diff --git a/org.hl7.fhir.r5/src/main/java/org/hl7/fhir/r5/utils/ToolingExtensions.java b/org.hl7.fhir.r5/src/main/java/org/hl7/fhir/r5/utils/ToolingExtensions.java
index 60bf03059..ced70d2a3 100644
--- a/org.hl7.fhir.r5/src/main/java/org/hl7/fhir/r5/utils/ToolingExtensions.java
+++ b/org.hl7.fhir.r5/src/main/java/org/hl7/fhir/r5/utils/ToolingExtensions.java
@@ -146,7 +146,10 @@ public class ToolingExtensions {
   public static final String EXT_CS_ALTERNATE_STATUS = "http://hl7.org/fhir/StructureDefinition/alternate-code-status";
   public static final String EXT_OBLIGATION_PROFILE_FLAG = "http://hl7.org/fhir/tools/StructureDefinition/obligation-profile";
   public static final String EXT_OBLIGATION_INHERITS = "http://hl7.org/fhir/tools/StructureDefinition/inherit-obligations";
-  public static final String DAR = "http://hl7.org/fhir/StructureDefinition/data-absent-reason";
+  public static final String EXT_DAR = "http://hl7.org/fhir/StructureDefinition/data-absent-reason";
+  public static final String EXT_NF = "http://hl7.org/fhir/StructureDefinition/iso21090-nullFlavor";
+  public static final String EXT_OT = "http://hl7.org/fhir/StructureDefinition/originalText";
+  public static final String EXT_CQF_EXP = "http://hl7.org/fhir/StructureDefinition/cqf-expression";
 
 
   // validated
@@ -261,7 +264,8 @@ public class ToolingExtensions {
   public static final String EXT_RESOURCE_NAME = "http://hl7.org/fhir/StructureDefinition/resource-instance-name";
   public static final String EXT_RESOURCE_DESC = "http://hl7.org/fhir/StructureDefinition/resource-instance-description";
   public static final String EXT_ARTIFACT_NAME = "http://hl7.org/fhir/StructureDefinition/artifact-name";
-  public static final String EXT_ARTIFACT_DESC = "http://hl7.org/fhir/StructureDefinition/artifact-description";
+  public static final String EXT_ARTIFACT_DESC = "http://hl7.org/fhir/StructureDefinition/artifact-description";  
+  public static final String EXT_ED_SUPPRESS = "http://hl7.org/fhir/StructureDefinition/elementdefinition-suppress";
   
   // specific extension helpers
 
diff --git a/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/Utilities.java b/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/Utilities.java
index 43cd93f75..061e882c0 100644
--- a/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/Utilities.java
+++ b/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/Utilities.java
@@ -1974,6 +1974,14 @@ public class Utilities {
     return res;
   }
 
+  public static String getRelativeUrlPath(String root, String path) {
+    String res = path.substring(root.length());
+    if (res.startsWith("/")) {
+      res = res.substring(1);
+    }
+    return res;
+  }
+
   public static List<String> listAllFiles(String path, List<String> ignoreList) {
     List<String> res = new ArrayList<>();
     addAllFiles(res, path, new File(path), ignoreList);
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 973834dec..19c6364bf 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
@@ -1014,6 +1014,7 @@ public class I18nConstants {
   public static final String CDA_UNKNOWN_TEMPLATE_EXT = "CDA_UNKNOWN_TEMPLATE_EXT";
   public static final String UNABLE_TO_DETERMINE_TYPE_CONTEXT_INV = "UNABLE_TO_DETERMINE_TYPE_CONTEXT_INV";
   public static final String ED_CONTEXT_INVARIANT_EXPRESSION_ERROR = "ED_CONTEXT_INVARIANT_EXPRESSION_ERROR";
+  public static final String VALIDATION_VAL_PROFILE_SIGNPOST_OBS = "VALIDATION_VAL_PROFILE_SIGNPOST_OBS";
 }
 
 
diff --git a/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/xml/IXMLWriter.java b/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/xml/IXMLWriter.java
index 2be6e0e6e..80459e7ad 100644
--- a/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/xml/IXMLWriter.java
+++ b/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/xml/IXMLWriter.java
@@ -103,4 +103,5 @@ public interface IXMLWriter {
 	// this is only implemented by an implementation that is producing an xhtml representation, and is able to render elements as hyperlinks 
   public abstract void link(String href);
   public abstract void anchor(String name);
+  public abstract void externalLink(String ref) throws IOException;
 }
\ No newline at end of file
diff --git a/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/xml/XMLWriter.java b/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/xml/XMLWriter.java
index b271da9a1..a8e40fee0 100644
--- a/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/xml/XMLWriter.java
+++ b/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/xml/XMLWriter.java
@@ -907,6 +907,10 @@ public class XMLWriter extends OutputStreamWriter implements IXMLWriter {
     attribute("http://www.w3.org/2001/XMLSchema-instance", "schemaLocation", ns+" "+loc);
     
   }
+  @Override
+  public void externalLink(String ref) {
+    // ignore this    
+  }
 	
