce0bdcdd",
+        "id": "1729351692482262000.f57244d4-ac08-4978-b5fb-42e66cb7849a",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -13740,10 +13740,10 @@
       }
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+      "fullUrl": "Organization/1729351692482747000.02bc0a62-5125-4089-a48b-1e8af090f27f",
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@@ -13758,10 +13758,10 @@
       }
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-      "fullUrl": "Practitioner/1729293370578245000.3b25a13d-9158-4dcc-a9df-79e81b401795",
+      "fullUrl": "Practitioner/1729351692483401000.72866769-9dc7-46b9-b69a-3867beb19ac3",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370578245000.3b25a13d-9158-4dcc-a9df-79e81b401795",
+        "id": "1729351692483401000.72866769-9dc7-46b9-b69a-3867beb19ac3",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -13809,7 +13809,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370577657000.558b9ff2-3bec-43d0-8cff-f7f41091247c"
+              "reference": "Organization/1729351692482747000.02bc0a62-5125-4089-a48b-1e8af090f27f"
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@@ -13825,10 +13825,10 @@
       }
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+      "fullUrl": "Organization/1729351692484625000.0e9708df-b8cd-4b82-9b9a-b23787f82ba9",
       "resource": {
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-        "id": "1729293370579324000.d274ea32-a936-4ede-96ad-b3020794c161",
+        "id": "1729351692484625000.0e9708df-b8cd-4b82-9b9a-b23787f82ba9",
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@@ -13843,10 +13843,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692485261000.657389b4-16eb-46b5-9f3d-f2f368943d67",
       "resource": {
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-        "id": "1729293370579906000.f06d9073-7782-4810-9a86-e72d7e94f806",
+        "id": "1729351692485261000.657389b4-16eb-46b5-9f3d-f2f368943d67",
         "extension": [
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@@ -13894,7 +13894,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370579324000.d274ea32-a936-4ede-96ad-b3020794c161"
+              "reference": "Organization/1729351692484625000.0e9708df-b8cd-4b82-9b9a-b23787f82ba9"
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@@ -13910,10 +13910,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729351692493917000.57135fcb-c7d8-482c-894b-7727631ba28c",
       "resource": {
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-        "id": "1729293370587797000.425ee6b5-e004-46d8-92de-ad755105ad93",
+        "id": "1729351692493917000.57135fcb-c7d8-482c-894b-7727631ba28c",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -13925,13 +13925,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370584032000.81bed709-808f-49b6-b6ce-60619f799b11"
+                  "reference": "Organization/1729351692489669000.eefc32f0-366d-42ae-af08-1f9504660014"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370584679000.01f34ead-b268-4ba7-a86c-b942ae8b3f1b"
+                  "reference": "Organization/1729351692490375000.ae04f35d-4f68-44b2-b641-37d96f2c3a28"
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@@ -13959,7 +13959,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370585700000.1ed6d50f-448e-48a8-9219-e57b0f44b002"
+                  "reference": "Practitioner/1729351692491536000.8de4e8aa-a958-44b1-b1b6-280b7de81864"
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@@ -14087,7 +14087,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370587398000.3a929ebb-4ee8-4be9-a5fa-a78d112c427c"
+                  "reference": "Practitioner/1729351692493494000.929e016b-b37c-425c-a6fe-d97076f3bc3a"
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@@ -14169,18 +14169,18 @@
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370580428000.4be89470-e7a5-4d2c-9550-e1720e579e37"
+          "reference": "PractitionerRole/1729351692485814000.e25c0c38-8a7a-4e5f-a9c3-3dc34fa4d406"
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+      "fullUrl": "Organization/1729351692485991000.af9ba61f-73f0-42eb-bc5a-a2b0db5d9eeb",
       "resource": {
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@@ -14195,10 +14195,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692486801000.c8ed5b88-9cbe-48dc-8d1c-74910f8d62ee",
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         "extension": [
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@@ -14250,7 +14250,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370580595000.0825267c-93b6-47fc-a254-1531a750a522"
+              "reference": "Organization/1729351692485991000.af9ba61f-73f0-42eb-bc5a-a2b0db5d9eeb"
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@@ -14266,10 +14266,10 @@
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@@ -14357,23 +14357,23 @@
       }
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+        "id": "1729351692485814000.e25c0c38-8a7a-4e5f-a9c3-3dc34fa4d406",
         "practitioner": {
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+          "reference": "Practitioner/1729351692486801000.c8ed5b88-9cbe-48dc-8d1c-74910f8d62ee"
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+      "fullUrl": "Organization/1729351692489669000.eefc32f0-366d-42ae-af08-1f9504660014",
       "resource": {
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+        "id": "1729351692489669000.eefc32f0-366d-42ae-af08-1f9504660014",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -14449,10 +14449,10 @@
       }
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+      "fullUrl": "Organization/1729351692490375000.ae04f35d-4f68-44b2-b641-37d96f2c3a28",
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         "extension": [
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@@ -14528,10 +14528,10 @@
       }
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@@ -14546,10 +14546,10 @@
       }
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@@ -14597,7 +14597,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351692490845000.f46c423a-243c-4e91-987f-0d2cf47490f6"
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@@ -14613,10 +14613,10 @@
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@@ -14631,10 +14631,10 @@
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@@ -14682,7 +14682,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729351692492839000.53af801c-f450-4be9-9b7f-b7f5f946ec4b"
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@@ -14698,10 +14698,10 @@
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@@ -14713,13 +14713,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370591542000.b5ceac70-3427-4026-9ee8-be5f37f13560"
+                  "reference": "Organization/1729351692497931000.f74f5f46-59ff-4bd2-86f6-b72273c474f9"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351692498666000.edacc0d6-56a1-4bff-96a2-4dfc2748d8f0"
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@@ -14747,7 +14747,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370593208000.67d1601a-cb2d-4319-a5a9-c4bf52fc79bb"
+                  "reference": "Practitioner/1729351692499781000.bd15592d-4548-4ace-b4ab-db5c4cdbc4cd"
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@@ -14875,7 +14875,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729351692501624000.7811c823-129f-4ff3-966e-02981dab05ab"
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@@ -14957,18 +14957,18 @@
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+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
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+          "reference": "PractitionerRole/1729351692494063000.4499a23c-0712-48d5-86b5-cd2671f7b439"
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@@ -14983,10 +14983,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692495040000.6d28e1a1-49f3-4389-a26e-41aba9e6a286",
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         "extension": [
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@@ -15038,7 +15038,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351692494239000.1a744983-cc94-48c5-a949-abf1cb63214b"
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@@ -15054,10 +15054,10 @@
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+        "id": "1729351692496147000.234a5797-af41-4dec-b8f7-dc1afcd70e5c",
         "extension": [
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@@ -15145,23 +15145,23 @@
       }
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+      "fullUrl": "PractitionerRole/1729351692494063000.4499a23c-0712-48d5-86b5-cd2671f7b439",
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+        "id": "1729351692494063000.4499a23c-0712-48d5-86b5-cd2671f7b439",
         "practitioner": {
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+          "reference": "Practitioner/1729351692495040000.6d28e1a1-49f3-4389-a26e-41aba9e6a286"
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         "organization": {
-          "reference": "Organization/1729293370589855000.feac9a76-e0fe-4429-98cd-b21e87fc93dd"
+          "reference": "Organization/1729351692496147000.234a5797-af41-4dec-b8f7-dc1afcd70e5c"
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         "extension": [
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@@ -15237,10 +15237,10 @@
       }
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+      "fullUrl": "Organization/1729351692498666000.edacc0d6-56a1-4bff-96a2-4dfc2748d8f0",
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         "extension": [
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@@ -15316,10 +15316,10 @@
       }
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@@ -15334,10 +15334,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692499781000.bd15592d-4548-4ace-b4ab-db5c4cdbc4cd",
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+        "id": "1729351692499781000.bd15592d-4548-4ace-b4ab-db5c4cdbc4cd",
         "extension": [
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@@ -15385,7 +15385,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370592625000.375b198c-a27f-4d4c-9825-54152cdbb41e"
+              "reference": "Organization/1729351692499141000.d448eab6-057a-4e28-a75e-486d8e10cb19"
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@@ -15401,10 +15401,10 @@
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-        "id": "1729293370594284000.f80e7ca1-4082-416a-be7c-0c8221e9f109",
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@@ -15419,10 +15419,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692501624000.7811c823-129f-4ff3-966e-02981dab05ab",
       "resource": {
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+        "id": "1729351692501624000.7811c823-129f-4ff3-966e-02981dab05ab",
         "extension": [
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@@ -15470,7 +15470,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370594284000.f80e7ca1-4082-416a-be7c-0c8221e9f109"
+              "reference": "Organization/1729351692500975000.a3993380-6e9d-4628-b517-1f26bf68043b"
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@@ -15486,10 +15486,10 @@
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+      "fullUrl": "ServiceRequest/1729351692510161000.211c650f-18df-42df-81e5-b2f9cb23f231",
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+        "id": "1729351692510161000.211c650f-18df-42df-81e5-b2f9cb23f231",
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -15501,13 +15501,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370599050000.b547f929-2c81-4d13-a754-b65bac1fed7b"
+                  "reference": "Organization/1729351692506101000.eed9e64f-75f4-49b8-baa9-eb950ea801e9"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370599713000.53e3caaf-5843-458a-948b-deaf747f9f35"
+                  "reference": "Organization/1729351692506804000.7d59a19e-2765-42de-a3e2-fb0b62a864c5"
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@@ -15535,7 +15535,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370600758000.bf9d3871-9ace-420d-b6a7-3a07e489ad21"
+                  "reference": "Practitioner/1729351692507920000.aa893045-0b4a-438d-9090-4e92cc0ab82e"
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@@ -15663,7 +15663,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370602456000.2b31b855-1503-4b4a-ac7d-fc47e6e2b496"
+                  "reference": "Practitioner/1729351692509727000.73d7e4d7-27bc-4259-b110-77e1caebaef9"
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@@ -15745,18 +15745,18 @@
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370595413000.4d565bd7-a7ba-4207-bcdc-6bf1c4f8450f"
+          "reference": "PractitionerRole/1729351692502228000.35f1a38d-0219-4e2b-92d5-fb9c51251c14"
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@@ -15771,10 +15771,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692503168000.be24600c-71ff-4c67-b4fd-edcc947a28b4",
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         "extension": [
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@@ -15826,7 +15826,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370595579000.5b9805ad-081c-4ec8-bc8d-8281ed3a74eb"
+              "reference": "Organization/1729351692502413000.cd95983c-d3c4-4b54-9017-d37084f6a6f1"
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@@ -15842,10 +15842,10 @@
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@@ -15933,23 +15933,23 @@
       }
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         "result": [
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+      "fullUrl": "DiagnosticReport/1729351692523603000.eaab5d6b-0fdf-449d-8d62-aa13d170439a",
       "resource": {
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+        "id": "1729351692523603000.eaab5d6b-0fdf-449d-8d62-aa13d170439a",
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@@ -17059,7 +17059,7 @@
         ],
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+            "reference": "ServiceRequest/1729351692453273000.bb54f821-9255-4bcd-a1f7-8ff31f92ee90"
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@@ -17083,7 +17083,7 @@
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+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "_effectiveDateTime": {
@@ -17105,21 +17105,21 @@
         },
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           {
-            "reference": "Specimen/1729293370494093000.38947b94-7854-4248-98a4-3642dbab1c1f"
+            "reference": "Specimen/1729351692398283000.aab9bede-7c39-4648-9fcf-be88c442b11c"
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     {
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+      "fullUrl": "DiagnosticReport/1729351692524862000.b6d0cb07-bf76-42c0-8e47-2e3c43c53b3c",
       "resource": {
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@@ -17172,7 +17172,7 @@
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@@ -17196,7 +17196,7 @@
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+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "_effectiveDateTime": {
@@ -17218,21 +17218,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370494382000.22ef33ac-d8a7-4949-91ba-4c76fae21002"
+            "reference": "Specimen/1729351692398601000.9505d189-a271-4cfc-81e2-2bb6381308d1"
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         "result": [
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-            "reference": "Observation/1729293370476825000.150574b5-5316-460c-851d-ac03733a15a6"
+            "reference": "Observation/1729351692381991000.b64a1344-51a5-46be-9c49-a13579bfe9f4"
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     {
-      "fullUrl": "DiagnosticReport/1729293370618478000.4ee45569-9901-475d-8741-2ce987dd2d1b",
+      "fullUrl": "DiagnosticReport/1729351692526139000.eeaa8b26-7d1c-498b-ad2c-a4e12ebdb406",
       "resource": {
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-        "id": "1729293370618478000.4ee45569-9901-475d-8741-2ce987dd2d1b",
+        "id": "1729351692526139000.eeaa8b26-7d1c-498b-ad2c-a4e12ebdb406",
         "identifier": [
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             "extension": [
@@ -17285,7 +17285,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370564974000.5e6ddab4-0233-4a21-91d8-2a8586c1c762"
+            "reference": "ServiceRequest/1729351692469418000.61b68a99-69e4-466c-8b00-af2b9d4a91fc"
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         "status": "final",
@@ -17309,7 +17309,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17331,21 +17331,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370494667000.84ac72eb-9bae-43d1-9a36-2d111ca86c7f"
+            "reference": "Specimen/1729351692398916000.5a648094-217a-4c7c-9c27-d773e1ca3b60"
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         ],
         "result": [
           {
-            "reference": "Observation/1729293370478735000.e62680ee-0ad6-46ff-89ee-1a10d1252117"
+            "reference": "Observation/1729351692383839000.fa86e287-a0a5-471f-a7df-cc9fc25517a9"
