diff --git a/src/lib/Microsoft.Health.Extensions.Fhir.R4/ServiceCollectionExtensions.cs b/src/lib/Microsoft.Health.Extensions.Fhir.R4/FhirClientExtensions.cs
similarity index 51%
rename from src/lib/Microsoft.Health.Extensions.Fhir.R4/ServiceCollectionExtensions.cs
rename to src/lib/Microsoft.Health.Extensions.Fhir.R4/FhirClientExtensions.cs
index 0fdc7860..b73741f9 100644
--- a/src/lib/Microsoft.Health.Extensions.Fhir.R4/ServiceCollectionExtensions.cs
+++ b/src/lib/Microsoft.Health.Extensions.Fhir.R4/FhirClientExtensions.cs
@@ -15,9 +15,9 @@
 
 namespace Microsoft.Health.Extensions.Fhir
 {
-    public static class ServiceCollectionExtensions
+    public static class FhirClientExtensions
     {
-        public static void AddFhirClient(this IServiceCollection serviceCollection, IConfiguration configuration)
+        public static IServiceCollection AddFhirClient(this IServiceCollection serviceCollection, IConfiguration configuration)
         {
             EnsureArg.IsNotNull(serviceCollection, nameof(serviceCollection));
             EnsureArg.IsNotNull(configuration, nameof(configuration));
@@ -25,35 +25,46 @@ public static void AddFhirClient(this IServiceCollection serviceCollection, ICon
             var url = new Uri(configuration.GetValue<string>("FhirService:Url"));
             bool useManagedIdentity = configuration.GetValue<bool>("FhirClient:UseManagedIdentity");
 
-            serviceCollection.AddSingleton(typeof(ITelemetryLogger), typeof(IomtTelemetryLogger));
-            var serviceProvider = serviceCollection.BuildServiceProvider();
-            var logger = serviceProvider.GetRequiredService<ITelemetryLogger>();
-
-            serviceCollection.AddHttpClient<IFhirClient, FhirClient>(client =>
+            serviceCollection.AddHttpClient<IFhirClient, FhirClient>((client, sp) =>
             {
                 client.BaseAddress = url;
                 client.Timeout = TimeSpan.FromSeconds(60);
 
+                var logger = sp.GetRequiredService<ITelemetryLogger>();
+
                 // Using discard because we don't need result
                 var fhirClient = new FhirClient(client);
                 _ = fhirClient.ValidateFhirClientAsync(logger);
+
                 return fhirClient;
             })
-            .AddAuthenticationHandler(serviceCollection, logger, url, useManagedIdentity);
-        }
-
-        public static void AddNamedManagedIdentityCredentialProvider(this IServiceCollection serviceCollection)
-        {
-            EnsureArg.IsNotNull(serviceCollection, nameof(serviceCollection));
+            .AddAuthenticationHandler(serviceCollection, url, useManagedIdentity);
 
-            serviceCollection.TryAddSingleton<ManagedIdentityAuthService>();
+            return serviceCollection;
         }
 
-        public static void AddNamedOAuth2ClientCredentialProvider(this IServiceCollection serviceCollection)
+        public static void AddAuthenticationHandler(
+           this IHttpClientBuilder httpClientBuilder,
+           IServiceCollection services,
+           Uri uri,
+           bool useManagedIdentity)
         {
-            EnsureArg.IsNotNull(serviceCollection, nameof(serviceCollection));
+            EnsureArg.IsNotNull(httpClientBuilder, nameof(httpClientBuilder));
+            EnsureArg.IsNotNull(services, nameof(services));
+            EnsureArg.IsNotNull(uri, nameof(uri));
 
-            serviceCollection.TryAddSingleton<OAuthConfidentialClientAuthService>();
+            if (useManagedIdentity)
+            {
+                services.TryAddSingleton(new ManagedIdentityAuthService());
+                httpClientBuilder.AddHttpMessageHandler(sp =>
+                    new BearerTokenAuthorizationMessageHandler(uri, sp.GetRequiredService<ManagedIdentityAuthService>(), sp.GetRequiredService<ITelemetryLogger>()));
+            }
+            else
+            {
+                services.TryAddSingleton(new OAuthConfidentialClientAuthService());
+                httpClientBuilder.AddHttpMessageHandler(sp =>
+                    new BearerTokenAuthorizationMessageHandler(uri, sp.GetRequiredService<OAuthConfidentialClientAuthService>(), sp.GetRequiredService<ITelemetryLogger>()));
+            }
         }
     }
 }
diff --git a/src/lib/Microsoft.Health.Extensions.Fhir.R4/FhirClientValidator.cs b/src/lib/Microsoft.Health.Extensions.Fhir.R4/FhirClientValidatorExtensions.cs
similarity index 95%
rename from src/lib/Microsoft.Health.Extensions.Fhir.R4/FhirClientValidator.cs
rename to src/lib/Microsoft.Health.Extensions.Fhir.R4/FhirClientValidatorExtensions.cs
index 3461d967..bf52c493 100644
--- a/src/lib/Microsoft.Health.Extensions.Fhir.R4/FhirClientValidator.cs
+++ b/src/lib/Microsoft.Health.Extensions.Fhir.R4/FhirClientValidatorExtensions.cs
@@ -12,7 +12,7 @@
 
