diff --git a/.github/actions/commonSetup/action.yml b/.github/actions/commonSetup/action.yml
index 621d1f2081..c15b0e993b 100644
--- a/.github/actions/commonSetup/action.yml
+++ b/.github/actions/commonSetup/action.yml
@@ -8,9 +8,6 @@ runs:
       with:
         distribution: temurin
         java-version: "17"
-    - name: Make files executable
-      shell: bash
-      run: chmod +x ./gradlew
 
     - name: "Setup Gradle"
       uses: gradle/gradle-build-action@v2
diff --git a/.github/workflows/build.yml b/.github/workflows/build.yml
index 0d7a9b64d9..191fd8401c 100644
--- a/.github/workflows/build.yml
+++ b/.github/workflows/build.yml
@@ -12,7 +12,7 @@
 # See the License for the specific language governing permissions and
 # limitations under the License.
 
-name: "GitHub Actions: Build"
+name: "Build"
 
 # Controls when the action will run. Triggers the workflow on push or pull request
 # events for the `master` branch
@@ -22,49 +22,65 @@ on:
     tags:
       build*
   pull_request:
+    # The branches below must be a subset of the branches above
     branches: [ master ]
+  schedule:
+    # Run once a week (even if no new code or PRs) to detect random regressions
+    - cron: '12 13 * * 2'
+
 env:
   # Allow precise monitoring of the save/restore of Gradle User Home by `gradle-build-action`
   # See https://github.com/marketplace/actions/gradle-build-action?version=v2.1.1#cache-debugging-and-analysis
   GRADLE_BUILD_ACTION_CACHE_DEBUG_ENABLED: true
   GRADLE_BUILD_ACTION_CACHE_KEY_PREFIX: "fhir" # change this to invalidate cache
-# A workflow run is made up of one or more jobs that can run sequentially or in parallel
+
+concurrency:
+  # github.head_ref uniquely identifies Pull Requests (but is not available when building branches like main or master)
+  # github.ref is the fallback used when building for workflows triggered by push
+  # Note that || are fallback values (not "concatenations")
+  group: ${{ github.workflow }}-${{ github.head_ref || github.ref }}
+  cancel-in-progress: true # Use e.g. ${{ github.ref != 'refs/heads/main' }} (or master, until #2180) to only cancel for PRs not on branch
+
+  # A workflow run is made up of one or more jobs that can run sequentially or in parallel
 jobs:
   # Build will compile APK, test APK and run tests, lint, etc.
   build:
+    runs-on: ubuntu-22.04-8core
+    timeout-minutes: 60
+    permissions:
+      actions: read
+      contents: read
 
-    runs-on: ubuntu-22.04-64core
+    strategy:
+      fail-fast: false
 
     # Steps represent a sequence of tasks that will be executed as part of the job
     steps:
-      - name: Cancel previous
-        uses: styfle/cancel-workflow-action@0.7.0
-        with:
-          access_token: ${{ github.token }}
 
       # Checks-out your repository under $GITHUB_WORKSPACE, so your job can access it
       - name: Checkout Repo
-        uses: actions/checkout@v3
+        uses: actions/checkout@v4
         with:
           # Fetch origin/master for spotless ratchet to work
           # https://github.com/diffplug/spotless/issues/1242
           fetch-depth: 0
+
       - name: Setup machine
         uses: ./.github/actions/commonSetup
 
       - name: Spotless check
-        run: ./gradlew spotlessCheck --scan --stacktrace
+        run: ./gradlew spotlessCheck --scan --full-stacktrace
 
-      - name: Build with Gradle
-        run: ./gradlew build --scan --stacktrace
+      - name: Build (full) with Gradle
+        run: ./gradlew build --scan --full-stacktrace
 
       - name: Check with Gradle
-        run: ./gradlew check --scan --stacktrace
+        run: ./gradlew check --scan --full-stacktrace
 
       - name: Release artifacts to local repo
         run: ./gradlew publishReleasePublicationToCIRepository --scan
       - name: Upload maven repo
-        uses: actions/upload-artifact@v2
+        uses: actions/upload-artifact@v4
         with:
           name: maven-repository
           path: build/ci-repo
@@ -76,7 +92,7 @@ jobs:
       # Upload the build dir for all the modules for diagnosis
       - name: Upload build dir
         if: ${{ failure() }}
-        uses: actions/upload-artifact@v2
+        uses: actions/upload-artifact@v4
         with:
           name: build
           path: build.zip
diff --git a/.github/workflows/codeql.yaml b/.github/workflows/codeql.yaml
index 6b30b500f4..925aff49bc 100644
--- a/.github/workflows/codeql.yaml
+++ b/.github/workflows/codeql.yaml
@@ -1,5 +1,24 @@
+# Copyright 2020 Google LLC
+#
+# 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.
+
 name: "CodeQL"
 
+# NB: This GitHub Action for https://codeql.github.com seems to be
+# a bit "special"; it does not appear to be (easily) possible to just
+# integrate and run this as part of the main build.yaml action; see
+# https://github.com/google/android-fhir/issues/2310.
+
 on:
   push:
     branches: [ "master" ]
@@ -9,10 +28,14 @@ on:
   schedule:
     - cron: '32 13 * * 2'
 
+concurrency:
+  group: ${{ github.workflow }}-${{ github.head_ref || github.ref || || github.run_id }}
+  cancel-in-progress: true
+
 jobs:
   analyze:
     name: Analyze
-    runs-on: ubuntu-22.04-64core
+    runs-on: ubuntu-22.04-8core
     timeout-minutes: 60
     permissions:
       actions: read
@@ -26,16 +49,16 @@ jobs:
 
     steps:
     - name: Checkout repository
-      uses: actions/checkout@v3
+      uses: actions/checkout@v4
 
     - name: Switch to Java 17 from Eclipse Temurin distro
-      uses: actions/setup-java@v3
+      uses: actions/setup-java@v4
       with:
         java-version: 17
         distribution: temurin
 
     - name: Initialize CodeQL
-      uses: github/codeql-action/init@v2
+      uses: github/codeql-action/init@v3
       with:
         languages: ${{ matrix.language }}
 
@@ -46,6 +69,6 @@ jobs:
       run: ./gradlew --scan --full-stacktrace -Dorg.gradle.dependency.verification=off compileDebugAndroidTestSources
 
     - name: Perform CodeQL Analysis
-      uses: github/codeql-action/analyze@v2
+      uses: github/codeql-action/analyze@v3
       with:
         category: "/language:${{matrix.language}}"
diff --git a/.github/workflows/runFlank.sh b/.github/workflows/runFlank.sh
new file mode 100755
index 0000000000..76e50e6a64
--- /dev/null
+++ b/.github/workflows/runFlank.sh
@@ -0,0 +1,31 @@
+#!/bin/bash
+#
+# Copyright 2022 Google LLC
+#
+# Licensed under the Apache License, Version 2.0 (the "License");
+# you may not use this file except in compliance with the License.
+# You may obtain a copy of the License at
+#
+#       http://www.apache.org/licenses/LICENSE-2.0
+#
+# Unless required by applicable law or agreed to in writing, software
+# distributed under the License is distributed on an "AS IS" BASIS,
+# WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
+# See the License for the specific language governing permissions and
+# limitations under the License.
+#
+
+# Fail on any error.
+set -e
+
+lib_names=("workflow:benchmark" "engine:benchmark" "datacapture" "engine" "knowledge" "workflow")
+firebase_pids=()
+
+for lib_name in "${lib_names[@]}"; do
+  ./gradlew :$lib_name:runFlank --scan --stacktrace &
+  firebase_pids+=("$!")
+done
+
+for firebase_pid in ${firebase_pids[*]}; do
+    wait $firebase_pid
+done
diff --git a/buildSrc/build.gradle.kts b/buildSrc/build.gradle.kts
index b515c1f35d..4dec42c493 100644
--- a/buildSrc/build.gradle.kts
+++ b/buildSrc/build.gradle.kts
@@ -9,15 +9,15 @@ repositories {
 }
 
 dependencies {
-  implementation("com.diffplug.spotless:spotless-plugin-gradle:6.21.0")
+  implementation("com.diffplug.spotless:spotless-plugin-gradle:6.22.0")
 
-  implementation("com.android.tools.build:gradle:8.1.2")
+  implementation("com.android.tools.build:gradle:8.1.4")
 
-  implementation("app.cash.licensee:licensee-gradle-plugin:1.3.0")
+  implementation("app.cash.licensee:licensee-gradle-plugin:1.8.0")
   implementation("com.osacky.flank.gradle:fladle:0.17.4")
 
-  implementation("com.spotify.ruler:ruler-gradle-plugin:1.2.1")
+  implementation("com.spotify.ruler:ruler-gradle-plugin:1.4.0")
 
-  implementation("ca.uhn.hapi.fhir:hapi-fhir-structures-r4:6.8.0")
-  implementation("com.squareup:kotlinpoet:1.12.0")
+  implementation("ca.uhn.hapi.fhir:hapi-fhir-structures-r4:6.10.0")
+  implementation("com.squareup:kotlinpoet:1.15.3")
 }
diff --git a/buildSrc/src/main/kotlin/Dependencies.kt b/buildSrc/src/main/kotlin/Dependencies.kt
index bf3b3fd7b7..8427272ecc 100644
--- a/buildSrc/src/main/kotlin/Dependencies.kt
+++ b/buildSrc/src/main/kotlin/Dependencies.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -15,6 +15,7 @@
  */
 
 import org.gradle.api.artifacts.Configuration
+import org.gradle.api.artifacts.DependencyConstraint
 import org.gradle.kotlin.dsl.exclude
 
 object Dependencies {
@@ -41,39 +42,54 @@ object Dependencies {
       "org.opencds.cqf.fhir:cqf-fhir-utility:${Versions.Cql.clinicalReasoning}"
   }
 
-  object Glide {
-    const val glide = "com.github.bumptech.glide:glide:${Versions.Glide.glide}"
-  }
-
   object HapiFhir {
-    const val fhirBase = "ca.uhn.hapi.fhir:hapi-fhir-base:${Versions.hapiFhir}"
-    const val fhirClient = "ca.uhn.hapi.fhir:hapi-fhir-client:${Versions.hapiFhir}"
-    const val structuresDstu2 = "ca.uhn.hapi.fhir:hapi-fhir-structures-dstu2:${Versions.hapiFhir}"
-    const val structuresDstu3 = "ca.uhn.hapi.fhir:hapi-fhir-structures-dstu3:${Versions.hapiFhir}"
-    const val structuresR4 = "ca.uhn.hapi.fhir:hapi-fhir-structures-r4:${Versions.hapiFhir}"
-    const val structuresR4b = "ca.uhn.hapi.fhir:hapi-fhir-structures-r4b:${Versions.hapiFhir}"
-    const val structuresR5 = "ca.uhn.hapi.fhir:hapi-fhir-structures-r5:${Versions.hapiFhir}"
-
-    const val validation = "ca.uhn.hapi.fhir:hapi-fhir-validation:${Versions.hapiFhir}"
-    const val validationDstu3 =
-      "ca.uhn.hapi.fhir:hapi-fhir-validation-resources-dstu3:${Versions.hapiFhir}"
-    const val validationR4 =
-      "ca.uhn.hapi.fhir:hapi-fhir-validation-resources-r4:${Versions.hapiFhir}"
-    const val validationR5 =
-      "ca.uhn.hapi.fhir:hapi-fhir-validation-resources-r5:${Versions.hapiFhir}"
-
-    const val fhirCoreDstu2 = "ca.uhn.hapi.fhir:org.hl7.fhir.dstu2:${Versions.hapiFhirCore}"
-    const val fhirCoreDstu2016 =
-      "ca.uhn.hapi.fhir:org.hl7.fhir.dstu2016may:${Versions.hapiFhirCore}"
-    const val fhirCoreDstu3 = "ca.uhn.hapi.fhir:org.hl7.fhir.dstu3:${Versions.hapiFhirCore}"
-    const val fhirCoreR4 = "ca.uhn.hapi.fhir:org.hl7.fhir.r4:${Versions.hapiFhirCore}"
-    const val fhirCoreR4b = "ca.uhn.hapi.fhir:org.hl7.fhir.r4b:${Versions.hapiFhirCore}"
-    const val fhirCoreR5 = "ca.uhn.hapi.fhir:org.hl7.fhir.r5:${Versions.hapiFhirCore}"
-    const val fhirCoreUtils = "ca.uhn.hapi.fhir:org.hl7.fhir.utilities:${Versions.hapiFhirCore}"
-    const val fhirCoreConvertors =
-      "ca.uhn.hapi.fhir:org.hl7.fhir.convertors:${Versions.hapiFhirCore}"
-
-    const val guavaCaching = "ca.uhn.hapi.fhir:hapi-fhir-caching-guava:${Versions.hapiFhir}"
+    const val fhirBaseModule = "ca.uhn.hapi.fhir:hapi-fhir-base"
+    const val fhirClientModule = "ca.uhn.hapi.fhir:hapi-fhir-client"
+    const val structuresDstu2Module = "ca.uhn.hapi.fhir:hapi-fhir-structures-dstu2"
+    const val structuresDstu3Module = "ca.uhn.hapi.fhir:hapi-fhir-structures-dstu3"
+    const val structuresR4Module = "ca.uhn.hapi.fhir:hapi-fhir-structures-r4"
+    const val structuresR4bModule = "ca.uhn.hapi.fhir:hapi-fhir-structures-r4b"
+    const val structuresR5Module = "ca.uhn.hapi.fhir:hapi-fhir-structures-r5"
+
+    const val validationModule = "ca.uhn.hapi.fhir:hapi-fhir-validation"
+    const val validationDstu3Module = "ca.uhn.hapi.fhir:hapi-fhir-validation-resources-dstu3"
+    const val validationR4Module = "ca.uhn.hapi.fhir:hapi-fhir-validation-resources-r4"
+    const val validationR5Module = "ca.uhn.hapi.fhir:hapi-fhir-validation-resources-r5"
+
+    const val fhirCoreDstu2Module = "ca.uhn.hapi.fhir:org.hl7.fhir.dstu2"
+    const val fhirCoreDstu2016Module = "ca.uhn.hapi.fhir:org.hl7.fhir.dstu2016may"
+    const val fhirCoreDstu3Module = "ca.uhn.hapi.fhir:org.hl7.fhir.dstu3"
+    const val fhirCoreR4Module = "ca.uhn.hapi.fhir:org.hl7.fhir.r4"
+    const val fhirCoreR4bModule = "ca.uhn.hapi.fhir:org.hl7.fhir.r4b"
+    const val fhirCoreR5Module = "ca.uhn.hapi.fhir:org.hl7.fhir.r5"
+    const val fhirCoreUtilsModule = "ca.uhn.hapi.fhir:org.hl7.fhir.utilities"
+    const val fhirCoreConvertorsModule = "ca.uhn.hapi.fhir:org.hl7.fhir.convertors"
+
+    const val guavaCachingModule = "ca.uhn.hapi.fhir:hapi-fhir-caching-guava"
+
+    const val fhirBase = "$fhirBaseModule:${Versions.hapiFhir}"
+    const val fhirClient = "$fhirClientModule:${Versions.hapiFhir}"
+    const val structuresDstu2 = "$structuresDstu2Module:${Versions.hapiFhir}"
+    const val structuresDstu3 = "$structuresDstu3Module:${Versions.hapiFhir}"
+    const val structuresR4 = "$structuresR4Module:${Versions.hapiFhir}"
+    const val structuresR4b = "$structuresR4bModule:${Versions.hapiFhir}"
+    const val structuresR5 = "$structuresR5Module:${Versions.hapiFhir}"
+
+    const val validation = "$validationModule:${Versions.hapiFhir}"
+    const val validationDstu3 = "$validationDstu3Module:${Versions.hapiFhir}"
+    const val validationR4 = "$validationR4Module:${Versions.hapiFhir}"
+    const val validationR5 = "$validationR5Module:${Versions.hapiFhir}"
+
+    const val fhirCoreDstu2 = "$fhirCoreDstu2Module:${Versions.hapiFhirCore}"
+    const val fhirCoreDstu2016 = "$fhirCoreDstu2016Module:${Versions.hapiFhirCore}"
+    const val fhirCoreDstu3 = "$fhirCoreDstu3Module:${Versions.hapiFhirCore}"
+    const val fhirCoreR4 = "$fhirCoreR4Module:${Versions.hapiFhirCore}"
+    const val fhirCoreR4b = "$fhirCoreR4bModule:${Versions.hapiFhirCore}"
+    const val fhirCoreR5 = "$fhirCoreR5Module:${Versions.hapiFhirCore}"
+    const val fhirCoreUtils = "$fhirCoreUtilsModule:${Versions.hapiFhirCore}"
+    const val fhirCoreConvertors = "$fhirCoreConvertorsModule:${Versions.hapiFhirCore}"
+
+    const val guavaCaching = "$guavaCachingModule:${Versions.hapiFhir}"
   }
 
   object Jackson {
@@ -83,13 +99,14 @@ object Dependencies {
     private const val datatypeGroup = "$mainGroup.datatype"
     private const val moduleGroup = "$mainGroup.module"
 
-    const val annotations = "$coreGroup:jackson-annotations:${Versions.jackson}"
-    const val bom = "$mainGroup:jackson-bom:${Versions.jackson}"
-    const val core = "$coreGroup:jackson-core:${Versions.jacksonCore}"
-    const val databind = "$coreGroup:jackson-databind:${Versions.jackson}"
-    const val dataformatXml = "$dataformatGroup:jackson-dataformat-xml:${Versions.jackson}"
-    const val jaxbAnnotations = "$moduleGroup:jackson-module-jaxb-annotations:${Versions.jackson}"
-    const val jsr310 = "$datatypeGroup:jackson-datatype-jsr310:${Versions.jackson}"
+    const val annotationsBase = "$coreGroup:jackson-annotations:${Versions.jackson}"
+    const val bomBase = "$mainGroup:jackson-bom:${Versions.jackson}"
+    const val coreBase = "$coreGroup:jackson-core:${Versions.jacksonCore}"
+    const val databindBase = "$coreGroup:jackson-databind:${Versions.jackson}"
+    const val dataformatXmlBase = "$dataformatGroup:jackson-dataformat-xml:${Versions.jackson}"
+    const val jaxbAnnotationsBase =
+      "$moduleGroup:jackson-module-jaxb-annotations:${Versions.jackson}"
+    const val jsr310Base = "$datatypeGroup:jackson-datatype-jsr310:${Versions.jackson}"
   }
 
   object Kotlin {
@@ -119,6 +136,7 @@ object Dependencies {
 
   object Retrofit {
     const val coreRetrofit = "com.squareup.retrofit2:retrofit:${Versions.retrofit}"
+    const val gsonConverter = "com.squareup.retrofit2:converter-gson:${Versions.retrofit}"
   }
 
   object Room {
@@ -151,7 +169,10 @@ object Dependencies {
   const val desugarJdkLibs = "com.android.tools:desugar_jdk_libs:${Versions.desugarJdkLibs}"
   const val fhirUcum = "org.fhir:ucum:${Versions.fhirUcum}"
   const val gson = "com.google.code.gson:gson:${Versions.gson}"
-  const val guava = "com.google.guava:guava:${Versions.guava}"
+
+  const val guavaModule = "com.google.guava:guava"
+  const val guava = "$guavaModule:${Versions.guava}"
+
   const val httpInterceptor = "com.squareup.okhttp3:logging-interceptor:${Versions.http}"
   const val http = "com.squareup.okhttp3:okhttp:${Versions.http}"
   const val mockWebServer = "com.squareup.okhttp3:mockwebserver:${Versions.http}"
@@ -163,6 +184,9 @@ object Dependencies {
   const val woodstox = "com.fasterxml.woodstox:woodstox-core:${Versions.woodstox}"
   const val xerces = "xerces:xercesImpl:${Versions.xerces}"
 
+  const val zxing = "com.google.zxing:core:${Versions.zxing}"
+  const val nimbus = "com.nimbusds:nimbus-jose-jwt:${Versions.nimbus}"
+
   // Dependencies for testing go here
   object AndroidxTest {
     const val archCore = "androidx.arch.core:core-testing:${Versions.AndroidxTest.archCore}"
@@ -218,24 +242,20 @@ object Dependencies {
       const val clinicalReasoning = "3.0.0-PRE9-SNAPSHOT"
     }
 
-    object Glide {
-      const val glide = "4.14.2"
-    }
-
     object Kotlin {
       const val kotlinCoroutinesCore = "1.7.2"
       const val stdlib = "1.8.20"
     }
 
     const val androidFhirCommon = "0.1.0-alpha05"
-    const val androidFhirEngine = "0.1.0-beta04"
-    const val androidFhirKnowledge = "0.1.0-alpha01"
+    const val androidFhirEngine = "0.1.0-beta05"
+    const val androidFhirKnowledge = "0.1.0-alpha03"
     const val apacheCommonsCompress = "1.21"
     const val desugarJdkLibs = "2.0.3"
     const val caffeine = "2.9.1"
     const val fhirUcum = "1.0.3"
     const val gson = "2.9.1"
-    const val guava = "32.1.2-android"
+    const val guava = "32.1.3-android"
 
     const val hapiFhir = "6.8.0"
     const val hapiFhirCore = "6.0.22"
@@ -253,6 +273,7 @@ object Dependencies {
     const val jsonAssert = "1.5.1"
     const val material = "1.9.0"
     const val retrofit = "2.9.0"
+    const val gsonConverter = "2.1.0"
     const val sqlcipher = "4.5.4"
     const val timber = "5.0.1"
     const val truth = "1.1.5"
@@ -260,6 +281,9 @@ object Dependencies {
     const val xerces = "2.12.2"
     const val xmlUnit = "2.9.1"
 
+    const val zxing = "3.4.1"
+    const val nimbus = "9.31"
+
     // Test dependencies
     object AndroidxTest {
       const val benchmarkJUnit = "1.1.1"
@@ -294,57 +318,38 @@ object Dependencies {
     exclude(group = "org.apache.httpcomponents")
     exclude(group = "org.antlr", module = "antlr4")
     exclude(group = "org.eclipse.persistence", module = "org.eclipse.persistence.moxy")
-  }
-
-  fun Configuration.forceGuava() {
-    // Removes caffeine
     exclude(module = "hapi-fhir-caching-caffeine")
     exclude(group = "com.github.ben-manes.caffeine", module = "caffeine")
-
-    resolutionStrategy {
-      force(guava)
-      force(HapiFhir.guavaCaching)
-    }
   }
 
-  fun Configuration.forceHapiVersion() {
-    // Removes newer versions of caffeine and manually imports 2.9
-    // Removes newer versions of hapi and keeps on 6.0.1
-    // (newer versions don't work on Android)
-    resolutionStrategy {
-      force(HapiFhir.fhirBase)
-      force(HapiFhir.fhirClient)
-      force(HapiFhir.fhirCoreConvertors)
-
-      force(HapiFhir.fhirCoreDstu2)
-      force(HapiFhir.fhirCoreDstu2016)
-      force(HapiFhir.fhirCoreDstu3)
-      force(HapiFhir.fhirCoreR4)
-      force(HapiFhir.fhirCoreR4b)
-      force(HapiFhir.fhirCoreR5)
-      force(HapiFhir.fhirCoreUtils)
-
-      force(HapiFhir.structuresDstu2)
-      force(HapiFhir.structuresDstu3)
-      force(HapiFhir.structuresR4)
-      force(HapiFhir.structuresR5)
-
-      force(HapiFhir.validation)
-      force(HapiFhir.validationDstu3)
-      force(HapiFhir.validationR4)
-      force(HapiFhir.validationR5)
-    }
-  }
-
-  fun Configuration.forceJacksonVersion() {
-    resolutionStrategy {
-      force(Jackson.annotations)
-      force(Jackson.bom)
-      force(Jackson.core)
-      force(Jackson.databind)
-      force(Jackson.jaxbAnnotations)
-      force(Jackson.jsr310)
-      force(Jackson.dataformatXml)
-    }
+  fun hapiFhirConstraints(): Map<String, DependencyConstraint.() -> Unit> {
+    return mutableMapOf<String, DependencyConstraint.() -> Unit>(
+      guavaModule to { version { strictly(Versions.guava) } },
+      HapiFhir.fhirBaseModule to { version { strictly(Versions.hapiFhir) } },
+      HapiFhir.fhirClientModule to { version { strictly(Versions.hapiFhir) } },
+      HapiFhir.fhirCoreConvertorsModule to { version { strictly(Versions.hapiFhirCore) } },
+      HapiFhir.fhirCoreDstu2Module to { version { strictly(Versions.hapiFhirCore) } },
+      HapiFhir.fhirCoreDstu2016Module to { version { strictly(Versions.hapiFhirCore) } },
+      HapiFhir.fhirCoreDstu3Module to { version { strictly(Versions.hapiFhirCore) } },
+      HapiFhir.fhirCoreR4Module to { version { strictly(Versions.hapiFhirCore) } },
+      HapiFhir.fhirCoreR4bModule to { version { strictly(Versions.hapiFhirCore) } },
+      HapiFhir.fhirCoreR5Module to { version { strictly(Versions.hapiFhirCore) } },
+      HapiFhir.fhirCoreUtilsModule to { version { strictly(Versions.hapiFhirCore) } },
+      HapiFhir.structuresDstu2Module to { version { strictly(Versions.hapiFhir) } },
+      HapiFhir.structuresDstu3Module to { version { strictly(Versions.hapiFhir) } },
+      HapiFhir.structuresR4Module to { version { strictly(Versions.hapiFhir) } },
+      HapiFhir.structuresR5Module to { version { strictly(Versions.hapiFhir) } },
+      HapiFhir.validationModule to { version { strictly(Versions.hapiFhir) } },
+      HapiFhir.validationDstu3Module to { version { strictly(Versions.hapiFhir) } },
+      HapiFhir.validationR4Module to { version { strictly(Versions.hapiFhir) } },
+      HapiFhir.validationR5Module to { version { strictly(Versions.hapiFhir) } },
+      Jackson.annotationsBase to { version { strictly(Versions.jackson) } },
+      Jackson.bomBase to { version { strictly(Versions.jackson) } },
+      Jackson.coreBase to { version { strictly(Versions.jacksonCore) } },
+      Jackson.databindBase to { version { strictly(Versions.jackson) } },
+      Jackson.jaxbAnnotationsBase to { version { strictly(Versions.jackson) } },
+      Jackson.jsr310Base to { version { strictly(Versions.jackson) } },
+      Jackson.dataformatXmlBase to { version { strictly(Versions.jackson) } },
+    )
   }
 }
diff --git a/buildSrc/src/main/kotlin/LicenseeConfig.kt b/buildSrc/src/main/kotlin/LicenseeConfig.kt
index ff66011e62..554c26a87a 100644
--- a/buildSrc/src/main/kotlin/LicenseeConfig.kt
+++ b/buildSrc/src/main/kotlin/LicenseeConfig.kt
@@ -22,6 +22,8 @@ fun Project.configureLicensee() {
   apply(plugin = "app.cash.licensee")
   configure<app.cash.licensee.LicenseeExtension> {
     allow("Apache-2.0")
+    allow("BSD-2-Clause")
+    allow("BSD-3-Clause")
     allow("MIT")
 
     ignoreDependencies("com.ibm.icu", "icu4j") {
@@ -113,10 +115,14 @@ fun Project.configureLicensee() {
     // Utilities
     // https://developers.google.com/android/reference/com/google/android/gms/common/package-summary
     allowDependency("com.google.android.gms", "play-services-base", "17.4.0") { because("") }
+    allowDependency("com.google.android.gms", "play-services-base", "18.0.1") { because("") }
+
+    allowDependency("com.google.android.odml", "image", "1.0.0-beta1") { because("") }
 
     // More utility classes
     // https://developers.google.com/android/reference/com/google/android/gms/common/package-summary
     allowDependency("com.google.android.gms", "play-services-basement", "17.4.0") { because("") }
+    allowDependency("com.google.android.gms", "play-services-basement", "18.0.0") { because("") }
 
     // https://developers.google.com/android/reference/com/google/android/gms/common/package-summary
     allowDependency("com.google.android.gms", "play-services-clearcut", "17.0.0") { because("") }
@@ -131,12 +137,16 @@ fun Project.configureLicensee() {
 
     // Tasks API Android https://developers.google.com/android/guides/tasks
     allowDependency("com.google.android.gms", "play-services-tasks", "17.2.0") { because("") }
+    allowDependency("com.google.android.gms", "play-services-tasks", "18.0.1") { because("") }
 
     // Barcode Scanning https://developers.google.com/ml-kit/vision/barcode-scanning
     allowDependency("com.google.mlkit", "barcode-scanning", "16.1.1") { because("") }
 
     // MLKit Common https://developers.google.com/ml-kit/vision/barcode-scanning
     allowDependency("com.google.mlkit", "common", "17.1.1") { because("") }
+    allowDependency("com.google.mlkit", "common", "18.0.0") { because("") }
+
+    allowDependency("com.google.mlkit", "camera", "16.0.0-beta3") { because("") }
 
     // Object Detection https://developers.google.com/ml-kit/vision/object-detection
     allowDependency("com.google.mlkit", "object-detection", "16.2.3") { because("") }
@@ -150,11 +160,14 @@ fun Project.configureLicensee() {
     // Vision Common
     // https://developers.google.com/android/reference/com/google/mlkit/vision/common/package-summary
     allowDependency("com.google.mlkit", "vision-common", "16.3.0") { because("") }
+    allowDependency("com.google.mlkit", "vision-common", "17.0.0") { because("") }
 
     // Vision Common
     // https://developers.google.com/android/reference/com/google/mlkit/vision/common/package-summary
     allowDependency("com.google.mlkit", "vision-internal-vkp", "18.0.0") { because("") }
 
+    allowDependency("com.google.mlkit", "vision-interfaces", "16.0.0") { because("") }
+
     // Glide
     allowDependency("com.github.bumptech.glide", "glide", "4.14.2") {
       because("BSD, part MIT and Apache 2.0. https://github.com/bumptech/glide#license")
@@ -174,6 +187,11 @@ fun Project.configureLicensee() {
     allowDependency("com.github.bumptech.glide", "gifdecoder", "4.14.2") {
       because("BSD, part MIT and Apache 2.0. https://github.com/bumptech/glide#license")
     }
+
+    // ICU4C License
+    allowDependency("com.ibm.icu", "icu4j", "72.1") {
+      because("BSD, part MIT and Apache 2.0. https://github.com/unicode-org/icu/blob/main/LICENSE")
+    }
   }
 }
 
diff --git a/buildSrc/src/main/kotlin/Releases.kt b/buildSrc/src/main/kotlin/Releases.kt
index 3aadfdf83b..38cb8d700c 100644
--- a/buildSrc/src/main/kotlin/Releases.kt
+++ b/buildSrc/src/main/kotlin/Releases.kt
@@ -48,7 +48,7 @@ object Releases {
 
   object Engine : LibraryArtifact {
     override val artifactId = "engine"
-    override val version = "0.1.0-beta04"
+    override val version = "0.1.0-beta05"
     override val name = "Android FHIR Engine Library"
   }
 
@@ -60,7 +60,7 @@ object Releases {
 
   object Workflow : LibraryArtifact {
     override val artifactId = "workflow"
-    override val version = "0.1.0-alpha03"
+    override val version = "0.1.0-alpha04"
     override val name = "Android FHIR Workflow Library"
   }
 
@@ -74,7 +74,7 @@ object Releases {
 
   object Knowledge : LibraryArtifact {
     override val artifactId = "knowledge"
-    override val version = "0.1.0-alpha02"
+    override val version = "0.1.0-alpha03"
     override val name = "Android FHIR Knowledge Manager Library"
   }
 
diff --git a/catalog/build.gradle.kts b/catalog/build.gradle.kts
index d137d0a320..e4bb7a4373 100644
--- a/catalog/build.gradle.kts
+++ b/catalog/build.gradle.kts
@@ -1,5 +1,3 @@
-import Dependencies.forceGuava
-
 plugins {
   id(Plugins.BuildPlugins.application)
   id(Plugins.BuildPlugins.kotlinAndroid)
@@ -42,8 +40,6 @@ android {
   kotlin { jvmToolchain(11) }
 }
 
-configurations { all { forceGuava() } }
-
 dependencies {
   androidTestImplementation(Dependencies.AndroidxTest.extJunit)
   androidTestImplementation(Dependencies.Espresso.espressoCore)
diff --git a/codelabs/datacapture/app/build.gradle.kts b/codelabs/datacapture/app/build.gradle.kts
index b593a68695..0c20e3acdc 100644
--- a/codelabs/datacapture/app/build.gradle.kts
+++ b/codelabs/datacapture/app/build.gradle.kts
@@ -4,12 +4,13 @@ plugins {
 }
 
 android {
-    compileSdk = 31
+    namespace = "com.google.codelab.sdclibrary"
+    compileSdk = 34
 
     defaultConfig {
         applicationId = "com.google.android.fhir.codelabs.datacapture"
         minSdk = 24
-        targetSdk = 31
+        targetSdk = 34
         versionCode = 1
         versionName = "1.0"
 
@@ -22,24 +23,30 @@ android {
             proguardFiles(getDefaultProguardFile("proguard-android-optimize.txt"), "proguard-rules.pro")
         }
     }
-    compileOptions {
-        sourceCompatibility = JavaVersion.VERSION_1_8
-        targetCompatibility = JavaVersion.VERSION_1_8
+    buildFeatures {
+        buildConfig = true
+        viewBinding = true
     }
-    kotlinOptions {
-        jvmTarget = "1.8"
+    compileOptions {
+        // Flag to enable support for the new language APIs
+        // See https://developer.android.com/studio/write/java8-support
+        isCoreLibraryDesugaringEnabled = true
     }
+
+    packaging { resources.excludes.addAll(listOf("META-INF/ASL-2.0.txt", "META-INF/LGPL-3.0.txt")) }
+    kotlin { jvmToolchain(11) }
 }
 
 dependencies {
-    implementation("androidx.core:core-ktx:1.7.0")
-    implementation("androidx.appcompat:appcompat:1.4.0")
-    implementation("com.google.android.material:material:1.4.0")
-    implementation("androidx.constraintlayout:constraintlayout:2.1.2")
-
-    testImplementation("junit:junit:4.+")
-    androidTestImplementation("androidx.test.ext:junit:1.1.3")
-    androidTestImplementation("androidx.test.espresso:espresso-core:3.4.0")
+    coreLibraryDesugaring("com.android.tools:desugar_jdk_libs:2.0.3")
+    implementation("androidx.core:core-ktx:1.12.0")
+    implementation("androidx.appcompat:appcompat:1.6.1")
+    implementation("com.google.android.material:material:1.10.0")
+    implementation("androidx.constraintlayout:constraintlayout:2.1.4")
+
+    testImplementation("junit:junit:4.13.2")
+    androidTestImplementation("androidx.test.ext:junit:1.1.5")
+    androidTestImplementation("androidx.test.espresso:espresso-core:3.5.1")
 
     // 3 Add dependencies for Structured Data Capture Library and Fragment KTX
 }
diff --git a/codelabs/datacapture/build.gradle.kts b/codelabs/datacapture/build.gradle.kts
index 77acf04960..dcd615f0cb 100644
--- a/codelabs/datacapture/build.gradle.kts
+++ b/codelabs/datacapture/build.gradle.kts
@@ -6,8 +6,8 @@ buildscript {
         gradlePluginPortal()
     }
     dependencies {
-        classpath("com.android.tools.build:gradle:7.0.4")
-        classpath("org.jetbrains.kotlin:kotlin-gradle-plugin:1.6.10")
+        classpath("com.android.tools.build:gradle:8.1.2")
+        classpath("org.jetbrains.kotlin:kotlin-gradle-plugin:1.8.20")
 
         // NOTE: Do not place your application dependencies here; they belong
         // in the individual module build.gradle.kts files
diff --git a/codelabs/datacapture/gradle.properties b/codelabs/datacapture/gradle.properties
index 98bed167dc..f20a5218ef 100644
--- a/codelabs/datacapture/gradle.properties
+++ b/codelabs/datacapture/gradle.properties
@@ -15,7 +15,5 @@ org.gradle.jvmargs=-Xmx2048m -Dfile.encoding=UTF-8
 # Android operating system, and which are packaged with your app"s APK
 # https://developer.android.com/topic/libraries/support-library/androidx-rn
 android.useAndroidX=true
-# Automatically convert third-party libraries to use AndroidX
-android.enableJetifier=true
 # Kotlin code style for this project: "official" or "obsolete":
-kotlin.code.style=official
\ No newline at end of file
+kotlin.code.style=official
diff --git a/codelabs/datacapture/gradle/wrapper/gradle-wrapper.properties b/codelabs/datacapture/gradle/wrapper/gradle-wrapper.properties
index b2a400b0e0..da1db5f04e 100644
--- a/codelabs/datacapture/gradle/wrapper/gradle-wrapper.properties
+++ b/codelabs/datacapture/gradle/wrapper/gradle-wrapper.properties
@@ -1,6 +1,5 @@
-#Fri Jan 28 09:30:50 GMT 2022
 distributionBase=GRADLE_USER_HOME
-distributionUrl=https\://services.gradle.org/distributions/gradle-7.0.2-bin.zip
 distributionPath=wrapper/dists
-zipStorePath=wrapper/dists
+distributionUrl=https\://services.gradle.org/distributions/gradle-8.0-bin.zip
 zipStoreBase=GRADLE_USER_HOME
+zipStorePath=wrapper/dists
diff --git a/codelabs/engine/README.md b/codelabs/engine/README.md
index fef62669b3..9b116e4cbb 100644
--- a/codelabs/engine/README.md
+++ b/codelabs/engine/README.md
@@ -28,88 +28,85 @@ upload any local changes to the server.
 *   The sample code
 *   Basic knowledge of Android development in Kotlin
 
-If you haven't built Android apps before, you can
-start by [building your first
-app](https://developer.android.com/training/basics/firstapp).
+If you haven't built Android apps before, you can start by
+[building your first app](https://developer.android.com/training/basics/firstapp).
 
 ## Set up a local HAPI FHIR server with test data
 
-[HAPI FHIR](https://hapifhir.io/hapi-fhir/) is a popular open-source FHIR
-server. We will use a local HAPI FHIR server in our codelab for the Android app
+[HAPI FHIR](https://hapifhir.io/hapi-fhir/) is a popular open source FHIR
+server. We use a local HAPI FHIR server in our codelab for the Android app
 to connect to.
 
 ### Set up the local HAPI FHIR server
 
-1.   Run the following command in a terminal to get the latest image of HAPI
-     FHIR
+1.  Run the following command in a terminal to get the latest image of HAPI FHIR
+    ```shell
+    docker pull hapiproject/hapi:latest
+    ```
 
-```shell
-docker pull hapiproject/hapi:latest
-```
-
-2.   Create a HAPI FHIR container by either
-     using Docker Desktop to run the previously download image `hapiproject/hapi`, or
-     running the following command
-
-```shell
-docker run -p 8080:8080 hapiproject/hapi:latest
-```
-
-Learn [more](https://github.com/hapifhir/hapi-fhir-jpaserver-starter#running-via-docker-hub).
+1.  Create a HAPI FHIR container by either using Docker Desktop to run the
+    previously download image `hapiproject/hapi`, or running the following
+    command
+    ```shell
+    docker run -p 8080:8080 hapiproject/hapi:latest
+    ```
+    Learn
+    [more](https://github.com/hapifhir/hapi-fhir-jpaserver-starter#running-via-docker-hub).
 
-3. Inspect the server by opening the URL `http://localhost:8080/` in a browser.
-   You should see the HAPI FHIR web interface.
+1.  Inspect the server by opening the URL `http://localhost:8080/` in a browser.
+    You should see the HAPI FHIR web interface.
 
-![HAPI FHIR web interface](images/image4.png "HAPI FHIR web interface")
+    ![HAPI FHIR web interface](images/image4.png "HAPI FHIR web interface")
 
 ### Populate the local HAPI FHIR server with test data
 
 To test our application, we'll need some test data on the server. We'll use
 synthetic data generated by Synthea.
 
-1.   First, we need to download sample data from [synthea-samples](
-     https://github.com/synthetichealth/synthea-sample-data/tree/master/downloads).
-     Download and unzip `synthea_sample_data_fhir_r4_sep2019.zip`. The un-zipped
-     sample data has numerous `.json` files, each being a transaction bundle for an
-     individual patient.
+1.  First, we need to download sample data from
+    [synthea-samples](https://github.com/synthetichealth/synthea-sample-data/tree/master/downloads).
+    Download and extract `synthea_sample_data_fhir_r4_sep2019.zip`. The
+    un-zipped
+    sample data has numerous `.json` files, each being a transaction bundle for
+    an individual patient.
 
-2.   We'll upload test data for three patients to the local HAPI FHIR server.
-     Run the following command in the directory containing JSON files
+1.  We'll upload test data for three patients to the local HAPI FHIR server. Run
+    the following command in the directory containing JSON files
 
-```shell
-curl -X POST -H "Content-Type: application/json" -d @./Aaron697_Brekke496_2fa15bc7-8866-461a-9000-f739e425860a.json http://localhost:8080/fhir/
-curl -X POST -H "Content-Type: application/json" -d @./Aaron697_Stiedemann542_41166989-975d-4d17-b9de-17f94cb3eec1.json http://localhost:8080/fhir/
-curl -X POST -H "Content-Type: application/json" -d @./Abby752_Kuvalis369_2b083021-e93f-4991-bf49-fd4f20060ef8.json http://localhost:8080/fhir/
-```
+    ```shell
+    curl -X POST -H "Content-Type: application/json" -d @./Aaron697_Brekke496_2fa15bc7-8866-461a-9000-f739e425860a.json http://localhost:8080/fhir/
+    curl -X POST -H "Content-Type: application/json" -d @./Aaron697_Stiedemann542_41166989-975d-4d17-b9de-17f94cb3eec1.json http://localhost:8080/fhir/
+    curl -X POST -H "Content-Type: application/json" -d @./Abby752_Kuvalis369_2b083021-e93f-4991-bf49-fd4f20060ef8.json http://localhost:8080/fhir/
+    ```
 
-3.   To upload test data for all patients to the server, run
+1.  To upload test data for all patients to the server, run
 
-```shell
-for f in *.json; do curl -X POST -H "Content-Type: application/json" -d @$f http://localhost:8080/fhir/ ; done
-```
+    ```shell
+    for f in *.json; do curl -X POST -H "Content-Type: application/json" -d @$f http://localhost:8080/fhir/ ; done
+    ```
 
-However, this can take a long time to complete and is not necessary for the
-codelab.
+    However, this can take a long time to complete and is not necessary for the
+    codelab.
 
-4. Verify that the test data is available on the server by opening the URL
-   `http://localhost:8080/fhir/Patient/` in a browser. You should see the text
-   `HTTP 200 OK` and the `Response Body` section of the page containing patient
-   data in a FHIR Bundle as the search result with a `total` count.
+1.  Verify that the test data is available on the server by opening the URL
+    `http://localhost:8080/fhir/Patient/` in a browser. You should see the text
+    `HTTP 200 OK` and the `Response Body` section of the page containing patient
+    data in a FHIR Bundle as the search result with a `total` count.
 
-![Test data on server](images/image5.png "Test data on server")
+    ![Test data on server](images/image5.png "Test data on server")
 
 ## Set up the Android app
 
 ### Download the Code
 
-To download the code for this codelab, clone the Android FHIR SDK repo: `git
-clone https://github.com/google/android-fhir.git`
+To download the code for this codelab, clone the Android FHIR SDK repository:
+`git clone https://github.com/google/android-fhir.git`
 
 The starter project for this codelab is located in `codelabs/engine`.
 
 ### Import the app into Android Studio
 
-Let's start by importing the starter app into Android Studio.
+We start by importing the starter app into Android Studio.
 
 Open Android Studio, select **Import Project (Gradle, Eclipse ADT, etc.)** and
 choose the `codelabs/engine/` folder from the source code that you have
@@ -120,231 +117,355 @@ downloaded earlier.
 ### Sync your project with Gradle files
 
 For your convenience, the FHIR Engine Library dependencies have already been
-add to the project. This allows you to integrate the FHIR Engine Library in your
-app. Observe the following lines to the end of the
-`app/build.gradle.kts` file of your project:
+added to the project. This allows you to integrate the FHIR Engine Library in
+your app. Observe the following lines to the end of the `app/build.gradle.kts`
+file of your project:
 
 ```kotlin
 dependencies {
     // ...
 
-    implementation("com.google.android.fhir:engine:0.1.0-beta03")
+    implementation("com.google.android.fhir:engine:0.1.0-beta05")
 }
 ```
 
 To be sure that all dependencies are available to your app, you should sync your
 project with gradle files at this point.
 
-Select **Sync Project with Gradle Files** (![Gradle sync button](images/image3.png "Gradle sync button"))from the Android Studio
-toolbar. You an also run the app again to check the dependencies are working
-correctly.
+Select **Sync Project with Gradle Files**
+(![Gradle sync button](images/image3.png "Gradle sync button"))from the Android
+Studio toolbar. You an also run the app again to check the dependencies are
+working correctly.
 
 ### Run the starter app
 
 Now that you have imported the project into Android Studio, you are ready to run
 the app for the first time.
 
-[Start the Android Studio emulator](
-https://developer.android.com/studio/run/emulator), and click Run
-(![Run button](images/image2.png "Run button")) in the Android Studio
-toolbar.
+[Start the Android Studio emulator](https://developer.android.com/studio/run/emulator),
+and click Run (![Run button](images/image2.png "Run button")) in the Android
+Studio toolbar.
 
 <img src="images/image6.png" alt="Hello World app" width="400">
 
 ## Create FHIR Engine instance
 
-To use the FHIR Engine Library, you need an instance of FHIR Engine. It will be
-the entry point of FHIR Engine APIs.
+To incorporate the FHIR Engine into your Android app, you'll need to use the
+FHIR Engine Library and initiate an instance of the FHIR Engine. The steps
+outlined below will guide you through the process.
+
+1.  Navigate to your Application class, which in this example is
+    `FhirApplication.kt`, located in
+    `app/src/main/java/com/google/android/fhir/codelabs/engine`.
+1.  Inside the `onCreate()` method, add the following code to initialize FHIR
+    Engine:
+    ```kotlin
+      FhirEngineProvider.init(
+          FhirEngineConfiguration(
+            enableEncryptionIfSupported = true,
+            RECREATE_AT_OPEN,
+            ServerConfiguration(
+              baseUrl = "http://10.0.2.2:8080/fhir/",
+              httpLogger =
+                HttpLogger(
+                  HttpLogger.Configuration(
+                    if (BuildConfig.DEBUG) HttpLogger.Level.BODY else HttpLogger.Level.BASIC,
+                  ),
+                ) {
+                  Log.d("App-HttpLog", it)
+                },
+            ),
+          ),
+      )
+    ```
+    ---
+
+    Notes:
+    * `enableEncryptionIfSupported`: Enables data encryption if the device
+      supports it.
+    * `RECREATE_AT_OPEN`: Determines the database error strategy. In
+      this case, it recreates the database if an error occurs upon opening.
+    * `baseUrl` in `ServerConfiguration`: This is the FHIR server's base URL.
+      The provided IP address `10.0.2.2` is specially reserved for localhost,
+      accessible from the Android emulator. Learn
+      [more](https://developer.android.com/studio/run/emulator-networking).
+
+1.  In the `FhirApplication` class, add the following line to lazily instantiate
+    the FHIR Engine:
+    ```kotlin
+      private val fhirEngine: FhirEngine by
+          lazy { FhirEngineProvider.getInstance(this) }
+    ```
+
+    This ensures the FhirEngine instance
+    is only created when it's accessed for the first time, not immediately when
+    the app starts.
+
+1.  Add the following convenience method in the `FhirApplication` class for
+    easier access throughout your application:
+
+    ```kotlin
+    companion object {
+        fun fhirEngine(context: Context) =
+            (context.applicationContext as FhirApplication).fhirEngine
+    }
+    ```
 
-1.   Open `FhirApplication.kt`
-     (**app/src/main/java/com/google/android/fhir/codelabs/engine**).
-2.   In function `onCreate()`, add the following code to initialize FHIR Engine:
+    This static method lets you retrieve the FHIR Engine instance from anywhere
+    in the app using the context.
 
-```kotlin
-FhirEngineProvider.init(
-    FhirEngineConfiguration(
-        enableEncryptionIfSupported = true,
-        RECREATE_AT_OPEN,
-        ServerConfiguration(
-            baseUrl = "http://10.0.2.2:8080/fhir/",
-            httpLogger =
-            HttpLogger(
-                HttpLogger.Configuration(
-                    if (BuildConfig.DEBUG) HttpLogger.Level.BODY else HttpLogger.Level.BASIC
-                )
-            ) { Log.d("App-HttpLog", it) },
-        ),
-    )
-)
-```
+## Sync data with FHIR server
 
-This initializes FHIR Engine by setting a number of configurations. Pay
-attention to the `baseUrl` in `ServerConfiguration`. The IP address `10.0.2.2`
-is reserved for the localhost accessible from the Android emulator. Learn
-[more](https://developer.android.com/studio/run/emulator-networking).
+1.  Create a new class `DownloadWorkManagerImpl.kt`. In this class, you'll
+    define how the application fetches the next resource from the list to
+    download.:
+    ```kotlin
+      class DownloadWorkManagerImpl : DownloadWorkManager {
+        private val urls = LinkedList(listOf("Patient"))
 
-3.   In `FhirApplication` class, add the following property to lazily
-     instantiate an actual FHIR Engine instance:
+        override suspend fun getNextRequest(): DownloadRequest? {
+          val url = urls.poll() ?: return null
+          return DownloadRequest.of(url)
+        }
 
-```kotlin
-    private val fhirEngine: FhirEngine by lazy { FhirEngineProvider.getInstance(this) }
-```
+        override suspend fun getSummaryRequestUrls() = mapOf<ResourceType, String>()
 
-4.   Finally, add the following code as a convenience method for the rest of the
-     codelab:
+        override suspend fun processResponse(response: Resource): Collection<Resource> {
+          var bundleCollection: Collection<Resource> = mutableListOf()
+          if (response is Bundle && response.type == Bundle.BundleType.SEARCHSET) {
+            bundleCollection = response.entry.map { it.resource }
+          }
+          return bundleCollection
+        }
+      }
+    ```
 
-```kotlin
-companion object {
-    fun fhirEngine(context: Context) = (context.applicationContext as FhirApplication).fhirEngine
-}
-```
+    This class has a queue of resource types it wants to download. It processes
+    responses and extracts the resources from the returned bundle, which get
+    saved into the local database.
 
-## Sync data with FHIR server
+1.  Create a new class `AppFhirSyncWorker.kt` This class defines how the app
+    will sync with the remote FHIR server using a background worker.
 
-1.   Create a new class `DownloadWorkManagerImpl.kt`:
+    ```kotlin
+    class AppFhirSyncWorker(appContext: Context, workerParams: WorkerParameters) :
+      FhirSyncWorker(appContext, workerParams) {
 
-```kotlin
-class DownloadWorkManagerImpl : DownloadWorkManager {
-  private val urls = LinkedList(listOf("Patient"))
+      override fun getDownloadWorkManager() = DownloadWorkManagerImpl()
 
-  override suspend fun getNextRequest(): Request? {
-    val url = urls.poll() ?: return null
-    return Request.of(url)
-  }
+      override fun getConflictResolver() = AcceptLocalConflictResolver
+
+      override fun getFhirEngine() = FhirApplication.fhirEngine(applicationContext)
+    }
+    ```
+
+    Here, we've defined which download manager, conflict resolver, and FHIR
+    engine instance to use for syncing.
 
-  override suspend fun getSummaryRequestUrls() = mapOf<ResourceType, String>()
+1.  In your ViewModel, `PatientListViewModel.kt`, you'll set up a one-time sync
+    mechanism. Locate and add this code to the `triggerOneTimeSync()` function:
 
-  override suspend fun processResponse(response: Resource): Collection<Resource> {
-    var bundleCollection: Collection<Resource> = mutableListOf()
-    if (response is Bundle && response.type == Bundle.BundleType.SEARCHSET) {
-      bundleCollection = response.entry.map { it.resource }
+    ```kotlin
+    viewModelScope.launch {
+          Sync.oneTimeSync<AppFhirSyncWorker>(getApplication())
+            .shareIn(this, SharingStarted.Eagerly, 10)
+            .collect { _pollState.emit(it) }
+        }
+    ```
+
+    This coroutine initiates a one-time sync with the FHIR server using the
+    AppFhirSyncWorker we defined earlier. It will then update the UI based on
+    the state of the sync process.
+
+1.  In the `PatientListFragment.kt` file, update the body of the
+    `handleSyncJobStatus` function:
+
+    ```kotlin
+    when (syncJobStatus) {
+        is SyncJobStatus.Finished -> {
+            Toast.makeText(requireContext(), "Sync Finished", Toast.LENGTH_SHORT).show()
+            viewModel.searchPatientsByName("")
+        }
+        else -> {}
     }
-    return bundleCollection
-  }
-}
-```
+    ```
 
-2.   Create a new class `FhirSyncWorker.kt`
+    Here, when the sync process finishes, a toast message will display notifying
+    the user, and the app will then display all patients by invoking a search
+    with an empty name.
 
-```kotlin
-class FhirSyncWorker(appContext: Context, workerParams: WorkerParameters) :
-  FhirSyncWorker(appContext, workerParams) {
+Now that everything is set up, run your app. Click the `Sync` button in the
+menu. If everything works correctly, you should see the patients from your local
+FHIR server being downloaded and displayed in the application.
 
-  override fun getDownloadWorkManager() = DownloadWorkManagerImpl()
+<img src="images/image7.png" alt="Patient list" width="400">
 
-  override fun getConflictResolver() = AcceptLocalConflictResolver
+## Modify and Upload Patient Data
 
-  override fun getFhirEngine() = FhirApplication.fhirEngine(applicationContext)
-}
-```
+In this section, we will guide you through the process of modifying patient data
+based on specific criteria and uploading the updated data to your FHIR server.
+Specifically, we will swap the address cities for patients residing in
+`Wakefield` and `Taunton`.
 
-3.   In `PatientListViewModel.kt`, add the following code to the body of
-     `triggerOneTimeSync()` function
+### **Step 1**: Set Up the Modification Logic in PatientListViewModel
 
-```kotlin
-viewModelScope.launch {
-      Sync.oneTimeSync<FhirSyncWorker>(getApplication())
-        .shareIn(this, SharingStarted.Eagerly, 10)
-        .collect { _pollState.emit(it) }
+The code in this section is added to the `triggerUpdate` function in
+`PatientListViewModel`
+
+1.  **Access the FHIR Engine**:
+
+    Start by getting a reference to the FHIR engine in the
+    `PatientListViewModel.kt`.
+
+    ```kotlin
+    viewModelScope.launch {
+       val fhirEngine = FhirApplication.fhirEngine(getApplication())
+    ```
+
+    This code launches a coroutine within the ViewModel's scope and initializes
+    the FHIR engine.
+
+1.  **Search for Patients from Wakefield**:
+
+    Use the FHIR engine to search for patients with an address city of
+    `Wakefield`.
+
+    ```kotlin
+    val patientsFromWakefield =
+         fhirEngine.search<Patient> {
+           filter(
+             Patient.ADDRESS_CITY,
+             {
+               modifier =  StringFilterModifier.MATCHES_EXACTLY
+               value = "Wakefield"
+             }
+           )
+         }
+    ```
+
+    Here, we are using the FHIR engine's `search` method to filter patients
+    based on their address city. The result will be a list of patients from
+    Wakefield.
+
+1.  **Search for Patients from Taunton**:
+
+    Similarly, search for patients with an address city of `Taunton`.
+
+    ```kotlin
+    val patientsFromTaunton =
+         fhirEngine.search<Patient> {
+           filter(
+             Patient.ADDRESS_CITY,
+             {
+               modifier =  StringFilterModifier.MATCHES_EXACTLY
+               value = "Taunton"
+             }
+           )
+         }
+    ```
+
+    We now have two lists of patients - one from Wakefield and the other from
+    Taunton.
+
+1.  **Modify Patient Addresses**:
+
+    Go through each patient in the `patientsFromWakefield` list, change their
+    city to `Taunton`, and update them in the FHIR engine.
+
+    ```kotlin
+    patientsFromWakefield.forEach {
+         it.resource.address.first().city = "Taunton"
+         fhirEngine.update(it.resource)
     }
-```
+    ```
 
-4. In `PatientListFragment.kt`, add the following code to the body of function
-   `handleSyncJobStatus`
+    Similarly, update each patient in the `patientsFromTaunton` list to have
+    their city changed to `Wakefield`.
 
-```kotlin
-when (syncJobStatus) {
-    is SyncJobStatus.Finished -> {
-        Toast.makeText(requireContext(), "Sync Finished", Toast.LENGTH_SHORT).show()
-        viewModel.searchPatientsByName("")
+    ```kotlin
+    patientsFromTaunton.forEach {
+         it.resource.address.first().city = "Wakefield"
+         fhirEngine.update(it.resource)
     }
-    else -> {}
-}
-```
+    ```
 
-Now click the `Sync` button in the menu, and you should see the patients in your
-local FHIR server being downloaded to the application.
+1.  **Initiate Synchronization**:
 
-<img src="images/image7.png" alt="Patient list" width="400">
+    After modifying the data locally, trigger a one-time sync to ensure the data
+    is updated on the FHIR server.
 
-## Modify and upload patient data
+    ```kotlin
+    triggerOneTimeSync()
+    }
+    ```
 
-In `PatientListViewModel.kt`, add the following code to `triggerUpdate` function
+    The closing brace `}` signifies the end of the coroutine launched at the
+    beginning.
 
-```kotlin
+### **Step 2**: Test the Functionality
 
-    viewModelScope.launch {
-      val fhirEngine = FhirApplication.fhirEngine(getApplication())
-      
-      val patientsFromWakefield =
-        fhirEngine.search<Patient> {
-          filter(
-            Patient.ADDRESS_CITY,
-            {
-              modifier = StringFilterModifier.CONTAINS
-              value = "Wakefield"
-            }
-          )
-        }
+1.  **UI Testing**:
 
-      val patientsFromTaunton =
-        fhirEngine.search<Patient> {
-          filter(
-            Patient.ADDRESS_CITY,
-            {
-              modifier = StringFilterModifier.CONTAINS
-              value = "Taunton"
-            }
-          )
-        }
+    Run your app. Click the `Update` button in the menu. You should see the
+    address cities for patient `Aaron697` and `Abby752` swapped.
 
-      patientsFromWakefield.forEach {
-        it.address.first().city = "Taunton"
-        fhirEngine.update(it)
-      }
+1.  **Server Verification**:
 
-      patientsFromTaunton.forEach {
-        it.address.first().city = "Wakefield"
-        fhirEngine.update(it)
-      }
+    Open a browser and navigate to `http://localhost:8080/fhir/Patient/`. Verify
+    that the address city for patients `Aaron697` and `Abby752` is updated on
+    the local FHIR server.
 
-      triggerOneTimeSync()
-    }
-```
+By following these steps, you've successfully implemented a mechanism to modify
+patient data and synchronize the changes with your FHIR server.
 
-Now click the `Update` button in the menu, you should see the address city for
-patient `Aaron697` and `Abby752` are swapped.
+## Search for Patients by Name
 
-Open the URL `http://localhost:8080/fhir/Patient/` in a browser and verify that
-the address city for these patients are updated on the local server.
+Searching for patients by their names can provide a user-friendly way of
+retrieving information. Here, we'll walk you through the process of implementing
+this feature in your application.
 
-## Search for patients by name
+### **Step 1**: Update the Function Signature
 
-1.   In `PatientListViewModel.kt` change the signature of function
-     `getSearchResults()` to `getSearchResults(nameQuery: String = "")`.
+Navigate to your `PatientListViewModel.kt` file and find the function named
+`searchPatientsByName`. We will be adding code into this function.
 
-2.   Modify the function body and add the following code to the `search`
-     function call
+To filter the results based on the provided name query, and emit the results for
+the UI to update, incorporate the following conditional code block:
 
 ```kotlin
-if (nameQuery.isNotEmpty()) {
-    filter(
-    Patient.NAME,
-    {
-        modifier = StringFilterModifier.CONTAINS
-        value = nameQuery
+    viewModelScope.launch {
+  val fhirEngine = FhirApplication.fhirEngine(getApplication())
+  if (nameQuery.isNotEmpty()) {
+    val searchResult = fhirEngine.search<Patient> {
+      filter(
+        Patient.NAME,
+        {
+          modifier = StringFilterModifier.CONTAINS
+          value = nameQuery
+        },
+      )
     }
-    )
+    liveSearchedPatients.value  =  searchResult.map { it.resource }
+  }
 }
 ```
 
-3.   Add the following code to `searchPatientsByName`
+Here, if the `nameQuery` is not empty, the search function will filter the
+results to only include patients whose names contain the specified query.
 
-```kotlin
-updatePatientList { getSearchResults(nameQuery) }
-```
+### **Step 2**: Test the New Search Functionality
 
-Relaunch the app, now you can search for patients by name.
+1.  **Relaunch the App**:
+
+    After making these changes, rebuild and run your app.
+
+1.  **Search for Patients**: On the patient list screen, use the search
+    functionality. You should now be able to enter a name (or part of a name) to
+    filter the list of patients accordingly.
+
+With these steps completed, you've enhanced your application by providing users
+with the ability to efficiently search for patients by their names. This can
+significantly improve user experience and efficiency in data retrieval.
 
 ## Congratulations!
 
@@ -371,4 +492,3 @@ You have used the FHIR Engine Library to manage FHIR resources in your app:
 ### Learn More
 
 *   [FHIR Engine developer documentation](https://github.com/google/android-fhir/wiki/FHIR-Engine-Library)
-
diff --git a/codelabs/engine/app/build.gradle.kts b/codelabs/engine/app/build.gradle.kts
index e31cb98661..b5ab70788a 100644
--- a/codelabs/engine/app/build.gradle.kts
+++ b/codelabs/engine/app/build.gradle.kts
@@ -4,48 +4,51 @@ plugins {
 }
 
 android {
-    compileSdk = 31
+    namespace = "com.google.android.fhir.codelabs.engine"
+    compileSdk = 34
 
     defaultConfig {
         applicationId = "com.google.android.fhir.codelabs.engine"
         minSdk = 24
-        targetSdk = 31
+        targetSdk = 34
         versionCode = 1
         versionName = "1.0"
 
         testInstrumentationRunner = "androidx.test.runner.AndroidJUnitRunner"
     }
-
-    buildFeatures { viewBinding = true }
     buildTypes {
         release {
             isMinifyEnabled = false
             proguardFiles(getDefaultProguardFile("proguard-android-optimize.txt"), "proguard-rules.pro")
         }
     }
-    compileOptions {
-        sourceCompatibility = JavaVersion.VERSION_1_8
-        targetCompatibility = JavaVersion.VERSION_1_8
-    }
-    kotlinOptions {
-        jvmTarget = "1.8"
+    buildFeatures {
+        buildConfig = true
+        viewBinding = true
     }
-    packaging {
-        resources.excludes.addAll(listOf("META-INF/ASL-2.0.txt", "META-INF/LGPL-3.0.txt"))
+    compileOptions {
+        // Flag to enable support for the new language APIs
+        // See https://developer.android.com/studio/write/java8-support
+        isCoreLibraryDesugaringEnabled = true
     }
+
+    packaging { resources.excludes.addAll(listOf("META-INF/ASL-2.0.txt", "META-INF/LGPL-3.0.txt")) }
+    kotlin { jvmToolchain(11) }
 }
 
 dependencies {
-    implementation("androidx.core:core-ktx:1.7.0")
-    implementation("androidx.appcompat:appcompat:1.4.0")
-    implementation("com.google.android.material:material:1.4.0")
-    implementation("androidx.constraintlayout:constraintlayout:2.1.2")
-    implementation("androidx.work:work-runtime-ktx:2.7.1")
-
-    testImplementation("junit:junit:4.+")
-    androidTestImplementation("androidx.test.ext:junit:1.1.3")
-    androidTestImplementation("androidx.test.espresso:espresso-core:3.4.0")
-
-    implementation("com.google.android.fhir:engine:0.1.0-beta03")
-    implementation("androidx.fragment:fragment-ktx:1.5.5")
+    coreLibraryDesugaring("com.android.tools:desugar_jdk_libs:2.0.3")
+
+    implementation("androidx.core:core-ktx:1.12.0")
+    implementation("androidx.appcompat:appcompat:1.6.1")
+    implementation("com.google.android.material:material:1.10.0")
+    implementation("androidx.constraintlayout:constraintlayout:2.1.4")
+    implementation("androidx.work:work-runtime-ktx:2.8.1")
+
+    testImplementation("junit:junit:4.13.2")
+    androidTestImplementation("androidx.test.ext:junit:1.1.5")
+    androidTestImplementation("androidx.test.espresso:espresso-core:3.5.1")
+
+    implementation("com.google.android.fhir:engine:0.1.0-beta05")
+    implementation("androidx.fragment:fragment-ktx:1.6.1")
 }
diff --git a/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/FhirApplication.kt b/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/FhirApplication.kt
index 658d84ca14..f734b4f450 100644
--- a/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/FhirApplication.kt
+++ b/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/FhirApplication.kt
@@ -17,41 +17,15 @@
 package com.google.android.fhir.codelabs.engine
 
 import android.app.Application
-import android.content.Context
-import android.util.Log
-import com.google.android.fhir.DatabaseErrorStrategy.RECREATE_AT_OPEN
-import com.google.android.fhir.FhirEngine
-import com.google.android.fhir.FhirEngineConfiguration
-import com.google.android.fhir.FhirEngineProvider
-import com.google.android.fhir.ServerConfiguration
-import com.google.android.fhir.sync.remote.HttpLogger
 
 class FhirApplication : Application() {
-  private val fhirEngine: FhirEngine by lazy { FhirEngineProvider.getInstance(this) }
+  // Add code to create companion object to access fhirEngine
 
   override fun onCreate() {
     super.onCreate()
 
-    FhirEngineProvider.init(
-      FhirEngineConfiguration(
-        enableEncryptionIfSupported = true,
-        RECREATE_AT_OPEN,
-        ServerConfiguration(
-          baseUrl = "http://10.0.2.2:8080/fhir/",
-          httpLogger =
-            HttpLogger(
-              HttpLogger.Configuration(
-                if (BuildConfig.DEBUG) HttpLogger.Level.BODY else HttpLogger.Level.BASIC,
-              ),
-            ) {
-              Log.d("App-HttpLog", it)
-            },
-        ),
-      ),
-    )
+    // Add code to initialise the FHIR Engine
   }
 
-  companion object {
-    fun fhirEngine(context: Context) = (context.applicationContext as FhirApplication).fhirEngine
-  }
+  // Add code to create companion object to access fhirEngine
 }
diff --git a/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientItemRecyclerViewAdapter.kt b/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientItemRecyclerViewAdapter.kt
index 4150da3492..a5cf3f448b 100644
--- a/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientItemRecyclerViewAdapter.kt
+++ b/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientItemRecyclerViewAdapter.kt
@@ -29,8 +29,10 @@ class PatientItemRecyclerViewAdapter :
   class PatientItemDiffCallback : DiffUtil.ItemCallback<Patient>() {
     override fun areItemsTheSame(oldItem: Patient, newItem: Patient) = oldItem.id == newItem.id
 
-    override fun areContentsTheSame(oldItem: Patient, newItem: Patient) =
-      oldItem.equalsDeep(newItem)
+    override fun areContentsTheSame(
+      oldItem: Patient,
+      newItem: Patient,
+    ) = oldItem.equalsDeep(newItem)
   }
 
   override fun onCreateViewHolder(parent: ViewGroup, viewType: Int): PatientItemViewHolder {
diff --git a/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientListFragment.kt b/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientListFragment.kt
index e81cc5416c..8c260fabf0 100644
--- a/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientListFragment.kt
+++ b/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientListFragment.kt
@@ -75,7 +75,9 @@ class PatientListFragment : Fragment() {
     }
   }
 
-  private fun handleSyncJobStatus(syncJobStatus: SyncJobStatus) {}
+  private fun handleSyncJobStatus(syncJobStatus: SyncJobStatus) {
+    // Add code to display Toast when sync job  is complete
+  }
 
   private fun initMenu() {
     (requireActivity() as MenuHost).addMenuProvider(
diff --git a/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientListViewModel.kt b/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientListViewModel.kt
index 0042ff52b7..b25123a148 100644
--- a/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientListViewModel.kt
+++ b/codelabs/engine/app/src/main/java/com/google/android/fhir/codelabs/engine/PatientListViewModel.kt
@@ -41,15 +41,21 @@ class PatientListViewModel(application: Application) : AndroidViewModel(applicat
     updatePatientList { getSearchResults() }
   }
 
-  fun triggerOneTimeSync() {}
+  fun triggerOneTimeSync() {
+    // Add code to start sync
+  }
 
   /*
   Fetches patients stored locally based on the city they are in, and then updates the city field for
   each patient. Once that is complete, trigger a new sync so the changes can be uploaded.
    */
-  fun triggerUpdate() {}
+  fun triggerUpdate() {
+    // Add code to trigger update
+  }
 
-  fun searchPatientsByName(nameQuery: String) {}
+  fun searchPatientsByName(nameQuery: String) {
+    // Add code to use fhirEngine to search for patients
+  }
 
   /**
    * [updatePatientList] calls the search and count lambda and updates the live data values
@@ -66,7 +72,7 @@ class PatientListViewModel(application: Application) : AndroidViewModel(applicat
     val patients: MutableList<Patient> = mutableListOf()
     FhirApplication.fhirEngine(this.getApplication())
       .search<Patient> { sort(Patient.GIVEN, Order.ASCENDING) }
-      .let { patients.addAll(it) }
+      .let { patients.addAll(it.map { it.resource }) }
     return patients
   }
 }
diff --git a/codelabs/engine/build.gradle.kts b/codelabs/engine/build.gradle.kts
index 77acf04960..dcd615f0cb 100644
--- a/codelabs/engine/build.gradle.kts
+++ b/codelabs/engine/build.gradle.kts
@@ -6,8 +6,8 @@ buildscript {
         gradlePluginPortal()
     }
     dependencies {
-        classpath("com.android.tools.build:gradle:7.0.4")
-        classpath("org.jetbrains.kotlin:kotlin-gradle-plugin:1.6.10")
+        classpath("com.android.tools.build:gradle:8.1.2")
+        classpath("org.jetbrains.kotlin:kotlin-gradle-plugin:1.8.20")
 
         // NOTE: Do not place your application dependencies here; they belong
         // in the individual module build.gradle.kts files
diff --git a/codelabs/engine/gradle.properties b/codelabs/engine/gradle.properties
index 98bed167dc..252175276f 100644
--- a/codelabs/engine/gradle.properties
+++ b/codelabs/engine/gradle.properties
@@ -15,7 +15,5 @@ org.gradle.jvmargs=-Xmx2048m -Dfile.encoding=UTF-8
 # Android operating system, and which are packaged with your app"s APK
 # https://developer.android.com/topic/libraries/support-library/androidx-rn
 android.useAndroidX=true
-# Automatically convert third-party libraries to use AndroidX
-android.enableJetifier=true
 # Kotlin code style for this project: "official" or "obsolete":
 kotlin.code.style=official
\ No newline at end of file
diff --git a/codelabs/engine/gradle/wrapper/gradle-wrapper.jar b/codelabs/engine/gradle/wrapper/gradle-wrapper.jar
index e708b1c023..ccebba7710 100644
Binary files a/codelabs/engine/gradle/wrapper/gradle-wrapper.jar and b/codelabs/engine/gradle/wrapper/gradle-wrapper.jar differ
diff --git a/codelabs/engine/gradle/wrapper/gradle-wrapper.properties b/codelabs/engine/gradle/wrapper/gradle-wrapper.properties
index b2a400b0e0..da1db5f04e 100644
--- a/codelabs/engine/gradle/wrapper/gradle-wrapper.properties
+++ b/codelabs/engine/gradle/wrapper/gradle-wrapper.properties
@@ -1,6 +1,5 @@
-#Fri Jan 28 09:30:50 GMT 2022
 distributionBase=GRADLE_USER_HOME
-distributionUrl=https\://services.gradle.org/distributions/gradle-7.0.2-bin.zip
 distributionPath=wrapper/dists
-zipStorePath=wrapper/dists
+distributionUrl=https\://services.gradle.org/distributions/gradle-8.0-bin.zip
 zipStoreBase=GRADLE_USER_HOME
+zipStorePath=wrapper/dists
diff --git a/codelabs/engine/gradlew b/codelabs/engine/gradlew
index 4f906e0c81..79a61d421c 100755
--- a/codelabs/engine/gradlew
+++ b/codelabs/engine/gradlew
@@ -1,7 +1,7 @@
-#!/usr/bin/env sh
+#!/bin/sh
 
 #
-# Copyright 2015 the original author or authors.
+# Copyright © 2015-2021 the original authors.
 #
 # Licensed under the Apache License, Version 2.0 (the "License");
 # you may not use this file except in compliance with the License.
@@ -17,67 +17,101 @@
 #
 
 ##############################################################################
-##
-##  Gradle start up script for UN*X
-##
+#
+#   Gradle start up script for POSIX generated by Gradle.
+#
+#   Important for running:
+#
+#   (1) You need a POSIX-compliant shell to run this script. If your /bin/sh is
+#       noncompliant, but you have some other compliant shell such as ksh or
+#       bash, then to run this script, type that shell name before the whole
+#       command line, like:
+#
+#           ksh Gradle
+#
+#       Busybox and similar reduced shells will NOT work, because this script
+#       requires all of these POSIX shell features:
+#         * functions;
+#         * expansions «$var», «${var}», «${var:-default}», «${var+SET}»,
+#           «${var#prefix}», «${var%suffix}», and «$( cmd )»;
+#         * compound commands having a testable exit status, especially «case»;
+#         * various built-in commands including «command», «set», and «ulimit».
+#
+#   Important for patching:
+#
+#   (2) This script targets any POSIX shell, so it avoids extensions provided
+#       by Bash, Ksh, etc; in particular arrays are avoided.
+#
+#       The "traditional" practice of packing multiple parameters into a
+#       space-separated string is a well documented source of bugs and security
+#       problems, so this is (mostly) avoided, by progressively accumulating
+#       options in "$@", and eventually passing that to Java.
+#
+#       Where the inherited environment variables (DEFAULT_JVM_OPTS, JAVA_OPTS,
+#       and GRADLE_OPTS) rely on word-splitting, this is performed explicitly;
+#       see the in-line comments for details.
+#
+#       There are tweaks for specific operating systems such as AIX, CygWin,
+#       Darwin, MinGW, and NonStop.
+#
+#   (3) This script is generated from the Groovy template
+#       https://github.com/gradle/gradle/blob/HEAD/subprojects/plugins/src/main/resources/org/gradle/api/internal/plugins/unixStartScript.txt
+#       within the Gradle project.
+#
+#       You can find Gradle at https://github.com/gradle/gradle/.
+#
 ##############################################################################
 
 # Attempt to set APP_HOME
+
 # Resolve links: $0 may be a link
-PRG="$0"
-# Need this for relative symlinks.
-while [ -h "$PRG" ] ; do
-    ls=`ls -ld "$PRG"`
-    link=`expr "$ls" : '.*-> \(.*\)$'`
-    if expr "$link" : '/.*' > /dev/null; then
-        PRG="$link"
-    else
-        PRG=`dirname "$PRG"`"/$link"
-    fi
+app_path=$0
+
+# Need this for daisy-chained symlinks.
+while
+    APP_HOME=${app_path%"${app_path##*/}"}  # leaves a trailing /; empty if no leading path
+    [ -h "$app_path" ]
+do
+    ls=$( ls -ld "$app_path" )
+    link=${ls#*' -> '}
+    case $link in             #(
+      /*)   app_path=$link ;; #(
+      *)    app_path=$APP_HOME$link ;;
+    esac
 done
-SAVED="`pwd`"
-cd "`dirname \"$PRG\"`/" >/dev/null
-APP_HOME="`pwd -P`"
-cd "$SAVED" >/dev/null
 
-APP_NAME="Gradle"
-APP_BASE_NAME=`basename "$0"`
+# This is normally unused
+# shellcheck disable=SC2034
+APP_BASE_NAME=${0##*/}
+APP_HOME=$( cd "${APP_HOME:-./}" && pwd -P ) || exit
 
 # Add default JVM options here. You can also use JAVA_OPTS and GRADLE_OPTS to pass JVM options to this script.
 DEFAULT_JVM_OPTS='"-Xmx64m" "-Xms64m"'
 
 # Use the maximum available, or set MAX_FD != -1 to use that value.
-MAX_FD="maximum"
+MAX_FD=maximum
 
 warn () {
     echo "$*"
-}
+} >&2
 
 die () {
     echo
     echo "$*"
     echo
     exit 1
-}
+} >&2
 
 # OS specific support (must be 'true' or 'false').
 cygwin=false
 msys=false
 darwin=false
 nonstop=false
-case "`uname`" in
-  CYGWIN* )
-    cygwin=true
-    ;;
-  Darwin* )
-    darwin=true
-    ;;
-  MINGW* )
-    msys=true
-    ;;
-  NONSTOP* )
-    nonstop=true
-    ;;
+case "$( uname )" in                #(
+  CYGWIN* )         cygwin=true  ;; #(
+  Darwin* )         darwin=true  ;; #(
+  MSYS* | MINGW* )  msys=true    ;; #(
+  NONSTOP* )        nonstop=true ;;
 esac
 
 CLASSPATH=$APP_HOME/gradle/wrapper/gradle-wrapper.jar
@@ -87,9 +121,9 @@ CLASSPATH=$APP_HOME/gradle/wrapper/gradle-wrapper.jar
 if [ -n "$JAVA_HOME" ] ; then
     if [ -x "$JAVA_HOME/jre/sh/java" ] ; then
         # IBM's JDK on AIX uses strange locations for the executables
-        JAVACMD="$JAVA_HOME/jre/sh/java"
+        JAVACMD=$JAVA_HOME/jre/sh/java
     else
-        JAVACMD="$JAVA_HOME/bin/java"
+        JAVACMD=$JAVA_HOME/bin/java
     fi
     if [ ! -x "$JAVACMD" ] ; then
         die "ERROR: JAVA_HOME is set to an invalid directory: $JAVA_HOME
@@ -98,7 +132,7 @@ Please set the JAVA_HOME variable in your environment to match the
 location of your Java installation."
     fi
 else
-    JAVACMD="java"
+    JAVACMD=java
     which java >/dev/null 2>&1 || die "ERROR: JAVA_HOME is not set and no 'java' command could be found in your PATH.
 