 	
 }
\ No newline at end of file
diff --git a/org.hl7.fhir.utilities/src/main/resources/Messages.properties b/org.hl7.fhir.utilities/src/main/resources/Messages.properties
index 333f28dc6..90062f33f 100644
--- a/org.hl7.fhir.utilities/src/main/resources/Messages.properties
+++ b/org.hl7.fhir.utilities/src/main/resources/Messages.properties
@@ -392,7 +392,7 @@ Unable_to_resolve_name_reference__at_path_ = Unable to resolve name reference {0
 Details_for__matching_against_Profile_ = Details for {0} matching against profile {1}
 Does_not_match_slice_ = Does not match slice ''{0}'' (discriminator: {1})
 Profile__does_not_match_for__because_of_the_following_profile_issues__ = Profile {0} does not match for {1} because of the following profile issues: {2}
-This_element_does_not_match_any_known_slice_ = This element does not match any known slice {0}
+This_element_does_not_match_any_known_slice_ = This element does not match any known slice {0} (this may not be a problem, but you should check that it''s not intended to match a slice)
 defined_in_the_profile = Defined in the profile
 This_does_not_appear_to_be_a_FHIR_resource_unknown_name_ = This content cannot be parsed (unknown or unrecognized resource name ''{0}'')
 This_cannot_be_parsed_as_a_FHIR_object_no_name = This content cannot be parsed (no name)
@@ -1070,4 +1070,6 @@ TERMINOLOGY_TX_OID_MULTIPLE_MATCHES = The OID ''{0}'' matches multiple code syst
 CDA_UNKNOWN_TEMPLATE = The CDA Template {0} is not known
 CDA_UNKNOWN_TEMPLATE_EXT = The CDA Template {0} / {1} is not known
 UNABLE_TO_DETERMINE_TYPE_CONTEXT_INV = The types could not be determined from the extension context, so the invariant can't be validated (types = {0})
-ED_CONTEXT_INVARIANT_EXPRESSION_ERROR = Error in constraint ''{0}'': {1}
\ No newline at end of file
+ED_CONTEXT_INVARIANT_EXPRESSION_ERROR = Error in constraint ''{0}'': {1}
+VALIDATION_VAL_PROFILE_SIGNPOST_OBS = Validate Observation against {1} profile because the {2} code {3} was found
+ 
\ No newline at end of file
diff --git a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/BaseValidator.java b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/BaseValidator.java
index 55dc10fdd..dc324a8d9 100644
--- a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/BaseValidator.java
+++ b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/BaseValidator.java
@@ -65,7 +65,9 @@ import org.hl7.fhir.r5.terminologies.ValueSetUtilities;
 import org.hl7.fhir.r5.utils.ToolingExtensions;
 import org.hl7.fhir.r5.utils.XVerExtensionManager;
 import org.hl7.fhir.r5.utils.XVerExtensionManager.XVerExtensionStatus;
+import org.hl7.fhir.r5.utils.validation.IResourceValidator;
 import org.hl7.fhir.r5.utils.validation.ValidationContextCarrier.IValidationContextResourceLoader;
+import org.hl7.fhir.r5.utils.validation.constants.BestPracticeWarningLevel;
 import org.hl7.fhir.utilities.FhirPublication;
 import org.hl7.fhir.utilities.StandardsStatus;
 import org.hl7.fhir.utilities.Utilities;
@@ -166,7 +168,9 @@ public class BaseValidator implements IValidationContextResourceLoader {
   protected boolean forPublication;
   protected boolean debug;
   protected boolean warnOnDraftOrExperimental; 
-  protected Set<String> statusWarnings = new HashSet<>();
+  protected Set<String> statusWarnings = new HashSet<>();  
+  protected BestPracticeWarningLevel bpWarnings = BestPracticeWarningLevel.Warning;
+
 
   public BaseValidator(IWorkerContext context, XVerExtensionManager xverManager, boolean debug) {
     super();
@@ -194,6 +198,7 @@ public class BaseValidator implements IValidationContextResourceLoader {
     this.debug = parent.debug;
     this.warnOnDraftOrExperimental = parent.warnOnDraftOrExperimental;
     this.statusWarnings = parent.statusWarnings;
+    this.bpWarnings = parent.bpWarnings;
   }
   
   private boolean doingLevel(IssueSeverity error) {
@@ -1402,4 +1407,29 @@ public class BaseValidator implements IValidationContextResourceLoader {
     return ok;
   }
 
+
+  public BestPracticeWarningLevel getBestPracticeWarningLevel() {
+    return bpWarnings;
+  }
+
+  
+  protected boolean bpCheck(List<ValidationMessage> errors, IssueType invalid, int line, int col, String literalPath, boolean test, String message, Object... theMessageArguments) {
+    if (bpWarnings != null) {
+      switch (bpWarnings) {
+        case Error:
+          rule(errors, NO_RULE_DATE, invalid, line, col, literalPath, test, message, theMessageArguments);
+          return test;
+        case Warning:
+          warning(errors, NO_RULE_DATE, invalid, line, col, literalPath, test, message, theMessageArguments);
+          return true;
+        case Hint:
+          hint(errors, NO_RULE_DATE, invalid, line, col, literalPath, test, message, theMessageArguments);
+          return true;
+        default: // do nothing
+          break;
+      }
+    }
+    return true;
+  }
+
 }
\ No newline at end of file
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 f33e19bff..0bc29f1b2 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
@@ -128,6 +128,7 @@ import org.hl7.fhir.r5.model.IntegerType;
 import org.hl7.fhir.r5.model.OperationOutcome.OperationOutcomeIssueComponent;
 import org.hl7.fhir.r5.model.Period;
 import org.hl7.fhir.r5.model.PrimitiveType;
+import org.hl7.fhir.r5.model.Property;
 import org.hl7.fhir.r5.model.Quantity;
 import org.hl7.fhir.r5.model.Range;
 import org.hl7.fhir.r5.model.Ratio;
@@ -203,6 +204,7 @@ import org.hl7.fhir.validation.instance.type.BundleValidator;
 import org.hl7.fhir.validation.instance.type.CodeSystemValidator;
 import org.hl7.fhir.validation.instance.type.ConceptMapValidator;
 import org.hl7.fhir.validation.instance.type.MeasureValidator;
+import org.hl7.fhir.validation.instance.type.ObservationValidator;
 import org.hl7.fhir.validation.instance.type.QuestionnaireValidator;
 import org.hl7.fhir.validation.instance.type.SearchParameterValidator;
 import org.hl7.fhir.validation.instance.type.StructureDefinitionValidator;
@@ -320,7 +322,9 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     public FunctionDetails resolveFunction(FHIRPathEngine engine, String functionName) {
       switch (functionName) {
       case "slice": return new FunctionDetails("Returns the given slice as defined in the given structure definition. If in an invariant, First parameter can be %profile - current profile", 2, 2);
-      default: throw new FHIRException(context.formatMessage(I18nConstants.NOT_DONE_YET_VALIDATORHOSTSERVICESRESOLVEFUNCTION_, functionName));
+      case "getResourceKey" : return new FunctionDetails("Unique Key for resource", 0, 0);
+      case "getReferenceKey" : return new FunctionDetails("Unique Key for resource that is the target of the reference", 0, 1);
+      default: return null;
       }      
     }
 
@@ -331,7 +335,9 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
       case "slice":
         // todo: check parameters 
         return focus;
-      
+
+      case "getResourceKey" : return new TypeDetails(CollectionStatus.SINGLETON, "string");
+      case "getReferenceKey" : return new TypeDetails(CollectionStatus.SINGLETON, "string");
       default: throw new Error(context.formatMessage(I18nConstants.NOT_DONE_YET_VALIDATORHOSTSERVICESCHECKFUNCTION));
       }
     }
@@ -339,11 +345,47 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     @Override
     public List<Base> executeFunction(FHIRPathEngine engine, Object appContext, List<Base> focus, String functionName, List<List<Base>> parameters) {
       switch (functionName) {
-      case "slice": return executeSlice(engine, appContext, focus, parameters);
+      case "slice": return executeSlice(engine, appContext, focus, parameters);case "getResourceKey" : return executeResourceKey(focus);
+      case "getReferenceKey" : return executeReferenceKey(null, focus, parameters);
       default: throw new Error(context.formatMessage(I18nConstants.NOT_DONE_YET_VALIDATORHOSTSERVICESEXECUTEFUNCTION));
       }
     }
 