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       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370619626000.8309ea4d-77ba-4fa2-b92d-2a785d98adc4",
+      "fullUrl": "DiagnosticReport/1729351692527397000.0d2f4e8e-2403-4221-90cf-9070bfe0243e",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370619626000.8309ea4d-77ba-4fa2-b92d-2a785d98adc4",
+        "id": "1729351692527397000.0d2f4e8e-2403-4221-90cf-9070bfe0243e",
         "identifier": [
           {
             "extension": [
@@ -17398,7 +17398,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370572799000.6eb041e2-9308-4af8-802a-7aa8313e7242"
+            "reference": "ServiceRequest/1729351692477598000.70b2b6c6-00ba-475b-95ea-02e28bb20c99"
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         "status": "final",
@@ -17422,7 +17422,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17444,21 +17444,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370494951000.050c1d45-e9d1-43fe-8fb8-a0d3a07e74c3"
+            "reference": "Specimen/1729351692399228000.95bfbb88-5dbe-413a-87fc-1370862eb764"
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         "result": [
           {
-            "reference": "Observation/1729293370480511000.3abe31cd-2773-41a7-a16c-dd932c1c77a6"
+            "reference": "Observation/1729351692385665000.84fce307-881e-4850-9bd0-e4e29282dbe3"
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     },
     {
-      "fullUrl": "DiagnosticReport/1729293370620804000.2ed130be-bc00-4177-9b8c-0f1f11f857e3",
+      "fullUrl": "DiagnosticReport/1729351692528664000.335fc139-6b85-4c60-80e4-c6beb2ac6854",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370620804000.2ed130be-bc00-4177-9b8c-0f1f11f857e3",
+        "id": "1729351692528664000.335fc139-6b85-4c60-80e4-c6beb2ac6854",
         "identifier": [
           {
             "extension": [
@@ -17511,7 +17511,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370580291000.8a89fbe6-9348-4d68-96b2-a65b4436fc3c"
+            "reference": "ServiceRequest/1729351692485670000.3d9376ac-a290-4119-b113-e0ae49320178"
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         "status": "final",
@@ -17535,7 +17535,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17557,21 +17557,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370495240000.cefdfb55-4bb1-4f2b-ae3c-069776553ff0"
+            "reference": "Specimen/1729351692399539000.a92a8b30-7e25-40c3-a708-bddfae3466c6"
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         ],
         "result": [
           {
-            "reference": "Observation/1729293370482296000.594d0b98-a064-45c1-8144-d1562a0aa7b9"
+            "reference": "Observation/1729351692387506000.d2276846-5f39-4baa-8a8a-635d8ef87a54"
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       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370622057000.73367673-7ca0-4e22-9f0c-71f78d3c7fb6",
+      "fullUrl": "DiagnosticReport/1729351692529940000.20984749-55b1-421f-8b11-5df540a84fc1",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370622057000.73367673-7ca0-4e22-9f0c-71f78d3c7fb6",
+        "id": "1729351692529940000.20984749-55b1-421f-8b11-5df540a84fc1",
         "identifier": [
           {
             "extension": [
@@ -17624,7 +17624,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370587797000.425ee6b5-e004-46d8-92de-ad755105ad93"
+            "reference": "ServiceRequest/1729351692493917000.57135fcb-c7d8-482c-894b-7727631ba28c"
           }
         ],
         "status": "final",
@@ -17648,7 +17648,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17670,21 +17670,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370495546000.a18176fd-a0f2-4208-b069-8528a7e43b4c"
+            "reference": "Specimen/1729351692399845000.6edb6c38-2001-400e-8c89-20592452db40"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370484238000.56ac1fa7-f887-4def-85a5-7635a20a88f5"
+            "reference": "Observation/1729351692389324000.068ebed0-c4b5-44e9-a3df-ea4c5f228fbb"
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         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370623399000.c885ba78-ff58-43d8-9f06-25b96a13080f",
+      "fullUrl": "DiagnosticReport/1729351692531206000.21b6027d-0ebc-4d08-b450-c868adff8ea7",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370623399000.c885ba78-ff58-43d8-9f06-25b96a13080f",
+        "id": "1729351692531206000.21b6027d-0ebc-4d08-b450-c868adff8ea7",
         "identifier": [
           {
             "extension": [
@@ -17737,7 +17737,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370595276000.794fef48-a04d-45af-9312-ced460d80e08"
+            "reference": "ServiceRequest/1729351692502056000.0842a79c-f523-44ae-bfed-a4059fa59261"
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         "status": "final",
@@ -17761,7 +17761,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17783,21 +17783,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370495842000.c7875c4c-37ca-435e-aa27-ad0bfec02dd6"
+            "reference": "Specimen/1729351692400161000.23759efe-ff41-47ee-ba14-9fa629c9b584"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370486076000.7ef8b361-acf0-4d6c-9c08-f20f01895b80"
+            "reference": "Observation/1729351692391132000.ae034a46-d24e-4499-a9d6-10d7e403f7ee"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370624615000.fa48bf41-cbeb-447a-b745-04971bb3321c",
+      "fullUrl": "DiagnosticReport/1729351692532497000.db7442ce-4b76-4c7e-98c5-2d43d9b832ad",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370624615000.fa48bf41-cbeb-447a-b745-04971bb3321c",
+        "id": "1729351692532497000.db7442ce-4b76-4c7e-98c5-2d43d9b832ad",
         "identifier": [
           {
             "extension": [
@@ -17850,7 +17850,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370602844000.728ca6ec-5617-480d-825b-635a9747d4f5"
+            "reference": "ServiceRequest/1729351692510161000.211c650f-18df-42df-81e5-b2f9cb23f231"
           }
         ],
         "status": "final",
@@ -17874,7 +17874,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17896,12 +17896,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370496129000.d5c1344f-e127-41c7-8a08-3816715ddd56"
+            "reference": "Specimen/1729351692400463000.6055b152-c01d-4534-b281-617a64e0a296"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370487848000.f0e59b04-66cb-4ed5-bdb5-f6b4224864db"
+            "reference": "Observation/1729351692392914000.aedeb0c2-e561-4bc2-b46a-73e7563011a8"
           }
         ]
       }
diff --git a/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_2_fhir_transformation.fhir b/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_2_fhir_transformation.fhir
index 16a172ccc..90340fac2 100644
--- a/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_2_fhir_transformation.fhir
+++ b/examples/Test/Results/004_AL_ORU_R01_NBS_Specimen_Unsatisfactory_2_fhir_transformation.fhir
@@ -1,8 +1,8 @@
 {
   "resourceType": "Bundle",
-  "id": "1729293370398334000.2a393687-0862-412f-8529-077241d85208",
+  "id": "1729351692323352000.041e9d8d-7cda-4cf4-bdb3-bbf0fc5d87dd",
   "meta": {
-    "lastUpdated": "2024-10-18T16:16:10.398-07:00"
+    "lastUpdated": "2024-10-19T08:28:12.323-07:00"
   },
   "identifier": {
     "system": "https://reportstream.cdc.gov/prime-router",
@@ -12,10 +12,10 @@
   "timestamp": "2023-06-06T17:28:49.000-07:00",
   "entry": [
     {
-      "fullUrl": "MessageHeader/1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835",
+      "fullUrl": "MessageHeader/1729351692324713000.0b4a1fd1-45ec-4d55-807c-cc562d015eb3",
       "resource": {
         "resourceType": "MessageHeader",
-        "id": "1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835",
+        "id": "1729351692324713000.0b4a1fd1-45ec-4d55-807c-cc562d015eb3",
         "meta": {
           "tag": [
             {
@@ -156,12 +156,12 @@
             "name": "BaptistOracle",
             "endpoint": "urn:oid:2.16.840.1.114222.4.1.000000",
             "receiver": {
-              "reference": "Organization/1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93"
+              "reference": "Organization/1729351692324439000.9a1799b3-12c6-4fd7-a1fe-e230a3e50098"
             }
           }
         ],
         "sender": {
-          "reference": "Organization/1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2"
+          "reference": "Organization/1729351692323850000.2fe6cd6d-e791-4b98-9b8b-0b26dbe2e5de"
         },
         "source": {
           "extension": [
@@ -187,10 +187,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2",
+      "fullUrl": "Organization/1729351692323850000.2fe6cd6d-e791-4b98-9b8b-0b26dbe2e5de",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370399498000.541d0dd7-7b86-4226-94ba-e544b9e209b2",
+        "id": "1729351692323850000.2fe6cd6d-e791-4b98-9b8b-0b26dbe2e5de",
         "identifier": [
           {
             "extension": [
@@ -223,10 +223,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93",
+      "fullUrl": "Organization/1729351692324439000.9a1799b3-12c6-4fd7-a1fe-e230a3e50098",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370402691000.934230c2-12a0-4e0b-9c6b-261ab9c7cd93",
+        "id": "1729351692324439000.9a1799b3-12c6-4fd7-a1fe-e230a3e50098",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/hl7v2Field",
@@ -265,55 +265,55 @@
       }
     },
     {
-      "fullUrl": "Provenance/1729293370416105000.3f4b5e28-ebb1-4a26-857f-19b8077b2b8f",
+      "fullUrl": "Provenance/1729351692326858000.523438c1-7505-4a30-932c-8ce657ff6084",
       "resource": {
         "resourceType": "Provenance",
-        "id": "1729293370416105000.3f4b5e28-ebb1-4a26-857f-19b8077b2b8f",
+        "id": "1729351692326858000.523438c1-7505-4a30-932c-8ce657ff6084",
         "target": [
           {
-            "reference": "MessageHeader/1729293370411340000.9a99de74-922e-4488-92fa-8941e6e60835"
+            "reference": "MessageHeader/1729351692324713000.0b4a1fd1-45ec-4d55-807c-cc562d015eb3"
           },
           {
-            "reference": "DiagnosticReport/1729293370608814000.e3661cfd-5e37-4f8d-a673-8efa91e7ece5"
+            "reference": "DiagnosticReport/1729351692515774000.b3a7d67b-c958-4b8b-bf9d-ccff0fc9cab1"
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@@ -335,17 +335,17 @@
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@@ -378,11 +378,11 @@
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@@ -404,17 +404,17 @@
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@@ -552,7 +552,7 @@
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@@ -702,10 +702,10 @@
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@@ -720,16 +720,16 @@
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@@ -741,10 +741,10 @@
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@@ -800,7 +800,7 @@
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@@ -890,10 +890,10 @@
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@@ -950,7 +950,7 @@
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@@ -963,7 +963,7 @@
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@@ -988,10 +988,10 @@
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@@ -1014,10 +1014,10 @@
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@@ -1048,15 +1048,15 @@
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@@ -1071,10 +1071,10 @@
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@@ -1131,7 +1131,7 @@
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@@ -1144,7 +1144,7 @@
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@@ -1169,10 +1169,10 @@
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@@ -1195,10 +1195,10 @@
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@@ -1229,15 +1229,15 @@
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@@ -1252,10 +1252,10 @@
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@@ -1312,7 +1312,7 @@
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@@ -1325,17 +1325,17 @@
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@@ -1358,10 +1358,10 @@
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@@ -1392,15 +1392,15 @@
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@@ -1415,10 +1415,10 @@
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@@ -1475,7 +1475,7 @@
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@@ -1488,7 +1488,7 @@
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@@ -1513,10 +1513,10 @@
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@@ -1539,10 +1539,10 @@
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@@ -1573,15 +1573,15 @@
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@@ -1596,10 +1596,10 @@
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@@ -1656,7 +1656,7 @@
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@@ -1669,7 +1669,7 @@
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@@ -1694,10 +1694,10 @@
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@@ -1720,10 +1720,10 @@
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@@ -1754,15 +1754,15 @@
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@@ -1777,10 +1777,10 @@
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@@ -1837,7 +1837,7 @@
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@@ -1850,7 +1850,7 @@
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@@ -1875,10 +1875,10 @@
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@@ -1901,10 +1901,10 @@
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@@ -1935,15 +1935,15 @@
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@@ -1958,10 +1958,10 @@
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@@ -2018,7 +2018,7 @@
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@@ -2031,7 +2031,7 @@
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@@ -2056,10 +2056,10 @@
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@@ -2082,10 +2082,10 @@
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@@ -2116,15 +2116,15 @@
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@@ -2139,10 +2139,10 @@
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@@ -2199,7 +2199,7 @@
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@@ -2212,7 +2212,7 @@
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@@ -2237,10 +2237,10 @@
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@@ -2263,10 +2263,10 @@
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@@ -2297,15 +2297,15 @@
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@@ -2320,10 +2320,10 @@
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@@ -2416,7 +2416,7 @@
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@@ -2429,16 +2429,16 @@
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@@ -2461,10 +2461,10 @@
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@@ -2558,7 +2558,7 @@
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@@ -2573,10 +2573,10 @@
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@@ -2635,7 +2635,7 @@
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@@ -2655,10 +2655,10 @@
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@@ -2790,7 +2790,7 @@
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@@ -2850,7 +2850,7 @@
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@@ -2883,10 +2883,10 @@
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@@ -2923,7 +2923,7 @@
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@@ -2946,10 +2946,10 @@
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@@ -2986,7 +2986,7 @@
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@@ -3041,7 +3041,7 @@
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@@ -3055,10 +3055,10 @@
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@@ -3095,7 +3095,7 @@
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@@ -3110,10 +3110,10 @@
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@@ -3170,7 +3170,7 @@
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@@ -3183,7 +3183,7 @@
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@@ -3208,10 +3208,10 @@
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@@ -3234,10 +3234,10 @@
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@@ -3268,15 +3268,15 @@
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@@ -3291,10 +3291,10 @@
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@@ -3351,7 +3351,7 @@
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@@ -3364,7 +3364,7 @@
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@@ -3415,10 +3415,10 @@
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@@ -3449,15 +3449,15 @@
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@@ -3532,7 +3532,7 @@
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@@ -3545,7 +3545,7 @@
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@@ -3570,10 +3570,10 @@
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@@ -3596,10 +3596,10 @@
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@@ -3630,15 +3630,15 @@
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@@ -3653,10 +3653,10 @@
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@@ -3713,7 +3713,7 @@
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@@ -3726,7 +3726,7 @@
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@@ -3777,10 +3777,10 @@