 Please set the JAVA_HOME variable in your environment to match the
@@ -106,80 +140,105 @@ location of your Java installation."
 fi
 
 # Increase the maximum file descriptors if we can.
-if [ "$cygwin" = "false" -a "$darwin" = "false" -a "$nonstop" = "false" ] ; then
-    MAX_FD_LIMIT=`ulimit -H -n`
-    if [ $? -eq 0 ] ; then
-        if [ "$MAX_FD" = "maximum" -o "$MAX_FD" = "max" ] ; then
-            MAX_FD="$MAX_FD_LIMIT"
-        fi
-        ulimit -n $MAX_FD
-        if [ $? -ne 0 ] ; then
-            warn "Could not set maximum file descriptor limit: $MAX_FD"
-        fi
-    else
-        warn "Could not query maximum file descriptor limit: $MAX_FD_LIMIT"
-    fi
+if ! "$cygwin" && ! "$darwin" && ! "$nonstop" ; then
+    case $MAX_FD in #(
+      max*)
+        # In POSIX sh, ulimit -H is undefined. That's why the result is checked to see if it worked.
+        # shellcheck disable=SC3045
+        MAX_FD=$( ulimit -H -n ) ||
+            warn "Could not query maximum file descriptor limit"
+    esac
+    case $MAX_FD in  #(
+      '' | soft) :;; #(
+      *)
+        # In POSIX sh, ulimit -n is undefined. That's why the result is checked to see if it worked.
+        # shellcheck disable=SC3045
+        ulimit -n "$MAX_FD" ||
+            warn "Could not set maximum file descriptor limit to $MAX_FD"
+    esac
 fi
 
-# For Darwin, add options to specify how the application appears in the dock
-if $darwin; then
-    GRADLE_OPTS="$GRADLE_OPTS \"-Xdock:name=$APP_NAME\" \"-Xdock:icon=$APP_HOME/media/gradle.icns\""
-fi
+# Collect all arguments for the java command, stacking in reverse order:
+#   * args from the command line
+#   * the main class name
+#   * -classpath
+#   * -D...appname settings
+#   * --module-path (only if needed)
+#   * DEFAULT_JVM_OPTS, JAVA_OPTS, and GRADLE_OPTS environment variables.
 
 # For Cygwin or MSYS, switch paths to Windows format before running java
-if [ "$cygwin" = "true" -o "$msys" = "true" ] ; then
-    APP_HOME=`cygpath --path --mixed "$APP_HOME"`
-    CLASSPATH=`cygpath --path --mixed "$CLASSPATH"`
-
-    JAVACMD=`cygpath --unix "$JAVACMD"`
-
-    # We build the pattern for arguments to be converted via cygpath
-    ROOTDIRSRAW=`find -L / -maxdepth 1 -mindepth 1 -type d 2>/dev/null`
-    SEP=""
-    for dir in $ROOTDIRSRAW ; do
-        ROOTDIRS="$ROOTDIRS$SEP$dir"
-        SEP="|"
-    done
-    OURCYGPATTERN="(^($ROOTDIRS))"
-    # Add a user-defined pattern to the cygpath arguments
-    if [ "$GRADLE_CYGPATTERN" != "" ] ; then
-        OURCYGPATTERN="$OURCYGPATTERN|($GRADLE_CYGPATTERN)"
-    fi
+if "$cygwin" || "$msys" ; then
+    APP_HOME=$( cygpath --path --mixed "$APP_HOME" )
+    CLASSPATH=$( cygpath --path --mixed "$CLASSPATH" )
+
+    JAVACMD=$( cygpath --unix "$JAVACMD" )
+
     # Now convert the arguments - kludge to limit ourselves to /bin/sh
-    i=0
-    for arg in "$@" ; do
-        CHECK=`echo "$arg"|egrep -c "$OURCYGPATTERN" -`
-        CHECK2=`echo "$arg"|egrep -c "^-"`                                 ### Determine if an option
-
-        if [ $CHECK -ne 0 ] && [ $CHECK2 -eq 0 ] ; then                    ### Added a condition
-            eval `echo args$i`=`cygpath --path --ignore --mixed "$arg"`
-        else
-            eval `echo args$i`="\"$arg\""
+    for arg do
+        if
+            case $arg in                                #(
+              -*)   false ;;                            # don't mess with options #(
+              /?*)  t=${arg#/} t=/${t%%/*}              # looks like a POSIX filepath
+                    [ -e "$t" ] ;;                      #(
+              *)    false ;;
+            esac
+        then
+            arg=$( cygpath --path --ignore --mixed "$arg" )
         fi
-        i=`expr $i + 1`
+        # Roll the args list around exactly as many times as the number of
+        # args, so each arg winds up back in the position where it started, but
+        # possibly modified.
+        #
+        # NB: a `for` loop captures its iteration list before it begins, so
+        # changing the positional parameters here affects neither the number of
+        # iterations, nor the values presented in `arg`.
+        shift                   # remove old arg
+        set -- "$@" "$arg"      # push replacement arg
     done
-    case $i in
-        0) set -- ;;
-        1) set -- "$args0" ;;
-        2) set -- "$args0" "$args1" ;;
-        3) set -- "$args0" "$args1" "$args2" ;;
-        4) set -- "$args0" "$args1" "$args2" "$args3" ;;
-        5) set -- "$args0" "$args1" "$args2" "$args3" "$args4" ;;
-        6) set -- "$args0" "$args1" "$args2" "$args3" "$args4" "$args5" ;;
-        7) set -- "$args0" "$args1" "$args2" "$args3" "$args4" "$args5" "$args6" ;;
-        8) set -- "$args0" "$args1" "$args2" "$args3" "$args4" "$args5" "$args6" "$args7" ;;
-        9) set -- "$args0" "$args1" "$args2" "$args3" "$args4" "$args5" "$args6" "$args7" "$args8" ;;
-    esac
 fi
 
-# Escape application args
-save () {
-    for i do printf %s\\n "$i" | sed "s/'/'\\\\''/g;1s/^/'/;\$s/\$/' \\\\/" ; done
-    echo " "
-}
-APP_ARGS=`save "$@"`
+# Collect all arguments for the java command;
+#   * $DEFAULT_JVM_OPTS, $JAVA_OPTS, and $GRADLE_OPTS can contain fragments of
+#     shell script including quotes and variable substitutions, so put them in
+#     double quotes to make sure that they get re-expanded; and
+#   * put everything else in single quotes, so that it's not re-expanded.
+
+set -- \
+        "-Dorg.gradle.appname=$APP_BASE_NAME" \
+        -classpath "$CLASSPATH" \
+        org.gradle.wrapper.GradleWrapperMain \
+        "$@"
+
+# Stop when "xargs" is not available.
+if ! command -v xargs >/dev/null 2>&1
+then
+    die "xargs is not available"
+fi
+
+# Use "xargs" to parse quoted args.
+#
+# With -n1 it outputs one arg per line, with the quotes and backslashes removed.
+#
+# In Bash we could simply go:
+#
+#   readarray ARGS < <( xargs -n1 <<<"$var" ) &&
+#   set -- "${ARGS[@]}" "$@"
+#
+# but POSIX shell has neither arrays nor command substitution, so instead we
+# post-process each arg (as a line of input to sed) to backslash-escape any
+# character that might be a shell metacharacter, then use eval to reverse
+# that process (while maintaining the separation between arguments), and wrap
+# the whole thing up as a single "set" statement.
+#
+# This will of course break if any of these variables contains a newline or
+# an unmatched quote.
+#
 
-# Collect all arguments for the java command, following the shell quoting and substitution rules
-eval set -- $DEFAULT_JVM_OPTS $JAVA_OPTS $GRADLE_OPTS "\"-Dorg.gradle.appname=$APP_BASE_NAME\"" -classpath "\"$CLASSPATH\"" org.gradle.wrapper.GradleWrapperMain "$APP_ARGS"
+eval "set -- $(
+        printf '%s\n' "$DEFAULT_JVM_OPTS $JAVA_OPTS $GRADLE_OPTS" |
+        xargs -n1 |
+        sed ' s~[^-[:alnum:]+,./:=@_]~\\&~g; ' |
+        tr '\n' ' '
+    )" '"$@"'
 
 exec "$JAVACMD" "$@"
diff --git a/codelabs/engine/gradlew.bat b/codelabs/engine/gradlew.bat
index ac1b06f938..6689b85bee 100644
--- a/codelabs/engine/gradlew.bat
+++ b/codelabs/engine/gradlew.bat
@@ -14,7 +14,7 @@
 @rem limitations under the License.
 @rem
 
-@if "%DEBUG%" == "" @echo off
+@if "%DEBUG%"=="" @echo off
 @rem ##########################################################################
 @rem
 @rem  Gradle startup script for Windows
@@ -25,7 +25,8 @@
 if "%OS%"=="Windows_NT" setlocal
 
 set DIRNAME=%~dp0
-if "%DIRNAME%" == "" set DIRNAME=.
+if "%DIRNAME%"=="" set DIRNAME=.
+@rem This is normally unused
 set APP_BASE_NAME=%~n0
 set APP_HOME=%DIRNAME%
 
@@ -40,7 +41,7 @@ if defined JAVA_HOME goto findJavaFromJavaHome
 
 set JAVA_EXE=java.exe
 %JAVA_EXE% -version >NUL 2>&1
-if "%ERRORLEVEL%" == "0" goto execute
+if %ERRORLEVEL% equ 0 goto execute
 
 echo.
 echo ERROR: JAVA_HOME is not set and no 'java' command could be found in your PATH.
@@ -75,13 +76,15 @@ set CLASSPATH=%APP_HOME%\gradle\wrapper\gradle-wrapper.jar
 
 :end
 @rem End local scope for the variables with windows NT shell
-if "%ERRORLEVEL%"=="0" goto mainEnd
+if %ERRORLEVEL% equ 0 goto mainEnd
 
 :fail
 rem Set variable GRADLE_EXIT_CONSOLE if you need the _script_ return code instead of
 rem the _cmd.exe /c_ return code!
-if  not "" == "%GRADLE_EXIT_CONSOLE%" exit 1
-exit /b 1
+set EXIT_CODE=%ERRORLEVEL%
+if %EXIT_CODE% equ 0 set EXIT_CODE=1
+if not ""=="%GRADLE_EXIT_CONSOLE%" exit %EXIT_CODE%
+exit /b %EXIT_CODE%
 
 :mainEnd
 if "%OS%"=="Windows_NT" endlocal
diff --git a/common/build.gradle.kts b/common/build.gradle.kts
index 0d2c90c049..7f53725c3e 100644
--- a/common/build.gradle.kts
+++ b/common/build.gradle.kts
@@ -1,3 +1,5 @@
+import Dependencies.removeIncompatibleDependencies
+
 plugins {
   id(Plugins.BuildPlugins.androidLib)
   id(Plugins.BuildPlugins.kotlinAndroid)
@@ -17,20 +19,10 @@ android {
   kotlin { jvmToolchain(11) }
 }
 
-configurations {
-  all {
-    exclude(module = "xpp3")
-    exclude(module = "hapi-fhir-caching-caffeine")
-    exclude(group = "com.github.ben-manes.caffeine", module = "caffeine")
-
-    resolutionStrategy { force("com.google.guava:guava:32.1.2-android") }
-  }
-}
+configurations { all { removeIncompatibleDependencies() } }
 
 dependencies {
-  // REVERT to DEPENDENCIES LATER
-  api("ca.uhn.hapi.fhir:hapi-fhir-structures-r4:6.8.0")
-  api("ca.uhn.hapi.fhir:hapi-fhir-caching-guava:6.8.0")
+  api(Dependencies.HapiFhir.structuresR4)
 
   implementation(Dependencies.fhirUcum)
 
@@ -39,4 +31,10 @@ dependencies {
   testImplementation(Dependencies.junit)
   testImplementation(Dependencies.robolectric)
   testImplementation(Dependencies.truth)
+
+  constraints {
+    Dependencies.hapiFhirConstraints().forEach { (libName, constraints) ->
+      api(libName, constraints)
+    }
+  }
 }
diff --git a/contrib/barcode/build.gradle.kts b/contrib/barcode/build.gradle.kts
index 2f847d9456..69790d9f7e 100644
--- a/contrib/barcode/build.gradle.kts
+++ b/contrib/barcode/build.gradle.kts
@@ -1,4 +1,4 @@
-import Dependencies.forceGuava
+import Dependencies.removeIncompatibleDependencies
 
 plugins {
   id(Plugins.BuildPlugins.androidLib)
@@ -46,12 +46,7 @@ android {
   kotlin { jvmToolchain(11) }
 }
 
-configurations {
-  all {
-    exclude(module = "xpp3")
-    forceGuava()
-  }
-}
+configurations { all { removeIncompatibleDependencies() } }
 
 dependencies {
   androidTestImplementation(Dependencies.AndroidxTest.core)
diff --git a/datacapture/build.gradle.kts b/datacapture/build.gradle.kts
index 6e8dbee0a8..d261f17e98 100644
--- a/datacapture/build.gradle.kts
+++ b/datacapture/build.gradle.kts
@@ -1,6 +1,4 @@
-import Dependencies.forceGuava
-import Dependencies.forceHapiVersion
-import Dependencies.forceJacksonVersion
+import Dependencies.removeIncompatibleDependencies
 import java.net.URL
 
 plugins {
@@ -59,9 +57,7 @@ configurations {
   all {
     exclude(module = "xpp3")
     exclude(group = "net.sf.saxon", module = "Saxon-HE")
-    forceGuava()
-    forceHapiVersion()
-    forceJacksonVersion()
+    removeIncompatibleDependencies()
   }
 }
 
@@ -82,12 +78,11 @@ dependencies {
 
   coreLibraryDesugaring(Dependencies.desugarJdkLibs)
 
-  implementation(Dependencies.androidFhirCommon)
   implementation(Dependencies.Androidx.appCompat)
   implementation(Dependencies.Androidx.constraintLayout)
   implementation(Dependencies.Androidx.coreKtx)
   implementation(Dependencies.Androidx.fragmentKtx)
-  implementation(Dependencies.Glide.glide)
+  implementation(libs.glide)
   implementation(Dependencies.HapiFhir.guavaCaching)
   implementation(Dependencies.HapiFhir.validation) {
     exclude(module = "commons-logging")
@@ -96,6 +91,7 @@ dependencies {
   implementation(Dependencies.Kotlin.kotlinCoroutinesCore)
   implementation(Dependencies.Kotlin.stdlib)
   implementation(Dependencies.Lifecycle.viewModelKtx)
+  implementation(Dependencies.androidFhirCommon)
   implementation(Dependencies.material)
   implementation(Dependencies.timber)
 
@@ -108,6 +104,13 @@ dependencies {
   testImplementation(Dependencies.mockitoKotlin)
   testImplementation(Dependencies.robolectric)
   testImplementation(Dependencies.truth)
+
+  constraints {
+    Dependencies.hapiFhirConstraints().forEach { (libName, constraints) ->
+      api(libName, constraints)
+      implementation(libName, constraints)
+    }
+  }
 }
 
 tasks.dokkaHtml.configure {
diff --git a/datacapture/src/androidTest/java/com/google/android/fhir/datacapture/test/QuestionnaireUiEspressoTest.kt b/datacapture/src/androidTest/java/com/google/android/fhir/datacapture/test/QuestionnaireUiEspressoTest.kt
index 9df329396e..96b75cba10 100644
--- a/datacapture/src/androidTest/java/com/google/android/fhir/datacapture/test/QuestionnaireUiEspressoTest.kt
+++ b/datacapture/src/androidTest/java/com/google/android/fhir/datacapture/test/QuestionnaireUiEspressoTest.kt
@@ -30,6 +30,7 @@ import androidx.test.espresso.matcher.ViewMatchers.withId
 import androidx.test.espresso.matcher.ViewMatchers.withText
 import androidx.test.ext.junit.rules.ActivityScenarioRule
 import androidx.test.ext.junit.runners.AndroidJUnit4
+import androidx.test.filters.SdkSuppress
 import androidx.test.platform.app.InstrumentationRegistry
 import ca.uhn.fhir.context.FhirContext
 import ca.uhn.fhir.context.FhirVersionEnum
@@ -478,7 +479,26 @@ class QuestionnaireUiEspressoTest {
     }
   }
 
-  private fun buildFragmentFromQuestionnaire(fileName: String, isReviewMode: Boolean = false) {
+  @Test
+  @SdkSuppress(minSdkVersion = 33)
+  fun clearAllAnswers_shouldClearDraftAnswer() {
+    val questionnaireFragment = buildFragmentFromQuestionnaire("/component_date_picker.json")
+    // Add month and day. No need to add slashes as they are added automatically
+    onView(withId(R.id.text_input_edit_text))
+      .perform(ViewActions.click())
+      .perform(ViewActions.typeTextIntoFocusedView("0105"))
+
+    questionnaireFragment.clearAllAnswers()
+
+    onView(withId(R.id.text_input_edit_text)).check { view, _ ->
+      assertThat((view as TextInputEditText).text.toString()).isEmpty()
+    }
+  }
+
+  private fun buildFragmentFromQuestionnaire(
+    fileName: String,
+    isReviewMode: Boolean = false,
+  ): QuestionnaireFragment {
     val questionnaireJsonString = readFileFromAssets(fileName)
     val questionnaireFragment =
       QuestionnaireFragment.builder()
@@ -491,6 +511,7 @@ class QuestionnaireUiEspressoTest {
         add(R.id.container_holder, questionnaireFragment)
       }
     }
+    return questionnaireFragment
   }
 
   private fun buildFragmentFromQuestionnaire(
diff --git a/datacapture/src/androidTest/java/com/google/android/fhir/datacapture/test/views/QuestionnaireItemDialogMultiSelectViewHolderFactoryEspressoTest.kt b/datacapture/src/androidTest/java/com/google/android/fhir/datacapture/test/views/QuestionnaireItemDialogMultiSelectViewHolderFactoryEspressoTest.kt
index 7c05378caa..4c3b530c55 100644
--- a/datacapture/src/androidTest/java/com/google/android/fhir/datacapture/test/views/QuestionnaireItemDialogMultiSelectViewHolderFactoryEspressoTest.kt
+++ b/datacapture/src/androidTest/java/com/google/android/fhir/datacapture/test/views/QuestionnaireItemDialogMultiSelectViewHolderFactoryEspressoTest.kt
@@ -58,6 +58,7 @@ import org.hl7.fhir.r4.model.Extension
 import org.hl7.fhir.r4.model.Questionnaire
 import org.hl7.fhir.r4.model.QuestionnaireResponse
 import org.junit.Before
+import org.junit.Ignore
 import org.junit.Rule
 import org.junit.Test
 
@@ -262,7 +263,7 @@ class QuestionnaireItemDialogMultiSelectViewHolderFactoryEspressoTest {
   }
 
   @Test
-  @SdkSuppress(minSdkVersion = 33) // TODO https://github.com/google/android-fhir/issues/1482 FIXME
+  @Ignore // TODO https://github.com/google/android-fhir/issues/1482 FIXME
   fun selectOther_shouldScrollDownToShowAddAnotherAnswer() {
     val questionnaireItem =
       answerOptions(
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/QuestionnaireFragment.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/QuestionnaireFragment.kt
index 6dfb20a6bc..a6ced886c3 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/QuestionnaireFragment.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/QuestionnaireFragment.kt
@@ -297,6 +297,8 @@ class QuestionnaireFragment : Fragment() {
    */
   fun getQuestionnaireResponse() = viewModel.getQuestionnaireResponse()
 
+  fun clearAllAnswers() = viewModel.clearAllAnswers()
+
   /** Helper to create [QuestionnaireFragment] with appropriate [Bundle] arguments. */
   class Builder {
 
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/QuestionnaireViewModel.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/QuestionnaireViewModel.kt
index 79ef7478b2..75afd1149b 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/QuestionnaireViewModel.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/QuestionnaireViewModel.kt
@@ -449,6 +449,15 @@ internal class QuestionnaireViewModel(application: Application, state: SavedStat
     }
   }
 
+  /** Clears all the answers from the questionnaire response by iterating through each item. */
+  fun clearAllAnswers() {
+    questionnaireResponse.allItems.forEach { it.answer = emptyList() }
+    draftAnswerMap.clear()
+    modifiedQuestionnaireResponseItemSet.clear()
+    responseItemToAnswersMapForDisabledQuestionnaireItem.clear()
+    modificationCount.update { it + 1 }
+  }
+
   /**
    * Validates entire questionnaire and return the validation results. As a side effect, it triggers
    * the UI update to show errors in case there are any validation errors.
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/enablement/EnablementEvaluator.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/enablement/EnablementEvaluator.kt
index 23a0431667..f4a6a403c3 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/enablement/EnablementEvaluator.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/enablement/EnablementEvaluator.kt
@@ -20,7 +20,7 @@ import com.google.android.fhir.compareTo
 import com.google.android.fhir.datacapture.extensions.allItems
 import com.google.android.fhir.datacapture.extensions.enableWhenExpression
 import com.google.android.fhir.datacapture.fhirpath.ExpressionEvaluator
-import com.google.android.fhir.datacapture.fhirpath.evaluateToBoolean
+import com.google.android.fhir.datacapture.fhirpath.convertToBoolean
 import com.google.android.fhir.equals
 import org.hl7.fhir.r4.model.Questionnaire
 import org.hl7.fhir.r4.model.QuestionnaireResponse
@@ -138,16 +138,12 @@ internal class EnablementEvaluator(
 
     // Evaluate `enableWhenExpression`.
     if (enableWhenExpression != null && enableWhenExpression.hasExpression()) {
-      val contextMap =
-        expressionEvaluator.extractDependentVariables(
-          questionnaireItem.enableWhenExpression!!,
+      return convertToBoolean(
+        expressionEvaluator.evaluateExpression(
           questionnaireItem,
-        )
-      return evaluateToBoolean(
-        questionnaireResponse,
-        questionnaireResponseItem,
-        enableWhenExpression.expression,
-        contextMap,
+          questionnaireResponseItem,
+          questionnaireItem.enableWhenExpression!!,
+        ),
       )
     }
 
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/expressions/EnabledAnswerOptionsEvaluator.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/expressions/EnabledAnswerOptionsEvaluator.kt
index 73a46304cc..1a971375d4 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/expressions/EnabledAnswerOptionsEvaluator.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/expressions/EnabledAnswerOptionsEvaluator.kt
@@ -24,7 +24,7 @@ import com.google.android.fhir.datacapture.extensions.extractAnswerOptions
 import com.google.android.fhir.datacapture.extensions.isFhirPath
 import com.google.android.fhir.datacapture.extensions.isXFhirQuery
 import com.google.android.fhir.datacapture.fhirpath.ExpressionEvaluator
-import com.google.android.fhir.datacapture.fhirpath.fhirPathEngine
+import com.google.android.fhir.datacapture.fhirpath.convertToBoolean
 import org.hl7.fhir.r4.model.Coding
 import org.hl7.fhir.r4.model.Questionnaire
 import org.hl7.fhir.r4.model.Questionnaire.QuestionnaireItemComponent
@@ -250,7 +250,7 @@ internal class EnabledAnswerOptionsEvaluator(
           val (expression, toggleOptions) = it
           val evaluationResult =
             if (expression.isFhirPath) {
-              fhirPathEngine.convertToBoolean(
+              convertToBoolean(
                 expressionEvaluator.evaluateExpression(
                   item,
                   questionnaireResponseItem,
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/extensions/MoreQuestionnaireItemComponents.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/extensions/MoreQuestionnaireItemComponents.kt
index 9f7c29f838..cb5687e1f9 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/extensions/MoreQuestionnaireItemComponents.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/extensions/MoreQuestionnaireItemComponents.kt
@@ -806,10 +806,9 @@ internal fun Questionnaire.QuestionnaireItemComponent.extractAnswerOptions(
  * `questionnaireResponseItemList` with the same linkId using the provided `transform` function
  * applied to each pair of questionnaire item and questionnaire response item.
  *
- * It is assumed that the linkIds are unique in `this` and in `questionnaireResponseItemList`.
- *
- * Although linkIds may appear more than once in questionnaire response, they would not appear more
- * than once within a list of questionnaire response items sharing the same parent.
+ * In case of repeated group item, `questionnaireResponseItemList` will contain
+ * QuestionnaireResponseItemComponent with same linkId. So these items are grouped with linkId and
+ * associated with its questionnaire item linkId.
  */
 internal inline fun <T> List<Questionnaire.QuestionnaireItemComponent>.zipByLinkId(
   questionnaireResponseItemList: List<QuestionnaireResponse.QuestionnaireResponseItemComponent>,
@@ -819,12 +818,13 @@ internal inline fun <T> List<Questionnaire.QuestionnaireItemComponent>.zipByLink
       QuestionnaireResponse.QuestionnaireResponseItemComponent,
     ) -> T,
 ): List<T> {
-  val linkIdToQuestionnaireResponseItemMap = questionnaireResponseItemList.associateBy { it.linkId }
-  return mapNotNull { questionnaireItem ->
-    linkIdToQuestionnaireResponseItemMap[questionnaireItem.linkId]?.let { questionnaireResponseItem,
-      ->
+  val linkIdToQuestionnaireResponseItemListMap = questionnaireResponseItemList.groupBy { it.linkId }
+  return flatMap { questionnaireItem ->
+    linkIdToQuestionnaireResponseItemListMap[questionnaireItem.linkId]?.mapNotNull {
+      questionnaireResponseItem ->
       transform(questionnaireItem, questionnaireResponseItem)
     }
+      ?: emptyList()
   }
 }
 
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/extensions/MoreTypes.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/extensions/MoreTypes.kt
index 7df499a385..ab5120d8bc 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/extensions/MoreTypes.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/extensions/MoreTypes.kt
@@ -18,7 +18,7 @@ package com.google.android.fhir.datacapture.extensions
 
 import android.content.Context
 import com.google.android.fhir.datacapture.R
-import com.google.android.fhir.datacapture.fhirpath.fhirPathEngine
+import com.google.android.fhir.datacapture.fhirpath.evaluateToBase
 import com.google.android.fhir.datacapture.views.factories.localDate
 import com.google.android.fhir.datacapture.views.factories.localTime
 import com.google.android.fhir.getLocalizedText
@@ -130,7 +130,7 @@ fun Type.valueOrCalculateValue(): Type {
       .firstOrNull { it.url == EXTENSION_CQF_CALCULATED_VALUE_URL }
       ?.let { extension ->
         val expression = (extension.value as Expression).expression
-        fhirPathEngine.evaluate(this, expression).singleOrNull()?.let { it as Type }
+        evaluateToBase(this, expression).singleOrNull()?.let { it as Type }
       }
       ?: this
   } else {
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/fhirpath/ExpressionEvaluator.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/fhirpath/ExpressionEvaluator.kt
index dc4404b5da..52a8745a81 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/fhirpath/ExpressionEvaluator.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/fhirpath/ExpressionEvaluator.kt
@@ -25,6 +25,7 @@ import com.google.android.fhir.datacapture.extensions.variableExpressions
 import org.hl7.fhir.exceptions.FHIRException
 import org.hl7.fhir.r4.model.Base
 import org.hl7.fhir.r4.model.Expression
+import org.hl7.fhir.r4.model.ExpressionNode
 import org.hl7.fhir.r4.model.Questionnaire
 import org.hl7.fhir.r4.model.Questionnaire.QuestionnaireItemComponent
 import org.hl7.fhir.r4.model.QuestionnaireResponse
@@ -81,6 +82,20 @@ internal class ExpressionEvaluator(
    */
   private val xFhirQueryEnhancementRegex = Regex("\\{\\{(.*?)\\}\\}")
 
+  /**
+   * Variable %questionnaire corresponds to the Questionnaire resource into
+   * QuestionnaireResponse.questionnaire element.
+   * https://build.fhir.org/ig/HL7/sdc/expressions.html#fhirpath-supplements
+   */
+  private val questionnaireFhirPathSupplement = "questionnaire"
+
+  /**
+   * Variable %qitem refer to Questionnaire.item that corresponds to context
+   * QuestionnaireResponse.item. It is only valid for FHIRPath expressions defined within a
+   * Questionnaire item. https://build.fhir.org/ig/HL7/sdc/expressions.html#fhirpath-supplements
+   */
+  private val questionnaireItemFhirPathSupplement = "qItem"
+
   /** Detects if any item into list is referencing a dependent item in its calculated expression */
   internal fun detectExpressionCyclicDependency(items: List<QuestionnaireItemComponent>) {
     items
@@ -113,12 +128,11 @@ internal class ExpressionEvaluator(
     expression: Expression,
   ): List<Base> {
     val appContext = extractDependentVariables(expression, questionnaireItem)
-    return fhirPathEngine.evaluate(
-      appContext,
+    return evaluateToBase(
       questionnaireResponse,
-      null,
       questionnaireResponseItem,
       expression.expression,
+      appContext,
     )
   }
 
@@ -209,7 +223,7 @@ internal class ExpressionEvaluator(
    * @param variablesMap the [Map<String, Base>] of variables, the default value is empty map is
    *   defined
    */
-  internal fun extractDependentVariables(
+  private fun extractDependentVariables(
     expression: Expression,
     questionnaireItem: QuestionnaireItemComponent,
     variablesMap: MutableMap<String, Base?> = mutableMapOf(),
@@ -224,7 +238,10 @@ internal class ExpressionEvaluator(
         )
       }
     }
-    return variablesMap
+    return variablesMap.apply {
+      put(questionnaireFhirPathSupplement, questionnaire)
+      put(questionnaireItemFhirPathSupplement, questionnaireItem)
+    }
   }
 
   /**
@@ -282,7 +299,9 @@ internal class ExpressionEvaluator(
 
     val fhirPathsEvaluatedPairs =
       questionnaireLaunchContextMap
+        ?.toMutableMap()
         .takeIf { !it.isNullOrEmpty() }
+        ?.also { it.put(questionnaireFhirPathSupplement, questionnaire) }
         ?.let { evaluateXFhirEnhancement(expression, it) }
         ?: emptySequence()
 
@@ -311,19 +330,12 @@ internal class ExpressionEvaluator(
       .findAll(expression.expression)
       .map { it.groupValues }
       .map { (fhirPathWithParentheses, fhirPath) ->
-        // TODO(omarismail94): See if FHIRPathEngine.check() can be used to distinguish invalid
-        // expression vs an expression that is valid, but does not return one resource only.
-        val expressionNode = fhirPathEngine.parse(fhirPath)
-        val resourceType =
-          expressionNode.constant?.primitiveValue()?.substring(1)
-            ?: expressionNode.name?.lowercase()
+        val expressionNode = extractExpressionNode(fhirPath)
         val evaluatedResult =
-          fhirPathEngine.evaluateToString(
-            launchContextMap,
-            null,
-            null,
-            launchContextMap[resourceType],
-            expressionNode,
+          evaluateToString(
+            expression = expressionNode,
+            data = launchContextMap[extractResourceType(expressionNode)],
+            contextMap = launchContextMap,
           )
 
         // If the result of evaluating the FHIRPath expressions is an invalid query, it returns
@@ -432,13 +444,11 @@ internal class ExpressionEvaluator(
         "Unsupported expression language, language should be text/fhirpath"
       }
 
-      fhirPathEngine
-        .evaluate(
-          /* appContext= */ dependentVariables,
-          /* focusResource= */ questionnaireResponse,
-          /* rootResource= */ null,
-          /* base= */ null,
-          /* path= */ expression.expression,
+      evaluateToBase(
+          questionnaireResponse = questionnaireResponse,
+          questionnaireResponseItem = null,
+          expression = expression.expression,
+          contextMap = dependentVariables,
         )
         .firstOrNull()
     } catch (exception: FHIRException) {
@@ -447,5 +457,15 @@ internal class ExpressionEvaluator(
     }
 }
 
+/**
+ * Extract [ResourceType] string representation from constant or name property of given
+ * [ExpressionNode].
+ */
+private fun extractResourceType(expressionNode: ExpressionNode): String? {
+  // TODO(omarismail94): See if FHIRPathEngine.check() can be used to distinguish invalid
+  // expression vs an expression that is valid, but does not return one resource only.
+  return expressionNode.constant?.primitiveValue()?.substring(1) ?: expressionNode.name?.lowercase()
+}
+
 /** Pair of a [Questionnaire.QuestionnaireItemComponent] with its evaluated answers */
 internal typealias ItemToAnswersPair = Pair<QuestionnaireItemComponent, List<Type>>
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/fhirpath/FhirPathUtil.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/fhirpath/FhirPathUtil.kt
index 04aff30392..4c7d626913 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/fhirpath/FhirPathUtil.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/fhirpath/FhirPathUtil.kt
@@ -20,12 +20,14 @@ import ca.uhn.fhir.context.FhirContext
 import ca.uhn.fhir.context.FhirVersionEnum
 import org.hl7.fhir.r4.hapi.ctx.HapiWorkerContext
 import org.hl7.fhir.r4.model.Base
+import org.hl7.fhir.r4.model.ExpressionNode
 import org.hl7.fhir.r4.model.QuestionnaireResponse
 import org.hl7.fhir.r4.model.QuestionnaireResponse.QuestionnaireResponseItemComponent
 import org.hl7.fhir.r4.model.Resource
+import org.hl7.fhir.r4.model.Type
 import org.hl7.fhir.r4.utils.FHIRPathEngine
 
-internal val fhirPathEngine: FHIRPathEngine =
+private val fhirPathEngine: FHIRPathEngine =
   with(FhirContext.forCached(FhirVersionEnum.R4)) {
     FHIRPathEngine(HapiWorkerContext(this, this.validationSupport)).apply {
       hostServices = FHIRPathEngineHostServices
@@ -38,6 +40,20 @@ internal val fhirPathEngine: FHIRPathEngine =
 internal fun evaluateToDisplay(expressions: List<String>, data: Resource) =
   expressions.joinToString(" ") { fhirPathEngine.evaluateToString(data, it) }
 
+/** Evaluates the expression over resource [Resource] and returns string value */
+internal fun evaluateToString(
+  expression: ExpressionNode,
+  data: Resource?,
+  contextMap: Map<String, Base?>,
+) =
+  fhirPathEngine.evaluateToString(
+    /* appInfo = */ contextMap,
+    /* focusResource = */ null,
+    /* rootResource = */ null,
+    /* base = */ data,
+    /* node = */ expression,
+  )
+
 /**
  * Evaluates the expression and returns the boolean result. The resources [QuestionnaireResponse]
  * and [QuestionnaireResponseItemComponent] are passed as fhirPath supplements as defined in fhir
@@ -60,3 +76,40 @@ internal fun evaluateToBoolean(
     expressionNode,
   )
 }
+
+/**
+ * Evaluates the expression and returns the list of [Base]. The resources [QuestionnaireResponse]
+ * and [QuestionnaireResponseItemComponent] are passed as fhirPath supplements as defined in fhir
+ * specs https://build.fhir.org/ig/HL7/sdc/expressions.html#fhirpath-supplements. All other
+ * constants are passed as contextMap
+ *
+ * %resource = [QuestionnaireResponse], %context = [QuestionnaireResponseItemComponent]
+ */
+internal fun evaluateToBase(
+  questionnaireResponse: QuestionnaireResponse?,
+  questionnaireResponseItem: QuestionnaireResponseItemComponent?,
+  expression: String,
+  contextMap: Map<String, Base?> = mapOf(),
+): List<Base> {
+  return fhirPathEngine.evaluate(
+    /* appContext = */ contextMap,
+    /* focusResource = */ questionnaireResponse,
+    /* rootResource = */ null,
+    /* base = */ questionnaireResponseItem,
+    /* path = */ expression,
+  )
+}
+
+/** Evaluates the given expression and returns list of [Base] */
+internal fun evaluateToBase(type: Type, expression: String): List<Base> {
+  return fhirPathEngine.evaluate(
+    /* base = */ type,
+    /* path = */ expression,
+  )
+}
+
+/** Evaluates the given list of [Base] elements and returns boolean result */
+internal fun convertToBoolean(items: List<Base>) = fhirPathEngine.convertToBoolean(items)
+
+/** Parse the given expression into [ExpressionNode] */
+internal fun extractExpressionNode(fhirPath: String) = fhirPathEngine.parse(fhirPath)
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/mapping/ResourceMapper.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/mapping/ResourceMapper.kt
index eeb37f4ca3..6ad8088ad3 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/mapping/ResourceMapper.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/mapping/ResourceMapper.kt
@@ -28,7 +28,8 @@ import com.google.android.fhir.datacapture.extensions.toCoding
 import com.google.android.fhir.datacapture.extensions.toIdType
 import com.google.android.fhir.datacapture.extensions.toUriType
 import com.google.android.fhir.datacapture.extensions.validateLaunchContextExtensions
-import com.google.android.fhir.datacapture.fhirpath.fhirPathEngine
+import com.google.android.fhir.datacapture.extensions.zipByLinkId
+import com.google.android.fhir.datacapture.fhirpath.evaluateToBase
 import java.lang.reflect.Field
 import java.lang.reflect.Method
 import java.lang.reflect.ParameterizedType
@@ -252,7 +253,13 @@ object ResourceMapper {
 
     questionnaireItem.initialExpression
       ?.let {
-        fhirPathEngine.evaluate(launchContexts, null, null, null, it.expression).firstOrNull()
+        evaluateToBase(
+            questionnaireResponse = null,
+            questionnaireResponseItem = null,
+            expression = it.expression,
+            contextMap = launchContexts,
+          )
+          .firstOrNull()
       }
       ?.let {
         // Set initial value for the questionnaire item. Questionnaire items should not have both
@@ -282,31 +289,17 @@ object ResourceMapper {
     extractionResult: MutableList<Resource>,
     profileLoader: ProfileLoader,
   ) {
-    val questionnaireItemListIterator = questionnaireItemList.iterator()
-    val questionnaireResponseItemListIterator = questionnaireResponseItemList.iterator()
-    while (
-      questionnaireItemListIterator.hasNext() && questionnaireResponseItemListIterator.hasNext()
-    ) {
-      val currentQuestionnaireResponseItem = questionnaireResponseItemListIterator.next()
-      var currentQuestionnaireItem = questionnaireItemListIterator.next()
-      // Find the next questionnaire item with the same link ID. This is necessary because some
-      // questionnaire items that are disabled might not have corresponding questionnaire response
-      // items.
-      while (
-        questionnaireItemListIterator.hasNext() &&
-          currentQuestionnaireItem.linkId != currentQuestionnaireResponseItem.linkId
-      ) {
-        currentQuestionnaireItem = questionnaireItemListIterator.next()
-      }
-      if (currentQuestionnaireItem.linkId == currentQuestionnaireResponseItem.linkId) {
-        extractByDefinition(
-          currentQuestionnaireItem,
-          currentQuestionnaireResponseItem,
-          extractionContext,
-          extractionResult,
-          profileLoader,
-        )
-      }
+    questionnaireItemList.zipByLinkId(questionnaireResponseItemList) {
+      questionnaireItem,
+      questionnaireResponseItem,
+      ->
+      extractByDefinition(
+        questionnaireItem,
+        questionnaireResponseItem,
+        extractionContext,
+        extractionResult,
+        profileLoader,
+      )
     }
   }
 
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/DatePickerViewHolderFactory.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/DatePickerViewHolderFactory.kt
index abd1b20836..d15ca93ff2 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/DatePickerViewHolderFactory.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/DatePickerViewHolderFactory.kt
@@ -65,7 +65,7 @@ internal object DatePickerViewHolderFactory :
       private lateinit var textInputEditText: TextInputEditText
       override lateinit var questionnaireViewItem: QuestionnaireViewItem
       private lateinit var canonicalizedDatePattern: String
-      private lateinit var textWatcher: DatePatternTextWatcher
+      private var textWatcher: TextWatcher? = null
 
       override fun init(itemView: View) {
         header = itemView.findViewById(R.id.header)
@@ -108,7 +108,6 @@ internal object DatePickerViewHolderFactory :
         val datePattern = questionnaireViewItem.questionnaireItem.dateEntryFormatOrSystemDefault
         // Special character used in date pattern
         val datePatternSeparator = getDateSeparator(datePattern)
-        textWatcher = DatePatternTextWatcher(datePatternSeparator)
         canonicalizedDatePattern = canonicalizeDatePattern(datePattern)
 
         with(textInputLayout) {
@@ -142,6 +141,7 @@ internal object DatePickerViewHolderFactory :
         } else {
           displayValidationResult(questionnaireViewItem.validationResult)
         }
+        textWatcher = DatePatternTextWatcher(datePatternSeparator)
         textInputEditText.addTextChangedListener(textWatcher)
       }
 
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/EditTextDecimalViewHolderFactory.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/EditTextDecimalViewHolderFactory.kt
index 31a5058c53..a4fb8d2443 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/EditTextDecimalViewHolderFactory.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/EditTextDecimalViewHolderFactory.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2022-2023 Google LLC
+ * Copyright 2022-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -47,16 +47,17 @@ internal object EditTextDecimalViewHolderFactory :
       ) {
         val questionnaireItemViewItemDecimalAnswer =
           questionnaireViewItem.answers.singleOrNull()?.valueDecimalType?.value?.toString()
-
         val draftAnswer = questionnaireViewItem.draftAnswer?.toString()
 
-        val decimalStringToDisplay = questionnaireItemViewItemDecimalAnswer ?: draftAnswer
-
-        if (
-          decimalStringToDisplay?.toDoubleOrNull() !=
+        if (questionnaireItemViewItemDecimalAnswer.isNullOrEmpty() && draftAnswer.isNullOrEmpty()) {
+          textInputEditText.setText("")
+        } else if (
+          questionnaireItemViewItemDecimalAnswer?.toDoubleOrNull() !=
             textInputEditText.text.toString().toDoubleOrNull()
         ) {
-          textInputEditText.setText(decimalStringToDisplay)
+          textInputEditText.setText(questionnaireItemViewItemDecimalAnswer)
+        } else if (draftAnswer != null && draftAnswer != textInputEditText.text.toString()) {
+          textInputEditText.setText(draftAnswer)
         }
         // Update error message if draft answer present
         if (draftAnswer != null) {
diff --git a/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/EditTextIntegerViewHolderFactory.kt b/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/EditTextIntegerViewHolderFactory.kt
index bb87204486..b9da83ca2b 100644
--- a/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/EditTextIntegerViewHolderFactory.kt
+++ b/datacapture/src/main/java/com/google/android/fhir/datacapture/views/factories/EditTextIntegerViewHolderFactory.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2022-2023 Google LLC
+ * Copyright 2022-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -64,14 +64,16 @@ internal object EditTextIntegerViewHolderFactory :
           questionnaireViewItem.answers.singleOrNull()?.valueIntegerType?.value?.toString()
         val draftAnswer = questionnaireViewItem.draftAnswer?.toString()
 
-        val text = answer ?: draftAnswer
-
         // Update the text on the UI only if the value of the saved answer or draft answer
         // is different from what the user is typing. We compare the two fields as integers to
         // avoid shifting focus if the text values are different, but their integer representation
         // is the same (e.g. "001" compared to "1")
-        if ((text?.toIntOrNull() != textInputEditText.text.toString().toIntOrNull())) {
-          textInputEditText.setText(text)
+        if (answer.isNullOrEmpty() && draftAnswer.isNullOrEmpty()) {
+          textInputEditText.setText("")
+        } else if (answer?.toIntOrNull() != textInputEditText.text.toString().toIntOrNull()) {
+          textInputEditText.setText(answer)
+        } else if (draftAnswer != null && draftAnswer != textInputEditText.text.toString()) {
+          textInputEditText.setText(draftAnswer)
         }
 
         // Update error message if draft answer present
diff --git a/datacapture/src/test/java/com/google/android/fhir/datacapture/QuestionnaireViewModelTest.kt b/datacapture/src/test/java/com/google/android/fhir/datacapture/QuestionnaireViewModelTest.kt
index 7250b0ce62..e3d7dc2f9f 100644
--- a/datacapture/src/test/java/com/google/android/fhir/datacapture/QuestionnaireViewModelTest.kt
+++ b/datacapture/src/test/java/com/google/android/fhir/datacapture/QuestionnaireViewModelTest.kt
@@ -81,6 +81,7 @@ import org.hl7.fhir.r4.model.Enumerations
 import org.hl7.fhir.r4.model.Expression
 import org.hl7.fhir.r4.model.Extension
 import org.hl7.fhir.r4.model.HumanName
+import org.hl7.fhir.r4.model.Identifier
 import org.hl7.fhir.r4.model.IntegerType
 import org.hl7.fhir.r4.model.Patient
 import org.hl7.fhir.r4.model.Practitioner
@@ -3874,6 +3875,103 @@ class QuestionnaireViewModelTest {
     assertResourceEquals(value, expectedResponse)
   }
 
+  @Test
+  fun `clearAllAnswers clears all answers in questionnaire response`() {
+    val questionnaireString =
+      """
+        {
+          "resourceType": "Questionnaire",
+          "id": "client-registration-sample",
+          "item": [
+            {
+              "linkId": "1",
+              "type": "group",
+              "item": [
+                {
+                  "linkId": "1.1",
+                  "text": "First Nested Item",
+                  "type": "boolean"
+                },
+                {
+                  "linkId": "1.2",
+                  "text": "Second Nested Item",
+                  "type": "boolean"
+                }
+              ]
+            }
+          ]
+        }
+            """
+        .trimIndent()
+
+    val questionnaireResponseString =
+      """
+           {
+              "resourceType": "QuestionnaireResponse",
+              "item": [
+                {
+                  "linkId": "1",
+                  "item": [
+                    {
+                      "linkId": "1.1",
+                      "text": "First Nested Item",
+                      "answer": [
+                        {
+                          "valueBoolean": true
+                        }
+                      ]
+                    },
+                    {
+                      "linkId": "1.2",
+                      "text": "Second Nested Item",
+                      "answer": [
+                        {
+                          "valueBoolean": true
+                        }
+                      ]
+                    }
+                  ]
+                }
+              ]
+            }
+      """
+        .trimIndent()
+
+    val expectedResponseString =
+      """
+        {
+          "resourceType": "QuestionnaireResponse",
+          "item": [
+            {
+              "linkId": "1",
+              "item": [
+                {
+                  "linkId": "1.1",
+                  "text": "First Nested Item"
+                },
+                {
+                  "linkId": "1.2",
+                  "text": "Second Nested Item"
+                }
+              ]
+            }
+          ]
+        }
+      """
+        .trimIndent()
+
+    state.set(EXTRA_QUESTIONNAIRE_JSON_STRING, questionnaireString)
+    state.set(EXTRA_QUESTIONNAIRE_RESPONSE_JSON_STRING, questionnaireResponseString)
+    val viewModel = QuestionnaireViewModel(context, state)
+    viewModel.clearAllAnswers()
+    val value = viewModel.getQuestionnaireResponse()
+    val expectedResponse =
+      printer.parseResource(QuestionnaireResponse::class.java, expectedResponseString)
+        as QuestionnaireResponse
+
+    assertResourceEquals(value, expectedResponse)
+  }
+
   // ==================================================================== //
   //                                                                      //
   //               Questionnaire Response with Nested Items               //
@@ -4583,7 +4681,7 @@ class QuestionnaireViewModelTest {
     }
 
   @Test
-  fun `should return questionnaire item answer options for answer expression with fhirpath supplement context`() =
+  fun `should return questionnaire item answer options for answer expression with fhirpath supplement %context`() =
     runTest {
       val questionnaire =
         Questionnaire().apply {
@@ -4634,6 +4732,109 @@ class QuestionnaireViewModelTest {
       }
     }
 
+  @Test
+  fun `should return questionnaire item answer options for answer expression with fhirpath supplement %questionnaire`() =
+    runTest {
+      val questionnaire =
+        Questionnaire().apply {
+          this.identifier = listOf(Identifier().apply { value = "A" })
+          addItem(
+            QuestionnaireItemComponent().apply {
+              linkId = "a"
+              text = "Question 1"
+              type = Questionnaire.QuestionnaireItemType.CHOICE
+              repeats = true
+              initial =
+                listOf(
+                  Questionnaire.QuestionnaireItemInitialComponent(Coding("test", "1", "One")),
+                  Questionnaire.QuestionnaireItemInitialComponent(Coding("test", "2", "Two")),
+                )
+            },
+          )
+          addItem(
+            QuestionnaireItemComponent().apply {
+              linkId = "b"
+              text = "Q2"
+              type = Questionnaire.QuestionnaireItemType.STRING
+              extension =
+                listOf(
+                  Extension(
+                    "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
+                    Expression().apply {
+                      this.expression = "'Questionnaire = ' + %questionnaire.identifier.value"
+                      this.language = Expression.ExpressionLanguage.TEXT_FHIRPATH.toCode()
+                    },
+                  ),
+                )
+            },
+          )
+        }
+
+      state.set(EXTRA_QUESTIONNAIRE_JSON_STRING, printer.encodeResourceToString(questionnaire))
+      val viewModel = QuestionnaireViewModel(context, state)
+
+      viewModel.runViewModelBlocking {
+        val viewItem =
+          viewModel
+            .getQuestionnaireItemViewItemList()
+            .map { it.asQuestion() }
+            .single { it.questionnaireItem.linkId == "b" }
+        assertThat(viewItem.enabledAnswerOptions.map { it.valueStringType.value })
+          .containsExactly("Questionnaire = A")
+      }
+    }
+
+  @Test
+  fun `should return questionnaire item answer options for answer expression with fhirpath supplement %qItem`() =
+    runTest {
+      val questionnaire =
+        Questionnaire().apply {
+          addItem(
+            QuestionnaireItemComponent().apply {
+              linkId = "a"
+              text = "Question 1"
+              type = Questionnaire.QuestionnaireItemType.CHOICE
+              repeats = true
+              initial =
+                listOf(
+                  Questionnaire.QuestionnaireItemInitialComponent(Coding("test", "1", "One")),
+                  Questionnaire.QuestionnaireItemInitialComponent(Coding("test", "2", "Two")),
+                )
+            },
+          )
+          addItem(
+            QuestionnaireItemComponent().apply {
+              linkId = "b"
+              text = "Q2"
+              type = Questionnaire.QuestionnaireItemType.STRING
+              extension =
+                listOf(
+                  Extension(
+                    "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
+                    Expression().apply {
+                      this.expression = "'Id of item = ' + %qItem.linkId"
+                      this.language = Expression.ExpressionLanguage.TEXT_FHIRPATH.toCode()
+                    },
+                  ),
+                )
+            },
+          )
+        }
+
+      state.set(EXTRA_QUESTIONNAIRE_JSON_STRING, printer.encodeResourceToString(questionnaire))
+      val viewModel = QuestionnaireViewModel(context, state)
+
+      viewModel.runViewModelBlocking {
+        val viewItem =
+          viewModel
+            .getQuestionnaireItemViewItemList()
+            .map { it.asQuestion() }
+            .single { it.questionnaireItem.linkId == "b" }
+        assertThat(viewItem.enabledAnswerOptions.map { it.valueStringType.value })
+          .containsExactly("Id of item = b")
+      }
+    }
+
   // ==================================================================== //
   //                                                                      //
   //                 Answer Options Toggle Expression                     //
diff --git a/datacapture/src/test/java/com/google/android/fhir/datacapture/enablement/EnablementEvaluatorTest.kt b/datacapture/src/test/java/com/google/android/fhir/datacapture/enablement/EnablementEvaluatorTest.kt
index 837321cae6..2b2c88deb1 100644
--- a/datacapture/src/test/java/com/google/android/fhir/datacapture/enablement/EnablementEvaluatorTest.kt
+++ b/datacapture/src/test/java/com/google/android/fhir/datacapture/enablement/EnablementEvaluatorTest.kt
@@ -267,7 +267,7 @@ class EnablementEvaluatorTest {
   }
 
   @Test
-  fun `evaluate() should evaluate enableWhenExpression with context fhirpath supplement literal`() =
+  fun `evaluate() should evaluate enableWhenExpression with %context fhirpath supplement literal`() =
     runBlocking {
       @Language("JSON")
       val questionnaireJson =
@@ -347,6 +347,144 @@ class EnablementEvaluatorTest {
         .isTrue()
     }
 
+  @Test
+  fun `evaluate() should evaluate enableWhenExpression with %questionnaire fhirpath supplement`() =
+    runBlocking {
+      @Language("JSON")
+      val questionnaireJson =
+        """
+    {
+      "resourceType": "Questionnaire",
+      "subjectType": "Practitioner",
+          "item": [
+            {
+              "extension": [
+                {
+                  "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
+                  "valueExpression": {
+                    "language": "text/fhirpath",
+                    "expression": "%questionnaire.subjectType='Practitioner'"
+                  }
+                }
+              ],
+              "linkId" : "contribution",
+              "text": "Contribution",
+              "type": "choice",
+              "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
+            }
+          ]
+    }
+                """
+          .trimIndent()
+
+      @Language("JSON")
+      val questionnaireResponseJson =
+        """
+    {
+      "resourceType": "QuestionnaireResponse",
+      "item": [
+        {
+          "linkId": "contribution",
+          "answer": [
+            {
+              "valueCoding": {
+                "code": "yes",
+                "display": "Yes"
+              }
+            }
+          ]
+        }
+      ]
+    }
+                """
+          .trimIndent()
+
+      val questionnaire =
+        iParser.parseResource(Questionnaire::class.java, questionnaireJson) as Questionnaire
+
+      val questionnaireResponse =
+        iParser.parseResource(QuestionnaireResponse::class.java, questionnaireResponseJson)
+          as QuestionnaireResponse
+
+      assertThat(
+          EnablementEvaluator(questionnaire, questionnaireResponse)
+            .evaluate(
+              questionnaire.item[0],
+              questionnaireResponse.item[0],
+            ),
+        )
+        .isTrue()
+    }
+
+  @Test
+  fun `evaluate() should evaluate enableWhenExpression with %qItem fhirpath supplement`() =
+    runBlocking {
+      @Language("JSON")
+      val questionnaireJson =
+        """
+    {
+      "resourceType": "Questionnaire",
+      "subjectType": "Practitioner",
+          "item": [
+            {
+              "extension": [
+                {
+                  "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
+                  "valueExpression": {
+                    "language": "text/fhirpath",
+                    "expression": "%qItem.text = 'Contribution'"
+                  }
+                }
+              ],
+              "linkId" : "contribution",
+              "text": "Contribution",
+              "type": "choice",
+              "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
+            }
+          ]
+    }
+                """
+          .trimIndent()
+
+      @Language("JSON")
+      val questionnaireResponseJson =
+        """
+    {
+      "resourceType": "QuestionnaireResponse",
+      "item": [
+        {
+          "linkId": "contribution",
+          "answer": [
+            {
+              "valueCoding": {
+                "code": "yes",
+                "display": "Yes"
+              }
+            }
+          ]
+        }
+      ]
+    }
+                """
+          .trimIndent()
+
+      val questionnaire =
+        iParser.parseResource(Questionnaire::class.java, questionnaireJson) as Questionnaire
+
+      val questionnaireResponse =
+        iParser.parseResource(QuestionnaireResponse::class.java, questionnaireResponseJson)
+          as QuestionnaireResponse
+
+      assertThat(
+          EnablementEvaluator(questionnaire, questionnaireResponse)
+            .evaluate(
+              questionnaire.item[0],
+              questionnaireResponse.item[0],
+            ),
+        )
+        .isTrue()
+    }
+
   @Test
   fun evaluate_expectAnswerDoesNotExist_answerDoesNotExist_shouldReturnTrue() {
     assertEnableWhen(
diff --git a/datacapture/src/test/java/com/google/android/fhir/datacapture/extensions/MoreQuestionnaireItemComponentsTest.kt b/datacapture/src/test/java/com/google/android/fhir/datacapture/extensions/MoreQuestionnaireItemComponentsTest.kt
index 6b1c5bc11c..5e155c1e0b 100644
--- a/datacapture/src/test/java/com/google/android/fhir/datacapture/extensions/MoreQuestionnaireItemComponentsTest.kt
+++ b/datacapture/src/test/java/com/google/android/fhir/datacapture/extensions/MoreQuestionnaireItemComponentsTest.kt
@@ -39,6 +39,7 @@ import org.hl7.fhir.r4.model.IntegerType
 import org.hl7.fhir.r4.model.Patient
 import org.hl7.fhir.r4.model.Quantity
 import org.hl7.fhir.r4.model.Questionnaire
+import org.hl7.fhir.r4.model.QuestionnaireResponse
 import org.hl7.fhir.r4.model.StringType
 import org.hl7.fhir.r4.utils.ToolingExtensions
 import org.junit.Assert.assertThrows
@@ -2295,6 +2296,81 @@ class MoreQuestionnaireItemComponentsTest {
     assertThat(questionnaireItem.dateEntryFormatOrSystemDefault).isEqualTo("y-MM-dd")
   }
 
+  @Test
+  fun `should return empty list for empty response item list with same linkId`() {
+    val questionnaireItemComponentList =
+      listOf(
+        Questionnaire.QuestionnaireItemComponent().apply { linkId = "1" },
+      )
+
+    val questionnaireResponseItemComponentList =
+      listOf<QuestionnaireResponse.QuestionnaireResponseItemComponent>()
+
+    val result =
+      questionnaireItemComponentList.zipByLinkId(questionnaireResponseItemComponentList) { _, _ -> }
+    assertThat(result.size).isEqualTo(0)
+  }
+
+  @Test
+  fun `should return non empty list for valid questionnaire item and response list`() {
+    val questionnaireItemComponentList =
+      listOf(
+        Questionnaire.QuestionnaireItemComponent().apply { linkId = "1" },
+        Questionnaire.QuestionnaireItemComponent().apply { linkId = "2" },
+      )
+
+    val questionnaireResponseItemComponentList =
+      listOf(
+        QuestionnaireResponse.QuestionnaireResponseItemComponent().apply { linkId = "1" },
+        QuestionnaireResponse.QuestionnaireResponseItemComponent().apply { linkId = "2" },
+      )
+
+    val zipList =
+      questionnaireItemComponentList.zipByLinkId(questionnaireResponseItemComponentList) { _, _ -> }
+    assertThat(zipList.size).isEqualTo(2)
+  }
+
+  @Test
+  fun `should return non empty list for valid questionnaire item and repeated response list with same linkId`() {
+    val questionnaireItemComponentList =
+      listOf(
+        Questionnaire.QuestionnaireItemComponent().apply { linkId = "1" },
+        Questionnaire.QuestionnaireItemComponent().apply { linkId = "2" },
+      )
+
+    val questionnaireResponseItemComponentList =
+      listOf(
+        QuestionnaireResponse.QuestionnaireResponseItemComponent().apply { linkId = "1" },
+        QuestionnaireResponse.QuestionnaireResponseItemComponent().apply { linkId = "2" },
+        QuestionnaireResponse.QuestionnaireResponseItemComponent().apply { linkId = "2" },
+      )
+
+    val zipList =
+      questionnaireItemComponentList.zipByLinkId(questionnaireResponseItemComponentList) { _, _ -> }
+    assertThat(zipList.size).isEqualTo(3)
+  }
+
+  @Test
+  fun `should return non empty list for out of order questionnaire item and response item`() {
+    val questionnaireItemComponentList =
+      listOf(
+        Questionnaire.QuestionnaireItemComponent().apply { linkId = "1" },
+        Questionnaire.QuestionnaireItemComponent().apply { linkId = "3" },
+        Questionnaire.QuestionnaireItemComponent().apply { linkId = "2" },
+      )
+
+    val questionnaireResponseItemComponentList =
+      listOf(
+        QuestionnaireResponse.QuestionnaireResponseItemComponent().apply { linkId = "3" },
+        QuestionnaireResponse.QuestionnaireResponseItemComponent().apply { linkId = "2" },
+        QuestionnaireResponse.QuestionnaireResponseItemComponent().apply { linkId = "1" },
+      )
+
+    val zipList =
+      questionnaireItemComponentList.zipByLinkId(questionnaireResponseItemComponentList) { _, _ -> }
+    assertThat(zipList.size).isEqualTo(3)
+  }
+
   private val displayCategoryExtensionWithInstructionsCode =
     Extension().apply {
       url = EXTENSION_DISPLAY_CATEGORY_URL
diff --git a/datacapture/src/test/java/com/google/android/fhir/datacapture/fhirpath/ExpressionEvaluatorTest.kt b/datacapture/src/test/java/com/google/android/fhir/datacapture/fhirpath/ExpressionEvaluatorTest.kt
index 9e1d533384..5266b19fb7 100644
--- a/datacapture/src/test/java/com/google/android/fhir/datacapture/fhirpath/ExpressionEvaluatorTest.kt
+++ b/datacapture/src/test/java/com/google/android/fhir/datacapture/fhirpath/ExpressionEvaluatorTest.kt
@@ -32,6 +32,7 @@ import org.hl7.fhir.r4.model.DateType
 import org.hl7.fhir.r4.model.Enumerations
 import org.hl7.fhir.r4.model.Expression
 import org.hl7.fhir.r4.model.HumanName
+import org.hl7.fhir.r4.model.Identifier
 import org.hl7.fhir.r4.model.IntegerType
 import org.hl7.fhir.r4.model.Location
 import org.hl7.fhir.r4.model.Patient
@@ -429,6 +430,84 @@ class ExpressionEvaluatorTest {
     }
   }
 
+  @Test
+  fun `should return not null value with expression for %questionnaire fhirpath supplement`() =
+    runBlocking {
+      val questionnaire =
+        Questionnaire().apply {
+          id = "a-questionnaire"
+          identifier =
+            listOf(
+              Identifier().apply { value = "q-identifier" },
+            )
+
+          addItem(
+            Questionnaire.QuestionnaireItemComponent().apply {
+              linkId = "a-item"
+              text = "a question"
+              type = Questionnaire.QuestionnaireItemType.GROUP
+              addExtension().apply {
+                url = EXTENSION_VARIABLE_URL
+                setValue(
+                  Expression().apply {
+                    name = "M"
+                    language = "text/fhirpath"
+                    expression = "%questionnaire.identifier.first().value"
+                  },
+                )
+              }
+            },
+          )
+        }
+
+      val expressionEvaluator = ExpressionEvaluator(questionnaire, QuestionnaireResponse())
+
+      val result =
+        expressionEvaluator.evaluateQuestionnaireItemVariableExpression(
+          questionnaire.item[0].variableExpressions.last(),
+          questionnaire.item[0],
+        )
+
+      assertThat((result as Type).asStringValue()).isEqualTo("q-identifier")
+    }
+
+  @Test
+  fun `should return not null value with expression for %qItem fhirpath supplement`() =
+    runBlocking {
+      val questionnaire =
+        Questionnaire().apply {
+          id = "a-questionnaire"
+
+          addItem(
+            Questionnaire.QuestionnaireItemComponent().apply {
+              linkId = "a-item"
+              text = "a question"
+              type = Questionnaire.QuestionnaireItemType.GROUP
+              addExtension().apply {
+                url = EXTENSION_VARIABLE_URL
+                setValue(
+                  Expression().apply {
+                    name = "M"
+                    language = "text/fhirpath"
+                    expression = "%qItem.text"
+                  },
+                )
+              }
+            },
+          )
+        }
+
+      val expressionEvaluator = ExpressionEvaluator(questionnaire, QuestionnaireResponse())
+
+      val result =
+        expressionEvaluator.evaluateQuestionnaireItemVariableExpression(
+          questionnaire.item[0].variableExpressions.last(),
+          questionnaire.item[0],
+        )
+
+      assertThat((result as Type).asStringValue()).isEqualTo("a question")
+    }
+
   @Test
   fun `should return not null value with expression dependent on answers of items for questionnaire item level`() =
     runBlocking {
@@ -621,6 +700,80 @@ class ExpressionEvaluatorTest {
         .isEqualTo(DateType(Date()).apply { add(Calendar.YEAR, -1) }.asStringValue())
     }
 
+  @Test
+  fun `evaluateCalculatedExpressions should return list of calculated values with fhirpath supplement %questionnaire`() =
+    runBlocking {
+      val questionnaire =
+        Questionnaire().apply {
+          id = "a-questionnaire"
+          identifier = listOf(Identifier().apply { value = "Questionnaire A" })
+
+          addItem(
+            Questionnaire.QuestionnaireItemComponent().apply {
+              linkId = "a-questionnaire-reason"
+              text = "Reason"
+              type = Questionnaire.QuestionnaireItemType.STRING
+              addExtension().apply {
+                url = EXTENSION_CALCULATED_EXPRESSION_URL
+                setValue(
+                  Expression().apply {
+                    this.language = "text/fhirpath"
+                    this.expression = "%questionnaire.identifier.first().value"
+                  },
+                )
+              }
+            },
+          )
+        }
+
+      val expressionEvaluator = ExpressionEvaluator(questionnaire, QuestionnaireResponse())
+
+      val result =
+        expressionEvaluator.evaluateCalculatedExpressions(
+          questionnaire.item.elementAt(0),
+          null,
+        )
+
+      assertThat(result.first().second.first().asStringValue()).isEqualTo("Questionnaire A")
+    }
+
+  @Test
+  fun `evaluateCalculatedExpressions should return list of calculated values with fhirpath supplement %qItem`() =
+    runBlocking {
+      val questionnaire =
+        Questionnaire().apply {
+          id = "a-questionnaire"
+          identifier = listOf(Identifier().apply { value = "Questionnaire A" })
+
+          addItem(
+            Questionnaire.QuestionnaireItemComponent().apply {
+              linkId = "a-questionnaire-reason"
+              text = "Reason"
+              type = Questionnaire.QuestionnaireItemType.STRING
+              addExtension().apply {
+                url = EXTENSION_CALCULATED_EXPRESSION_URL
+                setValue(
+                  Expression().apply {
+                    this.language = "text/fhirpath"
+                    this.expression = "'Question = ' + %qItem.text"
+                  },
+                )
+              }
+            },
+          )
+        }
+
+      val expressionEvaluator = ExpressionEvaluator(questionnaire, QuestionnaireResponse())
+
+      val result =
+        expressionEvaluator.evaluateCalculatedExpressions(
+          questionnaire.item.elementAt(0),
+          null,
+        )
+
+      assertThat(result.first().second.first().asStringValue()).isEqualTo("Question = Reason")
+    }
+
   @Test
   fun `detectExpressionCyclicDependency() should throw illegal argument exception when item with calculated expression have cyclic dependency`() {
     val questionnaire =
diff --git a/datacapture/src/test/java/com/google/android/fhir/datacapture/mapping/ResourceMapperTest.kt b/datacapture/src/test/java/com/google/android/fhir/datacapture/mapping/ResourceMapperTest.kt
index 4c88f02408..df84802581 100644
--- a/datacapture/src/test/java/com/google/android/fhir/datacapture/mapping/ResourceMapperTest.kt
+++ b/datacapture/src/test/java/com/google/android/fhir/datacapture/mapping/ResourceMapperTest.kt
@@ -812,16 +812,6 @@ class ResourceMapperTest {
     runBlocking {
       val questionnaire =
         Questionnaire()
-          .apply {
-            addExtension().apply {
-              url = EXTENSION_SDC_QUESTIONNAIRE_LAUNCH_CONTEXT
-              extension =
-                listOf(
-                  Extension("name", Coding(EXTENSION_LAUNCH_CONTEXT, "mother", "Mother")),
-                  Extension("type", CodeType("Patient")),
-                )
-            }
-          }
           .addItem(
             Questionnaire.QuestionnaireItemComponent().apply {
               linkId = "patient-dob"
@@ -839,9 +829,7 @@ class ResourceMapperTest {
             },
           )
 
-      val patientId = UUID.randomUUID().toString()
-      val patient = Patient().apply { id = "Patient/$patientId/_history/2" }
-      val questionnaireResponse = ResourceMapper.populate(questionnaire, mapOf("mother" to patient))
+      val questionnaireResponse = ResourceMapper.populate(questionnaire, emptyMap())
 
       assertThat((questionnaireResponse.item[0].answer[0].value as DateType).localDate)
         .isEqualTo((DateType(Date())).localDate)
@@ -1039,27 +1027,6 @@ class ResourceMapperTest {
                     }
                   ]
                 },
-                {
-                  "linkId": "PR-address",
-                  "item": [
-                    {
-                      "linkId": "PR-address-city",
-                      "answer": [
-                        {
-                          "valueString": "Nairobi"
-                        }
-                      ]
-                    },
-                    {
-                      "linkId": "PR-address-country",
-                      "answer": [
-                        {
-                          "valueString": "Kenya"
-                        }
-                      ]
-                    }
-                  ]
-                },
                 {
                   "linkId": "PR-active"
                 }
@@ -1189,6 +1156,121 @@ class ResourceMapperTest {
       assertThat(observation.valueQuantity.value).isEqualTo(BigDecimal(90))
     }
 
+  @Test
+  fun `extract() should perform definition-based extraction for repeated groups`() = runBlocking {
+    @Language("JSON")
+    val questionnaireJson =
+      """
+      {
+        "resourceType": "Questionnaire",
+        "item": [
+          {
+            "linkId": "repeated-parent",
+            "type": "group",
+            "repeats": true,
+            "extension": [
+              {
+                "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemExtractionContext",
+                "valueExpression": {
+                  "expression": "Observation"
+                }
+              }
+            ],
+            "item": [
+              {
+                "linkId": "1.0",
+                "type": "group",
+                "definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept",
+                "item": [
+                  {
+                    "linkId": "1.0.1",
+                    "type": "choice",
+                    "definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept.coding"
+                  }
+                ]
+              }
+            ]
+          }
+        ]
+      }
+            """
+        .trimIndent()
+
+    @Language("JSON")
+    val questionnaireResponseJson =
+      """
+        {
+          "resourceType": "QuestionnaireResponse",
+          "item": [
+            {
+              "linkId": "repeated-parent",
+              "item": [
+                {
+                  "linkId": "1.0",
+                  "item": [
+                    {
+                      "linkId": "1.0.1",
+                      "answer": [
+                        {
+                          "valueCoding": {
+                            "system": "test-coding-system",
+                            "code": "test-coding-code-1",
+                            "display": "Test Coding Display 1"
+                          }
+                        }
+                      ]
+                    }
+                  ]
+                }
+              ]
+            },
+            {
+              "linkId": "repeated-parent",
+              "item": [
+                {
+                  "linkId": "1.0",
+                  "item": [
+                    {
+                      "linkId": "1.0.1",
+                      "answer": [
+                        {
+                          "valueCoding": {
+                            "system": "test-coding-system",
+                            "code": "test-coding-code-2",
+                            "display": "Test Coding Display 2"
+                          }
+                        }
+                      ]
+                    }
+                  ]
+                }
+              ]
+            }
+          ]
+        }
+            """
+        .trimIndent()
+
+    val uriTestQuestionnaire =
+      iParser.parseResource(Questionnaire::class.java, questionnaireJson) as Questionnaire
+
+    val uriTestQuestionnaireResponse =
+      iParser.parseResource(QuestionnaireResponse::class.java, questionnaireResponseJson)
+        as QuestionnaireResponse
+
+    val bundle = ResourceMapper.extract(uriTestQuestionnaire, uriTestQuestionnaireResponse)
+
+    val observation1 = bundle.entry.first().resource as Observation
+    assertThat(observation1.valueCodeableConcept.coding[0].code).isEqualTo("test-coding-code-1")
+    assertThat(observation1.valueCodeableConcept.coding[0].display)
+      .isEqualTo("Test Coding Display 1")
+
+    val observation2 = bundle.entry[1].resource as Observation
+    assertThat(observation2.valueCodeableConcept.coding[0].code).isEqualTo("test-coding-code-2")
+    assertThat(observation2.valueCodeableConcept.coding[0].display)
+      .isEqualTo("Test Coding Display 2")
+  }
+
   @Test
   fun `populate() should fill QuestionnaireResponse with values when given a single Resource`() =
     runBlocking {
diff --git a/datacapture/src/test/java/com/google/android/fhir/datacapture/views/factories/EditTextDecimalViewHolderFactoryTest.kt b/datacapture/src/test/java/com/google/android/fhir/datacapture/views/factories/EditTextDecimalViewHolderFactoryTest.kt
index 8fcfa3f609..45aca98cc5 100644
--- a/datacapture/src/test/java/com/google/android/fhir/datacapture/views/factories/EditTextDecimalViewHolderFactoryTest.kt
+++ b/datacapture/src/test/java/com/google/android/fhir/datacapture/views/factories/EditTextDecimalViewHolderFactoryTest.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -447,4 +447,42 @@ class EditTextDecimalViewHolderFactoryTest {
     assertThat(viewHolder.itemView.findViewById<TextInputLayout>(R.id.text_input_layout).helperText)
       .isNull()
   }
+
+  @Test
+  fun `bind again should remove previous text`() {
+    viewHolder.bind(
+      QuestionnaireViewItem(
+        Questionnaire.QuestionnaireItemComponent(),
+        QuestionnaireResponse.QuestionnaireResponseItemComponent(),
+        validationResult = NotValidated,
+        answersChangedCallback = { _, _, _, _ -> },
+        draftAnswer = "1.1.1.1",
+      ),
+    )
+
+    assertThat(
+        viewHolder.itemView
+          .findViewById<TextInputEditText>(R.id.text_input_edit_text)
+          .text
+          .toString(),
+      )
+      .isEqualTo("1.1.1.1")
+
+    viewHolder.bind(
+      QuestionnaireViewItem(
+        Questionnaire.QuestionnaireItemComponent(),
+        QuestionnaireResponse.QuestionnaireResponseItemComponent(),
+        validationResult = NotValidated,
+        answersChangedCallback = { _, _, _, _ -> },
+      ),
+    )
+
+    assertThat(
+        viewHolder.itemView
+          .findViewById<TextInputEditText>(R.id.text_input_edit_text)
+          .text
+          .toString(),
+      )
+      .isEqualTo("")
+  }
 }
diff --git a/datacapture/src/test/java/com/google/android/fhir/datacapture/views/factories/EditTextIntegerViewHolderFactoryTest.kt b/datacapture/src/test/java/com/google/android/fhir/datacapture/views/factories/EditTextIntegerViewHolderFactoryTest.kt
index a0a8bb9d76..4f3eb3a056 100644
--- a/datacapture/src/test/java/com/google/android/fhir/datacapture/views/factories/EditTextIntegerViewHolderFactoryTest.kt
+++ b/datacapture/src/test/java/com/google/android/fhir/datacapture/views/factories/EditTextIntegerViewHolderFactoryTest.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -369,4 +369,42 @@ class EditTextIntegerViewHolderFactoryTest {
     assertThat(viewHolder.itemView.findViewById<TextInputLayout>(R.id.text_input_layout).helperText)
       .isNull()
   }
+
+  @Test
+  fun `bind again should remove previous text`() {
+    viewHolder.bind(
+      QuestionnaireViewItem(
+        Questionnaire.QuestionnaireItemComponent(),
+        QuestionnaireResponse.QuestionnaireResponseItemComponent(),
+        validationResult = NotValidated,
+        answersChangedCallback = { _, _, _, _ -> },
+        draftAnswer = "9999999999",
+      ),
+    )
+
+    assertThat(
+        viewHolder.itemView
+          .findViewById<TextInputEditText>(R.id.text_input_edit_text)
+          .text
+          .toString(),
+      )
+      .isEqualTo("9999999999")
+
+    viewHolder.bind(
+      QuestionnaireViewItem(
+        Questionnaire.QuestionnaireItemComponent(),
+        QuestionnaireResponse.QuestionnaireResponseItemComponent(),
+        validationResult = NotValidated,
+        answersChangedCallback = { _, _, _, _ -> },
+      ),
+    )
+
+    assertThat(
+        viewHolder.itemView
+          .findViewById<TextInputEditText>(R.id.text_input_edit_text)
+          .text
+          .toString(),
+      )
+      .isEqualTo("")
+  }
 }
diff --git a/demo/build.gradle.kts b/demo/build.gradle.kts
index 9e8718df2f..0e53d5f6ba 100644
--- a/demo/build.gradle.kts
+++ b/demo/build.gradle.kts
@@ -1,5 +1,3 @@
-import Dependencies.forceGuava
-
 plugins {
   id(Plugins.BuildPlugins.application)
   id(Plugins.BuildPlugins.kotlinAndroid)
@@ -40,8 +38,6 @@ android {
   kotlin { jvmToolchain(11) }
 }
 
-configurations { all { forceGuava() } }
-
 dependencies {
   androidTestImplementation(Dependencies.AndroidxTest.extJunit)
   androidTestImplementation(Dependencies.Espresso.espressoCore)
diff --git a/demo/src/main/java/com/google/android/fhir/demo/MainActivity.kt b/demo/src/main/java/com/google/android/fhir/demo/MainActivity.kt
index b74a418735..422110d638 100644
--- a/demo/src/main/java/com/google/android/fhir/demo/MainActivity.kt
+++ b/demo/src/main/java/com/google/android/fhir/demo/MainActivity.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2022 Google LLC
+ * Copyright 2022-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
diff --git a/demo/src/main/java/com/google/android/fhir/demo/MainActivityViewModel.kt b/demo/src/main/java/com/google/android/fhir/demo/MainActivityViewModel.kt
index 0097178c39..3410bf0332 100644
--- a/demo/src/main/java/com/google/android/fhir/demo/MainActivityViewModel.kt
+++ b/demo/src/main/java/com/google/android/fhir/demo/MainActivityViewModel.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -24,13 +24,16 @@ import androidx.lifecycle.MutableLiveData
 import androidx.lifecycle.viewModelScope
 import androidx.work.Constraints
 import com.google.android.fhir.demo.data.DemoFhirSyncWorker
+import com.google.android.fhir.sync.CurrentSyncJobStatus
 import com.google.android.fhir.sync.PeriodicSyncConfiguration
+import com.google.android.fhir.sync.PeriodicSyncJobStatus
 import com.google.android.fhir.sync.RepeatInterval
 import com.google.android.fhir.sync.Sync
-import com.google.android.fhir.sync.SyncJobStatus
+import java.time.OffsetDateTime
 import java.time.format.DateTimeFormatter
 import java.util.concurrent.TimeUnit
 import kotlinx.coroutines.InternalCoroutinesApi
+import kotlinx.coroutines.Job
 import kotlinx.coroutines.flow.Flow
 import kotlinx.coroutines.flow.MutableSharedFlow
 import kotlinx.coroutines.flow.SharingStarted
@@ -44,10 +47,14 @@ class MainActivityViewModel(application: Application) : AndroidViewModel(applica
   val lastSyncTimestampLiveData: LiveData<String>
     get() = _lastSyncTimestampLiveData
 
-  private val _pollState = MutableSharedFlow<SyncJobStatus>()
-  val pollState: Flow<SyncJobStatus>
+  private val _pollState = MutableSharedFlow<CurrentSyncJobStatus>()
+  val pollState: Flow<CurrentSyncJobStatus>
     get() = _pollState
 
+  private val _pollPeriodicSyncJobStatus = MutableSharedFlow<PeriodicSyncJobStatus>()
+  val pollPeriodicSyncJobStatus: Flow<PeriodicSyncJobStatus>
+    get() = _pollPeriodicSyncJobStatus
+
   init {
     viewModelScope.launch {
       Sync.periodicSync<DemoFhirSyncWorker>(
@@ -59,26 +66,34 @@ class MainActivityViewModel(application: Application) : AndroidViewModel(applica
             ),
         )
         .shareIn(this, SharingStarted.Eagerly, 10)
-        .collect { _pollState.emit(it) }
+        .collect { _pollPeriodicSyncJobStatus.emit(it) }
     }
   }
 
+  private var oneTimeSyncJob: Job? = null
+
   fun triggerOneTimeSync() {
-    viewModelScope.launch {
-      Sync.oneTimeSync<DemoFhirSyncWorker>(getApplication())
-        .shareIn(this, SharingStarted.Eagerly, 10)
-        .collect { _pollState.emit(it) }
-    }
+    // Cancels any ongoing sync job before starting a new one. Since this function may be called
+    // more than once, not canceling the ongoing job could result in the creation of multiple jobs
+    // that emit the same object.
+    oneTimeSyncJob?.cancel()
+    oneTimeSyncJob =
+      viewModelScope.launch {
+        Sync.oneTimeSync<DemoFhirSyncWorker>(getApplication())
+          .shareIn(this, SharingStarted.Eagerly, 0)
+          .collect { result -> result.let { _pollState.emit(it) } }
+      }
   }
 
