diff --git a/manage.py b/manage.py
index bf035135b2..7232d53319 100644
--- a/manage.py
+++ b/manage.py
@@ -97,6 +97,19 @@ def flush_cache():
         r.flushdb()
 
 
+@app.cli.command()
+def last_usage():
+    """Returns number of seconds since last usage was recorded
+
+    NB in the event of no recorded usage, such as after a redis flush
+    a value of -1 will be returned
+
+    """
+    from portal.usage_monitor import last_usage
+    seconds_old = last_usage() or -1
+    click.echo(seconds_old)
+
+
 @app.cli.command()
 def sync():
     """Synchronize database with latest schema and persistence data.
diff --git a/portal/config/eproms/CommunicationRequest.json b/portal/config/eproms/CommunicationRequest.json
index 7e60dc99f8..0c65aa6e19 100644
--- a/portal/config/eproms/CommunicationRequest.json
+++ b/portal/config/eproms/CommunicationRequest.json
@@ -240,6 +240,22 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Baseline | Day 1 Reminder"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"days\": 1}",
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_baseline"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -272,6 +288,22 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Baseline | Week 1 Reminder"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_baseline"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -304,6 +336,22 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Baseline | Week 2 Reminder"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_baseline"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -336,6 +384,22 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Baseline | Week 3 Reminder"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_baseline"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -368,6 +432,22 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Baseline | Week 4 Reminder"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"months\": 1}",
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_baseline"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -402,6 +482,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 3 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -436,6 +533,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 3 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -470,6 +584,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 3 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -504,6 +635,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 3 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -538,6 +686,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 3 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -572,6 +737,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 6 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start6mo_yearly_end30mo"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -606,6 +788,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 6 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start6mo_yearly_end30mo"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -640,6 +839,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 6 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start6mo_yearly_end30mo"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -674,6 +890,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 6 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start6mo_yearly_end30mo"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -708,6 +941,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 6 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start6mo_yearly_end30mo"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -747,14 +997,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 9 Month Reminder (2)"
+          "value": "IRONMAN v5 Recurring | 9 Month Reminder (1)"
         }
       ],
       "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"weeks\": 1}",
+      "notify_post_qb_start": "{\"days\": 0}",
       "qb_iteration": 1,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -764,14 +1014,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 9 Month Reminder (2)"
+          "value": "IRONMAN Recurring | 9 Month Reminder (2)"
         }
       ],
       "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
       "notify_post_qb_start": "{\"weeks\": 1}",
       "qb_iteration": 1,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -781,14 +1031,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 9 Month Reminder (3)"
+          "value": "IRONMAN v3 Recurring | 9 Month Reminder (2)"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
       "qb_iteration": 1,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -798,14 +1048,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 9 Month Reminder (3)"
+          "value": "IRONMAN v5 Recurring | 9 Month Reminder (2)"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
       "qb_iteration": 1,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -815,11 +1065,11 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 9 Month Reminder (4)"
+          "value": "IRONMAN Recurring | 9 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
-      "notify_post_qb_start": "{\"weeks\": 3}",
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
       "qb_iteration": 1,
       "questionnaire_bank": {
         "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
@@ -832,11 +1082,11 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 9 Month Reminder (4)"
+          "value": "IRONMAN v3 Recurring | 9 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
-      "notify_post_qb_start": "{\"weeks\": 3}",
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
       "qb_iteration": 1,
       "questionnaire_bank": {
         "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
@@ -849,10 +1099,78 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 9 Month Final Reminder"
+          "value": "IRONMAN v5 Recurring | 9 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 1,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 9 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 1,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 9 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 1,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 9 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 1,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 9 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
       "notify_post_qb_start": "{\"weeks\": 4}",
       "qb_iteration": 1,
       "questionnaire_bank": {
@@ -878,6 +1196,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 9 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 1,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -912,6 +1247,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 12 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -946,6 +1298,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 12 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -980,6 +1349,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 12 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1014,6 +1400,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 12 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1048,6 +1451,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 12 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1082,6 +1502,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 15 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1116,6 +1553,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 15 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1150,6 +1604,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 15 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1184,6 +1655,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 15 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1218,6 +1706,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 15 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1252,6 +1757,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 18 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start6mo_yearly_end30mo"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1291,14 +1813,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 18 Month Reminder (3)"
+          "value": "IRONMAN v5 Recurring | 18 Month Reminder (2)"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
-      "qb_iteration": 1,
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start6mo_yearly_end30mo"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1308,7 +1830,24 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 18 Month Reminder (3)"
+          "value": "IRONMAN Recurring | 18 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 1,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_6mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 18 Month Reminder (3)"
         }
       ],
       "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
@@ -1320,6 +1859,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 18 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start6mo_yearly_end30mo"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1354,6 +1910,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 18 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start6mo_yearly_end30mo"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1388,6 +1961,23 @@
       "resourceType": "CommunicationRequest",
       "status": "active"
     },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 18 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 0,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start6mo_yearly_end30mo"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
     {
       "identifier": [
         {
@@ -1417,7 +2007,1197 @@
       "notify_post_qb_start": "{\"days\": 0}",
       "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 21 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 21 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 21 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 21 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 21 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 21 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 21 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 21 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 21 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 21 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 21 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 21 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 21 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 24 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 1,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 24 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 1,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 24 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 1,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 24 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 1,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+      },
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+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 33 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 36 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 36 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 36 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 36 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 36 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 36 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 36 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 36 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 36 Month Reminder (3)"
+        }
+      ],
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 36 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 36 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 36 Month Reminder (4)"
+        }
+      ],
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN Recurring | 36 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v3 Recurring | 36 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 36 Month Final Reminder"
+        }
+      ],
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 2,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 39 Month Reminder (1)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
+      },
+      "resourceType": "CommunicationRequest",
+      "status": "active"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
+          "use": "usual",
+          "value": "IRONMAN v5 Recurring | 39 Month Reminder (2)"
+        }
+      ],
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 3,
+      "questionnaire_bank": {
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1427,14 +3207,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 21 Month Reminder (2)"
+          "value": "IRONMAN v5 Recurring | 39 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"weeks\": 1}",
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
       "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1444,14 +3224,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 21 Month Reminder (2)"
+          "value": "IRONMAN v5 Recurring | 39 Month Reminder (4)"
         }
       ],
-      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"weeks\": 1}",
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
       "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1461,14 +3241,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 21 Month Reminder (3)"
+          "value": "IRONMAN v5 Recurring | 39 Month Final Reminder"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
       "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1478,14 +3258,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 21 Month Reminder (3)"
+          "value": "IRONMAN v5 Recurring | 42 Month Reminder (1)"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
-      "qb_iteration": 3,
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start3.5years_yearly"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1495,14 +3275,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 21 Month Reminder (4)"
+          "value": "IRONMAN v5 Recurring | 42 Month Reminder (2)"
         }
       ],
-      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
-      "notify_post_qb_start": "{\"weeks\": 3}",
-      "qb_iteration": 3,
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start3.5years_yearly"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1512,14 +3292,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 21 Month Reminder (4)"
+          "value": "IRONMAN v5 Recurring | 42 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
-      "notify_post_qb_start": "{\"weeks\": 3}",
-      "qb_iteration": 3,
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start3.5years_yearly"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1529,14 +3309,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 21 Month Final Reminder"
+          "value": "IRONMAN v5 Recurring | 42 Month Reminder (4)"
         }
       ],
-      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
-      "notify_post_qb_start": "{\"weeks\": 4}",
-      "qb_iteration": 3,
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start3.5years_yearly"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1546,14 +3326,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 21 Month Final Reminder"
+          "value": "IRONMAN v5 Recurring | 42 Month Final Reminder"
         }
       ],
       "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
       "notify_post_qb_start": "{\"weeks\": 4}",
-      "qb_iteration": 3,
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_3mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start3.5years_yearly"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1563,14 +3343,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 24 Month Reminder (1)"
+          "value": "IRONMAN v5 Recurring | 45 Month Reminder (1)"
         }
       ],
       "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
       "notify_post_qb_start": "{\"days\": 0}",
-      "qb_iteration": 1,
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1580,14 +3360,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 24 Month Reminder (1)"
+          "value": "IRONMAN v5 Recurring | 45 Month Reminder (2)"
         }
       ],
       "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"days\": 0}",
-      "qb_iteration": 1,
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1597,14 +3377,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 24 Month Reminder (2)"
+          "value": "IRONMAN v5 Recurring | 45 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"weeks\": 1}",
-      "qb_iteration": 1,
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1614,14 +3394,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 24 Month Reminder (2)"
+          "value": "IRONMAN v5 Recurring | 45 Month Reminder (4)"
         }
       ],
-      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"weeks\": 1}",
-      "qb_iteration": 1,
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1631,14 +3411,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 24 Month Reminder (3)"
+          "value": "IRONMAN v5 Recurring | 45 Month Final Reminder"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
-      "qb_iteration": 1,
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1648,14 +3428,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 24 Month Reminder (3)"
+          "value": "IRONMAN v5 Recurring | 48 Month Reminder (1)"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
-      "qb_iteration": 1,
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 2,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1665,14 +3445,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 24 Month Reminder (4)"
+          "value": "IRONMAN v5 Recurring | 48 Month Reminder (2)"
         }
       ],
-      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
-      "notify_post_qb_start": "{\"weeks\": 3}",
-      "qb_iteration": 1,
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 2,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1682,14 +3462,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 24 Month Reminder (4)"
+          "value": "IRONMAN v5 Recurring | 48 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
-      "notify_post_qb_start": "{\"weeks\": 3}",
-      "qb_iteration": 1,
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 2,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1699,14 +3479,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 24 Month Final Reminder"
+          "value": "IRONMAN v5 Recurring | 48 Month Reminder (4)"
         }
       ],
-      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
-      "notify_post_qb_start": "{\"weeks\": 4}",
-      "qb_iteration": 1,
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 2,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1716,14 +3496,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 24 Month Final Reminder"
+          "value": "IRONMAN v5 Recurring | 48 Month Final Reminder"
         }
       ],
       "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
       "notify_post_qb_start": "{\"weeks\": 4}",
-      "qb_iteration": 1,
+      "qb_iteration": 2,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1733,14 +3513,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 30 Month Reminder (1)"
+          "value": "IRONMAN v5 Recurring | 51 Month Reminder (1)"
         }
       ],
       "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
       "notify_post_qb_start": "{\"days\": 0}",
-      "qb_iteration": 2,
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1750,14 +3530,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 30 Month Reminder (1)"
+          "value": "IRONMAN v5 Recurring | 51 Month Reminder (2)"
         }
       ],
       "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"days\": 0}",
-      "qb_iteration": 2,
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1767,14 +3547,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 30 Month Reminder (2)"
+          "value": "IRONMAN v5 Recurring | 51 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"weeks\": 1}",
-      "qb_iteration": 2,
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1784,14 +3564,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 30 Month Reminder (2)"