 namespace Microsoft.Health.Extensions.Fhir
 {
-    public static class FhirClientValidator
+    public static class FhirClientValidatorExtensions
     {
         public static async Task<bool> ValidateFhirClientAsync(
             this IFhirClient client,
diff --git a/src/lib/Microsoft.Health.Extensions.Fhir.R4/HttpClientBuilderRegistrationExtensions.cs b/src/lib/Microsoft.Health.Extensions.Fhir.R4/HttpClientBuilderRegistrationExtensions.cs
deleted file mode 100644
index a334f275..00000000
--- a/src/lib/Microsoft.Health.Extensions.Fhir.R4/HttpClientBuilderRegistrationExtensions.cs
+++ /dev/null
@@ -1,42 +0,0 @@
-// -------------------------------------------------------------------------------------------------
-// Copyright (c) Microsoft Corporation. All rights reserved.
-// Licensed under the MIT License (MIT). See LICENSE in the repo root for license information.
-// -------------------------------------------------------------------------------------------------
-
-using System;
-using EnsureThat;
-using Microsoft.Extensions.DependencyInjection;
-using Microsoft.Health.Extensions.Host.Auth;
-using Microsoft.Health.Logging.Telemetry;
-
-namespace Microsoft.Health.Extensions.Fhir
-{
-    public static class HttpClientBuilderRegistrationExtensions
-    {
-        public static void AddAuthenticationHandler(
-            this IHttpClientBuilder httpClientBuilder,
-            IServiceCollection services,
-            ITelemetryLogger logger,
-            Uri uri,
-            bool useManagedIdentity)
-        {
-            EnsureArg.IsNotNull(httpClientBuilder, nameof(httpClientBuilder));
-            EnsureArg.IsNotNull(services, nameof(services));
-            EnsureArg.IsNotNull(logger, nameof(logger));
-            EnsureArg.IsNotNull(uri, nameof(uri));
-
-            if (useManagedIdentity)
-            {
-                services.AddNamedManagedIdentityCredentialProvider();
-                httpClientBuilder.AddHttpMessageHandler(x =>
-                    new BearerTokenAuthorizationMessageHandler(uri, new ManagedIdentityAuthService(), logger));
-            }
-            else
-            {
-                services.AddNamedOAuth2ClientCredentialProvider();
-                httpClientBuilder.AddHttpMessageHandler(x =>
-                    new BearerTokenAuthorizationMessageHandler(uri, new OAuthConfidentialClientAuthService(), logger));
-            }
-        }
-    }
-}
diff --git a/src/lib/Microsoft.Health.Extensions.Fhir.R4/ObservationExtensions.cs b/src/lib/Microsoft.Health.Extensions.Fhir.R4/ObservationExtensions.cs
new file mode 100644
index 00000000..29757769
--- /dev/null
+++ b/src/lib/Microsoft.Health.Extensions.Fhir.R4/ObservationExtensions.cs
@@ -0,0 +1,34 @@
+// -------------------------------------------------------------------------------------------------
+// Copyright (c) Microsoft Corporation. All rights reserved.
+// Licensed under the MIT License (MIT). See LICENSE in the repo root for license information.
+// -------------------------------------------------------------------------------------------------
+
+using EnsureThat;
+using Hl7.Fhir.Model;
+
+namespace Microsoft.Health.Extensions.Fhir
+{
+    public static class ObservationExtensions
+    {
+        /// <summary>
+        /// Compares two observations to see if they are different.  If they are different the <paramref name="updatedObservation"/> status is changed to Amended.
+        /// </summary>
+        /// <param name="originalObservation">The original unmodified observation.</param>
+        /// <param name="updatedObservation">The potentially modified observation.</param>
+        /// <returns>Returns true if the <paramref name="updatedObservation"/> is different than the <paramref name="originalObservation"/>.  Otherwise false is returned.</returns>
+        public static bool AmendIfChanged(this Observation originalObservation, Observation updatedObservation)
+        {
+            EnsureArg.IsNotNull(originalObservation, nameof(originalObservation));
+            EnsureArg.IsNotNull(updatedObservation, nameof(updatedObservation));
+            EnsureArg.IsFalse(originalObservation == updatedObservation, optsFn: o => o.WithMessage($"Parameters {nameof(originalObservation)} and {nameof(updatedObservation)} are the same reference."));
+
+            if (!originalObservation.IsExactly(updatedObservation))
+            {
+                updatedObservation.Status = ObservationStatus.Amended;
+                return true;
+            }
+
+            return false;
+        }
+    }
+}
diff --git a/src/lib/Microsoft.Health.Extensions.Fhir.R4/ResourceExtensions.cs b/src/lib/Microsoft.Health.Extensions.Fhir.R4/ResourceExtensions.cs
new file mode 100644
index 00000000..a09145b3
--- /dev/null
+++ b/src/lib/Microsoft.Health.Extensions.Fhir.R4/ResourceExtensions.cs
@@ -0,0 +1,27 @@
+// -------------------------------------------------------------------------------------------------
+// Copyright (c) Microsoft Corporation. All rights reserved.
+// Licensed under the MIT License (MIT). See LICENSE in the repo root for license information.
+// -------------------------------------------------------------------------------------------------
+
+using EnsureThat;
+using Hl7.Fhir.Model;
+
+namespace Microsoft.Health.Extensions.Fhir
+{
+    public static class ResourceExtensions
+    {
+        /// <summary>
+        /// Performs full deep copy of the resource.
+        /// </summary>
+        /// <typeparam name="TResource">Type of resource to return.</typeparam>
+        /// <param name="resource">Resource to copy.</param>
+        /// <returns>New resource object with the contents of the original.</returns>
+        public static TResource FullCopy<TResource>(this TResource resource)
+            where TResource : class, IDeepCopyable
+        {
+            EnsureArg.IsNotNull(resource, nameof(resource));
+
+            return resource.DeepCopy() as TResource;
+        }
+    }
+}
diff --git a/src/lib/Microsoft.Health.Extensions.Fhir.R4/Service/FhirService.cs b/src/lib/Microsoft.Health.Extensions.Fhir.R4/Service/FhirService.cs
index 41d9e110..31a6159a 100644
--- a/src/lib/Microsoft.Health.Extensions.Fhir.R4/Service/FhirService.cs
+++ b/src/lib/Microsoft.Health.Extensions.Fhir.R4/Service/FhirService.cs
@@ -76,6 +76,12 @@ public async Task<T> UpdateResourceAsync<T>(
         {
             EnsureArg.IsNotNull(resource, nameof(resource));
 
