diff --git a/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/i18n/I18nConstants.java b/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/i18n/I18nConstants.java
index f0078c21f..7968cb2e7 100644
--- a/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/i18n/I18nConstants.java
+++ b/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/i18n/I18nConstants.java
@@ -1099,6 +1099,9 @@ public class I18nConstants {
   public static final String VALUESET_BAD_FILTER_VALUE_VALID_REGEX = "VALUESET_BAD_FILTER_VALUE_VALID_REGEX";
   public static final String VALUESET_BAD_PROPERTY_NO_REGEX = "VALUESET_BAD_PROPERTY_NO_REGEX";
   public static final String CODESYSTEM_PROPERTY_CODE_WARNING = "CODESYSTEM_PROPERTY_CODE_WARNING";
+  public static final String SD_ELEMENT_FIXED_WRONG_TYPE = "SD_ELEMENT_FIXED_WRONG_TYPE";
+  public static final String SD_ELEMENT_REASON_DERIVED = "SD_ELEMENT_REASON_DERIVED";
+  public static final String SD_ELEMENT_PATTERN_WRONG_TYPE = "SD_ELEMENT_PATTERN_WRONG_TYPE";
 }
 
 
diff --git a/org.hl7.fhir.utilities/src/main/resources/Messages.properties b/org.hl7.fhir.utilities/src/main/resources/Messages.properties
index d7b7683cb..7002b84bd 100644
--- a/org.hl7.fhir.utilities/src/main/resources/Messages.properties
+++ b/org.hl7.fhir.utilities/src/main/resources/Messages.properties
@@ -271,7 +271,7 @@ XHTML_XHTML_Entity_Illegal = Invalid entity in the XHTML (''{0}'')
 XHTML_XHTML_Image_Reference_Illegal = Invalid Image Reference in the XHTML (''{0}'')
 XHTML_XHTML_NS_InValid = Wrong namespace on the XHTML (''{0}'', should be ''{1}'')
 XHTML_XHTML_Name_Invalid = Wrong name on the XHTML (''{0}'') - must start with div
-_DT_Fixed_Wrong = Value is ''{0}'' but must be ''{1}''
+_DT_Fixed_Wrong = Value is ''{0}'' but must be ''{1}''{2}
 All_observations_should_have_an_effectiveDateTime_or_an_effectivePeriod = Best Practice Recommendation: In general, all observations should have an effective[x] ({0})
 All_observations_should_have_a_performer = Best Practice Recommendation: In general, all observations should have a performer
 All_observations_should_have_a_subject = Best Practice Recommendation: In general, all observations should have a subject
@@ -1137,4 +1137,7 @@ VALUESET_BAD_FILTER_VALUE_HAS_COMMA = The filter value has a comma, but the oper
 VALUESET_BAD_FILTER_VALUE_VALID_REGEX = The value for a filter based on property ''{0}'' should be a valid regex, not ''{1}'' (err = ''{2}'')
 VALUESET_BAD_PROPERTY_NO_REGEX = Cannot apply a regex filter to the property ''{0}'' (usually regex filters are applied to the codes, or a named property of the code system)
 CODESYSTEM_PROPERTY_CODE_WARNING = If the type is ''code'', then the valueSet property should be provided to clarify what kind of code will be found in the element
+SD_ELEMENT_FIXED_WRONG_TYPE = The base element has a fixed type of ''{0}'', so this element must have a fixed value of the same type, not ''{1}'' 
+SD_ELEMENT_REASON_DERIVED = , because the value must match the fixed value define in ''{0}''
+SD_ELEMENT_PATTERN_WRONG_TYPE = The base element has a pattern type of ''{0}'', so this element must have a pattern value of the same type, not ''{1}''
 
diff --git a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/InstanceValidator.java b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/InstanceValidator.java
index bbf2bd058..8c9041bbb 100644
--- a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/InstanceValidator.java
+++ b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/InstanceValidator.java
@@ -1049,14 +1049,14 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     return v1 == null ? Utilities.noString(v1) : v1.equals(v2);
   }
 
-  private boolean checkAddress(List<ValidationMessage> errors, String path, Element focus, Address fixed, String fixedSource, boolean pattern) {
+  private boolean checkAddress(List<ValidationMessage> errors, String path, Element focus, Address fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".use", focus.getNamedChild("use", false), fixed.getUseElement(), fixedSource, "use", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".text", focus.getNamedChild("text", false), fixed.getTextElement(), fixedSource, "text", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".city", focus.getNamedChild("city", false), fixed.getCityElement(), fixedSource, "city", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".state", focus.getNamedChild("state", false), fixed.getStateElement(), fixedSource, "state", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".country", focus.getNamedChild("country", false), fixed.getCountryElement(), fixedSource, "country", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".zip", focus.getNamedChild("zip", false), fixed.getPostalCodeElement(), fixedSource, "postalCode", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".use", focus.getNamedChild("use", false), fixed.getUseElement(), fixedSource, "use", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".text", focus.getNamedChild("text", false), fixed.getTextElement(), fixedSource, "text", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".city", focus.getNamedChild("city", false), fixed.getCityElement(), fixedSource, "city", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".state", focus.getNamedChild("state", false), fixed.getStateElement(), fixedSource, "state", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".country", focus.getNamedChild("country", false), fixed.getCountryElement(), fixedSource, "country", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".zip", focus.getNamedChild("zip", false), fixed.getPostalCodeElement(), fixedSource, "postalCode", focus, pattern, context) && ok;
 