+          "value": "IRONMAN v5 Recurring | 51 Month Reminder (4)"
         }
       ],
-      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"weeks\": 1}",
-      "qb_iteration": 2,
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1801,14 +3581,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 30 Month Reminder (3)"
+          "value": "IRONMAN v5 Recurring | 51 Month Final Reminder"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
-      "qb_iteration": 2,
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1818,14 +3598,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 30 Month Reminder (3)"
+          "value": "IRONMAN v5 Recurring | 54 Month Reminder (1)"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
-      "qb_iteration": 2,
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start3.5years_yearly"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1835,14 +3615,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 30 Month Reminder (4)"
+          "value": "IRONMAN v5 Recurring | 54 Month Reminder (2)"
         }
       ],
-      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
-      "notify_post_qb_start": "{\"weeks\": 3}",
-      "qb_iteration": 2,
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start3.5years_yearly"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1852,14 +3632,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 30 Month Reminder (4)"
+          "value": "IRONMAN v5 Recurring | 54 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
-      "notify_post_qb_start": "{\"weeks\": 3}",
-      "qb_iteration": 2,
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start3.5years_yearly"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1869,14 +3649,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 30 Month Final Reminder"
+          "value": "IRONMAN v5 Recurring | 54 Month Reminder (4)"
         }
       ],
-      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
-      "notify_post_qb_start": "{\"weeks\": 4}",
-      "qb_iteration": 2,
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start3.5years_yearly"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1886,14 +3666,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 30 Month Final Reminder"
+          "value": "IRONMAN v5 Recurring | 54 Month Final Reminder"
         }
       ],
       "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
       "notify_post_qb_start": "{\"weeks\": 4}",
-      "qb_iteration": 2,
+      "qb_iteration": 0,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_6mo_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_start3.5years_yearly"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1903,14 +3683,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 36 Month Reminder (1)"
+          "value": "IRONMAN v5 Recurring | 57 Month Reminder (1)"
         }
       ],
       "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
       "notify_post_qb_start": "{\"days\": 0}",
-      "qb_iteration": 2,
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1920,14 +3700,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 36 Month Reminder (1)"
+          "value": "IRONMAN v5 Recurring | 57 Month Reminder (2)"
         }
       ],
       "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"days\": 0}",
-      "qb_iteration": 2,
+      "notify_post_qb_start": "{\"weeks\": 1}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1937,14 +3717,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 36 Month Reminder (2)"
+          "value": "IRONMAN v5 Recurring | 57 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"weeks\": 1}",
-      "qb_iteration": 2,
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1954,14 +3734,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 36 Month Reminder (2)"
+          "value": "IRONMAN v5 Recurring | 57 Month Reminder (4)"
         }
       ],
-      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
-      "notify_post_qb_start": "{\"weeks\": 1}",
-      "qb_iteration": 2,
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1971,14 +3751,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 36 Month Reminder (3)"
+          "value": "IRONMAN v5 Recurring | 57 Month Final Reminder"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
-      "qb_iteration": 2,
+      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
+      "notify_post_qb_start": "{\"weeks\": 4}",
+      "qb_iteration": 3,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_3mo_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -1988,14 +3768,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 36 Month Reminder (3)"
+          "value": "IRONMAN v5 Recurring | 60 Month Reminder (1)"
         }
       ],
-      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
-      "notify_post_qb_start": "{\"weeks\": 2}",
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"days\": 0}",
       "qb_iteration": 2,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -2005,14 +3785,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 36 Month Reminder (4)"
+          "value": "IRONMAN v5 Recurring | 60 Month Reminder (2)"
         }
       ],
-      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
-      "notify_post_qb_start": "{\"weeks\": 3}",
+      "lr_uuid": "b71dfdf6-bb19-3fff-84bd-4cdb30050499",
+      "notify_post_qb_start": "{\"weeks\": 1}",
       "qb_iteration": 2,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -2022,14 +3802,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 36 Month Reminder (4)"
+          "value": "IRONMAN v5 Recurring | 60 Month Reminder (3)"
         }
       ],
-      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
-      "notify_post_qb_start": "{\"weeks\": 3}",
+      "lr_uuid": "b98cd174-7894-db68-b335-9e36e055592d",
+      "notify_post_qb_start": "{\"weeks\": 2}",
       "qb_iteration": 2,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -2039,14 +3819,14 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN Recurring | 36 Month Final Reminder"
+          "value": "IRONMAN v5 Recurring | 60 Month Reminder (4)"
         }
       ],
-      "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
-      "notify_post_qb_start": "{\"weeks\": 4}",
+      "lr_uuid": "2c837970-71e3-d736-9d2f-626f417bbbad",
+      "notify_post_qb_start": "{\"weeks\": 3}",
       "qb_iteration": 2,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
@@ -2056,18 +3836,18 @@
         {
           "system": "http://us.truenth.org/identity-codes/communicationrequest/name",
           "use": "usual",
-          "value": "IRONMAN v3 Recurring | 36 Month Final Reminder"
+          "value": "IRONMAN v5 Recurring | 60 Month Final Reminder"
         }
       ],
       "lr_uuid": "d9514c96-4769-993f-f6e4-03a67d8f7424",
       "notify_post_qb_start": "{\"weeks\": 4}",
       "qb_iteration": 2,
       "questionnaire_bank": {
-        "reference": "api/questionnaire_bank/IRONMAN_v3_recurring_annual_pattern"
+        "reference": "api/questionnaire_bank/IRONMAN_v5_recurring_annual_pattern"
       },
       "resourceType": "CommunicationRequest",
       "status": "active"
-    }
+    }	
   ],
   "id": "SitePersistence v0.2",
   "meta": {
diff --git a/portal/config/eproms/Organization.json b/portal/config/eproms/Organization.json
index cdbf4e0fa2..36f36ba4e3 100644
--- a/portal/config/eproms/Organization.json
+++ b/portal/config/eproms/Organization.json
@@ -3275,9 +3275,10 @@
           "timezone": "America/New_York",
           "url": "http://hl7.org/fhir/StructureDefinition/user-timezone"
         },
-        {
+       {
           "research_protocols": [
-			{"name": "IRONMAN v3"}
+			{"name": "IRONMAN v3", "retired_as_of": "2019-12-17T00:00:00Z"},
+			{"name": "IRONMAN v5"}
           ],
           "url": "http://us.truenth.org/identity-codes/research-protocol"
         }
@@ -3296,6 +3297,103 @@
         "reference": "api/organization/22000"
       },
       "resourceType": "Organization"
+    },
+    {
+      "extension": [
+        {
+          "url": "http://hl7.org/fhir/valueset/languages",
+          "valueCodeableConcept": {
+            "coding": [
+              {
+                "code": "en_AU",
+                "display": "Australian English",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "en_US",
+                "display": "American English",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "en_GB",
+                "display": "English",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "af_ZA",
+                "display": "Afrikaans",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "es_US",
+                "display": "Spanish (United States)",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "fr_CA",
+                "display": "Canadian French",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "zu_ZA",
+                "display": "Zulu",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "xh_ZA",
+                "display": "Xhosa",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "pt_BR",
+                "display": "Portuguese (Brazil)",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "sv_SE",
+                "display": "Swedish",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "de_CH",
+                "display": "Swiss German",
+                "system": "urn:ietf:bcp:47"
+              },
+              {
+                "code": "es_ES",
+                "display": "Spanish (Spain)",
+                "system": "urn:ietf:bcp:47"
+              }
+            ]
+          }
+        },
+        {
+          "timezone": "America/New_York",
+          "url": "http://hl7.org/fhir/StructureDefinition/user-timezone"
+        },
+       {
+          "research_protocols": [
+			{"name": "IRONMAN v2", "retired_as_of": "2015-12-15T00:00:00Z"},
+			{"name": "IRONMAN v3", "retired_as_of": "2016-12-15T00:00:00Z"},
+			{"name": "IRONMAN v5"}
+          ],
+          "url": "http://us.truenth.org/identity-codes/research-protocol"
+        }
+      ],
+      "id": 147999,
+      "identifier": [
+        {
+          "system": "http://pcctc.org/",
+          "use": "secondary",
+          "value": "147-999"
+        }
+      ],
+      "language": "en_US",
+      "name": "Test Site II",
+      "partOf": {
+        "reference": "api/organization/22000"
+      },
+      "resourceType": "Organization"
     }
   ],
   "id": "SitePersistence v0.2",
diff --git a/portal/config/eproms/Questionnaire.json b/portal/config/eproms/Questionnaire.json
index a46997a822..3e6d591570 100644
--- a/portal/config/eproms/Questionnaire.json
+++ b/portal/config/eproms/Questionnaire.json
@@ -6933,6 +6933,24 @@
           ]
         }
       ]
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/questionnaire",
+          "value": "ironmisc_v5"
+        }
+      ],
+      "resourceType": "Questionnaire"
+    },
+    {
+      "identifier": [
+        {
+          "system": "http://us.truenth.org/questionnaire",
+          "value": "physactivity"
+        }
+      ],
+      "resourceType": "Questionnaire"
     }
   ],
   "id": "SitePersistence v0.2",
diff --git a/portal/config/eproms/QuestionnaireBank.json b/portal/config/eproms/QuestionnaireBank.json
index 69984677ac..f23a36114b 100644
--- a/portal/config/eproms/QuestionnaireBank.json
+++ b/portal/config/eproms/QuestionnaireBank.json
@@ -147,6 +147,56 @@
       "resourceType": "QuestionnaireBank",
       "start": "{\"days\": 0}"
     },
+    {
+      "classification": "baseline",
+      "expired": "{\"months\": 2, \"days\": 14}",
+      "name": "IRONMAN_v5_baseline",
+      "overdue": "{\"days\": 1}",
+      "questionnaires": [
+        {
+          "questionnaire": {
+            "display": "eortc",
+            "reference": "api/questionnaire/eortc?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 0
+        },
+        {
+          "questionnaire": {
+            "display": "ironmisc_v5",
+            "reference": "api/questionnaire/ironmisc_v5?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 1
+        },
+        {
+          "questionnaire": {
+            "display": "factfpsi",
+            "reference": "api/questionnaire/factfpsi?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 2
+        },
+        {
+          "questionnaire": {
+            "display": "epic26",
+            "reference": "api/questionnaire/epic26?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 3
+        },
+        {
+          "questionnaire": {
+            "display": "prems",
+            "reference": "api/questionnaire/prems?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 4
+        }
+      ],
+      "recurs": [],
+      "research_protocol": {
+        "display": "IRONMAN v5",
+        "reference": "api/research_protocol/IRONMAN v5"
+      },
+      "resourceType": "QuestionnaireBank",
+      "start": "{\"days\": 0}"
+    },
     {
       "classification": "indefinite",
       "expired": "{\"years\": 50}",
@@ -189,6 +239,27 @@
       "resourceType": "QuestionnaireBank",
       "start": "{\"days\": 0}"
     },
+    {
+      "classification": "indefinite",
+      "expired": "{\"years\": 50}",
+      "name": "IRONMAN_v5_indefinite",
+      "questionnaires": [
+        {
+          "questionnaire": {
+            "display": "irondemog_v3",
+            "reference": "api/questionnaire/irondemog_v3?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 0
+        }
+      ],
+      "recurs": [],
+      "research_protocol": {
+        "display": "IRONMAN v5",
+        "reference": "api/research_protocol/IRONMAN v5"
+      },
+      "resourceType": "QuestionnaireBank",
+      "start": "{\"days\": 0}"
+    },
     {
       "classification": "recurring",
       "due": "{\"days\": 0}",
@@ -261,6 +332,42 @@
       "resourceType": "QuestionnaireBank",
       "start": "{\"days\": 0}"
     },
+    {
+      "classification": "recurring",
+      "due": "{\"days\": 0}",
+      "expired": "{\"months\": 3, \"days\": -2}",
+      "name": "IRONMAN_v5_recurring_3mo_pattern",
+      "overdue": "{\"days\": 16}",
+      "questionnaires": [
+        {
+          "questionnaire": {
+            "display": "eortc",
+            "reference": "api/questionnaire/eortc?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 0
+        },
+        {
+          "questionnaire": {
+            "display": "ironmisc_v5",
+            "reference": "api/questionnaire/ironmisc_v5?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 1
+        }
+      ],
+      "recurs": [
+        {
+          "cycle_length": "{\"months\": 6}",
+          "start": "{\"months\": 3, \"days\": -15}",
+          "termination": "{\"months\": 59}"
+        }
+      ],
+      "research_protocol": {
+        "display": "IRONMAN v5",
+        "reference": "api/research_protocol/IRONMAN v5"
+      },
+      "resourceType": "QuestionnaireBank",
+      "start": "{\"days\": 0}"
+    },
     {
       "classification": "recurring",
       "due": "{\"days\": 0}",
@@ -347,6 +454,99 @@
       "resourceType": "QuestionnaireBank",
       "start": "{\"days\": 0}"
     },
+    {
+      "classification": "recurring",
+      "due": "{\"days\": 0}",
+      "expired": "{\"months\": 3, \"days\": -2}",
+      "name": "IRONMAN_v5_start6mo_yearly_end30mo",
+      "overdue": "{\"days\": 16}",
+      "questionnaires": [
+        {
+          "questionnaire": {
+            "display": "eortc",
+            "reference": "api/questionnaire/eortc?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 0
+        },
+        {
+          "questionnaire": {
+            "display": "ironmisc_v5",
+            "reference": "api/questionnaire/ironmisc_v5?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 1
+        },
+        {
+          "questionnaire": {
+            "display": "factfpsi",
+            "reference": "api/questionnaire/factfpsi?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 2
+        },
+        {
+          "questionnaire": {
+            "display": "physactivity",
+            "reference": "api/questionnaire/physactivity?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 3
+        }
+      ],
+      "recurs": [
+        {
+          "cycle_length": "{\"years\": 1}",
+          "start": "{\"months\": 6, \"days\": -15}",
+          "termination": "{\"months\": 33}"
+        }
+      ],
+      "research_protocol": {
+        "display": "IRONMAN v5",
+        "reference": "api/research_protocol/IRONMAN v5"
+      },
+      "resourceType": "QuestionnaireBank",
+      "start": "{\"days\": 0}"
+    },
+    {
+      "classification": "recurring",
+      "due": "{\"days\": 0}",
+      "expired": "{\"months\": 3, \"days\": -2}",
+      "name": "IRONMAN_v5_start3.5years_yearly",
+      "overdue": "{\"days\": 16}",
+      "questionnaires": [
+        {
+          "questionnaire": {
+            "display": "eortc",
+            "reference": "api/questionnaire/eortc?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 0
+        },
+        {
+          "questionnaire": {
+            "display": "ironmisc_v5",
+            "reference": "api/questionnaire/ironmisc_v5?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 1
+        },
+        {
+          "questionnaire": {
+            "display": "factfpsi",
+            "reference": "api/questionnaire/factfpsi?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 2
+        }
+      ],
+      "recurs": [
+        {
+          "cycle_length": "{\"years\": 1}",
+          "start": "{\"months\": 42, \"days\": -15}",
+          "termination": "{\"months\": 62}"
+        }
+      ],
+      "research_protocol": {
+        "display": "IRONMAN v5",
+        "reference": "api/research_protocol/IRONMAN v5"
+      },
+      "resourceType": "QuestionnaireBank",
+      "start": "{\"days\": 0}"
+    },
     {
       "classification": "recurring",
       "due": "{\"days\": 0}",
@@ -460,6 +660,63 @@
       },
       "resourceType": "QuestionnaireBank",
       "start": "{\"days\": 0}"
+    },
+    {
+      "classification": "recurring",
+      "due": "{\"days\": 0}",
+      "expired": "{\"months\": 3, \"days\": -2}",
+      "name": "IRONMAN_v5_recurring_annual_pattern",
+      "overdue": "{\"days\": 16}",
+      "questionnaires": [
+        {
+          "questionnaire": {
+            "display": "eortc",
+            "reference": "api/questionnaire/eortc?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 0
+        },
+        {
+          "questionnaire": {
+            "display": "ironmisc_v5",
+            "reference": "api/questionnaire/ironmisc_v5?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 1
+        },
+        {
+          "questionnaire": {
+            "display": "factfpsi",
+            "reference": "api/questionnaire/factfpsi?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 2
+        },
+        {
+          "questionnaire": {
+            "display": "epic26",
+            "reference": "api/questionnaire/epic26?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 3
+        },
+        {
+          "questionnaire": {
+            "display": "prems",
+            "reference": "api/questionnaire/prems?system=http://us.truenth.org/questionnaire"
+          },
+          "rank": 4
+        }
+      ],
+      "recurs": [
+        {
+          "cycle_length": "{\"years\": 1}",
+          "start": "{\"months\": 12, \"days\": -15}",
+          "termination": "{\"years\": 5, \"months\": 3}"
+        }
+      ],
+      "research_protocol": {
+        "display": "IRONMAN v5",
+        "reference": "api/research_protocol/IRONMAN v5"
+      },
+      "resourceType": "QuestionnaireBank",
+      "start": "{\"days\": 0}"
     }
   ],
   "id": "SitePersistence v0.2",
diff --git a/portal/config/eproms/ResearchProtocol.json b/portal/config/eproms/ResearchProtocol.json
index 20c31b9878..ba6c297f1e 100644
--- a/portal/config/eproms/ResearchProtocol.json
+++ b/portal/config/eproms/ResearchProtocol.json
@@ -1,5 +1,10 @@
 {
   "entry": [
+    {
+      "created_at": "2019-12-16T14:00:00",
+      "name": "IRONMAN v5",
+      "resourceType": "ResearchProtocol"
+    },
     {
       "created_at": "2018-02-10T11:59:00",
       "name": "IRONMAN v3",
diff --git a/portal/migrations/script.py.mako b/portal/migrations/script.py.mako
index ed2ffe3f90..02b3b86ad0 100644
--- a/portal/migrations/script.py.mako
+++ b/portal/migrations/script.py.mako
@@ -7,10 +7,8 @@ Create Date: ${create_date}
 """
 from alembic import op
 import sqlalchemy as sa
-
 ${imports if imports else ""}
 
