diff --git a/org.hl7.fhir.r4/src/main/java/org/hl7/fhir/r4/importers/Mimic14Importer.java b/org.hl7.fhir.r4/src/main/java/org/hl7/fhir/r4/importers/Mimic14Importer.java
index 29d07c49f..ac4d8f88c 100644
--- a/org.hl7.fhir.r4/src/main/java/org/hl7/fhir/r4/importers/Mimic14Importer.java
+++ b/org.hl7.fhir.r4/src/main/java/org/hl7/fhir/r4/importers/Mimic14Importer.java
@@ -1,10 +1,36 @@
 package org.hl7.fhir.r4.importers;
 
+/*-
+ * #%L
+ * org.hl7.fhir.r4.importers
+ * %%
+ * Copyright (C) 2014 - 2019 Health Level 7
+ * %%
+ * Licensed under the Apache License, Version 2.0 (the "License");
+ * you may not use this file except in compliance with the License.
+ * You may obtain a copy of the License at
+ * 
+ *      http://www.apache.org/licenses/LICENSE-2.0
+ * 
+ * Unless required by applicable law or agreed to in writing, software
+ * distributed under the License is distributed on an "AS IS" BASIS,
+ * WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
+ * See the License for the specific language governing permissions and
+ * limitations under the License.
+ * #L%
+ */
+
+/**
+ * Development Notes: 
+ * - ignore ICUStays and Transfers for now - low yield, based on discussons with Tom/Alistair
+ */
+
 import java.io.FileInputStream;
 import java.io.FileNotFoundException;
 import java.io.FileOutputStream;
 import java.io.IOException;
 import java.math.BigDecimal;
+import java.nio.charset.Charset;
 import java.util.Date;
 import java.util.HashMap;
 import java.util.Map;
@@ -19,14 +45,23 @@ import org.hl7.fhir.r4.formats.JsonParser;
 import org.hl7.fhir.r4.model.Bundle;
 import org.hl7.fhir.r4.model.Bundle.BundleType;
 import org.hl7.fhir.r4.model.CodeableConcept;
+import org.hl7.fhir.r4.model.Coding;
 import org.hl7.fhir.r4.model.DateTimeType;
 import org.hl7.fhir.r4.model.DateType;
+import org.hl7.fhir.r4.model.DocumentReference;
 import org.hl7.fhir.r4.model.Encounter;
 import org.hl7.fhir.r4.model.Enumerations.AdministrativeGender;
+import org.hl7.fhir.r4.model.Enumerations.DocumentReferenceStatus;
 import org.hl7.fhir.r4.model.Observation;
+import org.hl7.fhir.r4.model.Observation.ObservationComponentComponent;
+import org.hl7.fhir.r4.model.Observation.ObservationStatus;
 import org.hl7.fhir.r4.model.Patient;
+import org.hl7.fhir.r4.model.Practitioner;
+import org.hl7.fhir.r4.model.PractitionerRole;
 import org.hl7.fhir.r4.model.Quantity;
+import org.hl7.fhir.r4.model.Quantity.QuantityComparator;
 import org.hl7.fhir.r4.model.Reference;
+import org.hl7.fhir.r4.model.Type;
 import org.hl7.fhir.utilities.CSVReader;
 import org.hl7.fhir.utilities.Utilities;
 
@@ -41,9 +76,24 @@ public class Mimic14Importer {
     private String loinc;
   }
   
+  public static class Item {
+    private int rowId;
+    private int itemId;
+    private String label;
+    private String abbreviation;
+    private String dbSource;
+    private String linksTo; // where it's used...
+    private String category; 
+    private String unitName;  // uom for item, if it has one
+    private String paramType; // type of item
+    private int conceptId;
+  }
+
   private static final String MRN_SYSTEM = null;
   private Date date;
   private Map<String, LabItem> labItems = new HashMap<>();
+  private Map<String, Item> items = new HashMap<>();
+//  private Map<String, PractitionerRole> careGivers = new HashMap<>();
   private Map<String, Patient> patients = new HashMap<>();
   private Map<String, Encounter> encounters = new HashMap<>();
 
@@ -64,11 +114,15 @@ public class Mimic14Importer {
   
    ucum = new UcumEssenceService(ucumSrc);
   
+   loadItems(Utilities.path(src, "d_items.csv"));
    loadLabItems(Utilities.path(src, "d_labitems.csv"));
+   loadCareGivers(Utilities.path(src, "caregivers.csv"), Utilities.path(dest, "care-givers.json"));
+   
    Bundle patients = processPatients(Utilities.path(src, "patients.csv"));
    Bundle encounters = processAdmissions(Utilities.path(src, "admissions.csv"));
    processLabEvents(Utilities.path(src, "labevents.csv"), Utilities.path(dest, "lab-observations.json"));
-
+   processMicroEvents(Utilities.path(src, "microbiologyevents.csv"), Utilities.path(dest, "micro-observations.json"));
+   processNoteEvents(Utilities.path(src, "noteevents.csv"), Utilities.path(dest, "notes.json"));
    