     List<Element> lines = new ArrayList<Element>();
     focus.getNamedChildren("line", lines);
@@ -1073,7 +1073,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
           List<ValidationMessage> errorsFixed = null;
           for (int j = 0; j < lines.size() && !found; ++j) {
             errorsFixed = new ArrayList<>();
-            checkFixedValue(errorsFixed, path + ".line", lines.get(j), fixedLine, fixedSource, "line", focus, pattern);
+            checkFixedValue(errorsFixed, path + ".line", lines.get(j), fixedLine, fixedSource, "line", focus, pattern, context);
             if (!hasErrors(errorsFixed)) {
               found = true;
             } else {
@@ -1092,7 +1092,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
       if (rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, lineSizeCheck, I18nConstants.FIXED_TYPE_CHECKS_DT_ADDRESS_LINE,
         Integer.toString(fixed.getLine().size()), Integer.toString(lines.size()))) {
         for (int i = 0; i < lines.size(); i++) {
-          ok = checkFixedValue(errors, path + ".line", lines.get(i), fixed.getLine().get(i), fixedSource, "line", focus, pattern) && ok;
+          ok = checkFixedValue(errors, path + ".line", lines.get(i), fixed.getLine().get(i), fixedSource, "line", focus, pattern, context) && ok;
         }
       } else {
         ok = false;
@@ -1101,15 +1101,15 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     return ok;
   }
 
-  private boolean checkAttachment(List<ValidationMessage> errors, String path, Element focus, Attachment fixed, String fixedSource, boolean pattern) {
+  private boolean checkAttachment(List<ValidationMessage> errors, String path, Element focus, Attachment fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".contentType", focus.getNamedChild("contentType", false), fixed.getContentTypeElement(), fixedSource, "contentType", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".language", focus.getNamedChild("language", false), fixed.getLanguageElement(), fixedSource, "language", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".data", focus.getNamedChild("data", false), fixed.getDataElement(), fixedSource, "data", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".url", focus.getNamedChild("url", false), fixed.getUrlElement(), fixedSource, "url", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".size", focus.getNamedChild("size", false), fixed.getSizeElement(), fixedSource, "size", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".hash", focus.getNamedChild("hash", false), fixed.getHashElement(), fixedSource, "hash", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".title", focus.getNamedChild("title", false), fixed.getTitleElement(), fixedSource, "title", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".contentType", focus.getNamedChild("contentType", false), fixed.getContentTypeElement(), fixedSource, "contentType", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".language", focus.getNamedChild("language", false), fixed.getLanguageElement(), fixedSource, "language", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".data", focus.getNamedChild("data", false), fixed.getDataElement(), fixedSource, "data", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".url", focus.getNamedChild("url", false), fixed.getUrlElement(), fixedSource, "url", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".size", focus.getNamedChild("size", false), fixed.getSizeElement(), fixedSource, "size", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".hash", focus.getNamedChild("hash", false), fixed.getHashElement(), fixedSource, "hash", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".title", focus.getNamedChild("title", false), fixed.getTitleElement(), fixedSource, "title", focus, pattern, context) && ok;
 
     return ok;
   }
@@ -1275,9 +1275,9 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     return false;
   }
 
-  private boolean checkCodeableConcept(List<ValidationMessage> errors, String path, Element focus, CodeableConcept fixed, String fixedSource, boolean pattern) {
+  private boolean checkCodeableConcept(List<ValidationMessage> errors, String path, Element focus, CodeableConcept fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".text", focus.getNamedChild("text", false), fixed.getTextElement(), fixedSource, "text", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".text", focus.getNamedChild("text", false), fixed.getTextElement(), fixedSource, "text", focus, pattern, context) && ok;
     List<Element> codings = new ArrayList<Element>();
     focus.getNamedChildren("coding", codings);
     if (pattern) {
@@ -1289,7 +1289,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
           List<ValidationMessage> errorsFixed;
           for (int j = 0; j < codings.size() && !found; ++j) {
             errorsFixed = new ArrayList<>();
-            checkFixedValue(errorsFixed, path + ".coding", codings.get(j), fixedCoding, fixedSource, "coding", focus, pattern);
+            checkFixedValue(errorsFixed, path + ".coding", codings.get(j), fixedCoding, fixedSource, "coding", focus, pattern, context);
             if (!hasErrors(errorsFixed)) {
               found = true;
             } else {
@@ -1333,7 +1333,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     } else {
       if (rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, codings.size() == fixed.getCoding().size(), I18nConstants.TERMINOLOGY_TX_CODING_COUNT, Integer.toString(fixed.getCoding().size()), Integer.toString(codings.size()))) {
         for (int i = 0; i < codings.size(); i++)
-          ok = checkFixedValue(errors, path + ".coding", codings.get(i), fixed.getCoding().get(i), fixedSource, "coding", focus, false) && ok;
+          ok = checkFixedValue(errors, path + ".coding", codings.get(i), fixed.getCoding().get(i), fixedSource, "coding", focus, false, context) && ok;
       } else {
         ok = false;
       }
@@ -1940,13 +1940,13 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     return b.toString();
   }
 