-
 # revision identifiers, used by Alembic.
 revision = ${repr(up_revision)}
 down_revision = ${repr(down_revision)}
diff --git a/portal/migrations/versions/4737a563e3f9_.py b/portal/migrations/versions/4737a563e3f9_.py
new file mode 100644
index 0000000000..4927f02bab
--- /dev/null
+++ b/portal/migrations/versions/4737a563e3f9_.py
@@ -0,0 +1,84 @@
+"""encode comorb QuestionnaireResponse answers
+
+Revision ID: 4737a563e3f9
+Revises: df233cc6fa8a
+Create Date: 2019-12-16 17:45:06.516658
+
+"""
+import copy
+
+from alembic import op
+from sqlalchemy.orm import sessionmaker
+
+from portal.models.questionnaire_response import QuestionnaireResponse
+from portal.models.questionnaire import Questionnaire
+
+# revision identifiers, used by Alembic.
+revision = '4737a563e3f9'
+down_revision = 'df233cc6fa8a'
+
+
+Session = sessionmaker()
+
+
+def fixup_comorb(questionnaire_response_json, comorb_options):
+    """Replace valueString text with corresponding valueCoding"""
+    # exit early if preconditions not met
+    if len(questionnaire_response_json['group']['question'][0]['answer']) == 0:
+        return questionnaire_response_json
+
+    # JSONB mutation detection work around
+    # See https://bugs.launchpad.net/fuel/+bug/1482658
+    qnr_json_copy = copy.deepcopy(questionnaire_response_json)
+
+    target_question = qnr_json_copy['group']['question'][0]
+    coded_answers = []
+    for answer in target_question['answer']:
+        if 'valueCoding' in answer:
+            return questionnaire_response_json
+        coded_answer = {'valueCoding': {
+            # lookup code from valueString
+            'code': comorb_options[answer['valueString']],
+            'system': 'https://eproms.truenth.org/api/codings/assessment',
+        }}
+        coded_answers.append(coded_answer)
+
+    target_question['answer'] = coded_answers
+    return qnr_json_copy
+
+
+def upgrade():
+    # ### commands auto generated by Alembic - please adjust! ###
+    session = Session(bind=op.get_bind())
+
+    instrument_id = 'comorb'
+    comorb_q = Questionnaire.find_by_name(name=instrument_id)
+    # exit if Questionnaire not found
+    if not comorb_q:
+        return
+    # invert dictionary to lookup code by answer
+    comorb_codes = {v: k for k, v in comorb_q.questionnaire_code_map().items()}
+
+    questionnaire_responses = session.query(QuestionnaireResponse).filter(
+        QuestionnaireResponse.document[
+            ("questionnaire", "reference")
+        ].astext.endswith(instrument_id)
+    ).order_by(QuestionnaireResponse.id)
+
+    for qnr in questionnaire_responses:
+        qnr_json = fixup_comorb(qnr.document, comorb_options=comorb_codes)
+        if qnr_json == qnr.document:
+            continue
+
+        qnr.document = qnr_json
+        session.add(qnr)
+        session.commit()
+        assert qnr.document
+        print("Processed QNR: %d" % qnr.id)
+    # ### end Alembic commands ###
+
+
+def downgrade():
+    # ### commands auto generated by Alembic - please adjust! ###
+    pass
+    # ### end Alembic commands ###
diff --git a/portal/migrations/versions/df233cc6fa8a_.py b/portal/migrations/versions/df233cc6fa8a_.py
new file mode 100644
index 0000000000..2ae4c71e0c
--- /dev/null
+++ b/portal/migrations/versions/df233cc6fa8a_.py
@@ -0,0 +1,50 @@
+"""Capture email_message.recipient ID when missed on __invite__ prefix
+
+Revision ID: df233cc6fa8a
+Revises: 908731b85112
+Create Date: 2019-12-12 16:13:54.058040
+
+"""
+from alembic import op
+from sqlalchemy.orm import sessionmaker
+from portal.models.message import EmailMessage
+from portal.models.user import INVITE_PREFIX, User
+
+# revision identifiers, used by Alembic.
+revision = 'df233cc6fa8a'
+down_revision = '908731b85112'
+Session = sessionmaker()
+
+
+def upgrade():
+    session = Session(bind=op.get_bind())
+
+    needing_attn = session.query(EmailMessage).filter(
+        EmailMessage.recipient_id.is_(None))
+    items = []  # don't update mid query
+    for em in needing_attn:
+        items.append({'id': em.id, 'recipients': em.recipients})
+
+    # Whip through, updating those for which we can find a valid recipient
+    corrected = 0
+    for i in items:
+        user = session.query(User).filter(
+            User.email == i['recipients']).first()
+        if not user:
+            user = session.query(User).filter(User.email == "{}{}".format(
+                INVITE_PREFIX, i['recipients'])).first()
+        if user:
+            em = session.query(EmailMessage).get(i['id'])
+            em.recipient_id = user.id
+            corrected += 1
+
+    if corrected:
+        session.commit()
+        print(
+            "Corrected {} EmailMessages of {} missing a recipient_id".format(
+                corrected, len(items)))
+
+
+def downgrade():
+    # No downgrade needed
+    pass
diff --git a/portal/models/clinical_constants.py b/portal/models/clinical_constants.py
index 765f34794b..2bee879969 100644
--- a/portal/models/clinical_constants.py
+++ b/portal/models/clinical_constants.py
@@ -16,6 +16,12 @@
 