   /** Emits last sync time. */
-  fun updateLastSyncTimestamp() {
+  fun updateLastSyncTimestamp(lastSync: OffsetDateTime? = null) {
     val formatter =
       DateTimeFormatter.ofPattern(
         if (DateFormat.is24HourFormat(getApplication())) formatString24 else formatString12,
       )
     _lastSyncTimestampLiveData.value =
-      Sync.getLastSyncTimestamp(getApplication())?.toLocalDateTime()?.format(formatter) ?: ""
+      lastSync?.let { it.toLocalDateTime()?.format(formatter) ?: "" }
+        ?: Sync.getLastSyncTimestamp(getApplication())?.toLocalDateTime()?.format(formatter) ?: ""
   }
 
   companion object {
diff --git a/demo/src/main/java/com/google/android/fhir/demo/PatientListFragment.kt b/demo/src/main/java/com/google/android/fhir/demo/PatientListFragment.kt
index 2f4fc18b64..5d6bc8a10b 100644
--- a/demo/src/main/java/com/google/android/fhir/demo/PatientListFragment.kt
+++ b/demo/src/main/java/com/google/android/fhir/demo/PatientListFragment.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2022-2023 Google LLC
+ * Copyright 2022-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -44,6 +44,8 @@ import androidx.recyclerview.widget.RecyclerView
 import com.google.android.fhir.FhirEngine
 import com.google.android.fhir.demo.PatientListViewModel.PatientListViewModelFactory
 import com.google.android.fhir.demo.databinding.FragmentPatientListBinding
+import com.google.android.fhir.sync.CurrentSyncJobStatus
+import com.google.android.fhir.sync.LastSyncJobStatus
 import com.google.android.fhir.sync.SyncJobStatus
 import kotlin.math.roundToInt
 import kotlinx.coroutines.launch
@@ -105,6 +107,7 @@ class PatientListFragment : Fragment() {
 
     searchView = binding.search
     topBanner = binding.syncStatusContainer.linearLayoutSyncStatus
+    topBanner.visibility = View.GONE
     syncStatus = binding.syncStatusContainer.tvSyncingStatus
     syncPercent = binding.syncStatusContainer.tvSyncingPercent
     syncProgress = binding.syncStatusContainer.progressSyncing
@@ -155,32 +158,68 @@ class PatientListFragment : Fragment() {
       mainActivityViewModel.pollState.collect {
         Timber.d("onViewCreated: pollState Got status $it")
         when (it) {
-          is SyncJobStatus.Started -> {
-            Timber.i("Sync: ${it::class.java.simpleName}")
+          is CurrentSyncJobStatus.Running -> {
+            Timber.i("Sync: ${it::class.java.simpleName} with data ${it.inProgressSyncJob}")
             fadeInTopBanner(it)
           }
-          is SyncJobStatus.InProgress -> {
-            Timber.i("Sync: ${it::class.java.simpleName} with data $it")
-            fadeInTopBanner(it)
-          }
-          is SyncJobStatus.Finished -> {
+          is CurrentSyncJobStatus.Succeeded -> {
             Timber.i("Sync: ${it::class.java.simpleName} at ${it.timestamp}")
             patientListViewModel.searchPatientsByName(searchView.query.toString().trim())
-            mainActivityViewModel.updateLastSyncTimestamp()
+            mainActivityViewModel.updateLastSyncTimestamp(it.timestamp)
             fadeOutTopBanner(it)
           }
-          is SyncJobStatus.Failed -> {
+          is CurrentSyncJobStatus.Failed -> {
             Timber.i("Sync: ${it::class.java.simpleName} at ${it.timestamp}")
             patientListViewModel.searchPatientsByName(searchView.query.toString().trim())
-            mainActivityViewModel.updateLastSyncTimestamp()
+            mainActivityViewModel.updateLastSyncTimestamp(it.timestamp)
             fadeOutTopBanner(it)
           }
-          else -> {
-            Timber.i("Sync: Unknown state.")
+          is CurrentSyncJobStatus.Enqueued -> {
+            Timber.i("Sync: Enqueued")
             patientListViewModel.searchPatientsByName(searchView.query.toString().trim())
-            mainActivityViewModel.updateLastSyncTimestamp()
             fadeOutTopBanner(it)
           }
+          CurrentSyncJobStatus.Cancelled -> TODO()
+        }
+      }
+    }
+
+    lifecycleScope.launch {
+      mainActivityViewModel.pollPeriodicSyncJobStatus.collect {
+        Timber.d("onViewCreated: pollState Got status ${it.currentSyncJobStatus}")
+        when (it.currentSyncJobStatus) {
+          is CurrentSyncJobStatus.Running -> {
+            Timber.i(
+              "Sync: ${it.currentSyncJobStatus::class.java.simpleName} with data ${it.currentSyncJobStatus}",
+            )
+            fadeInTopBanner(it.currentSyncJobStatus)
+          }
+          is CurrentSyncJobStatus.Succeeded -> {
+            val lastSyncTimestamp =
+              (it.currentSyncJobStatus as CurrentSyncJobStatus.Succeeded).timestamp
+            Timber.i(
+              "Sync: ${it.currentSyncJobStatus::class.java.simpleName} at $lastSyncTimestamp",
+            )
+            patientListViewModel.searchPatientsByName(searchView.query.toString().trim())
+            mainActivityViewModel.updateLastSyncTimestamp(lastSyncTimestamp)
+            fadeOutTopBanner(it.currentSyncJobStatus)
+          }
+          is CurrentSyncJobStatus.Failed -> {
+            val lastSyncTimestamp =
+              (it.currentSyncJobStatus as CurrentSyncJobStatus.Failed).timestamp
+            Timber.i(
+              "Sync: ${it.currentSyncJobStatus::class.java.simpleName} at $lastSyncTimestamp}",
+            )
+            patientListViewModel.searchPatientsByName(searchView.query.toString().trim())
+            mainActivityViewModel.updateLastSyncTimestamp(lastSyncTimestamp)
+            fadeOutTopBanner(it.currentSyncJobStatus)
+          }
+          is CurrentSyncJobStatus.Enqueued -> {
+            Timber.i("Sync: Enqueued")
+            patientListViewModel.searchPatientsByName(searchView.query.toString().trim())
+            fadeOutTopBanner(it.currentSyncJobStatus)
+          }
+          CurrentSyncJobStatus.Cancelled -> TODO()
         }
       }
     }
@@ -213,7 +252,7 @@ class PatientListFragment : Fragment() {
       .navigate(PatientListFragmentDirections.actionPatientListToAddPatientFragment())
   }
 
-  private fun fadeInTopBanner(state: SyncJobStatus) {
+  private fun fadeInTopBanner(state: CurrentSyncJobStatus) {
     if (topBanner.visibility != View.VISIBLE) {
       syncStatus.text = resources.getString(R.string.syncing).uppercase()
       syncPercent.text = ""
@@ -222,25 +261,35 @@ class PatientListFragment : Fragment() {
       topBanner.visibility = View.VISIBLE
       val animation = AnimationUtils.loadAnimation(topBanner.context, R.anim.fade_in)
       topBanner.startAnimation(animation)
-    } else if (state is SyncJobStatus.InProgress) {
+    } else if (
+      state is CurrentSyncJobStatus.Running && state.inProgressSyncJob is SyncJobStatus.InProgress
+    ) {
+      val inProgressState = state.inProgressSyncJob as? SyncJobStatus.InProgress
       val progress =
-        state
-          .let { it.completed.toDouble().div(it.total) }
-          .let { if (it.isNaN()) 0.0 else it }
-          .times(100)
-          .roundToInt()
-      "$progress% ${state.syncOperation.name.lowercase()}ed".also { syncPercent.text = it }
-      syncProgress.progress = progress
+        inProgressState
+          ?.let { it.completed.toDouble().div(it.total) }
+          ?.let { if (it.isNaN()) 0.0 else it }
+          ?.times(100)
+          ?.roundToInt()
+      "$progress% ${inProgressState?.syncOperation?.name?.lowercase()}ed"
+        .also { syncPercent.text = it }
+      syncProgress.progress = progress ?: 0
     }
   }
 
-  private fun fadeOutTopBanner(state: SyncJobStatus) {
-    if (state is SyncJobStatus.Finished) syncPercent.text = ""
-    syncProgress.visibility = View.GONE
+  private fun fadeOutTopBanner(state: CurrentSyncJobStatus) {
+    fadeOutTopBanner(state::class.java.simpleName.uppercase())
+  }
+
+  private fun fadeOutTopBanner(state: LastSyncJobStatus) {
+    fadeOutTopBanner(state::class.java.simpleName.uppercase())
+  }
 
+  private fun fadeOutTopBanner(statusText: String) {
+    syncPercent.text = ""
+    syncProgress.visibility = View.GONE
     if (topBanner.visibility == View.VISIBLE) {
-      "${resources.getString(R.string.sync).uppercase()} ${state::class.java.simpleName.uppercase()}"
-        .also { syncStatus.text = it }
+      "${resources.getString(R.string.sync).uppercase()} $statusText".also { syncStatus.text = it }
 
       val animation = AnimationUtils.loadAnimation(topBanner.context, R.anim.fade_out)
       topBanner.startAnimation(animation)
diff --git a/demo/src/main/java/com/google/android/fhir/demo/data/DemoFhirSyncWorker.kt b/demo/src/main/java/com/google/android/fhir/demo/data/DemoFhirSyncWorker.kt
index 80f8042b25..bcaff6ce96 100644
--- a/demo/src/main/java/com/google/android/fhir/demo/data/DemoFhirSyncWorker.kt
+++ b/demo/src/main/java/com/google/android/fhir/demo/data/DemoFhirSyncWorker.kt
@@ -22,6 +22,7 @@ import com.google.android.fhir.demo.FhirApplication
 import com.google.android.fhir.sync.AcceptLocalConflictResolver
 import com.google.android.fhir.sync.DownloadWorkManager
 import com.google.android.fhir.sync.FhirSyncWorker
+import com.google.android.fhir.sync.upload.UploadStrategy
 
 class DemoFhirSyncWorker(appContext: Context, workerParams: WorkerParameters) :
   FhirSyncWorker(appContext, workerParams) {
@@ -32,5 +33,7 @@ class DemoFhirSyncWorker(appContext: Context, workerParams: WorkerParameters) :
 
   override fun getConflictResolver() = AcceptLocalConflictResolver
 
+  override fun getUploadStrategy(): UploadStrategy = UploadStrategy.AllChangesSquashedBundlePut
+
   override fun getFhirEngine() = FhirApplication.fhirEngine(applicationContext)
 }
diff --git a/demo/src/main/res/layout/patient_detail.xml b/demo/src/main/res/layout/patient_detail.xml
index b19c8ce656..35b6467cde 100644
--- a/demo/src/main/res/layout/patient_detail.xml
+++ b/demo/src/main/res/layout/patient_detail.xml
@@ -25,7 +25,6 @@
         android:layout_height="match_parent"
         app:layoutManager="androidx.recyclerview.widget.LinearLayoutManager"
         xmlns:app="http://schemas.android.com/apk/res-auto"
-        android:layout_margin="@dimen/fab_margin"
         android:scrollbars="vertical"
     />
 </FrameLayout>
diff --git a/demo/src/main/res/layout/patient_details_card_view.xml b/demo/src/main/res/layout/patient_details_card_view.xml
index 32d3dcf6f1..1a9db16c1b 100644
--- a/demo/src/main/res/layout/patient_details_card_view.xml
+++ b/demo/src/main/res/layout/patient_details_card_view.xml
@@ -1,6 +1,7 @@
 <?xml version="1.0" encoding="utf-8" ?>
 <com.google.android.material.textview.MaterialTextView
     android:id="@+id/header"
+    android:layout_marginStart="@dimen/text_margin"
     android:paddingVertical="10dp"
     android:orientation="vertical"
     xmlns:android="http://schemas.android.com/apk/res/android"
diff --git a/demo/src/main/res/layout/patient_details_header.xml b/demo/src/main/res/layout/patient_details_header.xml
index c7699318c3..84d8c3e252 100644
--- a/demo/src/main/res/layout/patient_details_header.xml
+++ b/demo/src/main/res/layout/patient_details_header.xml
@@ -70,11 +70,7 @@
             android:layout_width="wrap_content"
             android:layout_height="wrap_content"
             android:layout_margin="5dp"
-            android:paddingStart="2dp"
-            android:drawablePadding="2dp"
-            android:drawableStart="@drawable/ic_baseline_add_24"
             android:text="@string/complete_survey"
-            android:textAppearance="?attr/textAppearanceBody2"
         />
   </LinearLayout>
 </FrameLayout>
diff --git a/demo/src/main/res/layout/patient_list_view.xml b/demo/src/main/res/layout/patient_list_view.xml
index 603086892d..08c1eed961 100644
--- a/demo/src/main/res/layout/patient_list_view.xml
+++ b/demo/src/main/res/layout/patient_list_view.xml
@@ -25,7 +25,7 @@
     <TextView
         android:id="@+id/patient_count"
         android:text="0 Patients"
-        android:layout_centerHorizontal="true"
+        android:layout_marginStart="@dimen/patient_count_start_margin"
         android:layout_width="wrap_content"
         android:layout_height="wrap_content"
     />
@@ -36,8 +36,6 @@
         android:name="com.google.fhirengine.example.PatientListFragment"
         android:layout_width="match_parent"
         android:layout_height="match_parent"
-        android:layout_marginLeft="16dp"
-        android:layout_marginRight="16dp"
         android:scrollbars="vertical"
         app:layoutManager="LinearLayoutManager"
         tools:context=".PatientListActivity"
diff --git a/demo/src/main/res/values/colors.xml b/demo/src/main/res/values/colors.xml
index 2cc0f1f91f..cb5eb3850e 100644
--- a/demo/src/main/res/values/colors.xml
+++ b/demo/src/main/res/values/colors.xml
@@ -21,7 +21,7 @@
     <color name="moderate_risk_background">#fff8e1</color>
     <color name="high_risk">#c62828</color>
     <color name="high_risk_background">#ffebee</color>
-    <color name="unknown_risk_background">#10156125</color>
+    <color name="unknown_risk_background">#DADCE0</color>
     <color name="unknown_risk">#ffffff</color>
     <color name="syncing_background">#E8F0FE</color>
     <color name="disable_state">#9AFFFFFF</color>
diff --git a/demo/src/main/res/values/dimens.xml b/demo/src/main/res/values/dimens.xml
index a4c743e50d..edc3804783 100644
--- a/demo/src/main/res/values/dimens.xml
+++ b/demo/src/main/res/values/dimens.xml
@@ -22,5 +22,6 @@
     <dimen name="text_margin">20dp</dimen>
     <dimen name="small_text_margin">2dp</dimen>
     <dimen name="status_margin">5dp</dimen>
-  <dimen name="header_height">170dp</dimen>
+    <dimen name="header_height">170dp</dimen>
+    <dimen name="patient_count_start_margin">65dp</dimen>
 </resources>
diff --git a/demo/src/main/res/values/styles.xml b/demo/src/main/res/values/styles.xml
index dcc7451ccb..3096ca4f64 100644
--- a/demo/src/main/res/values/styles.xml
+++ b/demo/src/main/res/values/styles.xml
@@ -67,7 +67,7 @@
 
     </style>
 
-    <style name="AppCard" parent="Widget.MaterialComponents.CardView">
+    <style name="AppCard" parent="Widget.Material3.CardView.Outlined">
         <item name="cardElevation">8dp</item>
     </style>
 
@@ -79,16 +79,21 @@
     </style>
 
     <style name="AppTheme.PatientDetails.headline">
-        <item name="android:textAppearance">?attr/textAppearanceHeadline6</item>
-        <item name="android:textSize">24sp</item>
+        <item
+            name="android:textAppearance"
+        >?attr/textAppearanceHeadlineSmall</item>
         <item name="android:textStyle">normal</item>
     </style>
 
     <style name="AppTheme.PatientDetails.Subtitle2">
-        <item name="android:textAppearance">?attr/textAppearanceSubtitle2</item>
+        <item
+            name="android:textAppearance"
+        >?attr/textAppearanceTitleSmall</item>
     </style>
 
     <style name="AppTheme.PatientDetails.body2">
-        <item name="android:textAppearance">?attr/textAppearanceBody2</item>
+        <item
+            name="android:textAppearance"
+        >?attr/textAppearanceBodyMedium</item>
     </style>
 </resources>
diff --git a/document/.gitignore b/document/.gitignore
new file mode 100644
index 0000000000..42afabfd2a
--- /dev/null
+++ b/document/.gitignore
@@ -0,0 +1 @@
+/build
\ No newline at end of file
diff --git a/document/build.gradle.kts b/document/build.gradle.kts
new file mode 100644
index 0000000000..6001760384
--- /dev/null
+++ b/document/build.gradle.kts
@@ -0,0 +1,58 @@
+plugins {
+  id(Plugins.BuildPlugins.androidLib)
+  id(Plugins.BuildPlugins.kotlinAndroid)
+}
+
+android {
+  namespace = "com.google.android.fhir.document"
+  compileSdk = Sdk.compileSdk
+
+  defaultConfig {
+    minSdk = Sdk.minSdk
+    testInstrumentationRunner = Dependencies.androidJunitRunner
+    consumerProguardFiles("consumer-rules.pro")
+  }
+
+  compileOptions {
+    // Flag to enable support for the new language APIs
+    // See https = //developer.android.com/studio/write/java8-support
+    isCoreLibraryDesugaringEnabled = true
+  }
+
+  buildTypes {
+    release {
+      isMinifyEnabled = false
+      proguardFiles(getDefaultProguardFile("proguard-android-optimize.txt"), "proguard-rules.pro")
+    }
+  }
+  packaging { resources.excludes.addAll(listOf("META-INF/ASL-2.0.txt", "META-INF/LGPL-3.0.txt")) }
+
+  sourceSets { getByName("test").apply { resources.setSrcDirs(listOf("test-data")) } }
+
+  kotlin { jvmToolchain(11) }
+}
+
+dependencies {
+  implementation(Dependencies.Androidx.coreKtx)
+  implementation(Dependencies.Androidx.appCompat)
+  implementation(Dependencies.material)
+  implementation(Dependencies.androidFhirEngine)
+  implementation(Dependencies.Retrofit.coreRetrofit)
+  implementation(Dependencies.Retrofit.gsonConverter)
+  implementation(Dependencies.httpInterceptor)
+  implementation(Dependencies.zxing)
+  implementation(Dependencies.nimbus)
+  implementation(Dependencies.timber)
+
+  coreLibraryDesugaring(Dependencies.desugarJdkLibs)
+
+  testImplementation(Dependencies.junit)
+  testImplementation(Dependencies.robolectric)
+  testImplementation(Dependencies.mockitoKotlin)
+  testImplementation(Dependencies.mockitoInline)
+  testImplementation(Dependencies.Kotlin.kotlinCoroutinesTest)
+  testImplementation(Dependencies.mockWebServer)
+
+  androidTestImplementation(Dependencies.AndroidxTest.extJunit)
+  androidTestImplementation(Dependencies.Espresso.espressoCore)
+}
diff --git a/document/consumer-rules.pro b/document/consumer-rules.pro
new file mode 100644
index 0000000000..e69de29bb2
diff --git a/document/proguard-rules.pro b/document/proguard-rules.pro
new file mode 100644
index 0000000000..481bb43481
--- /dev/null
+++ b/document/proguard-rules.pro
@@ -0,0 +1,21 @@
+# Add project specific ProGuard rules here.
+# You can control the set of applied configuration files using the
+# proguardFiles setting in build.gradle.
+#
+# For more details, see
+#   http://developer.android.com/guide/developing/tools/proguard.html
+
+# If your project uses WebView with JS, uncomment the following
+# and specify the fully qualified class name to the JavaScript interface
+# class:
+#-keepclassmembers class fqcn.of.javascript.interface.for.webview {
+#   public *;
+#}
+
+# Uncomment this to preserve the line number information for
+# debugging stack traces.
+#-keepattributes SourceFile,LineNumberTable
+
+# If you keep the line number information, uncomment this to
+# hide the original source file name.
+#-renamesourcefileattribute SourceFile
\ No newline at end of file
diff --git a/document/src/main/AndroidManifest.xml b/document/src/main/AndroidManifest.xml
new file mode 100644
index 0000000000..9d120112b8
--- /dev/null
+++ b/document/src/main/AndroidManifest.xml
@@ -0,0 +1,4 @@
+<?xml version="1.0" encoding="utf-8" ?>
+<manifest xmlns:android="http://schemas.android.com/apk/res/android">
+
+</manifest>
diff --git a/document/src/main/java/com.google.android.fhir.document/IPSDocument.kt b/document/src/main/java/com.google.android.fhir.document/IPSDocument.kt
new file mode 100644
index 0000000000..2845b23206
--- /dev/null
+++ b/document/src/main/java/com.google.android.fhir.document/IPSDocument.kt
@@ -0,0 +1,54 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document
+
+import org.hl7.fhir.r4.model.Bundle
+import org.hl7.fhir.r4.model.Patient
+import org.hl7.fhir.r4.model.Resource
+
+/**
+ * Represents an International Patient Summary (IPS) document, associating it with a specific
+ * patient and containing a list of titles present in the document. For detailed specifications, see
+ * [Official IPS Implementation Guide](https://build.fhir.org/ig/HL7/fhir-ips/index.html).
+ *
+ * This class serves as a developer-friendly, in-memory representation of an IPS document, allowing
+ * for easier manipulation and interaction with its components compared to a raw FHIR Composition
+ * resource.
+ *
+ * @property document The FHIR Bundle itself, which contains the IPS document
+ * @property titles A list of titles of the sections present in the document.
+ * @property patient The FHIR Patient resource associated with the IPS document.
+ */
+data class IPSDocument(
+  val document: Bundle,
+  val titles: ArrayList<Title>,
+  val patient: Patient,
+)
+
+/**
+ * Represents a title, which corresponds to a section present in the IPS document.
+ *
+ * @property name The string storing the title of the section itself. Examples: "Allergies and
+ *   Intolerances", "Immunizations", etc...
+ * @property dataEntries A list of FHIR resources which are present in the section. For example, if
+ *   the title is "Allergies and Intolerances", all the patient's current allergies and/or
+ *   intolerances will be listed here.
+ */
+data class Title(
+  val name: String,
+  val dataEntries: ArrayList<Resource>,
+)
diff --git a/document/src/main/java/com.google.android.fhir.document/RetrofitSHLService.kt b/document/src/main/java/com.google.android.fhir.document/RetrofitSHLService.kt
new file mode 100644
index 0000000000..27449d35b7
--- /dev/null
+++ b/document/src/main/java/com.google.android.fhir.document/RetrofitSHLService.kt
@@ -0,0 +1,107 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document
+
+import com.google.android.fhir.NetworkConfiguration
+import com.google.android.fhir.sync.remote.GzipUploadInterceptor
+import com.google.android.fhir.sync.remote.HttpLogger
+import java.util.concurrent.TimeUnit
+import okhttp3.OkHttpClient
+import okhttp3.RequestBody
+import okhttp3.ResponseBody
+import okhttp3.logging.HttpLoggingInterceptor
+import retrofit2.Response
+import retrofit2.Retrofit
+import retrofit2.converter.gson.GsonConverterFactory
+import retrofit2.http.Body
+import retrofit2.http.Header
+import retrofit2.http.Headers
+import retrofit2.http.POST
+import retrofit2.http.Url
+
+/* Interface to make HTTP requests to the SHL server */
+interface RetrofitSHLService {
+
+  /* Initial POST request to generate a manifest URL */
+  @POST
+  @Headers("Content-Type: application/json")
+  suspend fun getManifestUrlAndToken(
+    @Url path: String,
+    @Body request: RequestBody,
+  ): Response<ResponseBody>
+
+  /* POST request to add data to the SHL */
+  @POST
+  @Headers("Content-Type: application/json")
+  suspend fun postPayload(
+    @Url path: String,
+    @Body contentEncrypted: String,
+    @Header("Authorization") authorization: String,
+  ): Response<ResponseBody>
+
+  class Builder(
+    private val baseUrl: String,
+    private val networkConfiguration: NetworkConfiguration,
+  ) {
+    private var httpLoggingInterceptor: HttpLoggingInterceptor? = null
+
+    fun setHttpLogger(httpLogger: HttpLogger) = apply {
+      httpLoggingInterceptor = httpLogger.toOkHttpLoggingInterceptor()
+    }
+
+    fun build(): RetrofitSHLService {
+      val client =
+        OkHttpClient.Builder()
+          .connectTimeout(networkConfiguration.connectionTimeOut, TimeUnit.SECONDS)
+          .readTimeout(networkConfiguration.readTimeOut, TimeUnit.SECONDS)
+          .writeTimeout(networkConfiguration.writeTimeOut, TimeUnit.SECONDS)
+          .apply {
+            if (networkConfiguration.uploadWithGzip) {
+              addInterceptor(GzipUploadInterceptor)
+            }
+            httpLoggingInterceptor?.let { addInterceptor(it) }
+          }
+          .build()
+      return Retrofit.Builder()
+        .baseUrl(baseUrl)
+        .client(client)
+        .addConverterFactory(GsonConverterFactory.create())
+        .build()
+        .create(RetrofitSHLService::class.java)
+    }
+
+    /* Maybe move these to different class */
+    private fun HttpLogger.toOkHttpLoggingInterceptor() =
+      HttpLoggingInterceptor(log).apply {
+        level = configuration.level.toOkhttpLogLevel()
+        configuration.headersToIgnore?.forEach { this.redactHeader(it) }
+      }
+
+    private fun HttpLogger.Level.toOkhttpLogLevel() =
+      when (this) {
+        HttpLogger.Level.NONE -> HttpLoggingInterceptor.Level.NONE
+        HttpLogger.Level.BASIC -> HttpLoggingInterceptor.Level.BASIC
+        HttpLogger.Level.HEADERS -> HttpLoggingInterceptor.Level.HEADERS
+        HttpLogger.Level.BODY -> HttpLoggingInterceptor.Level.BODY
+      }
+  }
+
+  companion object {
+    fun builder(baseUrl: String, networkConfiguration: NetworkConfiguration) =
+      Builder(baseUrl, networkConfiguration)
+  }
+}
diff --git a/document/src/main/java/com.google.android.fhir.document/generate/EncryptionUtils.kt b/document/src/main/java/com.google.android.fhir.document/generate/EncryptionUtils.kt
new file mode 100644
index 0000000000..52e6ecfcbe
--- /dev/null
+++ b/document/src/main/java/com.google.android.fhir.document/generate/EncryptionUtils.kt
@@ -0,0 +1,48 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document.generate
+
+import android.util.Base64
+import com.nimbusds.jose.EncryptionMethod
+import com.nimbusds.jose.JWEAlgorithm
+import com.nimbusds.jose.JWEHeader
+import com.nimbusds.jose.JWEObject
+import com.nimbusds.jose.Payload
+import com.nimbusds.jose.crypto.DirectEncrypter
+import java.security.SecureRandom
+
+object EncryptionUtils {
+
+  /* Encrypt a given string as a JWE token, using a given key */
+  fun encrypt(data: String, key: String): String {
+    val header = JWEHeader(JWEAlgorithm.DIR, EncryptionMethod.A256GCM)
+    val jweObj = JWEObject(header, Payload(data))
+    val decodedKey = Base64.decode(key, Base64.URL_SAFE)
+    val encrypter = DirectEncrypter(decodedKey)
+    jweObj.encrypt(encrypter)
+    return jweObj.serialize()
+  }
+
+  /* Generate a random SHL-specific key */
+  fun generateRandomKey(): String {
+    val random = SecureRandom()
+    val shlKeySize = 32
+    val keyBytes = ByteArray(shlKeySize)
+    random.nextBytes(keyBytes)
+    return Base64.encodeToString(keyBytes, Base64.URL_SAFE)
+  }
+}
diff --git a/document/src/main/java/com.google.android.fhir.document/generate/QRGenerator.kt b/document/src/main/java/com.google.android.fhir.document/generate/QRGenerator.kt
new file mode 100644
index 0000000000..a5345bcf9e
--- /dev/null
+++ b/document/src/main/java/com.google.android.fhir.document/generate/QRGenerator.kt
@@ -0,0 +1,26 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document.generate
+
+import android.widget.ImageView
+
+/* The QR Generator interface handles the generation of SHL QR codes */
+interface QRGenerator {
+
+  /* Generate and display the SHL QR code */
+  fun generateAndSetQRCode(shLink: String, qrView: ImageView)
+}
diff --git a/document/src/main/java/com.google.android.fhir.document/generate/QRGeneratorImpl.kt b/document/src/main/java/com.google.android.fhir.document/generate/QRGeneratorImpl.kt
new file mode 100644
index 0000000000..3823397dab
--- /dev/null
+++ b/document/src/main/java/com.google.android.fhir.document/generate/QRGeneratorImpl.kt
@@ -0,0 +1,36 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document.generate
+
+import android.graphics.Bitmap
+import android.widget.ImageView
+
+internal class QRGeneratorImpl(private val qrGeneratorUtils: QRGeneratorUtils) : QRGenerator {
+
+  /* Generate and display the SHL QR code */
+  override fun generateAndSetQRCode(shLink: String, qrView: ImageView) {
+    val qrCodeBitmap = generateQRCode(shLink)
+    qrView.setImageBitmap(qrCodeBitmap)
+  }
+
+  /* Generates the SHL QR code for the given payload */
+  internal fun generateQRCode(content: String): Bitmap {
+    val qrCodeBitmap = qrGeneratorUtils.createQRCodeBitmap(content)
+    val logoBitmap = qrGeneratorUtils.createLogoBitmap(qrCodeBitmap)
+    return qrGeneratorUtils.overlayLogoOnQRCode(qrCodeBitmap, logoBitmap)
+  }
+}
diff --git a/document/src/main/java/com.google.android.fhir.document/generate/QRGeneratorUtils.kt b/document/src/main/java/com.google.android.fhir.document/generate/QRGeneratorUtils.kt
new file mode 100644
index 0000000000..5d98e46a92
--- /dev/null
+++ b/document/src/main/java/com.google.android.fhir.document/generate/QRGeneratorUtils.kt
@@ -0,0 +1,90 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document.generate
+
+import android.content.Context
+import android.graphics.Bitmap
+import android.graphics.Canvas
+import android.graphics.Color
+import android.graphics.drawable.Drawable
+import androidx.core.content.ContextCompat
+import com.google.android.fhir.document.R
+import com.google.zxing.BarcodeFormat
+import com.google.zxing.EncodeHintType
+import com.google.zxing.qrcode.QRCodeWriter
+
+internal class QRGeneratorUtils(private val context: Context) {
+
+  /* Creates a QR for a given string */
+  fun createQRCodeBitmap(content: String): Bitmap {
+    val hints = mutableMapOf<EncodeHintType, Any>()
+    hints[EncodeHintType.MARGIN] = 2
+    val qrCodeWriter = QRCodeWriter()
+    val bitMatrix = qrCodeWriter.encode(content, BarcodeFormat.QR_CODE, 512, 512, hints)
+    val width = bitMatrix.width
+    val height = bitMatrix.height
+    val qrCodeBitmap = Bitmap.createBitmap(width, height, Bitmap.Config.RGB_565)
+
+    for (x in 0 until width) {
+      for (y in 0 until height) {
+        qrCodeBitmap.setPixel(x, y, if (bitMatrix[x, y]) Color.BLACK else Color.WHITE)
+      }
+    }
+    return qrCodeBitmap
+  }
+
+  /* Creates a bitmap containing the SMART logo */
+  fun createLogoBitmap(qrCodeBitmap: Bitmap): Bitmap {
+    val logoScale = 0.4
+    val logoDrawable = ContextCompat.getDrawable(context, R.drawable.smart_logo)
+    val logoAspectRatio =
+      logoDrawable!!.intrinsicWidth.toFloat() / logoDrawable.intrinsicHeight.toFloat()
+    val width = qrCodeBitmap.width
+    val logoWidth = (width * logoScale).toInt()
+    val logoHeight = (logoWidth / logoAspectRatio).toInt()
+
+    return convertDrawableToBitmap(logoDrawable, logoWidth, logoHeight)
+  }
+
+  /* Overlays the SMART logo in the centre of a QR code */
+  fun overlayLogoOnQRCode(qrCodeBitmap: Bitmap, logoBitmap: Bitmap): Bitmap {
+    val centerX = (qrCodeBitmap.width - logoBitmap.width) / 2
+    val centerY = (qrCodeBitmap.height - logoBitmap.height) / 2
+
+    val backgroundBitmap =
+      Bitmap.createBitmap(logoBitmap.width, logoBitmap.height, Bitmap.Config.RGB_565)
+    backgroundBitmap.eraseColor(Color.WHITE)
+
+    val canvas = Canvas(backgroundBitmap)
+    canvas.drawBitmap(logoBitmap, 0f, 0f, null)
+
+    val finalBitmap = Bitmap.createBitmap(qrCodeBitmap)
+    val finalCanvas = Canvas(finalBitmap)
+    finalCanvas.drawBitmap(backgroundBitmap, centerX.toFloat(), centerY.toFloat(), null)
+
+    return finalBitmap
+  }
+
+  /* Converts the logo into a bitmap */
+  private fun convertDrawableToBitmap(drawable: Drawable, width: Int, height: Int): Bitmap {
+    val bitmap = Bitmap.createBitmap(width, height, Bitmap.Config.ARGB_8888)
+    val canvas = Canvas(bitmap)
+    drawable.setBounds(0, 0, canvas.width, canvas.height)
+    drawable.draw(canvas)
+    return bitmap
+  }
+}
diff --git a/document/src/main/java/com.google.android.fhir.document/generate/SHLinkGenerationData.kt b/document/src/main/java/com.google.android.fhir.document/generate/SHLinkGenerationData.kt
new file mode 100644
index 0000000000..8a09e1d106
--- /dev/null
+++ b/document/src/main/java/com.google.android.fhir.document/generate/SHLinkGenerationData.kt
@@ -0,0 +1,37 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document.generate
+
+import com.google.android.fhir.document.IPSDocument
+import java.time.Instant
+
+/**
+ * Represents a SHL data structure, which stores information needed to generate a SHL.
+ *
+ * SHLs, or Smart Health Links, are a standardized format for securely sharing health-related
+ * information. For official documentation and specifications, see
+ * [SHL Documentation](https://docs.smarthealthit.org/smart-health-links/).
+ *
+ * @property label A label describing the SHL data.
+ * @property expirationTime The expiration time of the SHL data, if any.
+ * @property ipsDoc The IPS document linked to by the SHL.
+ */
+data class SHLinkGenerationData(
+  val label: String,
+  val expirationTime: Instant?,
+  val ipsDoc: IPSDocument,
+)
diff --git a/document/src/main/java/com.google.android.fhir.document/generate/SHLinkGenerator.kt b/document/src/main/java/com.google.android.fhir.document/generate/SHLinkGenerator.kt
new file mode 100644
index 0000000000..61d151fba9
--- /dev/null
+++ b/document/src/main/java/com.google.android.fhir.document/generate/SHLinkGenerator.kt
@@ -0,0 +1,29 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document.generate
+
+/* The SHLink Generator interface handles the generation of Smart Health Links */
+interface SHLinkGenerator {
+
+  /* Returns the newly generated SHLink */
+  suspend fun generateSHLink(
+    shLinkGenerationData: SHLinkGenerationData,
+    passcode: String,
+    serverBaseUrl: String,
+    optionalViewer: String,
+  ): String
+}
diff --git a/document/src/main/java/com.google.android.fhir.document/generate/SHLinkGeneratorImpl.kt b/document/src/main/java/com.google.android.fhir.document/generate/SHLinkGeneratorImpl.kt
new file mode 100644
index 0000000000..998ed9e5de
--- /dev/null
+++ b/document/src/main/java/com.google.android.fhir.document/generate/SHLinkGeneratorImpl.kt
@@ -0,0 +1,154 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document.generate
+
+import android.content.ContentValues.TAG
+import android.util.Base64
+import ca.uhn.fhir.context.FhirContext
+import ca.uhn.fhir.context.FhirVersionEnum
+import com.google.android.fhir.document.RetrofitSHLService
+import okhttp3.MediaType.Companion.toMediaTypeOrNull
+import okhttp3.RequestBody.Companion.toRequestBody
+import org.json.JSONObject
+import timber.log.Timber
+
+internal class SHLinkGeneratorImpl(
+  private val apiService: RetrofitSHLService,
+  private val encryptionUtility: EncryptionUtils,
+) : SHLinkGenerator {
+
+  private val parser = FhirContext.forCached(FhirVersionEnum.R4).newJsonParser()
+
+  /* Generate an SHL */
+  override suspend fun generateSHLink(
+    shLinkGenerationData: SHLinkGenerationData,
+    passcode: String,
+    serverBaseUrl: String,
+    optionalViewer: String,
+  ): String {
+    val initialPostResponse = getManifestUrlAndToken(passcode)
+    return generateAndPostPayload(
+      initialPostResponse,
+      shLinkGenerationData,
+      passcode,
+      serverBaseUrl,
+      "$optionalViewer#",
+    )
+  }
+
+  /* Send a POST request to the SHL server to get a new manifest URL.
+  Can optionally add a passcode to the SHL here */
+  private suspend fun getManifestUrlAndToken(passcode: String): JSONObject {
+    val requestBody =
+      if (passcode.isNotBlank()) {
+        "{\"passcode\": \"$passcode\"}".toRequestBody("application/json".toMediaTypeOrNull())
+      } else {
+        "{}".toRequestBody("application/json".toMediaTypeOrNull())
+      }
+    val response = apiService.getManifestUrlAndToken("", requestBody)
+    return if (response.isSuccessful) {
+      val responseBody = response.body()?.string()
+      if (!responseBody.isNullOrBlank()) {
+        JSONObject(responseBody)
+      } else {
+        Timber.e("Empty response body")
+        JSONObject()
+      }
+    } else {
+      Timber.e("HTTP Error: ${response.code()}")
+      JSONObject()
+    }
+  }
+
+  /* POST the data to the SHL server and return the link itself */
+  private suspend fun generateAndPostPayload(
+    initialPostResponse: JSONObject,
+    shLinkGenerationData: SHLinkGenerationData,
+    passcode: String,
+    serverBaseUrl: String,
+    optionalViewer: String,
+  ): String {
+    val manifestToken = initialPostResponse.getString("id")
+    val manifestUrl = "$serverBaseUrl/api/shl/$manifestToken"
+    val managementToken = initialPostResponse.getString("managementToken")
+    val exp = shLinkGenerationData.expirationTime?.epochSecond?.toString() ?: ""
+    val key = encryptionUtility.generateRandomKey()
+    val shLinkPayload =
+      constructSHLinkPayload(
+        manifestUrl,
+        shLinkGenerationData.label,
+        getKeyFlags(passcode),
+        key,
+        exp,
+      )
+    val data: String = parser.encodeResourceToString(shLinkGenerationData.ipsDoc.document)
+    postPayload(data, manifestToken, key, managementToken)
+    val encodedPayload = base64UrlEncode(shLinkPayload)
+    return "${optionalViewer}shlink:/$encodedPayload"
+  }
+
+  /* Constructs the SHL payload */
+  private fun constructSHLinkPayload(
+    manifestUrl: String,
+    label: String?,
+    flags: String?,
+    key: String,
+    exp: String?,
+  ): String {
+    val payloadObject =
+      JSONObject()
+        .apply {
+          put("url", manifestUrl)
+          put("key", key)
+          flags?.let { put("flag", it) }
+          label?.takeIf { it.isNotEmpty() }?.let { put("label", it) }
+          exp?.takeIf { it.isNotEmpty() }?.let { put("exp", it) }
+        }
+        .toString()
+    return payloadObject
+  }
+
+  /* Base64Url encodes a given string */
+  private fun base64UrlEncode(data: String): String {
+    return Base64.encodeToString(data.toByteArray(), Base64.URL_SAFE)
+  }
+
+  /* Sets the P flag if a passcode has been set */
+  private fun getKeyFlags(passcode: String): String {
+    return if (passcode.isNotEmpty()) "P" else ""
+  }
+
+  /* POST the IPS document to the manifest URL */
+  private suspend fun postPayload(
+    file: String,
+    manifestToken: String,
+    key: String,
+    managementToken: String,
+  ) {
+    try {
+      val contentEncrypted = encryptionUtility.encrypt(file, key)
+      val authorization = "Bearer $managementToken"
+      val response = apiService.postPayload(manifestToken, contentEncrypted, authorization)
+      if (!response.isSuccessful) {
+        Timber.e("HTTP Error: ${response.code()}")
+      }
+    } catch (e: Exception) {
+      Timber.e(TAG, "Error while posting payload: ${e.message}", e)
+      throw e
+    }
+  }
+}
diff --git a/document/src/main/res/drawable/smart_logo.xml b/document/src/main/res/drawable/smart_logo.xml
new file mode 100644
index 0000000000..c612f50581
--- /dev/null
+++ b/document/src/main/res/drawable/smart_logo.xml
@@ -0,0 +1,55 @@
+<vector
+    xmlns:android="http://schemas.android.com/apk/res/android"
+    android:width="186dp"
+    android:height="40dp"
+    android:viewportWidth="186"
+    android:viewportHeight="40"
+>
+  <group>
+    <clip-path android:pathData="M0,0h186v40h-186z" />
+    <path
+            android:pathData="M12.93,0H18.2L24.42,10.12L30.74,0H35.9L24.42,18.65L12.93,0Z"
+            android:fillColor="#722772"
+        />
+    <path
+            android:pathData="M0,19.64L2.66,15.46H15.09L8.93,5.23L11.49,0.99L22.92,19.64H0Z"
+            android:fillColor="#E24A31"
+        />
+    <path
+            android:pathData="M48.89,21.29L46.28,25.47H33.85L40.01,35.82L37.4,40L25.97,21.29H48.89Z"
+            android:fillColor="#89BF44"
+        />
+    <path
+            android:pathData="M37.4,0.94L40.06,5.23L33.79,15.46H46.33L48.89,19.64H25.97L37.4,0.94Z"
+            android:fillColor="#E77D26"
+        />
+    <path
+            android:pathData="M11.49,40L8.82,35.71L15.09,25.47H2.55L0,21.29H22.92L11.49,40Z"
+            android:fillColor="#F1B42A"
+        />
+    <path
+            android:pathData="M74.58,16.14H64.2V19.88H73.69C75.08,19.88 76.02,20.1 76.52,20.59C77.02,21.09 77.3,21.97 77.3,23.29V25C77.3,26.32 77.08,27.2 76.58,27.69C76.08,28.19 75.13,28.41 73.75,28.41H64.7C63.31,28.41 62.32,28.19 61.82,27.69C61.32,27.2 61.04,26.32 61.04,25V24.12H63.59V26.26H74.74V22.25H65.26C63.87,22.25 62.93,22.02 62.43,21.53C61.93,21.03 61.65,20.15 61.7,18.83V17.46C61.7,16.14 61.98,15.26 62.48,14.76C62.98,14.27 63.92,14.05 65.31,14.05H73.58C74.97,14.05 75.91,14.27 76.41,14.76C76.91,15.26 77.19,16.03 77.19,17.18V18.06H74.63V16.14H74.58Z"
+            android:fillColor="#676868"
+        />
+    <path
+            android:pathData="M86.01,16.63C86.01,16.85 86.01,17.13 86.06,17.51C86.06,18.12 86.12,18.5 86.12,18.67V28.35H83.79V13.99H86.12L93.44,23.29L100.21,13.99H102.82V28.35H100.21V18.67C100.21,18.34 100.21,17.95 100.27,17.62C100.32,17.29 100.32,16.96 100.38,16.69C100.21,17.07 100.05,17.51 99.88,17.9C99.77,18.17 99.6,18.45 99.38,18.67L93.72,26.1H93L87.06,18.72C86.84,18.45 86.67,18.12 86.51,17.84C86.34,17.46 86.18,17.07 86.01,16.63Z"
+            android:fillColor="#676868"
+        />
+    <path
+            android:pathData="M135.84,28.46V14.1H147.77C148.6,14.05 149.49,14.27 150.16,14.76C150.71,15.31 150.93,16.08 150.88,16.91V20.1C150.93,20.87 150.71,21.64 150.16,22.19C149.49,22.69 148.6,22.91 147.77,22.85H145.83L152.38,28.46H148.66L142.78,22.85H138.73V28.46H135.84ZM146.49,16.25H138.61V20.87H146.49C146.94,20.92 147.38,20.81 147.77,20.59C148.05,20.26 148.16,19.82 148.1,19.44V17.73C148.16,17.35 147.99,16.96 147.77,16.63C147.38,16.36 146.94,16.19 146.49,16.25Z"
+            android:fillColor="#676868"
+        />
+    <path
+            android:pathData="M165.08,16.25V28.46H162.31V16.25H155.32V14.16H172.13V16.25H165.08Z"
+            android:fillColor="#676868"
+        />
+    <path
+            android:pathData="M130.68,28.46H125.35L119.14,18.23L112.7,28.46H107.54L119.14,9.65L130.68,28.46Z"
+            android:fillColor="#64AED0"
+        />
+    <path
+            android:pathData="M175.68,13.44C175.96,12.84 176.34,12.29 176.84,11.85C177.34,11.41 177.9,11.02 178.56,10.8C179.9,10.31 181.39,10.31 182.67,10.8C183.28,11.02 183.89,11.41 184.39,11.85C184.89,12.29 185.28,12.84 185.55,13.44C185.83,14.05 186,14.76 186,15.42C186,16.14 185.83,16.8 185.55,17.4C185.28,18.01 184.89,18.56 184.39,19C183.89,19.44 183.34,19.82 182.67,20.04C181.34,20.54 179.84,20.54 178.56,20.04C177.95,19.82 177.34,19.44 176.84,19C176.34,18.56 175.96,18.01 175.68,17.4C175.4,16.8 175.23,16.08 175.23,15.42C175.23,14.76 175.4,14.05 175.68,13.44ZM176.57,17.13C176.79,17.62 177.12,18.12 177.51,18.5C177.9,18.89 178.4,19.22 178.9,19.38C179.45,19.6 180.06,19.71 180.62,19.71C181.23,19.71 181.78,19.6 182.34,19.38C182.84,19.16 183.34,18.89 183.72,18.5C184.11,18.12 184.45,17.62 184.67,17.13C184.89,16.58 185,16.03 185,15.42C185,14.87 184.89,14.27 184.67,13.77C184.45,13.28 184.11,12.78 183.72,12.45C183.34,12.07 182.84,11.74 182.34,11.57C181.78,11.35 181.23,11.24 180.62,11.24C180.01,11.24 179.45,11.35 178.9,11.57C178.4,11.79 177.9,12.07 177.51,12.45C177.12,12.84 176.79,13.28 176.57,13.77C176.34,14.27 176.23,14.87 176.23,15.42C176.18,16.03 176.29,16.58 176.57,17.13ZM180.95,12.51C181.56,12.45 182.12,12.62 182.61,12.95C183,13.28 183.23,13.72 183.17,14.21C183.23,14.65 183.06,15.09 182.67,15.37C182.34,15.64 181.89,15.81 181.45,15.81L183.23,18.39H182.17L180.45,15.86H179.4V18.39H178.4V12.51H180.95ZM180.51,15.09C180.73,15.09 180.95,15.09 181.12,15.09C181.28,15.09 181.45,15.04 181.62,14.98C181.78,14.93 181.89,14.82 181.95,14.65C182.06,14.49 182.12,14.32 182.06,14.1C182.06,13.94 182,13.77 181.95,13.61C181.89,13.5 181.78,13.39 181.62,13.33C181.51,13.28 181.34,13.22 181.17,13.22C181.01,13.22 180.84,13.17 180.67,13.17H179.4V15.04H180.51V15.09Z"
+            android:fillColor="#676868"
+        />
+  </group>
+</vector>
diff --git a/document/src/test/java/com/google/android/fhir/document/EncryptionUtilsTest.kt b/document/src/test/java/com/google/android/fhir/document/EncryptionUtilsTest.kt
new file mode 100644
index 0000000000..ff9170931b
--- /dev/null
+++ b/document/src/test/java/com/google/android/fhir/document/EncryptionUtilsTest.kt
@@ -0,0 +1,51 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document
+
+import ca.uhn.fhir.context.FhirContext
+import ca.uhn.fhir.context.FhirVersionEnum
+import com.google.android.fhir.document.generate.EncryptionUtils
+import com.google.android.fhir.testing.readFromFile
+import com.nimbusds.jose.shaded.gson.Gson
+import org.hl7.fhir.r4.model.Bundle
+import org.junit.Assert
+import org.junit.Test
+import org.junit.runner.RunWith
+import org.robolectric.RobolectricTestRunner
+
+@RunWith(RobolectricTestRunner::class)
+class EncryptionUtilsTest {
+
+  private val parser = FhirContext.forCached(FhirVersionEnum.R4).newJsonParser()
+  private val minimalBundleString =
+    parser.encodeResourceToString(readFromFile(Bundle::class.java, "/bundleMinimal.json"))
+
+  @Test
+  fun randomKeysCanBeGenerated() {
+    val key = EncryptionUtils.generateRandomKey()
+    val base64UrlEncodedKeyLength = 45
+    assert(key.length == base64UrlEncodedKeyLength)
+  }
+
+  @Test
+  fun canConvertFilesIntoJweTokens() {
+    val encryptionKey = EncryptionUtils.generateRandomKey()
+    val contentJson = Gson().toJson(minimalBundleString)
+    val contentEncrypted = EncryptionUtils.encrypt(contentJson, encryptionKey)
+    Assert.assertEquals(contentEncrypted.split('.').size, 5)
+  }
+}
diff --git a/document/src/test/java/com/google/android/fhir/document/QRGeneratorImplTest.kt b/document/src/test/java/com/google/android/fhir/document/QRGeneratorImplTest.kt
new file mode 100644
index 0000000000..b0b6bfc26e
--- /dev/null
+++ b/document/src/test/java/com/google/android/fhir/document/QRGeneratorImplTest.kt
@@ -0,0 +1,90 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document
+
+import android.graphics.Bitmap
+import android.widget.ImageView
+import com.google.android.fhir.document.generate.QRGeneratorImpl
+import com.google.android.fhir.document.generate.QRGeneratorUtils
+import org.junit.Assert.assertEquals
+import org.junit.Assert.assertNull
+import org.junit.Before
+import org.junit.Test
+import org.mockito.Mock
+import org.mockito.Mockito.mock
+import org.mockito.Mockito.verify
+import org.mockito.Mockito.`when`
+import org.mockito.MockitoAnnotations
+
+class QRGeneratorImplTest {
+
+  @Mock private lateinit var qrGeneratorUtils: QRGeneratorUtils
+
+  @Mock private lateinit var qrView: ImageView
+
+  private lateinit var qrGeneratorImpl: QRGeneratorImpl
+
+  @Before
+  fun setUp() {
+    MockitoAnnotations.openMocks(this)
+    qrGeneratorImpl = QRGeneratorImpl(qrGeneratorUtils)
+  }
+
+  @Test
+  fun testGenerateAndSetQRCode() {
+    val shLink = "SHLink"
+    val qrCodeBitmap = mock(Bitmap::class.java)
+
+    `when`(qrGeneratorUtils.createQRCodeBitmap(shLink)).thenReturn(qrCodeBitmap)
+    `when`(qrGeneratorUtils.createLogoBitmap(qrCodeBitmap)).thenReturn(qrCodeBitmap)
+    `when`(
+        qrGeneratorUtils.overlayLogoOnQRCode(
+          qrCodeBitmap,
+          qrCodeBitmap,
+        ),
+      )
+      .thenReturn(qrCodeBitmap)
+
+    qrGeneratorImpl.generateAndSetQRCode(shLink, qrView)
+    verify(qrView).setImageBitmap(qrCodeBitmap)
+  }
+
+  @Test
+  fun testGenerateQRCode() {
+    val content = "content"
+    val qrCodeBitmap = mock(Bitmap::class.java)
+    `when`(qrGeneratorUtils.createQRCodeBitmap(content)).thenReturn(qrCodeBitmap)
+    `when`(qrGeneratorUtils.createLogoBitmap(qrCodeBitmap)).thenReturn(qrCodeBitmap)
+    `when`(
+        qrGeneratorUtils.overlayLogoOnQRCode(
+          qrCodeBitmap,
+          qrCodeBitmap,
+        ),
+      )
+      .thenReturn(qrCodeBitmap)
+    val result = qrGeneratorImpl.generateQRCode(content)
+    assertEquals(qrCodeBitmap, result)
+  }
+
+  @Test
+  fun testGenerateQRCodeWithNullBitmap() {
+    val content = "content"
+    `when`(qrGeneratorUtils.createQRCodeBitmap(content)).thenReturn(null)
+    val result = qrGeneratorImpl.generateQRCode(content)
+    assertNull(result)
+  }
+}
diff --git a/document/src/test/java/com/google/android/fhir/document/SHLinkGeneratorImplTest.kt b/document/src/test/java/com/google/android/fhir/document/SHLinkGeneratorImplTest.kt
new file mode 100644
index 0000000000..b6b085dca5
--- /dev/null
+++ b/document/src/test/java/com/google/android/fhir/document/SHLinkGeneratorImplTest.kt
@@ -0,0 +1,266 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.document
+
+import android.util.Base64
+import com.google.android.fhir.NetworkConfiguration
+import com.google.android.fhir.document.generate.EncryptionUtils
+import com.google.android.fhir.document.generate.SHLinkGenerationData
+import com.google.android.fhir.document.generate.SHLinkGeneratorImpl
+import java.time.Instant
+import kotlinx.coroutines.test.runTest
+import okhttp3.mockwebserver.MockResponse
+import okhttp3.mockwebserver.MockWebServer
+import okhttp3.mockwebserver.RecordedRequest
+import org.hl7.fhir.r4.model.Bundle
+import org.json.JSONObject
+import org.junit.Assert.assertEquals
+import org.junit.Assert.assertFalse
+import org.junit.Assert.assertTrue
+import org.junit.Before
+import org.junit.Test
+import org.junit.runner.RunWith
+import org.mockito.Mock
+import org.mockito.Mockito
+import org.mockito.Mockito.mock
+import org.mockito.Mockito.`when`
+import org.mockito.MockitoAnnotations
+import org.robolectric.RobolectricTestRunner
+import org.robolectric.annotation.Config
+
+@RunWith(RobolectricTestRunner::class)
+@Config(manifest = Config.NONE)
+class SHLinkGeneratorImplTest {
+
+  @Mock private lateinit var encryptionUtility: EncryptionUtils
+  private lateinit var shLinkGeneratorImpl: SHLinkGeneratorImpl
+
+  private val mockWebServer = MockWebServer()
+  private val baseUrl = "/shl/"
+
+  private val apiService by lazy {
+    RetrofitSHLService.Builder(mockWebServer.url(baseUrl).toString(), NetworkConfiguration())
+      .build()
+  }
+
+  private val mockIPSDocument = mock(IPSDocument::class.java)
+  private val initialPostResponse =
+    JSONObject().apply {
+      put("id", "123")
+      put("managementToken", "token123")
+    }
+
+  @Before
+  fun setUp() {
+    MockitoAnnotations.openMocks(this)
+    shLinkGeneratorImpl = SHLinkGeneratorImpl(apiService, encryptionUtility)
+    `when`(mockIPSDocument.document).thenReturn(Bundle())
+    `when`(
+        encryptionUtility.encrypt(
+          Mockito.anyString(),
+          Mockito.anyString(),
+        ),
+      )
+      .thenReturn("something")
+    `when`(encryptionUtility.generateRandomKey()).thenReturn("key")
+
+    // Mock response for getManifestUrlAndToken
+    val mockResponse = MockResponse().setResponseCode(200).setBody(initialPostResponse.toString())
+    mockWebServer.enqueue(mockResponse)
+
+    // Mock response for postPayload
+    val postPayloadResponse =
+      MockResponse().setResponseCode(200).setBody("{'test key': 'test value'}")
+    mockWebServer.enqueue(postPayloadResponse)
+  }
+
+  private suspend fun assertCommonFunctionality(
+    shLinkGenerationData: SHLinkGenerationData,
+    passcode: String,
+    optionalViewer: String,
+    expectedExp: String? = null,
+    expectedFlag: String? = null,
+    expectedLabel: String? = null,
+  ) {
+    val result =
+      shLinkGeneratorImpl.generateSHLink(
+        shLinkGenerationData,
+        passcode,
+        "",
+        optionalViewer,
+      )
+
+    val recordedRequestGetManifest: RecordedRequest = mockWebServer.takeRequest()
+    assertEquals("/shl/", recordedRequestGetManifest.path)
+    val recordedRequestPostPayload: RecordedRequest = mockWebServer.takeRequest()
+    assertEquals("/shl/123", recordedRequestPostPayload.path)
+
+    val parts = result.split("#shlink:/")
+    assertTrue(parts.size == 2)
+
+    val decodedJSON =
+      with(parts[1]) {
+        val decodedString = String(Base64.decode(this, Base64.URL_SAFE), Charsets.UTF_8)
+        JSONObject(decodedString)
+      }
+
+    expectedExp?.let {
+      assertTrue(decodedJSON.has("exp"))
+      assertEquals(decodedJSON.get("exp"), it)
+    }
+      ?: assertFalse(decodedJSON.has("exp"))
+
+    expectedFlag?.let {
+      assertTrue(decodedJSON.has("flag"))
+      assertEquals(decodedJSON.get("flag").toString(), expectedFlag)
+    }
+      ?: {
+        assertTrue(decodedJSON.has("flag"))
+        assertFalse(decodedJSON.get("flag").toString().contains("P"))
+      }
+
+    expectedLabel?.let {
+      assertTrue(decodedJSON.has("label"))
+      assertEquals(decodedJSON.get("label"), expectedLabel)
+    }
+      ?: assertFalse(decodedJSON.has("label"))
+
+    if (optionalViewer.isNotEmpty()) {
+      assertTrue(result.contains("$optionalViewer#shlink:/"))
+    }
+  }
+
+  @Test
+  fun testGenerateSHLinkWithExp() = runTest {
+    assertCommonFunctionality(
+      SHLinkGenerationData("", Instant.parse("2023-11-01T00:00:00.00Z"), mockIPSDocument),
+      "",
+      "",
+      "1698796800",
+      null,
+      null,
+    )
+  }
+
+  @Test
+  fun testGenerateSHLinkWithoutExp() = runTest {
+    assertCommonFunctionality(
+      SHLinkGenerationData("", null, mockIPSDocument),
+      "",
+      "",
+      null,
+      null,
+      null,
+    )
+  }
+
+  @Test
+  fun testGenerateSHLinkWithPasscode() = runTest {
+    assertCommonFunctionality(
+      SHLinkGenerationData("", null, mockIPSDocument),
+      "passcode",
+      "",
+      null,
+      "P",
+      null,
+    )
+  }
+
+  @Test
+  fun testGenerateSHLinkWithoutPasscode() = runTest {
+    assertCommonFunctionality(
+      SHLinkGenerationData("", null, mockIPSDocument),
+      "",
+      "",
+      null,
+      "",
+      null,
+    )
+  }
+
+  @Test
+  fun testGenerateSHLinkWithLabel() = runTest {
+    assertCommonFunctionality(
+      SHLinkGenerationData("label", null, mockIPSDocument),
+      "",
+      "",
+      null,
+      null,
+      "label",
+    )
+  }
+
+  @Test
+  fun testGenerateSHLinkWithoutLabel() = runTest {
+    assertCommonFunctionality(
+      SHLinkGenerationData("", null, mockIPSDocument),
+      "",
+      "",
+      null,
+      null,
+      null,
+    )
+  }
+
+  @Test
+  fun testGenerateSHLinkWithOptionalViewer() = runTest {
+    assertCommonFunctionality(
+      SHLinkGenerationData("", null, mockIPSDocument),
+      "",
+      "viewerUrl",
+      null,
+      null,
+      null,
+    )
+  }
+
+  @Test
+  fun testGenerateSHLinkWithoutOptionalViewer() = runTest {
+    assertCommonFunctionality(
+      SHLinkGenerationData("", null, mockIPSDocument),
+      "",
+      "",
+      null,
+      null,
+      null,
+    )
+  }
+
+  @Test
+  fun testGenerateSHLinkWithAllFeatures() = runTest {
+    assertCommonFunctionality(
+      SHLinkGenerationData("label", Instant.parse("2023-11-01T00:00:00.00Z"), mockIPSDocument),
+      "passcode",
+      "viewerUrl",
+      "1698796800",
+      "P",
+      "label",
+    )
+  }
+
+  @Test
+  fun testGenerateSHLinkWithNoFeatures() = runTest {
+    assertCommonFunctionality(
+      SHLinkGenerationData("", null, mockIPSDocument),
+      "",
+      "",
+      null,
+      null,
+      null,
+    )
+  }
+}
diff --git a/document/test-data/bundleMinimal.json b/document/test-data/bundleMinimal.json
new file mode 100644
index 0000000000..806bed6da8
--- /dev/null
+++ b/document/test-data/bundleMinimal.json
@@ -0,0 +1,443 @@
+{
+  "resourceType" : "Bundle",
+  "id" : "bundle-minimal",
+  "language" : "en-US",
+  "identifier" : {
+    "system" : "urn:oid:2.16.724.4.8.10.200.10",
+    "value" : "28b95815-76ce-457b-b7ae-a972e527db40"
+  },
+  "type" : "document",
+  "timestamp" : "2020-12-11T14:30:00+01:00",
+  "entry" : [{
+    "fullUrl" : "urn:uuid:6e1fb74a-742b-4c7b-8487-171dacb88766",
+    "resource" : {
+      "resourceType" : "Composition",
+      "id" : "6e1fb74a-742b-4c7b-8487-171dacb88766",
+      "text" : {
+        "status" : "generated",
+        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"6e1fb74a-742b-4c7b-8487-171dacb88766\" </p></div><p><b>status</b>: final</p><p><b>type</b>: Patient summary Document <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://loinc.org/\">LOINC</a>#60591-5)</span></p><p><b>date</b>: 2020-12-11 02:30:00+0100</p><p><b>author</b>: Beetje van Hulp, MD </p><p><b>title</b>: Patient Summary as of December 11, 2020 14:30</p><p><b>confidentiality</b>: N</p><blockquote><p><b>attester</b></p><p><b>mode</b>: legal</p><p><b>time</b>: 2020-12-11 02:30:00+0100</p><p><b>party</b>: Beetje van Hulp, MD </p></blockquote><blockquote><p><b>attester</b></p><p><b>mode</b>: legal</p><p><b>time</b>: 2020-12-11 02:30:00+0100</p><p><b>party</b>: Anorg Aniza Tion BV </p></blockquote><p><b>custodian</b>: Anorg Aniza Tion BV</p><h3>RelatesTos</h3><table class=\"grid\"><tr><td>-</td><td><b>Code</b></td><td><b>Target[x]</b></td></tr><tr><td>*</td><td>appends</td><td>id: 20e12ce3-857f-49c0-b888-cb670597f191</td></tr></table><h3>Events</h3><table class=\"grid\"><tr><td>-</td><td><b>Code</b></td><td><b>Period</b></td></tr><tr><td>*</td><td>care provision <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-v3-ActClass.html\">ActClass</a>#PCPR)</span></td><td>?? --&gt; 2020-12-11 02:30:00+0100</td></tr></table></div>"
+      },
+      "status" : "final",
+      "type" : {
+        "coding" : [{
+          "system" : "http://loinc.org",
+          "code" : "60591-5",
+          "display" : "Patient summary Document"
+        }]
+      },
+      "subject" : {
+        "reference" : "Patient/7685713c-e29e-4a75-8a90-45be7ba3be94"
+      },
+      "date" : "2020-12-11T14:30:00+01:00",
+      "author" : [{
+        "reference" : "Practitioner/98315ba9-ffea-41ef-b59b-a836c039858f"
+      }],
+      "title" : "Patient Summary as of December 11, 2020 14:30",
+      "confidentiality" : "N",
+      "attester" : [{
+        "mode" : "legal",
+        "time" : "2020-12-11T14:30:00+01:00",
+        "party" : {
+          "reference" : "Practitioner/98315ba9-ffea-41ef-b59b-a836c039858f"
+        }
+      },
+        {
+          "mode" : "legal",
+          "time" : "2020-12-11T14:30:00+01:00",
+          "party" : {
+            "reference" : "Organization/bb6bdf4f-7fcb-4d44-96a5-b858ad031d1d"
+          }
+        }],
+      "custodian" : {
+        "reference" : "Organization/bb6bdf4f-7fcb-4d44-96a5-b858ad031d1d"
+      },
+      "relatesTo" : [{
+        "code" : "appends",
+        "targetIdentifier" : {
+          "system" : "urn:oid:2.16.724.4.8.10.200.10",
+          "value" : "20e12ce3-857f-49c0-b888-cb670597f191"
+        }
+      }],
+      "event" : [{
+        "code" : [{
+          "coding" : [{
+            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActClass",
+            "code" : "PCPR"
+          }]
+        }],
+        "period" : {
+          "end" : "2020-12-11T14:30:00+01:00"
+        }
+      }],
+      "section" : [{
+        "title" : "Active Problems",
+        "code" : {
+          "coding" : [{
+            "system" : "http://loinc.org",
+            "code" : "11450-4",
+            "display" : "Problem list Reported"
+          }]
+        },
+        "text" : {
+          "status" : "generated",
+          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><ul><li><div><b>Condition Name</b>: Menopausal Flushing</div><div><b>Code</b>: <span>198436008</span></div><div><b>Status</b>: <span>Active</span></div></li></ul></div>"
+        },
+        "entry" : [{
+          "reference" : "Condition/ad84b7a2-b4dd-474e-bef3-0779e6cb595f"
+        }]
+      },
+        {
+          "title" : "Medication",
+          "code" : {
+            "coding" : [{
+              "system" : "http://loinc.org",
+              "code" : "10160-0",
+              "display" : "History of Medication use Narrative"
+            }]
+          },
+          "text" : {
+            "status" : "generated",
+            "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><ul><li><div><b>Medication Name</b>: Oral anastrozole 1mg tablet</div><div><b>Code</b>: <span></span></div><div><b>Status</b>: <span>Active, started March 2015</span></div><div>Instructions: Take 1 time per day</div></li></ul></div>"
+          },
+          "entry" : [{
+            "reference" : "MedicationStatement/6e883e5e-7648-485a-86de-3640a61601fe"
+          }]
+        },
+        {
+          "title" : "Allergies and Intolerances",
+          "code" : {
+            "coding" : [{
+              "system" : "http://loinc.org",
+              "code" : "48765-2",
+              "display" : "Allergies and adverse reactions Document"
+            }]
+          },
+          "text" : {
+            "status" : "generated",
+            "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><ul><li><div><b>Allergy Name</b>: Pencillins</div><div><b>Verification Status</b>: Confirmed</div><div><b>Reaction</b>: <span>no information</span></div></li></ul></div>"
+          },
+          "entry" : [{
+            "reference" : "AllergyIntolerance/fe2769fd-22c9-4307-9122-ee0466e5aebb"
+          }]
+        }]
+    }
+  },
+    {
+      "fullUrl" : "urn:uuid:7685713c-e29e-4a75-8a90-45be7ba3be94",
+      "resource" : {
+        "resourceType" : "Patient",
+        "id" : "7685713c-e29e-4a75-8a90-45be7ba3be94",
+        "text" : {
+          "status" : "generated",
+          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</b><a name=\"7685713c-e29e-4a75-8a90-45be7ba3be94\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Patient &quot;7685713c-e29e-4a75-8a90-45be7ba3be94&quot; </p></div><p><b>identifier</b>: id: 574687583</p><p><b>active</b>: true</p><p><b>name</b>: Martha DeLarosa </p><p><b>telecom</b>: <a href=\"tel:+31788700800\">+31788700800</a></p><p><b>gender</b>: female</p><p><b>birthDate</b>: 1972-05-01</p><p><b>address</b>: Laan Van Europa 1600 Dordrecht 3317 DB NL </p><h3>Contacts</h3><table class=\"grid\"><tr><td>-</td><td><b>Relationship</b></td><td><b>Name</b></td><td><b>Telecom</b></td><td><b>Address</b></td></tr><tr><td>*</td><td>mother <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-v3-RoleCode.html\">RoleCode</a>#MTH)</span></td><td>Martha Mum </td><td><a href=\"tel:+33-555-20036\">+33-555-20036</a></td><td>Promenade des Anglais 111 Lyon 69001 FR </td></tr></table></div>"
+        },
+        "identifier" : [{
+          "system" : "urn:oid:2.16.840.1.113883.2.4.6.3",
+          "value" : "574687583"
+        }],
+        "active" : true,
+        "name" : [{
+          "family" : "DeLarosa",
+          "given" : ["Martha"]
+        }],
+        "telecom" : [{
+          "system" : "phone",
+          "value" : "+31788700800",
+          "use" : "home"
+        }],
+        "gender" : "female",
+        "birthDate" : "1972-05-01",
+        "address" : [{
+          "line" : ["Laan Van Europa 1600"],
+          "city" : "Dordrecht",
+          "postalCode" : "3317 DB",
+          "country" : "NL"
+        }],
+        "contact" : [{
+          "relationship" : [{
+            "coding" : [{
+              "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
+              "code" : "MTH"
+            }]
+          }],
+          "name" : {
+            "family" : "Mum",
+            "given" : ["Martha"]
+          },
+          "telecom" : [{
+            "system" : "phone",
+            "value" : "+33-555-20036",
+            "use" : "home"
+          }],
+          "address" : {
+            "line" : ["Promenade des Anglais 111"],
+            "city" : "Lyon",
+            "postalCode" : "69001",
+            "country" : "FR"
+          }
+        }]
+      }
+    },
+    {
+      "fullUrl" : "urn:uuid:98315ba9-ffea-41ef-b59b-a836c039858f",
+      "resource" : {
+        "resourceType" : "Practitioner",
+        "id" : "98315ba9-ffea-41ef-b59b-a836c039858f",
+        "text" : {
+          "status" : "generated",
+          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Practitioner</b><a name=\"98315ba9-ffea-41ef-b59b-a836c039858f\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Practitioner &quot;98315ba9-ffea-41ef-b59b-a836c039858f&quot; </p></div><p><b>identifier</b>: id: 129854633</p><p><b>active</b>: true</p><p><b>name</b>: Beetje van Hulp </p><h3>Qualifications</h3><table class=\"grid\"><tr><td>-</td><td><b>Code</b></td></tr><tr><td>*</td><td>Doctor of Medicine <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (degreeLicenseCertificate[2.7]#MD)</span></td></tr></table></div>"
+        },
+        "identifier" : [{
+          "system" : "urn:oid:2.16.528.1.1007.3.1",
+          "value" : "129854633",
+          "assigner" : {
+            "display" : "CIBG"
+          }
+        }],
+        "active" : true,
+        "name" : [{
+          "family" : "van Hulp",
+          "given" : ["Beetje"]
+        }],
+        "qualification" : [{
+          "code" : {
+            "coding" : [{
+              "system" : "http://terminology.hl7.org/CodeSystem/v2-0360",
+              "version" : "2.7",
+              "code" : "MD",
+              "display" : "Doctor of Medicine"
+            }]
+          }
+        }]
+      }
+    },
+    {
+      "fullUrl" : "urn:uuid:bb6bdf4f-7fcb-4d44-96a5-b858ad031d1d",
+      "resource" : {
+        "resourceType" : "Organization",
+        "id" : "bb6bdf4f-7fcb-4d44-96a5-b858ad031d1d",
+        "text" : {
+          "status" : "generated",
+          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"bb6bdf4f-7fcb-4d44-96a5-b858ad031d1d\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Organization &quot;bb6bdf4f-7fcb-4d44-96a5-b858ad031d1d&quot; </p></div><p><b>identifier</b>: id: 564738757</p><p><b>active</b>: true</p><p><b>name</b>: Anorg Aniza Tion BV / The best custodian ever</p><p><b>telecom</b>: <a href=\"tel:+31-51-34343400\">+31-51-34343400</a></p><p><b>address</b>: Houttuinen 27 Dordrecht 3311 CE NL (WORK)</p></div>"
+        },
+        "identifier" : [{
+          "system" : "urn:oid:2.16.528.1.1007.3.3",
+          "value" : "564738757"
+        }],
+        "active" : true,
+        "name" : "Anorg Aniza Tion BV / The best custodian ever",
+        "telecom" : [{
+          "system" : "phone",
+          "value" : "+31-51-34343400",
+          "use" : "work"
+        }],
+        "address" : [{
+          "use" : "work",
+          "line" : ["Houttuinen 27"],
+          "city" : "Dordrecht",
+          "postalCode" : "3311 CE",
+          "country" : "NL"
+        }]
+      }
+    },
+    {
+      "fullUrl" : "urn:uuid:ad84b7a2-b4dd-474e-bef3-0779e6cb595f",
+      "resource" : {
+        "resourceType" : "Condition",
+        "id" : "ad84b7a2-b4dd-474e-bef3-0779e6cb595f",
+        "text" : {
+          "status" : "generated",
+          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Condition</b><a name=\"ad84b7a2-b4dd-474e-bef3-0779e6cb595f\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Condition &quot;ad84b7a2-b4dd-474e-bef3-0779e6cb595f&quot; </p></div><p><b>identifier</b>: id: cacceb57-395f-48e1-9c88-e9c9704dc2d2</p><p><b>clinicalStatus</b>: Active <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-condition-clinical.html\">Condition Clinical Status Codes</a>#active)</span></p><p><b>verificationStatus</b>: Confirmed <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-condition-ver-status.html\">ConditionVerificationStatus</a>#confirmed)</span></p><p><b>category</b>: Problem <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://loinc.org/\">LOINC</a>#75326-9)</span></p><p><b>severity</b>: Moderate <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://loinc.org/\">LOINC</a>#LA6751-7)</span></p><p><b>code</b>: Menopausal flushing (finding) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#198436008; <a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-icd10.html\">ICD-10</a>#N95.1 &quot;Menopausal and female climacteric states&quot;)</span></p><p><b>subject</b>: <a href=\"#Patient_7685713c-e29e-4a75-8a90-45be7ba3be94\">See above (Patient/7685713c-e29e-4a75-8a90-45be7ba3be94)</a></p><p><b>onset</b>: 2015</p><p><b>recordedDate</b>: 2016-10</p></div>"
+        },
+        "identifier" : [{
+          "system" : "urn:oid:1.2.3.999",
+          "value" : "cacceb57-395f-48e1-9c88-e9c9704dc2d2"
+        }],
+        "clinicalStatus" : {
+          "coding" : [{
+            "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
+            "code" : "active"
+          }]
+        },
+        "verificationStatus" : {
+          "coding" : [{
+            "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
+            "code" : "confirmed"
+          }]
+        },
+        "category" : [{
+          "coding" : [{
+            "system" : "http://loinc.org",
+            "code" : "75326-9",
+            "display" : "Problem"
+          }]
+        }],
+        "severity" : {
+          "coding" : [{
+            "system" : "http://loinc.org",
+            "code" : "LA6751-7",
+            "display" : "Moderate"
+          }]
+        },
+        "code" : {
+          "coding" : [{
+            "system" : "http://snomed.info/sct",
+            "code" : "198436008",
+            "display" : "Menopausal flushing (finding)",
+            "_display" : {
+              "extension" : [{
+                "extension" : [{
+                  "url" : "lang",
+                  "valueCode" : "nl-NL"
+                },
+                  {
+                    "url" : "content",
+                    "valueString" : "opvliegers"
+                  }],
+                "url" : "http://hl7.org/fhir/StructureDefinition/translation"
+              }]
+            }
+          },
+            {
+              "system" : "http://hl7.org/fhir/sid/icd-10",
+              "code" : "N95.1",
+              "display" : "Menopausal and female climacteric states"
+            }]
+        },
+        "subject" : {
+          "reference" : "Patient/7685713c-e29e-4a75-8a90-45be7ba3be94"
+        },
+        "onsetDateTime" : "2015",
+        "recordedDate" : "2016-10"
+      }
+    },
+    {
+      "fullUrl" : "urn:uuid:6e883e5e-7648-485a-86de-3640a61601fe",
+      "resource" : {
+        "resourceType" : "MedicationStatement",
+        "id" : "6e883e5e-7648-485a-86de-3640a61601fe",
+        "text" : {
+          "status" : "generated",
+          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: MedicationStatement</b><a name=\"6e883e5e-7648-485a-86de-3640a61601fe\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource MedicationStatement &quot;6e883e5e-7648-485a-86de-3640a61601fe&quot; </p></div><p><b>identifier</b>: id: 8faf0319-89d3-427c-b9d1-e8c8fd390dca</p><p><b>status</b>: active</p><p><b>medication</b>: <a href=\"#Medication_6369a973-afc7-4617-8877-3e9811e05a5b\">See above (Medication/6369a973-afc7-4617-8877-3e9811e05a5b)</a></p><p><b>subject</b>: <a href=\"#Patient_7685713c-e29e-4a75-8a90-45be7ba3be94\">See above (Patient/7685713c-e29e-4a75-8a90-45be7ba3be94)</a></p><p><b>effective</b>: 2015-03 --&gt; (ongoing)</p><blockquote><p><b>dosage</b></p><p><b>timing</b>: Count 1 times, Do Once</p><p><b>route</b>: Oral use <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (standardterms.edqm.eu#20053000)</span></p></blockquote></div>"
+        },
+        "identifier" : [{
+          "system" : "urn:oid:1.2.3.999",
+          "value" : "8faf0319-89d3-427c-b9d1-e8c8fd390dca"
+        }],
+        "status" : "active",
+        "medicationReference" : {
+          "reference" : "Medication/6369a973-afc7-4617-8877-3e9811e05a5b"
+        },
+        "subject" : {
+          "reference" : "Patient/7685713c-e29e-4a75-8a90-45be7ba3be94"
+        },
+        "effectivePeriod" : {
+          "start" : "2015-03"
+        },
+        "dosage" : [{
+          "timing" : {
+            "repeat" : {
+              "count" : 1,
+              "periodUnit" : "d"
+            }
+          },
+          "route" : {
+            "coding" : [{
+              "system" : "http://standardterms.edqm.eu",
+              "code" : "20053000",
+              "display" : "Oral use"
+            }]
+          },
+          "doseAndRate" : [{
+            "type" : {
+              "coding" : [{
+                "system" : "http://terminology.hl7.org/CodeSystem/dose-rate-type",
+                "code" : "ordered",
+                "display" : "Ordered"
+              }]
+            },
+            "doseQuantity" : {
+              "value" : 1,
+              "unit" : "tablet",
+              "system" : "http://unitsofmeasure.org",
+              "code" : "1"
+            }
+          }]
+        }]
+      }
+    },
+    {
+      "fullUrl" : "urn:uuid:6369a973-afc7-4617-8877-3e9811e05a5b",
+      "resource" : {
+        "resourceType" : "Medication",
+        "id" : "6369a973-afc7-4617-8877-3e9811e05a5b",
+        "text" : {
+          "status" : "generated",
+          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Medication</b><a name=\"6369a973-afc7-4617-8877-3e9811e05a5b\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Medication &quot;6369a973-afc7-4617-8877-3e9811e05a5b&quot; </p></div><p><b>code</b>: Product containing anastrozole (medicinal product) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#108774000; unknown#99872 &quot;ANASTROZOL 1MG TABLET&quot;; unknown#2076667 &quot;ANASTROZOL CF TABLET FILMOMHULD 1MG&quot;; <a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-v3-WC.html\">WHO ATC</a>#L02BG03 &quot;anastrozole&quot;)</span></p></div>"
+        },
+        "code" : {
+          "coding" : [{
+            "system" : "http://snomed.info/sct",
+            "code" : "108774000",
+            "display" : "Product containing anastrozole (medicinal product)"
+          },
+            {
+              "system" : "urn:oid:2.16.840.1.113883.2.4.4.1",
+              "code" : "99872",
+              "display" : "ANASTROZOL 1MG TABLET"
+            },
+            {
+              "system" : "urn:oid:2.16.840.1.113883.2.4.4.7",
+              "code" : "2076667",
+              "display" : "ANASTROZOL CF TABLET FILMOMHULD 1MG"
+            },
+            {
+              "system" : "http://www.whocc.no/atc",
+              "code" : "L02BG03",
+              "display" : "anastrozole"
+            }]
+        }
+      }
+    },
+    {
+      "fullUrl" : "urn:uuid:fe2769fd-22c9-4307-9122-ee0466e5aebb",
+      "resource" : {
+        "resourceType" : "AllergyIntolerance",
+        "id" : "fe2769fd-22c9-4307-9122-ee0466e5aebb",
+        "text" : {
+          "status" : "generated",
+          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: AllergyIntolerance</b><a name=\"fe2769fd-22c9-4307-9122-ee0466e5aebb\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource AllergyIntolerance &quot;fe2769fd-22c9-4307-9122-ee0466e5aebb&quot; </p></div><p><b>identifier</b>: id: 8d9566a4-d26d-46be-a3e4-c9f3a0e5cd83</p><p><b>clinicalStatus</b>: Active <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-allergyintolerance-clinical.html\">AllergyIntolerance Clinical Status Codes</a>#active)</span></p><p><b>verificationStatus</b>: Confirmed <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-allergyintolerance-verification.html\">AllergyIntolerance Verification Status</a>#confirmed)</span></p><p><b>type</b>: allergy</p><p><b>category</b>: medication</p><p><b>criticality</b>: high</p><p><b>code</b>: Substance with penicillin structure and antibacterial mechanism of action (substance) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#373270004)</span></p><p><b>patient</b>: <a href=\"#Patient_7685713c-e29e-4a75-8a90-45be7ba3be94\">See above (Patient/7685713c-e29e-4a75-8a90-45be7ba3be94)</a></p><p><b>onset</b>: 2010</p></div>"
+        },
+        "identifier" : [{
+          "system" : "urn:oid:1.2.3.999",
+          "value" : "8d9566a4-d26d-46be-a3e4-c9f3a0e5cd83"
+        }],
+        "clinicalStatus" : {
+          "coding" : [{
+            "system" : "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
+            "code" : "active"
+          }]
+        },
+        "verificationStatus" : {
+          "coding" : [{
+            "system" : "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
+            "code" : "confirmed"
+          }]
+        },
+        "type" : "allergy",
+        "category" : ["medication"],
+        "criticality" : "high",
+        "code" : {
+          "coding" : [{
+            "system" : "http://snomed.info/sct",
+            "code" : "373270004",
+            "display" : "Substance with penicillin structure and antibacterial mechanism of action (substance)"
+          }]
+        },
+        "patient" : {
+          "reference" : "Patient/7685713c-e29e-4a75-8a90-45be7ba3be94"
+        },
+        "onsetDateTime" : "2010"
+      }
+    }]
+}
\ No newline at end of file
diff --git a/engine/benchmark/build.gradle.kts b/engine/benchmark/build.gradle.kts
index 42c50096c1..4ac37e5d05 100644
--- a/engine/benchmark/build.gradle.kts
+++ b/engine/benchmark/build.gradle.kts
@@ -1,8 +1,3 @@
-import Dependencies.forceGuava
-import Dependencies.forceHapiVersion
-import Dependencies.forceJacksonVersion
-import Dependencies.removeIncompatibleDependencies
-
 plugins {
   id(Plugins.BuildPlugins.androidLib)
   id(Plugins.BuildPlugins.kotlinAndroid)
@@ -48,15 +43,6 @@ android {
 
 afterEvaluate { configureFirebaseTestLabForMicroBenchmark() }
 
-configurations {
-  all {
-    removeIncompatibleDependencies()
-    forceGuava()
-    forceHapiVersion()
-    forceJacksonVersion()
-  }
-}
-
 dependencies {
   androidTestImplementation(Dependencies.Androidx.workRuntimeKtx)
   androidTestImplementation(Dependencies.AndroidxTest.benchmarkJunit)
diff --git a/engine/benchmark/src/androidTest/java/com/google/android/fhir/benchmark/FhirSyncWorkerBenchmark.kt b/engine/benchmark/src/androidTest/java/com/google/android/fhir/benchmark/FhirSyncWorkerBenchmark.kt
index 1a2904e8b3..199a558026 100644
--- a/engine/benchmark/src/androidTest/java/com/google/android/fhir/benchmark/FhirSyncWorkerBenchmark.kt
+++ b/engine/benchmark/src/androidTest/java/com/google/android/fhir/benchmark/FhirSyncWorkerBenchmark.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -22,6 +22,7 @@ import androidx.benchmark.junit4.measureRepeated
 import androidx.test.core.app.ApplicationProvider
 import androidx.test.ext.junit.runners.AndroidJUnit4
 import androidx.test.filters.SdkSuppress
+import androidx.work.Data
 import androidx.work.ListenableWorker
 import androidx.work.WorkerParameters
 import androidx.work.testing.TestListenableWorkerBuilder
@@ -36,6 +37,7 @@ import com.google.android.fhir.sync.AcceptRemoteConflictResolver
 import com.google.android.fhir.sync.DownloadWorkManager
 import com.google.android.fhir.sync.FhirSyncWorker
 import com.google.android.fhir.sync.download.DownloadRequest
+import com.google.android.fhir.sync.upload.UploadStrategy
 import com.google.common.truth.Truth.assertThat
 import java.math.BigDecimal
 import java.util.LinkedList
@@ -88,6 +90,8 @@ class FhirSyncWorkerBenchmark {
     override fun getDownloadWorkManager(): DownloadWorkManager = BenchmarkTestDownloadManagerImpl()
 
     override fun getConflictResolver() = AcceptRemoteConflictResolver
+
+    override fun getUploadStrategy(): UploadStrategy = UploadStrategy.AllChangesSquashedBundlePut
   }
 
   open class BenchmarkTestDownloadManagerImpl(queries: List<String> = listOf("List/sync-list")) :
@@ -135,7 +139,12 @@ class FhirSyncWorkerBenchmark {
   private fun oneTimeSync(numberPatients: Int, numberObservations: Int, numberEncounters: Int) =
     runBlocking {
       val context: Context = ApplicationProvider.getApplicationContext()
-      val worker = TestListenableWorkerBuilder<BenchmarkTestOneTimeSyncWorker>(context).build()
+      val inputData =
+        Data.Builder()
+          .putString("sync_status_preferences_datastore_key", "BenchmarkTestOneTimeSyncWorker")
+          .build()
+      val worker =
+        TestListenableWorkerBuilder<BenchmarkTestOneTimeSyncWorker>(context, inputData).build()
       setupMockServerDispatcher(numberPatients, numberObservations, numberEncounters)
       benchmarkRule.measureRepeated {
         runBlocking {
diff --git a/engine/build.gradle.kts b/engine/build.gradle.kts
index 155f481ddc..ae44fe7a0c 100644
--- a/engine/build.gradle.kts
+++ b/engine/build.gradle.kts
@@ -1,6 +1,3 @@
-import Dependencies.forceGuava
-import Dependencies.forceHapiVersion
-import Dependencies.forceJacksonVersion
 import codegen.GenerateSearchParamsTask
 import java.net.URL
 