+
+    private List<Base> executeResourceKey(List<Base> focus) {
+      List<Base> base = new ArrayList<Base>();
+      if (focus.size() == 1) {
+        Base res = focus.get(0);
+        base.add(new StringType(res.fhirType()+"/"+res.getIdBase()));
+      }
+      return base;
+    }
+    
+    private List<Base> executeReferenceKey(Base rootResource, List<Base> focus, List<List<Base>> parameters) {
+      List<Base> base = new ArrayList<Base>();
+      if (focus.size() == 1) {
+        Base res = focus.get(0);
+        String ref = null;
+        if (res.fhirType().equals("Reference")) {
+          ref = getRef(res);
+        } else if (res.isPrimitive()) {
+          ref = res.primitiveValue();
+        } else {
+          throw new FHIRException("Unable to generate a reference key based on a "+res.fhirType());
+        }
+        base.add(new StringType(ref));
+      }
+      return base;
+    }
+
+    private String getRef(Base res) {
+      Property prop = res.getChildByName("reference");
+      if (prop != null && prop.getValues().size() == 1) {
+        return prop.getValues().get(0).primitiveValue();
+      }
+      return null;
+    }
+    
     private List<Base> executeSlice(FHIRPathEngine engine, Object appContext, List<Base> focus, List<List<Base>> parameters) {
       ValidationContext c = (ValidationContext) appContext;
       
@@ -512,7 +554,6 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
   private boolean noTerminologyChecks;
   private boolean hintAboutNonMustSupport;
   private boolean showMessagesFromReferences;
-  private BestPracticeWarningLevel bpWarnings = BestPracticeWarningLevel.Warning;
   private String validationLanguage;
   private boolean baseOnly;
   private boolean noCheckAggregation;
@@ -716,26 +757,6 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
         return true;
     return false;
   }
-
-  private boolean bpCheck(List<ValidationMessage> errors, IssueType invalid, int line, int col, String literalPath, boolean test, String message, Object... theMessageArguments) {
-    if (bpWarnings != null) {
-      switch (bpWarnings) {
-        case Error:
-          rule(errors, NO_RULE_DATE, invalid, line, col, literalPath, test, message, theMessageArguments);
-          return test;
-        case Warning:
-          warning(errors, NO_RULE_DATE, invalid, line, col, literalPath, test, message, theMessageArguments);
-          return true;
-        case Hint:
-          hint(errors, NO_RULE_DATE, invalid, line, col, literalPath, test, message, theMessageArguments);
-          return true;
-        default: // do nothing
-          break;
-      }
-    }
-    return true;
-  }
-
   @Override
   public org.hl7.fhir.r5.elementmodel.Element validate(Object appContext, List<ValidationMessage> errors, InputStream stream, FhirFormat format) throws FHIRException {
     return validate(appContext, errors, stream, format, new ArrayList<>());
@@ -4105,10 +4126,6 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     return null;
   }
 
-  public BestPracticeWarningLevel getBestPracticeWarningLevel() {
-    return bpWarnings;
-  }
-
   @Override
   public CheckDisplayOption getCheckDisplay() {
     return checkDisplay;
@@ -4649,14 +4666,6 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     this.anyExtensionsAllowed = anyExtensionsAllowed;
   }
 
-  public IResourceValidator setBestPracticeWarningLevel(BestPracticeWarningLevel value) {
-    if (value == null) {
-      bpWarnings = BestPracticeWarningLevel.Warning;   
-    } else {
-      bpWarnings = value;
-    }
-    return this;
-  }
 
   @Override
   public void setCheckDisplay(CheckDisplayOption checkDisplay) {
@@ -4724,15 +4733,14 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
             if (!criteriaElement.getPath().contains("[") && discriminator.contains("[")) {
               discriminator = discriminator.substring(0, discriminator.indexOf('['));
               String lastNode = tail(discriminator);
-              type = tail(criteriaElement.getPath()).substring(lastNode.length());
-              type = type.substring(0, 1).toLowerCase() + type.substring(1);
+              type = makeTypeForFHIRPath(criteriaElement.getPath()).substring(lastNode.length());
             } else if (!criteriaElement.hasType() || criteriaElement.getType().size() == 1) {
               if (discriminator.contains("["))
                 discriminator = discriminator.substring(0, discriminator.indexOf('['));
               if (criteriaElement.hasType()) {
-                type = criteriaElement.getType().get(0).getWorkingCode();
+                type = makeTypeForFHIRPath(criteriaElement.getType().get(0).getWorkingCode());
               } else if (!criteriaElement.getPath().contains(".")) {
-                type = criteriaElement.getPath();
+                type = makeTypeForFHIRPath(criteriaElement.getPath());
               } else {
                 throw new DefinitionException(context.formatMessage(I18nConstants.DISCRIMINATOR__IS_BASED_ON_TYPE_BUT_SLICE__IN__HAS_NO_TYPES, discriminator, ed.getId(), profile.getVersionedUrl()));
               }
@@ -4818,6 +4826,25 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     return pass;
   }
 
+  private String makeTypeForFHIRPath(String type) {
+    if (Utilities.isAbsoluteUrl(type)) {
+      if (type.startsWith("http://hl7.org/fhir/StructureDefinition/")) {
+        return tail(type);
+      } else if (type.startsWith("http://hl7.org/cda/stds/core/StructureDefinition/")) {
+        return "CDA."+tail(type); 
+      } else {
+        return tail(type); // todo?
+      }
+    } else {
+      String ptype = type.substring(0, 1).toLowerCase() + type.substring(1);
+      if (context.isPrimitiveType(ptype)) {
+        return ptype;        
+      } else {
+        return type;
+      }
+    }
+  }
+
   private boolean isBaseDefinition(String url) {
     boolean b = url.startsWith("http://hl7.org/fhir/") && !url.substring(40).contains("/");
     return b;
@@ -5425,7 +5452,7 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
       if (element.getType().equals(BUNDLE)) {
         return new BundleValidator(this, serverBase).validateBundle(errors, element, stack, checkSpecials, valContext, pct, mode) && ok;
       } else if (element.getType().equals("Observation")) {
-        return validateObservation(errors, element, stack) && ok;
+        return new ObservationValidator(this).validateObservation(valContext, errors, element, stack, pct, mode) && ok;
       } else if (element.getType().equals("Questionnaire")) {
         return new QuestionnaireValidator(this, myEnableWhenEvaluator, fpe, questionnaireMode).validateQuestionannaire(errors, element, element, stack) && ok;
       } else if (element.getType().equals("QuestionnaireResponse")) {
@@ -6814,21 +6841,6 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
     return false;
   }
 