-  private boolean checkCoding(List<ValidationMessage> errors, String path, Element focus, Coding fixed, String fixedSource, boolean pattern) {
+  private boolean checkCoding(List<ValidationMessage> errors, String path, Element focus, Coding fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".system", focus.getNamedChild("system", false), fixed.getSystemElement(), fixedSource, "system", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".version", focus.getNamedChild("version", false), fixed.getVersionElement(), fixedSource, "version", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".code", focus.getNamedChild("code", false), fixed.getCodeElement(), fixedSource, "code", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".display", focus.getNamedChild("display", false), fixed.getDisplayElement(), fixedSource, "display", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".userSelected", focus.getNamedChild("userSelected", false), fixed.getUserSelectedElement(), fixedSource, "userSelected", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".system", focus.getNamedChild("system", false), fixed.getSystemElement(), fixedSource, "system", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".version", focus.getNamedChild("version", false), fixed.getVersionElement(), fixedSource, "version", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".code", focus.getNamedChild("code", false), fixed.getCodeElement(), fixedSource, "code", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".display", focus.getNamedChild("display", false), fixed.getDisplayElement(), fixedSource, "display", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".userSelected", focus.getNamedChild("userSelected", false), fixed.getUserSelectedElement(), fixedSource, "userSelected", focus, pattern, context) && ok;
     return ok;
   }
 
@@ -2073,12 +2073,12 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     }
   }
 
-  private boolean checkContactPoint(List<ValidationMessage> errors, String path, Element focus, ContactPoint fixed, String fixedSource, boolean pattern) {
+  private boolean checkContactPoint(List<ValidationMessage> errors, String path, Element focus, ContactPoint fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".system", focus.getNamedChild("system", false), fixed.getSystemElement(), fixedSource, "system", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".value", focus.getNamedChild("value", false), fixed.getValueElement(), fixedSource, "value", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".use", focus.getNamedChild("use", false), fixed.getUseElement(), fixedSource, "use", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".period", focus.getNamedChild("period", false), fixed.getPeriod(), fixedSource, "period", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".system", focus.getNamedChild("system", false), fixed.getSystemElement(), fixedSource, "system", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".value", focus.getNamedChild("value", false), fixed.getValueElement(), fixedSource, "value", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".use", focus.getNamedChild("use", false), fixed.getUseElement(), fixedSource, "use", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".period", focus.getNamedChild("period", false), fixed.getPeriod(), fixedSource, "period", focus, pattern, context) && ok;
     return ok;
   }
 
