HeliosSoftware · aacruzgon · Mar 5, 2026
diff --git a/Cargo.lock b/Cargo.lock
diff --git a/README.md b/README.md
@@ -172,6 +172,7 @@ The Helios FHIR Server supports multiple storage backend configurations. Choose
 | **PostgreSQL** | Built-in full-text search (tsvector/tsquery) | Production OLTP deployments |
 | **PostgreSQL + Elasticsearch** | Elasticsearch-powered search with PostgreSQL CRUD | Production deployments needing RDBMS + robust search |
 | **S3** | Object storage for CRUD, versioning, history, and bulk operations (no search) | Archival, bulk analytics, cost-effective storage |
+| **S3 + Elasticsearch** | Elasticsearch-powered search with S3 object storage as canonical source | Object-storage-first deployments needing robust FHIR search |
 
 ### Running the Server
 
@@ -202,13 +203,23 @@ HFS_S3_BUCKET=my-fhir-bucket \
 AWS_PROFILE=your-aws-profile \
 AWS_REGION=us-east-1 \
   ./hfs
+
+# S3 + Elasticsearch (S3 is canonical, Elasticsearch handles all search)
+HFS_STORAGE_BACKEND=s3-elasticsearch \
+HFS_ELASTICSEARCH_NODES=http://localhost:9200 \
+HFS_S3_TENANCY_MODE=prefix-per-tenant \
+HFS_S3_BUCKET=hfs \
+HFS_S3_ENDPOINT_URL=http://localhost:9000 \
+HFS_S3_ALLOW_HTTP=true \
+HFS_S3_FORCE_PATH_STYLE=true \
+  ./hfs
 ```
 
 ### Environment Variables
 
 | Variable | Default | Description |
 |---|---|---|
-| `HFS_STORAGE_BACKEND` | `sqlite` | Backend mode: `sqlite`, `sqlite-elasticsearch`, `postgres`, `postgres-elasticsearch`, or `s3` |
+| `HFS_STORAGE_BACKEND` | `sqlite` | Backend mode: `sqlite`, `sqlite-elasticsearch`, `postgres`, `postgres-elasticsearch`, `s3`, or `s3-elasticsearch` |
 | `HFS_SERVER_PORT` | `8080` | Server port |
 | `HFS_SERVER_HOST` | `127.0.0.1` | Host to bind |
 | `HFS_DATABASE_URL` | `fhir.db` | Database URL (SQLite path or PostgreSQL connection string) |
@@ -219,8 +230,19 @@ AWS_REGION=us-east-1 \
 | `HFS_ELASTICSEARCH_USERNAME` | *(none)* | ES basic auth username |
 | `HFS_ELASTICSEARCH_PASSWORD` | *(none)* | ES basic auth password |
 | `HFS_S3_BUCKET` | `hfs` | S3 bucket name (prefix-per-tenant mode) |
+| `HFS_S3_TENANCY_MODE` | `prefix-per-tenant` | S3 tenant isolation mode (`prefix-per-tenant` or `bucket-per-tenant`) |
+| `HFS_S3_TENANT_BUCKET_MAP` | *(none)* | Per-tenant bucket mapping (`tenant=bucket,tenant2=bucket2`) for bucket-per-tenant mode |
+| `HFS_S3_DEFAULT_SYSTEM_BUCKET` | *(none)* | Optional fallback bucket for non-tenant/system artifacts |
 | `HFS_S3_REGION` | *(AWS provider chain)* | AWS region override |
+| `HFS_S3_PREFIX` | *(none)* | Optional global key prefix inside bucket(s) |
+| `HFS_S3_ENDPOINT_URL` | *(none)* | Custom S3 endpoint (for MinIO/local S3-compatible storage) |
+| `HFS_S3_FORCE_PATH_STYLE` | `false` | Use path-style addressing (`http://host/bucket/key`) |
+| `HFS_S3_ALLOW_HTTP` | `false` | Allow plain HTTP endpoints for local/dev environments |
 | `HFS_S3_VALIDATE_BUCKETS` | `true` | Validate bucket access on startup |
+| `HFS_S3_ES_REINDEX_ON_STARTUP` | `false` | Rebuild Elasticsearch index from S3 current objects at startup (`s3-elasticsearch` mode) |
+| `HFS_S3_ES_REINDEX_BATCH_SIZE` | `500` | Batch size for startup S3->ES reindex |
+| `HFS_S3_ES_REINDEX_CLEAR_EXISTING` | `false` | Clear tenant/type ES indices before reindex replay |
+| `HFS_S3_ES_REINDEX_RESOURCE_TYPES` | *(none)* | Optional comma-separated resource type filter for reindex |
 
 For detailed backend setup instructions (building from source, Docker commands, and search offloading architecture), see the [persistence crate documentation](crates/persistence/README.md#building--running-storage-backends).
 
@@ -432,4 +454,3 @@ The Helios FHIR Server is licensed under the [MIT License](LICENSE).
 ---
 
 HL7® and FHIR® are registered trademarks of Health Level Seven International.