@@ -87,10 +84,9 @@ configurations {
     exclude(module = "jakarta.activation-api")
     exclude(module = "javax.activation")
     exclude(module = "jakarta.xml.bind-api")
-
-    forceGuava()
-    forceHapiVersion()
-    forceJacksonVersion()
+    exclude(module = "hapi-fhir-caching-caffeine")
+    exclude(group = "com.github.ben-manes.caffeine", module = "caffeine")
+    exclude(module = "jcl-over-slf4j")
   }
 }
 
@@ -145,11 +141,19 @@ dependencies {
   testImplementation(Dependencies.AndroidxTest.workTestingRuntimeKtx)
   testImplementation(Dependencies.Kotlin.kotlinCoroutinesTest)
   testImplementation(Dependencies.junit)
+  testImplementation(Dependencies.jsonAssert)
   testImplementation(Dependencies.mockitoInline)
   testImplementation(Dependencies.mockitoKotlin)
   testImplementation(Dependencies.mockWebServer)
   testImplementation(Dependencies.robolectric)
   testImplementation(Dependencies.truth)
+
+  constraints {
+    Dependencies.hapiFhirConstraints().forEach { (libName, constraints) ->
+      api(libName, constraints)
+      implementation(libName, constraints)
+    }
+  }
 }
 
 tasks.dokkaHtml.configure {
diff --git a/engine/schemas/com.google.android.fhir.db.impl.ResourceDatabase/8.json b/engine/schemas/com.google.android.fhir.db.impl.ResourceDatabase/8.json
new file mode 100644
index 0000000000..a4a50d1caf
--- /dev/null
+++ b/engine/schemas/com.google.android.fhir.db.impl.ResourceDatabase/8.json
@@ -0,0 +1,1025 @@
+{
+  "formatVersion": 1,
+  "database": {
+    "version": 8,
+    "identityHash": "dee7984bc7a1af3c4358443b0d6bbc95",
+    "entities": [
+      {
+        "tableName": "ResourceEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceUuid` BLOB NOT NULL, `resourceType` TEXT NOT NULL, `resourceId` TEXT NOT NULL, `serializedResource` TEXT NOT NULL, `versionId` TEXT, `lastUpdatedRemote` INTEGER, `lastUpdatedLocal` INTEGER)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceId",
+            "columnName": "resourceId",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "serializedResource",
+            "columnName": "serializedResource",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "versionId",
+            "columnName": "versionId",
+            "affinity": "TEXT",
+            "notNull": false
+          },
+          {
+            "fieldPath": "lastUpdatedRemote",
+            "columnName": "lastUpdatedRemote",
+            "affinity": "INTEGER",
+            "notNull": false
+          },
+          {
+            "fieldPath": "lastUpdatedLocal",
+            "columnName": "lastUpdatedLocal",
+            "affinity": "INTEGER",
+            "notNull": false
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_ResourceEntity_resourceUuid",
+            "unique": true,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE UNIQUE INDEX IF NOT EXISTS `index_ResourceEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          },
+          {
+            "name": "index_ResourceEntity_resourceType_resourceId",
+            "unique": true,
+            "columnNames": [
+              "resourceType",
+              "resourceId"
+            ],
+            "orders": [],
+            "createSql": "CREATE UNIQUE INDEX IF NOT EXISTS `index_ResourceEntity_resourceType_resourceId` ON `${TABLE_NAME}` (`resourceType`, `resourceId`)"
+          }
+        ],
+        "foreignKeys": []
+      },
+      {
+        "tableName": "StringIndexEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceUuid` BLOB NOT NULL, `resourceType` TEXT NOT NULL, `index_name` TEXT NOT NULL, `index_path` TEXT NOT NULL, `index_value` TEXT NOT NULL, FOREIGN KEY(`resourceUuid`) REFERENCES `ResourceEntity`(`resourceUuid`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.name",
+            "columnName": "index_name",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.path",
+            "columnName": "index_path",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.value",
+            "columnName": "index_value",
+            "affinity": "TEXT",
+            "notNull": true
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_StringIndexEntity_resourceType_index_name_index_value",
+            "unique": false,
+            "columnNames": [
+              "resourceType",
+              "index_name",
+              "index_value"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_StringIndexEntity_resourceType_index_name_index_value` ON `${TABLE_NAME}` (`resourceType`, `index_name`, `index_value`)"
+          },
+          {
+            "name": "index_StringIndexEntity_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_StringIndexEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          }
+        ],
+        "foreignKeys": [
+          {
+            "table": "ResourceEntity",
+            "onDelete": "CASCADE",
+            "onUpdate": "NO ACTION",
+            "columns": [
+              "resourceUuid"
+            ],
+            "referencedColumns": [
+              "resourceUuid"
+            ]
+          }
+        ]
+      },
+      {
+        "tableName": "ReferenceIndexEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceUuid` BLOB NOT NULL, `resourceType` TEXT NOT NULL, `index_name` TEXT NOT NULL, `index_path` TEXT NOT NULL, `index_value` TEXT NOT NULL, FOREIGN KEY(`resourceUuid`) REFERENCES `ResourceEntity`(`resourceUuid`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.name",
+            "columnName": "index_name",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.path",
+            "columnName": "index_path",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.value",
+            "columnName": "index_value",
+            "affinity": "TEXT",
+            "notNull": true
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_ReferenceIndexEntity_resourceType_index_name_index_value",
+            "unique": false,
+            "columnNames": [
+              "resourceType",
+              "index_name",
+              "index_value"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_ReferenceIndexEntity_resourceType_index_name_index_value` ON `${TABLE_NAME}` (`resourceType`, `index_name`, `index_value`)"
+          },
+          {
+            "name": "index_ReferenceIndexEntity_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_ReferenceIndexEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          }
+        ],
+        "foreignKeys": [
+          {
+            "table": "ResourceEntity",
+            "onDelete": "CASCADE",
+            "onUpdate": "NO ACTION",
+            "columns": [
+              "resourceUuid"
+            ],
+            "referencedColumns": [
+              "resourceUuid"
+            ]
+          }
+        ]
+      },
+      {
+        "tableName": "TokenIndexEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceUuid` BLOB NOT NULL, `resourceType` TEXT NOT NULL, `index_name` TEXT NOT NULL, `index_path` TEXT NOT NULL, `index_system` TEXT, `index_value` TEXT NOT NULL, FOREIGN KEY(`resourceUuid`) REFERENCES `ResourceEntity`(`resourceUuid`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.name",
+            "columnName": "index_name",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.path",
+            "columnName": "index_path",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.system",
+            "columnName": "index_system",
+            "affinity": "TEXT",
+            "notNull": false
+          },
+          {
+            "fieldPath": "index.value",
+            "columnName": "index_value",
+            "affinity": "TEXT",
+            "notNull": true
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_TokenIndexEntity_resourceType_index_name_index_system_index_value_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceType",
+              "index_name",
+              "index_system",
+              "index_value",
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_TokenIndexEntity_resourceType_index_name_index_system_index_value_resourceUuid` ON `${TABLE_NAME}` (`resourceType`, `index_name`, `index_system`, `index_value`, `resourceUuid`)"
+          },
+          {
+            "name": "index_TokenIndexEntity_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_TokenIndexEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          }
+        ],
+        "foreignKeys": [
+          {
+            "table": "ResourceEntity",
+            "onDelete": "CASCADE",
+            "onUpdate": "NO ACTION",
+            "columns": [
+              "resourceUuid"
+            ],
+            "referencedColumns": [
+              "resourceUuid"
+            ]
+          }
+        ]
+      },
+      {
+        "tableName": "QuantityIndexEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceUuid` BLOB NOT NULL, `resourceType` TEXT NOT NULL, `index_name` TEXT NOT NULL, `index_path` TEXT NOT NULL, `index_system` TEXT NOT NULL, `index_code` TEXT NOT NULL, `index_value` REAL NOT NULL, FOREIGN KEY(`resourceUuid`) REFERENCES `ResourceEntity`(`resourceUuid`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.name",
+            "columnName": "index_name",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.path",
+            "columnName": "index_path",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.system",
+            "columnName": "index_system",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.code",
+            "columnName": "index_code",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.value",
+            "columnName": "index_value",
+            "affinity": "REAL",
+            "notNull": true
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_QuantityIndexEntity_resourceType_index_name_index_value_index_code",
+            "unique": false,
+            "columnNames": [
+              "resourceType",
+              "index_name",
+              "index_value",
+              "index_code"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_QuantityIndexEntity_resourceType_index_name_index_value_index_code` ON `${TABLE_NAME}` (`resourceType`, `index_name`, `index_value`, `index_code`)"
+          },
+          {
+            "name": "index_QuantityIndexEntity_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_QuantityIndexEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          }
+        ],
+        "foreignKeys": [
+          {
+            "table": "ResourceEntity",
+            "onDelete": "CASCADE",
+            "onUpdate": "NO ACTION",
+            "columns": [
+              "resourceUuid"
+            ],
+            "referencedColumns": [
+              "resourceUuid"
+            ]
+          }
+        ]
+      },
+      {
+        "tableName": "UriIndexEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceUuid` BLOB NOT NULL, `resourceType` TEXT NOT NULL, `index_name` TEXT NOT NULL, `index_path` TEXT NOT NULL, `index_value` TEXT NOT NULL, FOREIGN KEY(`resourceUuid`) REFERENCES `ResourceEntity`(`resourceUuid`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.name",
+            "columnName": "index_name",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.path",
+            "columnName": "index_path",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.value",
+            "columnName": "index_value",
+            "affinity": "TEXT",
+            "notNull": true
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_UriIndexEntity_resourceType_index_name_index_value",
+            "unique": false,
+            "columnNames": [
+              "resourceType",
+              "index_name",
+              "index_value"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_UriIndexEntity_resourceType_index_name_index_value` ON `${TABLE_NAME}` (`resourceType`, `index_name`, `index_value`)"
+          },
+          {
+            "name": "index_UriIndexEntity_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_UriIndexEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          }
+        ],
+        "foreignKeys": [
+          {
+            "table": "ResourceEntity",
+            "onDelete": "CASCADE",
+            "onUpdate": "NO ACTION",
+            "columns": [
+              "resourceUuid"
+            ],
+            "referencedColumns": [
+              "resourceUuid"
+            ]
+          }
+        ]
+      },
+      {
+        "tableName": "DateIndexEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceUuid` BLOB NOT NULL, `resourceType` TEXT NOT NULL, `index_name` TEXT NOT NULL, `index_path` TEXT NOT NULL, `index_from` INTEGER NOT NULL, `index_to` INTEGER NOT NULL, FOREIGN KEY(`resourceUuid`) REFERENCES `ResourceEntity`(`resourceUuid`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.name",
+            "columnName": "index_name",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.path",
+            "columnName": "index_path",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.from",
+            "columnName": "index_from",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.to",
+            "columnName": "index_to",
+            "affinity": "INTEGER",
+            "notNull": true
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_DateIndexEntity_resourceType_index_name_resourceUuid_index_from_index_to",
+            "unique": false,
+            "columnNames": [
+              "resourceType",
+              "index_name",
+              "resourceUuid",
+              "index_from",
+              "index_to"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_DateIndexEntity_resourceType_index_name_resourceUuid_index_from_index_to` ON `${TABLE_NAME}` (`resourceType`, `index_name`, `resourceUuid`, `index_from`, `index_to`)"
+          },
+          {
+            "name": "index_DateIndexEntity_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_DateIndexEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          }
+        ],
+        "foreignKeys": [
+          {
+            "table": "ResourceEntity",
+            "onDelete": "CASCADE",
+            "onUpdate": "NO ACTION",
+            "columns": [
+              "resourceUuid"
+            ],
+            "referencedColumns": [
+              "resourceUuid"
+            ]
+          }
+        ]
+      },
+      {
+        "tableName": "DateTimeIndexEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceUuid` BLOB NOT NULL, `resourceType` TEXT NOT NULL, `index_name` TEXT NOT NULL, `index_path` TEXT NOT NULL, `index_from` INTEGER NOT NULL, `index_to` INTEGER NOT NULL, FOREIGN KEY(`resourceUuid`) REFERENCES `ResourceEntity`(`resourceUuid`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.name",
+            "columnName": "index_name",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.path",
+            "columnName": "index_path",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.from",
+            "columnName": "index_from",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.to",
+            "columnName": "index_to",
+            "affinity": "INTEGER",
+            "notNull": true
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_DateTimeIndexEntity_resourceType_index_name_resourceUuid_index_from_index_to",
+            "unique": false,
+            "columnNames": [
+              "resourceType",
+              "index_name",
+              "resourceUuid",
+              "index_from",
+              "index_to"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_DateTimeIndexEntity_resourceType_index_name_resourceUuid_index_from_index_to` ON `${TABLE_NAME}` (`resourceType`, `index_name`, `resourceUuid`, `index_from`, `index_to`)"
+          },
+          {
+            "name": "index_DateTimeIndexEntity_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_DateTimeIndexEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          }
+        ],
+        "foreignKeys": [
+          {
+            "table": "ResourceEntity",
+            "onDelete": "CASCADE",
+            "onUpdate": "NO ACTION",
+            "columns": [
+              "resourceUuid"
+            ],
+            "referencedColumns": [
+              "resourceUuid"
+            ]
+          }
+        ]
+      },
+      {
+        "tableName": "NumberIndexEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceUuid` BLOB NOT NULL, `resourceType` TEXT NOT NULL, `index_name` TEXT NOT NULL, `index_path` TEXT NOT NULL, `index_value` REAL NOT NULL, FOREIGN KEY(`resourceUuid`) REFERENCES `ResourceEntity`(`resourceUuid`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.name",
+            "columnName": "index_name",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.path",
+            "columnName": "index_path",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.value",
+            "columnName": "index_value",
+            "affinity": "REAL",
+            "notNull": true
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_NumberIndexEntity_resourceType_index_name_index_value",
+            "unique": false,
+            "columnNames": [
+              "resourceType",
+              "index_name",
+              "index_value"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_NumberIndexEntity_resourceType_index_name_index_value` ON `${TABLE_NAME}` (`resourceType`, `index_name`, `index_value`)"
+          },
+          {
+            "name": "index_NumberIndexEntity_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_NumberIndexEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          }
+        ],
+        "foreignKeys": [
+          {
+            "table": "ResourceEntity",
+            "onDelete": "CASCADE",
+            "onUpdate": "NO ACTION",
+            "columns": [
+              "resourceUuid"
+            ],
+            "referencedColumns": [
+              "resourceUuid"
+            ]
+          }
+        ]
+      },
+      {
+        "tableName": "LocalChangeEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceType` TEXT NOT NULL, `resourceId` TEXT NOT NULL, `resourceUuid` BLOB NOT NULL, `timestamp` INTEGER NOT NULL, `type` INTEGER NOT NULL, `payload` TEXT NOT NULL, `versionId` TEXT)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceId",
+            "columnName": "resourceId",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "timestamp",
+            "columnName": "timestamp",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "type",
+            "columnName": "type",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "payload",
+            "columnName": "payload",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "versionId",
+            "columnName": "versionId",
+            "affinity": "TEXT",
+            "notNull": false
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_LocalChangeEntity_resourceType_resourceId",
+            "unique": false,
+            "columnNames": [
+              "resourceType",
+              "resourceId"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_LocalChangeEntity_resourceType_resourceId` ON `${TABLE_NAME}` (`resourceType`, `resourceId`)"
+          },
+          {
+            "name": "index_LocalChangeEntity_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_LocalChangeEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          }
+        ],
+        "foreignKeys": []
+      },
+      {
+        "tableName": "PositionIndexEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `resourceUuid` BLOB NOT NULL, `resourceType` TEXT NOT NULL, `index_latitude` REAL NOT NULL, `index_longitude` REAL NOT NULL, FOREIGN KEY(`resourceUuid`) REFERENCES `ResourceEntity`(`resourceUuid`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceUuid",
+            "columnName": "resourceUuid",
+            "affinity": "BLOB",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceType",
+            "columnName": "resourceType",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.latitude",
+            "columnName": "index_latitude",
+            "affinity": "REAL",
+            "notNull": true
+          },
+          {
+            "fieldPath": "index.longitude",
+            "columnName": "index_longitude",
+            "affinity": "REAL",
+            "notNull": true
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_PositionIndexEntity_resourceType_index_latitude_index_longitude",
+            "unique": false,
+            "columnNames": [
+              "resourceType",
+              "index_latitude",
+              "index_longitude"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_PositionIndexEntity_resourceType_index_latitude_index_longitude` ON `${TABLE_NAME}` (`resourceType`, `index_latitude`, `index_longitude`)"
+          },
+          {
+            "name": "index_PositionIndexEntity_resourceUuid",
+            "unique": false,
+            "columnNames": [
+              "resourceUuid"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_PositionIndexEntity_resourceUuid` ON `${TABLE_NAME}` (`resourceUuid`)"
+          }
+        ],
+        "foreignKeys": [
+          {
+            "table": "ResourceEntity",
+            "onDelete": "CASCADE",
+            "onUpdate": "NO ACTION",
+            "columns": [
+              "resourceUuid"
+            ],
+            "referencedColumns": [
+              "resourceUuid"
+            ]
+          }
+        ]
+      },
+      {
+        "tableName": "LocalChangeResourceReferenceEntity",
+        "createSql": "CREATE TABLE IF NOT EXISTS `${TABLE_NAME}` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `localChangeId` INTEGER NOT NULL, `resourceReferenceValue` TEXT NOT NULL, `resourceReferencePath` TEXT, FOREIGN KEY(`localChangeId`) REFERENCES `LocalChangeEntity`(`id`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+        "fields": [
+          {
+            "fieldPath": "id",
+            "columnName": "id",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "localChangeId",
+            "columnName": "localChangeId",
+            "affinity": "INTEGER",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceReferenceValue",
+            "columnName": "resourceReferenceValue",
+            "affinity": "TEXT",
+            "notNull": true
+          },
+          {
+            "fieldPath": "resourceReferencePath",
+            "columnName": "resourceReferencePath",
+            "affinity": "TEXT",
+            "notNull": false
+          }
+        ],
+        "primaryKey": {
+          "autoGenerate": true,
+          "columnNames": [
+            "id"
+          ]
+        },
+        "indices": [
+          {
+            "name": "index_LocalChangeResourceReferenceEntity_resourceReferenceValue",
+            "unique": false,
+            "columnNames": [
+              "resourceReferenceValue"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_LocalChangeResourceReferenceEntity_resourceReferenceValue` ON `${TABLE_NAME}` (`resourceReferenceValue`)"
+          },
+          {
+            "name": "index_LocalChangeResourceReferenceEntity_localChangeId",
+            "unique": false,
+            "columnNames": [
+              "localChangeId"
+            ],
+            "orders": [],
+            "createSql": "CREATE INDEX IF NOT EXISTS `index_LocalChangeResourceReferenceEntity_localChangeId` ON `${TABLE_NAME}` (`localChangeId`)"
+          }
+        ],
+        "foreignKeys": [
+          {
+            "table": "LocalChangeEntity",
+            "onDelete": "CASCADE",
+            "onUpdate": "NO ACTION",
+            "columns": [
+              "localChangeId"
+            ],
+            "referencedColumns": [
+              "id"
+            ]
+          }
+        ]
+      }
+    ],
+    "views": [],
+    "setupQueries": [
+      "CREATE TABLE IF NOT EXISTS room_master_table (id INTEGER PRIMARY KEY,identity_hash TEXT)",
+      "INSERT OR REPLACE INTO room_master_table (id,identity_hash) VALUES(42, 'dee7984bc7a1af3c4358443b0d6bbc95')"
+    ]
+  }
+}
\ No newline at end of file
diff --git a/engine/src/androidTest/java/com/google/android/fhir/db/impl/DatabaseImplTest.kt b/engine/src/androidTest/java/com/google/android/fhir/db/impl/DatabaseImplTest.kt
index 7ea0240a23..315791acf0 100644
--- a/engine/src/androidTest/java/com/google/android/fhir/db/impl/DatabaseImplTest.kt
+++ b/engine/src/androidTest/java/com/google/android/fhir/db/impl/DatabaseImplTest.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -25,6 +25,7 @@ import com.google.android.fhir.DateProvider
 import com.google.android.fhir.FhirServices
 import com.google.android.fhir.LocalChange
 import com.google.android.fhir.LocalChangeToken
+import com.google.android.fhir.SearchParamName
 import com.google.android.fhir.SearchResult
 import com.google.android.fhir.db.Database
 import com.google.android.fhir.db.ResourceNotFoundException
@@ -40,12 +41,14 @@ import com.google.android.fhir.search.has
 import com.google.android.fhir.search.include
 import com.google.android.fhir.search.revInclude
 import com.google.android.fhir.sync.upload.LocalChangesFetchMode
+import com.google.android.fhir.sync.upload.ResourceUploadResponseMapping
 import com.google.android.fhir.sync.upload.UploadSyncResult
 import com.google.android.fhir.testing.assertJsonArrayEqualsIgnoringOrder
 import com.google.android.fhir.testing.assertResourceEquals
 import com.google.android.fhir.testing.readFromFile
 import com.google.android.fhir.testing.readJsonArrayFromFile
 import com.google.android.fhir.versionId
+import com.google.common.truth.Correspondence
 import com.google.common.truth.Truth.assertThat
 import java.math.BigDecimal
 import java.time.Instant
@@ -80,6 +83,7 @@ import org.hl7.fhir.r4.model.RiskAssessment
 import org.hl7.fhir.r4.model.SearchParameter
 import org.hl7.fhir.r4.model.StringType
 import org.json.JSONArray
+import org.json.JSONObject
 import org.junit.After
 import org.junit.Assert.assertThrows
 import org.junit.Before
@@ -233,6 +237,23 @@ class DatabaseImplTest {
     assertThat(database.getLocalChanges(ResourceType.Encounter, patient.logicalId)).isEmpty()
   }
 
+  @Test
+  fun getAllChangesForEarliestChangedResource_withMultipleChanges_shouldReturnFirstChange() =
+    runBlocking {
+      val patient: Patient = readFromFile(Patient::class.java, "/date_test_patient.json")
+      database.insert(patient)
+      database.insert(TEST_PATIENT_2)
+      database.update(
+        TEST_PATIENT_1.copy().apply { gender = Enumerations.AdministrativeGender.FEMALE },
+      )
+      assertThat(
+          database.getAllChangesForEarliestChangedResource().all {
+            it.resourceId.equals(TEST_PATIENT_1.logicalId)
+          },
+        )
+        .isTrue()
+    }
+
   @Test
   fun clearDatabase_shouldClearAllTablesData() = runBlocking {
     val patient: Patient = readFromFile(Patient::class.java, "/date_test_patient.json")
@@ -535,12 +556,14 @@ class DatabaseImplTest {
           .first { it.resourceId == "remote-patient-3" }
           .let {
             UploadSyncResult.Success(
-              it.token,
               listOf(
-                Patient().apply {
-                  id = it.resourceId
-                  meta = remoteMeta
-                },
+                ResourceUploadResponseMapping(
+                  listOf(it),
+                  Patient().apply {
+                    id = it.resourceId
+                    meta = remoteMeta
+                  },
+                ),
               ),
             )
           }
@@ -748,7 +771,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    val ids = results.map { it.id }
+    val ids = results.map { it.resource.id }
     assertThat(ids)
       .containsExactly("RiskAssessment/$largerId", "RiskAssessment/$smallerId")
       .inOrder()
@@ -778,7 +801,7 @@ class DatabaseImplTest {
         Search(ResourceType.Patient).apply { filter(Patient.GIVEN, { value = "eve" }) }.getQuery(),
       )
 
-    assertThat(result.single().id).isEqualTo("Patient/${patient.id}")
+    assertThat(result.single().resource.id).isEqualTo("Patient/${patient.id}")
   }
 
   @Test
@@ -820,7 +843,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.single().id).isEqualTo("Patient/${patient.id}")
+    assertThat(result.single().resource.id).isEqualTo("Patient/${patient.id}")
   }
 
   @Test
@@ -873,7 +896,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.single().id).isEqualTo("Patient/${patient.id}")
+    assertThat(result.single().resource.id).isEqualTo("Patient/${patient.id}")
   }
 
   @Test
@@ -928,7 +951,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.single().id).isEqualTo("RiskAssessment/${riskAssessment.id}")
+    assertThat(result.single().resource.id).isEqualTo("RiskAssessment/${riskAssessment.id}")
   }
 
   @Test
@@ -985,7 +1008,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("RiskAssessment/${riskAssessment.id}")
+    assertThat(result.single().resource.id).isEqualTo("RiskAssessment/${riskAssessment.id}")
   }
 
   @Test
@@ -1043,7 +1066,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.single().id).isEqualTo("RiskAssessment/${riskAssessment.id}")
+    assertThat(result.single().resource.id).isEqualTo("RiskAssessment/${riskAssessment.id}")
   }
 
   @Test
@@ -1101,7 +1124,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.single().id).isEqualTo("RiskAssessment/${riskAssessment.id}")
+    assertThat(result.single().resource.id).isEqualTo("RiskAssessment/${riskAssessment.id}")
   }
 
   @Test
@@ -1159,7 +1182,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.single().id).isEqualTo("RiskAssessment/${riskAssessment.id}")
+    assertThat(result.single().resource.id).isEqualTo("RiskAssessment/${riskAssessment.id}")
   }
 
   @Test
@@ -1216,7 +1239,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("RiskAssessment/${riskAssessment.id}")
+    assertThat(result.single().resource.id).isEqualTo("RiskAssessment/${riskAssessment.id}")
   }
 
   @Test
@@ -1274,7 +1297,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.single().id).isEqualTo("RiskAssessment/${riskAssessment.id}")
+    assertThat(result.single().resource.id).isEqualTo("RiskAssessment/${riskAssessment.id}")
   }
 
   @Test
@@ -1332,7 +1355,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.single().id).isEqualTo("RiskAssessment/${riskAssessment.id}")
+    assertThat(result.single().resource.id).isEqualTo("RiskAssessment/${riskAssessment.id}")
   }
 
   @Test
@@ -1390,7 +1413,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.single().id).isEqualTo("RiskAssessment/${riskAssessment.id}")
+    assertThat(result.single().resource.id).isEqualTo("RiskAssessment/${riskAssessment.id}")
   }
 
   @Test
@@ -1445,7 +1468,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Patient/1")
+    assertThat(result.single().resource.id).isEqualTo("Patient/1")
   }
 
   @Test
@@ -1497,7 +1520,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Patient/1")
+    assertThat(result.single().resource.id).isEqualTo("Patient/1")
   }
 
   @Test
@@ -1548,7 +1571,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Patient/1")
+    assertThat(result.single().resource.id).isEqualTo("Patient/1")
   }
 
   @Test
@@ -1598,7 +1621,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Patient/1")
+    assertThat(result.single().resource.id).isEqualTo("Patient/1")
   }
 
   @Test
@@ -1648,7 +1671,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Patient/1")
+    assertThat(result.single().resource.id).isEqualTo("Patient/1")
   }
 
   @Test
@@ -1698,7 +1721,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Patient/1")
+    assertThat(result.single().resource.id).isEqualTo("Patient/1")
   }
 
   @Test
@@ -1748,7 +1771,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Patient/1")
+    assertThat(result.single().resource.id).isEqualTo("Patient/1")
   }
 
   @Test
@@ -1798,7 +1821,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Patient/1")
+    assertThat(result.single().resource.id).isEqualTo("Patient/1")
   }
 
   @Test
@@ -1848,7 +1871,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Patient/1")
+    assertThat(result.single().resource.id).isEqualTo("Patient/1")
   }
 
   @Test
@@ -1898,7 +1921,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Patient/1")
+    assertThat(result.single().resource.id).isEqualTo("Patient/1")
   }
 
   @Test
@@ -1955,7 +1978,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Observation/1")
+    assertThat(result.single().resource.id).isEqualTo("Observation/1")
   }
 
   @Test
@@ -2019,7 +2042,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Observation/1")
+    assertThat(result.single().resource.id).isEqualTo("Observation/1")
   }
 
   @Test
@@ -2083,7 +2106,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Observation/1")
+    assertThat(result.single().resource.id).isEqualTo("Observation/1")
   }
 
   @Test
@@ -2147,7 +2170,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Observation/1")
+    assertThat(result.single().resource.id).isEqualTo("Observation/1")
   }
 
   @Test
@@ -2211,7 +2234,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Observation/1")
+    assertThat(result.single().resource.id).isEqualTo("Observation/1")
   }
 
   @Test
@@ -2275,7 +2298,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Observation/1")
+    assertThat(result.single().resource.id).isEqualTo("Observation/1")
   }
 
   @Test
@@ -2339,7 +2362,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Observation/1")
+    assertThat(result.single().resource.id).isEqualTo("Observation/1")
   }
 
   @Test
@@ -2403,7 +2426,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.single().id).isEqualTo("Observation/1")
+    assertThat(result.single().resource.id).isEqualTo("Observation/1")
   }
 
   @Test
@@ -2420,7 +2443,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.filter { it.id == patient.id }).hasSize(1)
+    assertThat(result.filter { it.resource.id == patient.id }).hasSize(1)
   }
 
   @Test
@@ -2483,7 +2506,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.map { it.logicalId }).containsExactly("100").inOrder()
+    assertThat(result.map { it.resource.logicalId }).containsExactly("100").inOrder()
   }
 
   @Test
@@ -2529,7 +2552,7 @@ class DatabaseImplTest {
           }
           .getQuery(),
       )
-    assertThat(result.map { it.logicalId }).containsExactly("100").inOrder()
+    assertThat(result.map { it.resource.logicalId }).containsExactly("100").inOrder()
   }
 
   @Test
@@ -2555,7 +2578,7 @@ class DatabaseImplTest {
               .apply { sort(Patient.BIRTHDATE, Order.DESCENDING) }
               .getQuery(),
           )
-          .map { it.id },
+          .map { it.resource.id },
       )
       .containsExactly("Patient/younger-patient", "Patient/older-patient", "Patient/test_patient_1")
   }
@@ -2583,7 +2606,7 @@ class DatabaseImplTest {
               .apply { sort(Patient.BIRTHDATE, Order.ASCENDING) }
               .getQuery(),
           )
-          .map { it.id },
+          .map { it.resource.id },
       )
       .containsExactly("Patient/test_patient_1", "Patient/older-patient", "Patient/younger-patient")
   }
@@ -2672,7 +2695,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.map { it.vaccineCode.codingFirstRep.code })
+    assertThat(result.map { it.resource.vaccineCode.codingFirstRep.code })
       .containsExactly("XM1NL1", "XM5DF6")
       .inOrder()
   }
@@ -2747,7 +2770,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.map { it.vaccineCode.codingFirstRep.code })
+    assertThat(result.map { it.resource.vaccineCode.codingFirstRep.code })
       .containsExactly("XM1NL1", "XM5DF6")
       .inOrder()
   }
@@ -2839,7 +2862,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.map { it.nameFirstRep.nameAsSingleString })
+    assertThat(result.map { it.resource.nameFirstRep.nameAsSingleString })
       .containsExactly("John Doe", "Jane Doe", "John Roe", "Jane Roe")
       .inOrder()
   }
@@ -2903,7 +2926,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.map { it.nameFirstRep.nameAsSingleString }).contains("Darcy Smith")
+    assertThat(result.map { it.resource.nameFirstRep.nameAsSingleString }).contains("Darcy Smith")
   }
 
   @Test
@@ -2964,7 +2987,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.map { it.nameFirstRep.nameAsSingleString }).contains("Darcy Smith")
+    assertThat(result.map { it.resource.nameFirstRep.nameAsSingleString }).contains("Darcy Smith")
   }
 
   @Test
@@ -2989,7 +3012,7 @@ class DatabaseImplTest {
           .getQuery(),
       )
 
-    assertThat(result.map { it.logicalId })
+    assertThat(result.map { it.resource.logicalId })
       .containsAtLeast("patient-test-002", "patient-test-003", "patient-test-001")
       .inOrder()
   }
@@ -3079,20 +3102,21 @@ class DatabaseImplTest {
         .execute<Patient>(database)
 
     assertThat(result)
-      .isEqualTo(
-        listOf(
-          SearchResult(
-            patient01,
-            included = mapOf(Patient.GENERAL_PRACTITIONER.paramName to listOf(gp01)),
-            revIncluded = null,
-          ),
-          SearchResult(
-            patient02,
-            included = mapOf(Patient.GENERAL_PRACTITIONER.paramName to listOf(gp03)),
-            revIncluded = null,
-          ),
+      .comparingElementsUsing(SearchResultCorrespondence)
+      .displayingDiffsPairedBy { it.resource.logicalId }
+      .containsExactly(
+        SearchResult(
+          patient01,
+          included = mapOf(Patient.GENERAL_PRACTITIONER.paramName to listOf(gp01)),
+          revIncluded = null,
+        ),
+        SearchResult(
+          patient02,
+          included = mapOf(Patient.GENERAL_PRACTITIONER.paramName to listOf(gp03)),
+          revIncluded = null,
         ),
       )
+      .inOrder()
   }
 
   @Test
@@ -3169,22 +3193,23 @@ class DatabaseImplTest {
         .execute<Patient>(database)
 
     assertThat(result)
-      .isEqualTo(
-        listOf(
-          SearchResult(
-            patient01,
-            included = null,
-            revIncluded =
-              mapOf((ResourceType.Condition to Condition.SUBJECT.paramName) to listOf(con1)),
-          ),
-          SearchResult(
-            patient02,
-            included = null,
-            revIncluded =
-              mapOf((ResourceType.Condition to Condition.SUBJECT.paramName) to listOf(con3)),
-          ),
+      .comparingElementsUsing(SearchResultCorrespondence)
+      .displayingDiffsPairedBy { it.resource.logicalId }
+      .containsExactly(
+        SearchResult(
+          patient01,
+          included = null,
+          revIncluded =
+            mapOf((ResourceType.Condition to Condition.SUBJECT.paramName) to listOf(con1)),
+        ),
+        SearchResult(
+          patient02,
+          included = null,
+          revIncluded =
+            mapOf((ResourceType.Condition to Condition.SUBJECT.paramName) to listOf(con3)),
         ),
       )
+      .inOrder()
   }
 
   @Test
@@ -3488,50 +3513,576 @@ class DatabaseImplTest {
         .execute<Patient>(database)
 
     assertThat(result)
-      .isEqualTo(
-        listOf(
-          SearchResult(
-            resources["pa-01"]!!,
-            mapOf(
-              "general-practitioner" to listOf(resources["gp-01"]!!, resources["gp-02"]!!),
-              "organization" to listOf(resources["org-01"]!!),
-            ),
-            mapOf(
-              Pair(ResourceType.Condition, "subject") to
-                listOf(resources["con-01-pa-01"]!!, resources["con-03-pa-01"]!!),
-              Pair(ResourceType.Encounter, "subject") to
-                listOf(resources["en-01-pa-01"]!!, resources["en-02-pa-01"]!!),
-            ),
+      .comparingElementsUsing(SearchResultCorrespondence)
+      .displayingDiffsPairedBy { it.resource.logicalId }
+      .containsExactly(
+        SearchResult(
+          resources["pa-01"]!!,
+          mapOf(
+            "general-practitioner" to listOf(resources["gp-01"]!!, resources["gp-02"]!!),
+            "organization" to listOf(resources["org-01"]!!),
           ),
-          SearchResult(
-            resources["pa-02"]!!,
-            mapOf(
-              "general-practitioner" to listOf(resources["gp-01"]!!, resources["gp-02"]!!),
-              "organization" to listOf(resources["org-02"]!!),
-            ),
-            mapOf(
-              Pair(ResourceType.Condition, "subject") to
-                listOf(resources["con-01-pa-02"]!!, resources["con-03-pa-02"]!!),
-              Pair(ResourceType.Encounter, "subject") to
-                listOf(resources["en-01-pa-02"]!!, resources["en-02-pa-02"]!!),
-            ),
+          mapOf(
+            Pair(ResourceType.Condition, "subject") to
+              listOf(resources["con-01-pa-01"]!!, resources["con-03-pa-01"]!!),
+            Pair(ResourceType.Encounter, "subject") to
+              listOf(resources["en-01-pa-01"]!!, resources["en-02-pa-01"]!!),
+          ),
+        ),
+        SearchResult(
+          resources["pa-02"]!!,
+          mapOf(
+            "general-practitioner" to listOf(resources["gp-01"]!!, resources["gp-02"]!!),
+            "organization" to listOf(resources["org-02"]!!),
           ),
-          SearchResult(
-            resources["pa-03"]!!,
+          mapOf(
+            Pair(ResourceType.Condition, "subject") to
+              listOf(resources["con-01-pa-02"]!!, resources["con-03-pa-02"]!!),
+            Pair(ResourceType.Encounter, "subject") to
+              listOf(resources["en-01-pa-02"]!!, resources["en-02-pa-02"]!!),
+          ),
+        ),
+        SearchResult(
+          resources["pa-03"]!!,
+          mapOf(
+            "general-practitioner" to listOf(resources["gp-01"]!!, resources["gp-02"]!!),
+          ),
+          mapOf(
+            Pair(ResourceType.Condition, "subject") to
+              listOf(resources["con-01-pa-03"]!!, resources["con-03-pa-03"]!!),
+            Pair(ResourceType.Encounter, "subject") to
+              listOf(resources["en-01-pa-03"]!!, resources["en-02-pa-03"]!!),
+          ),
+        ),
+      )
+      .inOrder()
+  }
+
+  @Test
+  fun search_patient_and_include_practitioners_sorted_by_family_descending(): Unit = runBlocking {
+    val patient01 =
+      Patient().apply {
+        id = "pa-01"
+        addName(
+          HumanName().apply {
+            addGiven("James")
+            family = "Gorden"
+          },
+        )
+        addGeneralPractitioner(Reference("Practitioner/gp-01"))
+        addGeneralPractitioner(Reference("Practitioner/gp-02"))
+        addGeneralPractitioner(Reference("Practitioner/gp-04"))
+        managingOrganization = Reference("Organization/org-01")
+      }
+
+    val patient02 =
+      Patient().apply {
+        id = "pa-02"
+        addName(
+          HumanName().apply {
+            addGiven("James")
+            family = "Bond"
+          },
+        )
+        addGeneralPractitioner(Reference("Practitioner/gp-02"))
+        addGeneralPractitioner(Reference("Practitioner/gp-03"))
+        addGeneralPractitioner(Reference("Practitioner/gp-04"))
+        managingOrganization = Reference("Organization/org-03")
+      }
+    val patients = listOf(patient01, patient02)
+
+    val gp01 =
+      Practitioner().apply {
+        id = "gp-01"
+        addName(
+          HumanName().apply {
+            family = "Practitioner-01"
+            addGiven("General-01")
+          },
+        )
+        active = true
+      }
+    val gp02 =
+      Practitioner().apply {
+        id = "gp-02"
+        addName(
+          HumanName().apply {
+            family = "Practitioner-02"
+            addGiven("General-02")
+          },
+        )
+        active = true
+      }
+    val gp03 =
+      Practitioner().apply {
+        id = "gp-03"
+        addName(
+          HumanName().apply {
+            family = "Practitioner-03"
+            addGiven("General-03")
+          },
+        )
+        active = true
+      }
+
+    val gp04 =
+      Practitioner().apply {
+        id = "gp-04"
+        addName(
+          HumanName().apply {
+            family = "Practitioner-04"
+            addGiven("General-04")
+          },
+        )
+        active = false
+      }
+
+    val practitioners = listOf(gp01, gp02, gp03, gp04)
+
+    database.insertRemote(*(patients + practitioners).toTypedArray())
+
+    val result =
+      Search(ResourceType.Patient)
+        .apply {
+          filter(
+            Patient.GIVEN,
+            {
+              value = "James"
+              modifier = StringFilterModifier.MATCHES_EXACTLY
+            },
+          )
+
+          include<Practitioner>(Patient.GENERAL_PRACTITIONER) {
+            filter(Practitioner.ACTIVE, { value = of(true) })
+            sort(Practitioner.FAMILY, Order.DESCENDING)
+          }
+        }
+        .execute<Patient>(database)
+
+    assertThat(result)
+      .comparingElementsUsing(SearchResultCorrespondence)
+      .displayingDiffsPairedBy { it.resource.logicalId }
+      .containsExactly(
+        SearchResult(
+          patient01,
+          included = mapOf(Patient.GENERAL_PRACTITIONER.paramName to listOf(gp02, gp01)),
+          revIncluded = null,
+        ),
+        SearchResult(
+          patient02,
+          included = mapOf(Patient.GENERAL_PRACTITIONER.paramName to listOf(gp03, gp02)),
+          revIncluded = null,
+        ),
+      )
+      .inOrder()
+  }
+
+  @Test
+  fun search_patient_and_revInclude_encounters_sorted_by_date_descending(): Unit = runBlocking {
+    val patient01 =
+      Patient().apply {
+        id = "pa-01"
+        addName(
+          HumanName().apply {
+            addGiven("James")
+            family = "Gorden"
+          },
+        )
+        addGeneralPractitioner(Reference("Practitioner/gp-01"))
+      }
+
+    val patient02 =
+      Patient().apply {
+        id = "pa-02"
+        addName(
+          HumanName().apply {
+            addGiven("James")
+            family = "Bond"
+          },
+        )
+        addGeneralPractitioner(Reference("Practitioner/gp-02"))
+      }
+    val patients = listOf(patient01, patient02)
+
+    // encounters for patient 1
+    val enc1_1 =
+      Encounter().apply {
+        id = "enc1-01"
+        subject = Reference("Patient/pa-01")
+        status = Encounter.EncounterStatus.ARRIVED
+        period =
+          Period().apply {
+            start = DateType(2010, 1, 1).value
+            end = DateType(2010, 1, 2).value
+          }
+      }
+    val enc1_2 =
+      Encounter().apply {
+        id = "enc1-02"
+        subject = Reference("Patient/pa-01")
+        status = Encounter.EncounterStatus.CANCELLED
+        period =
+          Period().apply {
+            start = DateType(2010, 2, 1).value
+            end = DateType(2010, 2, 2).value
+          }
+      }
+
+    val enc1_3 =
+      Encounter().apply {
+        id = "enc1-03"
+        subject = Reference("Patient/pa-01")
+        status = Encounter.EncounterStatus.ARRIVED
+        period =
+          Period().apply {
+            start = DateType(2010, 3, 1).value
+            end = DateType(2010, 3, 2).value
+          }
+      }
+
+    val enc1_4 =
+      Encounter().apply {
+        id = "enc1-04"
+        subject = Reference("Patient/pa-01")
+        status = Encounter.EncounterStatus.ARRIVED
+        period =
+          Period().apply {
+            start = DateType(2010, 4, 1).value
+            end = DateType(2010, 4, 2).value
+          }
+      }
+
+    // encounters for patient 2
+    val enc2_1 =
+      Encounter().apply {
+        id = "enc2-01"
+        subject = Reference("Patient/pa-02")
+        status = Encounter.EncounterStatus.ARRIVED
+        period =
+          Period().apply {
+            start = DateType(2020, 1, 1).value
+            end = DateType(2020, 1, 2).value
+          }
+      }
+    val enc2_2 =
+      Encounter().apply {
+        id = "enc2-02"
+        subject = Reference("Patient/pa-02")
+        status = Encounter.EncounterStatus.CANCELLED
+        period =
+          Period().apply {
+            start = DateType(2020, 2, 1).value
+            end = DateType(2020, 2, 2).value
+          }
+      }
+
+    val enc2_3 =
+      Encounter().apply {
+        id = "enc2-03"
+        subject = Reference("Patient/pa-02")
+        status = Encounter.EncounterStatus.ARRIVED
+        period =
+          Period().apply {
+            start = DateType(2020, 3, 1).value
+            end = DateType(2020, 3, 2).value
+          }
+      }
+
+    val enc2_4 =
+      Encounter().apply {
+        id = "enc2-04"
+        subject = Reference("Patient/pa-02")
+        status = Encounter.EncounterStatus.ARRIVED
+        period =
+          Period().apply {
+            start = DateType(2020, 4, 1).value
+            end = DateType(2020, 4, 2).value
+          }
+      }
+
+    val encounters = listOf(enc1_1, enc1_2, enc1_3, enc1_4, enc2_1, enc2_2, enc2_3, enc2_4)
+    database.insertRemote(*(patients + encounters).toTypedArray())
+
+    val result =
+      Search(ResourceType.Patient)
+        .apply {
+          filter(
+            Patient.GIVEN,
+            {
+              value = "James"
+              modifier = StringFilterModifier.MATCHES_EXACTLY
+            },
+          )
+
+          revInclude<Encounter>(Encounter.SUBJECT) {
+            filter(
+              Encounter.STATUS,
+              {
+                value =
+                  of(
+                    Coding(
+                      "http://hl7.org/fhir/encounter-status",
+                      Encounter.EncounterStatus.ARRIVED.toCode(),
+                      "",
+                    ),
+                  )
+              },
+            )
+            sort(Encounter.DATE, Order.DESCENDING)
+          }
+        }
+        .execute<Patient>(database)
+
+    assertThat(result)
+      .comparingElementsUsing(SearchResultCorrespondence)
+      .displayingDiffsPairedBy { it.resource.logicalId }
+      .containsExactly(
+        SearchResult(
+          patient01,
+          included = null,
+          revIncluded =
             mapOf(
-              "general-practitioner" to listOf(resources["gp-01"]!!, resources["gp-02"]!!),
+              (ResourceType.Encounter to Encounter.SUBJECT.paramName) to
+                listOf(enc1_4, enc1_3, enc1_1),
             ),
+        ),
+        SearchResult(
+          patient02,
+          included = null,
+          revIncluded =
             mapOf(
-              Pair(ResourceType.Condition, "subject") to
-                listOf(resources["con-01-pa-03"]!!, resources["con-03-pa-03"]!!),
-              Pair(ResourceType.Encounter, "subject") to
-                listOf(resources["en-01-pa-03"]!!, resources["en-02-pa-03"]!!),
+              (ResourceType.Encounter to Encounter.SUBJECT.paramName) to
+                listOf(enc2_4, enc2_3, enc2_1),
             ),
-          ),
         ),
       )
   }
 
+  @Test
+  fun updateResourceAndReferences_shouldUpdateResourceEntityResourceId() = runBlocking {
+    // create a patient
+    val locallyCreatedPatientResourceId = "local-patient-1"
+    val locallyCreatedPatient =
+      Patient().apply {
+        id = locallyCreatedPatientResourceId
+        name = listOf(HumanName().setFamily("Family").setGiven(listOf(StringType("First Name"))))
+      }
+    database.insert(locallyCreatedPatient)
+    // Retrieving ResourceEntity so that we have the resourceUuid available for assertions
+    val patientResourceEntity =
+      database.selectEntity(locallyCreatedPatient.resourceType, locallyCreatedPatientResourceId)
+
+    // pretend that the resource has been created on the server with an updated ID
+    val remotelyCreatedPatientResourceId = "remote-patient-1"
+    val remotelyCreatedPatient =
+      locallyCreatedPatient.apply { id = remotelyCreatedPatientResourceId }
+
+    // perform updates
+    database.updateResourceAndReferences(
+      locallyCreatedPatientResourceId,
+      remotelyCreatedPatient,
+    )
+
+    // check if resource is fetch-able by its new server assigned ID
+    val updatedPatientResourceEntity =
+      database.selectEntity(remotelyCreatedPatient.resourceType, remotelyCreatedPatient.id)
+    assertThat(updatedPatientResourceEntity.resourceUuid)
+      .isEqualTo(patientResourceEntity.resourceUuid)
+  }
+
+  @Test
+  fun updateResourceAndReferences_shouldUpdateLocalChangeResourceId() = runBlocking {
+    // create a patient
+    val locallyCreatedPatientResourceId = "local-patient-1"
+    val locallyCreatedPatient =
+      Patient().apply {
+        id = locallyCreatedPatientResourceId
+        name = listOf(HumanName().setFamily("Family").setGiven(listOf(StringType("First Name"))))
+      }
+    database.insert(locallyCreatedPatient)
+    val patientResourceEntity =
+      database.selectEntity(locallyCreatedPatient.resourceType, locallyCreatedPatientResourceId)
+
+    // pretend that the resource has been created on the server with an updated ID
+    val remotelyCreatedPatientResourceId = "remote-patient-1"
+    val remotelyCreatedPatient =
+      locallyCreatedPatient.apply { id = remotelyCreatedPatientResourceId }
+
+    // perform updates
+    database.updateResourceAndReferences(
+      locallyCreatedPatientResourceId,
+      remotelyCreatedPatient,
+    )
+
+    // check if resource is fetch-able by its new server assigned ID
+    val patientLocalChanges = database.getLocalChanges(patientResourceEntity.resourceUuid)
+    assertThat(patientLocalChanges.all { it.resourceId == remotelyCreatedPatientResourceId })
+      .isTrue()
+  }
+
+  @Test
+  fun updateResourceAndReferences_shouldUpdateReferencesInReferringLocalChangesOfInsertType() =
+    runBlocking {
+      // create a patient
+      val locallyCreatedPatientResourceId = "local-patient-1"
+      val locallyCreatedPatient =
+        Patient().apply {
+          id = locallyCreatedPatientResourceId
+          name = listOf(HumanName().setFamily("Family").setGiven(listOf(StringType("First Name"))))
+        }
+      database.insert(locallyCreatedPatient)
+
+      // create an observation for the patient
+      val locallyCreatedObservationResourceId = "local-observation-1"
+      val locallyCreatedPatientObservation =
+        Observation().apply {
+          subject = Reference("Patient/$locallyCreatedPatientResourceId")
+          addPerformer(Reference("Practitioner/123"))
+          id = locallyCreatedObservationResourceId
+        }
+      database.insert(locallyCreatedPatientObservation)
+
+      // pretend that the resource has been created on the server with an updated ID
+      val remotelyCreatedPatientResourceId = "remote-patient-1"
+      val remotelyCreatedPatient =
+        locallyCreatedPatient.apply { id = remotelyCreatedPatientResourceId }
+
+      // perform updates
+      database.updateResourceAndReferences(
+        locallyCreatedPatientResourceId,
+        remotelyCreatedPatient,
+      )
+
+      // verify that Observation's LocalChanges are updated with new patient ID reference
+      val updatedObservationLocalChanges =
+        database.getLocalChanges(
+          locallyCreatedPatientObservation.resourceType,
+          locallyCreatedObservationResourceId,
+        )
+      assertThat(updatedObservationLocalChanges.size).isEqualTo(1)
+      val observationLocalChange = updatedObservationLocalChanges[0]
+      assertThat(observationLocalChange.type).isEqualTo(LocalChange.Type.INSERT)
+      val observationLocalChangePayload =
+        services.parser.parseResource(observationLocalChange.payload) as Observation
+      assertThat(observationLocalChangePayload.subject.reference)
+        .isEqualTo("Patient/$remotelyCreatedPatientResourceId")
+    }
+
+  @Test
+  fun updateResourceAndReferences_shouldUpdateReferencesInReferringLocalChangesOfUpdateType() =
+    runBlocking {
+      // create a patient
+      val locallyCreatedPatientResourceId = "local-patient-1"
+      val locallyCreatedPatient =
+        Patient().apply {
+          id = locallyCreatedPatientResourceId
+          name = listOf(HumanName().setFamily("Family").setGiven(listOf(StringType("First Name"))))
+        }
+      database.insert(locallyCreatedPatient)
+
+      // create an observation for the patient
+      val locallyCreatedObservationResourceId = "local-observation-1"
+      val locallyCreatedPatientObservation =
+        Observation().apply {
+          subject = Reference("Patient/$locallyCreatedPatientResourceId")
+          addPerformer(Reference("Practitioner/123"))
+          id = locallyCreatedObservationResourceId
+        }
+      database.insert(locallyCreatedPatientObservation)
+      database.update(
+        locallyCreatedPatientObservation.copy().apply {
+          performer = listOf(Reference("Patient/$locallyCreatedPatientResourceId"))
+        },
+      )
+
+      // pretend that the resource has been created on the server with an updated ID
+      val remotelyCreatedPatientResourceId = "remote-patient-1"
+      val remotelyCreatedPatient =
+        locallyCreatedPatient.apply { id = remotelyCreatedPatientResourceId }
+
+      // perform updates
+      database.updateResourceAndReferences(
+        locallyCreatedPatientResourceId,
+        remotelyCreatedPatient,
+      )
+
+      // verify that Observation's LocalChanges are updated with new patient ID reference
+      val updatedObservationLocalChanges =
+        database.getLocalChanges(
+          locallyCreatedPatientObservation.resourceType,
+          locallyCreatedObservationResourceId,
+        )
+      assertThat(updatedObservationLocalChanges.size).isEqualTo(2)
+      val observationLocalChange2 = updatedObservationLocalChanges[1]
+      assertThat(observationLocalChange2.type).isEqualTo(LocalChange.Type.UPDATE)
+      // payload =
+      // [{"op":"replace","path":"\/performer\/0\/reference","value":"Patient\/remote-patient-1"}]
+      val observationLocalChange2Payload = JSONArray(observationLocalChange2.payload)
+      val patch = observationLocalChange2Payload.get(0) as JSONObject
+      val referenceValue = patch.getString("value")
+      assertThat(referenceValue).isEqualTo("Patient/$remotelyCreatedPatientResourceId")
+    }
+
+  @Test
+  fun updateResourceAndReferences_shouldUpdateReferencesInReferringResource() = runBlocking {
+    // create a patient
+    val locallyCreatedPatientResourceId = "local-patient-1"
+    val locallyCreatedPatient =
+      Patient().apply {
+        id = locallyCreatedPatientResourceId
+        name = listOf(HumanName().setFamily("Family").setGiven(listOf(StringType("First Name"))))
+      }
+    database.insert(locallyCreatedPatient)
+
+    // create an observation for the patient
+    val locallyCreatedObservationResourceId = "local-observation-1"
+    val locallyCreatedPatientObservation =
+      Observation().apply {
+        subject = Reference("Patient/$locallyCreatedPatientResourceId")
+        addPerformer(Reference("Practitioner/123"))
+        id = locallyCreatedObservationResourceId
+      }
+    database.insert(locallyCreatedPatientObservation)
+
+    // pretend that the resource has been created on the server with an updated ID
+    val remotelyCreatedPatientResourceId = "remote-patient-1"
+    val remotelyCreatedPatient =
+      locallyCreatedPatient.apply { id = remotelyCreatedPatientResourceId }
+
+    // perform updates
+    database.updateResourceAndReferences(
+      locallyCreatedPatientResourceId,
+      remotelyCreatedPatient,
+    )
+
+    // verify that Observation is updated with new patient ID reference
+    val updatedObservationResource =
+      database.select(
+        locallyCreatedPatientObservation.resourceType,
+        locallyCreatedObservationResourceId,
+      ) as Observation
+    assertThat(updatedObservationResource.subject.reference)
+      .isEqualTo("Patient/$remotelyCreatedPatientResourceId")
+
+    // verify that Observation is searchable i.e. ReferenceIndex is updated with new patient ID
+    // reference
+    val searchedObservations =
+      database
+        .search<Observation>(
+          Search(ResourceType.Observation)
+            .apply {
+              filter(
+                Observation.SUBJECT,
+                { value = "Patient/$remotelyCreatedPatientResourceId" },
+              )
+            }
+            .getQuery(),
+        )
+        .map { it.resource }
+    assertThat(searchedObservations.size).isEqualTo(1)
+    assertThat(searchedObservations[0].logicalId).isEqualTo(locallyCreatedObservationResourceId)
+  }
+
   private companion object {
     const val mockEpochTimeStamp = 1628516301000
     const val TEST_PATIENT_1_ID = "test_patient_1"
@@ -3553,5 +4104,78 @@ class DatabaseImplTest {
     }
 
     @JvmStatic @Parameters(name = "encrypted={0}") fun data(): Array<Boolean> = arrayOf(true, false)
+
+    /**
+     * [Correspondence] to provide a custom [equalityCheck] for the [SearchResult]s. Also provides a
+     * custom diff formatting for failing cases.
+     */
+    val SearchResultCorrespondence: Correspondence<SearchResult<Resource>, SearchResult<Resource>> =
+      Correspondence.from<SearchResult<Resource>, SearchResult<Resource>>(
+          ::equalityCheck,
+          "is shallow equals (by logical id comparison) to the ",
+        )
+        .formattingDiffsUsing(::formatDiff)
+
+    private fun <R : Resource> equalityCheck(
+      actual: SearchResult<R>,
+      expected: SearchResult<R>,
+    ): Boolean {
+      return equalsShallow(actual.resource, expected.resource) &&
+        equalsShallow(actual.included, expected.included) &&
+        equalsShallow(actual.revIncluded, expected.revIncluded)
+    }
+
+    private fun equalsShallow(first: Resource, second: Resource) =
+      first.resourceType == second.resourceType && first.logicalId == second.logicalId
+
+    private fun equalsShallow(first: List<Resource>, second: List<Resource>) =
+      first.size == second.size &&
+        first.asSequence().zip(second.asSequence()).all { (x, y) -> equalsShallow(x, y) }
+
+    private fun equalsShallow(
+      first: Map<SearchParamName, List<Resource>>?,
+      second: Map<SearchParamName, List<Resource>>?,
+    ) =
+      if (first != null && second != null && first.size == second.size) {
+        first.entries.asSequence().zip(second.entries.asSequence()).all { (x, y) ->
+          x.key == y.key && equalsShallow(x.value, y.value)
+        }
+      } else {
+        first?.size == second?.size
+      }
+
+    @JvmName("equalsShallowRevInclude")
+    private fun equalsShallow(
+      first: Map<Pair<ResourceType, SearchParamName>, List<Resource>>?,
+      second: Map<Pair<ResourceType, SearchParamName>, List<Resource>>?,
+    ) =
+      if (first != null && second != null && first.size == second.size) {
+        first.entries.asSequence().zip(second.entries.asSequence()).all { (x, y) ->
+          x.key == y.key && equalsShallow(x.value, y.value)
+        }
+      } else {
+        first?.size == second?.size
+      }
+
+    /**
+     * Ideally, this functions should highlight the diff between the [actual] and [expected]. But,
+     * we are just highlighting the ids of resources contained in the [SearchResult].
+     */
+    private fun <R : Resource> formatDiff(
+      actual: SearchResult<R>,
+      expected: SearchResult<R>,
+    ): String {
+      return "Expected : ${expected.asString()} \n Actual ${actual.asString()}"
+    }
+
+    private fun <R : Resource> SearchResult<R>.asString(): String {
+      return "SearchResult[ resource: " +
+        resource.logicalId +
+        ", Included : " +
+        included?.map { it.key + ": " + it.value.joinToString { it.logicalId } } +
+        ", RevIncluded : " +
+        revIncluded?.map { it.key.toString() + ": " + it.value.joinToString { it.logicalId } } +
+        "]"
+    }
   }
 }
diff --git a/engine/src/androidTest/java/com/google/android/fhir/db/impl/EncryptedDatabaseErrorTest.kt b/engine/src/androidTest/java/com/google/android/fhir/db/impl/EncryptedDatabaseErrorTest.kt
index fdf5df0ce7..412da27b45 100644
--- a/engine/src/androidTest/java/com/google/android/fhir/db/impl/EncryptedDatabaseErrorTest.kt
+++ b/engine/src/androidTest/java/com/google/android/fhir/db/impl/EncryptedDatabaseErrorTest.kt
@@ -22,6 +22,8 @@ import androidx.test.core.app.ApplicationProvider
 import androidx.test.ext.junit.runners.AndroidJUnit4
 import androidx.test.filters.MediumTest
 import ca.uhn.fhir.context.FhirContext
+import ca.uhn.fhir.context.FhirVersionEnum
+import ca.uhn.fhir.util.FhirTerser
 import com.google.android.fhir.DatabaseErrorStrategy.RECREATE_AT_OPEN
 import com.google.android.fhir.DatabaseErrorStrategy.UNSPECIFIED
 import com.google.android.fhir.db.impl.DatabaseImpl.Companion.DATABASE_PASSPHRASE_NAME
@@ -48,6 +50,7 @@ import org.junit.runner.RunWith
 class EncryptedDatabaseErrorTest {
   private val context: Context = ApplicationProvider.getApplicationContext()
   private val parser = FhirContext.forR4().newJsonParser()
+  private val terser = FhirTerser(FhirContext.forCached(FhirVersionEnum.R4))
   private val resourceIndexer = ResourceIndexer(SearchParamDefinitionsProviderImpl())
 
   @After
@@ -64,6 +67,7 @@ class EncryptedDatabaseErrorTest {
         DatabaseImpl(
             context,
             parser,
+            terser,
             DatabaseConfig(
               inMemory = false,
               enableEncryption = false,
@@ -81,6 +85,7 @@ class EncryptedDatabaseErrorTest {
         DatabaseImpl(
             context,
             parser,
+            terser,
             DatabaseConfig(
               inMemory = false,
               enableEncryption = true,
@@ -111,6 +116,7 @@ class EncryptedDatabaseErrorTest {
         DatabaseImpl(
             context,
             parser,
+            terser,
             DatabaseConfig(
               inMemory = false,
               enableEncryption = true,
@@ -134,6 +140,7 @@ class EncryptedDatabaseErrorTest {
         DatabaseImpl(
             context,
             parser,
+            terser,
             DatabaseConfig(
               inMemory = false,
               enableEncryption = true,
@@ -163,6 +170,7 @@ class EncryptedDatabaseErrorTest {
       DatabaseImpl(
           context,
           parser,
+          terser,
           DatabaseConfig(
             inMemory = false,
             enableEncryption = true,
@@ -186,6 +194,7 @@ class EncryptedDatabaseErrorTest {
       DatabaseImpl(
           context,
           parser,
+          terser,
           DatabaseConfig(
             inMemory = false,
             enableEncryption = true,
@@ -218,6 +227,7 @@ class EncryptedDatabaseErrorTest {
         DatabaseImpl(
             context,
             parser,
+            terser,
             DatabaseConfig(
               inMemory = false,
               enableEncryption = true,
@@ -235,6 +245,7 @@ class EncryptedDatabaseErrorTest {
         DatabaseImpl(
             context,
             parser,
+            terser,
             DatabaseConfig(
               inMemory = false,
               enableEncryption = false,
diff --git a/engine/src/androidTest/java/com/google/android/fhir/db/impl/ResourceDatabaseMigrationTest.kt b/engine/src/androidTest/java/com/google/android/fhir/db/impl/ResourceDatabaseMigrationTest.kt
index 2eb7877e7b..56487f5ecb 100644
--- a/engine/src/androidTest/java/com/google/android/fhir/db/impl/ResourceDatabaseMigrationTest.kt
+++ b/engine/src/androidTest/java/com/google/android/fhir/db/impl/ResourceDatabaseMigrationTest.kt
@@ -29,6 +29,7 @@ import java.util.Date
 import kotlinx.coroutines.runBlocking
 import org.hl7.fhir.r4.model.HumanName
 import org.hl7.fhir.r4.model.Patient
+import org.hl7.fhir.r4.model.Reference
 import org.hl7.fhir.r4.model.Task
 import org.junit.Rule
 import org.junit.Test
@@ -293,6 +294,81 @@ class ResourceDatabaseMigrationTest {
     assertThat(localChangeResourceId).isEqualTo(retrievedTaskResourceId)
   }
 