@@ -2453,7 +2453,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
   }
 
   @SuppressWarnings("rawtypes")
-  private boolean checkFixedValue(List<ValidationMessage> errors, String path, Element focus, org.hl7.fhir.r5.model.Element fixed, String fixedSource, String propName, Element parent, boolean pattern) {
+  public boolean checkFixedValue(List<ValidationMessage> errors, String path, Element focus, org.hl7.fhir.r5.model.Element fixed, String fixedSource, String propName, Element parent, boolean pattern, String context) {
     boolean ok = true;
     if ((fixed == null || fixed.isEmpty()) && focus == null) {
       ; // this is all good
@@ -2464,61 +2464,61 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     } else {
       String value = focus.primitiveValue();
       if (fixed instanceof org.hl7.fhir.r5.model.BooleanType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.BooleanType) fixed).asStringValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.BooleanType) fixed).asStringValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.BooleanType) fixed).asStringValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.BooleanType) fixed).asStringValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.IntegerType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.IntegerType) fixed).asStringValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.IntegerType) fixed).asStringValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.IntegerType) fixed).asStringValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.IntegerType) fixed).asStringValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.DecimalType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.DecimalType) fixed).asStringValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.DecimalType) fixed).asStringValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.DecimalType) fixed).asStringValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.DecimalType) fixed).asStringValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.Base64BinaryType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.Base64BinaryType) fixed).asStringValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.Base64BinaryType) fixed).asStringValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.Base64BinaryType) fixed).asStringValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.Base64BinaryType) fixed).asStringValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.InstantType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.InstantType) fixed).getValue().toString(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.InstantType) fixed).asStringValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.InstantType) fixed).getValue().toString(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.InstantType) fixed).asStringValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.CodeType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.CodeType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.CodeType) fixed).getValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.CodeType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.CodeType) fixed).getValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.Enumeration)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.Enumeration) fixed).asStringValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.Enumeration) fixed).asStringValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.Enumeration) fixed).asStringValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.Enumeration) fixed).asStringValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.StringType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.StringType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.StringType) fixed).getValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.StringType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.StringType) fixed).getValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.UriType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.UriType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.UriType) fixed).getValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.UriType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.UriType) fixed).getValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.DateType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.DateType) fixed).getValue().toString(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.DateType) fixed).getValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.DateType) fixed).getValue().toString(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.DateType) fixed).getValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.DateTimeType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.DateTimeType) fixed).getValue().toString(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.DateTimeType) fixed).getValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.DateTimeType) fixed).getValue().toString(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.DateTimeType) fixed).getValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.OidType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.OidType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.OidType) fixed).getValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.OidType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.OidType) fixed).getValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.UuidType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.UuidType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.UuidType) fixed).getValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.UuidType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.UuidType) fixed).getValue(), context);
       else if (fixed instanceof org.hl7.fhir.r5.model.IdType)
-        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.IdType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.IdType) fixed).getValue());
+        ok = rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, check(((org.hl7.fhir.r5.model.IdType) fixed).getValue(), value), I18nConstants._DT_FIXED_WRONG, value, ((org.hl7.fhir.r5.model.IdType) fixed).getValue(), context);
       else if (fixed instanceof Quantity)
-        ok = checkQuantity(errors, path, focus, (Quantity) fixed, fixedSource, pattern) && ok;
+        ok = checkQuantity(errors, path, focus, (Quantity) fixed, fixedSource, pattern, context) && ok;
       else if (fixed instanceof Address)
-        ok = checkAddress(errors, path, focus, (Address) fixed, fixedSource, pattern);
+        ok = checkAddress(errors, path, focus, (Address) fixed, fixedSource, pattern, context);
       else if (fixed instanceof ContactPoint)
-        ok = checkContactPoint(errors, path, focus, (ContactPoint) fixed, fixedSource, pattern);
+        ok = checkContactPoint(errors, path, focus, (ContactPoint) fixed, fixedSource, pattern, context);
       else if (fixed instanceof Attachment)
-        ok = checkAttachment(errors, path, focus, (Attachment) fixed, fixedSource, pattern);
+        ok = checkAttachment(errors, path, focus, (Attachment) fixed, fixedSource, pattern, context);
       else if (fixed instanceof Identifier)
-        ok = checkIdentifier(errors, path, focus, (Identifier) fixed, fixedSource, pattern);
+        ok = checkIdentifier(errors, path, focus, (Identifier) fixed, fixedSource, pattern, context);
       else if (fixed instanceof Coding)
-        ok = checkCoding(errors, path, focus, (Coding) fixed, fixedSource, pattern);
+        ok = checkCoding(errors, path, focus, (Coding) fixed, fixedSource, pattern, context);
       else if (fixed instanceof HumanName)
-        ok = checkHumanName(errors, path, focus, (HumanName) fixed, fixedSource, pattern);
+        ok = checkHumanName(errors, path, focus, (HumanName) fixed, fixedSource, pattern, context);
       else if (fixed instanceof CodeableConcept)
-        ok = checkCodeableConcept(errors, path, focus, (CodeableConcept) fixed, fixedSource, pattern);
+        ok = checkCodeableConcept(errors, path, focus, (CodeableConcept) fixed, fixedSource, pattern, context);
       else if (fixed instanceof Timing)
-        ok = checkTiming(errors, path, focus, (Timing) fixed, fixedSource, pattern);
+        ok = checkTiming(errors, path, focus, (Timing) fixed, fixedSource, pattern, context);
       else if (fixed instanceof Period)
-        ok = checkPeriod(errors, path, focus, (Period) fixed, fixedSource, pattern);
+        ok = checkPeriod(errors, path, focus, (Period) fixed, fixedSource, pattern, context);
       else if (fixed instanceof Range)
-        ok = checkRange(errors, path, focus, (Range) fixed, fixedSource, pattern);
+        ok = checkRange(errors, path, focus, (Range) fixed, fixedSource, pattern, context);
       else if (fixed instanceof Ratio)
-        ok = checkRatio(errors, path, focus, (Ratio) fixed, fixedSource, pattern);
+        ok = checkRatio(errors, path, focus, (Ratio) fixed, fixedSource, pattern, context);
       else if (fixed instanceof SampledData)
-        ok = checkSampledData(errors, path, focus, (SampledData) fixed, fixedSource, pattern);
+        ok = checkSampledData(errors, path, focus, (SampledData) fixed, fixedSource, pattern, context);
       else if (fixed instanceof Reference)
-        ok = checkReference(errors, path, focus, (Reference) fixed, fixedSource, pattern);
+        ok = checkReference(errors, path, focus, (Reference) fixed, fixedSource, pattern, context);
       else
         ok = rule(errors, NO_RULE_DATE, IssueType.EXCEPTION, focus.line(), focus.col(), path, false, I18nConstants.INTERNAL_INT_BAD_TYPE, fixed.fhirType());
       List<Element> extensions = new ArrayList<Element>();
@@ -2529,7 +2529,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
         for (Extension e : fixed.getExtension()) {
           Element ex = getExtensionByUrl(extensions, e.getUrl());
           if (rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, ex != null, I18nConstants.EXTENSION_EXT_COUNT_NOTFOUND, e.getUrl())) {
-            ok = checkFixedValue(errors, path, ex.getNamedChild("extension", false).getNamedChild("value", false), e.getValue(), fixedSource, "extension.value", ex.getNamedChild("extension", false), false) && ok;
+            ok = checkFixedValue(errors, path, ex.getNamedChild("extension", false).getNamedChild("value", false), e.getValue(), fixedSource, "extension.value", ex.getNamedChild("extension", false), false, context) && ok;
           } else {
             ok = false;
           }
@@ -2541,18 +2541,18 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     return ok;
   }
 
-  private boolean checkHumanName(List<ValidationMessage> errors, String path, Element focus, HumanName fixed, String fixedSource, boolean pattern) {
+  private boolean checkHumanName(List<ValidationMessage> errors, String path, Element focus, HumanName fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".use", focus.getNamedChild("use", false), fixed.getUseElement(), fixedSource, "use", focus, pattern);
-    ok = checkFixedValue(errors, path + ".text", focus.getNamedChild("text", false), fixed.getTextElement(), fixedSource, "text", focus, pattern);
-    ok = checkFixedValue(errors, path + ".period", focus.getNamedChild("period", false), fixed.getPeriod(), fixedSource, "period", focus, pattern);
+    ok = checkFixedValue(errors, path + ".use", focus.getNamedChild("use", false), fixed.getUseElement(), fixedSource, "use", focus, pattern, context);
+    ok = checkFixedValue(errors, path + ".text", focus.getNamedChild("text", false), fixed.getTextElement(), fixedSource, "text", focus, pattern, context);
+    ok = checkFixedValue(errors, path + ".period", focus.getNamedChild("period", false), fixed.getPeriod(), fixedSource, "period", focus, pattern, context);
 