-
diff --git a/crates/fhir/tests/data/xml/R6/Requirements-example1(example1).xml b/crates/fhir/tests/data/xml/R6/Requirements-example1(example1).xml
@@ -50,6 +50,10 @@
     <label value="requirement-2"/>
     <conformance value="SHALL"/>
     <requirement value="Operations based on the codeSystem resource SHALL have the same result whether or not the relationships are represented explicitly as properties or implicitly using the CodeSystem resource hierarchy"/>
+    <category>
+      <system value="http://example.org/requirement-categories"/>
+      <code value="processing"/>
+    </category>
     <source>
       <display value="Jose Costa Teixeira"/>
     </source>

diff --git a/crates/fhir/tests/data/xml/R6/account.profile.xml b/crates/fhir/tests/data/xml/R6/account.profile.xml
diff --git a/crates/fhir/tests/data/xml/R6/activitydefinition.profile.xml b/crates/fhir/tests/data/xml/R6/activitydefinition.profile.xml
diff --git a/crates/fhir/tests/data/xml/R6/actordefinition.profile.xml b/crates/fhir/tests/data/xml/R6/actordefinition.profile.xml
diff --git a/crates/fhir/tests/data/xml/R6/address.profile.xml b/crates/fhir/tests/data/xml/R6/address.profile.xml
@@ -48,7 +48,7 @@
             <a href="types.html#Element" title="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.">id</a>, 
             <a href="types.html#Element" title="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.">extension</a>
           </td>
-        </tr>
+        </tr>
 
         <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgEAADClAVWFQIBRHMicAAAAAElFTkSuQmCC)" class="hierarchy">
@@ -71,7 +71,7 @@
             <a href="terminologies.html#required" title="To be conformant, the concept in this element SHALL be from the specified value set.">Required</a>)
             <br/>
           </td>
-        </tr>
+        </tr>
 
         <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgEAADClAVWFQIBRHMicAAAAAElFTkSuQmCC)" class="hierarchy">
@@ -93,7 +93,7 @@
             <a href="terminologies.html#required" title="To be conformant, the concept in this element SHALL be from the specified value set.">Required</a>)
             <br/>
           </td>
-        </tr>
+        </tr>
 
         <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgEAADClAVWFQIBRHMicAAAAAElFTkSuQmCC)" class="hierarchy">
@@ -112,7 +112,7 @@
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Text representation of the address
             <br/>
           </td>
-        </tr>
+        </tr>
 
         <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgEAADClAVWFQIBRHMicAAAAAElFTkSuQmCC)" class="hierarchy">
@@ -132,7 +132,7 @@
             <br/>This repeating element order: The order in which lines should appear in an address label
             <br/>
           </td>
-        </tr>
+        </tr>
 
         <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgEAADClAVWFQIBRHMicAAAAAElFTkSuQmCC)" class="hierarchy">
@@ -151,7 +151,7 @@
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Name of city, town etc.
             <br/>
           </td>
-        </tr>
+        </tr>
 
         <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgEAADClAVWFQIBRHMicAAAAAElFTkSuQmCC)" class="hierarchy">
@@ -170,7 +170,7 @@
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">District name (aka county)
             <br/>
           </td>
-        </tr>
+        </tr>
 
         <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgEAADClAVWFQIBRHMicAAAAAElFTkSuQmCC)" class="hierarchy">
@@ -189,7 +189,7 @@
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Sub-unit of country (abbreviations ok)
             <br/>
           </td>
-        </tr>
+        </tr>
 
         <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgEAADClAVWFQIBRHMicAAAAAElFTkSuQmCC)" class="hierarchy">
@@ -208,7 +208,7 @@
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Postal code for area
             <br/>
           </td>
-        </tr>
+        </tr>
 
         <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7">
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAALUlEQVR4Xu3IoREAIAwEwfT6/ddA0GBAxO3NrLlKUj9263wAAAAvrgEAADClAVWFQIBRHMicAAAAAElFTkSuQmCC)" class="hierarchy">
@@ -227,7 +227,7 @@
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Country (e.g. may be ISO 3166 2 or 3 letter code)
             <br/>
           </td>
-        </tr>
+        </tr>
 
         <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white">
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAyAAAAACCAYAAACg/LjIAAAAJUlEQVR4Xu3IIQEAAAgDsHd9/w4EQIOamFnaBgAA4MMKAACAKwNp30CqZFfFmwAAAABJRU5ErkJggg==)" class="hierarchy">
@@ -246,7 +246,7 @@
           <td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Time period when address was/is in use
             <br/>
           </td>
-        </tr>
+        </tr>
 
         <tr>
           <td colspan="5" class="hierarchy">
@@ -270,7 +270,7 @@
   <name value="Address"/>
   <status value="active"/>
   <experimental value="false"/>
-  <date value="2025-11-27T16:48:47+00:00"/>
+  <date value="2025-12-17T09:50:17+00:00"/>
   <publisher value="HL7 International / FHIR Infrastructure"/>
   <contact>
     <telecom>