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@@ -3811,15 +3811,15 @@
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@@ -3834,10 +3834,10 @@
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@@ -3894,7 +3894,7 @@
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@@ -3907,7 +3907,7 @@
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@@ -3932,10 +3932,10 @@
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@@ -3958,10 +3958,10 @@
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@@ -3992,15 +3992,15 @@
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@@ -4015,10 +4015,10 @@
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@@ -4075,7 +4075,7 @@
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@@ -4088,7 +4088,7 @@
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@@ -4113,10 +4113,10 @@
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@@ -4139,10 +4139,10 @@
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@@ -4173,15 +4173,15 @@
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@@ -4196,10 +4196,10 @@
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@@ -4256,7 +4256,7 @@
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@@ -4269,7 +4269,7 @@
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@@ -4294,10 +4294,10 @@
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@@ -4320,10 +4320,10 @@
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@@ -4354,15 +4354,15 @@
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@@ -4377,10 +4377,10 @@
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@@ -4437,7 +4437,7 @@
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@@ -4450,7 +4450,7 @@
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@@ -4475,10 +4475,10 @@
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@@ -4501,10 +4501,10 @@
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@@ -4535,15 +4535,15 @@
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@@ -4558,10 +4558,10 @@
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@@ -4618,7 +4618,7 @@
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@@ -4631,7 +4631,7 @@
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@@ -4656,10 +4656,10 @@
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@@ -4682,10 +4682,10 @@
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@@ -4716,15 +4716,15 @@
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@@ -4739,10 +4739,10 @@
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@@ -4799,7 +4799,7 @@
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@@ -4812,7 +4812,7 @@
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@@ -4837,10 +4837,10 @@
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@@ -4863,10 +4863,10 @@
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@@ -4897,15 +4897,15 @@
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@@ -4920,10 +4920,10 @@
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@@ -4980,7 +4980,7 @@
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@@ -4993,7 +4993,7 @@
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@@ -5018,10 +5018,10 @@
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@@ -5044,10 +5044,10 @@
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@@ -5078,15 +5078,15 @@
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@@ -5101,10 +5101,10 @@
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@@ -5161,7 +5161,7 @@
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@@ -5174,7 +5174,7 @@
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@@ -5199,10 +5199,10 @@
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@@ -5225,10 +5225,10 @@
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@@ -5259,15 +5259,15 @@
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@@ -5282,10 +5282,10 @@
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@@ -5295,10 +5295,10 @@
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@@ -5308,10 +5308,10 @@
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@@ -5321,10 +5321,10 @@
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@@ -5334,10 +5334,10 @@
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@@ -5347,10 +5347,10 @@
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@@ -5360,10 +5360,10 @@
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@@ -5373,10 +5373,10 @@
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@@ -5386,10 +5386,10 @@
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@@ -5399,10 +5399,10 @@
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@@ -5412,10 +5412,10 @@
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@@ -5425,10 +5425,10 @@
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@@ -5438,10 +5438,10 @@
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@@ -5451,10 +5451,10 @@
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@@ -5464,10 +5464,10 @@
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@@ -5629,10 +5629,10 @@
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@@ -5644,13 +5644,13 @@
               {
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                 "valueReference": {
-                  "reference": "Organization/1729293370502495000.7c5b41d7-f8d5-495b-a533-131ebc83c5ad"
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                 "valueReference": {
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+                  "reference": "Organization/1729351692407216000.84766b3a-7bef-40f5-afdb-77b1da566d69"
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@@ -5678,7 +5678,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370504286000.7329e47c-df43-4e49-8fb8-723458996e08"
+                  "reference": "Practitioner/1729351692408312000.7e6a2b1a-b9fc-4f40-b30e-b4cad501ac09"
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@@ -5806,7 +5806,7 @@
               {
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                 "valueReference": {
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+                  "reference": "Practitioner/1729351692410105000.f7afe0cd-3006-4a05-8aba-7244e5b4c202"
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@@ -5888,18 +5888,18 @@
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+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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@@ -5914,10 +5914,10 @@
       }
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         "extension": [
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@@ -5969,7 +5969,7 @@
             },
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             "assigner": {
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@@ -5985,10 +5985,10 @@
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         "extension": [
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@@ -6076,23 +6076,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729293370498751000.e20f6a21-84ff-45aa-be33-e3c42bd6ec81",
+      "fullUrl": "PractitionerRole/1729351692402742000.2b78fdee-9db1-4d1b-97f5-86f2922d830c",
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+          "reference": "Practitioner/1729351692403678000.49942331-2e45-4d4d-8e46-cdddaa35c90b"
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+          "reference": "Organization/1729351692404766000.66f59be9-25e3-475f-b9ae-e95f4d7b973e"
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@@ -6168,10 +6168,10 @@
       }
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@@ -6247,10 +6247,10 @@
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@@ -6265,10 +6265,10 @@
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@@ -6316,7 +6316,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351692407682000.85e90f79-9861-4cce-bbdb-5693ce164435"
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@@ -6332,10 +6332,10 @@
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@@ -6350,10 +6350,10 @@
       }
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@@ -6401,7 +6401,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351692409478000.32291df2-4c22-4bb9-ad8a-8cb3b4080971"
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@@ -6417,10 +6417,10 @@
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@@ -6559,7 +6559,7 @@
               {
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                 "valueReference": {
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@@ -6641,18 +6641,18 @@
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+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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+          "reference": "Practitioner/1729351692411459000.b40ab972-8153-4054-90ef-fc24c6429bbb"
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@@ -6667,10 +6667,10 @@
       }
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6722,7 +6722,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370506709000.2a643936-925d-41c9-bb3a-1a3b4b5c2f07"
+              "reference": "Organization/1729351692410721000.4fb5d374-d92e-4e30-b6e3-3fee412a24f0"
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@@ -6738,10 +6738,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293370509775000.2aec9b9f-7a93-4e31-b146-c5377b127bde",
+      "fullUrl": "Organization/1729351692413751000.49a340c4-d42b-4d4d-b792-e0d31fa6e905",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370509775000.2aec9b9f-7a93-4e31-b146-c5377b127bde",
+        "id": "1729351692413751000.49a340c4-d42b-4d4d-b792-e0d31fa6e905",
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@@ -6756,10 +6756,10 @@
       }
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     {
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+      "fullUrl": "Practitioner/1729351692414350000.d519d3a7-a9f8-4f5d-a168-3ccefb0f9279",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370510370000.94c63971-ab6e-4eed-bfe4-461374c09e0b",
+        "id": "1729351692414350000.d519d3a7-a9f8-4f5d-a168-3ccefb0f9279",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -6807,7 +6807,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370509775000.2aec9b9f-7a93-4e31-b146-c5377b127bde"
+              "reference": "Organization/1729351692413751000.49a340c4-d42b-4d4d-b792-e0d31fa6e905"
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@@ -6823,10 +6823,10 @@
       }
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     {
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+      "fullUrl": "ServiceRequest/1729351692422252000.4763f7f5-703e-4a13-8201-3091a7e1ce6e",
       "resource": {
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-        "id": "1729293370518394000.4bc3dd1e-e73a-4309-8696-5985a33efe36",
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -6838,13 +6838,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370514545000.94f6e26a-5a73-4eb8-b78e-29d202542c89"
+                  "reference": "Organization/1729351692418430000.22d68980-09df-4778-b4d0-7289cda21059"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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+                  "reference": "Organization/1729351692419083000.73a31cc3-39a2-4e40-aef2-1e9623a0a5b5"
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               {
@@ -6872,7 +6872,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370516264000.ec1e3eb0-30c9-401d-8675-1f87db9db0f0"
+                  "reference": "Practitioner/1729351692420166000.43868496-0e04-47c6-9968-d46542c45514"
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@@ -7000,7 +7000,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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+                  "reference": "Practitioner/1729351692421846000.d5bcff35-a19d-45fb-99c0-a256e38193ca"
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@@ -7082,18 +7082,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
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+          "reference": "PractitionerRole/1729351692414870000.89c8678c-5a0b-44c0-812f-d84876b594e0"
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+      "fullUrl": "Organization/1729351692415033000.c020102b-fa2a-41b1-98bd-d83a1880db31",
       "resource": {
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-        "id": "1729293370511076000.c5a7a0fb-543c-438c-8014-308aa5c836bd",
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@@ -7108,10 +7108,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692415775000.011641e3-bcb3-4c4c-a441-449450daa3f6",
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+        "id": "1729351692415775000.011641e3-bcb3-4c4c-a441-449450daa3f6",
         "extension": [
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@@ -7163,7 +7163,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370511076000.c5a7a0fb-543c-438c-8014-308aa5c836bd"
+              "reference": "Organization/1729351692415033000.c020102b-fa2a-41b1-98bd-d83a1880db31"
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@@ -7179,10 +7179,10 @@
       }
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+      "fullUrl": "Organization/1729351692416783000.6e16ed7d-7eac-46c9-b256-d2d3e86718ad",
       "resource": {
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+        "id": "1729351692416783000.6e16ed7d-7eac-46c9-b256-d2d3e86718ad",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7270,23 +7270,23 @@
       }
     },
     {
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+      "fullUrl": "PractitionerRole/1729351692414870000.89c8678c-5a0b-44c0-812f-d84876b594e0",
       "resource": {
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+        "id": "1729351692414870000.89c8678c-5a0b-44c0-812f-d84876b594e0",
         "practitioner": {
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+          "reference": "Practitioner/1729351692415775000.011641e3-bcb3-4c4c-a441-449450daa3f6"
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         "organization": {
-          "reference": "Organization/1729293370512860000.14fbc6a1-8423-41d2-bdff-f06580c03154"
+          "reference": "Organization/1729351692416783000.6e16ed7d-7eac-46c9-b256-d2d3e86718ad"
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-      "fullUrl": "Organization/1729293370514545000.94f6e26a-5a73-4eb8-b78e-29d202542c89",
+      "fullUrl": "Organization/1729351692418430000.22d68980-09df-4778-b4d0-7289cda21059",
       "resource": {
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-        "id": "1729293370514545000.94f6e26a-5a73-4eb8-b78e-29d202542c89",
+        "id": "1729351692418430000.22d68980-09df-4778-b4d0-7289cda21059",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7362,10 +7362,10 @@
       }
     },
     {
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+      "fullUrl": "Organization/1729351692419083000.73a31cc3-39a2-4e40-aef2-1e9623a0a5b5",
       "resource": {
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+        "id": "1729351692419083000.73a31cc3-39a2-4e40-aef2-1e9623a0a5b5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -7441,10 +7441,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293370515659000.6c1d15d4-dd5f-461b-b5ce-a6c5b64f63ad",
+      "fullUrl": "Organization/1729351692419523000.18f96c4a-8ad0-47d0-ac42-74a1fe475893",
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@@ -7459,10 +7459,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692420166000.43868496-0e04-47c6-9968-d46542c45514",
       "resource": {
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+        "id": "1729351692420166000.43868496-0e04-47c6-9968-d46542c45514",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7510,7 +7510,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370515659000.6c1d15d4-dd5f-461b-b5ce-a6c5b64f63ad"
+              "reference": "Organization/1729351692419523000.18f96c4a-8ad0-47d0-ac42-74a1fe475893"
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@@ -7526,10 +7526,10 @@
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+      "fullUrl": "Organization/1729351692421249000.922d2b4c-1ee5-4dfa-b17d-739d7186e713",
       "resource": {
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-        "id": "1729293370517391000.7c3b7c57-6614-4fad-ad03-aee9e44e5374",
+        "id": "1729351692421249000.922d2b4c-1ee5-4dfa-b17d-739d7186e713",
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@@ -7544,10 +7544,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293370517998000.1c81671f-8ad4-404c-bc9d-2a9ec8474018",
+      "fullUrl": "Practitioner/1729351692421846000.d5bcff35-a19d-45fb-99c0-a256e38193ca",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370517998000.1c81671f-8ad4-404c-bc9d-2a9ec8474018",
+        "id": "1729351692421846000.d5bcff35-a19d-45fb-99c0-a256e38193ca",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7595,7 +7595,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370517391000.7c3b7c57-6614-4fad-ad03-aee9e44e5374"
+              "reference": "Organization/1729351692421249000.922d2b4c-1ee5-4dfa-b17d-739d7186e713"
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@@ -7611,10 +7611,10 @@
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     {
