diff --git a/r5/narrative/output/ex-med-disp.html b/r5/narrative/output/ex-med-disp.html
index e6679dec..8c285434 100644
--- a/r5/narrative/output/ex-med-disp.html
+++ b/r5/narrative/output/ex-med-disp.html
@@ -73,6 +73,45 @@ <h3>Performers</h3>
     <p>
       <b>dosageInstruction</b>
     </p>
+    <p>
+      <b>sequence</b>
+: 1
+    </p>
+    <p>
+      <b>text</b>
+: Instil one drop in each eye twice daily
+    </p>
+    <p>
+      <b>timing</b>
+: 2 per 1 days
+    </p>
+    <p>
+      <b>route</b>
+:       <span title="Codes:{http://snomed.info/sct 54485002}">Ophthalmic route (qualifier value)</span>
+    </p>
+    <p>
+      <b>method</b>
+:       <span title="Codes:{http://snomed.info/sct 421538008}">Instill - dosing instruction imperative (qualifier value)</span>
+    </p>
+    <h3>DoseAndRates</h3>
+    <table class="grid">
+      <tr>
+        <td style="display: none">-</td>
+        <td>
+          <b>Type</b>
+        </td>
+        <td>
+          <b>Dose[x]</b>
+        </td>
+      </tr>
+      <tr>
+        <td style="display: none">*</td>
+        <td>
+          <span title="Codes:{http://terminology.hl7.org/CodeSystem/dose-rate-type ordered}">Ordered</span>
+        </td>
+        <td>1 OPDROP</td>
+      </tr>
+    </table>
   </blockquote>
   <hr/>
   <blockquote>
diff --git a/validator/manifest.json b/validator/manifest.json
index 0b13dd8f..04f54076 100644
--- a/validator/manifest.json
+++ b/validator/manifest.json
@@ -49841,6 +49841,107 @@
         }
       }
     },
+    {
+      "name": "q_val_fail",
+      "file": "q_val_fail.json",
+      "documentation": "see https://chat.fhir.org/#narrow/stream/179255-questionnaire/topic/R4.20-.20Struggling.20to.20validate.20a.20Questionnaire.20with.20open-choice",
+      "version": "4.0",
+      "java": {
+        "outcome": {
+          "resourceType": "OperationOutcome",
+          "issue": [
+            {
+              "severity": "warning",
+              "code": "invalid",
+              "details": {
+                "text": "Coding has no system. A code with no system has no defined meaning, and it cannot be validated. A system should be provided"
+              },
+              "diagnostics": "[14,22]",
+              "expression": [
+                "QuestionnaireResponse.contained[0]/*Questionnaire/ed364266b937bb3bd73082b1*/.item[0].extension[0].value.ofType(CodeableConcept).coding[0]"
+              ]
+            },
+            {
+              "severity": "warning",
+              "code": "code-invalid",
+              "details": {
+                "text": "None of the codings provided are in the value set 'Questionnaire Item UI Control Codes' (http://hl7.org/fhir/ValueSet/questionnaire-item-control|4.0.1), and a coding should come from this value set unless it has no suitable code (note that the validator cannot judge what is suitable) (codes = null#editableDropdown)"
+              },
+              "diagnostics": "[14,22]",
+              "expression": [
+                "QuestionnaireResponse.contained[0]/*Questionnaire/ed364266b937bb3bd73082b1*/.item[0].extension[0].value.ofType(CodeableConcept)"
+              ]
+            },
+            {
+              "severity": "warning",
+              "code": "code-invalid",
+              "details": {
+                "text": "A code with no system has no defined meaning, and it cannot be validated. A system should be provided"
+              },
+              "diagnostics": "[45,19]",
+              "expression": [
+                "QuestionnaireResponse.contained[0]/*Questionnaire/ed364266b937bb3bd73082b1*/.item[0].code[0]"
+              ]
+            },
+            {
+              "severity": "warning",
+              "code": "code-invalid",
+              "details": {
+                "text": "A code with no system has no defined meaning, and it cannot be validated. A system should be provided"
+              },
+              "diagnostics": "[26,22]",
+              "expression": [
+                "QuestionnaireResponse.contained[0]/*Questionnaire/ed364266b937bb3bd73082b1*/.item[0].answerOption[0].value.ofType(Coding)"
+              ]
+            },
+            {
+              "severity": "warning",
+              "code": "code-invalid",
+              "details": {