-  private boolean validateObservation(List<ValidationMessage> errors, Element element, NodeStack stack) {
-    boolean ok = true;
-    // all observations should have a subject, a performer, and a time
-
-    ok = bpCheck(errors, IssueType.INVALID, element.line(), element.col(), stack.getLiteralPath(), element.getNamedChild("subject") != null, I18nConstants.ALL_OBSERVATIONS_SHOULD_HAVE_A_SUBJECT) && ok;
-    List<Element> performers = new ArrayList<>();
-    element.getNamedChildren("performer", performers);
-    ok = bpCheck(errors, IssueType.INVALID, element.line(), element.col(), stack.getLiteralPath(), performers.size() > 0, I18nConstants.ALL_OBSERVATIONS_SHOULD_HAVE_A_PERFORMER) && ok;
-    ok = bpCheck(errors, IssueType.INVALID, element.line(), element.col(), stack.getLiteralPath(), 
-          element.getNamedChild("effectiveDateTime") != null || element.getNamedChild("effectivePeriod") != null || 
-          element.getNamedChild("effectiveTiming") != null || element.getNamedChild("effectiveInstant") != null, 
-          I18nConstants.ALL_OBSERVATIONS_SHOULD_HAVE_AN_EFFECTIVEDATETIME_OR_AN_EFFECTIVEPERIOD, element.getProperty().typeSummary()) && ok;    
-    return ok;
-  }
-
   /*
    * The actual base entry point for internal use (re-entrant)
    */
@@ -7305,5 +7317,13 @@ public class InstanceValidator extends BaseValidator implements IResourceValidat
   public void setSignatureServices(IDigitalSignatureServices signatureServices) {
     this.signatureServices = signatureServices;
   }
-  
+
+  public IResourceValidator setBestPracticeWarningLevel(BestPracticeWarningLevel value) {
+    if (value == null) {
+      bpWarnings = BestPracticeWarningLevel.Warning;   
+    } else {
+      bpWarnings = value;
+    }
+    return this;
+  }
 }
\ No newline at end of file
diff --git a/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/type/ObservationValidator.java b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/type/ObservationValidator.java
new file mode 100644
index 000000000..80ccddbf3
--- /dev/null
+++ b/org.hl7.fhir.validation/src/main/java/org/hl7/fhir/validation/instance/type/ObservationValidator.java
@@ -0,0 +1,129 @@
+package org.hl7.fhir.validation.instance.type;
+
+import java.util.ArrayList;
+import java.util.List;
+
+import org.hl7.fhir.exceptions.FHIRException;
+import org.hl7.fhir.r5.elementmodel.Element;
+import org.hl7.fhir.r5.model.StructureDefinition;
+import org.hl7.fhir.r5.model.Base.ValidationMode;
+import org.hl7.fhir.utilities.Utilities;
+import org.hl7.fhir.utilities.VersionUtilities;
+import org.hl7.fhir.utilities.i18n.I18nConstants;
+import org.hl7.fhir.utilities.validation.ValidationMessage;
+import org.hl7.fhir.utilities.validation.ValidationMessage.IssueType;
+import org.hl7.fhir.validation.BaseValidator;
+import org.hl7.fhir.validation.instance.InstanceValidator;
+import org.hl7.fhir.validation.instance.PercentageTracker;
+import org.hl7.fhir.validation.instance.utils.NodeStack;
+import org.hl7.fhir.validation.instance.utils.ValidationContext;
+
+public class ObservationValidator extends BaseValidator {
+
+
+  public ObservationValidator(BaseValidator parent) {
+    super(parent);
+  }
+
+  public boolean validateObservation(ValidationContext valContext, List<ValidationMessage> errors, Element element, NodeStack stack, PercentageTracker pct, ValidationMode mode) {
+    boolean ok = true;
+    // all observations should have a subject, a performer, and a time
+
+    ok = bpCheck(errors, IssueType.INVALID, element.line(), element.col(), stack.getLiteralPath(), element.getNamedChild("subject") != null, I18nConstants.ALL_OBSERVATIONS_SHOULD_HAVE_A_SUBJECT) && ok;
+    List<Element> performers = new ArrayList<>();
+    element.getNamedChildren("performer", performers);
+    ok = bpCheck(errors, IssueType.INVALID, element.line(), element.col(), stack.getLiteralPath(), performers.size() > 0, I18nConstants.ALL_OBSERVATIONS_SHOULD_HAVE_A_PERFORMER) && ok;
+    ok = bpCheck(errors, IssueType.INVALID, element.line(), element.col(), stack.getLiteralPath(), 
+          element.getNamedChild("effectiveDateTime") != null || element.getNamedChild("effectivePeriod") != null || 
+          element.getNamedChild("effectiveTiming") != null || element.getNamedChild("effectiveInstant") != null, 
+          I18nConstants.ALL_OBSERVATIONS_SHOULD_HAVE_AN_EFFECTIVEDATETIME_OR_AN_EFFECTIVEPERIOD, element.getProperty().typeSummary()) && ok;   
+    
+    // hook in the vital signs 
+    if (VersionUtilities.isR4Plus(context.getVersion())) {
+      Element code = element.getNamedChild("code");
+      List<String> codes = new ArrayList<>();
+      if (hasLoincCode(code, codes, "85353-1")) {
+        ok = checkObservationAgainstProfile(valContext, errors, element, stack, "http://hl7.org/fhir/StructureDefinition/vitalspanel", "Vital Signs Panel", "LOINC", codes, pct, mode) && ok;
+      } else if (hasLoincCode(code, codes, "9279-1", "76170-0", "76172-6", "76171-8", "19840-8", "33438-3", "76270-8", "11291-2")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/resprate", "Respiratory Rate", "LOINC", codes, pct, mode) && ok;
+      } else if (hasLoincCode(code, codes, "60978-4", "73795-7", "73799-9", "76476-1", "76477-9", "8867-4", "8889-8", "8890-6", "8891-4", "8892-2", "8893-0", "40443-4", "55425-3", "68999-2", "11328-2", "69000-8", "69000-8", "60978-4", "60978-4", "8890-6", "8886-4", "68999-2", "68999-2")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/heartrate", "Heart rate", "LOINC", codes, pct, mode) && ok;
+      } else if (hasLoincCode(code, codes, "2708-6", "19224-5", "20564-1", "2709-4", "2710-2", "2711-0", "2713-6", "51733-4", "59408-5", "59417-6", "89276-0", "97549-0")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/oxygensat", "Oxygen saturation", "LOINC", codes, pct, mode) && ok;
+      } else if (hasLoincCode(code, codes, "8310-5", "60834-9", "60835-6", "60836-4", "60838-0", "60955-2", "61009-7", "75539-7", "75987-8", "76010-8", "76011-6", "76278-1", "8309-7", "8310-5", "8328-7", "8329-5", "8330-3", "8331-1", "8332-9", "8333-7", "8334-5", "91371-5", "98657-0", "98663-8")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/bodytemp", "Body temperature", "LOINC", codes, pct, mode) && ok;
+      } else if (hasLoincCode(code, codes, "8302-2", "3137-7", "3138-5", "8302-2", "8306-3", "8308-9")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/bodyheight", "Body height", "LOINC", codes, pct, mode) && ok;
+      } else if (hasLoincCode(code, codes, "9843-4", "8287-5", "9843-4", "8289-1")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/headcircum", "Head circumference", "LOINC", codes, pct, mode) && ok;
+      } else if (hasLoincCode(code, codes, "29463-7", "29463-7", "3141-9", "3142-7", "75292-3", "79348-9", "8350-1", "8351-9")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/bodyweight", "Body weight", "LOINC", codes, pct, mode) && ok;
+      } else if (hasLoincCode(code, codes, "39156-5", "39156-5", "59574-4", "89270-3")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/bmi", "Body mass index", "LOINC", codes, pct, mode) && ok;