+  @Test
+  fun migrate7To8_should_execute_with_no_exception(): Unit = runBlocking {
+    val patientId = "patient-001"
+    val patientResourceUuid = "e2c79e28-ed4d-4029-a12c-108d1eb5bedb"
+    val patient: String =
+      Patient()
+        .apply {
+          id = patientId
+          addName(HumanName().apply { addGiven("Brad") })
+          addGeneralPractitioner(Reference("Practitioner/123"))
+          managingOrganization = Reference("Organization/123")
+          meta.lastUpdated = Date()
+        }
+        .let { iParser.encodeResourceToString(it) }
+
+    helper.createDatabase(DB_NAME, 7).apply {
+      val insertionDate = Date()
+      execSQL(
+        "INSERT INTO LocalChangeEntity (resourceType, resourceUuid, resourceId, timestamp, type, payload) VALUES ('Patient', '$patientResourceUuid', '$patientId', '${insertionDate.toTimeZoneString()}', '${DbTypeConverters.localChangeTypeToInt(LocalChangeEntity.Type.INSERT)}', '$patient'  );",
+      )
+      val updateDate = Date()
+      val patch =
+        "[{\"op\":\"replace\",\"path\":\"\\/generalPractitioner\\/0\\/reference\",\"value\":\"Practitioner\\/345\"}]"
+      execSQL(
+        "INSERT INTO LocalChangeEntity (resourceType, resourceUuid, resourceId, timestamp, type, payload) VALUES ('Patient', '$patientResourceUuid', '$patientId', '${updateDate.toTimeZoneString()}', '${DbTypeConverters.localChangeTypeToInt(LocalChangeEntity.Type.UPDATE)}', '$patch'  );",
+      )
+      val deleteDate = Date()
+      execSQL(
+        "INSERT INTO LocalChangeEntity (resourceType, resourceUuid, resourceId, timestamp, type, payload) VALUES ('Patient', '$patientResourceUuid', '$patientId', '${deleteDate.toTimeZoneString()}', '${DbTypeConverters.localChangeTypeToInt(LocalChangeEntity.Type.DELETE)}', ''  );",
+      )
+      close()
+    }
+
+    val migratedDatabase = helper.runMigrationsAndValidate(DB_NAME, 8, true, MIGRATION_7_8)
+
+    var localChange1Id: Long
+    var localChange2Id: Long
+
+    var localChangeReferences: MutableMap<Long, MutableList<String>>
+
+    migratedDatabase.let { database ->
+      database.query("SELECT id FROM LocalChangeEntity").let {
+        it.moveToFirst()
+        localChange1Id = it.getLong(0)
+        it.moveToNext()
+        localChange2Id = it.getLong(0)
+      }
+
+      database
+        .query(
+          "SELECT localChangeId, resourceReferenceValue FROM LocalChangeResourceReferenceEntity",
+        )
+        .let {
+          var continueToNextRow = it.moveToFirst()
+          localChangeReferences = mutableMapOf()
+          while (continueToNextRow) {
+            val localChangeId = it.getLong(0)
+            val referenceValue = it.getString(1)
+            val existingList = localChangeReferences.getOrDefault(localChangeId, mutableListOf())
+            existingList.add(referenceValue)
+            localChangeReferences[localChangeId] = existingList
+            continueToNextRow = it.moveToNext()
+          }
+        }
+    }
+    migratedDatabase.close()
+    assertThat(localChangeReferences).containsKey(localChange1Id)
+    assertThat(localChangeReferences).containsKey(localChange2Id)
+    assertThat(localChangeReferences[localChange1Id]!!.size).isEqualTo(2)
+    assertThat(localChangeReferences[localChange2Id]!!.size).isEqualTo(1)
+    assertThat(localChangeReferences[localChange1Id]!!)
+      .containsExactly("Practitioner/123", "Organization/123")
+    assertThat(localChangeReferences[localChange2Id]!!).containsExactly("Practitioner/345")
+  }
+
   companion object {
     const val DB_NAME = "migration_tests.db"
   }
diff --git a/engine/src/androidTest/java/com/google/android/fhir/db/impl/dao/LocalChangeDaoTest.kt b/engine/src/androidTest/java/com/google/android/fhir/db/impl/dao/LocalChangeDaoTest.kt
new file mode 100644
index 0000000000..650f8acae6
--- /dev/null
+++ b/engine/src/androidTest/java/com/google/android/fhir/db/impl/dao/LocalChangeDaoTest.kt
@@ -0,0 +1,359 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.db.impl.dao
+
+import androidx.room.Room
+import androidx.test.core.app.ApplicationProvider
+import androidx.test.ext.junit.runners.AndroidJUnit4
+import androidx.test.filters.SmallTest
+import ca.uhn.fhir.context.FhirContext
+import ca.uhn.fhir.context.FhirVersionEnum
+import ca.uhn.fhir.util.FhirTerser
+import com.google.android.fhir.db.impl.ResourceDatabase
+import com.google.android.fhir.db.impl.entities.LocalChangeEntity
+import com.google.android.fhir.db.impl.entities.ResourceEntity
+import com.google.android.fhir.logicalId
+import com.google.common.truth.Truth.assertThat
+import java.time.Instant
+import java.util.UUID
+import kotlinx.coroutines.runBlocking
+import org.hl7.fhir.r4.model.CarePlan
+import org.hl7.fhir.r4.model.CodeableConcept
+import org.hl7.fhir.r4.model.Coding
+import org.hl7.fhir.r4.model.Enumerations
+import org.hl7.fhir.r4.model.Patient
+import org.hl7.fhir.r4.model.Reference
+import org.junit.After
+import org.junit.Before
+import org.junit.Test
+import org.junit.runner.RunWith
+
+@SmallTest
+@RunWith(AndroidJUnit4::class)
+class LocalChangeDaoTest {
+  private lateinit var database: ResourceDatabase
+  private lateinit var localChangeDao: LocalChangeDao
+
+  @Before
+  fun setupDatabase() {
+    database =
+      Room.inMemoryDatabaseBuilder(
+          ApplicationProvider.getApplicationContext(),
+          ResourceDatabase::class.java,
+        )
+        .allowMainThreadQueries()
+        .build()
+
+    localChangeDao =
+      database.localChangeDao().also {
+        it.iParser = FhirContext.forCached(FhirVersionEnum.R4).newJsonParser()
+        it.fhirTerser = FhirTerser(FhirContext.forCached(FhirVersionEnum.R4))
+      }
+  }
+
+  @After
+  fun closeDatabase() {
+    database.close()
+  }
+
+  @Test
+  fun addInsert_shouldAddLocalChangeAndLocalChangeReferences() = runBlocking {
+    val patientId = "Patient1"
+    val carePlanResourceUuid = UUID.randomUUID()
+    val carePlan =
+      CarePlan().apply {
+        id = "CarePlan1"
+        subject = Reference("Patient/$patientId")
+        activityFirstRep.detail.performer.add(Reference("Patient/$patientId"))
+        category =
+          listOf(
+            CodeableConcept(
+              Coding("http://snomed.info/sct", "698360004", "Diabetes self management plan"),
+            ),
+          )
+      }
+    val carePlanCreationTime = Instant.now()
+    localChangeDao.addInsert(carePlan, carePlanResourceUuid, carePlanCreationTime)
+
+    val carePlanLocalChanges = localChangeDao.getLocalChanges(carePlanResourceUuid)
+    assertThat(carePlanLocalChanges.size).isEqualTo(1)
+    val carePlanLocalChange1 = carePlanLocalChanges[0]
+    assertThat(carePlanLocalChange1.resourceUuid).isEqualTo(carePlanResourceUuid)
+    assertThat(carePlanLocalChange1.resourceId).isEqualTo(carePlan.id)
+    assertThat(carePlanLocalChange1.type).isEqualTo(LocalChangeEntity.Type.INSERT)
+    assertThat(carePlanLocalChange1.payload)
+      .isEqualTo(localChangeDao.iParser.encodeResourceToString(carePlan))
+    val carePlanLocalChange1Id = carePlanLocalChange1.id
+
+    val localChangeResourceReferences =
+      localChangeDao.getReferencesForLocalChange(carePlanLocalChange1Id)
+    assertThat(localChangeResourceReferences.size).isEqualTo(2)
+    assertThat(localChangeResourceReferences[0].resourceReferencePath).isEqualTo("subject")
+    assertThat(localChangeResourceReferences[0].resourceReferenceValue)
+      .isEqualTo("Patient/$patientId")
+    assertThat(localChangeResourceReferences[1].resourceReferencePath)
+      .isEqualTo("activity.detail.performer")
+    assertThat(localChangeResourceReferences[1].resourceReferenceValue)
+      .isEqualTo("Patient/$patientId")
+  }
+
+  @Test
+  fun addUpdate_shouldAddLocalChangeAndLocalChangeReferences() = runBlocking {
+    val patientId = "Patient1"
+    val carePlanResourceUuid = UUID.randomUUID()
+    val originalCarePlan =
+      CarePlan().apply {
+        id = "CarePlan1"
+        subject = Reference("Patient/$patientId")
+        activityFirstRep.detail.performer.add(Reference("Patient/$patientId"))
+        category =
+          listOf(
+            CodeableConcept(
+              Coding("http://snomed.info/sct", "698360004", "Diabetes self management plan"),
+            ),
+          )
+      }
+    val carePlanCreationTime = Instant.now()
+    localChangeDao.addInsert(originalCarePlan, carePlanResourceUuid, carePlanCreationTime)
+
+    val practitionerReference = "Practitioner/Practitioner123"
+    val modifiedCarePlan =
+      originalCarePlan.copy().apply {
+        author = Reference(practitionerReference)
+        activityFirstRep.detail.performer.clear()
+        activityFirstRep.detail.performer.add(Reference(practitionerReference))
+      }
+    val carePlanUpdateTime = Instant.now()
+    localChangeDao.addUpdate(
+      oldEntity =
+        ResourceEntity(
+          id = 0,
+          lastUpdatedLocal = carePlanCreationTime,
+          lastUpdatedRemote = null,
+          versionId = null,
+          resourceId = originalCarePlan.logicalId,
+          resourceType = originalCarePlan.resourceType,
+          resourceUuid = carePlanResourceUuid,
+          serializedResource = localChangeDao.iParser.encodeResourceToString(originalCarePlan),
+        ),
+      updatedResource = modifiedCarePlan,
+      timeOfLocalChange = carePlanUpdateTime,
+    )
+
+    val carePlanLocalChanges = localChangeDao.getLocalChanges(carePlanResourceUuid)
+    assertThat(carePlanLocalChanges.size).isEqualTo(2)
+    val carePlanLocalChange1 = carePlanLocalChanges[0]
+    assertThat(carePlanLocalChange1.resourceUuid).isEqualTo(carePlanResourceUuid)
+    assertThat(carePlanLocalChange1.resourceId).isEqualTo(originalCarePlan.id)
+    assertThat(carePlanLocalChange1.type).isEqualTo(LocalChangeEntity.Type.INSERT)
+    assertThat(carePlanLocalChange1.payload)
+      .isEqualTo(localChangeDao.iParser.encodeResourceToString(originalCarePlan))
+
+    val carePlanLocalChange2 = carePlanLocalChanges[1]
+    assertThat(carePlanLocalChange2.resourceUuid).isEqualTo(carePlanResourceUuid)
+    assertThat(carePlanLocalChange2.resourceId).isEqualTo(originalCarePlan.id)
+    assertThat(carePlanLocalChange2.type).isEqualTo(LocalChangeEntity.Type.UPDATE)
+    assertThat(carePlanLocalChange2.payload)
+      .isEqualTo(
+        "[{\"op\":\"add\",\"path\":\"\\/author\",\"value\":{\"reference\":\"Practitioner\\/Practitioner123\"}}" +
+          ",{\"op\":\"replace\",\"path\":\"\\/activity\\/0\\/detail\\/performer\\/0\\/reference\",\"value\":\"Practitioner\\/Practitioner123\"}]",
+      )
+    val carePlanLocalChange2Id = carePlanLocalChange2.id
+
+    val localChangeResourceReferences =
+      localChangeDao.getReferencesForLocalChange(carePlanLocalChange2Id)
+    assertThat(localChangeResourceReferences.size).isEqualTo(3)
+    assertThat(localChangeResourceReferences[0].resourceReferencePath)
+      .isEqualTo("activity.detail.performer")
+    assertThat(localChangeResourceReferences[0].resourceReferenceValue)
+      .isEqualTo("Patient/$patientId")
+    assertThat(localChangeResourceReferences[1].resourceReferencePath).isEqualTo("author")
+    assertThat(localChangeResourceReferences[1].resourceReferenceValue)
+      .isEqualTo(practitionerReference)
+    assertThat(localChangeResourceReferences[2].resourceReferencePath)
+      .isEqualTo("activity.detail.performer")
+    assertThat(localChangeResourceReferences[2].resourceReferenceValue)
+      .isEqualTo(practitionerReference)
+  }
+
+  @Test
+  fun addDelete_shouldAddOnlyLocalChangeEntity() = runBlocking {
+    val patientId = "Patient1"
+    val carePlanResourceUuid = UUID.randomUUID()
+    val carePlan =
+      CarePlan().apply {
+        id = "CarePlan1"
+        subject = Reference("Patient/$patientId")
+        activityFirstRep.detail.performer.add(Reference("Patient/$patientId"))
+        category =
+          listOf(
+            CodeableConcept(
+              Coding("http://snomed.info/sct", "698360004", "Diabetes self management plan"),
+            ),
+          )
+      }
+    val carePlanCreationTime = Instant.now()
+    localChangeDao.addInsert(carePlan, carePlanResourceUuid, carePlanCreationTime)
+
+    localChangeDao.addDelete(
+      resourceUuid = carePlanResourceUuid,
+      resourceType = carePlan.resourceType,
+      remoteVersionId = null,
+      resourceId = carePlan.id,
+    )
+
+    val carePlanLocalChanges = localChangeDao.getLocalChanges(carePlanResourceUuid)
+    assertThat(carePlanLocalChanges.size).isEqualTo(2)
+    val carePlanLocalChange1 = carePlanLocalChanges[0]
+    assertThat(carePlanLocalChange1.resourceUuid).isEqualTo(carePlanResourceUuid)
+    assertThat(carePlanLocalChange1.resourceId).isEqualTo(carePlan.id)
+    assertThat(carePlanLocalChange1.type).isEqualTo(LocalChangeEntity.Type.INSERT)
+    assertThat(carePlanLocalChange1.payload)
+      .isEqualTo(localChangeDao.iParser.encodeResourceToString(carePlan))
+
+    val carePlanLocalChange2 = carePlanLocalChanges[1]
+    assertThat(carePlanLocalChange2.resourceUuid).isEqualTo(carePlanResourceUuid)
+    assertThat(carePlanLocalChange2.resourceId).isEqualTo(carePlan.id)
+    assertThat(carePlanLocalChange2.type).isEqualTo(LocalChangeEntity.Type.DELETE)
+    assertThat(carePlanLocalChange2.payload).isEqualTo("")
+    val carePlanLocalChange2Id = carePlanLocalChange2.id
+
+    val localChangeResourceReferences =
+      localChangeDao.getReferencesForLocalChange(carePlanLocalChange2Id)
+    assertThat(localChangeResourceReferences.size).isEqualTo(0)
+  }
+
+  @Test
+  fun updateResourceId_shouldUpdateLocalChangeAndLocalChangeReferences() = runBlocking {
+    val patientId = "Patient1"
+    val patientResourceUuid = UUID.randomUUID()
+    val patient =
+      Patient().apply {
+        gender = Enumerations.AdministrativeGender.MALE
+        id = patientId
+      }
+    val patientCreationTime = Instant.now()
+    localChangeDao.addInsert(patient, patientResourceUuid, patientCreationTime)
+
+    val carePlanResourceUuid = UUID.randomUUID()
+    val originalCarePlan =
+      CarePlan().apply {
+        id = "CarePlan1"
+        subject = Reference("Patient/$patientId")
+        activityFirstRep.detail.performer.add(Reference("Patient/$patientId"))
+        category =
+          listOf(
+            CodeableConcept(
+              Coding("http://snomed.info/sct", "698360004", "Diabetes self management plan"),
+            ),
+          )
+      }
+    val carePlanCreationTime = Instant.now()
+    localChangeDao.addInsert(originalCarePlan, carePlanResourceUuid, carePlanCreationTime)
+
+    val practitionerReference = "Practitioner/Practitioner123"
+    val modifiedCarePlan =
+      originalCarePlan.copy().apply {
+        author = Reference(practitionerReference)
+        activityFirstRep.detail.performer.clear()
+        activityFirstRep.detail.performer.add(Reference(practitionerReference))
+      }
+    val carePlanUpdateTime = Instant.now()
+    localChangeDao.addUpdate(
+      oldEntity =
+        ResourceEntity(
+          id = 0,
+          lastUpdatedLocal = carePlanCreationTime,
+          lastUpdatedRemote = null,
+          versionId = null,
+          resourceId = originalCarePlan.logicalId,
+          resourceType = originalCarePlan.resourceType,
+          resourceUuid = carePlanResourceUuid,
+          serializedResource = localChangeDao.iParser.encodeResourceToString(originalCarePlan),
+        ),
+      updatedResource = modifiedCarePlan,
+      timeOfLocalChange = carePlanUpdateTime,
+    )
+
+    val updatedPatientId = "SyncedPatient1"
+    val updatedPatient = patient.copy().apply { id = updatedPatientId }
+    localChangeDao.updateResourceIdAndReferences(
+      resourceUuid = patientResourceUuid,
+      oldResource = patient,
+      updatedResource = updatedPatient,
+    )
+
+    // assert that Patient's new ID is reflected in the Patient Resource Change
+    val patientLocalChanges = localChangeDao.getLocalChanges(patientResourceUuid)
+    assertThat(patientLocalChanges.size).isEqualTo(1)
+    assertThat(patientLocalChanges[0].resourceId).isEqualTo(updatedPatientId)
+
+    // assert that LocalChanges are still retrieved in the same sequence
+    val carePlanLocalChanges = localChangeDao.getLocalChanges(carePlanResourceUuid)
+    assertThat(carePlanLocalChanges.size).isEqualTo(2)
+    val carePlanLocalChange1 = carePlanLocalChanges[0]
+    assertThat(carePlanLocalChange1.resourceUuid).isEqualTo(carePlanResourceUuid)
+    assertThat(carePlanLocalChange1.resourceId).isEqualTo(originalCarePlan.id)
+    assertThat(carePlanLocalChange1.type).isEqualTo(LocalChangeEntity.Type.INSERT)
+    val updatedReferencesCarePlan =
+      originalCarePlan.copy().apply {
+        subject = Reference("Patient/$updatedPatientId")
+        activityFirstRep.detail.performer.clear()
+        activityFirstRep.detail.performer.add(Reference("Patient/$updatedPatientId"))
+      }
+    assertThat(carePlanLocalChange1.payload)
+      .isEqualTo(localChangeDao.iParser.encodeResourceToString(updatedReferencesCarePlan))
+    val carePlanLocalChange1Id = carePlanLocalChange1.id
+    // assert that LocalChangeReferences are updated as well
+    val localChange1ResourceReferences =
+      localChangeDao.getReferencesForLocalChange(carePlanLocalChange1Id)
+    assertThat(localChange1ResourceReferences.size).isEqualTo(2)
+    assertThat(localChange1ResourceReferences[0].resourceReferencePath).isEqualTo("subject")
+    assertThat(localChange1ResourceReferences[0].resourceReferenceValue)
+      .isEqualTo("Patient/$updatedPatientId")
+    assertThat(localChange1ResourceReferences[1].resourceReferencePath)
+      .isEqualTo("activity.detail.performer")
+    assertThat(localChange1ResourceReferences[1].resourceReferenceValue)
+      .isEqualTo("Patient/$updatedPatientId")
+
+    val carePlanLocalChange2 = carePlanLocalChanges[1]
+    assertThat(carePlanLocalChange2.resourceUuid).isEqualTo(carePlanResourceUuid)
+    assertThat(carePlanLocalChange2.resourceId).isEqualTo(originalCarePlan.id)
+    assertThat(carePlanLocalChange2.type).isEqualTo(LocalChangeEntity.Type.UPDATE)
+    assertThat(carePlanLocalChange2.payload)
+      .isEqualTo(
+        "[{\"op\":\"add\",\"path\":\"\\/author\",\"value\":{\"reference\":\"Practitioner\\/Practitioner123\"}}" +
+          ",{\"op\":\"replace\",\"path\":\"\\/activity\\/0\\/detail\\/performer\\/0\\/reference\",\"value\":\"Practitioner\\/Practitioner123\"}]",
+      )
+    val carePlanLocalChange2Id = carePlanLocalChange2.id
+    // assert that LocalChangeReferences are updated as well
+    val localChangeResourceReferences =
+      localChangeDao.getReferencesForLocalChange(carePlanLocalChange2Id)
+    assertThat(localChangeResourceReferences.size).isEqualTo(3)
+    assertThat(localChangeResourceReferences[0].resourceReferencePath)
+      .isEqualTo("activity.detail.performer")
+    assertThat(localChangeResourceReferences[0].resourceReferenceValue)
+      .isEqualTo("Patient/$updatedPatientId")
+    assertThat(localChangeResourceReferences[1].resourceReferencePath).isEqualTo("author")
+    assertThat(localChangeResourceReferences[1].resourceReferenceValue)
+      .isEqualTo(practitionerReference)
+    assertThat(localChangeResourceReferences[2].resourceReferencePath)
+      .isEqualTo("activity.detail.performer")
+    assertThat(localChangeResourceReferences[2].resourceReferenceValue)
+      .isEqualTo(practitionerReference)
+  }
+}
diff --git a/engine/src/androidTest/java/com/google/android/fhir/sync/SyncInstrumentedTest.kt b/engine/src/androidTest/java/com/google/android/fhir/sync/SyncInstrumentedTest.kt
index bb4f48b8c8..2aaa61c386 100644
--- a/engine/src/androidTest/java/com/google/android/fhir/sync/SyncInstrumentedTest.kt
+++ b/engine/src/androidTest/java/com/google/android/fhir/sync/SyncInstrumentedTest.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -25,8 +25,10 @@ import androidx.work.WorkManager
 import androidx.work.WorkerParameters
 import androidx.work.testing.WorkManagerTestInitHelper
 import com.google.android.fhir.FhirEngine
+import com.google.android.fhir.sync.upload.UploadStrategy
 import com.google.android.fhir.testing.TestDataSourceImpl
 import com.google.android.fhir.testing.TestDownloadManagerImpl
+import com.google.android.fhir.testing.TestFailingDatasource
 import com.google.android.fhir.testing.TestFhirEngineImpl
 import com.google.common.truth.Truth.assertThat
 import java.util.concurrent.TimeUnit
@@ -35,18 +37,21 @@ import kotlinx.coroutines.flow.SharingStarted
 import kotlinx.coroutines.flow.shareIn
 import kotlinx.coroutines.flow.transformWhile
 import kotlinx.coroutines.runBlocking
-import org.junit.Ignore
 import org.junit.Test
 import org.junit.runner.RunWith
 
+/**
+ * Note : If you are running these tests on a local machine in Android Studio, make sure to clear
+ * the storage and cache of the `com.google.android.fhir.test` app on the emulator/device before
+ * running each test individually.
+ */
 @OptIn(ExperimentalCoroutinesApi::class)
 @RunWith(AndroidJUnit4::class)
-@Ignore("Flaky/fails due to https://github.com/google/android-fhir/issues/2046")
 class SyncInstrumentedTest {
 
   private val context: Context = InstrumentationRegistry.getInstrumentation().targetContext
 
-  class TestSyncWorker(appContext: Context, workerParams: WorkerParameters) :
+  open class TestSyncWorker(appContext: Context, workerParams: WorkerParameters) :
     FhirSyncWorker(appContext, workerParams) {
 
     override fun getFhirEngine(): FhirEngine = TestFhirEngineImpl
@@ -56,6 +61,13 @@ class SyncInstrumentedTest {
     override fun getDownloadWorkManager(): DownloadWorkManager = TestDownloadManagerImpl()
 
     override fun getConflictResolver() = AcceptRemoteConflictResolver
+
+    override fun getUploadStrategy(): UploadStrategy = UploadStrategy.AllChangesSquashedBundlePut
+  }
+
+  class TestSyncWorkerForDownloadFailing(appContext: Context, workerParams: WorkerParameters) :
+    TestSyncWorker(appContext, workerParams) {
+    override fun getDataSource(): DataSource = TestFailingDatasource
   }
 
   @Test
@@ -65,8 +77,8 @@ class SyncInstrumentedTest {
     runBlocking {
       Sync.oneTimeSync<TestSyncWorker>(context = context)
         .transformWhile {
-          emit(it is SyncJobStatus.Finished)
-          it !is SyncJobStatus.Finished
+          emit(it is CurrentSyncJobStatus.Succeeded)
+          it !is CurrentSyncJobStatus.Succeeded
         }
         .shareIn(this, SharingStarted.Eagerly, 5)
     }
@@ -75,6 +87,101 @@ class SyncInstrumentedTest {
       .isEqualTo(WorkInfo.State.SUCCEEDED)
   }
 
+  @Test
+  fun oneTime_worker_syncState() {
+    WorkManagerTestInitHelper.initializeTestWorkManager(context)
+    val states = mutableListOf<CurrentSyncJobStatus>()
+    runBlocking {
+      Sync.oneTimeSync<TestSyncWorker>(context = context)
+        .transformWhile {
+          states.add(it)
+          emit(it is CurrentSyncJobStatus.Succeeded)
+          it !is CurrentSyncJobStatus.Succeeded
+        }
+        .shareIn(this, SharingStarted.Eagerly, 5)
+    }
+    assertThat(states.first()).isInstanceOf(CurrentSyncJobStatus.Running::class.java)
+    assertThat(states.last()).isInstanceOf(CurrentSyncJobStatus.Succeeded::class.java)
+  }
+
+  @Test
+  fun oneTime_worker_failedSyncState() {
+    WorkManagerTestInitHelper.initializeTestWorkManager(context)
+    val states = mutableListOf<CurrentSyncJobStatus>()
+    runBlocking {
+      Sync.oneTimeSync<TestSyncWorkerForDownloadFailing>(context = context)
+        .transformWhile {
+          states.add(it)
+          emit(it is CurrentSyncJobStatus.Failed)
+          it !is CurrentSyncJobStatus.Failed
+        }
+        .shareIn(this, SharingStarted.Eagerly, 5)
+    }
+    assertThat(states.first()).isInstanceOf(CurrentSyncJobStatus.Running::class.java)
+    assertThat(states.last()).isInstanceOf(CurrentSyncJobStatus.Failed::class.java)
+  }
+
+  @Test
+  fun periodic_worker_periodicSyncState() {
+    WorkManagerTestInitHelper.initializeTestWorkManager(context)
+    val states = mutableListOf<PeriodicSyncJobStatus>()
+    // run and wait for periodic worker to finish
+    runBlocking {
+      Sync.periodicSync<TestSyncWorker>(
+          context = context,
+          periodicSyncConfiguration =
+            PeriodicSyncConfiguration(
+              syncConstraints = Constraints.Builder().build(),
+              repeat = RepeatInterval(interval = 15, timeUnit = TimeUnit.MINUTES),
+            ),
+        )
+        .transformWhile {
+          states.add(it)
+          emit(it)
+          it.currentSyncJobStatus !is CurrentSyncJobStatus.Succeeded
+        }
+        .shareIn(this, SharingStarted.Eagerly, 5)
+    }
+
+    assertThat(states.first().currentSyncJobStatus)
+      .isInstanceOf(CurrentSyncJobStatus.Running::class.java)
+    assertThat(states.first().lastSyncJobStatus).isNull()
+    assertThat(states.last().currentSyncJobStatus)
+      .isInstanceOf(CurrentSyncJobStatus.Succeeded::class.java)
+    assertThat(states.last().lastSyncJobStatus)
+      .isInstanceOf(LastSyncJobStatus.Succeeded::class.java)
+  }
+
+  @Test
+  fun periodic_worker_failedPeriodicSyncState() {
+    WorkManagerTestInitHelper.initializeTestWorkManager(context)
+    val states = mutableListOf<PeriodicSyncJobStatus>()
+    // run and wait for periodic worker to finish
+    runBlocking {
+      Sync.periodicSync<TestSyncWorkerForDownloadFailing>(
+          context = context,
+          periodicSyncConfiguration =
+            PeriodicSyncConfiguration(
+              syncConstraints = Constraints.Builder().build(),
+              repeat = RepeatInterval(interval = 15, timeUnit = TimeUnit.MINUTES),
+            ),
+        )
+        .transformWhile {
+          states.add(it)
+          emit(it)
+          it.currentSyncJobStatus !is CurrentSyncJobStatus.Failed
+        }
+        .shareIn(this, SharingStarted.Eagerly, 5)
+    }
+
+    assertThat(states.first().currentSyncJobStatus)
+      .isInstanceOf(CurrentSyncJobStatus.Running::class.java)
+    assertThat(states.first().lastSyncJobStatus).isNull()
+    assertThat(states.last().currentSyncJobStatus)
+      .isInstanceOf(CurrentSyncJobStatus.Failed::class.java)
+    assertThat(states.last().lastSyncJobStatus).isInstanceOf(LastSyncJobStatus.Failed::class.java)
+  }
+
   @Test
   fun periodic_worker_still_queued_to_run_after_oneTime_worker_started() {
     WorkManagerTestInitHelper.initializeTestWorkManager(context)
@@ -91,7 +198,7 @@ class SyncInstrumentedTest {
         )
         .transformWhile {
           emit(it)
-          it !is SyncJobStatus.Finished
+          it.currentSyncJobStatus !is CurrentSyncJobStatus.Succeeded
         }
         .shareIn(this, SharingStarted.Eagerly, 5)
     }
@@ -107,7 +214,7 @@ class SyncInstrumentedTest {
       Sync.oneTimeSync<TestSyncWorker>(context = context)
         .transformWhile {
           emit(it)
-          it !is SyncJobStatus.Finished
+          it !is CurrentSyncJobStatus.Succeeded
         }
         .shareIn(this, SharingStarted.Eagerly, 5)
     }
diff --git a/engine/src/main/java/com/google/android/fhir/DatastoreUtil.kt b/engine/src/main/java/com/google/android/fhir/DatastoreUtil.kt
deleted file mode 100644
index c3d972c7c0..0000000000
--- a/engine/src/main/java/com/google/android/fhir/DatastoreUtil.kt
+++ /dev/null
@@ -1,46 +0,0 @@
-/*
- * Copyright 2022 Google LLC
- *
- * 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.
- */
-
-package com.google.android.fhir
-
-import android.content.Context
-import androidx.datastore.core.DataStore
-import androidx.datastore.preferences.core.Preferences
-import androidx.datastore.preferences.core.edit
-import androidx.datastore.preferences.core.stringPreferencesKey
-import androidx.datastore.preferences.preferencesDataStore
-import java.time.OffsetDateTime
-import kotlinx.coroutines.flow.first
-import kotlinx.coroutines.runBlocking
-
-private val Context.dataStore: DataStore<Preferences> by
-  preferencesDataStore(name = "FHIR_ENGINE_PREF_DATASTORE")
-
-internal class DatastoreUtil(private val context: Context) {
-  private val lastSyncTimestampKey by lazy { stringPreferencesKey("LAST_SYNC_TIMESTAMP") }
-
-  fun readLastSyncTimestamp(): OffsetDateTime? {
-    val millis = runBlocking { context.dataStore.data.first()[lastSyncTimestampKey] } ?: return null
-
-    return OffsetDateTime.parse(millis)
-  }
-
-  fun writeLastSyncTimestamp(datetime: OffsetDateTime) {
-    runBlocking {
-      context.dataStore.edit { pref -> pref[lastSyncTimestampKey] = datetime.toString() }
-    }
-  }
-}
diff --git a/engine/src/main/java/com/google/android/fhir/FhirEngine.kt b/engine/src/main/java/com/google/android/fhir/FhirEngine.kt
index cc0a971721..0bec8f3e2b 100644
--- a/engine/src/main/java/com/google/android/fhir/FhirEngine.kt
+++ b/engine/src/main/java/com/google/android/fhir/FhirEngine.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -153,42 +153,4 @@ data class SearchResult<R : Resource>(
   val included: Map<SearchParamName, List<Resource>>?,
   /** Matching referenced resources as per the [Search.revInclude] criteria in the query. */
   val revIncluded: Map<Pair<ResourceType, SearchParamName>, List<Resource>>?,
-) {
-  override fun equals(other: Any?) =
-    other is SearchResult<*> &&
-      equalsShallow(resource, other.resource) &&
-      equalsShallow(included, other.included) &&
-      equalsShallow(revIncluded, other.revIncluded)
-
-  private fun equalsShallow(first: Resource, second: Resource) =
-    first.resourceType == second.resourceType && first.logicalId == second.logicalId
-
-  private fun equalsShallow(first: List<Resource>, second: List<Resource>) =
-    first.size == second.size &&
-      first.asSequence().zip(second.asSequence()).all { (x, y) -> equalsShallow(x, y) }
-
-  private fun equalsShallow(
-    first: Map<SearchParamName, List<Resource>>?,
-    second: Map<SearchParamName, List<Resource>>?,
-  ) =
-    if (first != null && second != null && first.size == second.size) {
-      first.entries.asSequence().zip(second.entries.asSequence()).all { (x, y) ->
-        x.key == y.key && equalsShallow(x.value, y.value)
-      }
-    } else {
-      first?.size == second?.size
-    }
-
-  @JvmName("equalsShallowRevInclude")
-  private fun equalsShallow(
-    first: Map<Pair<ResourceType, SearchParamName>, List<Resource>>?,
-    second: Map<Pair<ResourceType, SearchParamName>, List<Resource>>?,
-  ) =
-    if (first != null && second != null && first.size == second.size) {
-      first.entries.asSequence().zip(second.entries.asSequence()).all { (x, y) ->
-        x.key == y.key && equalsShallow(x.value, y.value)
-      }
-    } else {
-      first?.size == second?.size
-    }
-}
+)
diff --git a/engine/src/main/java/com/google/android/fhir/FhirEngineProvider.kt b/engine/src/main/java/com/google/android/fhir/FhirEngineProvider.kt
index 6498d8feb8..b3775f8165 100644
--- a/engine/src/main/java/com/google/android/fhir/FhirEngineProvider.kt
+++ b/engine/src/main/java/com/google/android/fhir/FhirEngineProvider.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -19,8 +19,10 @@ package com.google.android.fhir
 import android.content.Context
 import com.google.android.fhir.DatabaseErrorStrategy.UNSPECIFIED
 import com.google.android.fhir.sync.DataSource
+import com.google.android.fhir.sync.FhirDataStore
 import com.google.android.fhir.sync.HttpAuthenticator
 import com.google.android.fhir.sync.remote.HttpLogger
+import java.io.File
 import org.hl7.fhir.r4.model.SearchParameter
 
 /** The provider for [FhirEngine] instance. */
@@ -31,7 +33,8 @@ object FhirEngineProvider {
   /**
    * Initializes the [FhirEngine] singleton with a custom Configuration.
    *
-   * This method throws [IllegalStateException] if it is called multiple times
+   * This method throws [IllegalStateException] if it is called multiple times. It throws
+   * [NullPointerException] if [FhirEngineConfiguration.context] is null.
    */
   @Synchronized
   fun init(fhirEngineConfiguration: FhirEngineConfiguration) {
@@ -58,6 +61,12 @@ object FhirEngineProvider {
     return getOrCreateFhirService(context).remoteDataSource
   }
 
+  @PublishedApi
+  @Synchronized
+  internal fun getFhirDataStore(context: Context): FhirDataStore {
+    return getOrCreateFhirService(context).fhirDataStore
+  }
+
   @Synchronized
   private fun getOrCreateFhirService(context: Context): FhirServices {
     if (fhirServices == null) {
@@ -161,4 +170,14 @@ data class NetworkConfiguration(
   val writeTimeOut: Long = 10,
   /** Compresses requests when uploading to a server that supports gzip. */
   val uploadWithGzip: Boolean = false,
+  /** Cache setting to enable Cache-Control Header */
+  val httpCache: CacheConfiguration? = null,
+)
+
+/** Cache configuration wrapper */
+data class CacheConfiguration(
+  /** Cache directory eg: File(application.cacheDir, "http_cache") */
+  val cacheDir: File,
+  /** Cache size in bits eg: 50L * 1024L * 1024L // 50 MiB */
+  val maxSize: Long,
 )
diff --git a/engine/src/main/java/com/google/android/fhir/FhirServices.kt b/engine/src/main/java/com/google/android/fhir/FhirServices.kt
index 75203b31ed..600bf0790b 100644
--- a/engine/src/main/java/com/google/android/fhir/FhirServices.kt
+++ b/engine/src/main/java/com/google/android/fhir/FhirServices.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2022-2023 Google LLC
+ * Copyright 2022-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -20,6 +20,7 @@ import android.content.Context
 import ca.uhn.fhir.context.FhirContext
 import ca.uhn.fhir.context.FhirVersionEnum
 import ca.uhn.fhir.parser.IParser
+import ca.uhn.fhir.util.FhirTerser
 import com.google.android.fhir.db.Database
 import com.google.android.fhir.db.impl.DatabaseConfig
 import com.google.android.fhir.db.impl.DatabaseEncryptionKeyProvider.isDatabaseEncryptionSupported
@@ -28,6 +29,7 @@ import com.google.android.fhir.impl.FhirEngineImpl
 import com.google.android.fhir.index.ResourceIndexer
 import com.google.android.fhir.index.SearchParamDefinitionsProviderImpl
 import com.google.android.fhir.sync.DataSource
+import com.google.android.fhir.sync.FhirDataStore
 import com.google.android.fhir.sync.remote.FhirHttpDataSource
 import com.google.android.fhir.sync.remote.RetrofitHttpService
 import org.hl7.fhir.r4.model.SearchParameter
@@ -38,6 +40,7 @@ internal data class FhirServices(
   val parser: IParser,
   val database: Database,
   val remoteDataSource: DataSource? = null,
+  val fhirDataStore: FhirDataStore,
 ) {
   class Builder(private val context: Context) {
     private var inMemory: Boolean = false
@@ -70,12 +73,14 @@ internal data class FhirServices(
 
     fun build(): FhirServices {
       val parser = FhirContext.forCached(FhirVersionEnum.R4).newJsonParser()
+      val terser = FhirTerser(FhirContext.forCached(FhirVersionEnum.R4))
       val searchParamMap =
         searchParameters?.asMapOfResourceTypeToSearchParamDefinitions() ?: emptyMap()
       val db =
         DatabaseImpl(
           context = context,
           iParser = parser,
+          fhirTerser = terser,
           DatabaseConfig(inMemory, enableEncryption, databaseErrorStrategy),
           resourceIndexer = ResourceIndexer(SearchParamDefinitionsProviderImpl(searchParamMap)),
         )
@@ -95,6 +100,7 @@ internal data class FhirServices(
         parser = parser,
         database = db,
         remoteDataSource = remoteDataSource,
+        fhirDataStore = FhirDataStore(context),
       )
     }
   }
diff --git a/engine/src/main/java/com/google/android/fhir/MoreResources.kt b/engine/src/main/java/com/google/android/fhir/MoreResources.kt
index 1511e5daa1..f444acbe19 100644
--- a/engine/src/main/java/com/google/android/fhir/MoreResources.kt
+++ b/engine/src/main/java/com/google/android/fhir/MoreResources.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2022 Google LLC
+ * Copyright 2022-2023 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -57,7 +57,7 @@ fun <R : Resource> getResourceClass(resourceType: String): Class<R> {
   return Class.forName(R4_RESOURCE_PACKAGE_PREFIX + className) as Class<R>
 }
 
-internal val Resource.versionId
+internal val Resource.versionId: String?
   get() = meta.versionId
 
 internal val Resource.lastUpdated
diff --git a/engine/src/main/java/com/google/android/fhir/db/Database.kt b/engine/src/main/java/com/google/android/fhir/db/Database.kt
index cbbc840b64..83157a35ba 100644
--- a/engine/src/main/java/com/google/android/fhir/db/Database.kt
+++ b/engine/src/main/java/com/google/android/fhir/db/Database.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -18,11 +18,13 @@ package com.google.android.fhir.db
 
 import com.google.android.fhir.LocalChange
 import com.google.android.fhir.LocalChangeToken
-import com.google.android.fhir.db.impl.dao.IndexedIdAndResource
+import com.google.android.fhir.db.impl.dao.ForwardIncludeSearchResult
+import com.google.android.fhir.db.impl.dao.ReverseIncludeSearchResult
 import com.google.android.fhir.db.impl.entities.LocalChangeEntity
 import com.google.android.fhir.db.impl.entities.ResourceEntity
 import com.google.android.fhir.search.SearchQuery
 import java.time.Instant
+import java.util.UUID
 import org.hl7.fhir.r4.model.Resource
 import org.hl7.fhir.r4.model.ResourceType
 
@@ -93,9 +95,11 @@ internal interface Database {
    */
   suspend fun delete(type: ResourceType, id: String)
 
-  suspend fun <R : Resource> search(query: SearchQuery): List<R>
+  suspend fun <R : Resource> search(query: SearchQuery): List<ResourceWithUUID<R>>
 
-  suspend fun searchReferencedResources(query: SearchQuery): List<IndexedIdAndResource>
+  suspend fun searchForwardReferencedResources(query: SearchQuery): List<ForwardIncludeSearchResult>
+
+  suspend fun searchReverseReferencedResources(query: SearchQuery): List<ReverseIncludeSearchResult>
 
   suspend fun count(query: SearchQuery): Long
 
@@ -105,6 +109,12 @@ internal interface Database {
    */
   suspend fun getAllLocalChanges(): List<LocalChange>
 
+  /**
+   * Retrieves all [LocalChange]s for the [Resource] which has the [LocalChange] with the oldest
+   * [LocalChange.timestamp]
+   */
+  suspend fun getAllChangesForEarliestChangedResource(): List<LocalChange>
+
   /** Retrieves the count of [LocalChange]s stored in the database. */
   suspend fun getLocalChangesCount(): Int
 
@@ -114,6 +124,18 @@ internal interface Database {
   /** Remove the [LocalChangeEntity] s with matching resource ids. */
   suspend fun deleteUpdates(resources: List<Resource>)
 
+  /**
+   * Updates the [ResourceEntity.serializedResource] and [ResourceEntity.resourceId] corresponding
+   * to the updatedResource. Updates all the [LocalChangeEntity] for this updated resource as well
+   * as all the [LocalChangeEntity] referring to this resource in their [LocalChangeEntity.payload]
+   * Updates the [ResourceEntity.serializedResource] for all the resources which refer to this
+   * updated resource.
+   */
+  suspend fun updateResourceAndReferences(
+    currentResourceId: String,
+    updatedResource: Resource,
+  )
+
   /** Runs the block as a database transaction. */
   suspend fun withTransaction(block: suspend () -> Unit)
 
@@ -139,6 +161,18 @@ internal interface Database {
    */
   suspend fun getLocalChanges(type: ResourceType, id: String): List<LocalChange>
 
+  /**
+   * Retrieve a list of [LocalChange] for [ResourceEntity] with given UUID, which can be used to
+   * purge resource from database. If there is no local change for [ResourceEntity.resourceUuid],
+   * return an empty list.
+   *
+   * @param resourceUuid The resource UUID [ResourceEntity.resourceUuid]
+   * @return [List]<[LocalChange]> A list of local changes for given [resourceType] and
+   *   [Resource.id] . If there is no local change for given [resourceType] and
+   *   [ResourceEntity.resourceUuid], return empty list.
+   */
+  suspend fun getLocalChanges(resourceUuid: UUID): List<LocalChange>
+
   /**
    * Purge resource from database based on resource type and id without any deletion of data from
    * the server.
@@ -152,3 +186,8 @@ internal interface Database {
    */
   suspend fun purge(type: ResourceType, id: String, forcePurge: Boolean = false)
 }
+
+data class ResourceWithUUID<R>(
+  val uuid: UUID,
+  val resource: R,
+)
diff --git a/engine/src/main/java/com/google/android/fhir/db/ResourceNotFoundException.kt b/engine/src/main/java/com/google/android/fhir/db/ResourceNotFoundException.kt
index 7b204c1116..a97c90c879 100644
--- a/engine/src/main/java/com/google/android/fhir/db/ResourceNotFoundException.kt
+++ b/engine/src/main/java/com/google/android/fhir/db/ResourceNotFoundException.kt
@@ -16,10 +16,13 @@
 
 package com.google.android.fhir.db
 
+import java.util.UUID
+
 /** Thrown to indicate that the requested resource is not found. */
 class ResourceNotFoundException : Exception {
-  val type: String
-  val id: String
+  lateinit var type: String
+  lateinit var id: String
+  lateinit var uuid: UUID
 
   constructor(
     type: String,
@@ -30,8 +33,17 @@ class ResourceNotFoundException : Exception {
     this.id = id
   }
 
-  constructor(type: String, id: String) : super("Resource not found with type $type and id $id!") {
+  constructor(
+    type: String,
+    id: String,
+  ) : super("Resource not found with type $type and id $id!") {
     this.type = type
     this.id = id
   }
+
+  constructor(
+    uuid: UUID,
+  ) : super("Resource not found with UUID $uuid!") {
+    this.uuid = uuid
+  }
 }
diff --git a/engine/src/main/java/com/google/android/fhir/db/impl/DatabaseImpl.kt b/engine/src/main/java/com/google/android/fhir/db/impl/DatabaseImpl.kt
index a5cf77719c..af044b4f63 100644
--- a/engine/src/main/java/com/google/android/fhir/db/impl/DatabaseImpl.kt
+++ b/engine/src/main/java/com/google/android/fhir/db/impl/DatabaseImpl.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -22,18 +22,22 @@ import androidx.room.Room
 import androidx.room.withTransaction
 import androidx.sqlite.db.SimpleSQLiteQuery
 import ca.uhn.fhir.parser.IParser
+import ca.uhn.fhir.util.FhirTerser
 import com.google.android.fhir.DatabaseErrorStrategy
 import com.google.android.fhir.LocalChange
 import com.google.android.fhir.LocalChangeToken
 import com.google.android.fhir.db.ResourceNotFoundException
+import com.google.android.fhir.db.ResourceWithUUID
 import com.google.android.fhir.db.impl.DatabaseImpl.Companion.UNENCRYPTED_DATABASE_NAME
-import com.google.android.fhir.db.impl.dao.IndexedIdAndResource
+import com.google.android.fhir.db.impl.dao.ForwardIncludeSearchResult
+import com.google.android.fhir.db.impl.dao.ReverseIncludeSearchResult
 import com.google.android.fhir.db.impl.entities.ResourceEntity
 import com.google.android.fhir.index.ResourceIndexer
 import com.google.android.fhir.logicalId
 import com.google.android.fhir.search.SearchQuery
 import com.google.android.fhir.toLocalChange
 import java.time.Instant
+import java.util.UUID
 import org.hl7.fhir.r4.model.Resource
 import org.hl7.fhir.r4.model.ResourceType
 
@@ -45,6 +49,7 @@ import org.hl7.fhir.r4.model.ResourceType
 internal class DatabaseImpl(
   private val context: Context,
   private val iParser: IParser,
+  private val fhirTerser: FhirTerser,
   databaseConfig: DatabaseConfig,
   private val resourceIndexer: ResourceIndexer,
 ) : com.google.android.fhir.db.Database {
@@ -102,6 +107,7 @@ internal class DatabaseImpl(
             MIGRATION_4_5,
             MIGRATION_5_6,
             MIGRATION_6_7,
+            MIGRATION_7_8,
           )
         }
         .build()
@@ -114,7 +120,11 @@ internal class DatabaseImpl(
     }
   }
 
-  private val localChangeDao = db.localChangeDao().also { it.iParser = iParser }
+  private val localChangeDao =
+    db.localChangeDao().also {
+      it.iParser = iParser
+      it.fhirTerser = fhirTerser
+    }
 
   override suspend fun <R : Resource> insert(vararg resource: R): List<String> {
     val logicalIds = mutableListOf<String>()
@@ -140,7 +150,7 @@ internal class DatabaseImpl(
       resources.forEach {
         val timeOfLocalChange = Instant.now()
         val oldResourceEntity = selectEntity(it.resourceType, it.logicalId)
-        resourceDao.update(it, timeOfLocalChange)
+        resourceDao.applyLocalUpdate(it, timeOfLocalChange)
         localChangeDao.addUpdate(oldResourceEntity, it, timeOfLocalChange)
       }
     }
@@ -191,23 +201,43 @@ internal class DatabaseImpl(
     }
   }
 
-  override suspend fun <R : Resource> search(query: SearchQuery): List<R> {
+  override suspend fun <R : Resource> search(
+    query: SearchQuery,
+  ): List<ResourceWithUUID<R>> {
     return db.withTransaction {
       resourceDao
         .getResources(SimpleSQLiteQuery(query.query, query.args.toTypedArray()))
-        .map { iParser.parseResource(it) as R }
-        .distinctBy { it.id }
+        .map { ResourceWithUUID(it.uuid, iParser.parseResource(it.serializedResource) as R) }
+        .distinctBy { it.uuid }
     }
   }
 
-  override suspend fun searchReferencedResources(query: SearchQuery): List<IndexedIdAndResource> {
+  override suspend fun searchForwardReferencedResources(
+    query: SearchQuery,
+  ): List<ForwardIncludeSearchResult> {
     return db.withTransaction {
       resourceDao
-        .getReferencedResources(SimpleSQLiteQuery(query.query, query.args.toTypedArray()))
+        .getForwardReferencedResources(SimpleSQLiteQuery(query.query, query.args.toTypedArray()))
         .map {
-          IndexedIdAndResource(
+          ForwardIncludeSearchResult(
             it.matchingIndex,
-            it.idOfBaseResourceOnWhichThisMatchedInc ?: it.idOfBaseResourceOnWhichThisMatchedRev!!,
+            it.baseResourceUUID,
+            iParser.parseResource(it.serializedResource) as Resource,
+          )
+        }
+    }
+  }
+
+  override suspend fun searchReverseReferencedResources(
+    query: SearchQuery,
+  ): List<ReverseIncludeSearchResult> {
+    return db.withTransaction {
+      resourceDao
+        .getReverseReferencedResources(SimpleSQLiteQuery(query.query, query.args.toTypedArray()))
+        .map {
+          ReverseIncludeSearchResult(
+            it.matchingIndex,
+            it.baseResourceTypeAndId,
             iParser.parseResource(it.serializedResource) as Resource,
           )
         }
@@ -228,6 +258,10 @@ internal class DatabaseImpl(
     return db.withTransaction { localChangeDao.getLocalChangesCount() }
   }
 
+  override suspend fun getAllChangesForEarliestChangedResource(): List<LocalChange> {
+    return localChangeDao.getAllChangesForEarliestChangedResource().map { it.toLocalChange() }
+  }
+
   override suspend fun deleteUpdates(token: LocalChangeToken) {
     db.withTransaction { localChangeDao.discardLocalChanges(token) }
   }
@@ -247,6 +281,85 @@ internal class DatabaseImpl(
     localChangeDao.discardLocalChanges(resources)
   }
 
+  override suspend fun updateResourceAndReferences(
+    currentResourceId: String,
+    updatedResource: Resource,
+  ) {
+    db.withTransaction {
+      val currentResourceEntity = selectEntity(updatedResource.resourceType, currentResourceId)
+      val oldResource = iParser.parseResource(currentResourceEntity.serializedResource) as Resource
+      val resourceUuid = currentResourceEntity.resourceUuid
+      updateResourceEntity(resourceUuid, updatedResource)
+
+      val uuidsOfReferringResources =
+        updateLocalChangeResourceIdAndReferences(
+          resourceUuid = resourceUuid,
+          oldResource = oldResource,
+          updatedResource = updatedResource,
+        )
+
+      updateReferringResources(
+        referringResourcesUuids = uuidsOfReferringResources,
+        oldResource = oldResource,
+        updatedResource = updatedResource,
+      )
+    }
+  }
+
+  /**
+   * Calls the [ResourceDao] to update the [ResourceEntity] associated with this resource. The
+   * function updates the resource and resourceId of the [ResourceEntity]
+   */
+  private suspend fun updateResourceEntity(resourceUuid: UUID, updatedResource: Resource) =
+    resourceDao.updateResourceWithUuid(resourceUuid, updatedResource)
+
+  /**
+   * Update the [LocalChange]s to reflect the change in the resource ID. This primarily includes
+   * modifying the [LocalChange.resourceId] for the changes of the affected resource. Also, update
+   * any references in the [LocalChange] which refer to the affected resource.
+   *
+   * The function returns a [List<[UUID]>] which corresponds to the [ResourceEntity.resourceUuid]
+   * which contain references to the affected resource.
+   */
+  private suspend fun updateLocalChangeResourceIdAndReferences(
+    resourceUuid: UUID,
+    oldResource: Resource,
+    updatedResource: Resource,
+  ) =
+    localChangeDao.updateResourceIdAndReferences(
+      resourceUuid = resourceUuid,
+      oldResource = oldResource,
+      updatedResource = updatedResource,
+    )
+
+  /**
+   * Update all [Resource] and their corresponding [ResourceEntity] which refer to the affected
+   * resource. The update of the references in the [Resource] is also expected to reflect in the
+   * [ReferenceIndex] i.e. the references used for search operations should also get updated to
+   * reflect the references with the new resource ID of the referred resource.
+   */
+  private suspend fun updateReferringResources(
+    referringResourcesUuids: List<UUID>,
+    oldResource: Resource,
+    updatedResource: Resource,
+  ) {
+    val oldReferenceValue = "${oldResource.resourceType.name}/${oldResource.logicalId}"
+    val updatedReferenceValue = "${updatedResource.resourceType.name}/${updatedResource.logicalId}"
+    referringResourcesUuids.forEach { resourceUuid ->
+      resourceDao.getResourceEntity(resourceUuid)?.let {
+        val referringResource = iParser.parseResource(it.serializedResource) as Resource
+        val updatedReferringResource =
+          addUpdatedReferenceToResource(
+            iParser,
+            referringResource,
+            oldReferenceValue,
+            updatedReferenceValue,
+          )
+        resourceDao.updateResourceWithUuid(resourceUuid, updatedReferringResource)
+      }
+    }
+  }
+
   override fun close() {
     db.close()
   }
@@ -263,6 +376,12 @@ internal class DatabaseImpl(
     }
   }
 
+  override suspend fun getLocalChanges(resourceUuid: UUID): List<LocalChange> {
+    return db.withTransaction {
+      localChangeDao.getLocalChanges(resourceUuid = resourceUuid).map { it.toLocalChange() }
+    }
+  }
+
   override suspend fun purge(type: ResourceType, id: String, forcePurge: Boolean) {
     db.withTransaction {
       // To check resource is present in DB else throw ResourceNotFoundException()
diff --git a/engine/src/main/java/com/google/android/fhir/db/impl/JsonUtils.kt b/engine/src/main/java/com/google/android/fhir/db/impl/JsonUtils.kt
new file mode 100644
index 0000000000..31be98d1e1
--- /dev/null
+++ b/engine/src/main/java/com/google/android/fhir/db/impl/JsonUtils.kt
@@ -0,0 +1,130 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.db.impl
+
+import ca.uhn.fhir.parser.IParser
+import org.hl7.fhir.r4.model.Resource
+import org.json.JSONArray
+import org.json.JSONObject
+
+internal fun addUpdatedReferenceToResource(
+  iParser: IParser,
+  resource: Resource,
+  outdatedReference: String,
+  updatedReference: String,
+): Resource {
+  val resourceJsonObject = JSONObject(iParser.encodeResourceToString(resource))
+  val updatedResource = replaceJsonValue(resourceJsonObject, outdatedReference, updatedReference)
+  return iParser.parseResource(updatedResource.toString()) as Resource
+}
+
+internal fun replaceJsonValue(
+  jsonObject: JSONObject,
+  currentValue: String,
+  newValue: String,
+): JSONObject {
+  val iterator: Iterator<*> = jsonObject.keys()
+  var key: String?
+  while (iterator.hasNext()) {
+    key = iterator.next() as String
+    // if object is just string we change value in key
+    if (jsonObject.optJSONArray(key) == null && jsonObject.optJSONObject(key) == null) {
+      if (jsonObject.optString(key) == currentValue) {
+        jsonObject.put(key, newValue)
+      }
+    }
+
+    // if it's jsonobject
+    if (jsonObject.optJSONObject(key) != null) {
+      replaceJsonValue(jsonObject.getJSONObject(key), currentValue, newValue)
+    }
+
+    // if it's jsonarray
+    if (jsonObject.optJSONArray(key) != null) {
+      val jArray = jsonObject.getJSONArray(key)
+      replaceJsonValue(jArray, currentValue, newValue)
+    }
+  }
+  return jsonObject
+}
+
+internal fun replaceJsonValue(
+  jsonArray: JSONArray,
+  currentValue: String,
+  newValue: String,
+): JSONArray {
+  for (i in 0 until jsonArray.length()) {
+    if (jsonArray.optJSONArray(i) != null) {
+      replaceJsonValue(jsonArray.getJSONArray(i), currentValue, newValue)
+    } else if (jsonArray.optJSONObject(i) != null) {
+      replaceJsonValue(jsonArray.getJSONObject(i), currentValue, newValue)
+    } else if (currentValue.equals(jsonArray.optString(i))) {
+      jsonArray.put(i, newValue)
+    }
+  }
+  return jsonArray
+}
+
+internal fun lookForReferencesInJsonPatch(jsonObject: JSONObject): String? {
+  // "[{\"op\":\"replace\",\"path\":\"\\/basedOn\\/0\\/reference\",\"value\":\"CarePlan\\/345\"}]"
+  if (jsonObject.getString("path").endsWith("reference")) {
+    return jsonObject.getString("value")
+  }
+  return null
+}
+
+internal fun extractAllValuesWithKey(lookupKey: String, jsonObject: JSONObject): List<String> {
+  val iterator: Iterator<*> = jsonObject.keys()
+  var key: String?
+  val referenceValues = mutableListOf<String>()
+  while (iterator.hasNext()) {
+    key = iterator.next() as String
+    // if object is just string we change value in key
+    if (jsonObject.optJSONArray(key) == null && jsonObject.optJSONObject(key) == null) {
+      if (key.equals(lookupKey)) {
+        referenceValues.add(jsonObject.getString(key))
+      }
+    }
+
+    // if it's jsonobject
+    if (jsonObject.optJSONObject(key) != null) {
+      referenceValues.addAll(extractAllValuesWithKey(lookupKey, jsonObject.getJSONObject(key)))
+    }
+
+    // if it's jsonarray
+    if (jsonObject.optJSONArray(key) != null) {
+      referenceValues.addAll(
+        extractAllValuesWithKey(lookupKey, jsonObject.getJSONArray(key)),
+      )
+    }
+  }
+  return referenceValues
+}
+
+internal fun extractAllValuesWithKey(lookupKey: String, jArray: JSONArray): List<String> {
+  val referenceValues = mutableListOf<String>()
+  for (i in 0 until jArray.length()) {
+    if (jArray.optJSONObject(i) != null) {
+      referenceValues.addAll(extractAllValuesWithKey(lookupKey, jArray.getJSONObject(i)))
+    } else if (jArray.optJSONArray(i) != null) {
+      referenceValues.addAll(
+        extractAllValuesWithKey(lookupKey, jArray.getJSONArray(i)),
+      )
+    }
+  }
+  return referenceValues
+}
diff --git a/engine/src/main/java/com/google/android/fhir/db/impl/ResourceDatabase.kt b/engine/src/main/java/com/google/android/fhir/db/impl/ResourceDatabase.kt
index f69998fd49..3502ab0b8e 100644
--- a/engine/src/main/java/com/google/android/fhir/db/impl/ResourceDatabase.kt
+++ b/engine/src/main/java/com/google/android/fhir/db/impl/ResourceDatabase.kt
@@ -26,6 +26,7 @@ import com.google.android.fhir.db.impl.dao.ResourceDao
 import com.google.android.fhir.db.impl.entities.DateIndexEntity
 import com.google.android.fhir.db.impl.entities.DateTimeIndexEntity
 import com.google.android.fhir.db.impl.entities.LocalChangeEntity
+import com.google.android.fhir.db.impl.entities.LocalChangeResourceReferenceEntity
 import com.google.android.fhir.db.impl.entities.NumberIndexEntity
 import com.google.android.fhir.db.impl.entities.PositionIndexEntity
 import com.google.android.fhir.db.impl.entities.QuantityIndexEntity
@@ -34,6 +35,8 @@ import com.google.android.fhir.db.impl.entities.ResourceEntity
 import com.google.android.fhir.db.impl.entities.StringIndexEntity
 import com.google.android.fhir.db.impl.entities.TokenIndexEntity
 import com.google.android.fhir.db.impl.entities.UriIndexEntity
+import org.json.JSONArray
+import org.json.JSONObject
 
 @Database(
   entities =
@@ -49,8 +52,9 @@ import com.google.android.fhir.db.impl.entities.UriIndexEntity
       NumberIndexEntity::class,
       LocalChangeEntity::class,
       PositionIndexEntity::class,
+      LocalChangeResourceReferenceEntity::class,
     ],
-  version = 7,
+  version = 8,
   exportSchema = true,
 )
 @TypeConverters(DbTypeConverters::class)
@@ -149,3 +153,58 @@ val MIGRATION_6_7 =
       )
     }
   }
+
+/** Create [LocalChangeResourceReferenceEntity] */
+val MIGRATION_7_8 =
+  object : Migration(7, 8) {
+    override fun migrate(database: SupportSQLiteDatabase) {
+      database.execSQL(
+        "CREATE TABLE IF NOT EXISTS `LocalChangeResourceReferenceEntity` (`id` INTEGER PRIMARY KEY AUTOINCREMENT NOT NULL, `localChangeId` INTEGER NOT NULL, `resourceReferenceValue` TEXT NOT NULL, `resourceReferencePath` TEXT, FOREIGN KEY(`localChangeId`) REFERENCES `LocalChangeEntity`(`id`) ON UPDATE NO ACTION ON DELETE CASCADE DEFERRABLE INITIALLY DEFERRED)",
+      )
+      database.execSQL(
+        "CREATE INDEX IF NOT EXISTS `index_LocalChangeResourceReferenceEntity_resourceReferenceValue` ON `LocalChangeResourceReferenceEntity` (`resourceReferenceValue`)",
+      )
+      database.execSQL(
+        "CREATE INDEX IF NOT EXISTS `index_LocalChangeResourceReferenceEntity_localChangeId` ON `LocalChangeResourceReferenceEntity` (`localChangeId`)",
+      )
+
+      database.query("SELECT id,type,payload from LocalChangeEntity").let {
+        var continueIterating = it.moveToFirst()
+        while (continueIterating) {
+          val localChangeId = it.getLong(0)
+          val localChangeType = it.getInt(1)
+          val localChangePayload = it.getString(2)
+          val references =
+            when (localChangeType) {
+              LocalChangeEntity.Type.INSERT.value ->
+                extractAllValuesWithKey("reference", JSONObject(localChangePayload))
+              LocalChangeEntity.Type.UPDATE.value -> {
+                val patchArray = JSONArray(localChangePayload)
+                val references = mutableListOf<String>()
+                for (i in 0 until patchArray.length()) {
+                  // look for any value with key "reference" in JsonPatch's value
+                  references.addAll(
+                    extractAllValuesWithKey("reference", patchArray.getJSONObject(i)),
+                  )
+                  // look for value if the path of the JsonPatch is a reference path itself
+                  // example:
+                  // "[{\"op\":\"replace\",\"path\":\"\\/basedOn\\/0\\/reference\",\"value\":\"CarePlan\\/345\"}]"
+                  lookForReferencesInJsonPatch(patchArray.getJSONObject(i))?.let { ref ->
+                    references.add(ref)
+                  }
+                }
+                references
+              }
+              LocalChangeEntity.Type.DELETE.value -> emptyList()
+              else -> throw IllegalArgumentException("Unknown LocalChangeType")
+            }
+          references.forEach { refValue ->
+            database.execSQL(
+              "INSERT INTO LocalChangeResourceReferenceEntity (localChangeId, resourceReferenceValue) VALUES ('$localChangeId', '$refValue' );",
+            )
+          }
+          continueIterating = it.moveToNext()
+        }
+      }
+    }
+  }
diff --git a/engine/src/main/java/com/google/android/fhir/db/impl/dao/LocalChangeDao.kt b/engine/src/main/java/com/google/android/fhir/db/impl/dao/LocalChangeDao.kt
index ecd24b4ece..43eac00442 100644
--- a/engine/src/main/java/com/google/android/fhir/db/impl/dao/LocalChangeDao.kt
+++ b/engine/src/main/java/com/google/android/fhir/db/impl/dao/LocalChangeDao.kt
@@ -18,16 +18,22 @@ package com.google.android.fhir.db.impl.dao
 
 import androidx.room.Dao
 import androidx.room.Insert
+import androidx.room.OnConflictStrategy
 import androidx.room.Query
 import androidx.room.Transaction
 import ca.uhn.fhir.parser.IParser
+import ca.uhn.fhir.util.FhirTerser
+import ca.uhn.fhir.util.ResourceReferenceInfo
 import com.fasterxml.jackson.databind.JsonNode
 import com.fasterxml.jackson.databind.ObjectMapper
 import com.github.fge.jsonpatch.diff.JsonDiff
 import com.google.android.fhir.LocalChangeToken
+import com.google.android.fhir.db.impl.addUpdatedReferenceToResource
 import com.google.android.fhir.db.impl.entities.LocalChangeEntity
 import com.google.android.fhir.db.impl.entities.LocalChangeEntity.Type
+import com.google.android.fhir.db.impl.entities.LocalChangeResourceReferenceEntity
 import com.google.android.fhir.db.impl.entities.ResourceEntity
+import com.google.android.fhir.db.impl.replaceJsonValue
 import com.google.android.fhir.logicalId
 import com.google.android.fhir.versionId
 import java.time.Instant
@@ -40,16 +46,25 @@ import timber.log.Timber
 
 /**
  * Dao for local changes made to a resource. One row in LocalChangeEntity corresponds to one change
- * e.g. an INSERT or UPDATE. The UPDATES (diffs) are stored as RFC 6902 JSON patches. When a
- * resource needs to be synced, all corresponding LocalChanges are 'squashed' to create a a single
- * LocalChangeEntity to sync with the server.
+ * e.g. an INSERT or UPDATE. The UPDATES (diffs) are stored as RFC 6902 JSON patches.
  */
 @Dao
 internal abstract class LocalChangeDao {
 
   lateinit var iParser: IParser
+  lateinit var fhirTerser: FhirTerser
 
-  @Insert abstract suspend fun addLocalChange(localChangeEntity: LocalChangeEntity)
+  @Insert(onConflict = OnConflictStrategy.REPLACE)
+  abstract suspend fun addLocalChange(localChangeEntity: LocalChangeEntity): Long
+
+  @Query(
+    """
+        UPDATE LocalChangeEntity 
+        SET resourceId = :updatedResourceId 
+        WHERE id = :localChangeId
+    """,
+  )
+  abstract suspend fun updateResourceId(localChangeId: Long, updatedResourceId: String): Int
 
   @Transaction
   open suspend fun addInsert(resource: Resource, resourceUuid: UUID, timeOfLocalChange: Instant) {
@@ -57,9 +72,9 @@ internal abstract class LocalChangeDao {
     val resourceType = resource.resourceType
     val resourceString = iParser.encodeResourceToString(resource)
 
-    addLocalChange(
+    val localChangeEntity =
       LocalChangeEntity(
-        id = 0,
+        id = DEFAULT_ID_VALUE,
         resourceType = resourceType.name,
         resourceId = resourceId,
         resourceUuid = resourceUuid,
@@ -67,13 +82,43 @@ internal abstract class LocalChangeDao {
         type = Type.INSERT,
         payload = resourceString,
         versionId = resource.versionId,
-      ),
-    )
+      )
+
+    val localChangeReferences =
+      extractResourceReferences(resource).mapNotNull { resourceReferenceInfo ->
+        if (resourceReferenceInfo.resourceReference.referenceElement.value != null) {
+          LocalChangeResourceReferenceEntity(
+            id = DEFAULT_ID_VALUE,
+            localChangeId = DEFAULT_ID_VALUE,
+            resourceReferencePath = resourceReferenceInfo.name,
+            resourceReferenceValue = resourceReferenceInfo.resourceReference.referenceElement.value,
+          )
+        } else {
+          null
+        }
+      }
+    createLocalChange(localChangeEntity, localChangeReferences)
   }
 
-  suspend fun addUpdate(oldEntity: ResourceEntity, resource: Resource, timeOfLocalChange: Instant) {
-    val resourceId = resource.logicalId
-    val resourceType = resource.resourceType
+  private suspend fun createLocalChange(
+    localChange: LocalChangeEntity,
+    localChangeReferences: List<LocalChangeResourceReferenceEntity>,
+  ) {
+    val localChangeId = addLocalChange(localChange)
+    if (localChangeReferences.isNotEmpty()) {
+      insertLocalChangeResourceReferences(
+        localChangeReferences.map { it.copy(localChangeId = localChangeId) },
+      )
+    }
+  }
+
+  suspend fun addUpdate(
+    oldEntity: ResourceEntity,
+    updatedResource: Resource,
+    timeOfLocalChange: Instant,
+  ) {
+    val resourceId = updatedResource.logicalId
+    val resourceType = updatedResource.resourceType
 
     if (
       !localChangeIsEmpty(resourceId, resourceType) &&
@@ -83,18 +128,18 @@ internal abstract class LocalChangeDao {
         "Unexpected DELETE when updating $resourceType/$resourceId. UPDATE failed.",
       )
     }
-    val jsonDiff =
-      diff(iParser, iParser.parseResource(oldEntity.serializedResource) as Resource, resource)
+    val oldResource = iParser.parseResource(oldEntity.serializedResource) as Resource
+    val jsonDiff = diff(iParser, oldResource, updatedResource)
     if (jsonDiff.length() == 0) {
       Timber.i(
-        "New resource ${resource.resourceType}/${resource.id} is same as old resource. " +
+        "New resource ${updatedResource.resourceType}/${updatedResource.id} is same as old resource. " +
           "Not inserting UPDATE LocalChange.",
       )
       return
     }
-    addLocalChange(
+    val localChangeEntity =
       LocalChangeEntity(
-        id = 0,
+        id = DEFAULT_ID_VALUE,
         resourceType = resourceType.name,
         resourceId = resourceId,
         resourceUuid = oldEntity.resourceUuid,
@@ -102,8 +147,18 @@ internal abstract class LocalChangeDao {
         type = Type.UPDATE,
         payload = jsonDiff.toString(),
         versionId = oldEntity.versionId,
-      ),
-    )
+      )
+
+    val localChangeReferences =
+      extractReferencesDiff(oldResource, updatedResource).map { resourceReferenceInfo ->
+        LocalChangeResourceReferenceEntity(
+          id = DEFAULT_ID_VALUE,
+          localChangeId = DEFAULT_ID_VALUE,
+          resourceReferencePath = resourceReferenceInfo.name,
+          resourceReferenceValue = resourceReferenceInfo.resourceReference.referenceElement.value,
+        )
+      }
+    createLocalChange(localChangeEntity, localChangeReferences)
   }
 
   suspend fun addDelete(
@@ -112,9 +167,9 @@ internal abstract class LocalChangeDao {
     resourceType: ResourceType,
     remoteVersionId: String?,
   ) {
-    addLocalChange(
+    createLocalChange(
       LocalChangeEntity(
-        id = 0,
+        id = DEFAULT_ID_VALUE,
         resourceType = resourceType.name,
         resourceId = resourceId,
         resourceUuid = resourceUuid,
@@ -123,9 +178,52 @@ internal abstract class LocalChangeDao {
         payload = "",
         versionId = remoteVersionId,
       ),
+      emptyList(),
     )
   }
 
+  private fun extractResourceReferences(resource: Resource) =
+    fhirTerser.getAllResourceReferences(resource).toSet()
+
+  /**
+   * Extract the difference in the [ResourceReferenceInfo]s in the two versions of the resource.
+   *
+   * Two versions of a resource can vary in two ways in terms of the resources they refer:
+   * 1) A reference present in oldVersionResource is removed, hence, not present in
+   *    newVersionResource.
+   * 2) A new reference is added to the oldVersionResource, hence, the reference is present in
+   *    newVersionResource and not in oldVersionResource.
+   *
+   * We compute the differences of both the above kinds to return the entire set of differences.
+   *
+   * This method is useful to extract differences for UPDATE kind of [LocalChange]
+   *
+   * @param oldVersionResource: The older version of the resource
+   * @param newVersionResource: The new version of the resource
+   * @return A set of [ResourceReferenceInfo] containing the differences in references between the
+   *   two resource versions.
+   */
+  private fun extractReferencesDiff(
+    oldVersionResource: Resource,
+    newVersionResource: Resource,
+  ): Set<ResourceReferenceInfo> {
+    require(oldVersionResource.resourceType.equals(newVersionResource.resourceType))
+    val oldVersionResourceReferences = extractResourceReferences(oldVersionResource).toSet()
+    val newVersionResourceReferences = extractResourceReferences(newVersionResource).toSet()
+    return oldVersionResourceReferences.minus(newVersionResourceReferences) +
+      newVersionResourceReferences.minus(oldVersionResourceReferences)
+  }
+
+  private fun Set<ResourceReferenceInfo>.minus(set: Set<ResourceReferenceInfo>) =
+    filter { ref ->
+        set.none {
+          it.name == ref.name &&
+            it.resourceReference.referenceElement.value ==
+              ref.resourceReference.referenceElement.value
+        }
+      }
+      .toSet()
+
   @Query(
     """
         SELECT type 
@@ -156,14 +254,23 @@ internal abstract class LocalChangeDao {
     """
         SELECT *
         FROM LocalChangeEntity
-        ORDER BY LocalChangeEntity.id ASC""",
+        ORDER BY timestamp ASC""",
   )
   abstract suspend fun getAllLocalChanges(): List<LocalChangeEntity>
 
   @Query(
     """
-        SELECT COUNT(*)
+        SELECT *
         FROM LocalChangeEntity
+        WHERE LocalChangeEntity.id IN (:ids) 
+        ORDER BY timestamp ASC""",
+  )
+  abstract suspend fun getLocalChanges(ids: List<Long>): List<LocalChangeEntity>
+
+  @Query(
+    """
+        SELECT COUNT(*)
+        FROM LocalChangeEntity 
         """,
   )
   abstract suspend fun getLocalChangesCount(): Int
@@ -198,7 +305,8 @@ internal abstract class LocalChangeDao {
     """
         SELECT *
         FROM LocalChangeEntity
-        WHERE resourceId = :resourceId AND resourceType = :resourceType
+        WHERE resourceId = :resourceId AND resourceType = :resourceType 
+        ORDER BY timestamp ASC
     """,
   )
   abstract suspend fun getLocalChanges(
@@ -206,7 +314,180 @@ internal abstract class LocalChangeDao {
     resourceId: String,
   ): List<LocalChangeEntity>
 
+  @Query(
+    """
+        SELECT *
+        FROM LocalChangeEntity
+        WHERE resourceUuid = :resourceUuid 
+        ORDER BY timestamp ASC
+    """,
+  )
+  abstract suspend fun getLocalChanges(
+    resourceUuid: UUID,
+  ): List<LocalChangeEntity>
+
+  @Query(
+    """
+        SELECT *
+        FROM LocalChangeResourceReferenceEntity
+        WHERE resourceReferenceValue = :resourceReferenceValue
+    """,
+  )
+  abstract suspend fun getLocalChangeReferencesWithValue(
+    resourceReferenceValue: String,
+  ): List<LocalChangeResourceReferenceEntity>
+
+  @Query(
+    """
+        SELECT *
+        FROM LocalChangeResourceReferenceEntity
+        WHERE localChangeId = :localChangeId
+    """,
+  )
+  abstract suspend fun getReferencesForLocalChange(
+    localChangeId: Long,
+  ): List<LocalChangeResourceReferenceEntity>
+
+  @Insert(onConflict = OnConflictStrategy.REPLACE)
+  abstract suspend fun insertLocalChangeResourceReferences(
+    resourceReferences: List<LocalChangeResourceReferenceEntity>,
+  )
+
+  /**
+   * Updates the resource IDs of the [LocalChange] of the updated resource. Updates [LocalChange]
+   * with references to the updated resource.
+   */
+  suspend fun updateResourceIdAndReferences(
+    resourceUuid: UUID,
+    oldResource: Resource,
+    updatedResource: Resource,
+  ): List<UUID> {
+    updateResourceIdInResourceLocalChanges(
+      resourceUuid = resourceUuid,
+      updatedResourceId = updatedResource.logicalId,
+    )
+    return updateReferencesInLocalChange(
+      oldResource = oldResource,
+      updatedResource = updatedResource,
+    )
+  }
+
+  /**
+   * Updates the [LocalChangeEntity]s for the updated resource by updating the
+   * [LocalChangeEntity.resourceId].
+   */
+  private suspend fun updateResourceIdInResourceLocalChanges(
+    resourceUuid: UUID,
+    updatedResourceId: String,
+  ) =
+    getLocalChanges(resourceUuid).forEach { localChangeEntity ->
+      updateResourceId(localChangeEntity.id, updatedResourceId)
+    }
+
+  /**
+   * Looks for [LocalChangeEntity] which refer to the updated resource through
+   * [LocalChangeResourceReferenceEntity]. For each [LocalChangeEntity] which contains reference to
+   * the updated resource in its payload, we update the payload with the reference and also update
+   * the corresponding [LocalChangeResourceReferenceEntity]. We delete the original
+   * [LocalChangeEntity] and create a new one with new [LocalChangeResourceReferenceEntity]s in its
+   * place. This method returns a list of the [ResourceEntity.resourceUuid] for all the resources
+   * whose [LocalChange] contained references to the oldResource
+   */
+  private suspend fun updateReferencesInLocalChange(
+    oldResource: Resource,
+    updatedResource: Resource,
+  ): List<UUID> {
+    val oldReferenceValue = "${oldResource.resourceType.name}/${oldResource.logicalId}"
+    val updatedReferenceValue = "${updatedResource.resourceType.name}/${updatedResource.logicalId}"
+    val referringLocalChangeIds =
+      getLocalChangeReferencesWithValue(oldReferenceValue).map { it.localChangeId }.distinct()
+    val referringLocalChanges = getLocalChanges(referringLocalChangeIds)
+
+    referringLocalChanges.forEach { existingLocalChangeEntity ->
+      val updatedLocalChangeEntity =
+        replaceReferencesInLocalChangePayload(
+            localChange = existingLocalChangeEntity,
+            oldReference = oldReferenceValue,
+            updatedReference = updatedReferenceValue,
+          )
+          .copy(id = DEFAULT_ID_VALUE)
+      val updatedLocalChangeReferences =
+        getReferencesForLocalChange(existingLocalChangeEntity.id).map {
+          localChangeResourceReferenceEntity ->
+          if (localChangeResourceReferenceEntity.resourceReferenceValue == oldReferenceValue) {
+            LocalChangeResourceReferenceEntity(
+              id = DEFAULT_ID_VALUE,
+              localChangeId = DEFAULT_ID_VALUE,
+              resourceReferencePath = localChangeResourceReferenceEntity.resourceReferencePath,
+              resourceReferenceValue = updatedReferenceValue,
+            )
+          } else {
+            localChangeResourceReferenceEntity.copy(
+              id = DEFAULT_ID_VALUE,
+              localChangeId = DEFAULT_ID_VALUE,
+            )
+          }
+        }
+      discardLocalChanges(existingLocalChangeEntity.id)
+      createLocalChange(updatedLocalChangeEntity, updatedLocalChangeReferences)
+    }
+    return referringLocalChanges.map { it.resourceUuid }.distinct()
+  }
+
+  private fun replaceReferencesInLocalChangePayload(
+    localChange: LocalChangeEntity,
+    oldReference: String,
+    updatedReference: String,
+  ): LocalChangeEntity {
+    return when (localChange.type) {
+      LocalChangeEntity.Type.INSERT -> {
+        val insertResourcePayload = iParser.parseResource(localChange.payload) as Resource
+        val updatedResourcePayload =
+          addUpdatedReferenceToResource(
+            iParser,
+            insertResourcePayload,
+            oldReference,
+            updatedReference,
+          )
+        return localChange.copy(
+          payload = iParser.encodeResourceToString(updatedResourcePayload),
+        )
+      }
+      LocalChangeEntity.Type.UPDATE -> {
+        val patchArray = JSONArray(localChange.payload)
+        val updatedPatchArray = JSONArray()
+        for (i in 0 until patchArray.length()) {
+          val updatedPatch =
+            replaceJsonValue(patchArray.getJSONObject(i), oldReference, updatedReference)
+          updatedPatchArray.put(updatedPatch)
+        }
+        return localChange.copy(
+          payload = updatedPatchArray.toString(),
+        )
+      }
+      LocalChangeEntity.Type.DELETE -> localChange
+    }
+  }
+
+  @Query(
+    """
+    SELECT * 
+      FROM LocalChangeEntity 
+      WHERE resourceUuid = (
+        SELECT resourceUuid 
+        FROM LocalChangeEntity 
+        ORDER BY timestamp ASC 
+        LIMIT 1)
+      ORDER BY timestamp ASC
+    """,
+  )
+  abstract suspend fun getAllChangesForEarliestChangedResource(): List<LocalChangeEntity>
+
   class InvalidLocalChangeException(message: String?) : Exception(message)
+
+  companion object {
+    const val DEFAULT_ID_VALUE = 0L
+  }
 }
 
 /** Calculates the JSON patch between two [Resource] s. */
diff --git a/engine/src/main/java/com/google/android/fhir/db/impl/dao/ResourceDao.kt b/engine/src/main/java/com/google/android/fhir/db/impl/dao/ResourceDao.kt
index d7f25d388f..45786270bb 100644
--- a/engine/src/main/java/com/google/android/fhir/db/impl/dao/ResourceDao.kt
+++ b/engine/src/main/java/com/google/android/fhir/db/impl/dao/ResourceDao.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -58,43 +58,87 @@ internal abstract class ResourceDao {
   lateinit var iParser: IParser
   lateinit var resourceIndexer: ResourceIndexer
 
-  open suspend fun update(resource: Resource, timeOfLocalChange: Instant?) {
+  /**
+   * Updates the resource in the [ResourceEntity] and adds indexes as a result of changes made on
+   * device.
+   *
+   * @param [resource] the resource with local (on device) updates
+   * @param [timeOfLocalChange] time when the local change was made
+   */
+  suspend fun applyLocalUpdate(resource: Resource, timeOfLocalChange: Instant?) {
     getResourceEntity(resource.logicalId, resource.resourceType)?.let {
-      // In case the resource has lastUpdated meta data, use it, otherwise use the old value.
-      val lastUpdatedRemote: Date? = resource.meta.lastUpdated
       val entity =
         it.copy(
           serializedResource = iParser.encodeResourceToString(resource),
           lastUpdatedLocal = timeOfLocalChange,
-          lastUpdatedRemote = lastUpdatedRemote?.toInstant() ?: it.lastUpdatedRemote,
         )
-      // The foreign key in Index entity tables is set with cascade delete constraint and
-      // insertResource has REPLACE conflict resolution. So, when we do an insert to update the
-      // resource, it deletes old resource and corresponding index entities (based on foreign key
-      // constrain) before inserting the new resource.
-      insertResource(entity)
-      val index =
-        ResourceIndices.Builder(resourceIndexer.index(resource))
-          .apply {
-            timeOfLocalChange?.let {
-              addDateTimeIndex(
-                createLocalLastUpdatedIndex(
-                  resource.resourceType,
-                  InstantType(Date.from(timeOfLocalChange)),
-                ),
-              )
-            }
-            lastUpdatedRemote?.let { date ->
-              addDateTimeIndex(createLastUpdatedIndex(resource.resourceType, InstantType(date)))
-            }
-          }
-          .build()
-      updateIndicesForResource(index, resource.resourceType, it.resourceUuid)
+      updateChanges(entity, resource)
+    }
+      ?: throw ResourceNotFoundException(
+        resource.resourceType.name,
+        resource.id,
+      )
+  }
+
+  suspend fun updateResourceWithUuid(resourceUuid: UUID, updatedResource: Resource) {
+    getResourceEntity(resourceUuid)?.let {
+      val entity =
+        it.copy(
+          resourceId = updatedResource.logicalId,
+          serializedResource = iParser.encodeResourceToString(updatedResource),
+          lastUpdatedRemote = updatedResource.meta.lastUpdated?.toInstant() ?: it.lastUpdatedRemote,
+        )
+      updateChanges(entity, updatedResource)
+    }
+      ?: throw ResourceNotFoundException(
+        resourceUuid,
+      )
+  }
+
+  /**
+   * Updates the resource in the [ResourceEntity] and adds indexes as a result of downloading the
+   * resource from server.
+   *
+   * @param [resource] the resource with the remote(server) updates
+   */
+  private suspend fun applyRemoteUpdate(resource: Resource) {
+    getResourceEntity(resource.logicalId, resource.resourceType)?.let {
+      val entity =
+        it.copy(
+          serializedResource = iParser.encodeResourceToString(resource),
+          lastUpdatedRemote = resource.meta.lastUpdated?.toInstant(),
+          versionId = resource.versionId,
+        )
+      updateChanges(entity, resource)
     }
       ?: throw ResourceNotFoundException(resource.resourceType.name, resource.id)
   }
 
-  open suspend fun insertAllRemote(resources: List<Resource>): List<UUID> {
+  private suspend fun updateChanges(entity: ResourceEntity, resource: Resource) {
+    // The foreign key in Index entity tables is set with cascade delete constraint and
+    // insertResource has REPLACE conflict resolution. So, when we do an insert to update the
+    // resource, it deletes old resource and corresponding index entities (based on foreign key
+    // constrain) before inserting the new resource.
+    insertResource(entity)
+    val index =
+      ResourceIndices.Builder(resourceIndexer.index(resource))
+        .apply {
+          entity.lastUpdatedLocal?.let { instant ->
+            addDateTimeIndex(
+              createLocalLastUpdatedIndex(resource.resourceType, InstantType(Date.from(instant))),
+            )
+          }
+          entity.lastUpdatedRemote?.let { instant ->
+            addDateTimeIndex(
+              createLastUpdatedIndex(resource.resourceType, InstantType(Date.from(instant))),
+            )
+          }
+        }
+        .build()
+    updateIndicesForResource(index, resource.resourceType, entity.resourceUuid)
+  }
+
+  suspend fun insertAllRemote(resources: List<Resource>): List<UUID> {
     return resources.map { resource -> insertRemoteResource(resource) }
   }
 
@@ -171,12 +215,29 @@ internal abstract class ResourceDao {
     resourceType: ResourceType,
   ): ResourceEntity?
 