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+      "fullUrl": "ServiceRequest/1729351692429662000.9d2fc68b-50cb-4900-86cc-585d9a718c45",
       "resource": {
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-        "id": "1729293370525986000.7677c5d9-97e1-4e5b-a3bc-96bb49dda547",
+        "id": "1729351692429662000.9d2fc68b-50cb-4900-86cc-585d9a718c45",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -7626,13 +7626,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370522227000.855413d7-444e-476e-a0dc-c949ed4e93f4"
+                  "reference": "Organization/1729351692425942000.60606cb3-e95e-423e-a7b5-6b219226373f"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370522890000.e33627aa-0e5c-40ad-a0b6-5479cf9edd9d"
+                  "reference": "Organization/1729351692426590000.b33af589-6db3-40e6-b44e-e5544f15ae65"
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@@ -7660,7 +7660,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370523920000.b90b834f-9e78-4a08-a725-f26768af2f0b"
+                  "reference": "Practitioner/1729351692427614000.24629bb8-2bb6-4044-87a9-5220aa3cd287"
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@@ -7788,7 +7788,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370525598000.bd2f67fd-0760-445d-bd77-bff82c10786b"
+                  "reference": "Practitioner/1729351692429278000.763d6dbd-e2f3-4cfe-98dc-98e3fc00334e"
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@@ -7870,18 +7870,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370518536000.27f22b6c-e3bc-4ea6-bafd-73be44d05eb3"
+          "reference": "PractitionerRole/1729351692422386000.520b10ab-0163-4b61-854c-f4d4f8f996ac"
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+      "fullUrl": "Organization/1729351692422548000.805e151c-cd3d-4994-b81b-9f569deb5bec",
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@@ -7896,10 +7896,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692423237000.4daac0c2-43a1-439b-a78f-1938a6657164",
       "resource": {
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+        "id": "1729351692423237000.4daac0c2-43a1-439b-a78f-1938a6657164",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -7951,7 +7951,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370518709000.cd6cde25-3f1b-4bd9-a7ca-bb6eefb82bfd"
+              "reference": "Organization/1729351692422548000.805e151c-cd3d-4994-b81b-9f569deb5bec"
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@@ -7967,10 +7967,10 @@
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+      "fullUrl": "Organization/1729351692424282000.7322633f-cafb-41b9-b615-145438a65ed2",
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+        "id": "1729351692424282000.7322633f-cafb-41b9-b615-145438a65ed2",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8058,23 +8058,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729293370518536000.27f22b6c-e3bc-4ea6-bafd-73be44d05eb3",
+      "fullUrl": "PractitionerRole/1729351692422386000.520b10ab-0163-4b61-854c-f4d4f8f996ac",
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+        "id": "1729351692422386000.520b10ab-0163-4b61-854c-f4d4f8f996ac",
         "practitioner": {
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+          "reference": "Practitioner/1729351692423237000.4daac0c2-43a1-439b-a78f-1938a6657164"
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+          "reference": "Organization/1729351692424282000.7322633f-cafb-41b9-b615-145438a65ed2"
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+      "fullUrl": "Organization/1729351692425942000.60606cb3-e95e-423e-a7b5-6b219226373f",
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-        "id": "1729293370522227000.855413d7-444e-476e-a0dc-c949ed4e93f4",
+        "id": "1729351692425942000.60606cb3-e95e-423e-a7b5-6b219226373f",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8150,10 +8150,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293370522890000.e33627aa-0e5c-40ad-a0b6-5479cf9edd9d",
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+        "id": "1729351692426590000.b33af589-6db3-40e6-b44e-e5544f15ae65",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8229,10 +8229,10 @@
       }
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@@ -8247,10 +8247,10 @@
       }
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-      "fullUrl": "Practitioner/1729293370523920000.b90b834f-9e78-4a08-a725-f26768af2f0b",
+      "fullUrl": "Practitioner/1729351692427614000.24629bb8-2bb6-4044-87a9-5220aa3cd287",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370523920000.b90b834f-9e78-4a08-a725-f26768af2f0b",
+        "id": "1729351692427614000.24629bb8-2bb6-4044-87a9-5220aa3cd287",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8298,7 +8298,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370523331000.d5a8648a-acee-40b2-8a5e-2a774895fc69"
+              "reference": "Organization/1729351692427024000.caa0253f-cdbf-4786-8d8f-50e63d244fc2"
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@@ -8314,10 +8314,10 @@
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+      "fullUrl": "Organization/1729351692428683000.43edcc13-7037-4ba2-8a2d-3c6368aff983",
       "resource": {
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-        "id": "1729293370524998000.ce092f5f-02b2-4cf0-80c6-ac344d6c1704",
+        "id": "1729351692428683000.43edcc13-7037-4ba2-8a2d-3c6368aff983",
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@@ -8332,10 +8332,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692429278000.763d6dbd-e2f3-4cfe-98dc-98e3fc00334e",
       "resource": {
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+        "id": "1729351692429278000.763d6dbd-e2f3-4cfe-98dc-98e3fc00334e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8383,7 +8383,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370524998000.ce092f5f-02b2-4cf0-80c6-ac344d6c1704"
+              "reference": "Organization/1729351692428683000.43edcc13-7037-4ba2-8a2d-3c6368aff983"
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@@ -8399,10 +8399,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729351692437084000.022bd0d3-59c5-4826-a784-c06500a2f3ff",
       "resource": {
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-        "id": "1729293370533546000.ce4cdcd2-29fd-41d9-8d95-efa07fca5aca",
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           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -8414,13 +8414,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370529740000.b9afa1b2-a896-4a73-87b2-3e16181a506a"
+                  "reference": "Organization/1729351692433332000.8a108ba9-080d-44d9-9870-993ea3ee36dd"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370530385000.a3a7df8e-d038-47be-963b-b045b70b8d24"
+                  "reference": "Organization/1729351692433972000.211a2cad-e9ad-42f4-a300-bcfc843945c6"
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@@ -8448,7 +8448,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370531448000.da555f25-8bb3-4c7e-887b-e7bda417a366"
+                  "reference": "Practitioner/1729351692435018000.cd5bdbda-f154-4c4e-8534-3f52d0d56180"
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@@ -8576,7 +8576,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370533137000.63d678d2-0d75-4fb2-a030-0db3a0c75e59"
+                  "reference": "Practitioner/1729351692436702000.1c49adf0-9039-40f9-9139-ca47360c2793"
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@@ -8658,18 +8658,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370526126000.e54bb504-19f0-400b-b72b-9305a9740c5b"
+          "reference": "PractitionerRole/1729351692429796000.756c20b6-5459-4299-8f88-44392acf268c"
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+      "fullUrl": "Organization/1729351692429956000.2e6ffaa1-006c-470d-852c-030cfadd09b0",
       "resource": {
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-        "id": "1729293370526294000.dec68d46-fb79-4a60-bdbe-4b1c4c21eb95",
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@@ -8684,10 +8684,10 @@
       }
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-      "fullUrl": "Practitioner/1729293370527013000.d3040ad5-3243-4892-88e8-55f8b4f61a18",
+      "fullUrl": "Practitioner/1729351692430657000.d29fdf30-6a61-49fa-bd2b-96bc5ea2505c",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370527013000.d3040ad5-3243-4892-88e8-55f8b4f61a18",
+        "id": "1729351692430657000.d29fdf30-6a61-49fa-bd2b-96bc5ea2505c",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -8739,7 +8739,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370526294000.dec68d46-fb79-4a60-bdbe-4b1c4c21eb95"
+              "reference": "Organization/1729351692429956000.2e6ffaa1-006c-470d-852c-030cfadd09b0"
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@@ -8755,10 +8755,10 @@
       }
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+      "fullUrl": "Organization/1729351692431668000.da49a27e-f546-4536-addd-b290364c0edd",
       "resource": {
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+        "id": "1729351692431668000.da49a27e-f546-4536-addd-b290364c0edd",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -8846,23 +8846,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293370526126000.e54bb504-19f0-400b-b72b-9305a9740c5b",
+      "fullUrl": "PractitionerRole/1729351692429796000.756c20b6-5459-4299-8f88-44392acf268c",
       "resource": {
         "resourceType": "PractitionerRole",
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+        "id": "1729351692429796000.756c20b6-5459-4299-8f88-44392acf268c",
         "practitioner": {
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+          "reference": "Practitioner/1729351692430657000.d29fdf30-6a61-49fa-bd2b-96bc5ea2505c"
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         "organization": {
-          "reference": "Organization/1729293370528086000.bedd1052-3ffd-4ce0-9179-928a304d1b07"
+          "reference": "Organization/1729351692431668000.da49a27e-f546-4536-addd-b290364c0edd"
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       "resource": {
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-        "id": "1729293370529740000.b9afa1b2-a896-4a73-87b2-3e16181a506a",
+        "id": "1729351692433332000.8a108ba9-080d-44d9-9870-993ea3ee36dd",
         "extension": [
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@@ -8938,10 +8938,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729351692433972000.211a2cad-e9ad-42f4-a300-bcfc843945c6",
       "resource": {
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-        "id": "1729293370530385000.a3a7df8e-d038-47be-963b-b045b70b8d24",
+        "id": "1729351692433972000.211a2cad-e9ad-42f4-a300-bcfc843945c6",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9017,10 +9017,10 @@
       }
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-      "fullUrl": "Organization/1729293370530857000.c44ed2d0-3fb2-4649-8c3e-c66ef69bf1d9",
+      "fullUrl": "Organization/1729351692434406000.13b9f9e3-4c95-4851-9f14-cf544c501ff4",
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@@ -9035,10 +9035,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692435018000.cd5bdbda-f154-4c4e-8534-3f52d0d56180",
       "resource": {
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-        "id": "1729293370531448000.da555f25-8bb3-4c7e-887b-e7bda417a366",
+        "id": "1729351692435018000.cd5bdbda-f154-4c4e-8534-3f52d0d56180",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9086,7 +9086,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370530857000.c44ed2d0-3fb2-4649-8c3e-c66ef69bf1d9"
+              "reference": "Organization/1729351692434406000.13b9f9e3-4c95-4851-9f14-cf544c501ff4"
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@@ -9102,10 +9102,10 @@
       }
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+      "fullUrl": "Organization/1729351692436113000.e588ffd9-e7e2-4855-a56d-215216847166",
       "resource": {
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-        "id": "1729293370532531000.dc611144-79ea-454a-b977-01dcc7edb432",
+        "id": "1729351692436113000.e588ffd9-e7e2-4855-a56d-215216847166",
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@@ -9120,10 +9120,10 @@
       }
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-      "fullUrl": "Practitioner/1729293370533137000.63d678d2-0d75-4fb2-a030-0db3a0c75e59",
+      "fullUrl": "Practitioner/1729351692436702000.1c49adf0-9039-40f9-9139-ca47360c2793",
       "resource": {
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-        "id": "1729293370533137000.63d678d2-0d75-4fb2-a030-0db3a0c75e59",
+        "id": "1729351692436702000.1c49adf0-9039-40f9-9139-ca47360c2793",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9171,7 +9171,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370532531000.dc611144-79ea-454a-b977-01dcc7edb432"
+              "reference": "Organization/1729351692436113000.e588ffd9-e7e2-4855-a56d-215216847166"
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@@ -9187,10 +9187,10 @@
       }
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     {
-      "fullUrl": "ServiceRequest/1729293370541304000.52dac68e-31e0-4467-a032-a880702141ee",
+      "fullUrl": "ServiceRequest/1729351692445516000.6396566f-ca10-4e30-8397-95757bb10dfa",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293370541304000.52dac68e-31e0-4467-a032-a880702141ee",
+        "id": "1729351692445516000.6396566f-ca10-4e30-8397-95757bb10dfa",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -9202,13 +9202,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370537522000.4af5319d-51fb-49de-962e-3e0a024c5e08"
+                  "reference": "Organization/1729351692441396000.073f4f68-9ce8-4bee-879f-4804dbc752f4"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370538193000.b8e648f5-0ba1-43af-8e2e-863140abbc3f"
+                  "reference": "Organization/1729351692442153000.1c41bb35-7833-4f61-bbe3-62e759366c22"
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               {
@@ -9236,7 +9236,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370539231000.3680d367-faac-4b60-a4bb-8cca68f80f6b"
+                  "reference": "Practitioner/1729351692443267000.bb63f9eb-771c-41d0-b0df-194ed909089b"
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@@ -9364,7 +9364,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370540911000.6e137b35-5571-4362-bbae-512092a98a94"
+                  "reference": "Practitioner/1729351692445101000.6f815bf0-85e6-46a8-9bab-e6979032bd64"
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@@ -9446,18 +9446,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293370533684000.128dda99-c3dc-49c6-abcd-c4a5d1b61b18"
+          "reference": "PractitionerRole/1729351692437217000.f14f44c0-1c0e-437b-b37c-9a355a968b38"
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     {
-      "fullUrl": "Organization/1729293370533852000.dca0289b-1f0e-4459-9865-0797a6974170",
+      "fullUrl": "Organization/1729351692437379000.73535cab-c3a1-49a0-beda-573aced36854",
       "resource": {
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-        "id": "1729293370533852000.dca0289b-1f0e-4459-9865-0797a6974170",
+        "id": "1729351692437379000.73535cab-c3a1-49a0-beda-573aced36854",
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@@ -9472,10 +9472,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692438226000.5d821a75-fd6d-4cba-a4f4-539ac653ba6d",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370534709000.61427778-d0e6-4e45-a5ea-caf223cd8f01",
+        "id": "1729351692438226000.5d821a75-fd6d-4cba-a4f4-539ac653ba6d",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9527,7 +9527,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370533852000.dca0289b-1f0e-4459-9865-0797a6974170"
+              "reference": "Organization/1729351692437379000.73535cab-c3a1-49a0-beda-573aced36854"
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@@ -9543,10 +9543,10 @@
       }
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-      "fullUrl": "Organization/1729293370535767000.f24f6b2f-369c-4734-98bf-d12c745a7088",
+      "fullUrl": "Organization/1729351692439437000.41b185b1-1ac4-45b5-a9b8-8d4eabb2d048",
       "resource": {
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-        "id": "1729293370535767000.f24f6b2f-369c-4734-98bf-d12c745a7088",
+        "id": "1729351692439437000.41b185b1-1ac4-45b5-a9b8-8d4eabb2d048",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9634,23 +9634,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729293370533684000.128dda99-c3dc-49c6-abcd-c4a5d1b61b18",
+      "fullUrl": "PractitionerRole/1729351692437217000.f14f44c0-1c0e-437b-b37c-9a355a968b38",
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+        "id": "1729351692437217000.f14f44c0-1c0e-437b-b37c-9a355a968b38",
         "practitioner": {
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+          "reference": "Practitioner/1729351692438226000.5d821a75-fd6d-4cba-a4f4-539ac653ba6d"
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-          "reference": "Organization/1729293370535767000.f24f6b2f-369c-4734-98bf-d12c745a7088"