+      } else if (hasLoincCode(code, codes, "85354-9", "96607-7", "35094-2", "8459-0", "85354-9", "76534-7", "96607-7", "55284-4", "8480-6")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/bp", "Blood pressure systolic and diastolic", "LOINC", codes, pct, mode) && ok;
+      
+      } else if (hasSctCode(code, codes, "46680005")) {
+        ok = checkObservationAgainstProfile(valContext, errors, element, stack, "http://hl7.org/fhir/StructureDefinition/vitalspanel", "Vital Signs Panel", "SNOMED CT", codes, pct, mode) && ok;
+      } else if (hasSctCode(code, codes, "86290005", "271625008", "271306003")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "Blood pressure systolic and diastolic", "Respiratory Rate", "SNOMED CT", codes, pct, mode) && ok;
+      } else if (hasSctCode(code, codes, "271306003", "249043002", "444981005", "399017001", "251670001", "429525003", "429614003")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/heartrate", "Heart rate", "SNOMED CT", codes, pct, mode) && ok;
+      } else if (hasSctCode(code, codes, "103228002", "103228002", "442349007", "442476006", "442440005", "431314004", "442734002", "713194001")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/oxygensat", "Oxygen saturation", "SNOMED CT", codes, pct, mode) && ok;
+      } else if (hasSctCode(code, codes, "386725007", "276885007", "300076005", "1222808002", "364246006", "307047009", "708499008", "708499008", "431598003", "698831002", "698832009", "415882003", "415974002", "415929009", "415945006")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/bodytemp", "Body temperature", "SNOMED CT", codes, pct, mode) && ok;
+      } else if (hasSctCode(code, codes, "1153637007", "1162419008", "50373000", "1162418000", "1230278008", "1162392001", "1162417005")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/bodyheight", "Body height", "SNOMED CT", codes, pct, mode) && ok;
+      } else if (hasSctCode(code, codes, "363812007", "169876006", "1269262007", "363811000")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/headcircum", "Head circumference", "SNOMED CT", codes, pct, mode) && ok;
+      } else if (hasSctCode(code, codes, "363811000", "60621009", "735395000", "425024002", "424927000", "784399000", "1162416001", "1162415002")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/bodyweight", "Body weight", "SNOMED CT", codes, pct, mode) && ok;
+      } else if (hasSctCode(code, codes, "60621009")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/bmi", "Body mass index", "SNOMED CT", codes, pct, mode) && ok;
+      } else if (hasSctCode(code, codes, "75367002", "251076008", "6797001", "163033001", "123820005", "163035008", "723232008", "386534000", "386536003", "271649006", "271649006", "271650006", "407556006", "407554009", "716579001", "399304008")) {
+        ok = checkObservationAgainstProfile(valContext,errors, element, stack, "http://hl7.org/fhir/StructureDefinition/bp", "Blood pressure systolic and diastolic", "SNOMED CT", codes, pct, mode) && ok;
+      }  
+    }
+    return ok;
+  }
+
+  private boolean checkObservationAgainstProfile(ValidationContext valContext, List<ValidationMessage> errors, Element element, NodeStack stack, String url, String name, String sys, List<String> loinc, PercentageTracker pct, ValidationMode mode) {
+    element.addMessage(signpost(errors, NO_RULE_DATE, IssueType.INFORMATIONAL, element.line(), element.col(), stack.getLiteralPath(), I18nConstants.VALIDATION_VAL_PROFILE_SIGNPOST_OBS, url, name, sys, loinc.get(0)));
+    StructureDefinition sd = context.fetchResource(StructureDefinition.class, url);
+    if (sd == null) {
+      return false;
+    } else {
+      return ((InstanceValidator) parent).startInner(valContext, errors, element, element, sd, stack, false, pct, mode);
+    }
+  }
+
+  private boolean hasLoincCode(Element code, List<String> codes, String... values) {
+    if (code != null) {
+      List<Element> codings = code.getChildren("coding");
+      for (Element coding : codings) {
+        if ("http://loinc.org".equals(coding.getNamedChildValue("system")) && Utilities.existsInList(coding.getNamedChildValue("code"), values)) {
+          codes.add(coding.getNamedChildValue("code"));
+          return true;
+        }
+      }
+    }
+    return false;
+  }
+
+  private boolean hasSctCode(Element code, List<String> codes, String... values) {
+    if (code != null) {
+      List<Element> codings = code.getChildren("coding");
+      for (Element coding : codings) {
+        if ("http://snomed.info/sct".equals(coding.getNamedChildValue("system")) && Utilities.existsInList(coding.getNamedChildValue("code"), values)) {
+          codes.add(coding.getNamedChildValue("code"));
+          return true;
+        }
+      }
+    }
+    return false;
+  }
+
+  
+
+}
diff --git a/org.hl7.fhir.validation/src/test/java/org/hl7/fhir/validation/tests/ValidationEngineTests.java b/org.hl7.fhir.validation/src/test/java/org/hl7/fhir/validation/tests/ValidationEngineTests.java
index 4625078b7..6f30fd303 100644
--- a/org.hl7.fhir.validation/src/test/java/org/hl7/fhir/validation/tests/ValidationEngineTests.java
+++ b/org.hl7.fhir.validation/src/test/java/org/hl7/fhir/validation/tests/ValidationEngineTests.java
@@ -271,7 +271,7 @@ public class ValidationEngineTests {
     int h = hints(op);
     Assertions.assertEquals(0, e);
     Assertions.assertEquals(4, w);
-    Assertions.assertEquals(0, h);
+    Assertions.assertEquals(1, h);
     assertTrue(logger.verifyHasNoRequests(), "Unexpected request to TX server");
     if (!TestUtilities.silent)
       System.out.println("  .. done: " + Integer.toString(e) + " errors, " + Integer.toString(w) + " warnings, " + Integer.toString(h) + " information messages");
diff --git a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/all-systems.cache b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/all-systems.cache
index 169fb075d..6a01d89ec 100644
--- a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/all-systems.cache
+++ b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/all-systems.cache
@@ -1465,6 +1465,71 @@ v: {
   "display" : "English (Region=United States)",
   "code" : "en-US",
   "system" : "urn:ietf:bcp:47",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://snomed.info/sct",
+  "version" : "http://snomed.info/sct/900000000000207008/version/20210731",
+  "code" : "27113001",
+  "display" : "Body weight (observable entity)"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "The CodeSystem http://snomed.info/sct version http://snomed.info/sct/900000000000207008/version/20210731 is unknown. Valid versions: [http://snomed.info/sct/11000146104/version/20230331,http://snomed.info/sct/11000172109/version/20221115,http://snomed.info/sct/2011000195101/version/20230607,http://snomed.info/sct/20611000087101/version/20220930,http://snomed.info/sct/32506021000036107/version/20220731,http://snomed.info/sct/45991000052106/version/20210531,http://snomed.info/sct/554471000005108/version/20210930,http://snomed.info/sct/731000124108/version/20230301,http://snomed.info/sct/83821000000107/version/20230412,http://snomed.info/sct/900000000000207008/version/20230131,http://snomed.info/sct/900000000000207008/version/20230731] (from Tx-Server)",