-  @RawQuery abstract suspend fun getResources(query: SupportSQLiteQuery): List<String>
+  @Query(
+    """
+        SELECT *
+        FROM ResourceEntity
+        WHERE resourceUuid = :resourceUuid
+    """,
+  )
+  abstract suspend fun getResourceEntity(
+    resourceUuid: UUID,
+  ): ResourceEntity?
+
+  @RawQuery
+  abstract suspend fun getResources(query: SupportSQLiteQuery): List<SerializedResourceWithUuid>
+
+  @RawQuery
+  abstract suspend fun getForwardReferencedResources(
+    query: SupportSQLiteQuery,
+  ): List<ForwardIncludeSearchResponse>
 
   @RawQuery
-  abstract suspend fun getReferencedResources(
+  abstract suspend fun getReverseReferencedResources(
     query: SupportSQLiteQuery,
-  ): List<IndexedIdAndSerializedResource>
+  ): List<ReverseIncludeSearchResponse>
 
   @RawQuery abstract suspend fun countResources(query: SupportSQLiteQuery): Long
 
@@ -189,7 +250,7 @@ internal abstract class ResourceDao {
   private suspend fun insertRemoteResource(resource: Resource): UUID {
     val existingResourceEntity = getResourceEntity(resource.logicalId, resource.resourceType)
     if (existingResourceEntity != null) {
-      update(resource, existingResourceEntity.lastUpdatedLocal)
+      applyRemoteUpdate(resource)
       return existingResourceEntity.resourceUuid
     }
     return insertResource(resource, null)
@@ -356,23 +417,39 @@ internal abstract class ResourceDao {
   }
 }
 
-/**
- * Data class representing the value returned by [getReferencedResources]. The optional fields may
- * or may-not contain values based on the search query.
- */
-internal data class IndexedIdAndSerializedResource(
+internal class ForwardIncludeSearchResponse(
+  @ColumnInfo(name = "index_name") val matchingIndex: String,
+  @ColumnInfo(name = "resourceUuid") val baseResourceUUID: UUID,
+  val serializedResource: String,
+)
+
+internal class ReverseIncludeSearchResponse(
   @ColumnInfo(name = "index_name") val matchingIndex: String,
-  @ColumnInfo(name = "index_value") val idOfBaseResourceOnWhichThisMatchedRev: String?,
-  @ColumnInfo(name = "resourceId") val idOfBaseResourceOnWhichThisMatchedInc: String?,
+  @ColumnInfo(name = "index_value") val baseResourceTypeAndId: String,
   val serializedResource: String,
 )
 
 /**
- * Data class representing an included or revIncluded [Resource], index on which the match was done
- * and the id of the base [Resource] for which this [Resource] has been included.
+ * Data class representing a forward included [Resource], index on which the match was done and the
+ * uuid of the base [Resource] for which this [Resource] has been included.
  */
-internal data class IndexedIdAndResource(
-  val matchingIndex: String,
-  val idOfBaseResourceOnWhichThisMatched: String,
+internal data class ForwardIncludeSearchResult(
+  val searchIndex: String,
+  val baseResourceUUID: UUID,
   val resource: Resource,
 )
+
+/**
+ * Data class representing a reverse included [Resource], index on which the match was done and the
+ * type and logical id of the base [Resource] for which this [Resource] has been included.
+ */
+internal data class ReverseIncludeSearchResult(
+  val searchIndex: String,
+  val baseResourceTypeWithId: String,
+  val resource: Resource,
+)
+
+internal data class SerializedResourceWithUuid(
+  @ColumnInfo(name = "resourceUuid") val uuid: UUID,
+  val serializedResource: String,
+)
diff --git a/engine/src/main/java/com/google/android/fhir/db/impl/entities/LocalChangeResourceReferenceEntity.kt b/engine/src/main/java/com/google/android/fhir/db/impl/entities/LocalChangeResourceReferenceEntity.kt
new file mode 100644
index 0000000000..b02883254e
--- /dev/null
+++ b/engine/src/main/java/com/google/android/fhir/db/impl/entities/LocalChangeResourceReferenceEntity.kt
@@ -0,0 +1,48 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.db.impl.entities
+
+import androidx.room.Entity
+import androidx.room.ForeignKey
+import androidx.room.Index
+import androidx.room.PrimaryKey
+
+@Entity(
+  indices =
+    [
+      Index(value = ["resourceReferenceValue"]),
+      // To avoid full table scans whenever parent table is modified.
+      Index(value = ["localChangeId"]),
+    ],
+  foreignKeys =
+    [
+      ForeignKey(
+        entity = LocalChangeEntity::class,
+        parentColumns = ["id"],
+        childColumns = ["localChangeId"],
+        onDelete = ForeignKey.CASCADE,
+        onUpdate = ForeignKey.NO_ACTION,
+        deferred = true,
+      ),
+    ],
+)
+internal data class LocalChangeResourceReferenceEntity(
+  @PrimaryKey(autoGenerate = true) val id: Long,
+  val localChangeId: Long,
+  val resourceReferenceValue: String,
+  val resourceReferencePath: String?,
+)
diff --git a/engine/src/main/java/com/google/android/fhir/impl/FhirEngineImpl.kt b/engine/src/main/java/com/google/android/fhir/impl/FhirEngineImpl.kt
index c1519cd4a8..0c105f1cef 100644
--- a/engine/src/main/java/com/google/android/fhir/impl/FhirEngineImpl.kt
+++ b/engine/src/main/java/com/google/android/fhir/impl/FhirEngineImpl.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -17,8 +17,8 @@
 package com.google.android.fhir.impl
 
 import android.content.Context
-import com.google.android.fhir.DatastoreUtil
 import com.google.android.fhir.FhirEngine
+import com.google.android.fhir.FhirEngineProvider
 import com.google.android.fhir.LocalChange
 import com.google.android.fhir.SearchResult
 import com.google.android.fhir.db.Database
@@ -67,7 +67,7 @@ internal class FhirEngineImpl(private val database: Database, private val contex
   }
 
   override suspend fun getLastSyncTimeStamp(): OffsetDateTime? {
-    return DatastoreUtil(context).readLastSyncTimestamp()
+    return FhirEngineProvider.getFhirDataStore(context).readLastSyncTimestamp()
   }
 
   override suspend fun clearDatabase() {
diff --git a/engine/src/main/java/com/google/android/fhir/search/MoreSearch.kt b/engine/src/main/java/com/google/android/fhir/search/MoreSearch.kt
index 60b3fe1472..d2b42c3f1a 100644
--- a/engine/src/main/java/com/google/android/fhir/search/MoreSearch.kt
+++ b/engine/src/main/java/com/google/android/fhir/search/MoreSearch.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -16,6 +16,9 @@
 
 package com.google.android.fhir.search
 
+import android.annotation.SuppressLint
+import androidx.annotation.VisibleForTesting
+import androidx.room.util.convertUUIDToByte
 import ca.uhn.fhir.rest.gclient.DateClientParam
 import ca.uhn.fhir.rest.gclient.NumberClientParam
 import ca.uhn.fhir.rest.gclient.StringClientParam
@@ -31,11 +34,13 @@ import com.google.android.fhir.logicalId
 import com.google.android.fhir.ucumUrl
 import java.math.BigDecimal
 import java.util.Date
+import java.util.UUID
 import kotlin.math.absoluteValue
 import kotlin.math.roundToLong
 import org.hl7.fhir.r4.model.DateTimeType
 import org.hl7.fhir.r4.model.DateType
 import org.hl7.fhir.r4.model.Resource
+import timber.log.Timber
 
 /**
  * The multiplier used to determine the range for the `ap` search prefix. See
@@ -49,35 +54,36 @@ internal suspend fun <R : Resource> Search.execute(database: Database): List<Sea
     if (forwardIncludes.isEmpty() || baseResources.isEmpty()) {
       null
     } else {
-      database.searchReferencedResources(
-        getIncludeQuery(includeIds = baseResources.map { it.logicalId }),
+      database.searchForwardReferencedResources(
+        getIncludeQuery(includeIds = baseResources.map { it.uuid }),
       )
     }
   val revIncludedResources =
     if (revIncludes.isEmpty() || baseResources.isEmpty()) {
       null
     } else {
-      database.searchReferencedResources(
-        getRevIncludeQuery(includeIds = baseResources.map { "${it.resourceType}/${it.logicalId}" }),
+      database.searchReverseReferencedResources(
+        getRevIncludeQuery(
+          includeIds = baseResources.map { "${it.resource.resourceType}/${it.resource.logicalId}" },
+        ),
       )
     }
 
-  return baseResources.map { baseResource ->
+  return baseResources.map { (uuid, baseResource) ->
     SearchResult(
       baseResource,
       included =
         includedResources
           ?.asSequence()
-          ?.filter { it.idOfBaseResourceOnWhichThisMatched == baseResource.logicalId }
-          ?.groupBy({ it.matchingIndex }, { it.resource }),
+          ?.filter { it.baseResourceUUID == uuid }
+          ?.groupBy({ it.searchIndex }, { it.resource }),
       revIncluded =
         revIncludedResources
           ?.asSequence()
           ?.filter {
-            it.idOfBaseResourceOnWhichThisMatched ==
-              "${baseResource.fhirType()}/${baseResource.logicalId}"
+            it.baseResourceTypeWithId == "${baseResource.fhirType()}/${baseResource.logicalId}"
           }
-          ?.groupBy({ it.resource.resourceType to it.matchingIndex }, { it.resource }),
+          ?.groupBy({ it.resource.resourceType to it.searchIndex }, { it.resource }),
     )
   }
 }
@@ -90,136 +96,138 @@ fun Search.getQuery(isCount: Boolean = false): SearchQuery {
   return getQuery(isCount, null)
 }
 
-private fun Search.getRevIncludeQuery(includeIds: List<String>): SearchQuery {
-  var matchQuery = ""
+@VisibleForTesting
+internal fun Search.getRevIncludeQuery(includeIds: List<String>): SearchQuery {
   val args = mutableListOf<Any>()
-  args.addAll(includeIds)
+  val uuidsString = CharArray(includeIds.size) { '?' }.joinToString()
 
-  // creating the match and filter query
-  revIncludes.forEachIndexed { index, (param, search) ->
+  fun generateFilterQuery(nestedSearch: NestedSearch): String {
+    val (param, search) = nestedSearch
     val resourceToInclude = search.type
     args.add(resourceToInclude.name)
     args.add(param.paramName)
-    matchQuery += " ( a.resourceType = ? and a.index_name IN (?) "
-
-    val allFilters = search.getFilterQueries()
+    args.addAll(includeIds)
+    args.add(resourceToInclude.name)
 
-    if (allFilters.isNotEmpty()) {
-      val iterator = allFilters.listIterator()
-      matchQuery += "AND b.resourceUuid IN (\n"
-      do {
-        iterator.next().let {
-          matchQuery += it.query
-          args.addAll(it.args)
-        }
+    var filterQuery = ""
+    val filters = search.getFilterQueries()
+    val iterator = filters.listIterator()
+    while (iterator.hasNext()) {
+      iterator.next().let {
+        filterQuery += it.query
+        args.addAll(it.args)
+      }
 
-        if (iterator.hasNext()) {
-          matchQuery +=
-            if (search.operation == Operation.OR) {
-              "\n UNION \n"
-            } else {
-              "\n INTERSECT \n"
-            }
-        }
-      } while (iterator.hasNext())
-      matchQuery += "\n)"
+      if (iterator.hasNext()) {
+        filterQuery +=
+          if (search.operation == Operation.OR) {
+            "\n UNION \n"
+          } else {
+            "\n INTERSECT \n"
+          }
+      }
     }
-
-    matchQuery += " \n)"
-
-    if (index != revIncludes.lastIndex) matchQuery += " OR "
+    return filterQuery
   }
 
-  return SearchQuery(
-    query =
+  return revIncludes
+    .map {
+      val (join, order) = it.search.getSortOrder(otherTable = "re")
+      args.addAll(join.args)
+      val filterQuery = generateFilterQuery(it)
       """
-    SELECT a.index_name, a.index_value, b.serializedResource 
-    FROM ReferenceIndexEntity a 
-    JOIN  ResourceEntity b
-    ON  a.resourceUuid = b.resourceUuid
-    AND  a.index_value IN( ${ CharArray(includeIds.size) { '?' }.joinToString()} ) 
-    ${if (matchQuery.isEmpty()) "" else "AND ($matchQuery) " }
-        """
-        .trimIndent(),
-    args = args,
-  )
+      SELECT  rie.index_name, rie.index_value, re.serializedResource
+      FROM ResourceEntity re
+      JOIN ReferenceIndexEntity rie
+      ON re.resourceUuid = rie.resourceUuid
+      ${join.query}
+      WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.index_value IN ($uuidsString) AND re.resourceType = ?
+      ${if (filterQuery.isNotEmpty()) "AND re.resourceUuid IN ($filterQuery)" else ""}
+      $order
+            """
+        .trimIndent()
+    }
+    .joinToString("\nUNION ALL\n") {
+      StringBuilder("SELECT * FROM (\n").append(it.trim()).append("\n)")
+    }
+    .split("\n")
+    .filter { it.isNotBlank() }
+    .joinToString("\n") { it.trim() }
+    .let { SearchQuery(it, args) }
 }
 
-private fun Search.getIncludeQuery(includeIds: List<String>): SearchQuery {
-  var matchQuery = ""
-  val args = mutableListOf<Any>(type.name)
-  args.addAll(includeIds)
+@SuppressLint("RestrictedApi")
+@VisibleForTesting
+internal fun Search.getIncludeQuery(includeIds: List<UUID>): SearchQuery {
+  val args = mutableListOf<Any>()
+  val baseResourceType = type
+  val uuidsString = CharArray(includeIds.size) { '?' }.joinToString()
 
-  // creating the match and filter query
-  forwardIncludes.forEachIndexed { index, (param, search) ->
+  fun generateFilterQuery(nestedSearch: NestedSearch): String {
+    val (param, search) = nestedSearch
     val resourceToInclude = search.type
-    args.add(resourceToInclude.name)
+    args.add(baseResourceType.name)
     args.add(param.paramName)
-    matchQuery += " ( c.resourceType = ? and b.index_name IN (?) "
-
-    val allFilters = search.getFilterQueries()
+    args.addAll(includeIds.map { convertUUIDToByte(it) })
+    args.add(resourceToInclude.name)
 
-    if (allFilters.isNotEmpty()) {
-      val iterator = allFilters.listIterator()
-      matchQuery += "AND c.resourceUuid IN (\n"
-      do {
-        iterator.next().let {
-          matchQuery += it.query
-          args.addAll(it.args)
-        }
+    var filterQuery = ""
+    val filters = search.getFilterQueries()
+    val iterator = filters.listIterator()
+    while (iterator.hasNext()) {
+      iterator.next().let {
+        filterQuery += it.query
+        args.addAll(it.args)
+      }
 
-        if (iterator.hasNext()) {
-          matchQuery +=
-            if (search.operation == Operation.OR) {
-              "\n UNION \n"
-            } else {
-              "\n INTERSECT \n"
-            }
-        }
-      } while (iterator.hasNext())
-      matchQuery += "\n)"
+      if (iterator.hasNext()) {
+        filterQuery +=
+          if (search.operation == Operation.OR) {
+            "\nUNION\n"
+          } else {
+            "\nINTERSECT\n"
+          }
+      }
     }
-
-    matchQuery += " \n)"
-
-    if (index != forwardIncludes.lastIndex) matchQuery += " OR "
+    return filterQuery
   }
 
-  return SearchQuery(
-    query =
-      //  spotless:off
-    """
-    SELECT b.index_name,  a.resourceId, c.serializedResource from ResourceEntity a 
-    JOIN ReferenceIndexEntity b 
-    On a.resourceUuid = b.resourceUuid
-    AND a.resourceType = ?
-    AND a.resourceId IN ( ${ CharArray(includeIds.size) { '?' }.joinToString()} ) 
-    JOIN ResourceEntity c
-    ON c.resourceType||"/"||c.resourceId = b.index_value
-    ${if (matchQuery.isEmpty()) "" else "AND ($matchQuery) " }
-    """.trimIndent(),
-    //  spotless:on
-    args = args,
-  )
+  return forwardIncludes
+    .map {
+      val (join, order) = it.search.getSortOrder(otherTable = "re")
+      args.addAll(join.args)
+      val filterQuery = generateFilterQuery(it)
+      """
+      SELECT  rie.index_name, rie.resourceUuid, re.serializedResource
+      FROM ResourceEntity re
+      JOIN ReferenceIndexEntity rie
+      ON re.resourceType||"/"||re.resourceId = rie.index_value
+      ${join.query}
+      WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.resourceUuid IN ($uuidsString) AND re.resourceType = ?
+      ${if (filterQuery.isNotEmpty()) "AND re.resourceUuid IN ($filterQuery)" else ""}
+      $order
+      """
+        .trimIndent()
+    }
+    .joinToString("\nUNION ALL\n") {
+      StringBuilder("SELECT * FROM (\n").append(it.trim()).append("\n)")
+    }
+    .split("\n")
+    .filter { it.isNotBlank() }
+    .joinToString("\n") { it.trim() }
+    .let { SearchQuery(it, args) }
 }
 
-private fun Search.getFilterQueries() =
-  (stringFilterCriteria +
-      quantityFilterCriteria +
-      numberFilterCriteria +
-      referenceFilterCriteria +
-      dateTimeFilterCriteria +
-      tokenFilterCriteria +
-      uriFilterCriteria)
-    .map { it.query(type) }
-
-internal fun Search.getQuery(
-  isCount: Boolean = false,
-  nestedContext: NestedContext? = null,
-): SearchQuery {
+private fun Search.getSortOrder(
+  otherTable: String,
+  isReferencedSearch: Boolean = false,
+): Pair<SearchQuery, String> {
   var sortJoinStatement = ""
   var sortOrderStatement = ""
-  val sortArgs = mutableListOf<Any>()
+  val args = mutableListOf<Any>()
+  if (isReferencedSearch && count != null) {
+    Timber.e("count not supported for [rev]include search.")
+  }
   sort?.let { sort ->
     val sortTableNames =
       when (sort) {
@@ -232,20 +240,20 @@ internal fun Search.getQuery(
           listOf(SortTableInfo.DATE_SORT_TABLE_INFO, SortTableInfo.DATE_TIME_SORT_TABLE_INFO)
         else -> throw NotImplementedError("Unhandled sort parameter of type ${sort::class}: $sort")
       }
-    sortJoinStatement = ""
-
-    sortTableNames.forEachIndexed { index, sortTableName ->
-      val tableAlias = 'b' + index
 
-      sortJoinStatement +=
-        //  spotless:off
+    sortJoinStatement =
+      sortTableNames
+        .mapIndexed { index, sortTableName ->
+          val tableAlias = 'b' + index
+          //  spotless:off
       """
       LEFT JOIN ${sortTableName.tableName} $tableAlias
-      ON a.resourceType = $tableAlias.resourceType AND a.resourceUuid = $tableAlias.resourceUuid AND $tableAlias.index_name = ?
+      ON $otherTable.resourceType = $tableAlias.resourceType AND $otherTable.resourceUuid = $tableAlias.resourceUuid AND $tableAlias.index_name = ?
       """
-      //  spotless:on
-      sortArgs += sort.paramName
-    }
+        //  spotless:on
+        }
+        .joinToString(separator = "\n")
+    sortTableNames.forEach { _ -> args.add(sort.paramName) }
 
     sortTableNames.forEachIndexed { index, sortTableName ->
       val tableAlias = 'b' + index
@@ -253,13 +261,34 @@ internal fun Search.getQuery(
         if (index == 0) {
           """
             ORDER BY $tableAlias.${sortTableName.columnName} ${order.sqlString}
-                    """
+          """
             .trimIndent()
         } else {
           ", $tableAlias.${SortTableInfo.DATE_TIME_SORT_TABLE_INFO.columnName} ${order.sqlString}"
         }
     }
   }
+  return Pair(SearchQuery(sortJoinStatement, args), sortOrderStatement)
+}
+
+private fun Search.getFilterQueries() =
+  (stringFilterCriteria +
+      quantityFilterCriteria +
+      numberFilterCriteria +
+      referenceFilterCriteria +
+      dateTimeFilterCriteria +
+      tokenFilterCriteria +
+      uriFilterCriteria)
+    .map { it.query(type) }
+
+internal fun Search.getQuery(
+  isCount: Boolean = false,
+  nestedContext: NestedContext? = null,
+): SearchQuery {
+  val (join, order) = getSortOrder(otherTable = "a")
+  val sortJoinStatement = join.query
+  val sortOrderStatement = order
+  val sortArgs = join.args
 
   var filterStatement = ""
   val filterArgs = mutableListOf<Any>()
@@ -293,6 +322,7 @@ internal fun Search.getQuery(
     filterArgs.addAll(it.args)
   }
   val whereArgs = mutableListOf<Any>()
+  val nestedArgs = mutableListOf<Any>()
   val query =
     when {
         isCount -> {
@@ -311,11 +341,12 @@ internal fun Search.getQuery(
         nestedContext != null -> {
           whereArgs.add(nestedContext.param.paramName)
           val start = "${nestedContext.parentType.name}/".length + 1
+          nestedArgs.add(nestedContext.parentType.name)
           //  spotless:off
         """
         SELECT resourceUuid
         FROM ResourceEntity a
-        WHERE a.resourceId IN (
+        WHERE a.resourceType = ? AND a.resourceId IN (
         SELECT substr(a.index_value, $start)
         FROM ReferenceIndexEntity a
         $sortJoinStatement
@@ -329,7 +360,7 @@ internal fun Search.getQuery(
         else ->
           //  spotless:off
         """ 
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         $sortJoinStatement
         WHERE a.resourceType = ?
@@ -342,7 +373,7 @@ internal fun Search.getQuery(
       .split("\n")
       .filter { it.isNotBlank() }
       .joinToString("\n") { it.trim() }
-  return SearchQuery(query, sortArgs + type.name + whereArgs + filterArgs + limitArgs)
+  return SearchQuery(query, nestedArgs + sortArgs + type.name + whereArgs + filterArgs + limitArgs)
 }
 
 private val Order?.sqlString: String
diff --git a/engine/src/main/java/com/google/android/fhir/search/NestedSearch.kt b/engine/src/main/java/com/google/android/fhir/search/NestedSearch.kt
index fe027fc272..4818680ec5 100644
--- a/engine/src/main/java/com/google/android/fhir/search/NestedSearch.kt
+++ b/engine/src/main/java/com/google/android/fhir/search/NestedSearch.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2022-2023 Google LLC
+ * Copyright 2022-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -68,7 +68,9 @@ inline fun <reified R : Resource> Search.has(
  * }
  * ```
  *
- * **NOTE**: [include] doesn't support order OR count.
+ * **NOTE**:
+ * * [include] doesn't support count.
+ * * Multiple includes of the same resource type do not guarantee the order of returned resources.
  */
 inline fun <reified R : Resource> Search.include(
   referenceParam: ReferenceClientParam,
@@ -99,7 +101,9 @@ inline fun <reified R : Resource> Search.include(
  * }
  * ```
  *
- * **NOTE**: [include] doesn't support order OR count.
+ * **NOTE**:
+ * * [include] doesn't support count.
+ * * Multiple includes of the same resource type do not guarantee the order of returned resources.
  */
 fun Search.include(
   resourceType: ResourceType,
@@ -129,7 +133,10 @@ fun Search.include(
  * }
  * ```
  *
- * **NOTE**: [revInclude] doesn't support order OR count.
+ * **NOTE**:
+ * * [revInclude] doesn't support count.
+ * * Multiple revIncludes of the same resource type do not guarantee the order of returned
+ *   resources.
  */
 inline fun <reified R : Resource> Search.revInclude(
   referenceParam: ReferenceClientParam,
@@ -160,7 +167,10 @@ inline fun <reified R : Resource> Search.revInclude(
  * }
  * ```
  *
- * **NOTE**: [revInclude] doesn't support order OR count.
+ * **NOTE**:
+ * * [revInclude] doesn't support count.
+ * * Multiple revIncludes of the same resource type do not guarantee the order of returned
+ *   resources.
  */
 fun Search.revInclude(
   resourceType: ResourceType,
diff --git a/engine/src/main/java/com/google/android/fhir/sync/Config.kt b/engine/src/main/java/com/google/android/fhir/sync/Config.kt
index 194890b2c5..8eaf884162 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/Config.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/Config.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -34,6 +34,8 @@ typealias ParamMap = Map<String, String>
 /** Constant for the Greater Than Search Prefix */
 @PublishedApi internal const val GREATER_THAN_PREFIX = "gt"
 
+@PublishedApi internal const val UNIQUE_WORK_NAME = "unique_work_name"
+
 val defaultRetryConfiguration =
   RetryConfiguration(BackoffCriteria(BackoffPolicy.LINEAR, 30, TimeUnit.SECONDS), 3)
 
diff --git a/engine/src/main/java/com/google/android/fhir/sync/FhirDataStore.kt b/engine/src/main/java/com/google/android/fhir/sync/FhirDataStore.kt
new file mode 100644
index 0000000000..5cb1245796
--- /dev/null
+++ b/engine/src/main/java/com/google/android/fhir/sync/FhirDataStore.kt
@@ -0,0 +1,107 @@
+/*
+ * Copyright 2023-2024 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.sync
+
+import android.content.Context
+import androidx.datastore.preferences.core.edit
+import androidx.datastore.preferences.core.emptyPreferences
+import androidx.datastore.preferences.core.stringPreferencesKey
+import androidx.datastore.preferences.preferencesDataStore
+import java.io.IOException
+import java.time.OffsetDateTime
+import kotlinx.coroutines.flow.Flow
+import kotlinx.coroutines.flow.catch
+import kotlinx.coroutines.flow.first
+import kotlinx.coroutines.flow.map
+import kotlinx.coroutines.runBlocking
+import timber.log.Timber
+
+@PublishedApi
+internal class FhirDataStore(context: Context) {
+  private val Context.dataStore by
+    preferencesDataStore(
+      name = FHIR_PREFERENCES_NAME,
+    )
+  private val dataStore = context.dataStore
+  private val serializer = SyncJobStatus.SyncJobStatusSerializer()
+  private val syncJobStatusFlowMap = mutableMapOf<String, Flow<SyncJobStatus?>>()
+  private val lastSyncTimestampKey by lazy { stringPreferencesKey(LAST_SYNC_TIMESTAMP) }
+
+  /**
+   * Observes the sync job terminal state for a given key and provides it as a Flow.
+   *
+   * @param key The key associated with the sync job.
+   * @return A Flow of [SyncJobStatus] representing the terminal state of the sync job, or null if
+   *   the state is not allowed.
+   */
+  @PublishedApi
+  internal fun observeTerminalSyncJobStatus(key: String): Flow<SyncJobStatus?> =
+    syncJobStatusFlowMap.getOrPut(key) {
+      dataStore.data
+        .catch { exception ->
+          if (exception is IOException) {
+            Timber.e(exception)
+            emit(emptyPreferences())
+          } else {
+            Timber.e(exception)
+            throw exception
+          }
+        }
+        .map { preferences -> serializer.deserialize(preferences[stringPreferencesKey(key)]) }
+    }
+
+  /**
+   * Edits the DataStore to store synchronization job status. It creates a data object containing
+   * the state type and serialized state of the synchronization job status. The edited preferences
+   * are updated with the serialized data.
+   *
+   * @param syncJobStatus The synchronization job status to be stored.
+   * @param key The key associated with the data to edit.
+   */
+  internal suspend fun writeTerminalSyncJobStatus(
+    key: String,
+    syncJobStatus: SyncJobStatus,
+  ) {
+    when (syncJobStatus) {
+      is SyncJobStatus.Succeeded,
+      is SyncJobStatus.Failed, -> {
+        writeSyncJobStatus(key, syncJobStatus)
+      }
+      else -> error("Do not write non-terminal state")
+    }
+  }
+
+  private suspend fun writeSyncJobStatus(key: String, syncJobStatus: SyncJobStatus) {
+    dataStore.edit { preferences ->
+      preferences[stringPreferencesKey(key)] = serializer.serialize(syncJobStatus)
+    }
+  }
+
+  internal fun readLastSyncTimestamp(): OffsetDateTime? {
+    val millis = runBlocking { dataStore.data.first()[lastSyncTimestampKey] } ?: return null
+    return OffsetDateTime.parse(millis)
+  }
+
+  internal fun writeLastSyncTimestamp(datetime: OffsetDateTime) {
+    runBlocking { dataStore.edit { pref -> pref[lastSyncTimestampKey] = datetime.toString() } }
+  }
+
+  companion object {
+    private const val FHIR_PREFERENCES_NAME = "FHIR_ENGINE_PREF_DATASTORE"
+    private const val LAST_SYNC_TIMESTAMP = "LAST_SYNC_TIMESTAMP"
+  }
+}
diff --git a/engine/src/main/java/com/google/android/fhir/sync/FhirSyncWorker.kt b/engine/src/main/java/com/google/android/fhir/sync/FhirSyncWorker.kt
index fe5a78206b..bc07ddc12a 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/FhirSyncWorker.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/FhirSyncWorker.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -25,7 +25,10 @@ import com.google.android.fhir.FhirEngine
 import com.google.android.fhir.FhirEngineProvider
 import com.google.android.fhir.OffsetDateTimeTypeAdapter
 import com.google.android.fhir.sync.download.DownloaderImpl
+import com.google.android.fhir.sync.upload.UploadStrategy
 import com.google.android.fhir.sync.upload.Uploader
+import com.google.android.fhir.sync.upload.patch.PatchGeneratorFactory
+import com.google.android.fhir.sync.upload.request.UploadRequestGeneratorFactory
 import com.google.gson.ExclusionStrategy
 import com.google.gson.FieldAttributes
 import com.google.gson.GsonBuilder
@@ -45,6 +48,8 @@ abstract class FhirSyncWorker(appContext: Context, workerParams: WorkerParameter
 
   abstract fun getConflictResolver(): ConflictResolver
 
+  abstract fun getUploadStrategy(): UploadStrategy
+
   private val gson =
     GsonBuilder()
       .registerTypeAdapter(OffsetDateTime::class.java, OffsetDateTimeTypeAdapter().nullSafe())
@@ -67,21 +72,41 @@ abstract class FhirSyncWorker(appContext: Context, workerParams: WorkerParameter
 
     val synchronizer =
       FhirSynchronizer(
-        applicationContext,
         getFhirEngine(),
-        Uploader(dataSource),
-        DownloaderImpl(dataSource, getDownloadWorkManager()),
-        getConflictResolver(),
+        UploadConfiguration(
+          Uploader(
+            dataSource = dataSource,
+            patchGenerator = PatchGeneratorFactory.byMode(getUploadStrategy().patchGeneratorMode),
+            requestGenerator =
+              UploadRequestGeneratorFactory.byMode(getUploadStrategy().requestGeneratorMode),
+          ),
+        ),
+        DownloadConfiguration(
+          DownloaderImpl(dataSource, getDownloadWorkManager()),
+          getConflictResolver(),
+        ),
+        FhirEngineProvider.getFhirDataStore(applicationContext),
       )
 
     val job =
       CoroutineScope(Dispatchers.IO).launch {
-        synchronizer.syncState.collect {
-          // now send Progress to work manager so caller app can listen
-          setProgress(buildWorkData(it))
-
-          if (it is SyncJobStatus.Finished || it is SyncJobStatus.Failed) {
-            this@launch.cancel()
+        val fhirDataStore = FhirEngineProvider.getFhirDataStore(applicationContext)
+        synchronizer.syncState.collect { syncJobStatus ->
+          val uniqueWorkerName = inputData.getString(UNIQUE_WORK_NAME)
+          when (syncJobStatus) {
+            is SyncJobStatus.Succeeded,
+            is SyncJobStatus.Failed, -> {
+              // While creating periodicSync request if
+              // putString(SYNC_STATUS_PREFERENCES_DATASTORE_KEY, uniqueWorkName) is not present,
+              // then inputData.getString(SYNC_STATUS_PREFERENCES_DATASTORE_KEY) can be null.
+              if (uniqueWorkerName != null) {
+                fhirDataStore.writeTerminalSyncJobStatus(uniqueWorkerName, syncJobStatus)
+              }
+              cancel()
+            }
+            else -> {
+              setProgress(buildWorkData(syncJobStatus))
+            }
           }
         }
       }
@@ -92,8 +117,6 @@ abstract class FhirSyncWorker(appContext: Context, workerParams: WorkerParameter
     // await/join is needed to collect states completely
     kotlin.runCatching { job.join() }.onFailure(Timber::w)
 
-    setProgress(output)
-
     Timber.d("Received result from worker $result and sending output $output")
 
     /**
@@ -102,7 +125,7 @@ abstract class FhirSyncWorker(appContext: Context, workerParams: WorkerParameter
      */
     val retries = inputData.getInt(MAX_RETRIES_ALLOWED, 0)
     return when (result) {
-      is SyncJobStatus.Finished -> Result.success(output)
+      is SyncJobStatus.Succeeded -> Result.success(output)
       else -> {
         if (retries > runAttemptCount) Result.retry() else Result.failure(output)
       }
diff --git a/engine/src/main/java/com/google/android/fhir/sync/FhirSynchronizer.kt b/engine/src/main/java/com/google/android/fhir/sync/FhirSynchronizer.kt
index acac045a14..e1b300884d 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/FhirSynchronizer.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/FhirSynchronizer.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -16,8 +16,6 @@
 
 package com.google.android.fhir.sync
 
-import android.content.Context
-import com.google.android.fhir.DatastoreUtil
 import com.google.android.fhir.FhirEngine
 import com.google.android.fhir.sync.download.DownloadState
 import com.google.android.fhir.sync.download.Downloader
@@ -44,20 +42,26 @@ private sealed class SyncResult {
 
 data class ResourceSyncException(val resourceType: ResourceType, val exception: Exception)
 
+internal data class UploadConfiguration(
+  val uploader: Uploader,
+)
+
+internal class DownloadConfiguration(
+  val downloader: Downloader,
+  val conflictResolver: ConflictResolver,
+)
+
 /** Class that helps synchronize the data source and save it in the local database */
 internal class FhirSynchronizer(
-  context: Context,
   private val fhirEngine: FhirEngine,
-  private val uploader: Uploader,
-  private val downloader: Downloader,
-  private val conflictResolver: ConflictResolver,
+  private val uploadConfiguration: UploadConfiguration,
+  private val downloadConfiguration: DownloadConfiguration,
+  private val datastoreUtil: FhirDataStore,
 ) {
 
   private val _syncState = MutableSharedFlow<SyncJobStatus>()
   val syncState: SharedFlow<SyncJobStatus> = _syncState
 
-  private val datastoreUtil = DatastoreUtil(context)
-
   private suspend fun setSyncState(state: SyncJobStatus) = _syncState.emit(state)
 
   private suspend fun setSyncState(result: SyncResult): SyncJobStatus {
@@ -66,7 +70,7 @@ internal class FhirSynchronizer(
 
     val state =
       when (result) {
-        is SyncResult.Success -> SyncJobStatus.Finished
+        is SyncResult.Success -> SyncJobStatus.Succeeded()
         is SyncResult.Error -> SyncJobStatus.Failed(result.exceptions)
       }
 
@@ -75,7 +79,7 @@ internal class FhirSynchronizer(
   }
 
   suspend fun synchronize(): SyncJobStatus {
-    setSyncState(SyncJobStatus.Started)
+    setSyncState(SyncJobStatus.Started())
 
     return listOf(download(), upload())
       .filterIsInstance<SyncResult.Error>()
@@ -91,9 +95,9 @@ internal class FhirSynchronizer(
 
   private suspend fun download(): SyncResult {
     val exceptions = mutableListOf<ResourceSyncException>()
-    fhirEngine.syncDownload(conflictResolver) {
+    fhirEngine.syncDownload(downloadConfiguration.conflictResolver) {
       flow {
-        downloader.download().collect {
+        downloadConfiguration.downloader.download().collect {
           when (it) {
             is DownloadState.Started -> {
               setSyncState(SyncJobStatus.InProgress(SyncOperation.DOWNLOAD, it.total))
@@ -119,7 +123,8 @@ internal class FhirSynchronizer(
   private suspend fun upload(): SyncResult {
     val exceptions = mutableListOf<ResourceSyncException>()
     val localChangesFetchMode = LocalChangesFetchMode.AllChanges
-    fhirEngine.syncUpload(localChangesFetchMode, uploader::upload).collect { progress ->
+    fhirEngine.syncUpload(localChangesFetchMode, uploadConfiguration.uploader::upload).collect {
+      progress ->
       progress.uploadError?.let { exceptions.add(it) }
         ?: setSyncState(
           SyncJobStatus.InProgress(
diff --git a/engine/src/main/java/com/google/android/fhir/sync/Sync.kt b/engine/src/main/java/com/google/android/fhir/sync/Sync.kt
index 584d76e2dc..3563bc687a 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/Sync.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/Sync.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -23,16 +23,26 @@ import androidx.work.ExistingPeriodicWorkPolicy
 import androidx.work.ExistingWorkPolicy
 import androidx.work.OneTimeWorkRequest
 import androidx.work.PeriodicWorkRequest
+import androidx.work.WorkInfo
+import androidx.work.WorkInfo.State.CANCELLED
+import androidx.work.WorkInfo.State.ENQUEUED
+import androidx.work.WorkInfo.State.RUNNING
 import androidx.work.WorkManager
 import androidx.work.hasKeyWithValueOfType
-import com.google.android.fhir.DatastoreUtil
+import com.google.android.fhir.FhirEngineProvider
 import com.google.android.fhir.OffsetDateTimeTypeAdapter
+import com.google.android.fhir.sync.CurrentSyncJobStatus.Cancelled
+import com.google.android.fhir.sync.CurrentSyncJobStatus.Enqueued
+import com.google.android.fhir.sync.CurrentSyncJobStatus.Failed
+import com.google.android.fhir.sync.CurrentSyncJobStatus.Running
+import com.google.android.fhir.sync.CurrentSyncJobStatus.Succeeded
 import com.google.gson.Gson
 import com.google.gson.GsonBuilder
 import java.time.OffsetDateTime
 import kotlinx.coroutines.ExperimentalCoroutinesApi
 import kotlinx.coroutines.flow.Flow
 import kotlinx.coroutines.flow.asFlow
+import kotlinx.coroutines.flow.combine
 import kotlinx.coroutines.flow.flatMapConcat
 import kotlinx.coroutines.flow.mapNotNull
 
@@ -49,21 +59,23 @@ object Sync {
    * the same [FhirSyncWorker] to retrieve the status of the job.
    *
    * @param retryConfiguration configuration to guide the retry mechanism, or `null` to stop retry.
-   * @return a [Flow] of [SyncJobStatus]
+   * @return a [Flow] of [CurrentSyncJobStatus]
    */
   inline fun <reified W : FhirSyncWorker> oneTimeSync(
     context: Context,
     retryConfiguration: RetryConfiguration? = defaultRetryConfiguration,
-  ): Flow<SyncJobStatus> {
+  ): Flow<CurrentSyncJobStatus> {
     val uniqueWorkName = "${W::class.java.name}-oneTimeSync"
     val flow = getWorkerInfo(context, uniqueWorkName)
+    val oneTimeWorkRequest =
+      createOneTimeWorkRequest(retryConfiguration, W::class.java, uniqueWorkName)
     WorkManager.getInstance(context)
       .enqueueUniqueWork(
         uniqueWorkName,
         ExistingWorkPolicy.KEEP,
-        createOneTimeWorkRequest(retryConfiguration, W::class.java),
+        oneTimeWorkRequest,
       )
-    return flow
+    return combineSyncStateForOneTimeSync(context, uniqueWorkName, flow)
   }
 
   /**
@@ -74,44 +86,114 @@ object Sync {
    *
    * @param periodicSyncConfiguration configuration to determine the sync frequency and retry
    *   mechanism
-   * @return a [Flow] of [SyncJobStatus]
+   * @return a [Flow] of [PeriodicSyncJobStatus]
    */
   @ExperimentalCoroutinesApi
   inline fun <reified W : FhirSyncWorker> periodicSync(
     context: Context,
     periodicSyncConfiguration: PeriodicSyncConfiguration,
-  ): Flow<SyncJobStatus> {
+  ): Flow<PeriodicSyncJobStatus> {
     val uniqueWorkName = "${W::class.java.name}-periodicSync"
     val flow = getWorkerInfo(context, uniqueWorkName)
+    val periodicWorkRequest =
+      createPeriodicWorkRequest(periodicSyncConfiguration, W::class.java, uniqueWorkName)
     WorkManager.getInstance(context)
       .enqueueUniquePeriodicWork(
         uniqueWorkName,
         ExistingPeriodicWorkPolicy.KEEP,
-        createPeriodicWorkRequest(periodicSyncConfiguration, W::class.java),
+        periodicWorkRequest,
       )
-    return flow
+    return combineSyncStateForPeriodicSync(context, uniqueWorkName, flow)
   }
 
   /** Gets the worker info for the [FhirSyncWorker] */
-  fun getWorkerInfo(context: Context, workName: String) =
+  @PublishedApi
+  internal fun getWorkerInfo(context: Context, workName: String) =
     WorkManager.getInstance(context)
       .getWorkInfosForUniqueWorkLiveData(workName)
       .asFlow()
       .flatMapConcat { it.asFlow() }
       .mapNotNull { workInfo ->
-        workInfo.progress
-          .takeIf { it.keyValueMap.isNotEmpty() && it.hasKeyWithValueOfType<String>("StateType") }
-          ?.let {
-            val state = it.getString("StateType")!!
-            val stateData = it.getString("State")
-            gson.fromJson(stateData, Class.forName(state)) as SyncJobStatus
-          }
+        workInfo.state to
+          workInfo.progress
+            .takeIf { it.keyValueMap.isNotEmpty() && it.hasKeyWithValueOfType<String>("StateType") }
+            ?.let {
+              val state = it.getString("StateType")!!
+              val stateData = it.getString("State")
+              gson.fromJson(stateData, Class.forName(state)) as SyncJobStatus
+            }
       }
 
+  /**
+   * Combines the sync state for a periodic sync operation, including work state, progress, and
+   * terminal states.
+   *
+   * @param context The Android application context.
+   * @param workName The name of the periodic sync work.
+   * @param syncJobProgressStateFlow A flow representing the progress of the sync job.
+   * @return A flow of [PeriodicSyncJobStatus] combining the sync job states.
+   */
+  @PublishedApi
+  internal fun combineSyncStateForPeriodicSync(
+    context: Context,
+    workName: String,
+    workerInfoSyncJobStatusPairFromWorkManagerFlow: Flow<Pair<WorkInfo.State, SyncJobStatus?>>,
+  ): Flow<PeriodicSyncJobStatus> {
+    val syncJobStatusInDataStoreFlow: Flow<SyncJobStatus?> =
+      FhirEngineProvider.getFhirDataStore(context).observeTerminalSyncJobStatus(workName)
+    return combine(workerInfoSyncJobStatusPairFromWorkManagerFlow, syncJobStatusInDataStoreFlow) {
+      workerInfoSyncJobStatusPairFromWorkManager,
+      syncJobStatusFromDataStore,
+      ->
+      PeriodicSyncJobStatus(
+        lastSyncJobStatus = mapSyncJobStatusToResult(syncJobStatusFromDataStore),
+        currentSyncJobStatus =
+          createSyncState(
+            WorkRequest.PERIODIC,
+            workerInfoSyncJobStatusPairFromWorkManager.first,
+            workerInfoSyncJobStatusPairFromWorkManager.second,
+            syncJobStatusFromDataStore,
+          ),
+      )
+    }
+  }
+
+  /**
+   * Combines the sync state for a one-time sync operation, including work state, progress, and
+   * terminal states.
+   *
+   * @param context The Android application context.
+   * @param workName The name of the one-time sync work.
+   * @param syncJobProgressStateFlow A flow representing the progress of the sync job.
+   * @return A flow of [CurrentSyncJobStatus] combining the sync job states.
+   */
+  @PublishedApi
+  internal fun combineSyncStateForOneTimeSync(
+    context: Context,
+    workName: String,
+    workerInfoSyncJobStatusPairFromWorkManagerFlow: Flow<Pair<WorkInfo.State, SyncJobStatus?>>,
+  ): Flow<CurrentSyncJobStatus> {
+    val syncJobStatusInDataStoreFlow: Flow<SyncJobStatus?> =
+      FhirEngineProvider.getFhirDataStore(context).observeTerminalSyncJobStatus(workName)
+
+    return combine(workerInfoSyncJobStatusPairFromWorkManagerFlow, syncJobStatusInDataStoreFlow) {
+      workerInfoSyncJobStatusPairFromWorkManager,
+      syncJobStatusFromDataStore,
+      ->
+      createSyncState(
+        WorkRequest.ONE_TIME,
+        workerInfoSyncJobStatusPairFromWorkManager.first,
+        workerInfoSyncJobStatusPairFromWorkManager.second,
+        syncJobStatusFromDataStore,
+      )
+    }
+  }
+
   @PublishedApi
   internal inline fun <W : FhirSyncWorker> createOneTimeWorkRequest(
     retryConfiguration: RetryConfiguration?,
     clazz: Class<W>,
+    uniqueWorkName: String,
   ): OneTimeWorkRequest {
     val oneTimeWorkRequestBuilder = OneTimeWorkRequest.Builder(clazz)
     retryConfiguration?.let {
@@ -121,7 +203,10 @@ object Sync {
         it.backoffCriteria.timeUnit,
       )
       oneTimeWorkRequestBuilder.setInputData(
-        Data.Builder().putInt(MAX_RETRIES_ALLOWED, it.maxRetries).build(),
+        Data.Builder()
+          .putInt(MAX_RETRIES_ALLOWED, it.maxRetries)
+          .putString(UNIQUE_WORK_NAME, uniqueWorkName)
+          .build(),
       )
     }
     return oneTimeWorkRequestBuilder.build()
@@ -131,6 +216,7 @@ object Sync {
   internal inline fun <W : FhirSyncWorker> createPeriodicWorkRequest(
     periodicSyncConfiguration: PeriodicSyncConfiguration,
     clazz: Class<W>,
+    uniqueWorkName: String,
   ): PeriodicWorkRequest {
     val periodicWorkRequestBuilder =
       PeriodicWorkRequest.Builder(
@@ -147,7 +233,10 @@ object Sync {
         it.backoffCriteria.timeUnit,
       )
       periodicWorkRequestBuilder.setInputData(
-        Data.Builder().putInt(MAX_RETRIES_ALLOWED, it.maxRetries).build(),
+        Data.Builder()
+          .putInt(MAX_RETRIES_ALLOWED, it.maxRetries)
+          .putString(UNIQUE_WORK_NAME, uniqueWorkName)
+          .build(),
       )
     }
     return periodicWorkRequestBuilder.build()
@@ -155,6 +244,116 @@ object Sync {
 
   /** Gets the timestamp of the last sync job. */
   fun getLastSyncTimestamp(context: Context): OffsetDateTime? {
-    return DatastoreUtil(context).readLastSyncTimestamp()
+    return FhirEngineProvider.getFhirDataStore(context).readLastSyncTimestamp()
+  }
+
+  private fun createSyncState(
+    workRequest: WorkRequest,
+    workInfoState: WorkInfo.State,
+    syncJobStatusFromWorkManager: SyncJobStatus?,
+    syncJobStatusFromDataStore: SyncJobStatus?,
+  ): CurrentSyncJobStatus {
+    return when (syncJobStatusFromWorkManager) {
+      is SyncJobStatus.Started,
+      is SyncJobStatus.InProgress, -> Running(syncJobStatusFromWorkManager)
+      null -> {
+        when (workRequest) {
+          WorkRequest.ONE_TIME ->
+            handleNullWorkManagerStatusForOneTimeSync(workInfoState, syncJobStatusFromDataStore)
+          WorkRequest.PERIODIC ->
+            handleNullWorkManagerStatusForPeriodicSync(workInfoState, syncJobStatusFromDataStore)
+        }
+      }
+      else -> error("Inconsistent syncJobStatus: $syncJobStatusFromWorkManager.")
+    }
+  }
+
+  /**
+   * Only call this API when `syncJobStatusFromWorkManager` is null. Create a [CurrentSyncJobStatus]
+   * from `syncJobStatusFromDataStore` if it is not null; otherwise, create it from
+   * [WorkInfo.State].
+   */
+  private fun handleNullWorkManagerStatusForOneTimeSync(
+    workInfoState: WorkInfo.State,
+    syncJobStatusFromDataStore: SyncJobStatus?,
+  ): CurrentSyncJobStatus =
+    syncJobStatusFromDataStore?.let {
+      when (it) {
+        is SyncJobStatus.Succeeded -> Succeeded(it.timestamp)
+        is SyncJobStatus.Failed -> Failed(it.timestamp)
+        else -> error("Inconsistent terminal syncJobStatus : $syncJobStatusFromDataStore")
+      }
+    }
+      ?: when (workInfoState) {
+        RUNNING -> Running(SyncJobStatus.Started())
+        ENQUEUED -> Enqueued
+        CANCELLED -> Cancelled
+        // syncJobStatusFromDataStore should not be null for SUCCEEDED, FAILED.
+        else -> error("Inconsistent WorkInfo.State: $workInfoState.")
+      }
+
+  /**
+   * Only call this API when syncJobStatusFromWorkManager is null. Create a [CurrentSyncJobStatus]
+   * from [WorkInfo.State]. (Note: syncJobStatusFromDataStore is updated as lastSynJobStatus, which
+   * is the terminalSyncJobStatus.)
+   */
+  private fun handleNullWorkManagerStatusForPeriodicSync(
+    workInfoState: WorkInfo.State,
+  ): CurrentSyncJobStatus =
+    when (workInfoState) {
+      RUNNING -> Running(SyncJobStatus.Started())
+      ENQUEUED -> Enqueued
+      CANCELLED -> Cancelled
+      else -> error("Inconsistent WorkInfo.State in periodic sync : $workInfoState.")
+    }
+
+  private fun handleNullWorkManagerStatusForPeriodicSync(
+    workInfoState: WorkInfo.State,
+    syncJobStatusFromDataStore: SyncJobStatus?,
+  ): CurrentSyncJobStatus =
+    when (workInfoState) {
+      RUNNING -> Running(SyncJobStatus.Started())
+      ENQUEUED -> {
+        syncJobStatusFromDataStore?.let { mapDataStoreSyncJobStatusToCurrentSyncJobStatus(it) }
+          ?: Enqueued
+      }
+      CANCELLED -> Cancelled
+      else -> error("Inconsistent WorkInfo.State in periodic sync : $workInfoState.")
+    }
+
+  private fun mapDataStoreSyncJobStatusToCurrentSyncJobStatus(
+    syncJobStatusFromDataStore: SyncJobStatus,
+  ) =
+    when (syncJobStatusFromDataStore) {
+      is SyncJobStatus.Succeeded -> Succeeded(syncJobStatusFromDataStore.timestamp)
+      is SyncJobStatus.Failed -> Failed(syncJobStatusFromDataStore.timestamp)
+      else -> error("Inconsistent syncJobStatus in the dataStore : $syncJobStatusFromDataStore.")
+    }
+
+  /**
+   * Maps the [lastSyncJobStatus] to a specific [LastSyncJobStatus] based on the provided status.
+   *
+   * @param lastSyncJobStatus The last synchronization job status of type [SyncJobStatus].
+   * @return The mapped [LastSyncJobStatus] based on the provided [lastSyncJobStatus]:
+   * - [LastSyncJobStatus.Succeeded] with the timestamp if the last job status is
+   *   [SyncJobStatus.Succeeded].
+   * - [LastSyncJobStatus.Failed] with exceptions and timestamp if the last job status is
+   *   [SyncJobStatus.Failed].
+   * - `null` if the last job status is neither Finished nor Failed.
+   */
+  private fun mapSyncJobStatusToResult(
+    lastSyncJobStatus: SyncJobStatus?,
+  ) =
+    lastSyncJobStatus?.let {
+      when (it) {
+        is SyncJobStatus.Succeeded -> LastSyncJobStatus.Succeeded(it.timestamp)
+        is SyncJobStatus.Failed -> LastSyncJobStatus.Failed(lastSyncJobStatus.timestamp)
+        else -> error("Inconsistent terminal syncJobStatus : $lastSyncJobStatus")
+      }
+    }
+
+  private enum class WorkRequest {
+    ONE_TIME,
+    PERIODIC,
   }
 }
diff --git a/engine/src/main/java/com/google/android/fhir/sync/SyncJobStatus.kt b/engine/src/main/java/com/google/android/fhir/sync/SyncJobStatus.kt
index 8c063a28df..c74644d0dc 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/SyncJobStatus.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/SyncJobStatus.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2022-2023 Google LLC
+ * Copyright 2022-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -16,13 +16,90 @@
 
 package com.google.android.fhir.sync
 
+import androidx.work.Data
+import androidx.work.workDataOf
+import com.google.android.fhir.OffsetDateTimeTypeAdapter
+import com.google.gson.GsonBuilder
 import java.time.OffsetDateTime
 
+/**
+ * Data class representing the state of a periodic synchronization operation. It is a combined state
+ * of [WorkInfo.State] and [SyncJobStatus]. See [CurrentSyncJobStatus] and [LastSyncJobStatus] for
+ * more details.
+ *
+ * @property lastSyncJobStatus The result of the last synchronization job [LastSyncJobStatus]. It
+ *   only represents terminal states.
+ * @property currentSyncJobStatus The current state of the synchronization job
+ *   [CurrentSyncJobStatus].
+ */
+data class PeriodicSyncJobStatus(
+  val lastSyncJobStatus: LastSyncJobStatus?,
+  val currentSyncJobStatus: CurrentSyncJobStatus,
+)
+
+/**
+ * Sealed class representing the result of a synchronization operation. These are terminal states of
+ * the sync operation, representing [Succeeded] and [Failed].
+ *
+ * @property timestamp The timestamp when the synchronization result occurred.
+ */
+sealed class LastSyncJobStatus(val timestamp: OffsetDateTime) {
+  /** Represents a successful synchronization result. */
+  class Succeeded(timestamp: OffsetDateTime) : LastSyncJobStatus(timestamp)
+
+  /** Represents a failed synchronization result. */
+  class Failed(timestamp: OffsetDateTime) : LastSyncJobStatus(timestamp)
+}
+
+/**
+ * Sealed class representing different states of a synchronization operation. It combines
+ * [WorkInfo.State] and [SyncJobStatus]. Enqueued state represents [WorkInfo.State.ENQUEUED] where
+ * [SyncJobStatus] is not applicable. Running state is a combined state of [WorkInfo.State.ENQUEUED]
+ * and [SyncJobStatus.Started] or [SyncJobStatus.InProgress]. Succeeded state is a combined state of
+ * [WorkInfo.State.SUCCEEDED] and [SyncJobStatus.Started] or [SyncJobStatus.Succeeded]. Failed state
+ * is a combined state of [WorkInfo.State.FAILED] and [SyncJobStatus.Failed]. Cancelled state
+ * represents [WorkInfo.State.CANCELLED] where [SyncJobStatus] is not applicable.
+ */
+sealed class CurrentSyncJobStatus {
+  /** State indicating that the synchronization operation is enqueued. */
+  object Enqueued : CurrentSyncJobStatus()
+
+  /**
+   * State indicating that the synchronization operation is running.
+   *
+   * @param inProgressSyncJob The current status of the synchronization job.
+   */
+  data class Running(val inProgressSyncJob: SyncJobStatus) : CurrentSyncJobStatus()
+
+  /**
+   * State indicating that the synchronization operation succeeded.
+   *
+   * @param timestamp The timestamp when the synchronization result occurred.
+   */
+  class Succeeded(val timestamp: OffsetDateTime) : CurrentSyncJobStatus()
+
+  /**
+   * State indicating that the synchronization operation failed.
+   *
+   * @param timestamp The timestamp when the synchronization result occurred.
+   */
+  class Failed(val timestamp: OffsetDateTime) : CurrentSyncJobStatus()
+
+  /** State indicating that the synchronization operation is canceled. */
+  object Cancelled : CurrentSyncJobStatus()
+}
+
+/**
+ * Sealed class representing different states of a synchronization operation. These states do not
+ * represent [WorkInfo.State], whereas [CurrentSyncJobStatus] combines [WorkInfo.State] and
+ * [SyncJobStatus] in one-time and periodic sync. For more details, see [CurrentSyncJobStatus] and
+ * [PeriodicSyncJobStatus].
+ */
 sealed class SyncJobStatus {
   val timestamp: OffsetDateTime = OffsetDateTime.now()
 
   /** Sync job has been started on the client but the syncing is not necessarily in progress. */
-  object Started : SyncJobStatus()
+  class Started : SyncJobStatus()
 
   /** Syncing in progress with the server. */
   data class InProgress(
@@ -32,8 +109,73 @@ sealed class SyncJobStatus {
   ) : SyncJobStatus()
 
   /** Sync job finished successfully. */
-  object Finished : SyncJobStatus()
+  class Succeeded : SyncJobStatus()
 
   /** Sync job failed. */
   data class Failed(val exceptions: List<ResourceSyncException>) : SyncJobStatus()
+
+  /** Helper class for serializing and deserializing [SyncJobStatus] objects. */
+  internal class SyncJobStatusSerializer {
+    private val serializer =
+      GsonBuilder()
+        .registerTypeAdapter(OffsetDateTime::class.java, OffsetDateTimeTypeAdapter().nullSafe())
+        .setExclusionStrategies(FhirSyncWorker.StateExclusionStrategy())
+        .create()
+
+    private val allowedSyncJobStatusPackages =
+      listOf(
+        AllowedSyncJobStatus.SUCCEEDED.allowedPackage,
+        AllowedSyncJobStatus.FAILED.allowedPackage,
+      )
+
+    /**
+     * Deserializes the given data string into a [SyncJobStatus] object.
+     *
+     * @param data The serialized data string.
+     * @return The deserialized [SyncJobStatus] object, or null if the deserialization fails or the
+     *   data is not of an allowed class.
+     */
+    fun deserialize(data: String?): SyncJobStatus? {
+      return serializer.fromJson(data, Data::class.java)?.let {
+        val stateType = it.getString(STATE_TYPE)
+        val stateData = it.getString(STATE)
+        if (stateType?.isAllowedClass() == true) {
+          stateData?.let { stateData ->
+            serializer.fromJson(stateData, Class.forName(stateType)) as? SyncJobStatus
+          }
+        } else {
+          error("Corrupt state type : $stateType")
+        }
+      }
+    }
+
+    /**
+     * Serializes the given [SyncJobStatus] object into a JSON-formatted string.
+     *
+     * @param syncJobStatus The [SyncJobStatus] object to serialize.
+     * @return The JSON-formatted string representing the serialized [SyncJobStatus] object.
+     */
+    fun serialize(syncJobStatus: SyncJobStatus): String {
+      val data =
+        workDataOf(
+          STATE_TYPE to syncJobStatus::class.java.name,
+          STATE to serializer.toJson(syncJobStatus),
+        )
+      return serializer.toJson(data)
+    }
+
+    private fun String.isAllowedClass(): Boolean {
+      return allowedSyncJobStatusPackages.any { this.startsWith(it) }
+    }
+
+    private companion object {
+      private const val STATE_TYPE = "STATE_TYPE"
+      private const val STATE = "STATE"
+    }
+  }
+
+  private enum class AllowedSyncJobStatus(val allowedPackage: String) {
+    SUCCEEDED(SyncJobStatus.Succeeded::class.java.name),
+    FAILED(SyncJobStatus.Failed::class.java.name),
+  }
 }
diff --git a/engine/src/main/java/com/google/android/fhir/sync/remote/RetrofitHttpService.kt b/engine/src/main/java/com/google/android/fhir/sync/remote/RetrofitHttpService.kt
index f92f674c2f..60e819027f 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/remote/RetrofitHttpService.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/remote/RetrofitHttpService.kt
@@ -20,6 +20,7 @@ import com.github.fge.jsonpatch.JsonPatch
 import com.google.android.fhir.NetworkConfiguration
 import com.google.android.fhir.sync.HttpAuthenticator
 import java.util.concurrent.TimeUnit
+import okhttp3.Cache
 import okhttp3.Interceptor
 import okhttp3.OkHttpClient
 import okhttp3.logging.HttpLoggingInterceptor
@@ -106,6 +107,7 @@ internal interface RetrofitHttpService : FhirHttpService {
                 },
               )
             }
+            networkConfiguration.httpCache?.let { this.cache(Cache(it.cacheDir, it.maxSize)) }
           }
           .build()
       return Retrofit.Builder()
diff --git a/engine/src/main/java/com/google/android/fhir/sync/upload/LocalChangeFetcher.kt b/engine/src/main/java/com/google/android/fhir/sync/upload/LocalChangeFetcher.kt
index 8b337963e7..98beb2c9c0 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/upload/LocalChangeFetcher.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/upload/LocalChangeFetcher.kt
@@ -71,6 +71,25 @@ internal class AllChangesLocalChangeFetcher(
     SyncUploadProgress(database.getLocalChangesCount(), total)
 }
 
+internal class PerResourceLocalChangeFetcher(
+  private val database: Database,
+) : LocalChangeFetcher {
+
+  override var total by Delegates.notNull<Int>()
+
+  suspend fun initTotalCount() {
+    total = database.getLocalChangesCount()
+  }
+
+  override suspend fun hasNext(): Boolean = database.getLocalChangesCount().isNotZero()
+
+  override suspend fun next(): List<LocalChange> =
+    database.getAllChangesForEarliestChangedResource()
+
+  override suspend fun getProgress(): SyncUploadProgress =
+    SyncUploadProgress(database.getLocalChangesCount(), total)
+}
+
 /** Represents the mode in which local changes should be fetched. */
 sealed class LocalChangesFetchMode {
   object AllChanges : LocalChangesFetchMode()
@@ -88,6 +107,8 @@ internal object LocalChangeFetcherFactory {
     when (mode) {
       is LocalChangesFetchMode.AllChanges ->
         AllChangesLocalChangeFetcher(database).apply { initTotalCount() }
+      is LocalChangesFetchMode.PerResource ->
+        PerResourceLocalChangeFetcher(database).apply { initTotalCount() }
       else -> throw NotImplementedError("$mode is not implemented yet.")
     }
 }
diff --git a/engine/src/main/java/com/google/android/fhir/sync/upload/ResourceConsolidator.kt b/engine/src/main/java/com/google/android/fhir/sync/upload/ResourceConsolidator.kt
index f5f3c8c7f7..344ad278d8 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/upload/ResourceConsolidator.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/upload/ResourceConsolidator.kt
@@ -16,11 +16,11 @@
 
 package com.google.android.fhir.sync.upload
 
+import com.google.android.fhir.LocalChangeToken
 import com.google.android.fhir.db.Database
 import org.hl7.fhir.r4.model.Bundle
-import org.hl7.fhir.r4.model.Resource
+import org.hl7.fhir.r4.model.DomainResource
 import org.hl7.fhir.r4.model.ResourceType
-import timber.log.Timber
 
 /**
  * Represents a mechanism to consolidate resources after they are uploaded.
@@ -44,11 +44,17 @@ internal class DefaultResourceConsolidator(private val database: Database) : Res
   override suspend fun consolidate(uploadSyncResult: UploadSyncResult) =
     when (uploadSyncResult) {
       is UploadSyncResult.Success -> {
-        database.deleteUpdates(uploadSyncResult.localChangeToken)
-        uploadSyncResult.resources.forEach {
+        database.deleteUpdates(
+          LocalChangeToken(
+            uploadSyncResult.uploadResponses.flatMap {
+              it.localChanges.flatMap { localChange -> localChange.token.ids }
+            },
+          ),
+        )
+        uploadSyncResult.uploadResponses.forEach {
           when (it) {
-            is Bundle -> updateVersionIdAndLastUpdated(it)
-            else -> updateVersionIdAndLastUpdated(it)
+            is BundleComponentUploadResponseMapping -> updateVersionIdAndLastUpdated(it.output)
+            is ResourceUploadResponseMapping -> updateVersionIdAndLastUpdated(it.output)
           }
         }
       }
@@ -59,23 +65,6 @@ internal class DefaultResourceConsolidator(private val database: Database) : Res
       }
     }
 
-  private suspend fun updateVersionIdAndLastUpdated(bundle: Bundle) {
-    when (bundle.type) {
-      Bundle.BundleType.TRANSACTIONRESPONSE -> {
-        bundle.entry.forEach {
-          when {
-            it.hasResource() -> updateVersionIdAndLastUpdated(it.resource)
-            it.hasResponse() -> updateVersionIdAndLastUpdated(it.response)
-          }
-        }
-      }
-      else -> {
-        // Leave it for now.
-        Timber.i("Received request to update meta values for ${bundle.type}")
-      }
-    }
-  }
-
   private suspend fun updateVersionIdAndLastUpdated(response: Bundle.BundleEntryResponseComponent) {
     if (response.hasEtag() && response.hasLastModified() && response.hasLocation()) {
       response.resourceIdAndType?.let { (id, type) ->
@@ -89,7 +78,7 @@ internal class DefaultResourceConsolidator(private val database: Database) : Res
     }
   }
 
-  private suspend fun updateVersionIdAndLastUpdated(resource: Resource) {
+  private suspend fun updateVersionIdAndLastUpdated(resource: DomainResource) {
     if (resource.hasMeta() && resource.meta.hasVersionId() && resource.meta.hasLastUpdated()) {
       database.updateVersionIdAndLastUpdated(
         resource.id,
diff --git a/engine/src/main/java/com/google/android/fhir/sync/upload/UploadStrategy.kt b/engine/src/main/java/com/google/android/fhir/sync/upload/UploadStrategy.kt
index ef082becc3..bc97f6e860 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/upload/UploadStrategy.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/upload/UploadStrategy.kt
@@ -35,59 +35,65 @@ private constructor(
   internal val patchGeneratorMode: PatchGeneratorMode,
   internal val requestGeneratorMode: UploadRequestGeneratorMode,
 ) {
-  object SingleChangePut :
-    UploadStrategy(
-      LocalChangesFetchMode.EarliestChange,
-      PatchGeneratorMode.PerChange,
-      UploadRequestGeneratorMode.UrlRequest(HttpVerb.PUT, HttpVerb.PATCH),
-    )
 
-  object SingleChangePost :
+  object AllChangesBundlePut :
     UploadStrategy(
-      LocalChangesFetchMode.EarliestChange,
+      LocalChangesFetchMode.AllChanges,
       PatchGeneratorMode.PerChange,
-      UploadRequestGeneratorMode.UrlRequest(HttpVerb.POST, HttpVerb.PATCH),
+      UploadRequestGeneratorMode.BundleRequest(Bundle.HTTPVerb.PUT, Bundle.HTTPVerb.PATCH),
     )
 
-  object SingleResourcePut :
+  object AllChangesSquashedBundlePut :
     UploadStrategy(
-      LocalChangesFetchMode.PerResource,
+      LocalChangesFetchMode.AllChanges,
       PatchGeneratorMode.PerResource,
-      UploadRequestGeneratorMode.UrlRequest(HttpVerb.PUT, HttpVerb.PATCH),
+      UploadRequestGeneratorMode.BundleRequest(Bundle.HTTPVerb.PUT, Bundle.HTTPVerb.PATCH),
     )
 
-  object SingleResourcePost :
+  /**
+   * All the [UploadStrategy]s below this line are still in progress and not available as of now. As
+   * and when an [UploadStrategy] is implemented, it should be moved above this comment section and
+   * made non private.
+   */
+  private object AllChangesSquashedBundlePost :
     UploadStrategy(
-      LocalChangesFetchMode.PerResource,
+      LocalChangesFetchMode.AllChanges,
       PatchGeneratorMode.PerResource,
-      UploadRequestGeneratorMode.UrlRequest(HttpVerb.POST, HttpVerb.PATCH),
+      UploadRequestGeneratorMode.BundleRequest(Bundle.HTTPVerb.POST, Bundle.HTTPVerb.PATCH),
     )
 
-  object AllChangesBundlePut :
+  private object SingleChangePut :
     UploadStrategy(
-      LocalChangesFetchMode.AllChanges,
+      LocalChangesFetchMode.EarliestChange,
       PatchGeneratorMode.PerChange,
-      UploadRequestGeneratorMode.BundleRequest(Bundle.HTTPVerb.PUT, Bundle.HTTPVerb.PATCH),
+      UploadRequestGeneratorMode.UrlRequest(HttpVerb.PUT, HttpVerb.PATCH),
     )
 
-  object AllChangesBundlePost :
+  private object SingleChangePost :
     UploadStrategy(
-      LocalChangesFetchMode.AllChanges,
+      LocalChangesFetchMode.EarliestChange,
       PatchGeneratorMode.PerChange,
-      UploadRequestGeneratorMode.BundleRequest(Bundle.HTTPVerb.POST, Bundle.HTTPVerb.PATCH),
+      UploadRequestGeneratorMode.UrlRequest(HttpVerb.POST, HttpVerb.PATCH),
     )
 
-  object AllChangesSquashedBundlePut :
+  private object SingleResourcePut :
     UploadStrategy(
-      LocalChangesFetchMode.AllChanges,
+      LocalChangesFetchMode.PerResource,
       PatchGeneratorMode.PerResource,
-      UploadRequestGeneratorMode.BundleRequest(Bundle.HTTPVerb.PUT, Bundle.HTTPVerb.PATCH),
+      UploadRequestGeneratorMode.UrlRequest(HttpVerb.PUT, HttpVerb.PATCH),
     )
 
-  object AllChangesSquashedBundlePost :
+  private object SingleResourcePost :
     UploadStrategy(
-      LocalChangesFetchMode.AllChanges,
+      LocalChangesFetchMode.PerResource,
       PatchGeneratorMode.PerResource,
+      UploadRequestGeneratorMode.UrlRequest(HttpVerb.POST, HttpVerb.PATCH),
+    )
+
+  private object AllChangesBundlePost :
+    UploadStrategy(
+      LocalChangesFetchMode.AllChanges,
+      PatchGeneratorMode.PerChange,
       UploadRequestGeneratorMode.BundleRequest(Bundle.HTTPVerb.POST, Bundle.HTTPVerb.PATCH),
     )
 }
diff --git a/engine/src/main/java/com/google/android/fhir/sync/upload/Uploader.kt b/engine/src/main/java/com/google/android/fhir/sync/upload/Uploader.kt
index b5a8ee66d8..4d75db5151 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/upload/Uploader.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/upload/Uploader.kt
@@ -20,14 +20,19 @@ import com.google.android.fhir.LocalChange
 import com.google.android.fhir.LocalChangeToken
 import com.google.android.fhir.sync.DataSource
 import com.google.android.fhir.sync.ResourceSyncException
-import com.google.android.fhir.sync.upload.patch.PerResourcePatchGenerator
-import com.google.android.fhir.sync.upload.request.TransactionBundleGenerator
-import com.google.android.fhir.sync.upload.request.UploadRequest
+import com.google.android.fhir.sync.upload.patch.PatchGenerator
+import com.google.android.fhir.sync.upload.request.BundleUploadRequestMapping
+import com.google.android.fhir.sync.upload.request.UploadRequestGenerator
+import com.google.android.fhir.sync.upload.request.UploadRequestMapping
+import com.google.android.fhir.sync.upload.request.UrlUploadRequestMapping
+import java.lang.IllegalStateException
 import org.hl7.fhir.exceptions.FHIRException
+import org.hl7.fhir.instance.model.api.IBase
+import org.hl7.fhir.instance.model.api.IBaseOperationOutcome
 import org.hl7.fhir.r4.model.Bundle
+import org.hl7.fhir.r4.model.DomainResource
 import org.hl7.fhir.r4.model.OperationOutcome
 import org.hl7.fhir.r4.model.Resource
-import org.hl7.fhir.r4.model.ResourceType
 import timber.log.Timber
 
 /**
@@ -38,56 +43,106 @@ import timber.log.Timber
  * 4. processing the responses from the server and consolidate any changes (i.e. updates resource
  *    IDs).
  */
-internal class Uploader(private val dataSource: DataSource) {
-  private val patchGenerator = PerResourcePatchGenerator
-  private val requestGenerator = TransactionBundleGenerator.getDefault()
-
+internal class Uploader(
+  private val dataSource: DataSource,
+  private val patchGenerator: PatchGenerator,
+  private val requestGenerator: UploadRequestGenerator,
+) {
   suspend fun upload(localChanges: List<LocalChange>): UploadSyncResult {
-    val patches = patchGenerator.generate(localChanges)
-    val requests = requestGenerator.generateUploadRequests(patches)
+    val mappedPatches = patchGenerator.generate(localChanges)
+    val mappedRequests = requestGenerator.generateUploadRequests(mappedPatches)
     val token = LocalChangeToken(localChanges.flatMap { it.token.ids })
 
-    val successfulResponses = mutableListOf<Resource>()
+    val successfulMappedResponses = mutableListOf<SuccessfulUploadResponseMapping>()
 
-    for (uploadRequest in requests) {
-      when (val result = handleUploadRequest(uploadRequest)) {
-        is UploadRequestResult.Success -> successfulResponses.add(result.resource)
+    for (mappedRequest in mappedRequests) {
+      when (val result = handleUploadRequest(mappedRequest)) {
+        is UploadRequestResult.Success ->
+          successfulMappedResponses.addAll(result.successfulUploadResponsMappings)
         is UploadRequestResult.Failure -> return UploadSyncResult.Failure(result.exception, token)
       }
     }
+    return UploadSyncResult.Success(successfulMappedResponses)
+  }
+
+  private fun handleUploadResponse(
+    mappedUploadRequest: UploadRequestMapping,
+    response: Resource,
+  ): UploadRequestResult {
+    val responsesList =
+      when {
+        mappedUploadRequest is UrlUploadRequestMapping && response is DomainResource ->
+          listOf(ResourceUploadResponseMapping(mappedUploadRequest.localChanges, response))
+        mappedUploadRequest is BundleUploadRequestMapping &&
+          response is Bundle &&
+          response.type == Bundle.BundleType.TRANSACTIONRESPONSE ->
+          handleBundleUploadResponse(mappedUploadRequest, response)
+        else ->
+          throw IllegalStateException(
+            "Unknown mapping for request and response. Request Type: ${mappedUploadRequest.javaClass}, Response Type: ${response.resourceType}",
+          )
+      }
+    return UploadRequestResult.Success(responsesList)
+  }
 
-    return UploadSyncResult.Success(token, successfulResponses)
+  private fun handleBundleUploadResponse(
+    mappedUploadRequest: BundleUploadRequestMapping,
+    bundleResponse: Bundle,
+  ): List<SuccessfulUploadResponseMapping> {
+    require(mappedUploadRequest.splitLocalChanges.size == bundleResponse.entry.size)
+    return mappedUploadRequest.splitLocalChanges.mapIndexed { index, localChanges ->
+      val bundleEntry = bundleResponse.entry[index]
+      when {
+        bundleEntry.hasResource() && bundleEntry.resource is DomainResource ->
+          ResourceUploadResponseMapping(localChanges, bundleEntry.resource as DomainResource)
+        bundleEntry.hasResponse() ->
+          BundleComponentUploadResponseMapping(localChanges, bundleEntry.response)
+        else ->
+          throw IllegalStateException(
+            "Unknown response: $bundleEntry for Bundle Request at index $index",
+          )
+      }
+    }
   }
 
-  private suspend fun handleUploadRequest(uploadRequest: UploadRequest): UploadRequestResult {
+  private suspend fun handleUploadRequest(
+    mappedUploadRequest: UploadRequestMapping,
+  ): UploadRequestResult {
     return try {
-      val response = dataSource.upload(uploadRequest)
+      val response = dataSource.upload(mappedUploadRequest.generatedRequest)
       when {
-        response is Bundle && response.type == Bundle.BundleType.TRANSACTIONRESPONSE ->
-          UploadRequestResult.Success(response)
         response is OperationOutcome && response.issue.isNotEmpty() ->
           UploadRequestResult.Failure(
             ResourceSyncException(
-              uploadRequest.resource.resourceType,
+              mappedUploadRequest.generatedRequest.resource.resourceType,
               FHIRException(response.issueFirstRep.diagnostics),
             ),
           )
+        (response is DomainResource || response is Bundle) &&
+          (response !is IBaseOperationOutcome) ->
+          handleUploadResponse(mappedUploadRequest, response)
         else ->
           UploadRequestResult.Failure(
             ResourceSyncException(
-              uploadRequest.resource.resourceType,
-              FHIRException("Unknown response for ${uploadRequest.resource.resourceType}"),
+              mappedUploadRequest.generatedRequest.resource.resourceType,
+              FHIRException(
+                "Unknown response for ${mappedUploadRequest.generatedRequest.resource.resourceType}",
+              ),
             ),
           )
       }
     } catch (e: Exception) {
       Timber.e(e)
-      UploadRequestResult.Failure(ResourceSyncException(ResourceType.Bundle, e))
+      UploadRequestResult.Failure(
+        ResourceSyncException(mappedUploadRequest.generatedRequest.resource.resourceType, e),
+      )
     }
   }
 
   private sealed class UploadRequestResult {
-    data class Success(val resource: Resource) : UploadRequestResult()
+    data class Success(
+      val successfulUploadResponsMappings: List<SuccessfulUploadResponseMapping>,
+    ) : UploadRequestResult()
 
     data class Failure(val exception: ResourceSyncException) : UploadRequestResult()
   }
@@ -95,10 +150,24 @@ internal class Uploader(private val dataSource: DataSource) {
 
 sealed class UploadSyncResult {
   data class Success(
-    val localChangeToken: LocalChangeToken,
-    val resources: List<Resource>,
+    val uploadResponses: List<SuccessfulUploadResponseMapping>,
   ) : UploadSyncResult()
 
   data class Failure(val syncError: ResourceSyncException, val localChangeToken: LocalChangeToken) :
     UploadSyncResult()
 }
+
+sealed class SuccessfulUploadResponseMapping(
+  open val localChanges: List<LocalChange>,
+  open val output: IBase,
+)
+
+internal data class ResourceUploadResponseMapping(
+  override val localChanges: List<LocalChange>,
+  override val output: DomainResource,
+) : SuccessfulUploadResponseMapping(localChanges, output)
+
+internal data class BundleComponentUploadResponseMapping(
+  override val localChanges: List<LocalChange>,
+  override val output: Bundle.BundleEntryResponseComponent,
+) : SuccessfulUploadResponseMapping(localChanges, output)
diff --git a/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PatchGenerator.kt b/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PatchGenerator.kt
index 090e85e2b7..325378d242 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PatchGenerator.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PatchGenerator.kt
@@ -19,7 +19,8 @@ package com.google.android.fhir.sync.upload.patch
 import com.google.android.fhir.LocalChange
 