 
 class ClinicalConstants(object):
+    __instance = None
+
+    def __new__(cls):
+        if ClinicalConstants.__instance is None:
+            ClinicalConstants.__instance = object.__new__(cls)
+        return ClinicalConstants.__instance
 
     def __iter__(self):
         for attr in dir(self):
diff --git a/portal/models/message.py b/portal/models/message.py
index 3b9686def9..874f00b813 100644
--- a/portal/models/message.py
+++ b/portal/models/message.py
@@ -1,6 +1,7 @@
 """Model classes for message data"""
 
 from datetime import datetime
+from flask import current_app
 from sqlalchemy.ext.hybrid import hybrid_property
 from textwrap import fill
 
@@ -9,7 +10,7 @@
 from ..audit import auditable_event
 from ..database import db
 from ..extensions import mail
-from .user import User
+from .user import INVITE_PREFIX, User
 
 
 def log_message(message, app):
@@ -78,6 +79,18 @@ def log_message(message, app):
 EMAIL_FOOTER = "</body></html>"
 
 
+def extra_headers():
+    """Function to deliver any configured extra_headers for outbound email
+
+    Returns an empty dict, or one including any desired extra_headers, such
+    as a ``List-Unsubscribe`` header.
+
+    """
+    # TN-2386 Include List-Unsubscribe header to improve spam scores
+    return {'List-Unsubscribe': "<mailto:{}?subject=unsubscribe>".format(
+        current_app.config['CONTACT_SENDTO_EMAIL'])}
+
+
 class EmailMessage(db.Model):
     __tablename__ = 'email_messages'
     id = db.Column(db.Integer, primary_key=True)
@@ -106,6 +119,10 @@ def recipients(self, value):
             raise ValueError("schema only supports single recipient")
 
         recipient_user = User.query.filter_by(email=value).first()
+        if not recipient_user:
+            # Capture email sent to a user prior to registration
+            recipient_user = User.query.filter_by(email="{}{}".format(
+                INVITE_PREFIX, value)).first()
         if recipient_user:
             self.recipient_id = recipient_user.id
         self._recipients = value
@@ -134,13 +151,18 @@ def send_message(self, cc_address=None):
         """
         message = Message(
             subject=self.subject,
+            extra_headers=extra_headers(),
             recipients=self.recipients.split())
         if cc_address:
             message.cc.append(cc_address)
         body = self.style_message(self.body)
         message.html = fill(
             body, width=280, break_long_words=False, break_on_hyphens=False)
-        mail.send(message)
+        exc = None
+        try:
+            mail.send(message)
+        except Exception as e:
+            exc = e
 
         user = User.query.filter_by(email='__system__').first()
         user_id = user.id if user else None
@@ -151,8 +173,18 @@ def send_message(self, cc_address=None):
         if user_id and subject_id:
             audit_msg = ("EmailMessage '{0.subject}' sent to "
                          "{0.recipients} from {0.sender}".format(self))
+            if exc:
+                audit_msg = "ERROR {}; {}".format(str(exc), audit_msg)
             auditable_event(message=audit_msg, user_id=user_id,
                             subject_id=subject_id, context="user")
+        else:
+            # This should never happen, alert if it does
+            current_app.logger.error(
+                "Unable to generate audit log for email {}".format(Message))
+        # If an exception was raised when attempting the send, re-raise now
+        # for clients to manage
+        if exc:
+            raise exc
 
     def __str__(self):
         return "EmailMessage subj:{} sent_at:{}".format(
diff --git a/portal/models/organization.py b/portal/models/organization.py
index d6d7ecb037..406375dc85 100644
--- a/portal/models/organization.py
+++ b/portal/models/organization.py
@@ -574,6 +574,10 @@ def apply_fhir(self):
                     retired_as_of=FHIR_datetime.parse(
                         rp.get('retired_as_of'), none_safe=True))
             else:
+                if existing not in remove_if_not_requested:
+                    raise ValueError(
+                        "duplicate RP names for org {}".format(
+                            self.organization.name))
                 remove_if_not_requested.remove(existing)
 
                 # Unfortunately, the association proxy requires
diff --git a/portal/models/procedure_codes.py b/portal/models/procedure_codes.py
index ce2a6c1790..26cd466244 100644
--- a/portal/models/procedure_codes.py
+++ b/portal/models/procedure_codes.py
@@ -65,6 +65,12 @@ class TxStartedConstants(object):
     from different coding systems under the same codeable_concept
 
     """
+    __instance = None
+
+    def __new__(cls):
+        if TxStartedConstants.__instance is None:
+            TxStartedConstants.__instance = object.__new__(cls)
+        return TxStartedConstants.__instance
 
     def __iter__(self):
         for attr in dir(self):
@@ -210,6 +216,12 @@ class TxNotStartedConstants(object):
     codeable concept containing a known procedure started coding.
 
