diff --git a/src/lib/handlebars-converter/handlebars-helpers.js b/src/lib/handlebars-converter/handlebars-helpers.js
index fc9cd939c..a3d804d56 100644
--- a/src/lib/handlebars-converter/handlebars-helpers.js
+++ b/src/lib/handlebars-converter/handlebars-helpers.js
@@ -643,6 +643,25 @@ module.exports.external = [
             }
         }
     },
+    {
+        name: 'isRaceUnknown',
+        description: 'determines if the race is unknown',
+        func: function isRaceUnknown(patient) {
+            const raceCodeNullFlavor = !!patient.raceCode?.nullFlavor;
+            const sdtcRaceCodeNullFlavor = !!patient["sdtc:raceCode"]?.nullFlavor;
+            return raceCodeNullFlavor || sdtcRaceCodeNullFlavor;
+        }
+    },
+    {
+        name: 'isEthnicityUnknown',
+        description: 'Determines if the Ethnicity is Unknown (has a null flavor)',
+        func: function isEthnicityUnknown(patient) {
+            const ethnicGroupCodeNulllavor = !!patient.ethnicGroupCode?.nullFlavor;
+            const raceCodeNullFlavor = !!patient.raceCode?.nullFlavor;
+            const sdtcRaceCodeNullFlavor = !!patient["sdtc:raceCode"]?.nullFlavor;
+            return ethnicGroupCodeNulllavor || raceCodeNullFlavor || sdtcRaceCodeNullFlavor;
+        }
+    },
     {
         name: 'getBirthSexInfo',
         description: "Returns first instance of birthSex id e.g. getBirthSexInfo msg '2.16.840.1.113883.10.20.22.2.14'",
diff --git a/src/templates/cda/Extensions/Birthsex.hbs b/src/templates/cda/Extensions/Birthsex.hbs
index 3c20d860f..90d02a784 100644
--- a/src/templates/cda/Extensions/Birthsex.hbs
+++ b/src/templates/cda/Extensions/Birthsex.hbs
@@ -1,5 +1,5 @@
 
   {
     "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
-    "valueCode": "{{getBirthSexInfo msg '2.16.840.1.113883.10.20.22.4.200'}}"
-  }
\ No newline at end of file
+    "valueCode": "{{birthsex}}"
+  }
diff --git a/src/templates/cda/Extensions/Ethnicity.hbs b/src/templates/cda/Extensions/Ethnicity.hbs
index 904dc6c91..5b2f8bd03 100644
--- a/src/templates/cda/Extensions/Ethnicity.hbs
+++ b/src/templates/cda/Extensions/Ethnicity.hbs
@@ -16,12 +16,11 @@
                           {{/if}}
                       },
                   {{else}}
-                      {{#if (or (eq this.code '2135-2') 
-                            (eq this.code '2186-5'))}}
+                      {{#if (or (eq this.code '2135-2') (eq this.code '2186-5'))}}
                           "url" : "ombCategory",
                       {{else}}
                           "url" : "detailed",
-                      {{/if}}                   
+                      {{/if}}
                       "valueCoding" :  {{>DataType/Coding.hbs code=this}},
                   {{/if}}
               },
@@ -40,6 +39,6 @@
                   "valueString":"{{patient.ethnicGroupCode.displayName}}",
               {{/if}}
           }
-      ],                        
+      ],
   {{/if}}
 }
diff --git a/src/templates/cda/Resources/Patient.hbs b/src/templates/cda/Resources/Patient.hbs
index 03f7d3df7..45ac19514 100644
--- a/src/templates/cda/Resources/Patient.hbs
+++ b/src/templates/cda/Resources/Patient.hbs
@@ -24,9 +24,17 @@
         "birthDate":"{{addHyphensDate patientRole.patient.birthTime.value}}",
         "gender":"{{toLower patientRole.patient.administrativeGenderCode.displayName}}",
         "extension" : [
-            {{>Extensions/Race.hbs patient=patientRole.patient}},
-            {{>Extensions/Ethnicity.hbs patient=patientRole.patient}},
-            {{>Extensions/Birthsex.hbs patient=patientRole.patient msg=msg}},
+            {{#unless (isRaceUnknown patientRole.patient)}}
+                {{>Extensions/Race.hbs patient=patientRole.patient}},
+            {{/unless}}
+            {{#unless (isEthnicityUnknown patientRole.patient)}}
+                {{>Extensions/Ethnicity.hbs patient=patientRole.patient}},
+            {{/unless}}
+            {{#with (getBirthSexInfo msg '2.16.840.1.113883.10.20.22.4.200') as |birthsex|}}
+                {{#if birthsex}}
+                    {{>Extensions/Birthsex.hbs patient=patientRole.patient birthsex=birthsex}},
+                {{/if}}
+            {{/with}}
         ],
         "address":
         [