 /**
- * Generates [Patch]es from [LocalChange]s.
+ * Generates [Patch]es from [LocalChange]s and output [List<[PatchMapping]>] to keep a mapping of
+ * the [LocalChange]s to their corresponding generated [Patch]
  *
  * INTERNAL ONLY. This interface should NEVER been exposed as an external API because it works
  * together with other components in the upload package to fulfill a specific upload strategy.
@@ -33,7 +34,7 @@ internal interface PatchGenerator {
    * NOTE: different implementations may have requirements on the size of [localChanges] and output
    * certain numbers of [Patch]es.
    */
-  fun generate(localChanges: List<LocalChange>): List<Patch>
+  fun generate(localChanges: List<LocalChange>): List<PatchMapping>
 }
 
 internal object PatchGeneratorFactory {
@@ -54,3 +55,13 @@ internal sealed class PatchGeneratorMode {
 
   object PerChange : PatchGeneratorMode()
 }
+
+/**
+ * Structure to maintain the mapping between [List<[LocalChange]>] and the [Patch] generated from
+ * those changes. This class should be used by any implementation of [PatchGenerator] to output the
+ * [Patch] in this format.
+ */
+internal data class PatchMapping(
+  val localChanges: List<LocalChange>,
+  val generatedPatch: Patch,
+)
diff --git a/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PerChangePatchGenerator.kt b/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PerChangePatchGenerator.kt
index 9d2840cd2f..153314e118 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PerChangePatchGenerator.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PerChangePatchGenerator.kt
@@ -25,15 +25,19 @@ import com.google.android.fhir.LocalChange
  * maintain an audit trail.
  */
 internal object PerChangePatchGenerator : PatchGenerator {
-  override fun generate(localChanges: List<LocalChange>): List<Patch> =
+  override fun generate(localChanges: List<LocalChange>): List<PatchMapping> =
     localChanges.map {
-      Patch(
-        resourceType = it.resourceType,
-        resourceId = it.resourceId,
-        versionId = it.versionId,
-        timestamp = it.timestamp,
-        type = it.type.toPatchType(),
-        payload = it.payload,
+      PatchMapping(
+        localChanges = listOf(it),
+        generatedPatch =
+          Patch(
+            resourceType = it.resourceType,
+            resourceId = it.resourceId,
+            versionId = it.versionId,
+            timestamp = it.timestamp,
+            type = it.type.toPatchType(),
+            payload = it.payload,
+          ),
       )
     }
 }
diff --git a/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PerResourcePatchGenerator.kt b/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PerResourcePatchGenerator.kt
index 8d1f6fd466..3931d51517 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PerResourcePatchGenerator.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/upload/patch/PerResourcePatchGenerator.kt
@@ -33,11 +33,18 @@ import org.json.JSONObject
  */
 internal object PerResourcePatchGenerator : PatchGenerator {
 
-  override fun generate(localChanges: List<LocalChange>): List<Patch> {
+  override fun generate(localChanges: List<LocalChange>): List<PatchMapping> {
     return localChanges
       .groupBy { it.resourceType to it.resourceId }
       .values
-      .mapNotNull { mergeLocalChangesForSingleResource(it) }
+      .mapNotNull { resourceLocalChanges ->
+        mergeLocalChangesForSingleResource(resourceLocalChanges)?.let { patch ->
+          PatchMapping(
+            localChanges = resourceLocalChanges,
+            generatedPatch = patch,
+          )
+        }
+      }
   }
 
   private fun mergeLocalChangesForSingleResource(localChanges: List<LocalChange>): Patch? {
diff --git a/engine/src/main/java/com/google/android/fhir/sync/upload/request/TransactionBundleGenerator.kt b/engine/src/main/java/com/google/android/fhir/sync/upload/request/TransactionBundleGenerator.kt
index 8753aad164..fa4fc5bc31 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/upload/request/TransactionBundleGenerator.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/upload/request/TransactionBundleGenerator.kt
@@ -16,7 +16,9 @@
 
 package com.google.android.fhir.sync.upload.request
 
+import com.google.android.fhir.LocalChange
 import com.google.android.fhir.sync.upload.patch.Patch
+import com.google.android.fhir.sync.upload.patch.PatchMapping
 import org.hl7.fhir.r4.model.Bundle
 
 /** Generates list of [BundleUploadRequest] of type Transaction [Bundle] from the [Patch]es */
@@ -27,21 +29,38 @@ internal class TransactionBundleGenerator(
     (patch: Patch, useETagForUpload: Boolean) -> BundleEntryComponentGenerator,
 ) : UploadRequestGenerator {
 
-  override fun generateUploadRequests(patches: List<Patch>): List<BundleUploadRequest> {
-    return patches.chunked(generatedBundleSize).map { generateBundleRequest(it) }
+  override fun generateUploadRequests(
+    mappedPatches: List<PatchMapping>,
+  ): List<BundleUploadRequestMapping> {
+    return mappedPatches.chunked(generatedBundleSize).map { patchList ->
+      generateBundleRequest(patchList).let { mappedBundleRequest ->
+        BundleUploadRequestMapping(
+          splitLocalChanges = mappedBundleRequest.first,
+          generatedRequest = mappedBundleRequest.second,
+        )
+      }
+    }
   }
 
-  private fun generateBundleRequest(patches: List<Patch>): BundleUploadRequest {
+  private fun generateBundleRequest(
+    patches: List<PatchMapping>,
+  ): Pair<List<List<LocalChange>>, BundleUploadRequest> {
+    val splitLocalChanges = mutableListOf<List<LocalChange>>()
     val bundleRequest =
       Bundle().apply {
         type = Bundle.BundleType.TRANSACTION
         patches.forEach {
-          this.addEntry(getBundleEntryComponentGeneratorForPatch(it, useETagForUpload).getEntry(it))
+          splitLocalChanges.add(it.localChanges)
+          this.addEntry(
+            getBundleEntryComponentGeneratorForPatch(it.generatedPatch, useETagForUpload)
+              .getEntry(it.generatedPatch),
+          )
         }
       }
-    return BundleUploadRequest(
-      resource = bundleRequest,
-    )
+    return splitLocalChanges to
+      BundleUploadRequest(
+        resource = bundleRequest,
+      )
   }
 
   companion object Factory {
diff --git a/engine/src/main/java/com/google/android/fhir/sync/upload/request/UploadRequestGenerator.kt b/engine/src/main/java/com/google/android/fhir/sync/upload/request/UploadRequestGenerator.kt
index d5c344d338..62a4612d97 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/upload/request/UploadRequestGenerator.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/upload/request/UploadRequestGenerator.kt
@@ -16,14 +16,23 @@
 
 package com.google.android.fhir.sync.upload.request
 
+import com.google.android.fhir.LocalChange
 import com.google.android.fhir.sync.upload.patch.Patch
+import com.google.android.fhir.sync.upload.patch.PatchMapping
 import org.hl7.fhir.r4.model.Bundle
 import org.hl7.fhir.r4.model.codesystems.HttpVerb
 
-/** Generator that generates [UploadRequest]s from the [Patch]es */
+/**
+ * Generator that generates [UploadRequest]s from the [Patch]es present in the
+ * [List<[PatchMapping]>]. Any implementation of this generator is expected to output
+ * [List<[UploadRequestMapping]>] which maps [UploadRequest] to the corresponding [LocalChange]s it
+ * was generated from.
+ */
 internal interface UploadRequestGenerator {
-  /** Generates a list of [UploadRequest] from the [Patch]es */
-  fun generateUploadRequests(patches: List<Patch>): List<UploadRequest>
+  /** Generates a list of [UploadRequestMapping] from the [PatchMapping]s */
+  fun generateUploadRequests(
+    mappedPatches: List<PatchMapping>,
+  ): List<UploadRequestMapping>
 }
 
 /** Mode to decide the type of [UploadRequest] that needs to be generated */
@@ -53,3 +62,17 @@ internal object UploadRequestGeneratorFactory {
         )
     }
 }
+
+internal sealed class UploadRequestMapping(
+  open val generatedRequest: UploadRequest,
+)
+
+internal data class UrlUploadRequestMapping(
+  val localChanges: List<LocalChange>,
+  override val generatedRequest: UrlUploadRequest,
+) : UploadRequestMapping(generatedRequest)
+
+internal data class BundleUploadRequestMapping(
+  val splitLocalChanges: List<List<LocalChange>>,
+  override val generatedRequest: BundleUploadRequest,
+) : UploadRequestMapping(generatedRequest)
diff --git a/engine/src/main/java/com/google/android/fhir/sync/upload/request/UrlRequestGenerator.kt b/engine/src/main/java/com/google/android/fhir/sync/upload/request/UrlRequestGenerator.kt
index 7898207b24..5fbb174e8a 100644
--- a/engine/src/main/java/com/google/android/fhir/sync/upload/request/UrlRequestGenerator.kt
+++ b/engine/src/main/java/com/google/android/fhir/sync/upload/request/UrlRequestGenerator.kt
@@ -20,6 +20,7 @@ import ca.uhn.fhir.context.FhirContext
 import ca.uhn.fhir.context.FhirVersionEnum
 import com.google.android.fhir.ContentTypes
 import com.google.android.fhir.sync.upload.patch.Patch
+import com.google.android.fhir.sync.upload.patch.PatchMapping
 import org.hl7.fhir.r4.model.Binary
 import org.hl7.fhir.r4.model.Resource
 import org.hl7.fhir.r4.model.codesystems.HttpVerb
@@ -29,8 +30,15 @@ internal class UrlRequestGenerator(
   private val getUrlRequestForPatch: (patch: Patch) -> UrlUploadRequest,
 ) : UploadRequestGenerator {
 
-  override fun generateUploadRequests(patches: List<Patch>): List<UrlUploadRequest> =
-    patches.map { getUrlRequestForPatch(it) }
+  override fun generateUploadRequests(
+    mappedPatches: List<PatchMapping>,
+  ): List<UrlUploadRequestMapping> =
+    mappedPatches.map {
+      UrlUploadRequestMapping(
+        localChanges = it.localChanges,
+        generatedRequest = getUrlRequestForPatch(it.generatedPatch),
+      )
+    }
 
   companion object Factory {
 
diff --git a/engine/src/main/java/com/google/android/fhir/testing/Utilities.kt b/engine/src/main/java/com/google/android/fhir/testing/Utilities.kt
index d24acda000..234b1a2ac2 100644
--- a/engine/src/main/java/com/google/android/fhir/testing/Utilities.kt
+++ b/engine/src/main/java/com/google/android/fhir/testing/Utilities.kt
@@ -36,6 +36,7 @@ import com.google.android.fhir.sync.upload.SyncUploadProgress
 import com.google.android.fhir.sync.upload.UploadSyncResult
 import com.google.android.fhir.sync.upload.request.BundleUploadRequest
 import com.google.android.fhir.sync.upload.request.UploadRequest
+import com.google.android.fhir.sync.upload.request.UrlUploadRequest
 import com.google.common.truth.Truth.assertThat
 import java.net.SocketTimeoutException
 import java.time.Instant
@@ -110,7 +111,12 @@ object TestDataSourceImpl : DataSource {
     }
 
   override suspend fun upload(request: UploadRequest): Resource {
-    return Bundle().apply { type = Bundle.BundleType.TRANSACTIONRESPONSE }
+    return Bundle().apply {
+      type = Bundle.BundleType.TRANSACTIONRESPONSE
+      addEntry(
+        Bundle.BundleEntryComponent().apply { resource = Patient().apply { id = "123" } },
+      )
+    }
   }
 }
 
@@ -183,7 +189,7 @@ object TestFhirEngineImpl : FhirEngine {
       LocalChange(
         resourceType = type.name,
         resourceId = id,
-        payload = "{ 'resourceType' : 'Patient', 'id' : '123' }",
+        payload = "{ 'resourceType' : '$type', 'id' : '$id' }",
         token = LocalChangeToken(listOf()),
         type = LocalChange.Type.INSERT,
         timestamp = Instant.now(),
@@ -222,3 +228,14 @@ class BundleDataSource(val onPostBundle: suspend (Bundle) -> Resource) : DataSou
   override suspend fun upload(request: UploadRequest) =
     onPostBundle((request as BundleUploadRequest).resource)
 }
+
+class UrlRequestDataSource(val onUrlRequestSend: suspend (UrlUploadRequest) -> Resource) :
+  DataSource {
+
+  override suspend fun download(downloadRequest: DownloadRequest): Resource {
+    TODO("Not yet implemented")
+  }
+
+  override suspend fun upload(request: UploadRequest) =
+    onUrlRequestSend((request as UrlUploadRequest))
+}
diff --git a/engine/src/test/java/com/google/android/fhir/FhirEngineProviderTest.kt b/engine/src/test/java/com/google/android/fhir/FhirEngineProviderTest.kt
index aba268fde2..591d7a4eda 100644
--- a/engine/src/test/java/com/google/android/fhir/FhirEngineProviderTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/FhirEngineProviderTest.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2021-2023 Google LLC
+ * Copyright 2021-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -19,7 +19,7 @@ package com.google.android.fhir
 import androidx.test.core.app.ApplicationProvider
 import androidx.test.platform.app.InstrumentationRegistry
 import com.google.common.truth.Truth.assertThat
-import java.lang.IllegalStateException
+import java.io.File
 import org.junit.After
 import org.junit.Test
 import org.junit.runner.RunWith
@@ -52,7 +52,11 @@ class FhirEngineProviderTest {
 
   @Test
   fun build_twiceWithAppContext_afterCleanup_shouldReturnDifferentInstances() {
-    provider.init(FhirEngineConfiguration(testMode = true))
+    provider.init(
+      FhirEngineConfiguration(
+        testMode = true,
+      ),
+    )
     val engineOne = provider.getInstance(ApplicationProvider.getApplicationContext())
     provider.cleanup()
     val engineTwo = provider.getInstance(ApplicationProvider.getApplicationContext())
@@ -61,7 +65,11 @@ class FhirEngineProviderTest {
 
   @Test
   fun cleanup_not_in_test_mode_fails() {
-    provider.init(FhirEngineConfiguration(testMode = false))
+    provider.init(
+      FhirEngineConfiguration(
+        testMode = false,
+      ),
+    )
 
     provider.getInstance(ApplicationProvider.getApplicationContext())
 
@@ -95,4 +103,27 @@ class FhirEngineProviderTest {
       assertThat(this.writeTimeOut).isEqualTo(6)
     }
   }
+
+  @Test
+  fun createFhirEngineConfiguration_configureOkHttpCache_shouldHaveOkHttpCache() {
+    val config =
+      FhirEngineConfiguration(
+        serverConfiguration =
+          ServerConfiguration(
+            "",
+            NetworkConfiguration(
+              httpCache =
+                CacheConfiguration(
+                  cacheDir = File("sample-dir", "http_cache"),
+                  // $0.05 worth of phone storage in 2020
+                  maxSize = 50L * 1024L * 1024L, // 50 MiB
+                ),
+            ),
+          ),
+      )
+    with(config.serverConfiguration!!.networkConfiguration) {
+      assertThat(this.httpCache?.maxSize).isEqualTo(50L * 1024L * 1024L)
+      assertThat(this.httpCache?.cacheDir?.path).isEqualTo("sample-dir${File.separator}http_cache")
+    }
+  }
 }
diff --git a/engine/src/test/java/com/google/android/fhir/JsonUtilsTest.kt b/engine/src/test/java/com/google/android/fhir/JsonUtilsTest.kt
new file mode 100644
index 0000000000..5c581ea704
--- /dev/null
+++ b/engine/src/test/java/com/google/android/fhir/JsonUtilsTest.kt
@@ -0,0 +1,263 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir
+
+import android.os.Build
+import ca.uhn.fhir.context.FhirContext
+import ca.uhn.fhir.context.FhirVersionEnum
+import com.google.android.fhir.db.impl.addUpdatedReferenceToResource
+import com.google.android.fhir.db.impl.extractAllValuesWithKey
+import com.google.android.fhir.db.impl.replaceJsonValue
+import com.google.common.truth.Truth.assertThat
+import junit.framework.TestCase
+import org.hl7.fhir.r4.model.CarePlan
+import org.hl7.fhir.r4.model.Patient
+import org.hl7.fhir.r4.model.Reference
+import org.json.JSONObject
+import org.junit.Test
+import org.junit.runner.RunWith
+import org.robolectric.RobolectricTestRunner
+import org.robolectric.annotation.Config
+import org.skyscreamer.jsonassert.JSONAssert
+
+@RunWith(RobolectricTestRunner::class)
+@Config(sdk = [Build.VERSION_CODES.P])
+class JsonUtilsTest : TestCase() {
+
+  @Test
+  fun addUpdatedReferenceToResource_updatesReferenceInPatient() {
+    val oldPractitionerReference = "Practitioner/123"
+    val updatedPractitionerReference = "Practitioner/345"
+    val patient =
+      Patient().apply {
+        id = "f001"
+        addGeneralPractitioner(Reference(oldPractitionerReference))
+      }
+    val updatedPatientResource =
+      addUpdatedReferenceToResource(
+        iParser,
+        patient,
+        oldPractitionerReference,
+        updatedPractitionerReference,
+      )
+        as Patient
+    assertThat(updatedPatientResource.generalPractitioner.first().reference)
+      .isEqualTo(updatedPractitionerReference)
+  }
+
+  @Test
+  fun addUpdatedReferenceToResource_updatesMultipleReferenceInCarePlan() {
+    val oldPatientReference = "Patient/123"
+    val updatedPatientReference = "Patient/345"
+    val carePlan =
+      CarePlan().apply {
+        id = "f001"
+        subject = (Reference(oldPatientReference))
+        activityFirstRep.detail.performer.add(Reference(oldPatientReference))
+      }
+    val updatedCarePlan =
+      addUpdatedReferenceToResource(iParser, carePlan, oldPatientReference, updatedPatientReference)
+        as CarePlan
+    assertThat(updatedCarePlan.subject.reference).isEqualTo(updatedPatientReference)
+    assertThat(updatedCarePlan.activityFirstRep.detail.performer.first().reference)
+      .isEqualTo(updatedPatientReference)
+  }
+
+  @Test
+  fun replaceJsonValue_jsonObject1() {
+    val json =
+      JSONObject(
+        """
+      {
+        "key1": "valueToBeReplaced",
+        "key2": {
+          "key3": {
+            "key4": [
+              "valueToBeReplaced",
+              "otherValueNotToBeReplaced"
+            ]
+          }
+        }
+      }
+            """
+          .trimIndent(),
+      )
+    val updatedJson = replaceJsonValue(json, "valueToBeReplaced", "newValue")
+    val expectedJson =
+      JSONObject(
+        """
+      {
+        "key1": "newValue",
+        "key2": {
+          "key3": {
+            "key4": [
+              "newValue",
+              "otherValueNotToBeReplaced"
+            ]
+          }
+        }
+      }
+            """
+          .trimIndent(),
+      )
+    JSONAssert.assertEquals(updatedJson, expectedJson, false)
+  }
+
+  @Test
+  fun replaceJsonValue_jsonObject2() {
+    val json =
+      JSONObject(
+        """
+        {
+          "key1": "valueToBeReplaced",
+          "key2": {
+            "key3": {
+              "key4": [
+                [
+                  "otherValueNotToBeReplaced",
+                  "valueToBeReplaced"
+                ],
+                [
+                  "otherValueNotToBeReplaced"
+                ]
+              ]
+            }
+          }
+        }
+            """
+          .trimIndent(),
+      )
+    val updatedJson = replaceJsonValue(json, "valueToBeReplaced", "newValue")
+    val expectedJson =
+      JSONObject(
+        """
+      {
+        "key1": "newValue",
+        "key2": {
+          "key3": {
+            "key4": [
+              [
+                "otherValueNotToBeReplaced",
+                "newValue"
+              ],
+              [
+                "otherValueNotToBeReplaced"
+              ]
+            ]
+          }
+        }
+      }
+            """
+          .trimIndent(),
+      )
+    JSONAssert.assertEquals(updatedJson, expectedJson, false)
+  }
+
+  @Test
+  fun replaceJsonValue_jsonObject3() {
+    val json =
+      JSONObject(
+        """
+        {
+          "key1": "valueToBeReplaced",
+          "key2": {
+            "key3": {
+              "key4": [
+                [
+                  {
+                    "key5": "valueToBeReplaced"
+                  }
+                ],
+                [
+                  {
+                    "key6": "otherValueNotToBeReplaced"
+                  }
+                ]
+              ]
+            }
+          }
+        }
+            """
+          .trimIndent(),
+      )
+    val updatedJson = replaceJsonValue(json, "valueToBeReplaced", "newValue")
+    val expectedJson =
+      JSONObject(
+        """
+      {
+        "key1": "newValue",
+        "key2": {
+          "key3": {
+            "key4": [
+              [
+                {
+                  "key5": "newValue"
+                }
+              ],
+              [
+                {
+                  "key6": "otherValueNotToBeReplaced"
+                }
+              ]
+            ]
+          }
+        }
+      }
+            """
+          .trimIndent(),
+      )
+    JSONAssert.assertEquals(updatedJson, expectedJson, false)
+  }
+
+  @Test
+  fun extractAllValueWithKey_extractsValuesFromJson() {
+    val testJson =
+      """
+      {
+        "key1": "newValue",
+        "reference": "testValue1",
+        "key2": {
+          "key3": {
+            "key4": [
+              [
+                {
+                  "reference": "testValue2"
+                }
+              ],
+              [
+                {
+                  "key6": "otherValueNotToBeReplaced"
+                }
+              ]
+            ]
+          },
+          "key5": {
+            "reference": "testValue3"
+          }
+        }
+      }
+        """
+        .trimIndent()
+    val referenceValues = extractAllValuesWithKey("reference", JSONObject(testJson))
+    assertThat(referenceValues.size).isEqualTo(3)
+    assertThat(referenceValues).containsExactly("testValue1", "testValue2", "testValue3")
+  }
+
+  companion object {
+    val iParser = FhirContext.forCached(FhirVersionEnum.R4).newJsonParser()
+  }
+}
diff --git a/engine/src/test/java/com/google/android/fhir/impl/FhirEngineImplTest.kt b/engine/src/test/java/com/google/android/fhir/impl/FhirEngineImplTest.kt
index a77a6b76f4..ba1d3f9e04 100644
--- a/engine/src/test/java/com/google/android/fhir/impl/FhirEngineImplTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/impl/FhirEngineImplTest.kt
@@ -24,6 +24,7 @@ import com.google.android.fhir.LocalChange.Type
 import com.google.android.fhir.LocalChangeToken
 import com.google.android.fhir.db.ResourceNotFoundException
 import com.google.android.fhir.get
+import com.google.android.fhir.lastUpdated
 import com.google.android.fhir.logicalId
 import com.google.android.fhir.search.LOCAL_LAST_UPDATED_PARAM
 import com.google.android.fhir.search.search
@@ -31,12 +32,15 @@ import com.google.android.fhir.sync.AcceptLocalConflictResolver
 import com.google.android.fhir.sync.AcceptRemoteConflictResolver
 import com.google.android.fhir.sync.ResourceSyncException
 import com.google.android.fhir.sync.upload.LocalChangesFetchMode
+import com.google.android.fhir.sync.upload.ResourceUploadResponseMapping
 import com.google.android.fhir.sync.upload.SyncUploadProgress
 import com.google.android.fhir.sync.upload.UploadSyncResult
 import com.google.android.fhir.testing.assertResourceEquals
 import com.google.android.fhir.testing.assertResourceNotEquals
 import com.google.android.fhir.testing.readFromFile
+import com.google.android.fhir.versionId
 import com.google.common.truth.Truth.assertThat
+import java.time.Instant
 import java.util.Date
 import kotlinx.coroutines.Dispatchers
 import kotlinx.coroutines.flow.flowOf
@@ -323,8 +327,12 @@ class FhirEngineImplTest {
       .syncUpload(LocalChangesFetchMode.AllChanges) {
         localChanges.addAll(it)
         UploadSyncResult.Success(
-          LocalChangeToken(it.flatMap { it.token.ids }),
-          listOf(),
+          listOf(
+            ResourceUploadResponseMapping(
+              it,
+              TEST_PATIENT_1,
+            ),
+          ),
         )
       }
       .collect { emittedProgress.add(it) }
@@ -592,6 +600,87 @@ class FhirEngineImplTest {
       assertResourceEquals(fhirEngine.get<Patient>("original-002"), localChange)
     }
 
+  @Test
+  fun `syncDownload ResourceEntity should have the latest versionId and lastUpdated from server`() =
+    runBlocking {
+      val originalPatient =
+        Patient().apply {
+          id = "original-002"
+          meta =
+            Meta().apply {
+              versionId = "1"
+              lastUpdated = Date.from(Instant.parse("2022-12-02T10:15:30.00Z"))
+            }
+          addName(
+            HumanName().apply {
+              family = "Stark"
+              addGiven("Tony")
+            },
+          )
+        }
+      // First sync
+      fhirEngine.syncDownload(AcceptLocalConflictResolver) { flowOf((listOf((originalPatient)))) }
+
+      val updatedPatient =
+        originalPatient.copy().apply {
+          meta =
+            Meta().apply {
+              versionId = "2"
+              lastUpdated = Date.from(Instant.parse("2022-12-03T10:15:30.00Z"))
+            }
+          addAddress(Address().apply { country = "USA" })
+        }
+
+      // Sync to get updates from server
+      fhirEngine.syncDownload(AcceptLocalConflictResolver) { flowOf((listOf(updatedPatient))) }
+
+      val result = services.database.selectEntity(ResourceType.Patient, "original-002")
+      assertThat(result.versionId).isEqualTo(updatedPatient.versionId)
+      assertThat(result.lastUpdatedRemote).isEqualTo(updatedPatient.lastUpdated)
+    }
+
+  @Test
+  fun `syncDownload LocalChangeEntity should have the latest versionId from server`() =
+    runBlocking {
+      val originalPatient =
+        Patient().apply {
+          id = "original-002"
+          meta =
+            Meta().apply {
+              versionId = "1"
+              lastUpdated = Date.from(Instant.parse("2022-12-02T10:15:30.00Z"))
+            }
+          addName(
+            HumanName().apply {
+              family = "Stark"
+              addGiven("Tony")
+            },
+          )
+        }
+      // First sync
+      fhirEngine.syncDownload(AcceptLocalConflictResolver) { flowOf((listOf((originalPatient)))) }
+
+      val localChange =
+        originalPatient.copy().apply { addAddress(Address().apply { city = "Malibu" }) }
+      fhirEngine.update(localChange)
+
+      val updatedPatient =
+        originalPatient.copy().apply {
+          meta =
+            Meta().apply {
+              versionId = "2"
+              lastUpdated = Date.from(Instant.parse("2022-12-03T10:15:30.00Z"))
+            }
+          addAddress(Address().apply { country = "USA" })
+        }
+
+      // Sync to get updates from server
+      fhirEngine.syncDownload(AcceptLocalConflictResolver) { flowOf((listOf(updatedPatient))) }
+
+      val result = fhirEngine.getLocalChanges(ResourceType.Patient, "original-002").first()
+      assertThat(result.versionId).isEqualTo(updatedPatient.versionId)
+    }
+
   @Test
   fun `create should allow patient search with LOCAL_LAST_UPDATED_PARAM`(): Unit = runBlocking {
     val patient = Patient().apply { id = "patient-id-create" }
diff --git a/engine/src/test/java/com/google/android/fhir/search/NumberSearchParameterizedTest.kt b/engine/src/test/java/com/google/android/fhir/search/NumberSearchParameterizedTest.kt
index 7a6b8f6f26..7dcb4e177d 100644
--- a/engine/src/test/java/com/google/android/fhir/search/NumberSearchParameterizedTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/search/NumberSearchParameterizedTest.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2021-2023 Google LLC
+ * Copyright 2021-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -51,7 +51,7 @@ class NumberSearchParameterizedTest(
 
   private val baseQuery: String =
     """
-    SELECT a.serializedResource
+    SELECT a.resourceUuid, a.serializedResource
     FROM ResourceEntity a
     WHERE a.resourceType = ?
     AND a.resourceUuid IN (
diff --git a/engine/src/test/java/com/google/android/fhir/search/SearchTest.kt b/engine/src/test/java/com/google/android/fhir/search/SearchTest.kt
index 420e5e7da8..11f9c93a8f 100644
--- a/engine/src/test/java/com/google/android/fhir/search/SearchTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/search/SearchTest.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2022-2023 Google LLC
+ * Copyright 2022-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -17,14 +17,17 @@
 package com.google.android.fhir.search
 
 import android.os.Build
+import androidx.room.util.convertUUIDToByte
 import ca.uhn.fhir.model.api.TemporalPrecisionEnum
 import ca.uhn.fhir.rest.param.ParamPrefixEnum
 import com.google.android.fhir.DateProvider
 import com.google.android.fhir.epochDay
+import com.google.common.truth.Correspondence
 import com.google.common.truth.Truth.assertThat
 import java.math.BigDecimal
 import java.time.Instant
 import java.util.Date
+import java.util.UUID
 import kotlin.math.absoluteValue
 import kotlin.math.roundToLong
 import kotlinx.coroutines.runBlocking
@@ -35,11 +38,14 @@ import org.hl7.fhir.r4.model.Condition
 import org.hl7.fhir.r4.model.ContactPoint
 import org.hl7.fhir.r4.model.DateTimeType
 import org.hl7.fhir.r4.model.DateType
+import org.hl7.fhir.r4.model.Encounter
 import org.hl7.fhir.r4.model.Identifier
 import org.hl7.fhir.r4.model.Immunization
 import org.hl7.fhir.r4.model.Library
 import org.hl7.fhir.r4.model.Observation
+import org.hl7.fhir.r4.model.Organization
 import org.hl7.fhir.r4.model.Patient
+import org.hl7.fhir.r4.model.Practitioner
 import org.hl7.fhir.r4.model.ResourceType
 import org.hl7.fhir.r4.model.RiskAssessment
 import org.hl7.fhir.r4.model.UriType
@@ -60,7 +66,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
                 """
@@ -92,7 +98,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         LIMIT ?
@@ -115,7 +121,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         LIMIT ? OFFSET ?
@@ -146,7 +152,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -199,7 +205,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -239,7 +245,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -279,7 +285,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -314,7 +320,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -357,7 +363,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -397,7 +403,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -437,7 +443,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -477,7 +483,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -522,7 +528,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -576,7 +582,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -616,7 +622,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -656,7 +662,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -699,7 +705,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -742,7 +748,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -782,7 +788,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -822,7 +828,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -862,7 +868,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -894,7 +900,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -931,7 +937,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -968,7 +974,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1005,7 +1011,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1045,7 +1051,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1080,7 +1086,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1125,7 +1131,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1169,7 +1175,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1199,7 +1205,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1228,7 +1234,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1264,7 +1270,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1295,7 +1301,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1334,7 +1340,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1375,7 +1381,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1415,7 +1421,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1455,7 +1461,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1494,7 +1500,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1532,7 +1538,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1571,7 +1577,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1609,7 +1615,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1649,7 +1655,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1681,7 +1687,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1708,7 +1714,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         LEFT JOIN StringIndexEntity b
         ON a.resourceType = b.resourceType AND a.resourceUuid = b.resourceUuid AND b.index_name = ?
@@ -1728,7 +1734,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         LEFT JOIN StringIndexEntity b
         ON a.resourceType = b.resourceType AND a.resourceUuid = b.resourceUuid AND b.index_name = ?
@@ -1750,7 +1756,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         LEFT JOIN NumberIndexEntity b
         ON a.resourceType = b.resourceType AND a.resourceUuid = b.resourceUuid AND b.index_name = ?
@@ -1776,7 +1782,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         LEFT JOIN StringIndexEntity b
         ON a.resourceType = b.resourceType AND a.resourceUuid = b.resourceUuid AND b.index_name = ?
@@ -1821,13 +1827,13 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """ 
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
         SELECT resourceUuid
         FROM ResourceEntity a
-        WHERE a.resourceId IN (
+        WHERE a.resourceType = ? AND a.resourceId IN (
         SELECT substr(a.index_value, 9)
         FROM ReferenceIndexEntity a
         WHERE a.resourceType = ? AND a.index_name = ?
@@ -1844,6 +1850,7 @@ class SearchTest {
     assertThat(query.args)
       .isEqualTo(
         listOf(
+          ResourceType.Patient.name,
           ResourceType.Patient.name,
           ResourceType.Condition.name,
           Condition.SUBJECT.paramName,
@@ -1896,7 +1903,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -1906,7 +1913,7 @@ class SearchTest {
         AND a.resourceUuid IN (
         SELECT resourceUuid
         FROM ResourceEntity a
-        WHERE a.resourceId IN (
+        WHERE a.resourceType = ? AND a.resourceId IN (
         SELECT substr(a.index_value, 9)
         FROM ReferenceIndexEntity a
         WHERE a.resourceType = ? AND a.index_name = ?
@@ -1931,6 +1938,7 @@ class SearchTest {
           ResourceType.Patient.name,
           Patient.ADDRESS_COUNTRY.paramName,
           "IN",
+          ResourceType.Patient.name,
           ResourceType.Immunization.name,
           Immunization.PATIENT.paramName,
           ResourceType.Immunization.name,
@@ -1968,13 +1976,13 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
         SELECT resourceUuid
         FROM ResourceEntity a
-        WHERE a.resourceId IN (
+        WHERE a.resourceType = ? AND a.resourceId IN (
         SELECT substr(a.index_value, 9)
         FROM ReferenceIndexEntity a
         WHERE a.resourceType = ? AND a.index_name = ?
@@ -1986,7 +1994,7 @@ class SearchTest {
         )  AND a.resourceUuid IN(
         SELECT resourceUuid
         FROM ResourceEntity a
-        WHERE a.resourceId IN (
+        WHERE a.resourceType = ? AND a.resourceId IN (
         SELECT substr(a.index_value, 9)
         FROM ReferenceIndexEntity a
         WHERE a.resourceType = ? AND a.index_name = ?
@@ -2003,6 +2011,7 @@ class SearchTest {
     assertThat(query.args)
       .isEqualTo(
         listOf(
+          ResourceType.Patient.name,
           ResourceType.Patient.name,
           ResourceType.Condition.name,
           Condition.SUBJECT.paramName,
@@ -2010,6 +2019,7 @@ class SearchTest {
           Condition.CODE.paramName,
           "44054006",
           "http://snomed.info/sct",
+          ResourceType.Patient.name,
           ResourceType.Condition.name,
           Condition.SUBJECT.paramName,
           ResourceType.Condition.name,
@@ -2028,7 +2038,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         LEFT JOIN DateIndexEntity b
         ON a.resourceType = b.resourceType AND a.resourceUuid = b.resourceUuid AND b.index_name = ?
@@ -2049,7 +2059,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         LEFT JOIN DateIndexEntity b
         ON a.resourceType = b.resourceType AND a.resourceUuid = b.resourceUuid AND b.index_name = ?
@@ -2085,7 +2095,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -2126,7 +2136,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -2159,7 +2169,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -2190,7 +2200,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -2228,7 +2238,7 @@ class SearchTest {
     assertThat(query.query)
       .isEqualTo(
         """
-        SELECT a.serializedResource
+        SELECT a.resourceUuid, a.serializedResource
         FROM ResourceEntity a
         WHERE a.resourceType = ?
         AND a.resourceUuid IN (
@@ -2251,8 +2261,490 @@ class SearchTest {
       )
   }
 
+  @Test
+  fun `search include all practitioners`() {
+    val query =
+      Search(ResourceType.Patient)
+        .apply { include<Practitioner>(Patient.GENERAL_PRACTITIONER) }
+        .getIncludeQuery(
+          listOf(
+            UUID.fromString("e2c79e28-ed4d-2029-a12c-108d1eb5bedb"),
+            UUID.fromString("e2c79e28-ed4d-4029-a12c-108d1eb5bedb"),
+          ),
+        )
+
+    assertThat(query.query)
+      .isEqualTo(
+        """
+          SELECT * FROM (
+          SELECT  rie.index_name, rie.resourceUuid, re.serializedResource
+          FROM ResourceEntity re
+          JOIN ReferenceIndexEntity rie
+          ON re.resourceType||"/"||re.resourceId = rie.index_value
+          WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.resourceUuid IN (?, ?) AND re.resourceType = ?
+          )
+          """
+          .trimIndent(),
+      )
+
+    assertThat(query.args)
+      .comparingElementsUsing(ArgsComparator)
+      .containsExactly(
+        "Patient",
+        "general-practitioner",
+        convertUUIDToByte(UUID.fromString("e2c79e28-ed4d-2029-a12c-108d1eb5bedb")),
+        convertUUIDToByte(UUID.fromString("e2c79e28-ed4d-4029-a12c-108d1eb5bedb")),
+        "Practitioner",
+      )
+      .inOrder()
+  }
+
+  @Test
+  fun `search include all active practitioners`() {
+    val query =
+      Search(ResourceType.Patient)
+        .apply {
+          include<Practitioner>(Patient.GENERAL_PRACTITIONER) {
+            filter(Practitioner.ACTIVE, { value = of(true) })
+          }
+        }
+        .getIncludeQuery(
+          listOf(
+            UUID.fromString("e2c79e28-ed4d-2029-a12c-108d1eb5bedb"),
+            UUID.fromString("e2c79e28-ed4d-4029-a12c-108d1eb5bedb"),
+          ),
+        )
+
+    assertThat(query.query)
+      .isEqualTo(
+        """
+          SELECT * FROM (
+          SELECT  rie.index_name, rie.resourceUuid, re.serializedResource
+          FROM ResourceEntity re
+          JOIN ReferenceIndexEntity rie
+          ON re.resourceType||"/"||re.resourceId = rie.index_value
+          WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.resourceUuid IN (?, ?) AND re.resourceType = ?
+          AND re.resourceUuid IN (
+          SELECT resourceUuid FROM TokenIndexEntity
+          WHERE resourceType = ? AND index_name = ? AND index_value = ?
+          )
+          )
+          """
+          .trimIndent(),
+      )
+
+    assertThat(query.args)
+      .comparingElementsUsing(ArgsComparator)
+      .containsExactly(
+        "Patient",
+        "general-practitioner",
+        convertUUIDToByte(UUID.fromString("e2c79e28-ed4d-2029-a12c-108d1eb5bedb")),
+        convertUUIDToByte(UUID.fromString("e2c79e28-ed4d-4029-a12c-108d1eb5bedb")),
+        "Practitioner",
+        "Practitioner",
+        "active",
+        "true",
+      )
+      .inOrder()
+  }
+
+  @Test
+  fun `search include all active practitioners and sort by given name`() {
+    val query =
+      Search(ResourceType.Patient)
+        .apply {
+          include<Practitioner>(Patient.GENERAL_PRACTITIONER) {
+            filter(Practitioner.ACTIVE, { value = of(true) })
+            sort(Practitioner.GIVEN, Order.DESCENDING)
+          }
+        }
+        .getIncludeQuery(
+          listOf(
+            UUID.fromString("e2c79e28-ed4d-2029-a12c-108d1eb5bedb"),
+            UUID.fromString("e2c79e28-ed4d-4029-a12c-108d1eb5bedb"),
+          ),
+        )
+
+    assertThat(query.query)
+      .isEqualTo(
+        """
+          SELECT * FROM (
+          SELECT  rie.index_name, rie.resourceUuid, re.serializedResource
+          FROM ResourceEntity re
+          JOIN ReferenceIndexEntity rie
+          ON re.resourceType||"/"||re.resourceId = rie.index_value
+          LEFT JOIN StringIndexEntity b
+          ON re.resourceType = b.resourceType AND re.resourceUuid = b.resourceUuid AND b.index_name = ?
+          WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.resourceUuid IN (?, ?) AND re.resourceType = ?
+          AND re.resourceUuid IN (
+          SELECT resourceUuid FROM TokenIndexEntity
+          WHERE resourceType = ? AND index_name = ? AND index_value = ?
+          )
+          ORDER BY b.index_value DESC
+          )
+          """
+          .trimIndent(),
+      )
+
+    assertThat(query.args)
+      .comparingElementsUsing(ArgsComparator)
+      .containsExactly(
+        "given",
+        "Patient",
+        "general-practitioner",
+        convertUUIDToByte(UUID.fromString("e2c79e28-ed4d-2029-a12c-108d1eb5bedb")),
+        convertUUIDToByte(UUID.fromString("e2c79e28-ed4d-4029-a12c-108d1eb5bedb")),
+        "Practitioner",
+        "Practitioner",
+        "active",
+        "true",
+      )
+      .inOrder()
+  }
+
+  @Test
+  fun `search include practitioners and organizations`() {
+    val query =
+      Search(ResourceType.Patient)
+        .apply {
+          include<Practitioner>(Patient.GENERAL_PRACTITIONER) {
+            filter(Practitioner.ACTIVE, { value = of(true) })
+            sort(Practitioner.GIVEN, Order.DESCENDING)
+          }
+
+          include<Organization>(Patient.ORGANIZATION) {
+            filter(Organization.ACTIVE, { value = of(true) })
+            sort(Organization.NAME, Order.DESCENDING)
+          }
+        }
+        .getIncludeQuery(
+          listOf(
+            UUID.fromString("e2c79e28-ed4d-2029-a12c-108d1eb5bedb"),
+            UUID.fromString("e2c79e28-ed4d-4029-a12c-108d1eb5bedb"),
+          ),
+        )
+
+    assertThat(query.query)
+      .isEqualTo(
+        """
+        SELECT * FROM (
+        SELECT  rie.index_name, rie.resourceUuid, re.serializedResource
+        FROM ResourceEntity re
+        JOIN ReferenceIndexEntity rie
+        ON re.resourceType||"/"||re.resourceId = rie.index_value
+        LEFT JOIN StringIndexEntity b
+        ON re.resourceType = b.resourceType AND re.resourceUuid = b.resourceUuid AND b.index_name = ?
+        WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.resourceUuid IN (?, ?) AND re.resourceType = ?
+        AND re.resourceUuid IN (
+        SELECT resourceUuid FROM TokenIndexEntity
+        WHERE resourceType = ? AND index_name = ? AND index_value = ?
+        )
+        ORDER BY b.index_value DESC
+        )
+        UNION ALL
+        SELECT * FROM (
+        SELECT  rie.index_name, rie.resourceUuid, re.serializedResource
+        FROM ResourceEntity re
+        JOIN ReferenceIndexEntity rie
+        ON re.resourceType||"/"||re.resourceId = rie.index_value
+        LEFT JOIN StringIndexEntity b
+        ON re.resourceType = b.resourceType AND re.resourceUuid = b.resourceUuid AND b.index_name = ?
+        WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.resourceUuid IN (?, ?) AND re.resourceType = ?
+        AND re.resourceUuid IN (
+        SELECT resourceUuid FROM TokenIndexEntity
+        WHERE resourceType = ? AND index_name = ? AND index_value = ?
+        )
+        ORDER BY b.index_value DESC
+        )
+        """
+          .trimIndent(),
+      )
+
+    assertThat(query.args)
+      .comparingElementsUsing(ArgsComparator)
+      .containsExactly(
+        "given",
+        "Patient",
+        "general-practitioner",
+        convertUUIDToByte(UUID.fromString("e2c79e28-ed4d-2029-a12c-108d1eb5bedb")),
+        convertUUIDToByte(UUID.fromString("e2c79e28-ed4d-4029-a12c-108d1eb5bedb")),
+        "Practitioner",
+        "Practitioner",
+        "active",
+        "true",
+        "name",
+        "Patient",
+        "organization",
+        convertUUIDToByte(UUID.fromString("e2c79e28-ed4d-2029-a12c-108d1eb5bedb")),
+        convertUUIDToByte(UUID.fromString("e2c79e28-ed4d-4029-a12c-108d1eb5bedb")),
+        "Organization",
+        "Organization",
+        "active",
+        "true",
+      )
+      .inOrder()
+  }
+
+  @Test
+  fun `search revInclude all conditions for patients`() {
+    val query =
+      Search(ResourceType.Patient)
+        .apply { revInclude<Condition>(Condition.SUBJECT) }
+        .getRevIncludeQuery(listOf("Patient/pa01", "Patient/pa02"))
+
+    assertThat(query.query)
+      .isEqualTo(
+        """
+          SELECT * FROM (
+          SELECT  rie.index_name, rie.index_value, re.serializedResource
+          FROM ResourceEntity re
+          JOIN ReferenceIndexEntity rie
+          ON re.resourceUuid = rie.resourceUuid
+          WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.index_value IN (?, ?) AND re.resourceType = ?
+          )
+          """
+          .trimIndent(),
+      )
+
+    assertThat(query.args)
+      .containsExactly("Condition", "subject", "Patient/pa01", "Patient/pa02", "Condition")
+      .inOrder()
+  }
+
+  @Test
+  fun `search revInclude diabetic conditions for patients`() {
+    val query =
+      Search(ResourceType.Patient)
+        .apply {
+          revInclude<Condition>(Condition.SUBJECT) {
+            filter(
+              Condition.CODE,
+              {
+                value =
+                  of(
+                    CodeableConcept(Coding("http://snomed.info/sct", "44054006", "Diabetes")),
+                  )
+              },
+            )
+          }
+        }
+        .getRevIncludeQuery(listOf("Patient/pa01", "Patient/pa02"))
+
+    assertThat(query.query)
+      .isEqualTo(
+        """
+        SELECT * FROM (
+        SELECT  rie.index_name, rie.index_value, re.serializedResource
+        FROM ResourceEntity re
+        JOIN ReferenceIndexEntity rie
+        ON re.resourceUuid = rie.resourceUuid
+        WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.index_value IN (?, ?) AND re.resourceType = ?
+        AND re.resourceUuid IN (
+        SELECT resourceUuid FROM TokenIndexEntity
+        WHERE resourceType = ? AND index_name = ? AND (index_value = ? AND IFNULL(index_system,'') = ?)
+        )
+        )
+                """
+          .trimIndent(),
+      )
+
+    assertThat(query.args)
+      .containsExactly(
+        "Condition",
+        "subject",
+        "Patient/pa01",
+        "Patient/pa02",
+        "Condition",
+        "Condition",
+        "code",
+        "44054006",
+        "http://snomed.info/sct",
+      )
+      .inOrder()
+  }
+
+  @Test
+  fun `search revInclude diabetic conditions for patients and sort by recorded date`() {
+    val query =
+      Search(ResourceType.Patient)
+        .apply {
+          revInclude<Condition>(Condition.SUBJECT) {
+            filter(
+              Condition.CODE,
+              {
+                value =
+                  of(
+                    CodeableConcept(Coding("http://snomed.info/sct", "44054006", "Diabetes")),
+                  )
+              },
+            )
+            sort(Condition.RECORDED_DATE, Order.DESCENDING)
+          }
+        }
+        .getRevIncludeQuery(listOf("Patient/pa01", "Patient/pa02"))
+
+    assertThat(query.query)
+      .isEqualTo(
+        """
+        SELECT * FROM (
+        SELECT  rie.index_name, rie.index_value, re.serializedResource
+        FROM ResourceEntity re
+        JOIN ReferenceIndexEntity rie
+        ON re.resourceUuid = rie.resourceUuid
+        LEFT JOIN DateIndexEntity b
+        ON re.resourceType = b.resourceType AND re.resourceUuid = b.resourceUuid AND b.index_name = ?
+        LEFT JOIN DateTimeIndexEntity c
+        ON re.resourceType = c.resourceType AND re.resourceUuid = c.resourceUuid AND c.index_name = ?
+        WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.index_value IN (?, ?) AND re.resourceType = ?
+        AND re.resourceUuid IN (
+        SELECT resourceUuid FROM TokenIndexEntity
+        WHERE resourceType = ? AND index_name = ? AND (index_value = ? AND IFNULL(index_system,'') = ?)
+        )
+        ORDER BY b.index_from DESC, c.index_from DESC
+        )
+            """
+          .trimIndent(),
+      )
+
+    assertThat(query.args)
+      .containsExactly(
+        "recorded-date",
+        "recorded-date",
+        "Condition",
+        "subject",
+        "Patient/pa01",
+        "Patient/pa02",
+        "Condition",
+        "Condition",
+        "code",
+        "44054006",
+        "http://snomed.info/sct",
+      )
+      .inOrder()
+  }
+
+  @Test
+  fun `search revInclude encounters and conditions filtered and sorted`() {
+    val query =
+      Search(ResourceType.Patient)
+        .apply {
+          revInclude<Encounter>(Encounter.SUBJECT) {
+            filter(
+              Encounter.STATUS,
+              {
+                value =
+                  of(
+                    Coding(
+                      "http://hl7.org/fhir/encounter-status",
+                      Encounter.EncounterStatus.ARRIVED.toCode(),
+                      "",
+                    ),
+                  )
+              },
+            )
+            sort(Encounter.DATE, Order.DESCENDING)
+          }
+
+          revInclude<Condition>(Condition.SUBJECT) {
+            filter(
+              Condition.CODE,
+              {
+                value =
+                  of(
+                    CodeableConcept(Coding("http://snomed.info/sct", "44054006", "Diabetes")),
+                  )
+              },
+            )
+            sort(Condition.RECORDED_DATE, Order.DESCENDING)
+          }
+        }
+        .getRevIncludeQuery(listOf("Patient/pa01", "Patient/pa02"))
+
+    assertThat(query.query)
+      .isEqualTo(
+        """
+          SELECT * FROM (
+          SELECT  rie.index_name, rie.index_value, re.serializedResource
+          FROM ResourceEntity re
+          JOIN ReferenceIndexEntity rie
+          ON re.resourceUuid = rie.resourceUuid
+          LEFT JOIN DateIndexEntity b
+          ON re.resourceType = b.resourceType AND re.resourceUuid = b.resourceUuid AND b.index_name = ?
+          LEFT JOIN DateTimeIndexEntity c
+          ON re.resourceType = c.resourceType AND re.resourceUuid = c.resourceUuid AND c.index_name = ?
+          WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.index_value IN (?, ?) AND re.resourceType = ?
+          AND re.resourceUuid IN (
+          SELECT resourceUuid FROM TokenIndexEntity
+          WHERE resourceType = ? AND index_name = ? AND (index_value = ? AND IFNULL(index_system,'') = ?)
+          )
+          ORDER BY b.index_from DESC, c.index_from DESC
+          )
+          UNION ALL
+          SELECT * FROM (
+          SELECT  rie.index_name, rie.index_value, re.serializedResource
+          FROM ResourceEntity re
+          JOIN ReferenceIndexEntity rie
+          ON re.resourceUuid = rie.resourceUuid
+          LEFT JOIN DateIndexEntity b
+          ON re.resourceType = b.resourceType AND re.resourceUuid = b.resourceUuid AND b.index_name = ?
+          LEFT JOIN DateTimeIndexEntity c
+          ON re.resourceType = c.resourceType AND re.resourceUuid = c.resourceUuid AND c.index_name = ?
+          WHERE rie.resourceType = ?  AND rie.index_name = ?  AND rie.index_value IN (?, ?) AND re.resourceType = ?
+          AND re.resourceUuid IN (
+          SELECT resourceUuid FROM TokenIndexEntity
+          WHERE resourceType = ? AND index_name = ? AND (index_value = ? AND IFNULL(index_system,'') = ?)
+          )
+          ORDER BY b.index_from DESC, c.index_from DESC
+          )
+          """
+          .trimIndent(),
+      )
+
+    assertThat(query.args)
+      .containsExactly(
+        "date",
+        "date",
+        "Encounter",
+        "subject",
+        "Patient/pa01",
+        "Patient/pa02",
+        "Encounter",
+        "Encounter",
+        "status",
+        "arrived",
+        "http://hl7.org/fhir/encounter-status",
+        "recorded-date",
+        "recorded-date",
+        "Condition",
+        "subject",
+        "Patient/pa01",
+        "Patient/pa02",
+        "Condition",
+        "Condition",
+        "code",
+        "44054006",
+        "http://snomed.info/sct",
+      )
+      .inOrder()
+  }
+
   private companion object {
     const val mockEpochTimeStamp = 1628516301000
     const val APPROXIMATION_COEFFICIENT = 0.1
+
+    /**
+     * Custom implementation to equality check values of [com.google.common.truth.IterableSubject].
+     */
+    val ArgsComparator: Correspondence<Any, Any> =
+      Correspondence.from(
+        { a, b ->
+          if (a is ByteArray && b is ByteArray) {
+            a.contentEquals(b)
+          } else {
+            a == b
+          }
+        },
+        "",
+      )
   }
 }
diff --git a/engine/src/test/java/com/google/android/fhir/sync/FhirDataStoreTest.kt b/engine/src/test/java/com/google/android/fhir/sync/FhirDataStoreTest.kt
new file mode 100644
index 0000000000..7b10e4e41c
--- /dev/null
+++ b/engine/src/test/java/com/google/android/fhir/sync/FhirDataStoreTest.kt
@@ -0,0 +1,46 @@
+/*
+ * Copyright 2023-2024 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.sync
+
+import androidx.test.core.app.ApplicationProvider
+import kotlinx.coroutines.cancel
+import kotlinx.coroutines.launch
+import kotlinx.coroutines.runBlocking
+import org.junit.Assert.assertTrue
+import org.junit.Test
+import org.junit.runner.RunWith
+import org.robolectric.RobolectricTestRunner
+import org.robolectric.annotation.Config
+
+@RunWith(RobolectricTestRunner::class)
+@Config(manifest = Config.NONE)
+class FhirDataStoreTest {
+  private val fhirDataStore = FhirDataStore(ApplicationProvider.getApplicationContext())
+
+  @Test
+  fun observeSyncJobTerminalState() = runBlocking {
+    val key = "key"
+    val editJob = launch {
+      fhirDataStore.writeTerminalSyncJobStatus(key, SyncJobStatus.Succeeded())
+      fhirDataStore.observeTerminalSyncJobStatus(key).collect {
+        assertTrue(it is SyncJobStatus.Succeeded)
+        this.cancel()
+      }
+    }
+    editJob.join()
+  }
+}
diff --git a/engine/src/test/java/com/google/android/fhir/sync/FhirSyncWorkerTest.kt b/engine/src/test/java/com/google/android/fhir/sync/FhirSyncWorkerTest.kt
index 11e7923cc4..e911d557fc 100644
--- a/engine/src/test/java/com/google/android/fhir/sync/FhirSyncWorkerTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/sync/FhirSyncWorkerTest.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -23,6 +23,7 @@ import androidx.work.ListenableWorker
 import androidx.work.WorkerParameters
 import androidx.work.testing.TestListenableWorkerBuilder
 import com.google.android.fhir.FhirEngine
+import com.google.android.fhir.sync.upload.UploadStrategy
 import com.google.android.fhir.testing.TestDataSourceImpl
 import com.google.android.fhir.testing.TestDownloadManagerImpl
 import com.google.android.fhir.testing.TestFailingDatasource
@@ -50,6 +51,8 @@ class FhirSyncWorkerTest {
     override fun getDownloadWorkManager(): DownloadWorkManager = TestDownloadManagerImpl()
 
     override fun getConflictResolver() = AcceptRemoteConflictResolver
+
+    override fun getUploadStrategy(): UploadStrategy = UploadStrategy.AllChangesSquashedBundlePut
   }
 
   class FailingPeriodicSyncWorker(appContext: Context, workerParams: WorkerParameters) :
@@ -62,6 +65,8 @@ class FhirSyncWorkerTest {
     override fun getDownloadWorkManager(): DownloadWorkManager = TestDownloadManagerImpl()
 
     override fun getConflictResolver() = AcceptRemoteConflictResolver
+
+    override fun getUploadStrategy(): UploadStrategy = UploadStrategy.AllChangesSquashedBundlePut
   }
 
   class FailingPeriodicSyncWorkerWithoutDataSource(
@@ -76,6 +81,8 @@ class FhirSyncWorkerTest {
     override fun getDataSource(): DataSource? = null
 
     override fun getConflictResolver() = AcceptRemoteConflictResolver
+
+    override fun getUploadStrategy(): UploadStrategy = UploadStrategy.AllChangesSquashedBundlePut
   }
 
   @Before
@@ -129,8 +136,8 @@ class FhirSyncWorkerTest {
     val worker =
       TestListenableWorkerBuilder<FailingPeriodicSyncWorker>(
           context,
-          inputData = Data.Builder().putInt(MAX_RETRIES_ALLOWED, 2).build(),
-          runAttemptCount = 1,
+          inputData = Data.Builder().putInt(MAX_RETRIES_ALLOWED, 1).build(),
+          runAttemptCount = 0,
         )
         .build()
     val result = runBlocking { worker.doWork() }
@@ -142,7 +149,7 @@ class FhirSyncWorkerTest {
     val worker =
       TestListenableWorkerBuilder<FailingPeriodicSyncWorkerWithoutDataSource>(
           context,
-          inputData = Data.Builder().putInt(MAX_RETRIES_ALLOWED, 2).build(),
+          inputData = Data.Builder().putInt(MAX_RETRIES_ALLOWED, 1).build(),
           runAttemptCount = 2,
         )
         .build()
diff --git a/engine/src/test/java/com/google/android/fhir/sync/FhirSynchronizerTest.kt b/engine/src/test/java/com/google/android/fhir/sync/FhirSynchronizerTest.kt
index ebfb432d46..e978562320 100644
--- a/engine/src/test/java/com/google/android/fhir/sync/FhirSynchronizerTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/sync/FhirSynchronizerTest.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -16,7 +16,6 @@
 
 package com.google.android.fhir.sync
 
-import androidx.test.core.app.ApplicationProvider
 import com.google.android.fhir.LocalChangeToken
 import com.google.android.fhir.sync.download.DownloadState
 import com.google.android.fhir.sync.download.Downloader
@@ -29,6 +28,7 @@ import kotlinx.coroutines.flow.flowOf
 import kotlinx.coroutines.launch
 import kotlinx.coroutines.test.UnconfinedTestDispatcher
 import kotlinx.coroutines.test.runTest
+import org.hl7.fhir.r4.model.Patient
 import org.hl7.fhir.r4.model.ResourceType
 import org.junit.Before
 import org.junit.Test
@@ -49,6 +49,8 @@ class FhirSynchronizerTest {
 
   @Mock private lateinit var conflictResolver: ConflictResolver
 
+  @Mock private lateinit var fhirDataStore: FhirDataStore
+
   private lateinit var fhirSynchronizer: FhirSynchronizer
 
   @Before
@@ -56,11 +58,10 @@ class FhirSynchronizerTest {
     MockitoAnnotations.openMocks(this)
     fhirSynchronizer =
       FhirSynchronizer(
-        ApplicationProvider.getApplicationContext(),
         TestFhirEngineImpl,
-        uploader,
-        downloader,
-        conflictResolver,
+        UploadConfiguration(uploader),
+        DownloadConfiguration(downloader, conflictResolver),
+        fhirDataStore,
       )
   }
 
@@ -71,7 +72,6 @@ class FhirSynchronizerTest {
       `when`(uploader.upload(any()))
         .thenReturn(
           UploadSyncResult.Success(
-            LocalChangeToken(listOf()),
             listOf(),
           ),
         )
@@ -81,16 +81,16 @@ class FhirSynchronizerTest {
 
       val result = fhirSynchronizer.synchronize()
 
-      assertThat(emittedValues)
-        .containsExactly(
-          SyncJobStatus.Started,
-          SyncJobStatus.InProgress(SyncOperation.DOWNLOAD, total = 10, completed = 10),
-          SyncJobStatus.InProgress(SyncOperation.UPLOAD, total = 1, completed = 0),
-          SyncJobStatus.InProgress(SyncOperation.UPLOAD, total = 1, completed = 1),
-          SyncJobStatus.Finished,
-        )
+      assertThat(emittedValues[0]).isInstanceOf(SyncJobStatus.Started::class.java)
+      assertThat(emittedValues[1])
+        .isEqualTo(SyncJobStatus.InProgress(SyncOperation.DOWNLOAD, total = 10, completed = 10))
+      assertThat(emittedValues[2])
+        .isEqualTo(SyncJobStatus.InProgress(SyncOperation.UPLOAD, total = 1, completed = 0))
+      assertThat(emittedValues[3])
+        .isEqualTo(SyncJobStatus.InProgress(SyncOperation.UPLOAD, total = 1, completed = 1))
+      assertThat(emittedValues[4]).isInstanceOf(SyncJobStatus.Succeeded::class.java)
 
-      assertThat(SyncJobStatus.Finished::class.java).isEqualTo(result::class.java)
+      assertThat(SyncJobStatus.Succeeded::class.java).isEqualTo(result::class.java)
     }
 
   @Test
@@ -101,7 +101,6 @@ class FhirSynchronizerTest {
       `when`(uploader.upload(any()))
         .thenReturn(
           UploadSyncResult.Success(
-            LocalChangeToken(listOf()),
             listOf(),
           ),
         )
@@ -111,14 +110,12 @@ class FhirSynchronizerTest {
 
       val result = fhirSynchronizer.synchronize()
 
-      assertThat(emittedValues)
-        .containsExactly(
-          SyncJobStatus.Started,
-          SyncJobStatus.InProgress(SyncOperation.UPLOAD, total = 1, completed = 0),
-          SyncJobStatus.InProgress(SyncOperation.UPLOAD, total = 1, completed = 1),
-          SyncJobStatus.Failed(exceptions = listOf(error)),
-        )
-
+      assertThat(emittedValues[0]).isInstanceOf(SyncJobStatus.Started::class.java)
+      assertThat(emittedValues[1])
+        .isEqualTo(SyncJobStatus.InProgress(SyncOperation.UPLOAD, total = 1, completed = 0))
+      assertThat(emittedValues[2])
+        .isEqualTo(SyncJobStatus.InProgress(SyncOperation.UPLOAD, total = 1, completed = 1))
+      assertThat(emittedValues[3]).isEqualTo(SyncJobStatus.Failed(exceptions = listOf(error)))
       assertThat(result).isInstanceOf(SyncJobStatus.Failed::class.java)
       assertThat(listOf(error)).isEqualTo((result as SyncJobStatus.Failed).exceptions)
     }
@@ -136,13 +133,12 @@ class FhirSynchronizerTest {
 
       val result = fhirSynchronizer.synchronize()
 
-      assertThat(emittedValues)
-        .containsExactly(
-          SyncJobStatus.Started,
-          SyncJobStatus.InProgress(SyncOperation.DOWNLOAD, total = 10, completed = 10),
-          SyncJobStatus.InProgress(SyncOperation.UPLOAD, total = 1, completed = 0),
-          SyncJobStatus.Failed(exceptions = listOf(error)),
-        )
+      assertThat(emittedValues[0]).isInstanceOf(SyncJobStatus.Started::class.java)
+      assertThat(emittedValues[1])
+        .isEqualTo(SyncJobStatus.InProgress(SyncOperation.DOWNLOAD, total = 10, completed = 10))
+      assertThat(emittedValues[2])
+        .isEqualTo(SyncJobStatus.InProgress(SyncOperation.UPLOAD, total = 1, completed = 0))
+      assertThat(emittedValues[3]).isEqualTo(SyncJobStatus.Failed(exceptions = listOf(error)))
       assertThat(result).isInstanceOf(SyncJobStatus.Failed::class.java)
       assertThat(listOf(error)).isEqualTo((result as SyncJobStatus.Failed).exceptions)
     }
diff --git a/engine/src/test/java/com/google/android/fhir/sync/SyncTest.kt b/engine/src/test/java/com/google/android/fhir/sync/SyncTest.kt
index 9f81d9c60c..8617353a75 100644
--- a/engine/src/test/java/com/google/android/fhir/sync/SyncTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/sync/SyncTest.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -20,6 +20,7 @@ import android.content.Context
 import androidx.work.BackoffPolicy
 import androidx.work.WorkerParameters
 import com.google.android.fhir.FhirEngine
+import com.google.android.fhir.sync.upload.UploadStrategy
 import com.google.android.fhir.testing.TestDataSourceImpl
 import com.google.android.fhir.testing.TestDownloadManagerImpl
 import com.google.android.fhir.testing.TestFhirEngineImpl
@@ -43,6 +44,8 @@ class SyncTest {
     override fun getDownloadWorkManager(): DownloadWorkManager = TestDownloadManagerImpl()
 
     override fun getConflictResolver() = AcceptRemoteConflictResolver
+
+    override fun getUploadStrategy(): UploadStrategy = UploadStrategy.AllChangesSquashedBundlePut
   }
 
   @Test
@@ -51,6 +54,7 @@ class SyncTest {
       Sync.createOneTimeWorkRequest(
         RetryConfiguration(BackoffCriteria(BackoffPolicy.LINEAR, 30, TimeUnit.SECONDS), 3),
         PassingPeriodicSyncWorker::class.java,
+        "unique-name",
       )
     assertThat(workRequest.workSpec.backoffPolicy).isEqualTo(BackoffPolicy.LINEAR)
     assertThat(workRequest.workSpec.backoffDelayDuration).isEqualTo(TimeUnit.SECONDS.toMillis(30))
@@ -59,7 +63,8 @@ class SyncTest {
 
   @Test
   fun createOneTimeWorkRequest_withoutRetryConfiguration_shouldHaveZeroMaxTries() {
-    val workRequest = Sync.createOneTimeWorkRequest(null, PassingPeriodicSyncWorker::class.java)
+    val workRequest =
+      Sync.createOneTimeWorkRequest(null, PassingPeriodicSyncWorker::class.java, "unique-name")
     assertThat(workRequest.workSpec.input.getInt(MAX_RETRIES_ALLOWED, 0)).isEqualTo(0)
     //    Not checking [workRequest.workSpec.backoffPolicy] and
     // [workRequest.workSpec.backoffDelayDuration] as they have default values.
@@ -75,6 +80,7 @@ class SyncTest {
             RetryConfiguration(BackoffCriteria(BackoffPolicy.LINEAR, 30, TimeUnit.SECONDS), 3),
         ),
         PassingPeriodicSyncWorker::class.java,
+        "unique-name",
       )
     assertThat(workRequest.workSpec.intervalDuration).isEqualTo(TimeUnit.MINUTES.toMillis(20))
     assertThat(workRequest.workSpec.backoffPolicy).isEqualTo(BackoffPolicy.LINEAR)
@@ -91,6 +97,7 @@ class SyncTest {
           retryConfiguration = null,
         ),
         PassingPeriodicSyncWorker::class.java,
+        "unique-name",
       )
     assertThat(workRequest.workSpec.intervalDuration).isEqualTo(TimeUnit.MINUTES.toMillis(20))
     assertThat(workRequest.workSpec.input.getInt(MAX_RETRIES_ALLOWED, 0)).isEqualTo(0)
diff --git a/engine/src/test/java/com/google/android/fhir/sync/upload/UploaderTest.kt b/engine/src/test/java/com/google/android/fhir/sync/upload/UploaderTest.kt
index 7036bfeed9..2c470d252c 100644
--- a/engine/src/test/java/com/google/android/fhir/sync/upload/UploaderTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/sync/upload/UploaderTest.kt
@@ -18,9 +18,16 @@ package com.google.android.fhir.sync.upload
 
 import ca.uhn.fhir.context.FhirContext
 import ca.uhn.fhir.context.FhirVersionEnum
+import com.google.android.fhir.LocalChange
 import com.google.android.fhir.LocalChangeToken
 import com.google.android.fhir.db.impl.entities.LocalChangeEntity
+import com.google.android.fhir.logicalId
+import com.google.android.fhir.sync.upload.patch.PatchGeneratorFactory
+import com.google.android.fhir.sync.upload.patch.PatchGeneratorMode
+import com.google.android.fhir.sync.upload.request.UploadRequestGeneratorFactory
+import com.google.android.fhir.sync.upload.request.UploadRequestGeneratorMode
 import com.google.android.fhir.testing.BundleDataSource
+import com.google.android.fhir.testing.UrlRequestDataSource
 import com.google.android.fhir.toLocalChange
 import com.google.common.truth.Truth.assertThat
 import java.net.ConnectException
@@ -33,6 +40,7 @@ import org.hl7.fhir.r4.model.HumanName
 import org.hl7.fhir.r4.model.OperationOutcome
 import org.hl7.fhir.r4.model.Patient
 import org.hl7.fhir.r4.model.ResourceType
+import org.hl7.fhir.r4.model.codesystems.HttpVerb
 import org.junit.Test
 import org.junit.runner.RunWith
 import org.robolectric.RobolectricTestRunner
@@ -41,19 +49,209 @@ import org.robolectric.RobolectricTestRunner
 class UploaderTest {
 
   @Test
-  fun `upload should succeed if response is transaction response`() = runTest {
+  fun `bundle upload for per resource patch should output responses mapped correctly to the local changes`() =
+    runTest {
+      val patient1Id = "Patient-001"
+      val patient2Id = "Patient-002"
+      val patient2 = Patient().apply { id = patient2Id }
+      val databaseLocalChanges =
+        listOf(
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient1Id,
+            type = LocalChange.Type.INSERT,
+            payload =
+              FhirContext.forCached(FhirVersionEnum.R4)
+                .newJsonParser()
+                .encodeResourceToString(patient),
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(1)),
+          ),
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient2Id,
+            type = LocalChange.Type.INSERT,
+            payload =
+              FhirContext.forCached(FhirVersionEnum.R4)
+                .newJsonParser()
+                .encodeResourceToString(patient2),
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(2)),
+          ),
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient1Id,
+            type = LocalChange.Type.UPDATE,
+            payload = "[{\"op\":\"replace\",\"path\":\"/name/0/family\",\"value\":\"Nucleus\"}]",
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(3)),
+          ),
+        )
+
+      val updatedPatient1 =
+        patient.copy().apply {
+          addName(
+            HumanName().apply {
+              addGiven("John")
+              family = "Nucleus"
+            },
+          )
+        }
+      val result =
+        Uploader(
+            BundleDataSource {
+              Bundle().apply {
+                type = Bundle.BundleType.TRANSACTIONRESPONSE
+                addEntry(
+                  Bundle.BundleEntryComponent().apply { resource = updatedPatient1 },
+                )
+                addEntry(
+                  Bundle.BundleEntryComponent().apply { resource = patient2 },
+                )
+              }
+            },
+            perResourcePatchGenerator,
+            bundleUploadRequestGenerator,
+          )
+          .upload(databaseLocalChanges)
+
+      assertThat(result).isInstanceOf(UploadSyncResult.Success::class.java)
+      with(result as UploadSyncResult.Success) { assertThat(uploadResponses).hasSize(2) }
+      with(result.uploadResponses[0]) {
+        assertThat(this).isInstanceOf(ResourceUploadResponseMapping::class.java)
+        assertThat(localChanges).hasSize(2)
+        assertThat(localChanges.all { it.resourceId == patient1Id }).isTrue()
+        assertThat(output).isInstanceOf(Patient::class.java)
+        assertThat((output as Patient).id).isEqualTo(patient1Id)
+      }
+
+      with(result.uploadResponses[1]) {
+        assertThat(this).isInstanceOf(ResourceUploadResponseMapping::class.java)
+        assertThat(localChanges).hasSize(1)
+        assertThat(localChanges.all { it.resourceId == patient2Id }).isTrue()
+        assertThat(output).isInstanceOf(Patient::class.java)
+        assertThat((output as Patient).id).isEqualTo(patient2Id)
+      }
+    }
+
+  @Test
+  fun `bundle upload for per change patch should output responses mapped correctly to the local changes`() =
+    runTest {
+      val patient1Id = "Patient-001"
+      val patient2Id = "Patient-002"
+      val patient2 = Patient().apply { id = patient2Id }
+      val databaseLocalChanges =
+        listOf(
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient1Id,
+            type = LocalChange.Type.INSERT,
+            payload =
+              FhirContext.forCached(FhirVersionEnum.R4)
+                .newJsonParser()
+                .encodeResourceToString(patient),
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(1)),
+          ),
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient2Id,
+            type = LocalChange.Type.INSERT,
+            payload =
+              FhirContext.forCached(FhirVersionEnum.R4)
+                .newJsonParser()
+                .encodeResourceToString(patient2),
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(2)),
+          ),
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient1Id,
+            type = LocalChange.Type.UPDATE,
+            payload = "[{\"op\":\"replace\",\"path\":\"/name/0/family\",\"value\":\"Nucleus\"}]",
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(3)),
+          ),
+        )
+
+      val updatedPatient1 =
+        patient.copy().apply {
+          addName(
+            HumanName().apply {
+              addGiven("John")
+              family = "Nucleus"
+            },
+          )
+        }
+      val result =
+        Uploader(
+            BundleDataSource {
+              Bundle().apply {
+                type = Bundle.BundleType.TRANSACTIONRESPONSE
+                addEntry(
+                  Bundle.BundleEntryComponent().apply { resource = patient },
+                )
+                addEntry(
+                  Bundle.BundleEntryComponent().apply { resource = patient2 },
+                )
+                addEntry(
+                  Bundle.BundleEntryComponent().apply { resource = updatedPatient1 },
+                )
+              }
+            },
+            perChangePatchGenerator,
+            bundleUploadRequestGenerator,
+          )
+          .upload(databaseLocalChanges)
+
+      assertThat(result).isInstanceOf(UploadSyncResult.Success::class.java)
+      with(result as UploadSyncResult.Success) { assertThat(uploadResponses).hasSize(3) }
+      with(result.uploadResponses[0]) {
+        assertThat(this).isInstanceOf(ResourceUploadResponseMapping::class.java)
+        assertThat(localChanges).hasSize(1)
+        assertThat(localChanges[0].resourceId).isEqualTo(patient1Id)
+        assertThat(output).isInstanceOf(Patient::class.java)
+        assertThat((output as Patient).id).isEqualTo(patient1Id)
+      }
+
+      with(result.uploadResponses[1]) {
+        assertThat(this).isInstanceOf(ResourceUploadResponseMapping::class.java)
+        assertThat(localChanges).hasSize(1)
+        assertThat(localChanges[0].resourceId).isEqualTo(patient2Id)
+        assertThat(output).isInstanceOf(Patient::class.java)
+        assertThat((output as Patient).id).isEqualTo(patient2Id)
+      }
+
+      with(result.uploadResponses[2]) {
+        assertThat(this).isInstanceOf(ResourceUploadResponseMapping::class.java)
+        assertThat(localChanges).hasSize(1)
+        assertThat(localChanges[0].resourceId).isEqualTo(patient1Id)
+        assertThat(output).isInstanceOf(Patient::class.java)
+        assertThat((output as Patient).id).isEqualTo(patient1Id)
+      }
+    }
+
+  @Test
+  fun `bundle upload should fail if bundle response has incorrect size`() = runTest {
     val result =
       Uploader(
           BundleDataSource { Bundle().apply { type = Bundle.BundleType.TRANSACTIONRESPONSE } },
+          perResourcePatchGenerator,
+          bundleUploadRequestGenerator,
         )
         .upload(localChanges)
 
-    assertThat(result).isInstanceOf(UploadSyncResult.Success::class.java)
-    with(result as UploadSyncResult.Success) { assertThat(resources).hasSize(1) }
+    assertThat(result).isInstanceOf(UploadSyncResult.Failure::class.java)
   }
 
   @Test
-  fun `upload should fail if response is operation outcome with issue`() = runBlocking {
+  fun `bundle upload should fail if response is operation outcome with issue`() = runBlocking {
     val result =
       Uploader(
           BundleDataSource {
@@ -67,6 +265,8 @@ class UploaderTest {
               )
             }
           },
+          perResourcePatchGenerator,
+          bundleUploadRequestGenerator,
         )
         .upload(localChanges)
 
@@ -74,10 +274,12 @@ class UploaderTest {
   }
 
   @Test
-  fun `upload should fail if response is empty operation outcome`() = runBlocking {
+  fun `bundle upload should fail if response is empty operation outcome`() = runBlocking {
     val result =
       Uploader(
           BundleDataSource { OperationOutcome() },
+          perResourcePatchGenerator,
+          bundleUploadRequestGenerator,
         )
         .upload(localChanges)
 
@@ -85,11 +287,13 @@ class UploaderTest {
   }
 
   @Test
-  fun `upload should fail if response is neither transaction response nor operation outcome`() =
+  fun `bundle upload should fail if response is neither transaction response nor operation outcome`() =
     runBlocking {
       val result =
         Uploader(
             BundleDataSource { Bundle().apply { type = Bundle.BundleType.SEARCHSET } },
+            perResourcePatchGenerator,
+            bundleUploadRequestGenerator,
           )
           .upload(localChanges)
 
@@ -97,10 +301,258 @@ class UploaderTest {
     }
 
   @Test
-  fun `upload should fail if there is connection exception`() = runBlocking {
+  fun `bundle upload should fail if there is connection exception`() = runBlocking {
     val result =
       Uploader(
           BundleDataSource { throw ConnectException("Failed to connect to server.") },
+          perResourcePatchGenerator,
+          bundleUploadRequestGenerator,
+        )
+        .upload(localChanges)
+
+    assertThat(result).isInstanceOf(UploadSyncResult.Failure::class.java)
+  }
+
+  @Test
+  fun `url upload for per resource patch should output responses mapped correctly to the local changes`() =
+    runTest {
+      val patient1Id = "Patient-001"
+      val patient2Id = "Patient-002"
+      val patient2 = Patient().apply { id = patient2Id }
+      val databaseLocalChanges =
+        listOf(
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient1Id,
+            type = LocalChange.Type.INSERT,
+            payload =
+              FhirContext.forCached(FhirVersionEnum.R4)
+                .newJsonParser()
+                .encodeResourceToString(patient),
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(1)),
+          ),
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient2Id,
+            type = LocalChange.Type.INSERT,
+            payload =
+              FhirContext.forCached(FhirVersionEnum.R4)
+                .newJsonParser()
+                .encodeResourceToString(patient2),
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(2)),
+          ),
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient1Id,
+            type = LocalChange.Type.UPDATE,
+            payload = "[{\"op\":\"replace\",\"path\":\"/name/0/family\",\"value\":\"Nucleus\"}]",
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(3)),
+          ),
+        )
+
+      val updatedPatient1 =
+        patient.copy().apply {
+          addName(
+            HumanName().apply {
+              addGiven("John")
+              family = "Nucleus"
+            },
+          )
+        }
+      val result =
+        Uploader(
+            UrlRequestDataSource {
+              when (it.resource.logicalId) {
+                patient1Id -> updatedPatient1
+                patient2Id -> patient2
+                else -> throw IllegalArgumentException("Unknown patient ID")
+              }
+            },
+            perResourcePatchGenerator,
+            urlUploadRequestGenerator,
+          )
+          .upload(databaseLocalChanges)
+
+      assertThat(result).isInstanceOf(UploadSyncResult.Success::class.java)
+      with(result as UploadSyncResult.Success) { assertThat(uploadResponses).hasSize(2) }
+      with(result.uploadResponses[0]) {
+        assertThat(this).isInstanceOf(ResourceUploadResponseMapping::class.java)
+        assertThat(localChanges).hasSize(2)
+        assertThat(localChanges.all { it.resourceId == patient1Id }).isTrue()
+        assertThat(output).isInstanceOf(Patient::class.java)
+        assertThat((output as Patient).id).isEqualTo(patient1Id)
+      }
+
+      with(result.uploadResponses[1]) {
+        assertThat(this).isInstanceOf(ResourceUploadResponseMapping::class.java)
+        assertThat(localChanges).hasSize(1)
+        assertThat(localChanges.all { it.resourceId == patient2Id }).isTrue()
+        assertThat(output).isInstanceOf(Patient::class.java)
+        assertThat((output as Patient).id).isEqualTo(patient2Id)
+      }
+    }
+
+  @Test
+  fun `url upload for per change patch should output responses mapped correctly to the local changes`() =
+    runTest {
+      val patient1Id = "Patient-001"
+      val patient2Id = "Patient-002"
+      val patient2 = Patient().apply { id = patient2Id }
+      val databaseLocalChanges =
+        listOf(
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient1Id,
+            type = LocalChange.Type.INSERT,
+            payload =
+              FhirContext.forCached(FhirVersionEnum.R4)
+                .newJsonParser()
+                .encodeResourceToString(patient),
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(1)),
+          ),
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient2Id,
+            type = LocalChange.Type.INSERT,
+            payload =
+              FhirContext.forCached(FhirVersionEnum.R4)
+                .newJsonParser()
+                .encodeResourceToString(patient2),
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(2)),
+          ),
+          LocalChange(
+            resourceType = ResourceType.Patient.name,
+            resourceId = patient1Id,
+            type = LocalChange.Type.UPDATE,
+            payload = "[{\"op\":\"replace\",\"path\":\"/name/0/family\",\"value\":\"Nucleus\"}]",
+            timestamp = Instant.now(),
+            versionId = null,
+            token = LocalChangeToken(listOf(3)),
+          ),
+        )
+
+      val updatedPatient1 =
+        patient.copy().apply {
+          addName(
+            HumanName().apply {
+              addGiven("John")
+              family = "Nucleus"
+            },
+          )
+        }
+      val result =
+        Uploader(
+            UrlRequestDataSource {
+              when (it.httpVerb) {
+                HttpVerb.PUT -> {
+                  when (it.resource.logicalId) {
+                    patient1Id -> updatedPatient1
+                    patient2Id -> patient2
+                    else -> throw IllegalArgumentException("Unknown patient ID")
+                  }
+                }
+                HttpVerb.PATCH -> updatedPatient1
+                else -> throw IllegalArgumentException("Unknown patient ID")
+              }
+            },
+            perChangePatchGenerator,
+            urlUploadRequestGenerator,
+          )
+          .upload(databaseLocalChanges)
+
+      assertThat(result).isInstanceOf(UploadSyncResult.Success::class.java)
+      with(result as UploadSyncResult.Success) { assertThat(uploadResponses).hasSize(3) }
+      with(result.uploadResponses[0]) {
+        assertThat(this).isInstanceOf(ResourceUploadResponseMapping::class.java)
+        assertThat(localChanges).hasSize(1)
+        assertThat(localChanges[0].resourceId).isEqualTo(patient1Id)
+        assertThat(output).isInstanceOf(Patient::class.java)
+        assertThat((output as Patient).id).isEqualTo(patient1Id)
+      }
+
+      with(result.uploadResponses[1]) {
+        assertThat(this).isInstanceOf(ResourceUploadResponseMapping::class.java)
+        assertThat(localChanges).hasSize(1)
+        assertThat(localChanges[0].resourceId).isEqualTo(patient2Id)
+        assertThat(output).isInstanceOf(Patient::class.java)
+        assertThat((output as Patient).id).isEqualTo(patient2Id)
+      }
+
+      with(result.uploadResponses[2]) {
+        assertThat(this).isInstanceOf(ResourceUploadResponseMapping::class.java)
+        assertThat(localChanges).hasSize(1)
+        assertThat(localChanges[0].resourceId).isEqualTo(patient1Id)
+        assertThat(output).isInstanceOf(Patient::class.java)
+        assertThat((output as Patient).id).isEqualTo(patient1Id)
+      }
+    }
+
+  @Test
+  fun `url upload should fail if response has incorrect resource type`() = runTest {
+    val result =
+      Uploader(
+          UrlRequestDataSource { Bundle().apply { type = Bundle.BundleType.SEARCHSET } },
+          perResourcePatchGenerator,
+          urlUploadRequestGenerator,
+        )
+        .upload(localChanges)
+
+    assertThat(result).isInstanceOf(UploadSyncResult.Failure::class.java)
+  }
+
+  @Test
+  fun `url upload should fail if response is operation outcome with issue`() = runBlocking {
+    val result =
+      Uploader(
+          UrlRequestDataSource {
+            OperationOutcome().apply {
+              addIssue(
+                OperationOutcome.OperationOutcomeIssueComponent().apply {
+                  severity = OperationOutcome.IssueSeverity.WARNING
+                  code = OperationOutcome.IssueType.CONFLICT
+                  diagnostics = "The resource has already been updated."
+                },
+              )
+            }
+          },
+          perResourcePatchGenerator,
+          urlUploadRequestGenerator,
+        )
+        .upload(localChanges)
+
+    assertThat(result).isInstanceOf(UploadSyncResult.Failure::class.java)
+  }
+
+  @Test
+  fun `url upload should fail if response is empty operation outcome`() = runBlocking {
+    val result =
+      Uploader(
+          UrlRequestDataSource { OperationOutcome() },
+          perResourcePatchGenerator,
+          urlUploadRequestGenerator,
+        )
+        .upload(localChanges)
+
+    assertThat(result).isInstanceOf(UploadSyncResult.Failure::class.java)
+  }
+
+  @Test
+  fun `url upload should fail if there is connection exception`() = runBlocking {
+    val result =
+      Uploader(
+          UrlRequestDataSource { throw ConnectException("Failed to connect to server.") },
+          perResourcePatchGenerator,
+          urlUploadRequestGenerator,
         )
         .upload(localChanges)
 