+          "reference": "Organization/1729351692439437000.41b185b1-1ac4-45b5-a9b8-8d4eabb2d048"
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     {
-      "fullUrl": "Organization/1729293370537522000.4af5319d-51fb-49de-962e-3e0a024c5e08",
+      "fullUrl": "Organization/1729351692441396000.073f4f68-9ce8-4bee-879f-4804dbc752f4",
       "resource": {
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-        "id": "1729293370537522000.4af5319d-51fb-49de-962e-3e0a024c5e08",
+        "id": "1729351692441396000.073f4f68-9ce8-4bee-879f-4804dbc752f4",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9726,10 +9726,10 @@
       }
     },
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -9805,10 +9805,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370538636000.e546e04e-a869-479b-b0db-9c6e9c92d3a6",
+      "fullUrl": "Organization/1729351692442621000.a15aa813-dffc-482e-9010-ff021c4ba7d8",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370538636000.e546e04e-a869-479b-b0db-9c6e9c92d3a6",
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@@ -9823,10 +9823,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692443267000.bb63f9eb-771c-41d0-b0df-194ed909089b",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370539231000.3680d367-faac-4b60-a4bb-8cca68f80f6b",
+        "id": "1729351692443267000.bb63f9eb-771c-41d0-b0df-194ed909089b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9874,7 +9874,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370538636000.e546e04e-a869-479b-b0db-9c6e9c92d3a6"
+              "reference": "Organization/1729351692442621000.a15aa813-dffc-482e-9010-ff021c4ba7d8"
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@@ -9890,10 +9890,10 @@
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+      "fullUrl": "Organization/1729351692444437000.496f011f-ca2f-444e-bcda-c7959dd8449b",
       "resource": {
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-        "id": "1729293370540321000.a5be6f85-1231-4b0b-a5ac-7fe331956569",
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@@ -9908,10 +9908,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692445101000.6f815bf0-85e6-46a8-9bab-e6979032bd64",
       "resource": {
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-        "id": "1729293370540911000.6e137b35-5571-4362-bbae-512092a98a94",
+        "id": "1729351692445101000.6f815bf0-85e6-46a8-9bab-e6979032bd64",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -9959,7 +9959,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370540321000.a5be6f85-1231-4b0b-a5ac-7fe331956569"
+              "reference": "Organization/1729351692444437000.496f011f-ca2f-444e-bcda-c7959dd8449b"
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@@ -9975,10 +9975,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729351692453273000.bb54f821-9255-4bcd-a1f7-8ff31f92ee90",
       "resource": {
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-        "id": "1729293370548857000.04937421-45d1-496e-b708-795471ce6e07",
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -9990,13 +9990,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370545084000.df323123-0707-41a8-b8fb-cd27ba5f4c4a"
+                  "reference": "Organization/1729351692449522000.5023174b-0aec-455b-ab07-c06467d6f0ba"
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370545749000.c1f1c0b9-179d-4042-870f-09b610100064"
+                  "reference": "Organization/1729351692450186000.bf713f7c-c516-424a-9f07-b5543672b8c8"
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               {
@@ -10024,7 +10024,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370546783000.7dbcaba6-923f-426f-9e44-0610dc709ddc"
+                  "reference": "Practitioner/1729351692451209000.bb0ac022-1d31-48e4-9a8e-064d0a8c3d4e"
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@@ -10152,7 +10152,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
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+                  "reference": "Practitioner/1729351692452889000.085a97b5-2e13-4bdf-ad01-42d32379a793"
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@@ -10234,18 +10234,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370541442000.3c6545eb-7522-4e7c-9f75-286d4b5591ab"
+          "reference": "PractitionerRole/1729351692445659000.58d46215-be32-42dd-8c17-425bfdbfc656"
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+      "fullUrl": "Organization/1729351692445834000.ab069ef5-ea7b-4d83-a2db-f8569590d4e5",
       "resource": {
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-        "id": "1729293370541609000.62313409-ed6a-46f8-b229-f06a8ee3afb9",
+        "id": "1729351692445834000.ab069ef5-ea7b-4d83-a2db-f8569590d4e5",
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@@ -10260,10 +10260,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692446619000.d8cf22b7-f3d3-4ad5-9ef0-a6dd348d6b9a",
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -10315,7 +10315,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370541609000.62313409-ed6a-46f8-b229-f06a8ee3afb9"
+              "reference": "Organization/1729351692445834000.ab069ef5-ea7b-4d83-a2db-f8569590d4e5"
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@@ -10331,10 +10331,10 @@
       }
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+      "fullUrl": "Organization/1729351692447748000.83db6dc1-ebc1-4e02-9274-19544000ad71",
       "resource": {
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-        "id": "1729293370543381000.522c5ae9-8b84-44e9-b50c-efa624a42198",
+        "id": "1729351692447748000.83db6dc1-ebc1-4e02-9274-19544000ad71",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -10422,23 +10422,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293370541442000.3c6545eb-7522-4e7c-9f75-286d4b5591ab",
+      "fullUrl": "PractitionerRole/1729351692445659000.58d46215-be32-42dd-8c17-425bfdbfc656",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293370541442000.3c6545eb-7522-4e7c-9f75-286d4b5591ab",
+        "id": "1729351692445659000.58d46215-be32-42dd-8c17-425bfdbfc656",
         "practitioner": {
-          "reference": "Practitioner/1729293370542340000.8a695ff7-f503-41f0-8e2f-21c34c895f0f"
+          "reference": "Practitioner/1729351692446619000.d8cf22b7-f3d3-4ad5-9ef0-a6dd348d6b9a"
         },
         "organization": {
-          "reference": "Organization/1729293370543381000.522c5ae9-8b84-44e9-b50c-efa624a42198"
+          "reference": "Organization/1729351692447748000.83db6dc1-ebc1-4e02-9274-19544000ad71"
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     {
-      "fullUrl": "Organization/1729293370545084000.df323123-0707-41a8-b8fb-cd27ba5f4c4a",
+      "fullUrl": "Organization/1729351692449522000.5023174b-0aec-455b-ab07-c06467d6f0ba",
       "resource": {
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-        "id": "1729293370545084000.df323123-0707-41a8-b8fb-cd27ba5f4c4a",
+        "id": "1729351692449522000.5023174b-0aec-455b-ab07-c06467d6f0ba",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -10514,10 +10514,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370545749000.c1f1c0b9-179d-4042-870f-09b610100064",
+      "fullUrl": "Organization/1729351692450186000.bf713f7c-c516-424a-9f07-b5543672b8c8",
       "resource": {
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-        "id": "1729293370545749000.c1f1c0b9-179d-4042-870f-09b610100064",
+        "id": "1729351692450186000.bf713f7c-c516-424a-9f07-b5543672b8c8",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -10593,10 +10593,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370546199000.aca21840-6441-42ab-b802-671cb3553c3c",
+      "fullUrl": "Organization/1729351692450620000.ab7de672-7a61-4d30-8a3d-cf2101ef7b9d",
       "resource": {
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-        "id": "1729293370546199000.aca21840-6441-42ab-b802-671cb3553c3c",
+        "id": "1729351692450620000.ab7de672-7a61-4d30-8a3d-cf2101ef7b9d",
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@@ -10611,10 +10611,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293370546783000.7dbcaba6-923f-426f-9e44-0610dc709ddc",
+      "fullUrl": "Practitioner/1729351692451209000.bb0ac022-1d31-48e4-9a8e-064d0a8c3d4e",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370546783000.7dbcaba6-923f-426f-9e44-0610dc709ddc",
+        "id": "1729351692451209000.bb0ac022-1d31-48e4-9a8e-064d0a8c3d4e",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -10662,7 +10662,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370546199000.aca21840-6441-42ab-b802-671cb3553c3c"
+              "reference": "Organization/1729351692450620000.ab7de672-7a61-4d30-8a3d-cf2101ef7b9d"
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@@ -10678,10 +10678,10 @@
       }
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-      "fullUrl": "Organization/1729293370547870000.c1db8f1a-b0ab-488f-ac8d-7617a619aeae",
+      "fullUrl": "Organization/1729351692452298000.da90a056-432c-450e-95f1-90ec7ba0e1bc",
       "resource": {
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-        "id": "1729293370547870000.c1db8f1a-b0ab-488f-ac8d-7617a619aeae",
+        "id": "1729351692452298000.da90a056-432c-450e-95f1-90ec7ba0e1bc",
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@@ -10696,10 +10696,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293370548457000.e4cb45c6-e782-4111-ae84-5e8442263550",
+      "fullUrl": "Practitioner/1729351692452889000.085a97b5-2e13-4bdf-ad01-42d32379a793",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370548457000.e4cb45c6-e782-4111-ae84-5e8442263550",
+        "id": "1729351692452889000.085a97b5-2e13-4bdf-ad01-42d32379a793",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -10747,7 +10747,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370547870000.c1db8f1a-b0ab-488f-ac8d-7617a619aeae"
+              "reference": "Organization/1729351692452298000.da90a056-432c-450e-95f1-90ec7ba0e1bc"
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@@ -10763,10 +10763,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293370556418000.2b8ab7f1-edcb-42b5-9bfb-bea7e0e99164",
+      "fullUrl": "ServiceRequest/1729351692461366000.7b049d53-b94b-4810-a4ac-ab5c75f5a11b",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293370556418000.2b8ab7f1-edcb-42b5-9bfb-bea7e0e99164",
+        "id": "1729351692461366000.7b049d53-b94b-4810-a4ac-ab5c75f5a11b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -10778,13 +10778,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370552574000.cc71e62f-ecb9-4396-ba35-ec603b65b7f7"
+                  "reference": "Organization/1729351692457294000.fb5ac4e7-157c-416d-94f7-3b6f5d9e286b"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370553226000.a9a3b7c4-3081-4697-9b66-8c96167cbcfd"
+                  "reference": "Organization/1729351692458001000.d7a54ceb-19ea-4a11-9f04-a3156fa81dde"
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@@ -10812,7 +10812,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370554277000.4a8ce38c-7d5f-4976-b8bb-0d7071db7e51"
+                  "reference": "Practitioner/1729351692459114000.d955ab56-b637-4e1f-9893-d9d633de4da5"
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@@ -10940,7 +10940,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370556006000.4e694806-5563-4d56-be88-21baa1cc383a"
+                  "reference": "Practitioner/1729351692460918000.f351abe2-0909-4b5a-b753-fe28ded785f0"
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@@ -11022,18 +11022,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370548996000.a6a1e9e8-d0e2-4944-a507-188ff08d7ffa"
+          "reference": "PractitionerRole/1729351692453417000.ca7e777e-e00a-45d8-a88b-27580ceafda8"
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     {
-      "fullUrl": "Organization/1729293370549165000.5fdc8f3f-35f5-4f2d-86f7-3afff9344b13",
+      "fullUrl": "Organization/1729351692453593000.555cc3f0-59ee-4a1a-b29f-e511466a3f97",
       "resource": {
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+        "id": "1729351692453593000.555cc3f0-59ee-4a1a-b29f-e511466a3f97",
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@@ -11048,10 +11048,10 @@
       }
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-      "fullUrl": "Practitioner/1729293370549874000.3efe7bb1-a011-4fc9-b33f-a9e0e8fb7cbe",
+      "fullUrl": "Practitioner/1729351692454369000.0653a888-9871-46e5-a2b3-8f5124ea6210",
       "resource": {
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+        "id": "1729351692454369000.0653a888-9871-46e5-a2b3-8f5124ea6210",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11103,7 +11103,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370549165000.5fdc8f3f-35f5-4f2d-86f7-3afff9344b13"
+              "reference": "Organization/1729351692453593000.555cc3f0-59ee-4a1a-b29f-e511466a3f97"
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@@ -11119,10 +11119,10 @@
       }
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-      "fullUrl": "Organization/1729293370550904000.8f62c7ac-d26d-4cd8-a72f-e503940d6642",
+      "fullUrl": "Organization/1729351692455469000.eba75a92-8145-42ed-be80-f77a1f768a05",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370550904000.8f62c7ac-d26d-4cd8-a72f-e503940d6642",
+        "id": "1729351692455469000.eba75a92-8145-42ed-be80-f77a1f768a05",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11210,23 +11210,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293370548996000.a6a1e9e8-d0e2-4944-a507-188ff08d7ffa",
+      "fullUrl": "PractitionerRole/1729351692453417000.ca7e777e-e00a-45d8-a88b-27580ceafda8",
       "resource": {
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-        "id": "1729293370548996000.a6a1e9e8-d0e2-4944-a507-188ff08d7ffa",
+        "id": "1729351692453417000.ca7e777e-e00a-45d8-a88b-27580ceafda8",
         "practitioner": {
-          "reference": "Practitioner/1729293370549874000.3efe7bb1-a011-4fc9-b33f-a9e0e8fb7cbe"
+          "reference": "Practitioner/1729351692454369000.0653a888-9871-46e5-a2b3-8f5124ea6210"
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         "organization": {
-          "reference": "Organization/1729293370550904000.8f62c7ac-d26d-4cd8-a72f-e503940d6642"
+          "reference": "Organization/1729351692455469000.eba75a92-8145-42ed-be80-f77a1f768a05"
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+        "id": "1729351692457294000.fb5ac4e7-157c-416d-94f7-3b6f5d9e286b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11302,10 +11302,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370553226000.a9a3b7c4-3081-4697-9b66-8c96167cbcfd",
+      "fullUrl": "Organization/1729351692458001000.d7a54ceb-19ea-4a11-9f04-a3156fa81dde",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370553226000.a9a3b7c4-3081-4697-9b66-8c96167cbcfd",
+        "id": "1729351692458001000.d7a54ceb-19ea-4a11-9f04-a3156fa81dde",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11381,10 +11381,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370553680000.d8a581e3-56ef-48bc-a3b9-1cab419ac562",
+      "fullUrl": "Organization/1729351692458473000.fef234a4-9b0c-4a98-8105-e073c6db1b9f",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370553680000.d8a581e3-56ef-48bc-a3b9-1cab419ac562",
+        "id": "1729351692458473000.fef234a4-9b0c-4a98-8105-e073c6db1b9f",
         "identifier": [
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@@ -11399,10 +11399,10 @@
       }
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     {
-      "fullUrl": "Practitioner/1729293370554277000.4a8ce38c-7d5f-4976-b8bb-0d7071db7e51",
+      "fullUrl": "Practitioner/1729351692459114000.d955ab56-b637-4e1f-9893-d9d633de4da5",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370554277000.4a8ce38c-7d5f-4976-b8bb-0d7071db7e51",
+        "id": "1729351692459114000.d955ab56-b637-4e1f-9893-d9d633de4da5",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11450,7 +11450,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370553680000.d8a581e3-56ef-48bc-a3b9-1cab419ac562"
+              "reference": "Organization/1729351692458473000.fef234a4-9b0c-4a98-8105-e073c6db1b9f"
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@@ -11466,10 +11466,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729351692460292000.227ef3e8-0a5c-413d-9bf2-f7d1e4893eee",
       "resource": {
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-        "id": "1729293370555419000.9151ca57-b460-4ffb-b1f1-ba99cf40d885",
+        "id": "1729351692460292000.227ef3e8-0a5c-413d-9bf2-f7d1e4893eee",
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@@ -11484,10 +11484,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692460918000.f351abe2-0909-4b5a-b753-fe28ded785f0",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370556006000.4e694806-5563-4d56-be88-21baa1cc383a",
+        "id": "1729351692460918000.f351abe2-0909-4b5a-b753-fe28ded785f0",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11535,7 +11535,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370555419000.9151ca57-b460-4ffb-b1f1-ba99cf40d885"