+            if (string.IsNullOrWhiteSpace(ifMatchVersion) && resource.HasVersionId)
+            {
+                // Underlying FhirClient already adds the W/"" formating and inserts content of the ifMatchVersion
+                ifMatchVersion = resource.VersionId.ToString();
+            }
+
             return await _fhirClient.UpdateAsync(resource, ifMatchVersion, provenanceHeader, cancellationToken).ConfigureAwait(false);
         }
 
diff --git a/src/lib/Microsoft.Health.Fhir.R4.Ingest.Templates/Template/CodeValueFhirTemplateProcessor.cs b/src/lib/Microsoft.Health.Fhir.R4.Ingest.Templates/Template/CodeValueFhirTemplateProcessor.cs
index d4586fc7..10f272e3 100644
--- a/src/lib/Microsoft.Health.Fhir.R4.Ingest.Templates/Template/CodeValueFhirTemplateProcessor.cs
+++ b/src/lib/Microsoft.Health.Fhir.R4.Ingest.Templates/Template/CodeValueFhirTemplateProcessor.cs
@@ -128,42 +128,42 @@ protected override Observation MergeObservationImpl(CodeValueFhirTemplate templa
             EnsureArg.IsNotNull(grp, nameof(grp));
             EnsureArg.IsNotNull(existingObservation, nameof(existingObservation));
 
-            existingObservation.Status = ObservationStatus.Amended;
+            var mergedObservation = existingObservation.DeepCopy() as Observation;
 
-            existingObservation.Category = null;
+            mergedObservation.Category = null;
             if (template?.Category?.Count > 0)
             {
-                existingObservation.Category = ResolveCategory(template.Category);
+                mergedObservation.Category = ResolveCategory(template.Category);
             }
 
             var values = grp.GetValues();
-            (DateTime start, DateTime end) observationPeriod = GetObservationPeriod(existingObservation);
+            (DateTime start, DateTime end) observationPeriod = GetObservationPeriod(mergedObservation);
 
             // Update observation value
             if (!string.IsNullOrWhiteSpace(template?.Value?.ValueName) && values.TryGetValue(template?.Value?.ValueName, out var obValues))
             {
-                existingObservation.Value = _valueProcessor.MergeValue(template.Value, CreateMergeData(grp.Boundary, observationPeriod, obValues), existingObservation.Value);
+                mergedObservation.Value = _valueProcessor.MergeValue(template.Value, CreateMergeData(grp.Boundary, observationPeriod, obValues), mergedObservation.Value);
             }
 
             // Update observation component values
             if (template?.Components?.Count > 0)
             {
-                if (existingObservation.Component == null)
+                if (mergedObservation.Component == null)
                 {
-                    existingObservation.Component = new List<Observation.ComponentComponent>(template.Components.Count);
+                    mergedObservation.Component = new List<Observation.ComponentComponent>(template.Components.Count);
                 }
 
                 foreach (var component in template.Components)
                 {
                     if (values.TryGetValue(component.Value.ValueName, out var compValues))
                     {
-                        var foundComponent = existingObservation.Component
+                        var foundComponent = mergedObservation.Component
                             .Where(c => c.Code.Coding.Any(code => code.Code == component.Value.ValueName && code.System == FhirImportService.ServiceSystem))
                             .FirstOrDefault();
 