+  "class" : "CODESYSTEM_UNSUPPORTED",
+  "unknown-systems" : "http://snomed.info/sct|http://snomed.info/sct/900000000000207008/version/20210731",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://snomed.info/sct",
+  "code" : "276885007"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Core body temperature",
+  "code" : "276885007",
+  "system" : "http://snomed.info/sct",
+  "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "code" : "Cel"
+}, "url": "http://hl7.org/fhir/ValueSet/ucum-bodytemp", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"true", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Cel",
+  "code" : "Cel",
+  "system" : "http://unitsofmeasure.org",
+  "version" : "2.0.1",
   "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
diff --git a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/loinc.cache b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/loinc.cache
index d8690cd22..4f5d6015c 100644
--- a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/loinc.cache
+++ b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/loinc.cache
@@ -5739,7 +5739,6 @@ v: {
   "severity" : "error",
   "error" : "Unknown Code 'X-34133-9' in the system 'http://loinc.org|2.74'; The provided code 'http://loinc.org#X-34133-9' is not in the value set 'http://hl7.org/fhir/ValueSet/@all' (from Tx-Server)",
   "class" : "UNKNOWN",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -5760,6 +5759,397 @@ v: {
   "severity" : "error",
   "error" : "Unknown Code 'X-34133-9' in the system 'http://loinc.org|2.74'; The provided code 'http://loinc.org#X-34133-9' is not in the value set 'http://hl7.org/fhir/ValueSet/doc-typecodes--0|4.0.1' (from Tx-Server)",
   "class" : "UNKNOWN",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "96607-7",
+  "display" : "Blood pressure panel mean systolic and mean diastolic"
+}, "valueSet" :null, "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Blood pressure panel mean systolic and mean diastolic",
+  "code" : "96607-7",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "96608-5",
+  "display" : "Systolic blood pressure mean"
+}, "valueSet" :null, "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Systolic blood pressure mean",
+  "code" : "96608-5",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "96609-3",
+  "display" : "Diastolic blood pressure mean"
+}, "valueSet" :null, "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Diastolic blood pressure mean",
+  "code" : "96609-3",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "96607-7"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "The provided code 'http://loinc.org#96607-7' is not in the value set 'http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0|4.0.1' (from Tx-Server)",
+  "class" : "UNKNOWN",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "96608-5"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "The provided code 'http://loinc.org#96608-5' is not in the value set 'http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0|4.0.1' (from Tx-Server)",
+  "class" : "UNKNOWN",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "96609-3"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "The provided code 'http://loinc.org#96609-3' is not in the value set 'http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0|4.0.1' (from Tx-Server)",
+  "class" : "UNKNOWN",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "59408-5"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "The provided code 'http://loinc.org#59408-5' is not in the value set 'http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0|4.0.1' (from Tx-Server)",
+  "class" : "UNKNOWN",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "59408-5",
+  "display" : "O2 % BldC Oximetry"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "Wrong Display Name 'O2 % BldC Oximetry' for http://loinc.org#59408-5 - should be one of 26 choices: 'Oxygen saturation in Arterial blood by Pulse oximetry', 'SaO2 % BldA PulseOx', 'O2 SaO2' (pl-PL), 'saturacja krwi tlenem' (pl-PL), 'MFr O2' (zh-CN), 'tO2' (zh-CN), '总氧' (zh-CN), '氧气 SaO2 动脉血 动脉血O2饱和度 可用数量表示的' (zh-CN), '定量性' (zh-CN), '数值型' (zh-CN), '数量型' (zh-CN), '连续数值型标尺 时刻' (zh-CN), '随机' (zh-CN), '随意' (zh-CN), '瞬间 肺部测量指标与呼吸机管理 脉搏血氧测定法' (zh-CN), '脉搏血氧定量' (zh-CN), '脉搏血氧测定' (zh-CN), '脉搏血氧仪 血氧测定法 饱和 饱和状态 饱和程度' (zh-CN), 'O2-Sättigung' (de-DE), 'Frazione di massa Gestione ventilazione polmonare Punto nel tempo (episodio) Sangue arterioso' (it-IT), 'Oksijen doymuşluğu' (tr-TR), 'Количественный Кровь артериальная Массовая доля Насыщение кислородом Оксигемометрия' (ru-RU), 'Гемоксиметрия Точка во времени' (ru-RU), 'Момент' (ru-RU), 'zuurstofsaturatiemeting' (nl-NL) or 'O2 SatO2' (fr-BE) (for the language(s) '--') (from Tx-Server)",
+  "class" : "UNKNOWN",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "2708-6",
+  "display" : "Oxygen saturation in Arterial blood"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Oxygen saturation in Arterial blood",
+  "code" : "2708-6",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "3150-0"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "The provided code 'http://loinc.org#3150-0' is not in the value set 'http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0|4.0.1' (from Tx-Server)",
+  "class" : "UNKNOWN",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "3151-8"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "The provided code 'http://loinc.org#3151-8' is not in the value set 'http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0|4.0.1' (from Tx-Server)",
+  "class" : "UNKNOWN",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "8867-4"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Heart rate",
+  "code" : "8867-4",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "8867-4",
+  "display" : "Heart rate"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Heart rate",
+  "code" : "8867-4",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "8867-4"
+}, "valueSet" :null, "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Heart rate",
+  "code" : "8867-4",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "version" : "2.71",
+  "code" : "29463-7",
+  "display" : "Body weight"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body weight",
+  "code" : "29463-7",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "version" : "2.71",
+  "code" : "29463-7"
+}, "valueSet" :null, "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body weight",
+  "code" : "29463-7",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "8310-5"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body temperature",
+  "code" : "8310-5",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "8310-5"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body temperature",