     """
+    __instance = None
+
+    def __new__(cls):
+        if TxNotStartedConstants.__instance is None:
+            TxNotStartedConstants.__instance = object.__new__(cls)
+        return TxNotStartedConstants.__instance
 
     def __iter__(self):
         for attr in dir(self):
diff --git a/portal/models/qb_timeline.py b/portal/models/qb_timeline.py
index 78dcde99bb..82e9b44441 100644
--- a/portal/models/qb_timeline.py
+++ b/portal/models/qb_timeline.py
@@ -1,3 +1,4 @@
+from collections import namedtuple
 from datetime import MAXYEAR, datetime
 from time import sleep
 
@@ -12,6 +13,7 @@
 from ..database import db
 from ..date_tools import FHIR_datetime, RelativeDelta
 from ..dogpile_cache import dogpile_cache
+from ..set_tools import left_center_right
 from ..timeout_lock import TimeoutLock
 from ..trace import trace
 from .overall_status import OverallStatus
@@ -22,7 +24,7 @@
     trigger_date,
     visit_name,
 )
-from .questionnaire_response import QNR_results
+from .questionnaire_response import QNR_results, QuestionnaireResponse
 from .research_protocol import ResearchProtocol
 from .role import ROLE
 from .user import User
@@ -266,6 +268,179 @@ def second_null_safe_datetime(x):
     return x[1]
 
 
+RPD = namedtuple("RPD", ['rp', 'retired', 'qbds'])
+
+
+def cur_next_rp_gen(user, classification, trigger_date):
+    """Generator to manage transitions through research protocols
+
+    Returns a *pair* of research protocol data (RPD) namedtuples,
+    one for current (active) RP data, one for the "next".
+
+    :param user: applicable patient
+    :param classification: None or 'indefinite' for special handling
+    :param trigger_date: patient's initial trigger date
+
+    :yields: cur_RPD, next_RPD
+
+    """
+    rps = ResearchProtocol.assigned_to(user)
+    sorted_rps = sorted(
+        list(rps), key=second_null_safe_datetime, reverse=True)
+
+    def qbds_for_rp(rp, classification, trigger_date):
+        if rp is None:
+            return None
+        if classification == 'indefinite':
+            return indef_qbs_by_rp(rp.id, trigger_date=trigger_date)
+        return ordered_rp_qbs(rp.id, trigger_date=trigger_date)
+
+    while sorted_rps:
+        # Start with oldest RP (current) till it's time to progress (next)
+        current_rp, current_retired = sorted_rps.pop()
+        if sorted_rps:
+            next_rp, next_retired = sorted_rps[-1]
+        else:
+            next_rp = None
+        trace("current RP '{}'({}), next RP '{}'({})".format(
+            current_rp.name, current_rp.id, next_rp.name
+            if next_rp else 'None', next_rp.id if next_rp else 'None'))
+
+        curRPD = RPD(
+            rp=current_rp,
+            retired=current_retired,
+            qbds=qbds_for_rp(current_rp, classification, trigger_date))
+        if next_rp:
+            nextRPD = RPD(
+                rp=next_rp,
+                retired=next_retired,
+                qbds=qbds_for_rp(next_rp, classification, trigger_date)
+            )
+            if curRPD.retired == nextRPD.retired:
+                raise ValueError(
+                    "Invalid state: multiple RPs w/ same retire date")
+        else:
+            nextRPD = None
+        yield curRPD, nextRPD
+
+
+class RP_flyweight(object):
+    """maintains state for RPs as it transitions
+
+    Any number of Research Protocols may apply to a user.  This
+    class manages transitioning through the applicable as time
+    passes, maintaining a "current" and "next" as well as the ability
+    to continue marching forward.
+
+    """
+
+    def __init__(self, user, trigger_date, classification):
+        """Initialize flyweight state
+        :param user: the patient
+        :param trigger_date: the patient's initial trigger date
+        :param classification: `indefinite` or None
+        """
+        self.user = user
+        self.td = trigger_date
+        self.classification = classification
+        self.rp_walker = cur_next_rp_gen(
+            user=self.user, trigger_date=self.td,
+            classification=self.classification)
+        self.cur_rpd, self.nxt_rpd = next(self.rp_walker, (None, None))
+        self.skipped_nxt_start = None
+
+    def adjust_start(self):
+        """The QB start may need a minor adjustment, done once when ready"""
+        self.cur_qbd.relative_start = self.cur_start
+
+        # sanity check - make sure we don't adjust twice
+        if hasattr(self.cur_qbd, 'already_adjusted'):
+            raise RuntimeError(
+                'already adjusted the qbd relative start')
+        self.cur_qbd.already_adjusted = True
+
+    def consider_transition(self):
+        """Returns true only if state suggests it *may* be transtion time"""
+        return self.nxt_rpd and self.cur_rpd.retired < self.cur_exp
+
+    def next_qbd(self):
+        """Advance to next qbd on applicable RPs"""
+        self.cur_qbd, self.cur_start, self.cur_exp = None, None, None
+        if self.cur_rpd:
+            self.cur_qbd = next(self.cur_rpd.qbds, None)
+        if self.cur_qbd:
+            self.cur_start = calc_and_adjust_start(
+                user=self.user, qbd=self.cur_qbd, initial_trigger=self.td)
+            self.cur_exp = calc_and_adjust_expired(
+                user=self.user, qbd=self.cur_qbd, initial_trigger=self.td)
+
+        self.nxt_qbd, self.nxt_start = None, None
+        if self.nxt_rpd:
+            self.nxt_qbd = next(self.nxt_rpd.qbds, None)
+        if self.nxt_qbd:
+            self.nxt_start = calc_and_adjust_start(
+                user=self.user, qbd=self.nxt_qbd, initial_trigger=self.td)
+            if self.cur_qbd is None:
+                trace("Finished cur RP with remaining QBs in next")
+                self.cur_start = self.nxt_start
+                self.transition()
+            elif self.cur_start != self.nxt_start:
+                # Valid only when the RP being replaced doesn't have all the
+                # visits defined in the next one (i.e. v3 doesn't have months
+                # 27 or 33 and v5 does). Look ahead for a match
+                self.skipped_nxt_start = self.nxt_start
+                self.nxt_start = None
+                self.nxt_qbd = next(self.nxt_rpd.qbds, None)
+                if self.nxt_qbd:
+                    self.nxt_start = calc_and_adjust_start(
+                        user=self.user, qbd=self.nxt_qbd,
+                        initial_trigger=self.td)
+                if self.cur_start != self.nxt_start:
+                    # Still no match means poorly defined RP QBs
+                    raise ValueError(
+                        "Invalid state {}:{} not in lock-step even on "
+                        "look ahead; RPs need to maintain same "
+                        "schedule {}, {}, {}".format(
+                            self.cur_rpd.rp.name, self.nxt_rpd.rp.name,
+                            self.cur_start, self.nxt_start,
+                            self.skipped_nxt_start))
+        if self.cur_qbd:
+            trace("advanced to next QB: {} w/ start {}".format(
+                self.cur_qbd.questionnaire_bank.name, self.cur_start))
+        else:
+            trace("out of QBs!")
+
+    def transition(self):
+        """Transition internal state to 'next' Research Protocol"""
+        trace("transitioning to the next RP w/ cur_start {}".format(
+            self.cur_start))
+        if self.cur_start != self.nxt_start:
+            raise ValueError(
+                "Invalid state {}:{} not in lock-step; RPs need "
+                "to maintain same schedule".format(
+                    self.cur_rpd.rp.name, self.nxt_rpd.rp.name))
+
+        self.cur_rpd, self.nxt_rpd = next(self.rp_walker)
+
+        # Need to "catch-up" the fresh generators to match current
+        # if we skipped ahead, only catch-up to the skipped_start
+        start = self.cur_start
+        if self.skipped_nxt_start:
+            assert self.skipped_nxt_start < start
+            start = self.skipped_nxt_start
+        while True:
+            # Fear not, won't loop forever as `next_qbd` will
+            # quickly exhaust, thus raising an exception, in
+            # the event of a config error where RPs somehow
+            # change the start, expiration synchronization.
+            self.next_qbd()
+            if start == self.cur_start:
+                break
+
+        # reset in case of another advancement
+        self.skipped_nxt_start = None
+
+
 def ordered_qbs(user, classification=None):
     """Generator to yield ordered qbs for a user
 
@@ -294,87 +469,98 @@ def ordered_qbs(user, classification=None):
         else:
             trace("no trigger date therefore nothing from ordered_qbds()")
             return
+    else:
+        trace("initial trigger date {}".format(td))
 
-    # Zero to one RP makes things significantly easier - otherwise
-    # swap in a strategy that can work with the change.
-    rps = ResearchProtocol.assigned_to(user)
+    rp_flyweight = RP_flyweight(
+        user=user, trigger_date=td, classification=classification)
 