                         if (foundComponent == null)
                         {
-                            existingObservation.Component.Add(
+                            mergedObservation.Component.Add(
                                 new Observation.ComponentComponent
                                 {
                                     Code = ResolveCode(component.Value.ValueName, component.Codes),
@@ -189,9 +189,9 @@ protected override Observation MergeObservationImpl(CodeValueFhirTemplate templa
                 observationPeriod.end = grp.Boundary.End;
             }
 
-            existingObservation.Effective = observationPeriod.ToPeriod();
+            mergedObservation.Effective = observationPeriod.ToPeriod();
 
-            return existingObservation;
+            return mergedObservation;
         }
 
         protected override IEnumerable<IObservationGroup> CreateObservationGroupsImpl(CodeValueFhirTemplate template, IMeasurementGroup measurementGroup)
diff --git a/src/lib/Microsoft.Health.Fhir.R4.Ingest/Service/R4FhirImportService.cs b/src/lib/Microsoft.Health.Fhir.R4.Ingest/Service/R4FhirImportService.cs
index 2f972c61..07396721 100644
--- a/src/lib/Microsoft.Health.Fhir.R4.Ingest/Service/R4FhirImportService.cs
+++ b/src/lib/Microsoft.Health.Fhir.R4.Ingest/Service/R4FhirImportService.cs
@@ -113,8 +113,8 @@ public virtual async Task<string> SaveObservationAsync(ILookupTemplate<IFhirTemp
                     // Merge the new data with the existing Observation.
                     var mergedObservation = MergeObservation(config, existingObservation, observationGroup);
 
-                    // Check to see if there are any changes after merging.
-                    if (mergedObservation.IsExactly(existingObservation))
+                    // Check to see if there are any changes after merging and update the Status to amended if changed.
+                    if (!existingObservation.AmendIfChanged(mergedObservation))
                     {
                         // There are no changes to the Observation - Do not update.
                         return (existingObservation, ResourceOperation.NoOperation);
diff --git a/test/Microsoft.Health.Fhir.R4.Ingest.UnitTests/Service/R4FhirImportServiceTests.cs b/test/Microsoft.Health.Fhir.R4.Ingest.UnitTests/Service/R4FhirImportServiceTests.cs
index 3486080a..5dc27593 100644
--- a/test/Microsoft.Health.Fhir.R4.Ingest.UnitTests/Service/R4FhirImportServiceTests.cs
+++ b/test/Microsoft.Health.Fhir.R4.Ingest.UnitTests/Service/R4FhirImportServiceTests.cs
@@ -3,6 +3,7 @@
 // Licensed under the MIT License (MIT). See LICENSE in the repo root for license information.
 // -------------------------------------------------------------------------------------------------
 
+using System;
 using System.Collections.Generic;
 using System.Net;
 using System.Net.Http;
@@ -10,6 +11,7 @@
 using Microsoft.Extensions.Caching.Memory;
 using Microsoft.Health.Common;
 using Microsoft.Health.Common.Telemetry;
+using Microsoft.Health.Extensions.Fhir;
 using Microsoft.Health.Fhir.Client;
 using Microsoft.Health.Fhir.Ingest.Data;
 using Microsoft.Health.Fhir.Ingest.Telemetry;
@@ -42,9 +44,9 @@ public async void GivenValidData_WhenProcessAsync_ThenSaveObservationInvokedForE
                 Substitute.For<IObservationGroup>(),
             };
 
-            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Model.Observation>>()
+            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Observation>>()
                 .Mock(m => m.CreateObservationGroups(default, default).ReturnsForAnyArgs(observationGroups))
-                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Model.Observation()));
+                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Observation()));
             var cache = Substitute.For<IMemoryCache>();
 
             var measurementGroup = Substitute.For<IMeasurementGroup>();
@@ -68,7 +70,7 @@ public async void GivenValidData_WhenProcessAsync_ThenSaveObservationInvokedForE
         public async void GivenNotFoundObservation_WhenSaveObservationAsync_ThenCreateInvoked_Test()
         {
             var fhirClient = Utilities.CreateMockFhirService();
-            fhirClient.CreateResourceAsync(Arg.Any<Model.Observation>()).ReturnsForAnyArgs(Task.FromResult(new Model.Observation()));
+            fhirClient.CreateResourceAsync(Arg.Any<Observation>()).ReturnsForAnyArgs(Task.FromResult(new Observation()));
 
             var ids = BuildIdCollection();
             var identityService = Substitute.For<IResourceIdentityService>()
@@ -76,8 +78,8 @@ public async void GivenNotFoundObservation_WhenSaveObservationAsync_ThenCreateIn
 
             var observationGroup = Substitute.For<IObservationGroup>();
 