+  "code" : "8310-5",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
   "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
diff --git a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/snomed.cache b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/snomed.cache
index 047a17c52..e3e7c6929 100644
--- a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/snomed.cache
+++ b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/snomed.cache
@@ -4228,7 +4228,6 @@ v: {
   "code" : "78615007",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome",
   "issue" : [{
@@ -4293,7 +4292,6 @@ v: {
   "code" : "246075003",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -4316,7 +4314,50 @@ v: {
   "code" : "363702006",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://snomed.info/sct",
+  "code" : "723961002",
+  "display" : "Structure of left brachial artery (body structure)"
+}, "valueSet" :null, "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Structure of left brachial artery (body structure)",
+  "code" : "723961002",
+  "system" : "http://snomed.info/sct",
+  "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://snomed.info/sct",
+  "version" : "http://snomed.info/sct/900000000000207008/version/20210731",
+  "code" : "27113001"
+}, "valueSet" :null, "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "The CodeSystem http://snomed.info/sct version http://snomed.info/sct/900000000000207008/version/20210731 is unknown. Valid versions: [http://snomed.info/sct/11000146104/version/20230331,http://snomed.info/sct/11000172109/version/20221115,http://snomed.info/sct/2011000195101/version/20230607,http://snomed.info/sct/20611000087101/version/20220930,http://snomed.info/sct/32506021000036107/version/20220731,http://snomed.info/sct/45991000052106/version/20210531,http://snomed.info/sct/554471000005108/version/20210930,http://snomed.info/sct/731000124108/version/20230301,http://snomed.info/sct/83821000000107/version/20230412,http://snomed.info/sct/900000000000207008/version/20230131,http://snomed.info/sct/900000000000207008/version/20230731] (from Tx-Server)",
+  "class" : "CODESYSTEM_UNSUPPORTED",
+  "unknown-systems" : "http://snomed.info/sct|http://snomed.info/sct/900000000000207008/version/20210731",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
diff --git a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/ucum.cache b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/ucum.cache
index 635c4f27b..7bb071a09 100644
--- a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/ucum.cache
+++ b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/4.0.1/ucum.cache
@@ -556,7 +556,6 @@ v: {
   "code" : "h",
   "system" : "http://unitsofmeasure.org",
   "version" : "2.0.1",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -578,7 +577,6 @@ v: {
   "code" : "ar",
   "system" : "http://unitsofmeasure.org",
   "version" : "2.0.1",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -600,6 +598,26 @@ v: {
   "code" : "l",
   "system" : "http://unitsofmeasure.org",
   "version" : "2.0.1",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://unitsofmeasure.org",
+  "code" : "mm[Hg]{hg}"
+}, "url": "http://hl7.org/fhir/ValueSet/ucum-vitals-common--0", "version": "4.0.1", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "The provided code 'http://unitsofmeasure.org#mm[Hg]{hg}' is not in the value set 'http://hl7.org/fhir/ValueSet/ucum-vitals-common--0|4.0.1' (from Tx-Server)",
+  "class" : "UNKNOWN",
   "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
diff --git a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/all-systems.cache b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/all-systems.cache
index a9d4f86d7..6f0645f12 100644
--- a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/all-systems.cache
+++ b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/all-systems.cache
@@ -73,7 +73,6 @@ v: {
   "display" : "text/plain",
   "code" : "text/plain",
   "system" : "urn:ietf:bcp:13",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -96,7 +95,6 @@ v: {
   "code" : "271649006",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -116,7 +114,6 @@ v: {
   "display" : "json",
   "code" : "json",
   "system" : "urn:ietf:bcp:13",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -137,7 +134,6 @@ v: {
   "display" : "World",
   "code" : "001",
   "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -156,7 +152,6 @@ v: {
 v: {
   "code" : "nl-NL",
   "system" : "urn:ietf:bcp:47",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -175,7 +170,6 @@ v: {
 v: {
   "code" : "en-AU",
   "system" : "urn:ietf:bcp:47",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -195,7 +189,6 @@ v: {
   "display" : "English",
   "code" : "en",
   "system" : "urn:ietf:bcp:47",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -217,6 +210,49 @@ v: {
   "display" : "World",
   "code" : "001",
   "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://snomed.info/sct",
+  "code" : "27113001",
+  "display" : "Body weight"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "5.0.0", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"true", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body weight",
+  "code" : "27113001",
+  "system" : "http://snomed.info/sct",
+  "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "code" : "[lb_av]"
+}, "url": "http://hl7.org/fhir/ValueSet/ucum-bodyweight", "version": "5.0.0", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"true", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"true", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "[lb_av]",
+  "code" : "[lb_av]",
+  "system" : "http://unitsofmeasure.org",
+  "version" : "2.0.1",
   "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
diff --git a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/loinc.cache b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/loinc.cache
index 1fe216ac1..6c0613d07 100644
--- a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/loinc.cache
+++ b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/loinc.cache
@@ -814,6 +814,70 @@ v: {
     "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
   }]
 }}####
+v: {
+  "display" : "Body weight",
+  "code" : "29463-7",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "29463-7"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "5.0.0", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body weight",
+  "code" : "29463-7",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "29463-7",
+  "display" : "Body Weight"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "5.0.0", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"false", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body weight",
+  "code" : "29463-7",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "29463-7"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "5.0.0", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"true", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
 v: {
   "display" : "Body weight",
   "code" : "29463-7",
@@ -826,3 +890,114 @@ v: {
 