+              "reference": "Organization/1729351692460292000.227ef3e8-0a5c-413d-9bf2-f7d1e4893eee"
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@@ -11551,10 +11551,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729351692469418000.61b68a99-69e4-466c-8b00-af2b9d4a91fc",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293370564974000.5e6ddab4-0233-4a21-91d8-2a8586c1c762",
+        "id": "1729351692469418000.61b68a99-69e4-466c-8b00-af2b9d4a91fc",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -11566,13 +11566,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370561029000.031d7ab2-acb1-403d-a265-2f31461143e3"
+                  "reference": "Organization/1729351692465338000.e5ec1648-5167-4431-9011-ec90d1f39da9"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370561746000.05132d5c-d80b-4b62-9949-ca574d0cb9c3"
+                  "reference": "Organization/1729351692466036000.3b6ebcc4-458e-47a8-98fa-34e0c56d5d54"
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               {
@@ -11600,7 +11600,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370562836000.7eda87a0-275a-41be-8ab4-11c3d848bc5d"
+                  "reference": "Practitioner/1729351692467152000.05fc9d60-43ba-43eb-abdb-e6afd4031e82"
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@@ -11728,7 +11728,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370564570000.37bd92af-ae1d-471d-a8c0-835cd1cef9e8"
+                  "reference": "Practitioner/1729351692468999000.924f99fc-44db-4fed-a4eb-e8099e47700b"
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@@ -11810,18 +11810,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293370556593000.d2c89c77-17c9-4f36-877f-013f7364a7e0"
+          "reference": "PractitionerRole/1729351692461508000.18d8761b-c126-4fb2-a7d8-da8257d4a1db"
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-      "fullUrl": "Organization/1729293370556815000.5fb3d2fb-c460-4e22-b8f2-2bbcff062b79",
+      "fullUrl": "Organization/1729351692461680000.dcf120f2-6e19-45ac-aed8-8ef9f6accc4d",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370556815000.5fb3d2fb-c460-4e22-b8f2-2bbcff062b79",
+        "id": "1729351692461680000.dcf120f2-6e19-45ac-aed8-8ef9f6accc4d",
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@@ -11836,10 +11836,10 @@
       }
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-      "fullUrl": "Practitioner/1729293370557761000.0306231a-ad35-4af2-98c9-1999d3c1f8a2",
+      "fullUrl": "Practitioner/1729351692462437000.e42f5f80-8183-4692-ae19-26756ee2c863",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370557761000.0306231a-ad35-4af2-98c9-1999d3c1f8a2",
+        "id": "1729351692462437000.e42f5f80-8183-4692-ae19-26756ee2c863",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -11891,7 +11891,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370556815000.5fb3d2fb-c460-4e22-b8f2-2bbcff062b79"
+              "reference": "Organization/1729351692461680000.dcf120f2-6e19-45ac-aed8-8ef9f6accc4d"
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@@ -11907,10 +11907,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729351692463549000.3090ed2b-6306-47fe-bf8a-c3f14b544d87",
       "resource": {
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-        "id": "1729293370559029000.345401c8-393d-4705-a178-ae1aa5cf2fe9",
+        "id": "1729351692463549000.3090ed2b-6306-47fe-bf8a-c3f14b544d87",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -11998,23 +11998,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293370556593000.d2c89c77-17c9-4f36-877f-013f7364a7e0",
+      "fullUrl": "PractitionerRole/1729351692461508000.18d8761b-c126-4fb2-a7d8-da8257d4a1db",
       "resource": {
         "resourceType": "PractitionerRole",
-        "id": "1729293370556593000.d2c89c77-17c9-4f36-877f-013f7364a7e0",
+        "id": "1729351692461508000.18d8761b-c126-4fb2-a7d8-da8257d4a1db",
         "practitioner": {
-          "reference": "Practitioner/1729293370557761000.0306231a-ad35-4af2-98c9-1999d3c1f8a2"
+          "reference": "Practitioner/1729351692462437000.e42f5f80-8183-4692-ae19-26756ee2c863"
         },
         "organization": {
-          "reference": "Organization/1729293370559029000.345401c8-393d-4705-a178-ae1aa5cf2fe9"
+          "reference": "Organization/1729351692463549000.3090ed2b-6306-47fe-bf8a-c3f14b544d87"
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     {
-      "fullUrl": "Organization/1729293370561029000.031d7ab2-acb1-403d-a265-2f31461143e3",
+      "fullUrl": "Organization/1729351692465338000.e5ec1648-5167-4431-9011-ec90d1f39da9",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370561029000.031d7ab2-acb1-403d-a265-2f31461143e3",
+        "id": "1729351692465338000.e5ec1648-5167-4431-9011-ec90d1f39da9",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12090,10 +12090,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370561746000.05132d5c-d80b-4b62-9949-ca574d0cb9c3",
+      "fullUrl": "Organization/1729351692466036000.3b6ebcc4-458e-47a8-98fa-34e0c56d5d54",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370561746000.05132d5c-d80b-4b62-9949-ca574d0cb9c3",
+        "id": "1729351692466036000.3b6ebcc4-458e-47a8-98fa-34e0c56d5d54",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12169,10 +12169,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370562216000.44f28bba-1f10-4a88-aaf5-3153c20edb07",
+      "fullUrl": "Organization/1729351692466507000.eb735866-9c90-4225-90aa-04a6acb66efe",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370562216000.44f28bba-1f10-4a88-aaf5-3153c20edb07",
+        "id": "1729351692466507000.eb735866-9c90-4225-90aa-04a6acb66efe",
         "identifier": [
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@@ -12187,10 +12187,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293370562836000.7eda87a0-275a-41be-8ab4-11c3d848bc5d",
+      "fullUrl": "Practitioner/1729351692467152000.05fc9d60-43ba-43eb-abdb-e6afd4031e82",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370562836000.7eda87a0-275a-41be-8ab4-11c3d848bc5d",
+        "id": "1729351692467152000.05fc9d60-43ba-43eb-abdb-e6afd4031e82",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12238,7 +12238,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370562216000.44f28bba-1f10-4a88-aaf5-3153c20edb07"
+              "reference": "Organization/1729351692466507000.eb735866-9c90-4225-90aa-04a6acb66efe"
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@@ -12254,10 +12254,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293370563972000.37e08b99-448f-4deb-b09d-e329ddd8bf94",
+      "fullUrl": "Organization/1729351692468351000.f2785e55-0485-447c-ab3c-bd04ef58b0b1",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370563972000.37e08b99-448f-4deb-b09d-e329ddd8bf94",
+        "id": "1729351692468351000.f2785e55-0485-447c-ab3c-bd04ef58b0b1",
         "identifier": [
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@@ -12272,10 +12272,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293370564570000.37bd92af-ae1d-471d-a8c0-835cd1cef9e8",
+      "fullUrl": "Practitioner/1729351692468999000.924f99fc-44db-4fed-a4eb-e8099e47700b",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370564570000.37bd92af-ae1d-471d-a8c0-835cd1cef9e8",
+        "id": "1729351692468999000.924f99fc-44db-4fed-a4eb-e8099e47700b",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12323,7 +12323,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370563972000.37e08b99-448f-4deb-b09d-e329ddd8bf94"
+              "reference": "Organization/1729351692468351000.f2785e55-0485-447c-ab3c-bd04ef58b0b1"
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@@ -12339,10 +12339,10 @@
       }
     },
     {
-      "fullUrl": "ServiceRequest/1729293370572799000.6eb041e2-9308-4af8-802a-7aa8313e7242",
+      "fullUrl": "ServiceRequest/1729351692477598000.70b2b6c6-00ba-475b-95ea-02e28bb20c99",
       "resource": {
         "resourceType": "ServiceRequest",
-        "id": "1729293370572799000.6eb041e2-9308-4af8-802a-7aa8313e7242",
+        "id": "1729351692477598000.70b2b6c6-00ba-475b-95ea-02e28bb20c99",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -12354,13 +12354,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370568837000.c23b7ba6-aacd-4327-b266-391d52da4c7e"
+                  "reference": "Organization/1729351692473452000.1d5038a5-e40d-4357-aea0-6e88eb3a7902"
                 }
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               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370569639000.1dbe5d9f-f11a-43a7-a3ad-940b98808a90"
+                  "reference": "Organization/1729351692474163000.89cd0d88-dec0-4409-a82c-365208f65145"
                 }
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               {
@@ -12388,7 +12388,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370570704000.80f1a9f8-b14e-4a91-8d0f-d6023ed3cd01"
+                  "reference": "Practitioner/1729351692475310000.2ce2b8ea-a61c-48af-b848-b0731f2e3b9b"
                 }
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@@ -12516,7 +12516,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370572411000.f9917c46-dcb3-4913-8abd-1358e73aeb02"
+                  "reference": "Practitioner/1729351692477184000.d7e80073-eb92-4520-8d90-6af17f8acccb"
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@@ -12598,18 +12598,18 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "requester": {
-          "reference": "PractitionerRole/1729293370565116000.5095d6d6-89e7-45f1-94e9-b0cc63b7c3fa"
+          "reference": "PractitionerRole/1729351692469579000.15f735f5-22e6-4f39-887d-c07dc14df39d"
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       }
     },
     {
-      "fullUrl": "Organization/1729293370565283000.f92ca226-9778-4051-ae95-42d854c58320",
+      "fullUrl": "Organization/1729351692469756000.b4fef0a6-fc0e-4449-8ae9-ce32cca3f648",
       "resource": {
         "resourceType": "Organization",
-        "id": "1729293370565283000.f92ca226-9778-4051-ae95-42d854c58320",
+        "id": "1729351692469756000.b4fef0a6-fc0e-4449-8ae9-ce32cca3f648",
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@@ -12624,10 +12624,10 @@
       }
     },
     {
-      "fullUrl": "Practitioner/1729293370565994000.e6e5cc89-54cd-45ff-944e-f299fcc1cf74",
+      "fullUrl": "Practitioner/1729351692470521000.1fc8ceeb-858c-42eb-aa48-a45c08f0cdf1",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370565994000.e6e5cc89-54cd-45ff-944e-f299fcc1cf74",
+        "id": "1729351692470521000.1fc8ceeb-858c-42eb-aa48-a45c08f0cdf1",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -12679,7 +12679,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370565283000.f92ca226-9778-4051-ae95-42d854c58320"
+              "reference": "Organization/1729351692469756000.b4fef0a6-fc0e-4449-8ae9-ce32cca3f648"
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@@ -12695,10 +12695,10 @@
       }
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     {
-      "fullUrl": "Organization/1729293370567007000.36f93bad-a041-4632-bdaf-dcaf0eabeb88",
+      "fullUrl": "Organization/1729351692471629000.3b293395-4c8e-40ed-9825-4e623d0c6683",
       "resource": {
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-        "id": "1729293370567007000.36f93bad-a041-4632-bdaf-dcaf0eabeb88",
+        "id": "1729351692471629000.3b293395-4c8e-40ed-9825-4e623d0c6683",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12786,23 +12786,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293370565116000.5095d6d6-89e7-45f1-94e9-b0cc63b7c3fa",
+      "fullUrl": "PractitionerRole/1729351692469579000.15f735f5-22e6-4f39-887d-c07dc14df39d",
       "resource": {
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-        "id": "1729293370565116000.5095d6d6-89e7-45f1-94e9-b0cc63b7c3fa",
+        "id": "1729351692469579000.15f735f5-22e6-4f39-887d-c07dc14df39d",
         "practitioner": {
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+          "reference": "Practitioner/1729351692470521000.1fc8ceeb-858c-42eb-aa48-a45c08f0cdf1"
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         "organization": {
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+          "reference": "Organization/1729351692471629000.3b293395-4c8e-40ed-9825-4e623d0c6683"
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+      "fullUrl": "Organization/1729351692473452000.1d5038a5-e40d-4357-aea0-6e88eb3a7902",
       "resource": {
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-        "id": "1729293370568837000.c23b7ba6-aacd-4327-b266-391d52da4c7e",
+        "id": "1729351692473452000.1d5038a5-e40d-4357-aea0-6e88eb3a7902",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12878,10 +12878,10 @@
       }
     },
     {
-      "fullUrl": "Organization/1729293370569639000.1dbe5d9f-f11a-43a7-a3ad-940b98808a90",
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+        "id": "1729351692474163000.89cd0d88-dec0-4409-a82c-365208f65145",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -12957,10 +12957,10 @@
       }
     },
     {
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+        "id": "1729351692474642000.fa524655-5e8f-47b3-aba1-2ba12009c91e",
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@@ -12975,10 +12975,10 @@
       }
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     {
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+      "fullUrl": "Practitioner/1729351692475310000.2ce2b8ea-a61c-48af-b848-b0731f2e3b9b",
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         "extension": [
           {
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@@ -13026,7 +13026,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370570118000.a345606c-c5ba-4f93-8cc4-c30b2fd4f766"
+              "reference": "Organization/1729351692474642000.fa524655-5e8f-47b3-aba1-2ba12009c91e"
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@@ -13042,10 +13042,10 @@
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@@ -13060,10 +13060,10 @@
       }
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       "resource": {
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-        "id": "1729293370572411000.f9917c46-dcb3-4913-8abd-1358e73aeb02",
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         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -13111,7 +13111,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370571819000.f75bedf3-872f-4637-9553-22d2458a4187"
+              "reference": "Organization/1729351692476529000.2948c1c8-ef3f-4fad-8c40-77aabc00c4f0"
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@@ -13127,10 +13127,10 @@
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       "resource": {
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+        "id": "1729351692485670000.3d9376ac-a290-4119-b113-e0ae49320178",
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -13142,13 +13142,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370576576000.8193f176-dad4-4696-b153-92a8eac042d2"
+                  "reference": "Organization/1729351692481519000.f3c8adeb-dbb3-4790-9fd6-3ee010379b45"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370577221000.3b5bf30f-100c-4361-b220-cdc9ce0bdcdd"
+                  "reference": "Organization/1729351692482262000.f57244d4-ac08-4978-b5fb-42e66cb7849a"
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@@ -13176,7 +13176,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370578245000.3b25a13d-9158-4dcc-a9df-79e81b401795"
+                  "reference": "Practitioner/1729351692483401000.72866769-9dc7-46b9-b69a-3867beb19ac3"
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@@ -13304,7 +13304,7 @@
               {
                 "url": "OBR.16",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370579906000.f06d9073-7782-4810-9a86-e72d7e94f806"
+                  "reference": "Practitioner/1729351692485261000.657389b4-16eb-46b5-9f3d-f2f368943d67"
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@@ -13386,18 +13386,18 @@
           ]
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370572944000.c49009f0-5e20-4492-abac-95eac1fc4606"
+          "reference": "PractitionerRole/1729351692477743000.b873a7fe-4f63-4041-b4ea-cd9105090e69"
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+      "fullUrl": "Organization/1729351692477916000.6f4927ff-81ec-4069-870a-9fe92ba469ec",
       "resource": {
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-        "id": "1729293370573109000.5ff1ace1-805f-41a9-bd94-3ef2f972cffb",
+        "id": "1729351692477916000.6f4927ff-81ec-4069-870a-9fe92ba469ec",
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@@ -13412,10 +13412,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692478687000.7c7cc05d-2265-401b-8fa2-31f77678bdd3",
       "resource": {
         "resourceType": "Practitioner",
-        "id": "1729293370573828000.cc741e05-cdc4-4c27-a5c4-78fb45afc672",
+        "id": "1729351692478687000.7c7cc05d-2265-401b-8fa2-31f77678bdd3",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -13467,7 +13467,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370573109000.5ff1ace1-805f-41a9-bd94-3ef2f972cffb"