-            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Model.Observation>>()
-                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Model.Observation()));
+            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Observation>>()
+                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Observation()));
             var cache = Substitute.For<IMemoryCache>();
             var config = Substitute.For<ILookupTemplate<IFhirTemplate>>();
 
@@ -93,24 +95,53 @@ public async void GivenNotFoundObservation_WhenSaveObservationAsync_ThenCreateIn
         [Fact]
         public async void GivenFoundObservation_WhenSaveObservationAsync_ThenUpdateInvoked_Test()
         {
-            var foundObservation = new Model.Observation { Id = "1" };
-            var foundBundle = new Model.Bundle
+            var foundObservation = new Observation
             {
-                Entry = new List<Model.Bundle.EntryComponent>
+                Id = "1",
+                Code = new CodeableConcept { Text = "Test Code" },
+                Value = new SampledData
                 {
-                    new Model.Bundle.EntryComponent
+                    Origin = new Model.Quantity
                     {
-                        Resource = foundObservation,
+                        Value = 0m,
+                        Unit = "count/min",
                     },
+                    Period = 1000m,
+                    Dimensions = 1,
+                    Data = "1 E E E E E E E E E",
                 },
+                Device = new ResourceReference(@"Device/123"),
+                Subject = new ResourceReference(@"Patient/abc"),
+                Status = ObservationStatus.Final,
+                Identifier = new List<Identifier>
+                {
+                    new Identifier
+                    {
+                        System = "Test",
+                        Value = "id",
+                    },
+                },
+                Effective = new Period(new FhirDateTime(DateTimeOffset.Now.AddHours(-1)), new FhirDateTime(DateTimeOffset.Now)),
             };
 
-            var savedObservation = new Model.Observation();
+            var mergedObservation = (Observation)foundObservation.DeepCopy();
+            mergedObservation.Status = ObservationStatus.Amended;
+            ((SampledData)mergedObservation.Value).Data = "1 1 E E E E E E E E";
+
+            var foundBundle = new Bundle
+            {
+                Entry = new List<Bundle.EntryComponent>
+                {
+                    new Bundle.EntryComponent
+                    {
+                        Resource = foundObservation,
+                    },
+                },
+            };
 
             var fhirClient = Utilities.CreateMockFhirService();
-            fhirClient.CreateResourceAsync(Arg.Any<Model.Observation>()).ReturnsForAnyArgs(Task.FromResult(new Model.Observation()));
             fhirClient.SearchForResourceAsync(Arg.Any<Model.ResourceType>(), Arg.Any<string>()).ReturnsForAnyArgs(Task.FromResult(foundBundle));
-            fhirClient.UpdateResourceAsync(Arg.Any<Model.Observation>()).ReturnsForAnyArgs(Task.FromResult(savedObservation));
+            fhirClient.UpdateResourceAsync(Arg.Any<Observation>()).ReturnsForAnyArgs(Task.FromResult(mergedObservation));
 
             var ids = BuildIdCollection();
             var identityService = Substitute.For<IResourceIdentityService>()
@@ -118,9 +149,9 @@ public async void GivenFoundObservation_WhenSaveObservationAsync_ThenUpdateInvok
 
             var observationGroup = Substitute.For<IObservationGroup>();
 
-            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Model.Observation>>()
-                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Model.Observation()))
-                .Mock(m => m.MergeObservation(default, default, default).ReturnsForAnyArgs(new Model.Observation() { Id = "2" }));
+            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Observation>>()
+                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Observation()))
+                .Mock(m => m.MergeObservation(default, default, default).ReturnsForAnyArgs(mergedObservation));
 
             var cache = Substitute.For<IMemoryCache>();
             var config = Substitute.For<ILookupTemplate<IFhirTemplate>>();
@@ -132,41 +163,42 @@ public async void GivenFoundObservation_WhenSaveObservationAsync_ThenUpdateInvok
             var result = await service.SaveObservationAsync(config, observationGroup, ids);
 
             templateProcessor.ReceivedWithAnyArgs(1).MergeObservation(default, default, default);
+            await fhirClient.ReceivedWithAnyArgs(1).UpdateResourceAsync<Observation>(default);
             logger.Received(1).LogMetric(Arg.Is<Metric>(x => Equals("ObservationUpdated", x.Dimensions[DimensionNames.Name])), 1);
         }
 
         [Fact]
         public async void GivenFoundObservationAndConflictOnSave_WhenSaveObservationAsync_ThenGetAndUpdateInvoked_Test()
         {
-            var foundObservation1 = new Model.Observation { Id = "1" };
-            var foundBundle1 = new Model.Bundle
+            var foundObservation1 = new Observation { Id = "1" };
+            var foundBundle1 = new Bundle
             {
-                Entry = new List<Model.Bundle.EntryComponent>
+                Entry = new List<Bundle.EntryComponent>
                 {
-                    new Model.Bundle.EntryComponent
+                    new Bundle.EntryComponent
                     {
                         Resource = foundObservation1,
                     },
                 },
             };
 