    System.out.println("saving");
    
@@ -78,6 +132,32 @@ public class Mimic14Importer {
    System.out.println("done");
   }
 
+  private void loadItems(String src) throws NumberFormatException, FHIRException, IOException {
+    System.out.print("Processing Items... ");
+    CSVReader csv = new CSVReader(new FileInputStream(src));
+    int t = 0;
+    csv.readHeaders();    
+    while (csv.line()) {
+      Item item = new Item();
+      t++;
+      item.rowId = Integer.parseInt(csv.cell("row_id"));
+      item.itemId = Integer.parseInt(csv.cell("itemid"));
+      item.label = csv.cell("label");
+      item.abbreviation = csv.cell("abbreviation");
+      item.dbSource = csv.cell("dbsource");
+      item.linksTo = csv.cell("linksto");
+      item.category = csv.cell("category");
+      item.unitName = csv.cell("unitname");
+      item.paramType = csv.cell("param_type");
+      if (csv.has("conceptid")) {
+        item.conceptId = Integer.parseInt(csv.cell("conceptid"));
+      }
+      items.put(csv.cell("itemid"), item);
+    }
+    System.out.println(Integer.toString(t)+" found");
+    csv.close();
+  }
+
   private void loadLabItems(String src) throws NumberFormatException, FHIRException, IOException {
     System.out.print("Processing Lab Items... ");
     CSVReader csv = new CSVReader(new FileInputStream(src));
@@ -95,6 +175,28 @@ public class Mimic14Importer {
       labItems.put(csv.cell("itemid"), item);
     }
     System.out.println(Integer.toString(t)+" found");
+    csv.close();
+  }
+
+  private void loadCareGivers(String src, String dest) throws NumberFormatException, FHIRException, IOException {
+    System.out.print("Processing Care Givers... ");
+    CSVReader csv = new CSVReader(new FileInputStream(src));
+    int t = 0;
+    csv.readHeaders();    
+    Bundle bnd = new Bundle();
+    bnd.setId("care-givers");
+    bnd.setType(BundleType.COLLECTION);
+    bnd.setTimestamp(date);    
+    while (csv.line()) {
+      PractitionerRole pr = new PractitionerRole();
+      t++;
+      pr.setId(csv.cell("cgid"));
+      pr.addCode().addCoding().setSystem("http://mimic.physionet.org/fhir/CareGiverType").setCode(csv.cell("label")).setDisplay(csv.cell("description"));
+      bnd.addEntry().setResource(pr);
+    }
+    System.out.println(Integer.toString(t)+" found");
+    csv.close();
+    new JsonParser().setOutputStyle(OutputStyle.PRETTY).compose(new FileOutputStream(dest), bnd);    
   }
 
   private void processLabEvents(String src, String dest) throws FileNotFoundException, IOException {
@@ -109,10 +211,12 @@ public class Mimic14Importer {
     while (csv.line()) {
       Observation obs = new Observation();
       t++;
+
       Patient pat = patients.get(csv.cell("subject_id"));
       Encounter enc = encounters.get(csv.cell("hadm_id"));
       LabItem item = labItems.get(csv.cell("itemid"));
-      obs.setId(csv.cell("hadm_id"));
+      obs.setId(csv.cell("row_id"));
+      obs.setStatus(ObservationStatus.FINAL);
       if (pat != null) {
         obs.setSubject(new Reference("Patient/"+pat.getId()));
       }
@@ -152,9 +256,161 @@ public class Mimic14Importer {
       bnd.addEntry().setResource(obs);
     }
     System.out.println(Integer.toString(t)+" found");
+    csv.close();
     new JsonParser().setOutputStyle(OutputStyle.PRETTY).compose(new FileOutputStream(dest), bnd);    
   }
   