-    if len(rps) > 0:
-        # RP switch is delayed if user submitted any results for the then
-        # active QB on the RP active at that time.
+    if rp_flyweight.cur_rpd:
         user_qnrs = QNR_results(user)
+        rp_flyweight.next_qbd()
 
-        # With multiple RPs, move in lock step, determine when to switch.
-        sorted_rps = sorted(
-            list(rps), key=second_null_safe_datetime, reverse=True)
-
-        # Start with oldest RP (current) till it's time to progress (next)
-        current_rp, current_retired = sorted_rps.pop()
-        if sorted_rps:
-            trace("multiple RPs found")
-            next_rp, next_retired = sorted_rps.pop()
-        else:
-            trace("single RP found")
-            next_rp = None
-
-        if sorted_rps:
-            raise ValueError("can't cope with > 2 RPs at this time")
-
-        if classification == 'indefinite':
-            current_qbds = indef_qbs_by_rp(current_rp.id, trigger_date=td)
-            next_rp_qbds = (
-                indef_qbs_by_rp(next_rp.id, trigger_date=td) if next_rp else
-                None)
-        else:
-            current_qbds = ordered_rp_qbs(current_rp.id, trigger_date=td)
-            next_rp_qbds = (
-                ordered_rp_qbs(next_rp.id, trigger_date=td) if next_rp else
-                None)
+        if not rp_flyweight.cur_qbd:
+            trace("no current found in initial QBD lookup, bail")
+            return
 
         while True:
-            # Advance both qb generators in sync while both RPs are defined
-            try:
-                current_qbd = next(current_qbds)
-            except StopIteration:
-                return
-            if next_rp_qbds:
-                try:
-                    next_rp_qbd = next(next_rp_qbds)
-                except StopIteration:
-                    return
-            users_start = calc_and_adjust_start(
-                user=user, qbd=current_qbd, initial_trigger=td)
-            users_expiration = calc_and_adjust_expired(
-                user=user, qbd=current_qbd, initial_trigger=td)
-
-            # if there's still a next and current gets retired before this
-            # QB's expiration, switch over *unless* user submitted a matching
-            # QNR on the current RP
-            if (next_rp_qbds and current_retired < users_expiration and
-                    not user_qnrs.earliest_result(
-                        qb_id=current_qbd.questionnaire_bank.id,
-                        iteration=current_qbd.iteration)):
-                current_qbds = next_rp_qbds
-                current_qbd, current_retired = next_rp_qbd, next_retired
-                next_rp_qbds, next_retired = None, None
-                users_start = calc_and_adjust_start(
-                    user=user, qbd=current_qbd, initial_trigger=td)
-
-            # done if user withdrew before the next start
-            if withdrawal_date and withdrawal_date < users_start:
+            if rp_flyweight.consider_transition():
+                # if there's a nextRP and curRP is retired before the
+                # user's QB for the curRP expires, we look to transition
+                # the user to the nextRP.
+                #
+                # if however, the user has already posted QNRs for the
+                # currentRP one of two things needs to happen:
+                #
+                #   1. if any of the QNRs are for instruments which
+                #      deterministically* demonstrate work on the current
+                #      RP has begun, we postpone the transition to the next
+                #      RP till the subsequent "visit" (i.e. next QB which
+                #      will come up in the next iteration)
+                #   2. if all the submissions for the currentRP are
+                #      non-deterministic*, we transition now and update the
+                #      QNRs so they point to the QB of the nextRP
+                #
+                # * over RPs {v2,v3}, "epic23" vs "epic26" deterministically
+                #   define the QB whereas "eortc" is non-deterministic, as
+                #   it belongs to both
+
+                transition_now = False
+                cur_only, common, next_only = left_center_right(
+                    rp_flyweight.cur_qbd.questionnaire_instruments,
+                    rp_flyweight.nxt_qbd.questionnaire_instruments)
+                combined_instruments = cur_only.union(common).union(next_only)
+                qnrs_for_period = user_qnrs.authored_during_period(
+                    start=rp_flyweight.cur_start, end=rp_flyweight.cur_exp,
+                    restrict_to_instruments=combined_instruments)
+                if len(qnrs_for_period) == 0:
+                    transition_now = True
+
+                period_instruments = set(
+                    [q.instrument for q in qnrs_for_period])
+                if not transition_now and period_instruments & cur_only:
+                    if period_instruments & next_only:
+                        current_app.logger.error(
+                            "Transition ERROR, {} has deterministic QNRs "
+                            "for multiple RPs '{}':'{}' during same visit; "
+                            "User submitted {}; cur_only {}, common {}, "
+                            "next_only {}".format(
+                                user, rp_flyweight.cur_rpd.rp.name,
+                                rp_flyweight.nxt_rpd.rp.name,
+                                str(period_instruments), str(cur_only),
+                                str(common), str(next_only)))
+                    # Don't transition yet, as definitive work on the old
+                    # (current) RP has already been posted
+                    transition_now = False
+                else:
+                    # Safe to transition, but first update all the common,
+                    # existing QNRs to reference the *next* RP
+                    for q in qnrs_for_period:
+                        if q.instrument not in common:
+                            continue
+                        qnr = QuestionnaireResponse.query.get(q.qnr_id)
+                        qnr.qb_id = rp_flyweight.nxt_qbd.qb_id
+                        qnr.qb_iteration = rp_flyweight.nxt_qbd.iteration
+                    transition_now = True
+
+                if transition_now:
+                    rp_flyweight.transition()
+
+            # done if user withdrew before QB starts
+            if withdrawal_date and withdrawal_date < rp_flyweight.cur_start:
                 trace("withdrawn as of {}".format(withdrawal_date))
                 break
 
-            current_qbd.relative_start = users_start
-            # sanity check - make sure we don't adjust twice
-            if hasattr(current_qbd, 'already_adjusted'):
-                raise RuntimeError('already adjusted the qbd relative start')
-            current_qbd.already_adjusted = True
-            yield current_qbd
+            rp_flyweight.adjust_start()
+            yield rp_flyweight.cur_qbd
+
+            rp_flyweight.next_qbd()
+            if not rp_flyweight.cur_qbd:
+                return
     else:
         trace("no RPs found")
 
-        # Neither RP case hit, try intervention associated QBs
+        # No applicable RPs, try intervention associated QBs
         if classification == 'indefinite':
             iqbds = indef_intervention_qbs(user, trigger_date=td)
         else:
diff --git a/portal/models/qbd.py b/portal/models/qbd.py
index bf8900a3b6..20d09e916d 100644
--- a/portal/models/qbd.py
+++ b/portal/models/qbd.py
@@ -54,6 +54,10 @@ def questionnaire_bank(self, qb):
         self.qb_id = qb.id
         self._questionnaire_bank = qb
 
+    @property
+    def questionnaire_instruments(self):
+        return set(q.name for q in self.questionnaire_bank.questionnaires)
+
     def as_json(self):
         from ..models.questionnaire_bank import visit_name
 
diff --git a/portal/models/questionnaire_response.py b/portal/models/questionnaire_response.py
index 024e8718f6..7c359770ce 100644
--- a/portal/models/questionnaire_response.py
+++ b/portal/models/questionnaire_response.py
@@ -434,6 +434,20 @@ def qnrs_missing_qb_association(self):
         associated = [qnr for qnr in self.qnrs if qnr.qb_id is not None]
         return len(self.qnrs) != len(associated)
 