-            var foundObservation2 = new Model.Observation { Id = "2" };
-            var foundBundle2 = new Model.Bundle
+            var foundObservation2 = new Observation { Id = "2" };
+            var foundBundle2 = new Bundle
             {
-                Entry = new List<Model.Bundle.EntryComponent>
+                Entry = new List<Bundle.EntryComponent>
                 {
-                    new Model.Bundle.EntryComponent
+                    new Bundle.EntryComponent
                     {
                         Resource = foundObservation2,
                     },
                 },
             };
 
-            var savedObservation = new Model.Observation();
+            var savedObservation = new Observation();
 
             var fhirClient = Utilities.CreateMockFhirService();
             fhirClient.SearchForResourceAsync(Arg.Any<Model.ResourceType>(), Arg.Any<string>()).ReturnsForAnyArgs(Task.FromResult(foundBundle1));
-            fhirClient.UpdateResourceAsync(Arg.Any<Model.Observation>())
+            fhirClient.UpdateResourceAsync(Arg.Any<Observation>())
                 .Returns(
                     x => { throw new FhirException(new FhirResponse<OperationOutcome>(new HttpResponseMessage(HttpStatusCode.Conflict), new OperationOutcome())); },
                     x => Task.FromResult(savedObservation));
@@ -177,8 +209,8 @@ public async void GivenFoundObservationAndConflictOnSave_WhenSaveObservationAsyn
 
             var observationGroup = Substitute.For<IObservationGroup>();
 
-            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Model.Observation>>()
-                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Model.Observation()))
+            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Observation>>()
+                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Observation()))
                 .Mock(m => m.MergeObservation(default, default, default).ReturnsForAnyArgs(foundObservation2));
 
             var cache = Substitute.For<IMemoryCache>();
@@ -203,12 +235,12 @@ public void GivenValidTemplate_WhenGenerateObservation_ExpectedReferencesSet_Tes
             ids[ResourceType.Encounter] = "encounterId";
 
             var identityService = Substitute.For<IResourceIdentityService>();
-            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Model.Observation>>()
-                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Model.Observation()));
+            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Observation>>()
+                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Observation()));
             var cache = Substitute.For<IMemoryCache>();
 
             var observationGroup = Substitute.For<IObservationGroup>();
-            var identifer = new Model.Identifier();
+            var identifer = new Identifier();
             var config = Substitute.For<ILookupTemplate<IFhirTemplate>>();
 
             var logger = Substitute.For<ITelemetryLogger>();
@@ -233,21 +265,21 @@ public void GivenValidTemplate_WhenGenerateObservation_ExpectedReferencesSet_Tes
         [Fact]
         public async Task GivenCachedObservationDeleted_WhenGenerateObservation_ThenCacheIsUpdatedAndCreateInvoked_Test()
         {
-            var savedObservation = new Model.Observation { Id = "1" };
+            var savedObservation = new Observation { Id = "1" };
 
             // Mock the cached Observation
             var cache = Substitute.For<IMemoryCache>();
-            cache.TryGetValue(Arg.Any<object>(), out Model.Observation observation)
+            cache.TryGetValue(Arg.Any<object>(), out Observation observation)
                 .Returns(x =>
                 {
-                    x[1] = new Model.Observation();
+                    x[1] = new Observation();
                     return true;
                 });
 
             var fhirClient = Utilities.CreateMockFhirService();
-            fhirClient.UpdateResourceAsync(Arg.Any<Model.Observation>()).ThrowsForAnyArgs(new FhirException(new FhirResponse<OperationOutcome>(new HttpResponseMessage(HttpStatusCode.Conflict), new OperationOutcome())));
-            fhirClient.SearchForResourceAsync(Arg.Any<Model.ResourceType>(), Arg.Any<string>()).ReturnsForAnyArgs(Task.FromResult(new Model.Bundle()));
-            fhirClient.CreateResourceAsync(Arg.Any<Model.Observation>()).ReturnsForAnyArgs(Task.FromResult(savedObservation));
+            fhirClient.UpdateResourceAsync(Arg.Any<Observation>()).ThrowsForAnyArgs(new FhirException(new FhirResponse<OperationOutcome>(new HttpResponseMessage(HttpStatusCode.Conflict), new OperationOutcome())));
+            fhirClient.SearchForResourceAsync(Arg.Any<Model.ResourceType>(), Arg.Any<string>()).ReturnsForAnyArgs(Task.FromResult(new Bundle()));
+            fhirClient.CreateResourceAsync(Arg.Any<Observation>()).ReturnsForAnyArgs(Task.FromResult(savedObservation));
 
             var ids = BuildIdCollection();
             var identityService = Substitute.For<IResourceIdentityService>()
@@ -255,9 +287,9 @@ public async Task GivenCachedObservationDeleted_WhenGenerateObservation_ThenCach
 
             var observationGroup = Substitute.For<IObservationGroup>();
 