+  private void processMicroEvents(String src, String dest) throws FileNotFoundException, IOException {
+    System.out.print("Processing Micro Events... ");
+    CSVReader csv = new CSVReader(new FileInputStream(src));
+    Bundle bnd = new Bundle();
+    bnd.setId("lab-observations");
+    bnd.setType(BundleType.COLLECTION);
+    bnd.setTimestamp(date);    
+    csv.readHeaders();
+    Map<String, Observation> cache = new HashMap<>();
+    
+    int t = 0;
+    while (csv.line()) {
+      String cacheId = csv.cell("hadm_id")+"|"+csv.cell("spec_itemid")+"|"+csv.cell("org_itemid")+"|"+(csv.has("charttime") ? csv.cell("charttime") : csv.cell("chartdate"))+"|"+csv.cell("isolate_num");
+
+      Patient pat = patients.get(csv.cell("subject_id"));
+      Encounter enc = encounters.get(csv.cell("hadm_id"));
+      Item spec = items.get(csv.cell("spec_itemid"));
+      Item org = items.get(csv.cell("org_itemid"));
+      Item ab = items.get(csv.cell("ab_itemid"));
+
+      Observation obs;
+      if (cache.containsKey(cacheId)) {
+        obs = cache.get(cacheId);
+      } else {
+        obs = new Observation();
+        t++;
+        cache.put(cacheId, obs);
+        obs.setId(csv.cell("row_id"));
+        obs.setStatus(ObservationStatus.FINAL);
+        obs.addCategory().setText("microbiology");
+        bnd.addEntry().setResource(obs);
+ 
+        // todo: these are all cultures, but the codes state mainly what the culture is on
+        obs.getCode().setText(csv.cell("spec_itemid"));
+        obs.getCode().addCoding().setSystem("http://mimic.physionet.org/fhir/TestType").setCode(csv.cell("spec_itemid"));
+      }
+
+      if (pat != null) {
+        obs.setSubject(new Reference("Patient/"+pat.getId()));
+      }
+      if (enc != null) {
+        obs.setEncounter(new Reference("Encounter/"+enc.getId()));
+      }
+      
+      if (csv.has("charttime")) {
+        obs.setEffective(readDateTime(csv.cell("charttime")));
+      } else {
+        obs.setEffective(readDateTime(csv.cell("chartdate")));
+      }
+      if (org == null) {
+        obs.setValue(new CodeableConcept(new Coding().setSystem("http://mimic.physionet.org/fhir/TestValue").setCode("negative")));
+      } else {
+        obs.setValue(new CodeableConcept(new Coding().setSystem("http://mimic.physionet.org/fhir/Organism").setCode(csv.cell("org_itemid"))).setText(csv.cell("org_name")));
+      }
+      if (ab != null) {
+        ObservationComponentComponent oc = obs.addComponent();
+        oc.setCode(new CodeableConcept(new Coding().setSystem("http://mimic.physionet.org/fhir/Antibiotic").setCode(csv.cell("ab_itemid"))).setText(csv.cell("ab_name")));
+        if (csv.has("dilution_text")) {
+          oc.setValue(parseQuantity(csv.cell("dilution_text")));
+        }
+        if (csv.has("interpretation")) {
+          oc.addInterpretation().addCoding().setSystem("http://mimic.physionet.org/fhir/Interpretation").setCode(csv.cell("interpretation"));
+        }
+      }
+    }
+    System.out.println(Integer.toString(t)+" found");
+    csv.close();
+    new JsonParser().setOutputStyle(OutputStyle.PRETTY).compose(new FileOutputStream(dest), bnd);    
+  }
+
+  private void processNoteEvents(String src, String dest) throws FileNotFoundException, IOException {
+    System.out.print("Processing Note Events... ");
+    CSVReader csv = new CSVReader(new FileInputStream(src));
+    Bundle bnd = new Bundle();
+    bnd.setId("notes");
+    bnd.setType(BundleType.COLLECTION);
+    bnd.setTimestamp(date);    
+    csv.readHeaders();
+    Map<String, Observation> cache = new HashMap<>();
+    
+    int t = 0;
+    while (csv.line()) {
+
+      Patient pat = patients.get(csv.cell("subject_id"));
+      Encounter enc = encounters.get(csv.cell("hadm_id"));
+
+      DocumentReference dr = new DocumentReference();
+      dr.setId(csv.cell("row_id"));
+      if (pat != null) {
+        dr.setSubject(new Reference("Patient/"+pat.getId()));
+      }
+      if (enc != null) {
+        dr.getContext().addEncounter(new Reference("Encounter/"+enc.getId()));
+      }
+      if ("1".equals(csv.cell("iserror"))) {
+        dr.setStatus(DocumentReferenceStatus.ENTEREDINERROR);        
+      } else {
+        dr.setStatus(DocumentReferenceStatus.CURRENT);
+      }
+      if (csv.has("cgid")) {
+        dr.addAuthor().setReference("PractitionerRole/"+csv.cell("cgid"));
+      }
+      String cat = csv.cell("category");
+      String desc = csv.cell("description");
+      if ("Discharge summary".equals(cat) && "Report".equals(desc)) {