     List<Element> parts = new ArrayList<Element>();
     if (!pattern || fixed.hasFamily()) {
       focus.getNamedChildren("family", parts);
       if (rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, parts.size() > 0 == fixed.hasFamily(), I18nConstants.FIXED_TYPE_CHECKS_DT_NAME_FAMILY, (fixed.hasFamily() ? "1" : "0"), Integer.toString(parts.size()))) {
         for (int i = 0; i < parts.size(); i++)
-          ok = checkFixedValue(errors, path + ".family", parts.get(i), fixed.getFamilyElement(), fixedSource, "family", focus, pattern) && ok;
+          ok = checkFixedValue(errors, path + ".family", parts.get(i), fixed.getFamilyElement(), fixedSource, "family", focus, pattern, context) && ok;
       } else {
         ok = false;
       }
@@ -2561,7 +2561,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
       focus.getNamedChildren("given", parts);
       if (rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, parts.size() == fixed.getGiven().size(), I18nConstants.FIXED_TYPE_CHECKS_DT_NAME_GIVEN, Integer.toString(fixed.getGiven().size()), Integer.toString(parts.size()))) {
         for (int i = 0; i < parts.size(); i++)
-          ok = checkFixedValue(errors, path + ".given", parts.get(i), fixed.getGiven().get(i), fixedSource, "given", focus, pattern) && ok;
+          ok = checkFixedValue(errors, path + ".given", parts.get(i), fixed.getGiven().get(i), fixedSource, "given", focus, pattern, context) && ok;
       } else {
         ok = false;
       }
@@ -2570,7 +2570,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
       focus.getNamedChildren("prefix", parts);
       if (rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, parts.size() == fixed.getPrefix().size(), I18nConstants.FIXED_TYPE_CHECKS_DT_NAME_PREFIX, Integer.toString(fixed.getPrefix().size()), Integer.toString(parts.size()))) {
         for (int i = 0; i < parts.size(); i++)
-          ok = checkFixedValue(errors, path + ".prefix", parts.get(i), fixed.getPrefix().get(i), fixedSource, "prefix", focus, pattern) && ok;
+          ok = checkFixedValue(errors, path + ".prefix", parts.get(i), fixed.getPrefix().get(i), fixedSource, "prefix", focus, pattern, context) && ok;
       } else {
         ok = false;
       }
@@ -2579,7 +2579,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
       focus.getNamedChildren("suffix", parts);
       if (rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, parts.size() == fixed.getSuffix().size(), I18nConstants.FIXED_TYPE_CHECKS_DT_NAME_SUFFIX, Integer.toString(fixed.getSuffix().size()), Integer.toString(parts.size()))) {
         for (int i = 0; i < parts.size(); i++)
-          ok = checkFixedValue(errors, path + ".suffix", parts.get(i), fixed.getSuffix().get(i), fixedSource, "suffix", focus, pattern) && ok;
+          ok = checkFixedValue(errors, path + ".suffix", parts.get(i), fixed.getSuffix().get(i), fixedSource, "suffix", focus, pattern, context) && ok;
       } else {
         ok = false;
       }
@@ -2598,21 +2598,21 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     return ok;
   }
 
-  private boolean checkIdentifier(List<ValidationMessage> errors, String path, Element focus, Identifier fixed, String fixedSource, boolean pattern) {
+  private boolean checkIdentifier(List<ValidationMessage> errors, String path, Element focus, Identifier fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".use", focus.getNamedChild("use", false), fixed.getUseElement(), fixedSource, "use", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".type", focus.getNamedChild(TYPE, false), fixed.getType(), fixedSource, TYPE, focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".system", focus.getNamedChild("system", false), fixed.getSystemElement(), fixedSource, "system", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".value", focus.getNamedChild("value", false), fixed.getValueElement(), fixedSource, "value", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".period", focus.getNamedChild("period", false), fixed.getPeriod(), fixedSource, "period", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".assigner", focus.getNamedChild("assigner", false), fixed.getAssigner(), fixedSource, "assigner", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".use", focus.getNamedChild("use", false), fixed.getUseElement(), fixedSource, "use", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".type", focus.getNamedChild(TYPE, false), fixed.getType(), fixedSource, TYPE, focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".system", focus.getNamedChild("system", false), fixed.getSystemElement(), fixedSource, "system", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".value", focus.getNamedChild("value", false), fixed.getValueElement(), fixedSource, "value", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".period", focus.getNamedChild("period", false), fixed.getPeriod(), fixedSource, "period", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".assigner", focus.getNamedChild("assigner", false), fixed.getAssigner(), fixedSource, "assigner", focus, pattern, context) && ok;
     return ok;
   }
 
-  private boolean checkPeriod(List<ValidationMessage> errors, String path, Element focus, Period fixed, String fixedSource, boolean pattern) {
+  private boolean checkPeriod(List<ValidationMessage> errors, String path, Element focus, Period fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".start", focus.getNamedChild("start", false), fixed.getStartElement(), fixedSource, "start", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".end", focus.getNamedChild("end", false), fixed.getEndElement(), fixedSource, "end", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".start", focus.getNamedChild("start", false), fixed.getStartElement(), fixedSource, "start", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".end", focus.getNamedChild("end", false), fixed.getEndElement(), fixedSource, "end", focus, pattern, context) && ok;
     return ok;
   }
 