-            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Model.Observation>>()
-                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Model.Observation()))
-                .Mock(m => m.MergeObservation(default, default, default).ReturnsForAnyArgs(new Model.Observation { Id = "2" }));
+            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Observation>>()
+                .Mock(m => m.CreateObservation(default, default).ReturnsForAnyArgs(new Observation()))
+                .Mock(m => m.MergeObservation(default, default, default).ReturnsForAnyArgs(new Observation { Id = "2" }));
 
             var config = Substitute.For<ILookupTemplate<IFhirTemplate>>();
 
@@ -278,11 +310,11 @@ public async Task GivenCachedObservationDeleted_WhenGenerateObservation_ThenCach
         [Fact]
         public async Task GivenCachedObservationUnchanged_WhenGenerateObservation_ThenCacheNoOperation_Test()
         {
-            var cachedObservation = new Model.Observation { Id = "1" };
+            var cachedObservation = new Observation { Id = "1" };
 
             // Mock the cached Observation
             var cache = Substitute.For<IMemoryCache>();
-            cache.TryGetValue(Arg.Any<object>(), out Model.Observation observation)
+            cache.TryGetValue(Arg.Any<object>(), out Observation observation)
                 .Returns(x =>
                 {
                     x[1] = cachedObservation;
@@ -297,8 +329,8 @@ public async Task GivenCachedObservationUnchanged_WhenGenerateObservation_ThenCa
 
             var observationGroup = Substitute.For<IObservationGroup>();
 
-            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Model.Observation>>()
-                .Mock(m => m.MergeObservation(default, default, default).ReturnsForAnyArgs(cachedObservation));
+            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Observation>>()
+                .Mock(m => m.MergeObservation(default, default, default).ReturnsForAnyArgs(cachedObservation.FullCopy()));
 
             var config = Substitute.For<ILookupTemplate<IFhirTemplate>>();
 
@@ -318,23 +350,23 @@ public async Task GivenCachedObservationUnchanged_WhenGenerateObservation_ThenCa
         [Fact]
         public async void GivenFoundObservationUnchanged_WhenSaveObservationAsync_ThenUpdateInvoked_Test()
         {
-            var foundObservation = new Model.Observation { Id = "1" };
-            var foundBundle = new Model.Bundle
+            var foundObservation = new Observation { Id = "1" };
+            var foundBundle = new Bundle
             {
-                Entry = new List<Model.Bundle.EntryComponent>
+                Entry = new List<Bundle.EntryComponent>
                 {
-                    new Model.Bundle.EntryComponent
+                    new Bundle.EntryComponent
                     {
                         Resource = foundObservation,
                     },
                 },
             };
 
-            var savedObservation = new Model.Observation();
+            var savedObservation = new Observation();
 
             var fhirClient = Utilities.CreateMockFhirService();
             fhirClient.SearchForResourceAsync(Arg.Any<Model.ResourceType>(), Arg.Any<string>()).ReturnsForAnyArgs(Task.FromResult(foundBundle));
-            fhirClient.UpdateResourceAsync(Arg.Any<Model.Observation>()).ReturnsForAnyArgs(Task.FromResult(savedObservation));
+            fhirClient.UpdateResourceAsync(Arg.Any<Observation>()).ReturnsForAnyArgs(Task.FromResult(savedObservation));
 
             var ids = BuildIdCollection();
             var identityService = Substitute.For<IResourceIdentityService>()
@@ -342,8 +374,8 @@ public async void GivenFoundObservationUnchanged_WhenSaveObservationAsync_ThenUp
 
             var observationGroup = Substitute.For<IObservationGroup>();
 
-            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Model.Observation>>()
-                .Mock(m => m.MergeObservation(default, default, default).ReturnsForAnyArgs(foundObservation));
+            var templateProcessor = Substitute.For<IFhirTemplateProcessor<ILookupTemplate<IFhirTemplate>, Observation>>()
+                .Mock(m => m.MergeObservation(default, default, default).ReturnsForAnyArgs(foundObservation.FullCopy()));
 
             var cache = Substitute.For<IMemoryCache>();
             var config = Substitute.For<ILookupTemplate<IFhirTemplate>>();
@@ -358,7 +390,7 @@ public async void GivenFoundObservationUnchanged_WhenSaveObservationAsync_ThenUp
             logger.Received(1).LogMetric(Arg.Is<Metric>(x => Equals("ObservationNoOperation", x.Dimensions[DimensionNames.Name])), 1);
         }
 
-        private static IDictionary<Data.ResourceType, string> BuildIdCollection()
+        private static IDictionary<ResourceType, string> BuildIdCollection()
         {
             var lookup = IdentityLookupFactory.Instance.Create();
             lookup[ResourceType.Device] = "deviceId";
@@ -366,7 +398,7 @@ public async void GivenFoundObservationUnchanged_WhenSaveObservationAsync_ThenUp
             return lookup;
         }
 