+        dr.getType().addCoding().setSystem("http://loinc.org").setCode("18842-5").setDisplay("Discharge summary");
+        dr.addCategory().addCoding().setSystem("http://fhir.org/guides/argonaut/clinicalnotes/CodeSystem/documentreference-category").setCode("other");
+      } else if ("Echo".equals(cat) && "Report".equals(desc)) {
+        dr.getType().addCoding().setSystem("http://loinc.org").setCode("59282-4").setDisplay("Stress cardiac echo study report US");
+        dr.addCategory().addCoding().setSystem("http://fhir.org/guides/argonaut/clinicalnotes/CodeSystem/documentreference-category").setCode("other");
+      } else if ("Radiology".equals(cat) && "CHEST (PORTABLE AP)".equals(desc)) {
+        dr.getType().addCoding().setSystem("http://loinc.org").setCode("59282-4").setDisplay("Chest X-ray AP portable single view");
+        dr.addCategory().addCoding().setSystem("http://fhir.org/guides/argonaut/clinicalnotes/CodeSystem/documentreference-category").setCode("other");
+      } else if ("Nursing/other".equals(cat) && "Report".equals(desc)) {
+        dr.getType().addCoding().setSystem("http://loinc.org").setCode("34119-8").setDisplay("Nursing facility Initial assessment note");
+        dr.addCategory().addCoding().setSystem("http://fhir.org/guides/argonaut/clinicalnotes/CodeSystem/documentreference-category").setCode("other");
+      } else if ("Physician".equals(cat) && "Physician Surgical Admission Note".equals(desc)) {
+        dr.getType().addCoding().setSystem("http://loinc.org").setCode("36589-0").setDisplay("Surgery Admission evaluation note");
+        dr.addCategory().addCoding().setSystem("http://fhir.org/guides/argonaut/clinicalnotes/CodeSystem/documentreference-category").setCode("other");
+      } else {
+        throw new FHIRException("Unhandled Note type '"+cat+"'/'"+desc+"'");
+      }
+      dr.addContent().getAttachment().setContentType("text/plain; charset=UTF-8").setData(csv.cell("text").getBytes(Charset.forName("UTF-8")));
+      bnd.addEntry().setResource(dr);
+    }
+    System.out.println(Integer.toString(t)+" found");
+    csv.close();
+    new JsonParser().setOutputStyle(OutputStyle.PRETTY).compose(new FileOutputStream(dest), bnd);    
+  }
+  
+
+  private Type parseQuantity(String cell) {
+    if (cell.startsWith("<=")) {
+      return new Quantity().setComparator(QuantityComparator.LESS_OR_EQUAL).setValue(new BigDecimal(cell.substring(2)));
+    }
+    if (cell.startsWith("<")) {
+      return new Quantity().setComparator(QuantityComparator.LESS_THAN).setValue(new BigDecimal(cell.substring(2)));
+    }
+    if (cell.startsWith(">=") || cell.startsWith("=>") ) {
+      return new Quantity().setComparator(QuantityComparator.GREATER_OR_EQUAL).setValue(new BigDecimal(cell.substring(2)));
+    }
+    if (cell.startsWith(">")) {
+      return new Quantity().setComparator(QuantityComparator.GREATER_THAN).setValue(new BigDecimal(cell.substring(2)));
+    }
+    if (!Utilities.isDecimal(cell, true)) {
+      throw new Error("Not a valid decimal: "+cell);
+    }
+      
+    return new Quantity().setValue(new BigDecimal(cell));
+  }
+
   private Bundle processAdmissions(String src) throws FileNotFoundException, IOException {
     System.out.print("Processing Admissions... ");
     CSVReader csv = new CSVReader(new FileInputStream(src));
@@ -202,6 +458,7 @@ public class Mimic14Importer {
       bnd.addEntry().setResource(enc);
     }
     System.out.println(Integer.toString(t)+" found");
+    csv.close();
     return bnd;
   }
   
@@ -231,6 +488,7 @@ public class Mimic14Importer {
       bnd.addEntry().setResource(pat);
     }
     System.out.println(Integer.toString(t)+" found");
+    csv.close();
     return bnd;
   }
 
diff --git a/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/CSVReader.java b/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/CSVReader.java
index 3252a3206..8fdd90cd8 100644
--- a/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/CSVReader.java
+++ b/org.hl7.fhir.utilities/src/main/java/org/hl7/fhir/utilities/CSVReader.java
@@ -152,8 +152,14 @@ public class CSVReader extends InputStreamReader {
 		while (inQuote || (peek() != '\r' && peek() != '\n')) {
 			char c = peek();
 			next();
-			if (c == '"') 
-				inQuote = !inQuote;
+			if (c == '"') {
+				if (ready() && peek() == '"') {
+	        b.append(c);
+          next();
+				} else {
+			    inQuote = !inQuote;
+				}
+			}
 			else if (!inQuote && c == ',') {
 				res.add(b.toString().trim());
 				b = new StringBuilder();