@@ -2958,10 +2958,10 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     }
 
     if (context.hasFixed()) {
-      ok = checkFixedValue(errors, path, e, context.getFixed(), profile.getVersionedUrl(), context.getSliceName(), null, false) && ok;
+      ok = checkFixedValue(errors, path, e, context.getFixed(), profile.getVersionedUrl(), context.getSliceName(), null, false, "") && ok;
     }
     if (context.hasPattern()) {
-      ok = checkFixedValue(errors, path, e, context.getPattern(), profile.getVersionedUrl(), context.getSliceName(), null, true) && ok;
+      ok = checkFixedValue(errors, path, e, context.getPattern(), profile.getVersionedUrl(), context.getSliceName(), null, true, "") && ok;
     }
 
     if (ok && !ID_EXEMPT_LIST.contains(e.fhirType())) { // ids get checked elsewhere
@@ -3612,13 +3612,13 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     return false;
   }
 
-  private boolean checkQuantity(List<ValidationMessage> errors, String path, Element focus, Quantity fixed, String fixedSource, boolean pattern) {
+  private boolean checkQuantity(List<ValidationMessage> errors, String path, Element focus, Quantity fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".value", focus.getNamedChild("value", false), fixed.getValueElement(), fixedSource, "value", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".comparator", focus.getNamedChild("comparator", false), fixed.getComparatorElement(), fixedSource, "comparator", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".unit", focus.getNamedChild("unit", false), fixed.getUnitElement(), fixedSource, "unit", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".system", focus.getNamedChild("system", false), fixed.getSystemElement(), fixedSource, "system", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".code", focus.getNamedChild("code", false), fixed.getCodeElement(), fixedSource, "code", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".value", focus.getNamedChild("value", false), fixed.getValueElement(), fixedSource, "value", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".comparator", focus.getNamedChild("comparator", false), fixed.getComparatorElement(), fixedSource, "comparator", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".unit", focus.getNamedChild("unit", false), fixed.getUnitElement(), fixedSource, "unit", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".system", focus.getNamedChild("system", false), fixed.getSystemElement(), fixedSource, "system", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".code", focus.getNamedChild("code", false), fixed.getCodeElement(), fixedSource, "code", focus, pattern, context) && ok;
     return ok;
   }
 
@@ -3832,17 +3832,17 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
 
   // implementation
 
-  private boolean checkRange(List<ValidationMessage> errors, String path, Element focus, Range fixed, String fixedSource, boolean pattern) {
+  private boolean checkRange(List<ValidationMessage> errors, String path, Element focus, Range fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".low", focus.getNamedChild("low", false), fixed.getLow(), fixedSource, "low", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".high", focus.getNamedChild("high", false), fixed.getHigh(), fixedSource, "high", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".low", focus.getNamedChild("low", false), fixed.getLow(), fixedSource, "low", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".high", focus.getNamedChild("high", false), fixed.getHigh(), fixedSource, "high", focus, pattern, context) && ok;
     return ok;
   }
 
-  private boolean checkRatio(List<ValidationMessage> errors, String path, Element focus, Ratio fixed, String fixedSource, boolean pattern) {
+  private boolean checkRatio(List<ValidationMessage> errors, String path, Element focus, Ratio fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".numerator", focus.getNamedChild("numerator", false), fixed.getNumerator(), fixedSource, "numerator", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".denominator", focus.getNamedChild("denominator", false), fixed.getDenominator(), fixedSource, "denominator", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".numerator", focus.getNamedChild("numerator", false), fixed.getNumerator(), fixedSource, "numerator", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".denominator", focus.getNamedChild("denominator", false), fixed.getDenominator(), fixedSource, "denominator", focus, pattern, context) && ok;
     return ok;
   }
 
@@ -4238,41 +4238,41 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     }
   }
 