-        private static Model.Observation ThrowConflictException()
+        private static Observation ThrowConflictException()
         {
             throw new FhirException(new FhirResponse<OperationOutcome>(new HttpResponseMessage(HttpStatusCode.Conflict), new OperationOutcome()));
         }
diff --git a/test/Microsoft.Health.Fhir.R4.Ingest.UnitTests/Template/CodeValueFhirTemplateProcessorTests.cs b/test/Microsoft.Health.Fhir.R4.Ingest.UnitTests/Template/CodeValueFhirTemplateProcessorTests.cs
index 1ceacd11..6a40dda6 100644
--- a/test/Microsoft.Health.Fhir.R4.Ingest.UnitTests/Template/CodeValueFhirTemplateProcessorTests.cs
+++ b/test/Microsoft.Health.Fhir.R4.Ingest.UnitTests/Template/CodeValueFhirTemplateProcessorTests.cs
@@ -290,7 +290,7 @@ public void GivenEmptyTemplate_WhenMergObservation_ThenObservationReturned_Test(
 
             var newObservation = processor.MergeObservation(template, observationGroup, oldObservation);
 
-            Assert.Equal(ObservationStatus.Amended, newObservation.Status);
+            Assert.Equal(oldObservation.Status, newObservation.Status);
             valueProcessor.DidNotReceiveWithAnyArgs().MergeValue(default, default, default);
         }
 
@@ -336,7 +336,7 @@ public void GivenTemplateWithValue_WhenMergObservation_ThenObservationReturned_T
             var newObservation = processor.MergeObservation(template, observationGroup, oldObservation);
             Assert.Equal(dataType, newObservation.Value);
 
-            Assert.Equal(ObservationStatus.Amended, newObservation.Status);
+            Assert.Equal(oldObservation.Status, newObservation.Status);
             valueProcessor.Received(1)
                 .MergeValue(
                     valueType,
@@ -346,7 +346,7 @@ public void GivenTemplateWithValue_WhenMergObservation_ThenObservationReturned_T
                         && v.ObservationPeriod.start == boundary.start
                         && v.ObservationPeriod.end == boundary.end
                         && v.Data.First().Item2 == "v1"),
-                    oldValue);
+                    Arg.Is<Quantity>(v => v.IsExactly(oldValue)));
         }
 
         [Fact]
@@ -460,7 +460,7 @@ public void GivenTemplateWithComponent_WhenMergObservation_ThenObservationReturn
                     Assert.Equal(dataType, c.Value);
                 });
 
-            Assert.Equal(ObservationStatus.Amended, newObservation.Status);
+            Assert.Equal(oldObservation.Status, newObservation.Status);
             valueProcessor.Received(1)
                 .MergeValue(
                     valueType1,
@@ -470,7 +470,7 @@ public void GivenTemplateWithComponent_WhenMergObservation_ThenObservationReturn
                         && v.ObservationPeriod.start == boundary.start
                         && v.ObservationPeriod.end == boundary.end
                         && v.Data.First().Item2 == "v2"),
-                    oldValue);
+                    Arg.Is<Quantity>(v => v.IsExactly(oldValue)));
 
             valueProcessor.Received(1)
                 .CreateValue(
@@ -558,7 +558,7 @@ public void GivenTemplateWithComponentAndObservationWithOutComponent_WhenMergObs
                     Assert.Equal(dataType, c.Value);
                 });
 
-            Assert.Equal(ObservationStatus.Amended, newObservation.Status);
+            Assert.Equal(oldObservation.Status, newObservation.Status);
 
             valueProcessor.Received(1)
                 .CreateValue(
@@ -820,7 +820,7 @@ public void GivenExistingObservation_WhenMergeObservationWithDataOutsideEffectiv
             Assert.Equal(boundary.start, start);
             Assert.Equal(boundary.end, end);
 
-            Assert.Equal(ObservationStatus.Amended, newObservation.Status);
+            Assert.Equal(oldObservation.Status, newObservation.Status);
             valueProcessor.Received(1)
                 .MergeValue(
                     valueType,
@@ -830,7 +830,7 @@ public void GivenExistingObservation_WhenMergeObservationWithDataOutsideEffectiv
                         && v.ObservationPeriod.start == observationStart
                         && v.ObservationPeriod.end == observationEnd
                         && v.Data.First().Item2 == "v1"),
-                    oldValue);
+                    Arg.Is<Quantity>(v => v.IsExactly(oldValue)));
         }
 
         [Fact]
@@ -875,7 +875,7 @@ public void GivenExistingObservation_WhenMergeObservationWithDataInsideEffective
             Assert.Equal(observationStart, start);
             Assert.Equal(observationEnd, end);
 
-            Assert.Equal(ObservationStatus.Amended, newObservation.Status);
+            Assert.Equal(oldObservation.Status, newObservation.Status);
             valueProcessor.Received(1)
                 .MergeValue(
                     valueType,
@@ -885,7 +885,7 @@ public void GivenExistingObservation_WhenMergeObservationWithDataInsideEffective
                         && v.ObservationPeriod.start == observationStart
                         && v.ObservationPeriod.end == observationEnd
                         && v.Data.First().Item2 == "v1"),
-                    oldValue);
+                    Arg.Is<Quantity>(v => v.IsExactly(oldValue)));
         }
     }
 }