+                "text": "A code with no system has no defined meaning, and it cannot be validated. A system should be provided"
+              },
+              "diagnostics": "[32,22]",
+              "expression": [
+                "QuestionnaireResponse.contained[0]/*Questionnaire/ed364266b937bb3bd73082b1*/.item[0].answerOption[1].value.ofType(Coding)"
+              ]
+            },
+            {
+              "severity": "warning",
+              "code": "code-invalid",
+              "details": {
+                "text": "A code with no system has no defined meaning, and it cannot be validated. A system should be provided"
+              },
+              "diagnostics": "[38,22]",
+              "expression": [
+                "QuestionnaireResponse.contained[0]/*Questionnaire/ed364266b937bb3bd73082b1*/.item[0].answerOption[2].value.ofType(Coding)"
+              ]
+            },
+            {
+              "severity": "warning",
+              "code": "invariant",
+              "details": {
+                "text": "Constraint failed: que-0: 'Name should be usable as an identifier for the module by machine processing applications such as code generation'"
+              },
+              "diagnostics": "[7,7]",
+              "expression": [
+                "QuestionnaireResponse.contained[0]/*Questionnaire/ed364266b937bb3bd73082b1*/"
+              ]
+            },
+            {
+              "severity": "warning",
+              "code": "structure",
+              "details": {
+                "text": "The string value 'Blood' matches an entry in the list of valid Codings, so this is probably an error"
+              },
+              "diagnostics": "[66,36]",
+              "expression": [
+                "QuestionnaireResponse.item[0].answer[0]"
+              ]
+            }
+          ]
+        }
+      }
+    },
     {
       "name": "zzz",
       "file": "zzz.json",
diff --git a/validator/q_val_fail.json b/validator/q_val_fail.json
new file mode 100644
index 00000000..298ca5df
--- /dev/null
+++ b/validator/q_val_fail.json
@@ -0,0 +1,84 @@
+{
+  "id":"9bb747d7-2666-47f2-9c79-20bc05198448",
+  "meta":{
+     "versionId":"5"
+  },
+  "contained":[
+     {
+        "id":"ed364266b937bb3bd73082b1",
+        "item":[
+           {
+              "extension":[
+                 {
+                    "url":"http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
+                    "valueCodeableConcept":{
+                       "coding":[
+                          {
+                             "code":"editableDropdown"
+                          }
+                       ]
+                    }
+                 }
+              ],
+              "id":"specimen-source",
+              "answerOption":[
+                 {
+                    "valueCoding":{
+                       "code":"U",
+                       "display":"Urine"
+                    }
+                 },
+                 {
+                    "valueCoding":{
+                       "code":"B",
+                       "display":"Blood"
+                    }
+                 },
+                 {
+                    "valueCoding":{
+                       "code":"S",
+                       "display":"Saliva"
+                    }
+                 }
+              ],
+              "code":[
+                 {
+                    "code":"specimen-source"
+                 }
+              ],
+              "linkId":"specimen-source",
+              "text":"Source of specimen",
+              "type":"open-choice"
+           }
+        ],
+        "name":"Test Open Choice question",
+        "status":"active",
+        "subjectType":[
+           "Patient"
+        ],
+        "resourceType":"Questionnaire"
+     }
+  ],
+  "item":[
+     {
+        "answer":[
+           {
+              "valueString":"Blood"
+           }
+        ],
+        "linkId":"specimen-source",
+        "text":"Source of specimen"
+     }
+  ],
+  "questionnaire":"#ed364266b937bb3bd73082b1",
+  "status":"in-progress",
+  "subject":{
+     "display":"Test Patient",
+     "identifier":{
+        "value":"4"
+     },
+     "reference":"Patient/4",
+     "type":"Patient"
+  },
+  "resourceType":"QuestionnaireResponse"
+}