+              "reference": "Organization/1729351692477916000.6f4927ff-81ec-4069-870a-9fe92ba469ec"
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@@ -13483,10 +13483,10 @@
       }
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+      "fullUrl": "Organization/1729351692479754000.f2de98e5-c8c6-430f-ad25-403c5aefb447",
       "resource": {
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+        "id": "1729351692479754000.f2de98e5-c8c6-430f-ad25-403c5aefb447",
         "extension": [
           {
             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -13574,23 +13574,23 @@
       }
     },
     {
-      "fullUrl": "PractitionerRole/1729293370572944000.c49009f0-5e20-4492-abac-95eac1fc4606",
+      "fullUrl": "PractitionerRole/1729351692477743000.b873a7fe-4f63-4041-b4ea-cd9105090e69",
       "resource": {
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-        "id": "1729293370572944000.c49009f0-5e20-4492-abac-95eac1fc4606",
+        "id": "1729351692477743000.b873a7fe-4f63-4041-b4ea-cd9105090e69",
         "practitioner": {
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+          "reference": "Practitioner/1729351692478687000.7c7cc05d-2265-401b-8fa2-31f77678bdd3"
         },
         "organization": {
-          "reference": "Organization/1729293370574884000.4d9338dc-239b-4ef0-acbb-c65a994ed7ea"
+          "reference": "Organization/1729351692479754000.f2de98e5-c8c6-430f-ad25-403c5aefb447"
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-      "fullUrl": "Organization/1729293370576576000.8193f176-dad4-4696-b153-92a8eac042d2",
+      "fullUrl": "Organization/1729351692481519000.f3c8adeb-dbb3-4790-9fd6-3ee010379b45",
       "resource": {
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-        "id": "1729293370576576000.8193f176-dad4-4696-b153-92a8eac042d2",
+        "id": "1729351692481519000.f3c8adeb-dbb3-4790-9fd6-3ee010379b45",
         "extension": [
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@@ -13666,10 +13666,10 @@
       }
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     {
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+      "fullUrl": "Organization/1729351692482262000.f57244d4-ac08-4978-b5fb-42e66cb7849a",
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-        "id": "1729293370577221000.3b5bf30f-100c-4361-b220-cdc9ce0bdcdd",
+        "id": "1729351692482262000.f57244d4-ac08-4978-b5fb-42e66cb7849a",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -13745,10 +13745,10 @@
       }
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@@ -13763,10 +13763,10 @@
       }
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-      "fullUrl": "Practitioner/1729293370578245000.3b25a13d-9158-4dcc-a9df-79e81b401795",
+      "fullUrl": "Practitioner/1729351692483401000.72866769-9dc7-46b9-b69a-3867beb19ac3",
       "resource": {
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-        "id": "1729293370578245000.3b25a13d-9158-4dcc-a9df-79e81b401795",
+        "id": "1729351692483401000.72866769-9dc7-46b9-b69a-3867beb19ac3",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/assigning-authority",
@@ -13814,7 +13814,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370577657000.558b9ff2-3bec-43d0-8cff-f7f41091247c"
+              "reference": "Organization/1729351692482747000.02bc0a62-5125-4089-a48b-1e8af090f27f"
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@@ -13830,10 +13830,10 @@
       }
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+      "fullUrl": "Organization/1729351692484625000.0e9708df-b8cd-4b82-9b9a-b23787f82ba9",
       "resource": {
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-        "id": "1729293370579324000.d274ea32-a936-4ede-96ad-b3020794c161",
+        "id": "1729351692484625000.0e9708df-b8cd-4b82-9b9a-b23787f82ba9",
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@@ -13848,10 +13848,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692485261000.657389b4-16eb-46b5-9f3d-f2f368943d67",
       "resource": {
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+        "id": "1729351692485261000.657389b4-16eb-46b5-9f3d-f2f368943d67",
         "extension": [
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@@ -13899,7 +13899,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370579324000.d274ea32-a936-4ede-96ad-b3020794c161"
+              "reference": "Organization/1729351692484625000.0e9708df-b8cd-4b82-9b9a-b23787f82ba9"
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@@ -13915,10 +13915,10 @@
       }
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+      "fullUrl": "ServiceRequest/1729351692493917000.57135fcb-c7d8-482c-894b-7727631ba28c",
       "resource": {
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-        "id": "1729293370587797000.425ee6b5-e004-46d8-92de-ad755105ad93",
+        "id": "1729351692493917000.57135fcb-c7d8-482c-894b-7727631ba28c",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/business-event",
@@ -13930,13 +13930,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370584032000.81bed709-808f-49b6-b6ce-60619f799b11"
+                  "reference": "Organization/1729351692489669000.eefc32f0-366d-42ae-af08-1f9504660014"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370584679000.01f34ead-b268-4ba7-a86c-b942ae8b3f1b"
+                  "reference": "Organization/1729351692490375000.ae04f35d-4f68-44b2-b641-37d96f2c3a28"
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@@ -13964,7 +13964,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370585700000.1ed6d50f-448e-48a8-9219-e57b0f44b002"
+                  "reference": "Practitioner/1729351692491536000.8de4e8aa-a958-44b1-b1b6-280b7de81864"
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@@ -14092,7 +14092,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370587398000.3a929ebb-4ee8-4be9-a5fa-a78d112c427c"
+                  "reference": "Practitioner/1729351692493494000.929e016b-b37c-425c-a6fe-d97076f3bc3a"
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@@ -14174,18 +14174,18 @@
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         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370580428000.4be89470-e7a5-4d2c-9550-e1720e579e37"
+          "reference": "PractitionerRole/1729351692485814000.e25c0c38-8a7a-4e5f-a9c3-3dc34fa4d406"
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+      "fullUrl": "Organization/1729351692485991000.af9ba61f-73f0-42eb-bc5a-a2b0db5d9eeb",
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@@ -14200,10 +14200,10 @@
       }
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         "extension": [
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@@ -14255,7 +14255,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370580595000.0825267c-93b6-47fc-a254-1531a750a522"
+              "reference": "Organization/1729351692485991000.af9ba61f-73f0-42eb-bc5a-a2b0db5d9eeb"
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@@ -14271,10 +14271,10 @@
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@@ -14362,23 +14362,23 @@
       }
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         "practitioner": {
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+          "reference": "Practitioner/1729351692486801000.c8ed5b88-9cbe-48dc-8d1c-74910f8d62ee"
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+          "reference": "Organization/1729351692487888000.396707e8-3f4f-42b6-9963-eec251cceba2"
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+      "fullUrl": "Organization/1729351692489669000.eefc32f0-366d-42ae-af08-1f9504660014",
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+        "id": "1729351692489669000.eefc32f0-366d-42ae-af08-1f9504660014",
         "extension": [
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@@ -14454,10 +14454,10 @@
       }
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+      "fullUrl": "Organization/1729351692490375000.ae04f35d-4f68-44b2-b641-37d96f2c3a28",
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@@ -14533,10 +14533,10 @@
       }
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@@ -14551,10 +14551,10 @@
       }
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@@ -14602,7 +14602,7 @@
             },
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             "assigner": {
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@@ -14618,10 +14618,10 @@
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@@ -14636,10 +14636,10 @@
       }
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@@ -14687,7 +14687,7 @@
             },
             "value": "1174911127",
             "assigner": {
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+              "reference": "Organization/1729351692492839000.53af801c-f450-4be9-9b7f-b7f5f946ec4b"
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@@ -14703,10 +14703,10 @@
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@@ -14718,13 +14718,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370591542000.b5ceac70-3427-4026-9ee8-be5f37f13560"
+                  "reference": "Organization/1729351692497931000.f74f5f46-59ff-4bd2-86f6-b72273c474f9"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
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@@ -14752,7 +14752,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370593208000.67d1601a-cb2d-4319-a5a9-c4bf52fc79bb"
+                  "reference": "Practitioner/1729351692499781000.bd15592d-4548-4ace-b4ab-db5c4cdbc4cd"
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@@ -14880,7 +14880,7 @@
               {
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                 "valueReference": {
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@@ -14962,18 +14962,18 @@
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+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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+          "reference": "PractitionerRole/1729351692494063000.4499a23c-0712-48d5-86b5-cd2671f7b439"
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@@ -14988,10 +14988,10 @@
       }
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         "extension": [
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@@ -15043,7 +15043,7 @@
             },
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             "assigner": {
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+              "reference": "Organization/1729351692494239000.1a744983-cc94-48c5-a949-abf1cb63214b"
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@@ -15059,10 +15059,10 @@
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         "extension": [
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@@ -15150,23 +15150,23 @@
       }
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     {
-      "fullUrl": "PractitionerRole/1729293370587938000.21163b40-26bb-4de5-af7b-47fec8df54d8",
+      "fullUrl": "PractitionerRole/1729351692494063000.4499a23c-0712-48d5-86b5-cd2671f7b439",
       "resource": {
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-        "id": "1729293370587938000.21163b40-26bb-4de5-af7b-47fec8df54d8",
+        "id": "1729351692494063000.4499a23c-0712-48d5-86b5-cd2671f7b439",
         "practitioner": {
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+          "reference": "Practitioner/1729351692495040000.6d28e1a1-49f3-4389-a26e-41aba9e6a286"
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-          "reference": "Organization/1729293370589855000.feac9a76-e0fe-4429-98cd-b21e87fc93dd"
+          "reference": "Organization/1729351692496147000.234a5797-af41-4dec-b8f7-dc1afcd70e5c"
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         "extension": [
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@@ -15242,10 +15242,10 @@
       }
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+      "fullUrl": "Organization/1729351692498666000.edacc0d6-56a1-4bff-96a2-4dfc2748d8f0",
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+        "id": "1729351692498666000.edacc0d6-56a1-4bff-96a2-4dfc2748d8f0",
         "extension": [
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             "url": "https://reportstream.cdc.gov/fhir/StructureDefinition/organization-name-type",
@@ -15321,10 +15321,10 @@
       }
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@@ -15339,10 +15339,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692499781000.bd15592d-4548-4ace-b4ab-db5c4cdbc4cd",
       "resource": {
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-        "id": "1729293370593208000.67d1601a-cb2d-4319-a5a9-c4bf52fc79bb",
+        "id": "1729351692499781000.bd15592d-4548-4ace-b4ab-db5c4cdbc4cd",
         "extension": [
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@@ -15390,7 +15390,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370592625000.375b198c-a27f-4d4c-9825-54152cdbb41e"
+              "reference": "Organization/1729351692499141000.d448eab6-057a-4e28-a75e-486d8e10cb19"
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@@ -15406,10 +15406,10 @@
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-        "id": "1729293370594284000.f80e7ca1-4082-416a-be7c-0c8221e9f109",
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@@ -15424,10 +15424,10 @@
       }
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+      "fullUrl": "Practitioner/1729351692501624000.7811c823-129f-4ff3-966e-02981dab05ab",
       "resource": {
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+        "id": "1729351692501624000.7811c823-129f-4ff3-966e-02981dab05ab",
         "extension": [
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@@ -15475,7 +15475,7 @@
             },
             "value": "1174911127",
             "assigner": {
-              "reference": "Organization/1729293370594284000.f80e7ca1-4082-416a-be7c-0c8221e9f109"
+              "reference": "Organization/1729351692500975000.a3993380-6e9d-4628-b517-1f26bf68043b"
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@@ -15491,10 +15491,10 @@
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+      "fullUrl": "ServiceRequest/1729351692510161000.211c650f-18df-42df-81e5-b2f9cb23f231",
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+        "id": "1729351692510161000.211c650f-18df-42df-81e5-b2f9cb23f231",
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@@ -15506,13 +15506,13 @@
               {
                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370599050000.b547f929-2c81-4d13-a754-b65bac1fed7b"
+                  "reference": "Organization/1729351692506101000.eed9e64f-75f4-49b8-baa9-eb950ea801e9"
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                 "url": "orc-21-ordering-facility-name",
                 "valueReference": {
-                  "reference": "Organization/1729293370599713000.53e3caaf-5843-458a-948b-deaf747f9f35"
+                  "reference": "Organization/1729351692506804000.7d59a19e-2765-42de-a3e2-fb0b62a864c5"
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@@ -15540,7 +15540,7 @@
               {
                 "url": "orc-12-ordering-provider",
                 "valueReference": {
-                  "reference": "Practitioner/1729293370600758000.bf9d3871-9ace-420d-b6a7-3a07e489ad21"
+                  "reference": "Practitioner/1729351692507920000.aa893045-0b4a-438d-9090-4e92cc0ab82e"
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@@ -15668,7 +15668,7 @@
               {
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                 "valueReference": {
-                  "reference": "Practitioner/1729293370602456000.2b31b855-1503-4b4a-ac7d-fc47e6e2b496"
+                  "reference": "Practitioner/1729351692509727000.73d7e4d7-27bc-4259-b110-77e1caebaef9"
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@@ -15750,18 +15750,18 @@
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+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
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         "requester": {
-          "reference": "PractitionerRole/1729293370595413000.4d565bd7-a7ba-4207-bcdc-6bf1c4f8450f"
+          "reference": "PractitionerRole/1729351692502228000.35f1a38d-0219-4e2b-92d5-fb9c51251c14"
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@@ -15776,10 +15776,10 @@
       }
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         "extension": [
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@@ -15831,7 +15831,7 @@
             },
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             "assigner": {
-              "reference": "Organization/1729293370595579000.5b9805ad-081c-4ec8-bc8d-8281ed3a74eb"
+              "reference": "Organization/1729351692502413000.cd95983c-d3c4-4b54-9017-d37084f6a6f1"
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@@ -15847,10 +15847,10 @@
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           {
-            "reference": "ServiceRequest/1729293370541304000.52dac68e-31e0-4467-a032-a880702141ee"
+            "reference": "ServiceRequest/1729351692445516000.6396566f-ca10-4e30-8397-95757bb10dfa"
           }
         ],
         "status": "final",