@@ -108,6 +560,27 @@ class UploaderTest {
   }
 
   companion object {
+    private val perResourcePatchGenerator =
+      PatchGeneratorFactory.byMode(PatchGeneratorMode.PerResource)
+    private val perChangePatchGenerator = PatchGeneratorFactory.byMode(PatchGeneratorMode.PerChange)
+    private val urlUploadRequestGenerator =
+      UploadRequestGeneratorFactory.byMode(
+        UploadRequestGeneratorMode.UrlRequest(HttpVerb.PUT, HttpVerb.PATCH),
+      )
+    private val bundleUploadRequestGenerator =
+      UploadRequestGeneratorFactory.byMode(
+        UploadRequestGeneratorMode.BundleRequest(Bundle.HTTPVerb.PUT, Bundle.HTTPVerb.PATCH),
+      )
+    val patient =
+      Patient().apply {
+        id = "Patient-001"
+        addName(
+          HumanName().apply {
+            addGiven("John")
+            family = "Doe"
+          },
+        )
+      }
     val localChanges =
       listOf(
         LocalChangeEntity(
@@ -119,17 +592,7 @@ class UploaderTest {
             payload =
               FhirContext.forCached(FhirVersionEnum.R4)
                 .newJsonParser()
-                .encodeResourceToString(
-                  Patient().apply {
-                    id = "Patient-001"
-                    addName(
-                      HumanName().apply {
-                        addGiven("John")
-                        family = "Doe"
-                      },
-                    )
-                  },
-                ),
+                .encodeResourceToString(patient),
             timestamp = Instant.now(),
           )
           .toLocalChange()
diff --git a/engine/src/test/java/com/google/android/fhir/sync/upload/AllChangesLocalChangeFetcherTest.kt b/engine/src/test/java/com/google/android/fhir/sync/upload/fetcher/AllChangesLocalChangeFetcherTest.kt
similarity index 94%
rename from engine/src/test/java/com/google/android/fhir/sync/upload/AllChangesLocalChangeFetcherTest.kt
rename to engine/src/test/java/com/google/android/fhir/sync/upload/fetcher/AllChangesLocalChangeFetcherTest.kt
index 89a334cf20..3c0255eb5a 100644
--- a/engine/src/test/java/com/google/android/fhir/sync/upload/AllChangesLocalChangeFetcherTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/sync/upload/fetcher/AllChangesLocalChangeFetcherTest.kt
@@ -14,10 +14,12 @@
  * limitations under the License.
  */
 
-package com.google.android.fhir.sync.upload
+package com.google.android.fhir.sync.upload.fetcher
 
 import androidx.test.core.app.ApplicationProvider
 import com.google.android.fhir.FhirServices
+import com.google.android.fhir.sync.upload.AllChangesLocalChangeFetcher
+import com.google.android.fhir.sync.upload.SyncUploadProgress
 import com.google.common.truth.Truth.assertThat
 import java.util.Date
 import kotlinx.coroutines.test.runTest
diff --git a/engine/src/test/java/com/google/android/fhir/sync/upload/fetcher/PerResourceLocalChangeFetcherTest.kt b/engine/src/test/java/com/google/android/fhir/sync/upload/fetcher/PerResourceLocalChangeFetcherTest.kt
new file mode 100644
index 0000000000..17627de13e
--- /dev/null
+++ b/engine/src/test/java/com/google/android/fhir/sync/upload/fetcher/PerResourceLocalChangeFetcherTest.kt
@@ -0,0 +1,114 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.sync.upload.fetcher
+
+import androidx.test.core.app.ApplicationProvider
+import com.google.android.fhir.FhirServices
+import com.google.android.fhir.LocalChange
+import com.google.android.fhir.logicalId
+import com.google.android.fhir.sync.upload.PerResourceLocalChangeFetcher
+import com.google.common.truth.Truth.assertThat
+import java.util.Date
+import kotlinx.coroutines.test.runTest
+import org.hl7.fhir.r4.model.Enumerations
+import org.hl7.fhir.r4.model.Meta
+import org.hl7.fhir.r4.model.Patient
+import org.junit.Test
+import org.junit.runner.RunWith
+import org.robolectric.RobolectricTestRunner
+
+@RunWith(RobolectricTestRunner::class)
+class PerResourceLocalChangeFetcherTest {
+
+  private val services =
+    FhirServices.builder(ApplicationProvider.getApplicationContext()).inMemory().build()
+  private val database = services.database
+
+  @Test
+  fun `fetcher is created correctly`() = runTest {
+    database.insert(TEST_PATIENT_1, TEST_PATIENT_2)
+    database.update(
+      TEST_PATIENT_1.copy().apply { gender = Enumerations.AdministrativeGender.FEMALE },
+    )
+    val fetcher = PerResourceLocalChangeFetcher(database).apply { initTotalCount() }
+
+    assertThat(fetcher.getProgress().initialTotal).isEqualTo(3)
+  }
+
+  @Test
+  fun `hasNext returns correct value`() = runTest {
+    database.insert(TEST_PATIENT_1, TEST_PATIENT_2)
+    database.update(
+      TEST_PATIENT_1.copy().apply { gender = Enumerations.AdministrativeGender.FEMALE },
+    )
+    val fetcher = PerResourceLocalChangeFetcher(database).apply { initTotalCount() }
+
+    assertThat(fetcher.hasNext()).isTrue()
+    database.deleteUpdates(listOf(TEST_PATIENT_1))
+    assertThat(fetcher.hasNext()).isTrue()
+    database.deleteUpdates(listOf(TEST_PATIENT_2))
+    assertThat(fetcher.hasNext()).isFalse()
+  }
+
+  @Test
+  fun `next returns correct set of changes in the right order`() = runTest {
+    database.insert(TEST_PATIENT_1, TEST_PATIENT_2)
+    database.update(
+      TEST_PATIENT_1.copy().apply { gender = Enumerations.AdministrativeGender.FEMALE },
+    )
+    val fetcher = PerResourceLocalChangeFetcher(database).apply { initTotalCount() }
+
+    val firstSetOfChanges = fetcher.next()
+    database.deleteUpdates(listOf(TEST_PATIENT_1))
+    val secondSetOfChanges = fetcher.next()
+    database.deleteUpdates(listOf(TEST_PATIENT_2))
+
+    assertThat(firstSetOfChanges.size).isEqualTo(2)
+    with(firstSetOfChanges[0]) {
+      assertThat(type).isEqualTo(LocalChange.Type.INSERT)
+      assertThat(resourceId).isEqualTo(TEST_PATIENT_1.logicalId)
+    }
+
+    with(firstSetOfChanges[1]) {
+      assertThat(type).isEqualTo(LocalChange.Type.UPDATE)
+      assertThat(resourceId).isEqualTo(TEST_PATIENT_1.logicalId)
+    }
+
+    assertThat(secondSetOfChanges.size).isEqualTo(1)
+    with(secondSetOfChanges[0]) {
+      assertThat(type).isEqualTo(LocalChange.Type.INSERT)
+      assertThat(resourceId).isEqualTo(TEST_PATIENT_2.logicalId)
+    }
+  }
+
+  companion object {
+    private const val TEST_PATIENT_1_ID = "test_patient_1"
+    private var TEST_PATIENT_1 =
+      Patient().apply {
+        id = TEST_PATIENT_1_ID
+        gender = Enumerations.AdministrativeGender.MALE
+      }
+
+    private const val TEST_PATIENT_2_ID = "test_patient_2"
+    private var TEST_PATIENT_2 =
+      Patient().apply {
+        id = TEST_PATIENT_2_ID
+        gender = Enumerations.AdministrativeGender.MALE
+        meta = Meta().apply { lastUpdated = Date() }
+      }
+  }
+}
diff --git a/engine/src/test/java/com/google/android/fhir/sync/upload/patch/PerResourcePatchGeneratorTest.kt b/engine/src/test/java/com/google/android/fhir/sync/upload/patch/PerResourcePatchGeneratorTest.kt
index f111e2d114..2eb6297f1a 100644
--- a/engine/src/test/java/com/google/android/fhir/sync/upload/patch/PerResourcePatchGeneratorTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/sync/upload/patch/PerResourcePatchGeneratorTest.kt
@@ -55,10 +55,17 @@ class PerResourcePatchGeneratorTest {
     val patches = PerResourcePatchGenerator.generate(listOf(insertionLocalChange))
 
     with(patches.single()) {
-      assertThat(type).isEqualTo(Patch.Type.INSERT)
-      assertThat(resourceId).isEqualTo(patient.logicalId)
-      assertThat(resourceType).isEqualTo(patient.resourceType.name)
-      assertThat(payload).isEqualTo(jsonParser.encodeResourceToString(patient))
+      with(generatedPatch) {
+        assertThat(type).isEqualTo(Patch.Type.INSERT)
+        assertThat(resourceId).isEqualTo(patient.logicalId)
+        assertThat(resourceType).isEqualTo(patient.resourceType.name)
+        assertThat(payload).isEqualTo(jsonParser.encodeResourceToString(patient))
+      }
+
+      with(localChanges) {
+        assertThat(this).hasSize(1)
+        assertThat(this[0]).isEqualTo(insertionLocalChange)
+      }
     }
   }
 
@@ -79,11 +86,18 @@ class PerResourcePatchGeneratorTest {
     val patches = PerResourcePatchGenerator.generate(listOf(updateLocalChange1))
 
     with(patches.single()) {
-      assertThat(type).isEqualTo(Patch.Type.UPDATE)
-      assertThat(resourceId).isEqualTo(remotePatient.logicalId)
-      assertThat(resourceType).isEqualTo(remotePatient.resourceType.name)
-      assertThat(versionId).isEqualTo(remoteMeta.versionId)
-      assertJsonArrayEqualsIgnoringOrder(JSONArray(payload), updatePatch)
+      with(generatedPatch) {
+        assertThat(type).isEqualTo(Patch.Type.UPDATE)
+        assertThat(resourceId).isEqualTo(remotePatient.logicalId)
+        assertThat(resourceType).isEqualTo(remotePatient.resourceType.name)
+        assertThat(versionId).isEqualTo(remoteMeta.versionId)
+        assertJsonArrayEqualsIgnoringOrder(JSONArray(payload), updatePatch)
+      }
+
+      with(localChanges) {
+        assertThat(this).hasSize(1)
+        assertThat(this[0]).isEqualTo(updateLocalChange1)
+      }
     }
   }
 
@@ -101,11 +115,18 @@ class PerResourcePatchGeneratorTest {
     val patches = PerResourcePatchGenerator.generate(listOf(deleteLocalChange))
 
     with(patches.single()) {
-      assertThat(type).isEqualTo(Patch.Type.DELETE)
-      assertThat(resourceId).isEqualTo(remotePatient.logicalId)
-      assertThat(resourceType).isEqualTo(remotePatient.resourceType.name)
-      assertThat(versionId).isEqualTo(remoteMeta.versionId)
-      assertThat(payload).isEmpty()
+      with(generatedPatch) {
+        assertThat(type).isEqualTo(Patch.Type.DELETE)
+        assertThat(resourceId).isEqualTo(remotePatient.logicalId)
+        assertThat(resourceType).isEqualTo(remotePatient.resourceType.name)
+        assertThat(versionId).isEqualTo(remoteMeta.versionId)
+        assertThat(payload).isEmpty()
+      }
+
+      with(localChanges) {
+        assertThat(this).hasSize(1)
+        assertThat(this[0]).isEqualTo(deleteLocalChange)
+      }
     }
   }
 
@@ -121,10 +142,17 @@ class PerResourcePatchGeneratorTest {
       PerResourcePatchGenerator.generate(listOf(insertionLocalChange, updateLocalChange))
 
     with(patches.single()) {
-      assertThat(type).isEqualTo(Patch.Type.INSERT)
-      assertThat(resourceId).isEqualTo(patient.logicalId)
-      assertThat(resourceType).isEqualTo(patient.resourceType.name)
-      assertThat(payload).isEqualTo(patientString)
+      with(generatedPatch) {
+        assertThat(type).isEqualTo(Patch.Type.INSERT)
+        assertThat(resourceId).isEqualTo(patient.logicalId)
+        assertThat(resourceType).isEqualTo(patient.resourceType.name)
+        assertThat(payload).isEqualTo(patientString)
+      }
+
+      with(localChanges) {
+        assertThat(this).hasSize(2)
+        assertThat(this).containsExactly(insertionLocalChange, updateLocalChange)
+      }
     }
   }
 
@@ -271,11 +299,18 @@ class PerResourcePatchGeneratorTest {
     val patches = PerResourcePatchGenerator.generate(listOf(updateLocalChange1, updateLocalChange2))
 
     with(patches.single()) {
-      assertThat(type).isEqualTo(Patch.Type.UPDATE)
-      assertThat(resourceId).isEqualTo(remotePatient.logicalId)
-      assertThat(resourceType).isEqualTo(remotePatient.resourceType.name)
-      assertThat(versionId).isEqualTo(remoteMeta.versionId)
-      assertJsonArrayEqualsIgnoringOrder(JSONArray(payload), updatePatch)
+      with(generatedPatch) {
+        assertThat(type).isEqualTo(Patch.Type.UPDATE)
+        assertThat(resourceId).isEqualTo(remotePatient.logicalId)
+        assertThat(resourceType).isEqualTo(remotePatient.resourceType.name)
+        assertThat(versionId).isEqualTo(remoteMeta.versionId)
+        assertJsonArrayEqualsIgnoringOrder(JSONArray(payload), updatePatch)
+      }
+
+      with(localChanges) {
+        assertThat(size).isEqualTo(2)
+        assertThat(this).containsExactly(updateLocalChange1, updateLocalChange2)
+      }
     }
   }
 
@@ -302,11 +337,18 @@ class PerResourcePatchGeneratorTest {
       )
 
     with(patches.single()) {
-      assertThat(type).isEqualTo(Patch.Type.DELETE)
-      assertThat(resourceId).isEqualTo(remotePatient.logicalId)
-      assertThat(resourceType).isEqualTo(remotePatient.resourceType.name)
-      assertThat(versionId).isEqualTo(remoteMeta.versionId)
-      assertThat(payload).isEmpty()
+      with(generatedPatch) {
+        assertThat(type).isEqualTo(Patch.Type.DELETE)
+        assertThat(resourceId).isEqualTo(remotePatient.logicalId)
+        assertThat(resourceType).isEqualTo(remotePatient.resourceType.name)
+        assertThat(versionId).isEqualTo(remoteMeta.versionId)
+        assertThat(payload).isEmpty()
+      }
+
+      with(localChanges) {
+        assertThat(size).isEqualTo(3)
+        assertThat(this).containsExactly(updateLocalChange1, updateLocalChange2, deleteLocalChange)
+      }
     }
   }
 
diff --git a/engine/src/test/java/com/google/android/fhir/sync/upload/request/IndividualGeneratorTest.kt b/engine/src/test/java/com/google/android/fhir/sync/upload/request/IndividualGeneratorTest.kt
index 37d5baf49f..0e02b6261a 100644
--- a/engine/src/test/java/com/google/android/fhir/sync/upload/request/IndividualGeneratorTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/sync/upload/request/IndividualGeneratorTest.kt
@@ -16,16 +16,14 @@
 
 package com.google.android.fhir.sync.upload.request
 
-import ca.uhn.fhir.context.FhirContext
-import ca.uhn.fhir.context.FhirVersionEnum
-import com.google.android.fhir.sync.upload.patch.Patch
+import com.google.android.fhir.sync.upload.patch.PatchMapping
+import com.google.android.fhir.sync.upload.request.RequestGeneratorTestUtils.deleteLocalChange
+import com.google.android.fhir.sync.upload.request.RequestGeneratorTestUtils.insertionLocalChange
+import com.google.android.fhir.sync.upload.request.RequestGeneratorTestUtils.toPatch
+import com.google.android.fhir.sync.upload.request.RequestGeneratorTestUtils.updateLocalChange
 import com.google.common.truth.Truth.assertThat
-import java.time.Instant
 import kotlinx.coroutines.test.runTest
 import org.hl7.fhir.r4.model.Binary
-import org.hl7.fhir.r4.model.HumanName
-import org.hl7.fhir.r4.model.Patient
-import org.hl7.fhir.r4.model.ResourceType
 import org.hl7.fhir.r4.model.codesystems.HttpVerb
 import org.junit.Test
 import org.junit.runner.RunWith
@@ -34,8 +32,6 @@ import org.robolectric.RobolectricTestRunner
 @RunWith(RobolectricTestRunner::class)
 class IndividualGeneratorTest {
 
-  private val jsonParser = FhirContext.forCached(FhirVersionEnum.R4).newJsonParser()
-
   @Test
   fun `should return empty list if there are no local changes`() = runTest {
     val generator = UrlRequestGenerator.getDefault()
@@ -46,179 +42,99 @@ class IndividualGeneratorTest {
   @Test
   fun `should create a POST request for insert`() = runTest {
     val generator = UrlRequestGenerator.getGenerator(HttpVerb.POST, HttpVerb.PATCH)
+    val patchOutput =
+      PatchMapping(
+        localChanges = listOf(insertionLocalChange),
+        generatedPatch = insertionLocalChange.toPatch(),
+      )
     val requests =
       generator.generateUploadRequests(
-        listOf(
-          Patch(
-            resourceType = ResourceType.Patient.name,
-            resourceId = "Patient-001",
-            type = Patch.Type.INSERT,
-            payload =
-              jsonParser.encodeResourceToString(
-                Patient().apply {
-                  id = "Patient-001"
-                  addName(
-                    HumanName().apply {
-                      addGiven("John")
-                      family = "Doe"
-                    },
-                  )
-                },
-              ),
-            timestamp = Instant.now(),
-          ),
-        ),
+        listOf(patchOutput),
       )
 
     with(requests.single()) {
-      assertThat(httpVerb).isEqualTo(HttpVerb.POST)
-      assertThat(url).isEqualTo("Patient")
+      with(generatedRequest) {
+        assertThat(httpVerb).isEqualTo(HttpVerb.POST)
+        assertThat(url).isEqualTo("Patient")
+      }
+
+      assertThat(localChanges).isEqualTo(patchOutput.localChanges)
     }
   }
 
   @Test
   fun `should create a PUT request for insert`() = runTest {
     val generator = UrlRequestGenerator.getDefault()
+    val patchOutput =
+      PatchMapping(
+        localChanges = listOf(insertionLocalChange),
+        generatedPatch = insertionLocalChange.toPatch(),
+      )
     val requests =
       generator.generateUploadRequests(
-        listOf(
-          Patch(
-            resourceType = ResourceType.Patient.name,
-            resourceId = "Patient-001",
-            type = Patch.Type.INSERT,
-            payload =
-              jsonParser.encodeResourceToString(
-                Patient().apply {
-                  id = "Patient-001"
-                  addName(
-                    HumanName().apply {
-                      addGiven("John")
-                      family = "Doe"
-                    },
-                  )
-                },
-              ),
-            timestamp = Instant.now(),
-          ),
-        ),
+        listOf(patchOutput),
       )
 
     with(requests.single()) {
-      assertThat(httpVerb).isEqualTo(HttpVerb.PUT)
-      assertThat(url).isEqualTo("Patient/Patient-001")
+      with(generatedRequest) {
+        assertThat(httpVerb).isEqualTo(HttpVerb.PUT)
+        assertThat(url).isEqualTo("Patient/Patient-001")
+      }
+      assertThat(localChanges).isEqualTo(patchOutput.localChanges)
     }
   }
 
   @Test
   fun `should create a PATCH request for update`() = runTest {
-    val patches =
-      listOf(
-        Patch(
-          resourceType = ResourceType.Patient.name,
-          resourceId = "Patient-002",
-          type = Patch.Type.UPDATE,
-          payload =
-            "[{\"op\":\"replace\",\"path\":\"\\/name\\/0\\/given\\/0\",\"value\":\"Janet\"}]",
-          timestamp = Instant.now(),
-        ),
+    val patchOutput =
+      PatchMapping(
+        localChanges = listOf(updateLocalChange),
+        generatedPatch = updateLocalChange.toPatch(),
       )
     val generator = UrlRequestGenerator.Factory.getDefault()
-    val requests = generator.generateUploadRequests(patches)
+    val requests = generator.generateUploadRequests(listOf(patchOutput))
     with(requests.single()) {
-      assertThat(requests.size).isEqualTo(1)
-      assertThat(httpVerb).isEqualTo(HttpVerb.PATCH)
-      assertThat(url).isEqualTo("Patient/Patient-002")
-      assertThat((resource as Binary).data.toString(Charsets.UTF_8))
-        .isEqualTo(
-          "[{\"op\":\"replace\",\"path\":\"\\/name\\/0\\/given\\/0\",\"value\":\"Janet\"}]",
-        )
+      with(generatedRequest) {
+        assertThat(requests.size).isEqualTo(1)
+        assertThat(httpVerb).isEqualTo(HttpVerb.PATCH)
+        assertThat(url).isEqualTo("Patient/Patient-001")
+        assertThat((resource as Binary).data.toString(Charsets.UTF_8))
+          .isEqualTo(
+            "[{\"op\":\"replace\",\"path\":\"\\/name\\/0\\/given\\/0\",\"value\":\"Janet\"}]",
+          )
+      }
+      assertThat(localChanges).isEqualTo(patchOutput.localChanges)
     }
   }
 
   @Test
   fun `should create a DELETE request for delete`() = runTest {
-    val patches =
-      listOf(
-        Patch(
-          resourceType = ResourceType.Patient.name,
-          resourceId = "Patient-001",
-          type = Patch.Type.DELETE,
-          payload =
-            jsonParser.encodeResourceToString(
-              Patient().apply {
-                id = "Patient-001"
-                addName(
-                  HumanName().apply {
-                    addGiven("John")
-                    family = "Doe"
-                  },
-                )
-              },
-            ),
-          timestamp = Instant.now(),
-        ),
+    val patchOutput =
+      PatchMapping(
+        localChanges = listOf(deleteLocalChange),
+        generatedPatch = deleteLocalChange.toPatch(),
       )
     val generator = UrlRequestGenerator.Factory.getDefault()
-    val requests = generator.generateUploadRequests(patches)
+    val requests = generator.generateUploadRequests(listOf(patchOutput))
     with(requests.single()) {
-      assertThat(httpVerb).isEqualTo(HttpVerb.DELETE)
-      assertThat(url).isEqualTo("Patient/Patient-001")
+      with(generatedRequest) {
+        assertThat(httpVerb).isEqualTo(HttpVerb.DELETE)
+        assertThat(url).isEqualTo("Patient/Patient-001")
+      }
+      assertThat(localChanges).isEqualTo(patchOutput.localChanges)
     }
   }
 
   @Test
   fun `should return multiple requests in order`() = runTest {
-    val patches =
-      listOf(
-        Patch(
-          resourceType = ResourceType.Patient.name,
-          resourceId = "Patient-001",
-          type = Patch.Type.INSERT,
-          payload =
-            jsonParser.encodeResourceToString(
-              Patient().apply {
-                id = "Patient-001"
-                addName(
-                  HumanName().apply {
-                    addGiven("John")
-                    family = "Doe"
-                  },
-                )
-              },
-            ),
-          timestamp = Instant.now(),
-        ),
-        Patch(
-          resourceType = ResourceType.Patient.name,
-          resourceId = "Patient-002",
-          type = Patch.Type.UPDATE,
-          payload =
-            "[{\"op\":\"replace\",\"path\":\"\\/name\\/0\\/given\\/0\",\"value\":\"Janet\"}]",
-          timestamp = Instant.now(),
-        ),
-        Patch(
-          resourceType = ResourceType.Patient.name,
-          resourceId = "Patient-003",
-          type = Patch.Type.DELETE,
-          payload =
-            jsonParser.encodeResourceToString(
-              Patient().apply {
-                id = "Patient-003"
-                addName(
-                  HumanName().apply {
-                    addGiven("John")
-                    family = "Roe"
-                  },
-                )
-              },
-            ),
-          timestamp = Instant.now(),
-        ),
-      )
+    val patchOutputList =
+      listOf(insertionLocalChange, updateLocalChange, deleteLocalChange).map {
+        PatchMapping(listOf(it), it.toPatch())
+      }
     val generator = UrlRequestGenerator.Factory.getDefault()
-    val result = generator.generateUploadRequests(patches)
+    val result = generator.generateUploadRequests(patchOutputList)
     assertThat(result).hasSize(3)
-    assertThat(result.map { it.httpVerb })
+    assertThat(result.map { it.generatedRequest.httpVerb })
       .containsExactly(HttpVerb.PUT, HttpVerb.PATCH, HttpVerb.DELETE)
       .inOrder()
   }
diff --git a/engine/src/test/java/com/google/android/fhir/sync/upload/request/RequestGeneratorTestUtils.kt b/engine/src/test/java/com/google/android/fhir/sync/upload/request/RequestGeneratorTestUtils.kt
new file mode 100644
index 0000000000..6f8bc949dd
--- /dev/null
+++ b/engine/src/test/java/com/google/android/fhir/sync/upload/request/RequestGeneratorTestUtils.kt
@@ -0,0 +1,93 @@
+/*
+ * Copyright 2023 Google LLC
+ *
+ * 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.
+ */
+
+package com.google.android.fhir.sync.upload.request
+
+import ca.uhn.fhir.context.FhirContext
+import ca.uhn.fhir.context.FhirVersionEnum
+import com.google.android.fhir.LocalChange
+import com.google.android.fhir.LocalChangeToken
+import com.google.android.fhir.sync.upload.patch.Patch
+import java.time.Instant
+import org.hl7.fhir.r4.model.HumanName
+import org.hl7.fhir.r4.model.Patient
+import org.hl7.fhir.r4.model.ResourceType
+
+object RequestGeneratorTestUtils {
+
+  fun LocalChange.toPatch() =
+    Patch(
+      resourceType = resourceType,
+      resourceId = resourceId,
+      versionId = versionId,
+      timestamp = timestamp,
+      payload = payload,
+      type = Patch.Type.from(type.value),
+    )
+
+  val jsonParser = FhirContext.forCached(FhirVersionEnum.R4).newJsonParser()
+  val insertionLocalChange =
+    LocalChange(
+      resourceType = ResourceType.Patient.name,
+      resourceId = "Patient-001",
+      type = LocalChange.Type.INSERT,
+      payload =
+        jsonParser.encodeResourceToString(
+          Patient().apply {
+            id = "Patient-001"
+            addName(
+              HumanName().apply {
+                addGiven("John")
+                family = "Doe"
+              },
+            )
+          },
+        ),
+      timestamp = Instant.now(),
+      token = LocalChangeToken(listOf(1L)),
+    )
+  val updateLocalChange =
+    LocalChange(
+      resourceType = ResourceType.Patient.name,
+      resourceId = "Patient-001",
+      type = LocalChange.Type.UPDATE,
+      payload = "[{\"op\":\"replace\",\"path\":\"\\/name\\/0\\/given\\/0\",\"value\":\"Janet\"}]",
+      timestamp = Instant.now(),
+      token = LocalChangeToken(listOf(2L)),
+      versionId = "v-p002-01",
+    )
+  val deleteLocalChange =
+    LocalChange(
+      resourceType = ResourceType.Patient.name,
+      resourceId = "Patient-001",
+      type = LocalChange.Type.DELETE,
+      payload =
+        jsonParser.encodeResourceToString(
+          Patient().apply {
+            id = "Patient-001"
+            addName(
+              HumanName().apply {
+                addGiven("John")
+                family = "Doe"
+              },
+            )
+          },
+        ),
+      timestamp = Instant.now(),
+      token = LocalChangeToken(listOf(2L)),
+      versionId = "v-p003-01",
+    )
+}
diff --git a/engine/src/test/java/com/google/android/fhir/sync/upload/request/TransactionBundleGeneratorTest.kt b/engine/src/test/java/com/google/android/fhir/sync/upload/request/TransactionBundleGeneratorTest.kt
index d21e30a4c6..6319ac0eee 100644
--- a/engine/src/test/java/com/google/android/fhir/sync/upload/request/TransactionBundleGeneratorTest.kt
+++ b/engine/src/test/java/com/google/android/fhir/sync/upload/request/TransactionBundleGeneratorTest.kt
@@ -18,14 +18,17 @@ package com.google.android.fhir.sync.upload.request
 
 import ca.uhn.fhir.context.FhirContext
 import ca.uhn.fhir.context.FhirVersionEnum
-import com.google.android.fhir.db.impl.dao.diff
-import com.google.android.fhir.sync.upload.patch.Patch
+import com.google.android.fhir.LocalChange
+import com.google.android.fhir.LocalChangeToken
+import com.google.android.fhir.sync.upload.patch.PatchMapping
+import com.google.android.fhir.sync.upload.request.RequestGeneratorTestUtils.deleteLocalChange
+import com.google.android.fhir.sync.upload.request.RequestGeneratorTestUtils.insertionLocalChange
+import com.google.android.fhir.sync.upload.request.RequestGeneratorTestUtils.toPatch
+import com.google.android.fhir.sync.upload.request.RequestGeneratorTestUtils.updateLocalChange
 import com.google.common.truth.Truth.assertThat
 import java.time.Instant
 import kotlinx.coroutines.runBlocking
 import org.hl7.fhir.r4.model.Bundle
-import org.hl7.fhir.r4.model.HumanName
-import org.hl7.fhir.r4.model.Patient
 import org.hl7.fhir.r4.model.ResourceType
 import org.junit.Assert.assertThrows
 import org.junit.Test
@@ -46,85 +49,24 @@ class TransactionBundleGeneratorTest {
   @Test
   fun `generateUploadRequests() should return single Transaction Bundle with 3 entries`() =
     runBlocking {
-      val jsonParser = FhirContext.forCached(FhirVersionEnum.R4).newJsonParser()
       val patches =
-        listOf(
-          Patch(
-            resourceType = ResourceType.Patient.name,
-            resourceId = "Patient-001",
-            type = Patch.Type.INSERT,
-            payload =
-              jsonParser.encodeResourceToString(
-                Patient().apply {
-                  id = "Patient-001"
-                  addName(
-                    HumanName().apply {
-                      addGiven("John")
-                      family = "Doe"
-                    },
-                  )
-                },
-              ),
-            timestamp = Instant.now(),
-          ),
-          Patch(
-            resourceType = ResourceType.Patient.name,
-            resourceId = "Patient-002",
-            type = Patch.Type.UPDATE,
-            payload =
-              diff(
-                  jsonParser,
-                  Patient().apply {
-                    id = "Patient-002"
-                    addName(
-                      HumanName().apply {
-                        addGiven("Jane")
-                        family = "Doe"
-                      },
-                    )
-                  },
-                  Patient().apply {
-                    id = "Patient-002"
-                    addName(
-                      HumanName().apply {
-                        addGiven("Janet")
-                        family = "Doe"
-                      },
-                    )
-                  },
-                )
-                .toString(),
-            timestamp = Instant.now(),
-          ),
-          Patch(
-            resourceType = ResourceType.Patient.name,
-            resourceId = "Patient-003",
-            type = Patch.Type.DELETE,
-            payload =
-              jsonParser.encodeResourceToString(
-                Patient().apply {
-                  id = "Patient-003"
-                  addName(
-                    HumanName().apply {
-                      addGiven("John")
-                      family = "Roe"
-                    },
-                  )
-                },
-              ),
-            timestamp = Instant.now(),
-          ),
-        )
+        listOf(insertionLocalChange, updateLocalChange, deleteLocalChange).map {
+          PatchMapping(listOf(it), it.toPatch())
+        }
       val generator = TransactionBundleGenerator.Factory.getDefault()
       val result = generator.generateUploadRequests(patches)
 
       assertThat(result).hasSize(1)
-      val bundleUploadRequest = result[0]
-      assertThat(bundleUploadRequest.resource.type).isEqualTo(Bundle.BundleType.TRANSACTION)
-      assertThat(bundleUploadRequest.resource.entry).hasSize(3)
-      assertThat(bundleUploadRequest.resource.entry.map { it.request.method })
-        .containsExactly(Bundle.HTTPVerb.PUT, Bundle.HTTPVerb.PATCH, Bundle.HTTPVerb.DELETE)
-        .inOrder()
+      with(result[0].generatedRequest.resource) {
+        assertThat(type).isEqualTo(Bundle.BundleType.TRANSACTION)
+        assertThat(entry).hasSize(3)
+        assertThat(entry.map { it.request.method })
+          .containsExactly(Bundle.HTTPVerb.PUT, Bundle.HTTPVerb.PATCH, Bundle.HTTPVerb.DELETE)
+          .inOrder()
+      }
+
+      assertThat(result[0].splitLocalChanges).hasSize(3)
+      assertThat(result[0].splitLocalChanges.all { it.size == 1 }).isTrue()
     }
 
   @Test
@@ -132,75 +74,9 @@ class TransactionBundleGeneratorTest {
     runBlocking {
       val jsonParser = FhirContext.forCached(FhirVersionEnum.R4).newJsonParser()
       val patches =
-        listOf(
-          Patch(
-            resourceType = ResourceType.Patient.name,
-            resourceId = "Patient-001",
-            type = Patch.Type.INSERT,
-            payload =
-              jsonParser.encodeResourceToString(
-                Patient().apply {
-                  id = "Patient-001"
-                  addName(
-                    HumanName().apply {
-                      addGiven("John")
-                      family = "Doe"
-                    },
-                  )
-                },
-              ),
-            timestamp = Instant.now(),
-          ),
-          Patch(
-            resourceType = ResourceType.Patient.name,
-            resourceId = "Patient-002",
-            type = Patch.Type.UPDATE,
-            payload =
-              diff(
-                  jsonParser,
-                  Patient().apply {
-                    id = "Patient-002"
-                    addName(
-                      HumanName().apply {
-                        addGiven("Jane")
-                        family = "Doe"
-                      },
-                    )
-                  },
-                  Patient().apply {
-                    id = "Patient-002"
-                    addName(
-                      HumanName().apply {
-                        addGiven("Janet")
-                        family = "Doe"
-                      },
-                    )
-                  },
-                )
-                .toString(),
-            versionId = "v-p002-01",
-            timestamp = Instant.now(),
-          ),
-          Patch(
-            resourceType = ResourceType.Patient.name,
-            resourceId = "Patient-003",
-            type = Patch.Type.DELETE,
-            payload =
-              jsonParser.encodeResourceToString(
-                Patient().apply {
-                  id = "Patient-003"
-                  addName(
-                    HumanName().apply {
-                      addGiven("John")
-                      family = "Roe"
-                    },
-                  )
-                },
-              ),
-            versionId = "v-p003-01",
-            timestamp = Instant.now(),
-          ),
-        )
+        listOf(insertionLocalChange, updateLocalChange, deleteLocalChange).map {
+          PatchMapping(listOf(it), it.toPatch())
+        }
       val generator =
         TransactionBundleGenerator.Factory.getGenerator(
           Bundle.HTTPVerb.PUT,
@@ -208,90 +84,113 @@ class TransactionBundleGeneratorTest {
           1,
           true,
         )
-      val result = generator.generateUploadRequests(patches)
-
-      // Exactly 3 Requests are generated
-      assertThat(result).hasSize(3)
-      // Each Request is of type Bundle
-      assertThat(result.all { it.resource.type == Bundle.BundleType.TRANSACTION }).isTrue()
-      // Each Bundle has exactly 1 entry
-      assertThat(result.all { it.resource.entry.size == 1 }).isTrue()
-      assertThat(result.map { it.resource.entry.first().request.method })
-        .containsExactly(Bundle.HTTPVerb.PUT, Bundle.HTTPVerb.PATCH, Bundle.HTTPVerb.DELETE)
-        .inOrder()
-      assertThat(result.map { it.resource.entry.first().request.ifMatch })
-        .containsExactly(null, "W/\"v-p002-01\"", "W/\"v-p003-01\"")
-        .inOrder()
+      with(generator.generateUploadRequests(patches)) {
+        // Exactly 3 Requests are generated
+        assertThat(this).hasSize(3)
+        // Each Request is of type Bundle
+        assertThat(all { it.generatedRequest.resource.type == Bundle.BundleType.TRANSACTION })
+          .isTrue()
+        // Each Bundle has exactly 1 entry
+        assertThat(all { it.generatedRequest.resource.entry.size == 1 }).isTrue()
+        assertThat(map { it.generatedRequest.resource.entry.first().request.method })
+          .containsExactly(Bundle.HTTPVerb.PUT, Bundle.HTTPVerb.PATCH, Bundle.HTTPVerb.DELETE)
+          .inOrder()
+        assertThat(map { it.generatedRequest.resource.entry.first().request.ifMatch })
+          .containsExactly(null, "W/\"v-p002-01\"", "W/\"v-p003-01\"")
+          .inOrder()
+        // Each Bundle request is mapped to 1 LocalChange
+        assertThat(all { it.splitLocalChanges.size == 1 }).isTrue()
+        assertThat(all { it.splitLocalChanges[0].size == 1 }).isTrue()
+      }
     }
 
   @Test
   fun `generate() should return Bundle Entry without if-match when useETagForUpload is false`() =
     runBlocking {
+      val localChange =
+        LocalChange(
+          resourceType = ResourceType.Patient.name,
+          resourceId = "Patient-002",
+          type = LocalChange.Type.UPDATE,
+          payload = "[]",
+          versionId = "patient-002-version-1",
+          timestamp = Instant.now(),
+          token = LocalChangeToken(listOf(1L)),
+        )
       val patches =
         listOf(
-          Patch(
-            resourceType = ResourceType.Patient.name,
-            resourceId = "Patient-002",
-            type = Patch.Type.UPDATE,
-            payload = "[]",
-            versionId = "patient-002-version-1",
-            timestamp = Instant.now(),
+          PatchMapping(
+            localChanges = listOf(localChange),
+            generatedPatch = localChange.toPatch(),
           ),
         )
       val generator = TransactionBundleGenerator.Factory.getDefault(useETagForUpload = false)
       val result = generator.generateUploadRequests(patches)
 
-      assertThat(result.first().resource.entry.first().request.ifMatch).isNull()
+      assertThat(result.first().generatedRequest.resource.entry.first().request.ifMatch).isNull()
+      assertThat(result.first().splitLocalChanges.size).isEqualTo(1)
+      assertThat(result.first().splitLocalChanges[0].size).isEqualTo(1)
     }
 
   @Test
   fun `generate() should return Bundle Entry with if-match when useETagForUpload is true`() =
     runBlocking {
+      val localChange =
+        LocalChange(
+          resourceType = ResourceType.Patient.name,
+          resourceId = "Patient-002",
+          type = LocalChange.Type.UPDATE,
+          payload = "[]",
+          versionId = "patient-002-version-1",
+          timestamp = Instant.now(),
+          token = LocalChangeToken(listOf(1L)),
+        )
       val patches =
         listOf(
-          Patch(
-            resourceType = ResourceType.Patient.name,
-            resourceId = "Patient-002",
-            type = Patch.Type.UPDATE,
-            payload = "[]",
-            versionId = "patient-002-version-1",
-            timestamp = Instant.now(),
+          PatchMapping(
+            localChanges = listOf(localChange),
+            generatedPatch = localChange.toPatch(),
           ),
         )
       val generator = TransactionBundleGenerator.Factory.getDefault(useETagForUpload = true)
       val result = generator.generateUploadRequests(patches)
 
-      assertThat(result.first().resource.entry.first().request.ifMatch)
+      assertThat(result.first().generatedRequest.resource.entry.first().request.ifMatch)
         .isEqualTo("W/\"patient-002-version-1\"")
+      assertThat(result.first().splitLocalChanges.size).isEqualTo(1)
+      assertThat(result.first().splitLocalChanges[0].size).isEqualTo(1)
     }
 
   @Test
   fun `generate() should return Bundle Entry without if-match when the LocalChangeEntity has no versionId`() =
     runBlocking {
-      val patches =
+      val localChanges =
         listOf(
-          Patch(
+          LocalChange(
             resourceType = ResourceType.Patient.name,
             resourceId = "Patient-002",
-            type = Patch.Type.UPDATE,
+            type = LocalChange.Type.UPDATE,
             payload = "[]",
             versionId = "",
             timestamp = Instant.now(),
+            token = LocalChangeToken(listOf(1L)),
           ),
-          Patch(
+          LocalChange(
             resourceType = ResourceType.Patient.name,
             resourceId = "Patient-003",
-            type = Patch.Type.UPDATE,
+            type = LocalChange.Type.UPDATE,
             payload = "[]",
             versionId = null,
             timestamp = Instant.now(),
+            token = LocalChangeToken(listOf(2L)),
           ),
         )
+      val patches = localChanges.map { PatchMapping(listOf(it), it.toPatch()) }
       val generator = TransactionBundleGenerator.Factory.getDefault(useETagForUpload = true)
       val result = generator.generateUploadRequests(patches)
 
-      assertThat(result.first().resource.entry[0].request.ifMatch).isNull()
-      assertThat(result.first().resource.entry[1].request.ifMatch).isNull()
+      assertThat(result.first().generatedRequest.resource.entry[0].request.ifMatch).isNull()
+      assertThat(result.first().generatedRequest.resource.entry[1].request.ifMatch).isNull()
     }
 
   @Test
diff --git a/gradle/libs.versions.toml b/gradle/libs.versions.toml
new file mode 100644
index 0000000000..ac89294412
--- /dev/null
+++ b/gradle/libs.versions.toml
@@ -0,0 +1,11 @@
+# see https://docs.gradle.org/current/userguide/platforms.html
+
+[versions]
+glide = "4.16.0"
+
+[libraries]
+glide = { module = "com.github.bumptech.glide:glide", version.ref = "glide" }
+
+[bundles]
+
+[plugins]
diff --git a/knowledge/build.gradle.kts b/knowledge/build.gradle.kts
index b6a4f541f2..669b1031fb 100644
--- a/knowledge/build.gradle.kts
+++ b/knowledge/build.gradle.kts
@@ -1,4 +1,4 @@
-import Dependencies.forceGuava
+import Dependencies.removeIncompatibleDependencies
 import java.net.URL
 
 plugins {
@@ -67,13 +67,7 @@ android {
 
 afterEvaluate { configureFirebaseTestLabForLibraries() }
 
-configurations {
-  all {
-    exclude(module = "xpp3")
-    exclude(module = "xpp3_min")
-    forceGuava()
-  }
-}
+configurations { all { removeIncompatibleDependencies() } }
 
 dependencies {
   androidTestImplementation(Dependencies.AndroidxTest.core)
@@ -109,6 +103,12 @@ dependencies {
   testImplementation(Dependencies.mockWebServer)
   testImplementation(Dependencies.robolectric)
   testImplementation(Dependencies.truth)
+
+  constraints {
+    Dependencies.hapiFhirConstraints().forEach { (libName, constraints) ->
+      api(libName, constraints)
+    }
+  }
 }
 
 tasks.dokkaHtml.configure {
diff --git a/knowledge/src/main/java/com/google/android/fhir/knowledge/KnowledgeManager.kt b/knowledge/src/main/java/com/google/android/fhir/knowledge/KnowledgeManager.kt
index 60f1ad1845..83c3d95990 100644
--- a/knowledge/src/main/java/com/google/android/fhir/knowledge/KnowledgeManager.kt
+++ b/knowledge/src/main/java/com/google/android/fhir/knowledge/KnowledgeManager.kt
@@ -28,9 +28,11 @@ import com.google.android.fhir.knowledge.npm.NpmPackageDownloader
 import com.google.android.fhir.knowledge.npm.OkHttpNpmPackageDownloader
 import java.io.File
 import java.io.FileInputStream
+import java.io.FileOutputStream
 import kotlinx.coroutines.Dispatchers
 import kotlinx.coroutines.withContext
 import org.hl7.fhir.instance.model.api.IBaseResource
+import org.hl7.fhir.r4.model.IdType
 import org.hl7.fhir.r4.model.MetadataResource
 import org.hl7.fhir.r4.model.Resource
 import org.hl7.fhir.r4.model.ResourceType
@@ -95,7 +97,13 @@ internal constructor(
       try {
         val resource = jsonParser.parseResource(FileInputStream(file))
         if (resource is Resource) {
-          importResource(igId, resource, file)
+          val newId = indexResourceFile(igId, resource, file)
+          resource.setId(IdType(resource.resourceType.name, newId))
+
+          // Overrides the Id in the file
+          FileOutputStream(file).use {
+            it.write(jsonParser.encodeResourceToString(resource).toByteArray())
+          }
         } else {
           Timber.d("Unable to import file: %file")
         }
@@ -124,7 +132,7 @@ internal constructor(
         url != null && version != null ->
           listOfNotNull(knowledgeDao.getResourceWithUrlAndVersion(url, version))
         url != null -> listOfNotNull(knowledgeDao.getResourceWithUrl(url))
-        id != null -> listOfNotNull(knowledgeDao.getResourceWithUrlLike("%$id"))
+        id != null -> listOfNotNull(knowledgeDao.getResourcesWithId(id.toLong()))
         name != null && version != null ->
           listOfNotNull(knowledgeDao.getResourcesWithNameAndVersion(resType, name, version))
         name != null -> knowledgeDao.getResourcesWithName(resType, name)
@@ -154,11 +162,19 @@ internal constructor(
         }
       }
     when (resource) {
-      is Resource -> importResource(igId, resource, file)
+      is Resource -> {
+        val newId = indexResourceFile(igId, resource, file)
+        resource.setId(IdType(resource.resourceType.name, newId))
+
+        // Overrides the Id in the file
+        FileOutputStream(file).use {
+          it.write(jsonParser.encodeResourceToString(resource).toByteArray())
+        }
+      }
     }
   }
 
-  private suspend fun importResource(igId: Long?, resource: Resource, file: File) {
+  private suspend fun indexResourceFile(igId: Long?, resource: Resource, file: File): Long {
     val metadataResource = resource as? MetadataResource
     val res =
       ResourceMetadataEntity(
@@ -169,7 +185,8 @@ internal constructor(
         metadataResource?.version,
         file,
       )
-    knowledgeDao.insertResource(igId, res)
+
+    return knowledgeDao.insertResource(igId, res)
   }
 
   private fun loadResource(resourceEntity: ResourceMetadataEntity): IBaseResource {
diff --git a/knowledge/src/main/java/com/google/android/fhir/knowledge/db/dao/KnowledgeDao.kt b/knowledge/src/main/java/com/google/android/fhir/knowledge/db/dao/KnowledgeDao.kt
index a76390c879..bc5d937b78 100644
--- a/knowledge/src/main/java/com/google/android/fhir/knowledge/db/dao/KnowledgeDao.kt
+++ b/knowledge/src/main/java/com/google/android/fhir/knowledge/db/dao/KnowledgeDao.kt
@@ -35,7 +35,7 @@ abstract class KnowledgeDao {
   internal open suspend fun insertResource(
     implementationGuideId: Long?,
     resource: ResourceMetadataEntity,
-  ) {
+  ): Long {
     val resourceMetadata =
       if (resource.url != null && resource.version != null) {
         getResourceWithUrlAndVersion(resource.url, resource.version)
@@ -48,6 +48,7 @@ abstract class KnowledgeDao {
     // exception if they are different.
     val resourceMetadataId = resourceMetadata?.resourceMetadataId ?: insert(resource)
     insert(ImplementationGuideResourceMetadataEntity(0, implementationGuideId, resourceMetadataId))
+    return resourceMetadataId
   }
 
   @Transaction
@@ -94,12 +95,6 @@ abstract class KnowledgeDao {
     url: String,
   ): ResourceMetadataEntity?
 
-  // Remove after https://github.com/google/android-fhir/issues/1920
-  @Query("SELECT * from ResourceMetadataEntity WHERE url LIKE :urlPart")
-  internal abstract suspend fun getResourceWithUrlLike(
-    urlPart: String,
-  ): ResourceMetadataEntity?
-
   @Query(
     "SELECT * from ResourceMetadataEntity WHERE  resourceType = :resourceType AND name = :name",
   )
@@ -108,6 +103,13 @@ abstract class KnowledgeDao {
     name: String?,
   ): List<ResourceMetadataEntity>
 
+  @Query(
+    "SELECT * from ResourceMetadataEntity WHERE resourceMetadataId = :id",
+  )
+  internal abstract suspend fun getResourcesWithId(
+    id: Long?,
+  ): ResourceMetadataEntity?
+
   @Query(
     "SELECT * from ResourceMetadataEntity WHERE resourceType = :resourceType AND name = :name AND version = :version",
   )
diff --git a/knowledge/src/test/java/com/google/android/fhir/knowledge/KnowledgeManagerTest.kt b/knowledge/src/test/java/com/google/android/fhir/knowledge/KnowledgeManagerTest.kt
index c28c651767..2b1d187194 100644
--- a/knowledge/src/test/java/com/google/android/fhir/knowledge/KnowledgeManagerTest.kt
+++ b/knowledge/src/test/java/com/google/android/fhir/knowledge/KnowledgeManagerTest.kt
@@ -113,14 +113,14 @@ internal class KnowledgeManagerTest {
   fun `inserting a library of a different version creates new entry`() = runTest {
     val libraryAOld =
       Library().apply {
-        id = "defaultA"
+        id = "Library/defaultA-A.1.0.0"
         name = "defaultA"
         url = "www.exampleA.com"
         version = "A.1.0.0"
       }
     val libraryANew =
       Library().apply {
-        id = "defaultA"
+        id = "Library/defaultA-A.1.0.1"
         name = "defaultA"
         url = "www.exampleA.com"
         version = "A.1.0.1"
@@ -131,6 +131,18 @@ internal class KnowledgeManagerTest {
 
     val resources = knowledgeDb.knowledgeDao().getResources()
     assertThat(resources).hasSize(2)
+
+    val resourceA100 =
+      knowledgeManager
+        .loadResources(resourceType = "Library", name = "defaultA", version = "A.1.0.0")
+        .single()
+    assertThat(resourceA100.idElement.toString()).isEqualTo("Library/1")
+
+    val resourceA101 =
+      knowledgeManager
+        .loadResources(resourceType = "Library", name = "defaultA", version = "A.1.0.1")
+        .single()
+    assertThat(resourceA101.idElement.toString()).isEqualTo("Library/2")
   }
 
   fun `installing from npmPackageManager`() = runTest {
@@ -153,7 +165,8 @@ internal class KnowledgeManagerTest {
   }
 
   private fun writeToFile(library: Library): File {
-    return File(context.filesDir, library.name).apply {
+    return File(context.filesDir, library.id).apply {
+      this.parentFile?.mkdirs()
       writeText(jsonParser.encodeResourceToString(library))
     }
   }
diff --git a/kokoro/gcp_ubuntu/kokoro_build.sh b/kokoro/gcp_ubuntu/kokoro_build.sh
index bc7c4eb45b..d3ed56d6b1 100755
--- a/kokoro/gcp_ubuntu/kokoro_build.sh
+++ b/kokoro/gcp_ubuntu/kokoro_build.sh
@@ -92,16 +92,7 @@ function build_only() {
 function device_tests() {
   ./gradlew packageDebugAndroidTest --scan --stacktrace
   ./gradlew packageReleaseAndroidTest --scan --stacktrace
-    local lib_names=("workflow:benchmark" "engine:benchmark" "datacapture" "engine" "knowledge" "workflow")
-    firebase_pids=()
-    for lib_name in "${lib_names[@]}"; do
-      ./gradlew :$lib_name:runFlank  --scan --stacktrace &
-      firebase_pids+=("$!")
-    done
-
-    for firebase_pid in ${firebase_pids[*]}; do
-        wait $firebase_pid
-    done
+  .github/workflows/runFlank.sh
 }
 
 # Generates JaCoCo reports and uploads to Codecov: https://about.codecov.io/
diff --git a/settings.gradle.kts b/settings.gradle.kts
index a3fb255a35..16f5bbdf50 100644
--- a/settings.gradle.kts
+++ b/settings.gradle.kts
@@ -3,7 +3,7 @@ import androidx.build.gradle.gcpbuildcache.GcpBuildCacheServiceFactory
 
 plugins {
   id("com.gradle.enterprise") version ("3.10")
-  id("androidx.build.gradle.gcpbuildcache") version "1.0.0-beta01"
+  id("androidx.build.gradle.gcpbuildcache") version "1.0.0-beta05"
   id("org.gradle.toolchains.foojay-resolver-convention") version ("0.5.0")
 }
 
@@ -31,13 +31,13 @@ if (kokoroRun == true) {
 // NECESSARY force of the Jackson to run generateSearchParams in the new version of HAPI (6.8)
 buildscript {
   dependencies {
-    classpath("com.fasterxml.jackson.core:jackson-core:2.15.2")
-    classpath("com.fasterxml.jackson.core:jackson-annotations:2.15.2")
-    classpath("com.fasterxml.jackson.core:jackson-databind:2.15.2")
-    classpath("com.fasterxml.jackson.dataformat:jackson-dataformat-xml:2.15.2")
-    classpath("com.fasterxml.jackson.module:jackson-module-jaxb-annotations:2.15.2")
-    classpath("com.fasterxml.jackson.datatype:jackson-datatype-jsr310:2.15.2")
-    classpath("com.fasterxml.jackson.module:jackson-module-kotlin:2.15.2")
+    classpath("com.fasterxml.jackson.core:jackson-core:2.16.0")
+    classpath("com.fasterxml.jackson.core:jackson-annotations:2.15.3")
+    classpath("com.fasterxml.jackson.core:jackson-databind:2.16.0")
+    classpath("com.fasterxml.jackson.dataformat:jackson-dataformat-xml:2.16.0")
+    classpath("com.fasterxml.jackson.module:jackson-module-jaxb-annotations:2.16.0")
+    classpath("com.fasterxml.jackson.datatype:jackson-datatype-jsr310:2.16.0")
+    classpath("com.fasterxml.jackson.module:jackson-module-kotlin:2.16.0")
   }
 }
 
@@ -49,6 +49,8 @@ include(":contrib:barcode")
 
 include(":datacapture")
 
+include(":document")
+
 include(":demo")
 
 include(":engine")
diff --git a/workflow-testing/build.gradle.kts b/workflow-testing/build.gradle.kts
index 9d0b9b5842..dadb083443 100644
--- a/workflow-testing/build.gradle.kts
+++ b/workflow-testing/build.gradle.kts
@@ -1,6 +1,3 @@
-import Dependencies.forceGuava
-import Dependencies.forceHapiVersion
-import Dependencies.forceJacksonVersion
 import Dependencies.removeIncompatibleDependencies
 
 plugins {
@@ -15,14 +12,7 @@ android {
   kotlin { jvmToolchain(11) }
 }
 
-configurations {
-  all {
-    removeIncompatibleDependencies()
-    forceGuava()
-    forceHapiVersion()
-    forceJacksonVersion()
-  }
-}
+configurations { all { removeIncompatibleDependencies() } }
 
 dependencies {
   compileOnly(Dependencies.Cql.evaluator)
@@ -30,19 +20,15 @@ dependencies {
   compileOnly(Dependencies.Cql.evaluatorFhirUtilities)
   compileOnly(project(":engine")) { exclude(module = "truth") }
 
-  // Forces the most recent version of jackson, ignoring what dependencies use.
-  // Remove these lines when HAPI 6.4 becomes available.
-  compileOnly(Dependencies.Jackson.annotations)
-  compileOnly(Dependencies.Jackson.bom)
-  compileOnly(Dependencies.Jackson.core)
-  compileOnly(Dependencies.Jackson.databind)
-  compileOnly(Dependencies.Jackson.dataformatXml)
-  compileOnly(Dependencies.Jackson.jaxbAnnotations)
-  compileOnly(Dependencies.Jackson.jsr310)
-
   compileOnly(Dependencies.junit)
   compileOnly(Dependencies.jsonAssert)
   compileOnly(Dependencies.woodstox)
   compileOnly(Dependencies.xmlUnit)
   compileOnly(Dependencies.truth)
+
+  constraints {
+    Dependencies.hapiFhirConstraints().forEach { (libName, constraints) ->
+      compileOnly(libName, constraints)
+    }
+  }
 }
diff --git a/workflow-testing/src/main/java/com/google/android/fhir/workflow/testing/CqlBuilder.kt b/workflow-testing/src/main/java/com/google/android/fhir/workflow/testing/CqlBuilder.kt
index 648d28a873..93085ec0e5 100644
--- a/workflow-testing/src/main/java/com/google/android/fhir/workflow/testing/CqlBuilder.kt
+++ b/workflow-testing/src/main/java/com/google/android/fhir/workflow/testing/CqlBuilder.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2022-2023 Google LLC
+ * Copyright 2022-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -40,7 +40,7 @@ object CqlBuilder : Loadable() {
   /**
    * Compiles a CQL InputStream to ELM
    *
-   * @param cqlText the CQL Library
+   * @param cqlText the CQL Library's input stream
    * @return a [CqlTranslator] object that contains the elm representation of the library inside it.
    */
   fun compile(cqlText: InputStream): CqlTranslator {
diff --git a/workflow-testing/src/main/resources/plan-definition/cql-applicability-condition/care_plan.json b/workflow-testing/src/main/resources/plan-definition/cql-applicability-condition/care_plan.json
index 11924add40..892663c8e0 100644
--- a/workflow-testing/src/main/resources/plan-definition/cql-applicability-condition/care_plan.json
+++ b/workflow-testing/src/main/resources/plan-definition/cql-applicability-condition/care_plan.json
@@ -1,9 +1,9 @@
 {
   "resourceType": "CarePlan",
-  "id": "Plan-Definition-Example",
+  "id": "17",
   "contained": [ {
     "resourceType": "RequestGroup",
-    "id": "Plan-Definition-Example",
+    "id": "17",
     "instantiatesCanonical": [ "http://example.com/PlanDefinition/Plan-Definition-Example" ],
     "status": "draft",
     "intent": "proposal",
@@ -20,12 +20,12 @@
         }
       } ],
       "resource": {
-        "reference": "Task/Activity-Example"
+        "reference": "Task/16"
       }
     } ]
   }, {
     "resourceType": "Task",
-    "id": "Activity-Example",
+    "id": "16",
     "extension": [ {
       "url": "http://hl7.org/fhir/aphl/StructureDefinition/condition",
       "valueExpression": {
@@ -35,7 +35,7 @@
     } ],
     "instantiatesCanonical": "http://example.com/ActivityDefinition/Activity-Example",
     "basedOn": [ {
-      "reference": "#RequestGroup/Plan-Definition-Example",
+      "reference": "#RequestGroup/17",
       "type": "RequestGroup"
     } ],
     "status": "draft",
@@ -53,7 +53,7 @@
   },
   "activity": [ {
     "reference": {
-      "reference": "#RequestGroup/Plan-Definition-Example"
+      "reference": "#RequestGroup/17"
     }
   } ]
 }
\ No newline at end of file
diff --git a/workflow-testing/src/main/resources/plan-definition/med-request/med_request_careplan.json b/workflow-testing/src/main/resources/plan-definition/med-request/med_request_careplan.json
index cf71f8ef1b..117d63447d 100644
--- a/workflow-testing/src/main/resources/plan-definition/med-request/med_request_careplan.json
+++ b/workflow-testing/src/main/resources/plan-definition/med-request/med_request_careplan.json
@@ -1,10 +1,10 @@
 {
   "resourceType": "CarePlan",
-  "id": "MedRequest-Example",
+  "id": "17",
   "contained": [
     {
       "resourceType": "RequestGroup",
-      "id": "MedRequest-Example",
+      "id": "17",
       "instantiatesCanonical": [
         "http://localhost/PlanDefinition/MedRequest-Example"
       ],
@@ -18,14 +18,14 @@
           "id": "medication-action-1",
           "title": "Administer Medication 1",
           "resource": {
-            "reference": "MedicationRequest/MedicationRequest-1"
+            "reference": "MedicationRequest/16"
           }
         }
       ]
     },
     {
       "resourceType": "MedicationRequest",
-      "id": "MedicationRequest-1",
+      "id": "16",
       "status": "draft",
       "intent": "order",
       "medicationCodeableConcept": {
@@ -50,7 +50,7 @@
   "activity": [
     {
       "reference": {
-        "reference": "#RequestGroup/MedRequest-Example"
+        "reference": "#RequestGroup/17"
       }
     }
   ]
diff --git a/workflow/benchmark/build.gradle.kts b/workflow/benchmark/build.gradle.kts
index 7cb5f95994..258054a8aa 100644
--- a/workflow/benchmark/build.gradle.kts
+++ b/workflow/benchmark/build.gradle.kts
@@ -1,4 +1,3 @@
-import Dependencies.forceGuava
 import Dependencies.removeIncompatibleDependencies
 
 plugins {
@@ -46,12 +45,7 @@ android {
 
 afterEvaluate { configureFirebaseTestLabForMicroBenchmark() }
 
-configurations {
-  all {
-    removeIncompatibleDependencies()
-    forceGuava()
-  }
-}
+configurations { all { removeIncompatibleDependencies() } }
 
 dependencies {
   androidTestImplementation(Dependencies.AndroidxTest.benchmarkJunit)
@@ -74,4 +68,10 @@ dependencies {
     exclude(group = Dependencies.androidFhirGroup, module = Dependencies.androidFhirKnowledgeModule)
   }
   androidTestImplementation(project(":workflow-testing"))
+
+  constraints {
+    Dependencies.hapiFhirConstraints().forEach { (libName, constraints) ->
+      androidTestImplementation(libName, constraints)
+    }
+  }
 }
diff --git a/workflow/build.gradle.kts b/workflow/build.gradle.kts
index 5ae54c8cb0..27b9a66c88 100644
--- a/workflow/build.gradle.kts
+++ b/workflow/build.gradle.kts
@@ -1,6 +1,3 @@
-import Dependencies.forceGuava
-import Dependencies.forceHapiVersion
-import Dependencies.forceJacksonVersion
 import Dependencies.removeIncompatibleDependencies
 import java.net.URL
 
@@ -76,17 +73,9 @@ android {
 
 afterEvaluate { configureFirebaseTestLabForLibraries() }
 
-configurations {
-  all {
-    removeIncompatibleDependencies()
-    forceGuava()
-    forceHapiVersion()
-    forceJacksonVersion()
-  }
-}
+configurations { all { removeIncompatibleDependencies() } }
 
 dependencies {
-  testImplementation(project(mapOf("path" to ":knowledge")))
   coreLibraryDesugaring(Dependencies.desugarJdkLibs)
 
   androidTestImplementation(Dependencies.AndroidxTest.core)
@@ -104,19 +93,16 @@ dependencies {
   api(Dependencies.HapiFhir.guavaCaching)
 
   implementation(Dependencies.Androidx.coreKtx)
-
   implementation(Dependencies.Cql.evaluator)
   implementation(Dependencies.Cql.evaluatorFhirJackson)
-  implementation(Dependencies.timber)
-
   implementation(Dependencies.HapiFhir.guavaCaching)
-
   implementation(Dependencies.Kotlin.kotlinCoroutinesAndroid)
   implementation(Dependencies.Kotlin.kotlinCoroutinesCore)
   implementation(Dependencies.Kotlin.stdlib)
+  implementation(Dependencies.androidFhirEngine) { exclude(module = "truth") }
+  implementation(Dependencies.androidFhirKnowledge)
+  implementation(Dependencies.timber)
   implementation(Dependencies.xerces)
-  implementation(project(":engine")) { exclude(module = "truth") }
-  implementation(project(":knowledge"))
 
   testImplementation(Dependencies.AndroidxTest.core)
   testImplementation(Dependencies.jsonAssert)
@@ -124,7 +110,15 @@ dependencies {
   testImplementation(Dependencies.robolectric)
   testImplementation(Dependencies.truth)
   testImplementation(Dependencies.xmlUnit)
+  testImplementation(project(mapOf("path" to ":knowledge")))
   testImplementation(project(":workflow-testing"))
+
+  constraints {
+    Dependencies.hapiFhirConstraints().forEach { (libName, constraints) ->
+      api(libName, constraints)
+      implementation(libName, constraints)
+    }
+  }
 }
 
 tasks.dokkaHtml.configure {
diff --git a/workflow/src/main/java/com/google/android/fhir/workflow/FhirOperator.kt b/workflow/src/main/java/com/google/android/fhir/workflow/FhirOperator.kt
index e5d0c820ea..fb3e0a6c75 100644
--- a/workflow/src/main/java/com/google/android/fhir/workflow/FhirOperator.kt
+++ b/workflow/src/main/java/com/google/android/fhir/workflow/FhirOperator.kt
@@ -1,5 +1,5 @@
 /*
- * Copyright 2023 Google LLC
+ * Copyright 2023-2024 Google LLC
  *
  * Licensed under the Apache License, Version 2.0 (the "License");
  * you may not use this file except in compliance with the License.
@@ -25,16 +25,20 @@ import com.google.android.fhir.FhirEngineProvider
 import com.google.android.fhir.knowledge.KnowledgeManager
 import com.google.android.fhir.workflow.repositories.FhirEngineRepository
 import com.google.android.fhir.workflow.repositories.KnowledgeRepository
+import org.hl7.fhir.instance.model.api.IBaseBundle
+import org.hl7.fhir.instance.model.api.IBaseDatatype
 import org.hl7.fhir.instance.model.api.IBaseParameters
 import org.hl7.fhir.instance.model.api.IBaseResource
 import org.hl7.fhir.r4.model.CanonicalType
 import org.hl7.fhir.r4.model.IdType
-import org.hl7.fhir.r4.model.Measure
 import org.hl7.fhir.r4.model.MeasureReport
 import org.hl7.fhir.r4.model.Parameters
+import org.hl7.fhir.r4.model.PlanDefinition
+import org.hl7.fhir.r4.model.Reference
 import org.opencds.cqf.fhir.cql.EvaluationSettings
 import org.opencds.cqf.fhir.cql.LibraryEngine
 import org.opencds.cqf.fhir.cr.measure.MeasureEvaluationOptions
+import org.opencds.cqf.fhir.cr.measure.common.MeasureReportType
 import org.opencds.cqf.fhir.cr.measure.r4.R4MeasureProcessor
 import org.opencds.cqf.fhir.cr.plandefinition.r4.PlanDefinitionProcessor
 import org.opencds.cqf.fhir.utility.monad.Eithers
@@ -162,20 +166,35 @@ internal constructor(
     start: String,
     end: String,
     reportType: String,
-    subjectId: String?,
-    practitioner: String?,
+    subjectId: String? = null,
+    practitioner: String? = null,
+    additionalData: IBaseBundle? = null,
   ): MeasureReport {
-    val measure = Eithers.forLeft3<CanonicalType, IdType, Measure>(CanonicalType(measureUrl))
-    return measureProcessor.evaluateMeasure(
-      /* measure = */ measure,
-      /* periodStart = */ start,
-      /* periodEnd = */ end,
-      /* reportType = */ reportType,
-      /* subjectIds = */ listOf(
-        subjectId,
-      ), // https://github.com/cqframework/clinical-reasoning/issues/358
-      /* additionalData = */ null,
-    )
+    val subject =
+      if (!practitioner.isNullOrBlank()) {
+        checkAndAddType(practitioner, "Practitioner")
+      } else if (!subjectId.isNullOrBlank()) {
+        checkAndAddType(subjectId, "Patient")
+      } else {
+        // List of null is required to run population-level measures
+        null
+      }
+
+    val report =
+      measureProcessor.evaluateMeasure(
+        /* measure = */ Eithers.forLeft3(CanonicalType(measureUrl)),
+        /* periodStart = */ start,
+        /* periodEnd = */ end,
+        /* reportType = */ reportType,
+        /* subjectIds = */ listOf(subject),
+        /* additionalData = */ additionalData,
+      )
+
+    // add subject reference for non-individual reportTypes
+    if (report.type.name == MeasureReportType.SUMMARY.name && !subject.isNullOrBlank()) {
+      report.setSubject(Reference(subject))
+    }
+    return report
   }
 
   /**
@@ -185,8 +204,12 @@ internal constructor(
    * from a worker thread or it may throw [BlockingMainThreadException] exception.
    */
   @WorkerThread
-  fun generateCarePlan(planDefinitionId: String, patientId: String): IBaseResource {
-    return generateCarePlan(planDefinitionId, patientId, encounterId = null)
+  @Deprecated(
+    "Use generateCarePlan with the planDefinition's url instead.",
+    ReplaceWith("this.generateCarePlan(CanonicalType, String)"),
+  )
+  fun generateCarePlan(planDefinitionId: String, subject: String): IBaseResource {
+    return generateCarePlan(planDefinitionId, subject, encounterId = null)
   }
 
   /**
@@ -196,16 +219,20 @@ internal constructor(
    * from a worker thread or it may throw [BlockingMainThreadException] exception.
    */
   @WorkerThread
+  @Deprecated(
+    "Use generateCarePlan with the planDefinition's url instead.",
+    ReplaceWith("this.generateCarePlan(CanonicalType, String, String)"),
+  )
   fun generateCarePlan(
     planDefinitionId: String,
-    patientId: String,
+    subject: String,
     encounterId: String?,
   ): IBaseResource {
     return planDefinitionProcessor.apply(
       /* id = */ IdType("PlanDefinition", planDefinitionId),
       /* canonical = */ null,
       /* planDefinition = */ null,
-      /* subject = */ patientId,
+      /* subject = */ subject,
       /* encounterId = */ encounterId,
       /* practitionerId = */ null,
       /* organizationId = */ null,
@@ -222,6 +249,87 @@ internal constructor(
     ) as IBaseResource
   }
 
+  @WorkerThread
+  fun generateCarePlan(
+    planDefinition: CanonicalType,
+    subject: String,
+    encounterId: String? = null,
+    practitionerId: String? = null,
+    organizationId: String? = null,
+    userType: IBaseDatatype? = null,
+    userLanguage: IBaseDatatype? = null,
+    userTaskContext: IBaseDatatype? = null,
+    setting: IBaseDatatype? = null,
+    settingContext: IBaseDatatype? = null,
+    parameters: IBaseParameters? = null,
+    useServerData: Boolean? = null,
+    bundle: IBaseBundle? = null,
+    prefetchData: IBaseParameters? = null,
+  ): IBaseResource {
+    return planDefinitionProcessor.apply(
+      /* id = */ null,
+      /* canonical = */ planDefinition,
+      /* planDefinition = */ null,
+      /* subject = */ subject,
+      /* encounterId = */ encounterId,
+      /* practitionerId = */ practitionerId,
+      /* organizationId = */ organizationId,
+      /* userType = */ userType,
+      /* userLanguage = */ userLanguage,
+      /* userTaskContext = */ userTaskContext,
+      /* setting = */ setting,
+      /* settingContext = */ settingContext,
+      /* parameters = */ parameters,
+      /* useServerData = */ useServerData,
+      /* bundle = */ bundle,
+      /* prefetchData = */ prefetchData,
+      libraryProcessor,
+    ) as IBaseResource
+  }
+
+  @WorkerThread
+  fun generateCarePlan(
+    planDefinition: PlanDefinition,
+    subject: String,
+    encounterId: String? = null,
+    practitionerId: String? = null,
+    organizationId: String? = null,
+    userType: IBaseDatatype? = null,
+    userLanguage: IBaseDatatype? = null,
+    userTaskContext: IBaseDatatype? = null,
+    setting: IBaseDatatype? = null,
+    settingContext: IBaseDatatype? = null,
+    parameters: IBaseParameters? = null,
+    useServerData: Boolean? = null,
+    bundle: IBaseBundle? = null,
+    prefetchData: IBaseParameters? = null,
+  ): IBaseResource {
+    return planDefinitionProcessor.apply(
+      /* id = */ null,
+      /* canonical = */ null,
+      /* planDefinition = */ planDefinition,
+      /* subject = */ subject,
+      /* encounterId = */ encounterId,
+      /* practitionerId = */ practitionerId,
+      /* organizationId = */ organizationId,
+      /* userType = */ userType,
+      /* userLanguage = */ userLanguage,
+      /* userTaskContext = */ userTaskContext,
+      /* setting = */ setting,
+      /* settingContext = */ settingContext,
+      /* parameters = */ parameters,
+      /* useServerData = */ useServerData,
+      /* bundle = */ bundle,
+      /* prefetchData = */ prefetchData,
+      libraryProcessor,
+    ) as IBaseResource
+  }
+
+  /** Checks if the Resource ID contains a type and if not, adds a default type */
+  fun checkAndAddType(id: String, defaultType: String): String {
+    return if (id.indexOf("/") == -1) "$defaultType/$id" else id
+  }
+
   class Builder(private val applicationContext: Context) {
     private var fhirContext: FhirContext? = null
     private var fhirEngine: FhirEngine? = null
diff --git a/workflow/src/test/java/com/google/android/fhir/workflow/FhirOperatorTest.kt b/workflow/src/test/java/com/google/android/fhir/workflow/FhirOperatorTest.kt
index 712f4dcdff..c534d728b4 100644
--- a/workflow/src/test/java/com/google/android/fhir/workflow/FhirOperatorTest.kt
+++ b/workflow/src/test/java/com/google/android/fhir/workflow/FhirOperatorTest.kt
@@ -32,6 +32,7 @@ import java.lang.IllegalArgumentException
 import java.util.TimeZone
 import kotlin.reflect.KSuspendFunction1
 import org.hl7.fhir.r4.model.Bundle
+import org.hl7.fhir.r4.model.CanonicalType
 import org.hl7.fhir.r4.model.Library
 import org.hl7.fhir.r4.model.MetadataResource
 import org.hl7.fhir.r4.model.Resource
@@ -98,8 +99,11 @@ class FhirOperatorTest {
 
     assertThat(
         fhirOperator.generateCarePlan(
-          planDefinitionId = "plandefinition-RuleFilters-1.0.0",
-          patientId = "Reportable",
+          planDefinition =
+            CanonicalType(
+              "http://hl7.org/fhir/us/ecr/PlanDefinition/plandefinition-RuleFilters-1.0.0",
+            ),
+          subject = "Patient/Reportable",
           encounterId = "reportable-encounter",
         ),
       )
@@ -113,12 +117,10 @@ class FhirOperatorTest {
 
     val carePlan =
       fhirOperator.generateCarePlan(
-        planDefinitionId = "MedRequest-Example",
-        patientId = "Patient/Patient-Example",
+        planDefinition = CanonicalType("http://localhost/PlanDefinition/MedRequest-Example"),
+        subject = "Patient/Patient-Example",
       )
 
-    println(jsonParser.encodeResourceToString(carePlan))
-
     assertEquals(
       readResourceAsString("/plan-definition/med-request/med_request_careplan.json"),
       jsonParser.encodeResourceToString(carePlan),
@@ -137,8 +139,8 @@ class FhirOperatorTest {
 
     val carePlan =
       fhirOperator.generateCarePlan(
-        planDefinitionId = "Plan-Definition-Example",
-        patientId = "Patient/Female-Patient-Example",
+        planDefinition = CanonicalType("http://example.com/PlanDefinition/Plan-Definition-Example"),
+        subject = "Patient/Female-Patient-Example",
       )
 
     println(jsonParser.setPrettyPrint(true).encodeResourceToString(carePlan))
@@ -287,11 +289,16 @@ class FhirOperatorTest {
   private fun writeToFile(resource: Resource): File {
     val fileName =
       if (resource is MetadataResource && resource.name != null) {
-        resource.name
+        if (resource.version != null) {
+          resource.name + "-" + resource.version
+        } else {
+          resource.name
+        }
       } else {
-        resource.idElement.idPart
+        resource.idElement.toString()
       }
     return File(context.filesDir, fileName).apply {
+      this.parentFile.mkdirs()
       writeText(jsonParser.encodeResourceToString(resource))
     }
   }