-  private boolean checkSampledData(List<ValidationMessage> errors, String path, Element focus, SampledData fixed, String fixedSource, boolean pattern) {
+  private boolean checkSampledData(List<ValidationMessage> errors, String path, Element focus, SampledData fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".origin", focus.getNamedChild("origin", false), fixed.getOrigin(), fixedSource, "origin", focus, pattern) && ok;
-    if (VersionUtilities.isR5VerOrLater(context.getVersion())) {
-      ok = checkFixedValue(errors, path + ".interval", focus.getNamedChild("period", false), fixed.getIntervalElement(), fixedSource, "interval", focus, pattern) && ok;
-      ok = checkFixedValue(errors, path + ".intervalUnit", focus.getNamedChild("period", false), fixed.getIntervalUnitElement(), fixedSource, "intervalUnit", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".origin", focus.getNamedChild("origin", false), fixed.getOrigin(), fixedSource, "origin", focus, pattern, context) && ok;
+    if (VersionUtilities.isR5VerOrLater(this.context.getVersion())) {
+      ok = checkFixedValue(errors, path + ".interval", focus.getNamedChild("period", false), fixed.getIntervalElement(), fixedSource, "interval", focus, pattern, context) && ok;
+      ok = checkFixedValue(errors, path + ".intervalUnit", focus.getNamedChild("period", false), fixed.getIntervalUnitElement(), fixedSource, "intervalUnit", focus, pattern, context) && ok;
     } else {
-      ok = checkFixedValue(errors, path + ".period", focus.getNamedChild("period", false), fixed.getIntervalElement(), fixedSource, "period", focus, pattern) && ok;
+      ok = checkFixedValue(errors, path + ".period", focus.getNamedChild("period", false), fixed.getIntervalElement(), fixedSource, "period", focus, pattern, context) && ok;
     }
-    ok = checkFixedValue(errors, path + ".factor", focus.getNamedChild("factor", false), fixed.getFactorElement(), fixedSource, "factor", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".lowerLimit", focus.getNamedChild("lowerLimit", false), fixed.getLowerLimitElement(), fixedSource, "lowerLimit", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".upperLimit", focus.getNamedChild("upperLimit", false), fixed.getUpperLimitElement(), fixedSource, "upperLimit", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".dimensions", focus.getNamedChild("dimensions", false), fixed.getDimensionsElement(), fixedSource, "dimensions", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".data", focus.getNamedChild("data", false), fixed.getDataElement(), fixedSource, "data", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".factor", focus.getNamedChild("factor", false), fixed.getFactorElement(), fixedSource, "factor", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".lowerLimit", focus.getNamedChild("lowerLimit", false), fixed.getLowerLimitElement(), fixedSource, "lowerLimit", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".upperLimit", focus.getNamedChild("upperLimit", false), fixed.getUpperLimitElement(), fixedSource, "upperLimit", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".dimensions", focus.getNamedChild("dimensions", false), fixed.getDimensionsElement(), fixedSource, "dimensions", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".data", focus.getNamedChild("data", false), fixed.getDataElement(), fixedSource, "data", focus, pattern, context) && ok;
     return ok;
   }
 
-  private boolean checkReference(List<ValidationMessage> errors, String path, Element focus, Reference fixed, String fixedSource, boolean pattern) {
+  private boolean checkReference(List<ValidationMessage> errors, String path, Element focus, Reference fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".reference", focus.getNamedChild("reference", false), fixed.getReferenceElement_(), fixedSource, "reference", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".type", focus.getNamedChild("type", false), fixed.getTypeElement(), fixedSource, "type", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".identifier", focus.getNamedChild("identifier", false), fixed.getIdentifier(), fixedSource, "identifier", focus, pattern) && ok;
-    ok = checkFixedValue(errors, path + ".display", focus.getNamedChild("display", false), fixed.getDisplayElement(), fixedSource, "display", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".reference", focus.getNamedChild("reference", false), fixed.getReferenceElement_(), fixedSource, "reference", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".type", focus.getNamedChild("type", false), fixed.getTypeElement(), fixedSource, "type", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".identifier", focus.getNamedChild("identifier", false), fixed.getIdentifier(), fixedSource, "identifier", focus, pattern, context) && ok;
+    ok = checkFixedValue(errors, path + ".display", focus.getNamedChild("display", false), fixed.getDisplayElement(), fixedSource, "display", focus, pattern, context) && ok;
     return ok;
   }
 
-  private boolean checkTiming(List<ValidationMessage> errors, String path, Element focus, Timing fixed, String fixedSource, boolean pattern) {
+  private boolean checkTiming(List<ValidationMessage> errors, String path, Element focus, Timing fixed, String fixedSource, boolean pattern, String context) {
     boolean ok = true;
-    ok = checkFixedValue(errors, path + ".repeat", focus.getNamedChild("repeat", false), fixed.getRepeat(), fixedSource, "value", focus, pattern) && ok;
+    ok = checkFixedValue(errors, path + ".repeat", focus.getNamedChild("repeat", false), fixed.getRepeat(), fixedSource, "value", focus, pattern, context) && ok;
 
     List<Element> events = new ArrayList<Element>();
     focus.getNamedChildren("event", events);
     if (rule(errors, NO_RULE_DATE, IssueType.VALUE, focus.line(), focus.col(), path, events.size() == fixed.getEvent().size(), I18nConstants.BUNDLE_MSG_EVENT_COUNT, Integer.toString(fixed.getEvent().size()), Integer.toString(events.size()))) {
       for (int i = 0; i < events.size(); i++)
-        ok = checkFixedValue(errors, path + ".event", events.get(i), fixed.getEvent().get(i), fixedSource, "event", focus, pattern) && ok;
+        ok = checkFixedValue(errors, path + ".event", events.get(i), fixed.getEvent().get(i), fixedSource, "event", focus, pattern, context) && ok;
     } else {
       ok = false;
     }
@@ -6115,10 +6115,10 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     ValidationInfo vi = element.addDefinition(profile, definition, mode);
     
     if (definition.getFixed() != null) {
-      ok = checkFixedValue(errors, stack.getLiteralPath(), element, definition.getFixed(), profile.getVersionedUrl(), definition.getSliceName(), null, false) && ok;
+      ok = checkFixedValue(errors, stack.getLiteralPath(), element, definition.getFixed(), profile.getVersionedUrl(), definition.getSliceName(), null, false, "") && ok;
     } 
     if (definition.getPattern() != null) {
-      ok = checkFixedValue(errors, stack.getLiteralPath(), element, definition.getPattern(), profile.getVersionedUrl(), definition.getSliceName(), null, true) && ok;
+      ok = checkFixedValue(errors, stack.getLiteralPath(), element, definition.getPattern(), profile.getVersionedUrl(), definition.getSliceName(), null, true, "") && ok;
     }
     