@@ -16975,7 +16975,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -16997,21 +16997,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370493808000.759270a9-f2c6-4461-b80d-a56a12f78f34"
+            "reference": "Specimen/1729351692397971000.466b1708-c7ea-4c56-8c6d-70b261e3a12b"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370473178000.c551838e-f44d-41f3-a1bf-695e62edb97f"
+            "reference": "Observation/1729351692378121000.31df9de0-521d-4593-8878-2730c2109775"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370616153000.57d4b495-761c-44ca-80d3-9cbb63c94150",
+      "fullUrl": "DiagnosticReport/1729351692523603000.eaab5d6b-0fdf-449d-8d62-aa13d170439a",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370616153000.57d4b495-761c-44ca-80d3-9cbb63c94150",
+        "id": "1729351692523603000.eaab5d6b-0fdf-449d-8d62-aa13d170439a",
         "identifier": [
           {
             "extension": [
@@ -17064,7 +17064,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370548857000.04937421-45d1-496e-b708-795471ce6e07"
+            "reference": "ServiceRequest/1729351692453273000.bb54f821-9255-4bcd-a1f7-8ff31f92ee90"
           }
         ],
         "status": "final",
@@ -17088,7 +17088,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17110,21 +17110,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370494093000.38947b94-7854-4248-98a4-3642dbab1c1f"
+            "reference": "Specimen/1729351692398283000.aab9bede-7c39-4648-9fcf-be88c442b11c"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370475074000.4d737378-3204-4477-a1c0-9f49951a78b0"
+            "reference": "Observation/1729351692380048000.203d4c74-8f4f-4fb8-afc4-e7c8c4f3a24a"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370617300000.e2532e84-fc25-4c89-ace7-afc9c9b01798",
+      "fullUrl": "DiagnosticReport/1729351692524862000.b6d0cb07-bf76-42c0-8e47-2e3c43c53b3c",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370617300000.e2532e84-fc25-4c89-ace7-afc9c9b01798",
+        "id": "1729351692524862000.b6d0cb07-bf76-42c0-8e47-2e3c43c53b3c",
         "identifier": [
           {
             "extension": [
@@ -17177,7 +17177,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370556418000.2b8ab7f1-edcb-42b5-9bfb-bea7e0e99164"
+            "reference": "ServiceRequest/1729351692461366000.7b049d53-b94b-4810-a4ac-ab5c75f5a11b"
           }
         ],
         "status": "final",
@@ -17201,7 +17201,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17223,21 +17223,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370494382000.22ef33ac-d8a7-4949-91ba-4c76fae21002"
+            "reference": "Specimen/1729351692398601000.9505d189-a271-4cfc-81e2-2bb6381308d1"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370476825000.150574b5-5316-460c-851d-ac03733a15a6"
+            "reference": "Observation/1729351692381991000.b64a1344-51a5-46be-9c49-a13579bfe9f4"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370618478000.4ee45569-9901-475d-8741-2ce987dd2d1b",
+      "fullUrl": "DiagnosticReport/1729351692526139000.eeaa8b26-7d1c-498b-ad2c-a4e12ebdb406",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370618478000.4ee45569-9901-475d-8741-2ce987dd2d1b",
+        "id": "1729351692526139000.eeaa8b26-7d1c-498b-ad2c-a4e12ebdb406",
         "identifier": [
           {
             "extension": [
@@ -17290,7 +17290,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370564974000.5e6ddab4-0233-4a21-91d8-2a8586c1c762"
+            "reference": "ServiceRequest/1729351692469418000.61b68a99-69e4-466c-8b00-af2b9d4a91fc"
           }
         ],
         "status": "final",
@@ -17314,7 +17314,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17336,21 +17336,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370494667000.84ac72eb-9bae-43d1-9a36-2d111ca86c7f"
+            "reference": "Specimen/1729351692398916000.5a648094-217a-4c7c-9c27-d773e1ca3b60"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370478735000.e62680ee-0ad6-46ff-89ee-1a10d1252117"
+            "reference": "Observation/1729351692383839000.fa86e287-a0a5-471f-a7df-cc9fc25517a9"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370619626000.8309ea4d-77ba-4fa2-b92d-2a785d98adc4",
+      "fullUrl": "DiagnosticReport/1729351692527397000.0d2f4e8e-2403-4221-90cf-9070bfe0243e",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370619626000.8309ea4d-77ba-4fa2-b92d-2a785d98adc4",
+        "id": "1729351692527397000.0d2f4e8e-2403-4221-90cf-9070bfe0243e",
         "identifier": [
           {
             "extension": [
@@ -17403,7 +17403,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370572799000.6eb041e2-9308-4af8-802a-7aa8313e7242"
+            "reference": "ServiceRequest/1729351692477598000.70b2b6c6-00ba-475b-95ea-02e28bb20c99"
           }
         ],
         "status": "final",
@@ -17427,7 +17427,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17449,21 +17449,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370494951000.050c1d45-e9d1-43fe-8fb8-a0d3a07e74c3"
+            "reference": "Specimen/1729351692399228000.95bfbb88-5dbe-413a-87fc-1370862eb764"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370480511000.3abe31cd-2773-41a7-a16c-dd932c1c77a6"
+            "reference": "Observation/1729351692385665000.84fce307-881e-4850-9bd0-e4e29282dbe3"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370620804000.2ed130be-bc00-4177-9b8c-0f1f11f857e3",
+      "fullUrl": "DiagnosticReport/1729351692528664000.335fc139-6b85-4c60-80e4-c6beb2ac6854",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370620804000.2ed130be-bc00-4177-9b8c-0f1f11f857e3",
+        "id": "1729351692528664000.335fc139-6b85-4c60-80e4-c6beb2ac6854",
         "identifier": [
           {
             "extension": [
@@ -17516,7 +17516,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370580291000.8a89fbe6-9348-4d68-96b2-a65b4436fc3c"
+            "reference": "ServiceRequest/1729351692485670000.3d9376ac-a290-4119-b113-e0ae49320178"
           }
         ],
         "status": "final",
@@ -17540,7 +17540,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17562,21 +17562,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370495240000.cefdfb55-4bb1-4f2b-ae3c-069776553ff0"
+            "reference": "Specimen/1729351692399539000.a92a8b30-7e25-40c3-a708-bddfae3466c6"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370482296000.594d0b98-a064-45c1-8144-d1562a0aa7b9"
+            "reference": "Observation/1729351692387506000.d2276846-5f39-4baa-8a8a-635d8ef87a54"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370622057000.73367673-7ca0-4e22-9f0c-71f78d3c7fb6",
+      "fullUrl": "DiagnosticReport/1729351692529940000.20984749-55b1-421f-8b11-5df540a84fc1",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370622057000.73367673-7ca0-4e22-9f0c-71f78d3c7fb6",
+        "id": "1729351692529940000.20984749-55b1-421f-8b11-5df540a84fc1",
         "identifier": [
           {
             "extension": [
@@ -17629,7 +17629,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370587797000.425ee6b5-e004-46d8-92de-ad755105ad93"
+            "reference": "ServiceRequest/1729351692493917000.57135fcb-c7d8-482c-894b-7727631ba28c"
           }
         ],
         "status": "final",
@@ -17653,7 +17653,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17675,21 +17675,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370495546000.a18176fd-a0f2-4208-b069-8528a7e43b4c"
+            "reference": "Specimen/1729351692399845000.6edb6c38-2001-400e-8c89-20592452db40"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370484238000.56ac1fa7-f887-4def-85a5-7635a20a88f5"
+            "reference": "Observation/1729351692389324000.068ebed0-c4b5-44e9-a3df-ea4c5f228fbb"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370623399000.c885ba78-ff58-43d8-9f06-25b96a13080f",
+      "fullUrl": "DiagnosticReport/1729351692531206000.21b6027d-0ebc-4d08-b450-c868adff8ea7",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370623399000.c885ba78-ff58-43d8-9f06-25b96a13080f",
+        "id": "1729351692531206000.21b6027d-0ebc-4d08-b450-c868adff8ea7",
         "identifier": [
           {
             "extension": [
@@ -17742,7 +17742,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370595276000.794fef48-a04d-45af-9312-ced460d80e08"
+            "reference": "ServiceRequest/1729351692502056000.0842a79c-f523-44ae-bfed-a4059fa59261"
           }
         ],
         "status": "final",
@@ -17766,7 +17766,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17788,21 +17788,21 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370495842000.c7875c4c-37ca-435e-aa27-ad0bfec02dd6"
+            "reference": "Specimen/1729351692400161000.23759efe-ff41-47ee-ba14-9fa629c9b584"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370486076000.7ef8b361-acf0-4d6c-9c08-f20f01895b80"
+            "reference": "Observation/1729351692391132000.ae034a46-d24e-4499-a9d6-10d7e403f7ee"
           }
         ]
       }
     },
     {
-      "fullUrl": "DiagnosticReport/1729293370624615000.fa48bf41-cbeb-447a-b745-04971bb3321c",
+      "fullUrl": "DiagnosticReport/1729351692532497000.db7442ce-4b76-4c7e-98c5-2d43d9b832ad",
       "resource": {
         "resourceType": "DiagnosticReport",
-        "id": "1729293370624615000.fa48bf41-cbeb-447a-b745-04971bb3321c",
+        "id": "1729351692532497000.db7442ce-4b76-4c7e-98c5-2d43d9b832ad",
         "identifier": [
           {
             "extension": [
@@ -17855,7 +17855,7 @@
         ],
         "basedOn": [
           {
-            "reference": "ServiceRequest/1729293370602844000.728ca6ec-5617-480d-825b-635a9747d4f5"
+            "reference": "ServiceRequest/1729351692510161000.211c650f-18df-42df-81e5-b2f9cb23f231"
           }
         ],
         "status": "final",
@@ -17879,7 +17879,7 @@
           ]
         },
         "subject": {
-          "reference": "Patient/1729293370426567000.c4e7b893-af36-42c4-942f-1e213bc11652"
+          "reference": "Patient/1729351692334560000.f2982374-c9cc-4c10-9128-27f123fe70a5"
         },
         "effectiveDateTime": "2023-06-03T04:50:00Z",
         "_effectiveDateTime": {
@@ -17901,12 +17901,12 @@
         },
         "specimen": [
           {
-            "reference": "Specimen/1729293370496129000.d5c1344f-e127-41c7-8a08-3816715ddd56"
+            "reference": "Specimen/1729351692400463000.6055b152-c01d-4534-b281-617a64e0a296"
           }
         ],
         "result": [
           {
-            "reference": "Observation/1729293370487848000.f0e59b04-66cb-4ed5-bdb5-f6b4224864db"
+            "reference": "Observation/1729351692392914000.aedeb0c2-e561-4bc2-b46a-73e7563011a8"
           }
         ]
       }

From 27125d31f3a49a0f07fabc2f506de012a745859c Mon Sep 17 00:00:00 2001
From: Basilio Bogado <541149+basiliskus@users.noreply.github.com>
Date: Mon, 21 Oct 2024 15:53:24 -0700
Subject: [PATCH 30/30] Fix merge

---
 scripts/hurl/local_test_utils.sh | 153 -------------------------------
 1 file changed, 153 deletions(-)
 delete mode 100755 scripts/hurl/local_test_utils.sh

diff --git a/scripts/hurl/local_test_utils.sh b/scripts/hurl/local_test_utils.sh
deleted file mode 100755
index efc2cd695..000000000
--- a/scripts/hurl/local_test_utils.sh
+++ /dev/null
@@ -1,153 +0,0 @@
-#!/bin/bash
-
-CURRENT_DIR=$(pwd)
-RS_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/rs"
-TI_HRL_SCRIPT_PATH="$CDCTI_HOME/scripts/hurl/ti"
-FILE_NAME_SUFFIX_STEP_0="_0_initial_message"
-FILE_NAME_SUFFIX_STEP_1="_1_hl7_translation"
-FILE_NAME_SUFFIX_STEP_2="_2_fhir_transformation"
-FILE_NAME_SUFFIX_STEP_3="_3_hl7_translation_final"
-
-TIMEOUT=180       # 3 minutes
-RETRY_INTERVAL=10 # Retry every 10 seconds
-
-AZURITE_CONNECTION_STRING="DefaultEndpointsProtocol=http;AccountName=devstoreaccount1;AccountKey=Eby8vdM02xNOcqFlqUwJPLlmEtlCDXJ1OUzFT50uSRZ6IFsuFq2UVErCz4I6tq/K1SZFPTOtr/KBHBeksoGMGw==;BlobEndpoint=http://localhost:10000/devstoreaccount1;" # pragma: allowlist secret
-
-RS_LOCAL_API="http://localhost:7071"
-TI_LOCAL_API="http://localhost:8080"
-
-LOCAL_APIS=("$RS_LOCAL_API" "$TI_LOCAL_API")
-# Check if the RS and TO local APIs are reachable
-for service in "${LOCAL_APIS[@]}"; do
-    if ! curl -s --head --fail "$service" | grep "200 OK" >/dev/null; then
-        echo "The service at $service is not reachable"
-        exit 1
-    fi
-done
-
-# Check jq is installed
-if ! command -v jq &>/dev/null; then
-    echo "jq could not be found. Please install jq to proceed."
-    exit 1
-fi
-
-# Check az (Azure CLI) is installed
-if ! command -v az &>/dev/null; then
-    echo "Azure CLI (az) could not be found. Please install Azure CLI to proceed."
-    exit 1
-fi
-
-check_submission_status() {
-    local submission_id=$1
-    start_time=$(date +%s)
-
-    while true; do
-        history_response=$(
-            cd "$RS_HRL_SCRIPT_PATH" || exit 1
-            ./hrl history.hurl -i "$submission_id"
-        )
-        overall_status=$(echo "$history_response" | jq -r '.overallStatus')
-
-        echo -n "  Status: $overall_status"
-        if [ "$overall_status" == "Delivered" ]; then
-            echo "!"
-            return 0
-        else
-            echo ". Retrying in $RETRY_INTERVAL seconds..."
-        fi
-
-        # Check if the timeout has been reached
-        current_time=$(date +%s)
-        elapsed_time=$((current_time - start_time))
-        if [ "$elapsed_time" -ge "$TIMEOUT" ]; then
-            echo "  Timeout reached after $elapsed_time seconds. Status is still: $overall_status."
-            return 1
-        fi
-
-        sleep $RETRY_INTERVAL
-    done
-}
-
-get_sent_report_id_from_history_response() {
-    local history_response=$1
-    echo $history_response | jq '.destinations[0].sentReports[0].externalName' | sed 's/.*-\([0-9a-f]\{8\}-[0-9a-f]\{4\}-[0-9a-f]\{4\}-[0-9a-f]\{4\}-[0-9a-f]\{12\}\)-.*/\1/'
-}
-
-download_from_azurite() {
-    local blob_name=$1
-    local file_path=$2
-
-    echo "  Downloading from blob storage '$blob_name' to '$file_path'"
-    az storage blob download \
-        --container-name "reports" \
-        --name $blob_name \
-        --file $file_path \
-        --connection-string $AZURITE_CONNECTION_STRING \
-        --output none
-
-    if [[ "$file_path" == *.fhir ]]; then
-        echo "  Formatting the content for: $file_path"
-        formatted_content=$(jq '.' "$file_path")
-        echo "$formatted_content" >"$file_path"
-    fi
-}
-
-submit_message() {
-    local file=$1
-    local message_file_path=$(dirname "$file")
-    local message_file_name=$(basename "$file")
-    local message_base_name="${message_file_name%.hl7}"
-    message_base_name="${message_base_name%$FILE_NAME_SUFFIX_STEP_0}"
-
-    msh9=$(awk -F'|' '/^MSH/ { print $9 }' "$file")
-    if [[ "$msh9" == "ORU^R01^ORU_R01" ]]; then
-        first_leg_receiver="flexion.etor-service-receiver-results"
-        second_leg_receiver="flexion.simulated-hospital"
-    elif [[ "$msh9" == "OML^O21^OML_O21" || "$msh9" == "ORM^O01^ORM_O01" ]]; then
-        first_leg_receiver="flexion.etor-service-receiver-orders"
-        second_leg_receiver="flexion.simulated-lab"
-    else
-        echo "Unknown receivers for MSH-9 value '$msh9'. Skipping the message"
-        return
-    fi
-
-    echo "Assuming receivers are '$first_leg_receiver' and '$second_leg_receiver' because of MSH-9 value '$msh9'"
-
-    waters_response=$(
-        cd "$RS_HRL_SCRIPT_PATH" || exit 1
-        ./hrl waters.hurl -f "$message_file_name" -r "$message_file_path"
-    )
-    submission_id=$(echo "$waters_response" | jq -r '.id')
-
-    echo "[First leg] Checking submission status for ID: $submission_id"
-    if ! check_submission_status "$submission_id"; then
-        echo "Failed to deliver the first leg of the message. Skipping the next steps."
-        return
-    fi
-
-    inbound_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    translated_blob_name="ready/$first_leg_receiver/$inbound_submission_id.fhir"
-    translated_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_1.fhir"
-    download_from_azurite "$translated_blob_name" "$translated_file_path"
-
-    metadata_response=$(
-        cd "$TI_HRL_SCRIPT_PATH" || exit 1
-        ./hrl metadata.hurl -i "$inbound_submission_id"
-    )
-    outbound_submission_id=$(echo "$metadata_response" | jq -r '.issue[] | select(.details.text == "outbound submission id") | .diagnostics')
-
-    transformed_blob_name="receive/flexion.etor-service-sender/$outbound_submission_id.fhir"
-    transformed_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_2.fhir"
-    download_from_azurite "$transformed_blob_name" "$transformed_file_path"
-
-    echo "[Second leg] Checking submission status for ID: $outbound_submission_id"
-    if ! check_submission_status "$outbound_submission_id"; then
-        echo "Failed to deliver the second leg of the message. Skipping the next steps."
-        return
-    fi
-
-    final_submission_id=$(get_sent_report_id_from_history_response "$history_response")
-    final_blob_name="ready/$second_leg_receiver/$final_submission_id.hl7"
-    final_file_path="$message_file_path/$message_base_name$FILE_NAME_SUFFIX_STEP_3.hl7"
-    download_from_azurite "$final_blob_name" "$final_file_path"
-}