+    def authored_during_period(self, start, end, restrict_to_instruments=None):
+        """Return the ordered list of QNRs with authored in [start, end)"""
+        results = []
+        for qnr in self.qnrs:
+            if qnr.authored < start:
+                continue
+            if qnr.authored >= end:
+                return results
+            if (restrict_to_instruments and
+                    qnr.instrument not in restrict_to_instruments):
+                continue
+            results.append(qnr)
+        return results
+
     def earliest_result(self, qb_id, iteration):
         """Returns timestamp of earliest result for given params, or None"""
         for qnr in self.qnrs:
diff --git a/portal/models/reference.py b/portal/models/reference.py
index 437441d580..feb697c68e 100644
--- a/portal/models/reference.py
+++ b/portal/models/reference.py
@@ -164,7 +164,7 @@ def get_object_by_identifier(obj, system, value):
             (re.compile('[Oo]rganization/(\d+)'), Organization, 'id'),
             (re.compile('[Qq]uestionnaire/(\w+)\?[Ss]ystem=(\S+)'),
              Questionnaire, 'identifier'),
-            (re.compile('[Qq]uestionnaire_[Bb]ank/(\w+)'),
+            (re.compile('[Qq]uestionnaire_[Bb]ank/(\w+[.]?\w*)'),
              QuestionnaireBank, 'name'),
             (re.compile('[Ii]ntervention/(\w+)'), Intervention, 'name'),
             (re.compile('[Pp]atient/(\d+)'), User, 'id'),
diff --git a/portal/set_tools.py b/portal/set_tools.py
new file mode 100644
index 0000000000..ad40b278a5
--- /dev/null
+++ b/portal/set_tools.py
@@ -0,0 +1,9 @@
+"""Module for additional set tools/utilities"""
+
+
+def left_center_right(leftset, rightset):
+    """Return left only, center (common) and right only elements"""
+    left = leftset - rightset
+    common = leftset & rightset
+    right = rightset - leftset
+    return left, common, right
diff --git a/portal/static/js/src/accountCreation.js b/portal/static/js/src/accountCreation.js
index 995de80f56..9282f20377 100644
--- a/portal/static/js/src/accountCreation.js
+++ b/portal/static/js/src/accountCreation.js
@@ -490,8 +490,11 @@ import {CurrentUserObj} from "./mixins/CurrentUser.js";
             let self = this;
             CurrentUserObj.initCurrentUser(function() {
                 OT.init(function() {
-                    self.getOrgs(self.populateOrgsByRole);
-                    self.handleMedidataRave(CurrentUserObj.topLevelOrgs, CurrentUserObj.isAdminUser());
+                    setTimeout(function() {
+                        //delay a bit to call orgs api after current user info is loaded
+                        this.getOrgs(this.populateOrgsByRole);
+                        this.handleMedidataRave(CurrentUserObj.topLevelOrgs, CurrentUserObj.isAdminUser());
+                    }.bind(self), 150);
                 });
             });
         };
diff --git a/portal/static/js/src/gil.js b/portal/static/js/src/gil.js
index a2bcbaa182..6bcac215a0 100755
--- a/portal/static/js/src/gil.js
+++ b/portal/static/js/src/gil.js
@@ -675,20 +675,12 @@ module.exports = OrgTool = (function() {
     };
     this.getOrgs = function(userId, sync, callback) {
         var self = this;
-        $.ajax ({
-            type: "GET",
-            url: "/api/organization",
-            async: sync? false : true
-        }).done(function(data) {
-
+        callback = callback || function() {};
+        //use common ajax function, which will retry and report error with detail
+        tnthAjax.getOrgs(userId, {sync: sync}, function(data) {
           $("#fillOrgs").attr("userId", userId);
-
           (self.populateOrgsList).apply(self, [data.entry]);
           self.populateUI();
-          if (callback) {
-            callback();
-          }
-
           $("#modal-org").on("hide.bs.modal", function(e) {
             if (typeof sessionStorage !== "undefined") {
               sessionStorage.setItem("noOrgModalViewed", "true");
@@ -745,11 +737,7 @@ module.exports = OrgTool = (function() {
                   };
               });
           });
-        }).fail(function(xhr) {
-          window.app.global.reportError(userId, "/api/organization", xhr.responseText);
-          if (callback) {
-            callback();
-          }
+          callback(data);
         });
     },
     this.updateOrg = function(userId, callback) {
diff --git a/portal/static/js/src/modules/TnthAjax.js b/portal/static/js/src/modules/TnthAjax.js
index 3c0a76a0a9..2a4c920709 100644
--- a/portal/static/js/src/modules/TnthAjax.js
+++ b/portal/static/js/src/modules/TnthAjax.js
@@ -71,10 +71,12 @@ export default { /*global $ */
                     }, 3000); //retry after 3 seconds
                 })(self, url, method, userId, params, callback);
             } else {
-                params.attempts = 0;
                 fieldHelper.showError(targetField);
                 callback({"error": true, "data": xhr});
                 self.sendError(xhr, url, userId, params);
+                //reset attempts after reporting error so we know how many attempts have been made
+                //multiple attempts can signify server not being responsive or busy network
+                params.attempts = 0;
             }
         });
     },
diff --git a/portal/static/js/src/profile.js b/portal/static/js/src/profile.js
index fd05042e23..1ea3218c34 100644
--- a/portal/static/js/src/profile.js
+++ b/portal/static/js/src/profile.js
@@ -159,7 +159,7 @@ export default (function() {
                 consentDate: "",
                 completionDate: "",
                 todayObj: { displayDay: "", displayMonth: "", displayYear: ""},
-                errorMessage: ""
+                errorMessage: null
             },
             patientEmailForm: {
                 loading: false
@@ -1742,9 +1742,16 @@ export default (function() {
             },
             manualEntryModalVis: function(hide) {
                 if (hide) {
+                    /*
+                     * TODO, need to find out why IE is raising vue error here
+                     */
                     this.manualEntry.loading = true;
+                    $("#manualEntryLoader").show();
+                    $("#manualEntryButtonsContainer").hide();
                 } else {
                     this.manualEntry.loading = false;
+                    $("#manualEntryLoader").hide();
+                    $("#manualEntryButtonsContainer").show();
                 }
             },
             continueToAssessment: function(method, completionDate, assessment_url) {
@@ -1774,7 +1781,7 @@ export default (function() {
                 setTimeout(function(callback) {
                     callback = callback || function() {};
                     if (callback) { callback(); }
-                }, 1000, self.manualEntryModalVis);
+                }, 5000, self.manualEntryModalVis);
             },
             setManualEntryDateToToday: function() {
                 this.manualEntry.todayObj = this.modules.tnthDates.getTodayDateObj();
@@ -1791,6 +1798,19 @@ export default (function() {
                     this.manualEntry.completionDate = this.manualEntry.consentDate;
                 }
             },
+            resetManualEntryFormValidationError: function() {
+                //reset error message to null
+                this.manualEntry.errorMessage = null;
+                //reset bootstrap form validation error
+                $("#manualEntryCompletionDateContainer").removeClass("has-error");
+                $("#manualEntryMessageContainer").html("").removeClass("with-errors");
+            },
+            setManualEntryErrorMessage: function(message) {
+                if (!message) {
+                    return;
+                }
+                $("#manualEntryMessageContainer").html(message);
+            },
             initCustomPatientDetailSection: function() {
                 var subjectId = this.subjectId, self = this;
                 $(window).on("beforeunload", function() { //fix for safari
@@ -1803,8 +1823,8 @@ export default (function() {
                     self.manualEntry.initloading = true;
                 });
                 $("#manualEntryModal").on("shown.bs.modal", function() {
-                    self.manualEntry.errorMessage = "";
                     self.manualEntry.method = "";
+                    self.resetManualEntryFormValidationError();
                     self.modules.tnthAjax.getConsent(subjectId, {sync: true}, function(data) { //get consent date
                         var dataArray = [];
                         if (!data || !data.consent_agreements || data.consent_agreements.length === 0) {
@@ -1842,7 +1862,7 @@ export default (function() {
                 });
 
                 $("input[name='entryMethod']").on("click", function() {
-                    self.manualEntry.errorMessage = "";
+                    self.resetManualEntryFormValidationError();
                     self.manualEntry.method = $(this).val();
                     if ($(this).val() === "interview_assisted") {
                         //if method is interview assisted, reset completion date to GMT date/time for today
@@ -1858,26 +1878,27 @@ export default (function() {
                 ["qCompletionDay", "qCompletionMonth", "qCompletionYear"].forEach(function(fn) {
                     var fd = $("#" + fn),
                         tnthDates = self.modules.tnthDates;
+
                     fd.on("change", function(e) {
                         e.stopImmediatePropagation();
+
+                        //reset error
+                        self.resetManualEntryFormValidationError();
+                        $("#meSubmit").attr("disabled", false);
+                    
                         var d = $("#qCompletionDay");
                         var m = $("#qCompletionMonth");
                         var y = $("#qCompletionYear");
-                        var isValid = d.val() !== "" && m.val() !== "" && y.val() !== "" && d.get(0).validity.valid && m.get(0).validity.valid && y.get(0).validity.valid;
-                        if (!isValid) {
-                            $("#meSubmit").attr("disabled", true);
-                            return;
-                        }
+
                         //add true boolean flag to check for future date entry
                         var errorMessage = tnthDates.dateValidator(d.val(), m.val(), y.val(), true);
                         if (errorMessage) {
                             self.manualEntry.errorMessage = errorMessage;
+                            self.setManualEntryErrorMessage(errorMessage);
+                            $("#meSubmit").attr("disabled", true);
                             return false;
                         }
-
-                        //reset error
-                        self.manualEntry.errorMessage = "";
-
+            
                         var gmtDateObj = tnthDates.getDateObj(y.val(), m.val(), d.val(), 12, 0, 0);
                         self.manualEntry.completionDate = self.modules.tnthDates.getDateWithTimeZone(gmtDateObj, "system");
 
@@ -1920,17 +1941,18 @@ export default (function() {
                     self.modules.tnthAjax.getCurrentQB(subjectId, completionDate, null, function(data) {
                         if (data.error) {
                             self.manualEntry.errorMessage = i18next.t("Server error occurred checking questionnaire window");
-                            self.manualEntryModalVis();
-                            return false;
                         }
                         //check questionnaire time windows
                         if (!(data.questionnaire_bank && Object.keys(data.questionnaire_bank).length > 0)) {
                             self.manualEntry.errorMessage = i18next.t("Invalid completion date. Date of completion is outside the days allowed.");
+                        }
+                        if (self.manualEntry.errorMessage) {
+                            self.setManualEntryErrorMessage(self.manualEntry.errorMessage);
                             self.manualEntryModalVis();
-                        } else {
-                            self.manualEntry.errorMessage = "";
-                            self.continueToAssessment(method, completionDate, linkUrl);
+                            return false;
                         }
+                        self.resetManualEntryFormValidationError();
+                        self.continueToAssessment(method, completionDate, linkUrl);
                     });
                 });
 