 }
 -------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "3141-9"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0", "version": "5.0.0", "langs":"", "useServer":"true", "useClient":"false", "guessSystem":"false", "valueSetMode":"CHECK_MEMERSHIP_ONLY", "displayWarningMode":"false", "versionFlexible":"true", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "severity" : "error",
+  "error" : "The provided code 'http://loinc.org#3141-9' is not in the value set 'http://hl7.org/fhir/ValueSet/observation-vitalsignresult--0|5.0.0' (from Tx-Server)",
+  "class" : "UNKNOWN",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "29463-7",
+  "display" : "Body Weight"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "5.0.0", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"true", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body weight",
+  "code" : "29463-7",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "3141-9",
+  "display" : "Body weight Measured"
+}, "url": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult", "version": "5.0.0", "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"NO_MEMBERSHIP_CHECK", "displayWarningMode":"false", "versionFlexible":"true", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body weight Measured",
+  "code" : "3141-9",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "29463-7"
+}, "valueSet" :null, "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"true", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body weight",
+  "code" : "29463-7",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://loinc.org",
+  "code" : "3141-9"
+}, "valueSet" :null, "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"true", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body weight Measured",
+  "code" : "3141-9",
+  "system" : "http://loinc.org",
+  "version" : "2.74",
+  "unknown-systems" : "",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
diff --git a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/snomed.cache b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/snomed.cache
index 9ba2bad42..bd77588df 100644
--- a/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/snomed.cache
+++ b/org.hl7.fhir.validation/src/test/resources/txCache/org.hl7.fhir.validation/5.0.0/snomed.cache
@@ -428,7 +428,6 @@ v: {
   "code" : "368209003",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -451,7 +450,6 @@ v: {
   "code" : "271649006",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -473,7 +471,6 @@ v: {
   "code" : "271649006",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -520,7 +517,6 @@ v: {
   "code" : "132037003",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/731000124108/version/20230301",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome",
   "issue" : [{
@@ -550,7 +546,6 @@ v: {
   "severity" : "error",
   "error" : "Wrong Display Name 'Pineywoods pig breed. Not.' for http://snomed.info/sct#132037003 - should be one of 3 choices: 'Pineywoods pig', 'Pineywoods pig breed (organism)' or 'Pineywoods pig breed' (for the language(s) '--') (from Tx-Server)",
   "class" : "UNKNOWN",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome",
   "issue" : [{
@@ -580,7 +575,6 @@ v: {
   "code" : "109006",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -602,7 +596,6 @@ v: {
   "code" : "109006",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -625,7 +618,6 @@ v: {
   "code" : "109006",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -647,7 +639,6 @@ v: {
   "code" : "109006",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -670,7 +661,6 @@ v: {
   "code" : "106004",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -691,7 +681,6 @@ v: {
   "severity" : "error",
   "error" : "The provided code 'http://snomed.info/sct#106004' is not in the value set 'http://hl7.org/fhir/ValueSet/clinical-findings--0|5.0.0' (from Tx-Server)",
   "class" : "UNKNOWN",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -714,7 +703,6 @@ v: {
   "code" : "106004",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -743,7 +731,6 @@ v: {
   "code" : "106004",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -766,7 +753,6 @@ v: {
   "code" : "85600001",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -789,7 +775,6 @@ v: {
   "code" : "58108001",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome",
   "issue" : [{
@@ -840,7 +825,6 @@ v: {
   "code" : "122555007",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -863,7 +847,6 @@ v: {
   "code" : "263678003",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -886,7 +869,6 @@ v: {
   "code" : "119364003",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -909,7 +891,6 @@ v: {
   "code" : "61088005",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -932,7 +913,6 @@ v: {
   "code" : "702281005",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -955,7 +935,6 @@ v: {
   "code" : "119361006",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -978,7 +957,6 @@ v: {
   "code" : "32039001",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -999,7 +977,6 @@ v: {
   "code" : "230993007",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -1020,7 +997,6 @@ v: {
   "code" : "385633008",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
-  "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
 }
@@ -1041,6 +1017,27 @@ v: {
   "code" : "260388006",
   "system" : "http://snomed.info/sct",
   "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
+  "issues" : {
+  "resourceType" : "OperationOutcome"
+}
+
+}
+-------------------------------------------------------------------------------------
+{"code" : {
+  "system" : "http://snomed.info/sct",
+  "code" : "27113001"
+}, "valueSet" :null, "langs":"", "useServer":"true", "useClient":"true", "guessSystem":"false", "valueSetMode":"ALL_CHECKS", "displayWarningMode":"false", "versionFlexible":"true", "profile": {
+  "resourceType" : "Parameters",
+  "parameter" : [{
+    "name" : "profile-url",
+    "valueString" : "http://hl7.org/fhir/ExpansionProfile/dc8fd4bc-091a-424a-8a3b-6198ef146891"
+  }]
+}}####
+v: {
+  "display" : "Body weight",
+  "code" : "27113001",
+  "system" : "http://snomed.info/sct",
+  "version" : "http://snomed.info/sct/900000000000207008/version/20230731",
   "unknown-systems" : "",
   "issues" : {
   "resourceType" : "OperationOutcome"
diff --git a/pom.xml b/pom.xml
index fb5b99691..584efa606 100644
--- a/pom.xml
+++ b/pom.xml
@@ -20,7 +20,7 @@
     <properties>
         <guava_version>32.0.1-jre</guava_version>
         <hapi_fhir_version>6.4.1</hapi_fhir_version>
-        <validator_test_case_version>1.4.14</validator_test_case_version>
+        <validator_test_case_version>1.4.15-SNAPSHOT</validator_test_case_version>
         <jackson_version>2.15.2</jackson_version>
         <junit_jupiter_version>5.9.2</junit_jupiter_version>
         <junit_platform_launcher_version>1.8.2</junit_platform_launcher_version>