     // get the list of direct defined children, including slices
@@ -6403,10 +6403,10 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
         ok = checkPrimitive(valContext, errors, ei.getPath(), type, checkDefn, ei.getElement(), profile, localStack, stack, valContext.getRootResource()) && ok;
       } else {
         if (checkDefn.hasFixed()) {
-          ok = checkFixedValue(errors, ei.getPath(), ei.getElement(), checkDefn.getFixed(), profile.getVersionedUrl(), checkDefn.getSliceName(), null, false) && ok;
+          ok = checkFixedValue(errors, ei.getPath(), ei.getElement(), checkDefn.getFixed(), profile.getVersionedUrl(), checkDefn.getSliceName(), null, false, "") && ok;
         }
         if (checkDefn.hasPattern()) {
-          ok = checkFixedValue(errors, ei.getPath(), ei.getElement(), checkDefn.getPattern(), profile.getVersionedUrl(), checkDefn.getSliceName(), null, true) && ok;
+          ok = checkFixedValue(errors, ei.getPath(), ei.getElement(), checkDefn.getPattern(), profile.getVersionedUrl(), checkDefn.getSliceName(), null, true, "") && ok;
         }
       }
       if (type.equals("Identifier")) {
@@ -7340,7 +7340,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
   private boolean valueMatchesCriteria(Element value, ElementDefinition criteria, StructureDefinition profile) throws FHIRException {
     if (criteria.hasFixed()) {
       List<ValidationMessage> msgs = new ArrayList<ValidationMessage>();
-      checkFixedValue(msgs, "{virtual}", value, criteria.getFixed(), profile.getVersionedUrl(), "value", null, false);
+      checkFixedValue(msgs, "{virtual}", value, criteria.getFixed(), profile.getVersionedUrl(), "value", null, false, "");
       return msgs.size() == 0;
     } else if (criteria.hasBinding() && criteria.getBinding().getStrength() == BindingStrength.REQUIRED && criteria.getBinding().hasValueSet()) {
       throw new FHIRException(context.formatMessage(I18nConstants.UNABLE_TO_RESOLVE_SLICE_MATCHING__SLICE_MATCHING_BY_VALUE_SET_NOT_DONE));
diff --git a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/type/StructureDefinitionValidator.java b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/type/StructureDefinitionValidator.java
index f82b128ad..09878ce94 100644
--- a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/type/StructureDefinitionValidator.java
+++ b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/type/StructureDefinitionValidator.java
@@ -416,6 +416,33 @@ public class StructureDefinitionValidator extends BaseValidator {
       addCharacteristics(characteristics, path);
     }
 
+    if (!snapshot && (element.hasChild("fixed") || element.hasChild("pattern"))) {
+      ElementDefinition ed = getDefinitionFromBase(base, element.getNamedChildValue("id"), element.getNamedChildValue("path"));
+      if (ed != null && (ed.hasFixed() || ed.hasPattern())) {
+        if (ed.hasFixed()) {
+          Element fixed = element.getNamedChild("fixed");
+          if (fixed != null) {
+            NodeStack fn = stack.push(fixed, 0, null, null);            
+            if (rule(errors, "2024-03-26", IssueType.INVALID, fn, fixed.fhirType().equals(ed.getFixed().fhirType()), I18nConstants.SD_ELEMENT_FIXED_WRONG_TYPE, fixed.fhirType(), ed.getFixed().fhirType())) {
+              ok = ((org.hl7.fhir.validation.instance.InstanceValidator) parent).checkFixedValue(errors, path, fixed, ed.getFixed(), base.getVersionedUrl(), "fixed", element, false, context.formatMessage(I18nConstants.SD_ELEMENT_REASON_DERIVED, base.getVersionedUrl())) && ok;
+
+            } else {
+              ok = false;
+            }
+          }
+        } else {
+          Element pattern = element.getNamedChild("pattern");
+          if (pattern != null) {
+            NodeStack fn = stack.push(pattern, 0, null, null);            
+            if (rule(errors, "2024-03-26", IssueType.INVALID, fn, pattern.fhirType().equals(ed.getFixed().fhirType()), I18nConstants.SD_ELEMENT_PATTERN_WRONG_TYPE, pattern.fhirType(), ed.getFixed().fhirType())) {
+              ok = ((org.hl7.fhir.validation.instance.InstanceValidator) parent).checkFixedValue(errors, path, pattern, ed.getFixed(), base.getVersionedUrl(), "pattern", element, true, context.formatMessage(I18nConstants.SD_ELEMENT_REASON_DERIVED, base.getVersionedUrl())) && ok;
+            } else {
+              ok = false;
+            }
+          }
+        }
+      }
+    }
     for (Element type : types) {
       if (hasMustSupportExtension(type)) {
         typeMustSupport = true;
@@ -534,6 +561,17 @@ public class StructureDefinitionValidator extends BaseValidator {
     return ok;
   }
 
+  private ElementDefinition getDefinitionFromBase(StructureDefinition base, String id, String path) {
+    ElementDefinition ed = null;
+    if (id != null) {
+      ed = base.getSnapshot().getElementById(id);
+    }
+    if (path != null) {
+      ed = base.getSnapshot().getElementById(path);
+    }
+    return ed;
+  }
+
   private boolean validateElementDefinitionInvariant(List<ValidationMessage> errors, Element invariant, NodeStack stack, Map<String, String> invariantMap, List<Element> elements, Element element, 
       String path, String rootPath, String profileUrl, String profileType, boolean snapshot, StructureDefinition base) {
     boolean ok = true;