diff --git a/portal/static/less/eproms.less b/portal/static/less/eproms.less
index 7b39a71527..9b349f6709 100644
--- a/portal/static/less/eproms.less
+++ b/portal/static/less/eproms.less
@@ -4007,7 +4007,7 @@ body.vis-on-callback { /* allow page-specific presentation of content after load
   margin-top: 1em;
   label {
     position: relative;
-    top: 0.35em;
+    top: 2px;
     margin-bottom: 4px;
   }
 }
diff --git a/portal/templates/profile/profile_macros.html b/portal/templates/profile/profile_macros.html
index 048ca94334..12ecbdcd94 100644
--- a/portal/templates/profile/profile_macros.html
+++ b/portal/templates/profile/profile_macros.html
@@ -1120,10 +1120,10 @@ <h4 class="modal-title">{{ _("Enter questionnaire manually on patient's behalf")
                                                     <input class="form-control" id="qCompletionYear" name="qCompletionYear" aria-label="{{_('Completion Year')}}" data-exempt-from-disabling="true" placeholder="YYYY" pattern = "(19|20)\d{2}" type="text" maxlength="4" data-error="{{_('Date must be valid and in the required format.')}}" data-trigger-event="change" autocomplete="off" v-model="manualEntry.todayObj.displayYear" required />
                                                 </div>
                                             </div>
-                                        </div>
                                         {% raw %}
-                                            <div id="manualEntryMessageContainer" class="error-message">{{manualEntry.errorMessage}}</div>
+                                            <div id="manualEntryMessageContainer" class="error-message help-block with-errors">{{manualEntry.errorMessage}}</div>
                                         {% endraw %}
+                                        </div>
                                     </div>
                                 </div>
                                 <div class="modal-footer">
@@ -1131,7 +1131,7 @@ <h4 class="modal-title">{{ _("Enter questionnaire manually on patient's behalf")
                                         <i class="fa fa-spinner fa-spin fa-2x loading-message"></i>
                                     </div>
                                     <div id="manualEntryButtonsContainer" v-show="!manualEntry.loading">
-                                        <a href="#" id="meSubmit" class="btn btn-default" v-bind:disabled="(!manualEntry.method) || manualEntry.errorMessage != ''">{{_("OK")}}</a>
+                                        <a href="#" id="meSubmit" class="btn btn-default" v-bind:disabled="(!manualEntry.method) || manualEntry.errorMessage">{{_("OK")}}</a>
                                         <button type="button" class="btn btn-default" data-dismiss="modal">{{_("Cancel")}}</button>
                                     </div>
                                 </div>
diff --git a/portal/usage_monitor.py b/portal/usage_monitor.py
new file mode 100644
index 0000000000..2af1b7287e
--- /dev/null
+++ b/portal/usage_monitor.py
@@ -0,0 +1,21 @@
+"""API to record and track seconds since last request"""
+from flask import current_app
+import redis
+
+
+def _connection():
+    # Documented to be pooled at the library level
+    return redis.Redis.from_url(current_app.config['REDIS_URL'])
+
+
+KEY = 'Usage Tracker'
+
+
+def mark_usage():
+    conn = _connection()
+    conn.set(name=KEY, value="ping")
+
+
+def last_usage():
+    conn = _connection()
+    return conn.object(key=KEY, infotype='idletime')
diff --git a/portal/views/patient.py b/portal/views/patient.py
index e2acb2bf4e..d5425bef10 100644
--- a/portal/views/patient.py
+++ b/portal/views/patient.py
@@ -42,8 +42,8 @@ def patient_search():
     Takes key=value pairs to look up.  Email, identifier searches supported.
 
     Example searches:
-        /api/patient?email=username@server.com
-        /api/patient?identifier=http://us.truenth.org/identity-codes/external-study-id|123-45-678
+        /api/patient/?email=username@server.com
+        /api/patient/?identifier=http://us.truenth.org/identity-codes/external-study-id|123-45-678
 
     Identifier search pattern:
         ?identifier=<system>|<value>
@@ -312,7 +312,7 @@ def patient_timeline(patient_id):
 
         update_users_QBT(patient_id, invalidate_existing=purge)
     except ValueError as ve:
-        abort(500, ve.message)
+        abort(500, str(ve))
 
     results = []
     # We order by at (to get the latest status for a given QB) and
diff --git a/portal/views/truenth.py b/portal/views/truenth.py
index 5bb0745e51..fa0f713919 100644
--- a/portal/views/truenth.py
+++ b/portal/views/truenth.py
@@ -16,6 +16,7 @@
 from ..extensions import oauth
 from ..models.client import validate_origin
 from ..models.user import current_user
+from ..usage_monitor import mark_usage
 from .crossdomain import crossdomain
 
 truenth_api = Blueprint('truenth_api', __name__, url_prefix='/api')
@@ -28,6 +29,7 @@ def ping():
     """POST request prolong session by reseting cookie timeout"""
     current_app.logger.debug("ping received")
     session.modified = True
+    mark_usage()
     return 'OK'
 
 
diff --git a/portal/views/user.py b/portal/views/user.py
index e3e1fb2d99..481a936bde 100644
--- a/portal/views/user.py
+++ b/portal/views/user.py
@@ -348,7 +348,7 @@ def delete_user(user_id):
     try:
         user.delete_user(acting_user=current_user())
     except ValueError as v:
-        return jsonify(message=v.message)
+        return jsonify(message=str(v))
     return jsonify(message="deleted")
 
 
diff --git a/requirements.dev.txt b/requirements.dev.txt
index be1fab4a9b..ad3c367298 100644
--- a/requirements.dev.txt
+++ b/requirements.dev.txt
@@ -10,7 +10,7 @@ imagesize==1.1.0          # via sphinx
 mock==3.0.5
 packaging==19.2           # via sphinx, tox
 page-objects==1.1.0
-pluggy==0.13.0             # via tox
+pluggy==0.13.1             # via tox
 # use pre-compiled binary for testing, build from source for prod
 # http://initd.org/psycopg/docs/install.html#binary-install-from-pypi
 psycopg2-binary==2.8.4
@@ -26,7 +26,7 @@ sphinx==2.2.1
 sphinxcontrib-websupport==1.1.2  # via sphinx
 tox==3.14.0
 typing==3.7.4.1             # via sphinx
-virtualenv==16.7.7        # via tox
+virtualenv==16.7.8        # via tox
 waitress==1.3.1           # via webtest
 webob==1.8.5              # via webtest
 webtest==2.0.33           # via flask-webtest
diff --git a/requirements.txt b/requirements.txt
index 36f9488f6e..a7319f38f1 100644
--- a/requirements.txt
+++ b/requirements.txt
@@ -35,7 +35,7 @@ idna==2.8                 # via requests
 itsdangerous==1.1.0        # via flask
 jinja2==2.10.3              # via flask, flask-babel, sphinx
 jsonschema==3.0.2
-kombu==4.6.5              # pyup: < 5.0 # via celery
+kombu==4.6.6              # pyup: < 5.0 # via celery
 mako==1.1.0               # via alembic
 markupsafe==1.1.1           # via jinja2, mako
 oauthlib==2.1.0 # pyup: < 3.0.0  # pin until flask-oauthlib, flask-dance, requests-oauthlib upgraded
@@ -47,14 +47,14 @@ python-dateutil==2.8.0
 python-editor==1.0.4      # via alembic
 python-levenshtein==0.12.0
 python-memcached==1.59    # via flask-dogpile-cache
-pytz==2019.2              # via babel, celery
+pytz==2019.3              # via babel, celery
 pyyaml==5.1.2              # via flask-swagger, swagger-spec-validator
 redis==3.3.11
 requests-cache==0.5.2
 requests-oauthlib==1.1.0  # pyup: <1.2.0 # pin until OAuthlib>=3.0.0 # via flask-oauthlib
 requests==2.22.0          # via flask-recaptcha, requests-cache, requests-oauthlib, sphinx
-six==1.12.0               # via bcrypt, packaging, python-dateutil, python-memcached, sphinx, swagger-spec-validator, tox, validators, webtest
-sqlalchemy==1.2.18         # via alembic, flask-sqlalchemy
+six==1.13.0               # via bcrypt, packaging, python-dateutil, python-memcached, sphinx, swagger-spec-validator, tox, validators, webtest
+sqlalchemy==1.3.11         # via alembic, flask-sqlalchemy
 swagger-spec-validator==2.4.3
 urllib3==1.25.7             # via requests
 validators==0.14.0 # pyup: <=0.10.1 # pin until require_tld supported again
diff --git a/tests/test_qb_timeline.py b/tests/test_qb_timeline.py
index d4fc153042..8c3ae399a0 100644
--- a/tests/test_qb_timeline.py
+++ b/tests/test_qb_timeline.py
@@ -419,7 +419,7 @@ def test_change_midstream_results_rp(self):
         qb_name = "CRV_recurring_3mo_period v2"
         nineMo = QuestionnaireBank.query.filter(
             QuestionnaireBank.name == qb_name).one()
-        mock_qr('epic_26_v2', qb=nineMo, iteration=1)
+        mock_qr('epic26_v2', qb=nineMo, iteration=1, timestamp=nowish)
 
         user = db.session.merge(self.test_user)
         gen = ordered_qbs(user)
@@ -457,7 +457,7 @@ def test_change_before_start_rp_w_result(self):
         qb_name = "CRV Baseline v2"
         baseline = QuestionnaireBank.query.filter(
             QuestionnaireBank.name == qb_name).one()
-        mock_qr('epic_26_v2', qb=baseline, iteration=None)
+        mock_qr('epic26_v2', qb=baseline, iteration=None, timestamp=back7)
 
         user = db.session.merge(self.test_user)
         gen = ordered_qbs(user)
diff --git a/tests/test_scheduled_job.py b/tests/test_scheduled_job.py
index ad2bf735ab..49dbdd7279 100644
--- a/tests/test_scheduled_job.py
+++ b/tests/test_scheduled_job.py
@@ -9,6 +9,7 @@
 from portal.models.role import ROLE
 from portal.models.scheduled_job import ScheduledJob
 from portal.tasks import test as test_task
+from sqlalchemy.orm import session
 from tests import TestCase
 
 
@@ -175,4 +176,4 @@ def test_job_trigger(self):
         resp = self.client.post('/api/scheduled_job/{}/trigger'.format(job.id))
         assert resp.status_code == 200
 
-        db.session.close_all()
+        session.close_all_sessions()