diff --git a/packages/smart-forms-renderer/src/test/data/removeIdSample.ts b/packages/smart-forms-renderer/src/test/data/removeIdSample.ts
index 76114805c..a46c8785f 100644
--- a/packages/smart-forms-renderer/src/test/data/removeIdSample.ts
+++ b/packages/smart-forms-renderer/src/test/data/removeIdSample.ts
@@ -81,10 +81,12 @@ export const qrRemoveIdResult: QuestionnaireResponse = {
       item: [
         {
           linkId: 'myPatient1.name',
+          definition: 'http://hl7.org/fhir/StructureDefinition/Patient#Patient.name',
           text: 'name *',
           item: [
             {
               linkId: 'myPatient1.name.first',
+              definition: 'http://hl7.org/fhir/StructureDefinition/Patient#Patient.name.given',
               text: 'firstName *',
               answer: [
                 {
@@ -96,10 +98,12 @@ export const qrRemoveIdResult: QuestionnaireResponse = {
         },
         {
           linkId: 'myPatient1.name',
+          definition: 'http://hl7.org/fhir/StructureDefinition/Patient#Patient.name',
           text: 'name *',
           item: [
             {
               linkId: 'myPatient1.name.first',
+              definition: 'http://hl7.org/fhir/StructureDefinition/Patient#Patient.name.given',
               text: 'firstName *',
               answer: [
                 {
diff --git a/packages/smart-forms-renderer/src/test/removeEmptyAnswers.test.ts b/packages/smart-forms-renderer/src/test/removeEmptyAnswers.test.ts
index bbfb2c6f4..ec7f26c06 100644
--- a/packages/smart-forms-renderer/src/test/removeEmptyAnswers.test.ts
+++ b/packages/smart-forms-renderer/src/test/removeEmptyAnswers.test.ts
@@ -117,6 +117,52 @@ describe('removeEmptyAnswersFromItemRecursive', () => {
     expect(result).toEqual(qrItem);
   });
 
+  it('should preserve definition from qItem when present', () => {
+    const qItem: QuestionnaireItem = {
+      linkId: 'test-item',
+      type: 'boolean',
+      text: 'Has triple negative breast cancer',
+      definition: 'http://example.org/fhir/StructureDefinition/IsTNBCFeature#Observation.value[x]'
+    };
+
+    const qrItem: QuestionnaireResponseItem = {
+      linkId: 'test-item',
+      definition: 'http://example.org/fhir/StructureDefinition/IsTNBCFeature#Observation.value[x]',
+      text: 'Has triple negative breast cancer',
+      answer: [{ valueBoolean: true }]
+    };
+
+    mockQrItemHasItemsOrAnswer.mockReturnValue(true);
+    mockIsHiddenByEnableWhen.mockReturnValue(false);
+
+    const result = removeEmptyAnswersFromItemRecursive(qItem, qrItem, enableWhenContext);
+
+    expect((result as QuestionnaireResponseItem).definition).toBe(
+      'http://example.org/fhir/StructureDefinition/IsTNBCFeature#Observation.value[x]'
+    );
+  });
+
+  it('should not include definition property when qItem has none', () => {
+    const qItem: QuestionnaireItem = {
+      linkId: 'test-item',
+      type: 'string',
+      text: 'No definition here'
+    };
+
+    const qrItem: QuestionnaireResponseItem = {
+      linkId: 'test-item',
+      text: 'No definition here',
+      answer: [{ valueString: 'answer' }]
+    };
+
+    mockQrItemHasItemsOrAnswer.mockReturnValue(true);
+    mockIsHiddenByEnableWhen.mockReturnValue(false);
+
+    const result = removeEmptyAnswersFromItemRecursive(qItem, qrItem, enableWhenContext);
+
+    expect(result).not.toHaveProperty('definition');
+  });
+
   it('should return null when item is hidden by enableWhen', () => {
     const qItem: QuestionnaireItem = {
       linkId: 'test-item',
diff --git a/packages/smart-forms-renderer/src/test/removeRepeatId.test.ts b/packages/smart-forms-renderer/src/test/removeRepeatId.test.ts
index e3aadc31c..e36696fe8 100644
--- a/packages/smart-forms-renderer/src/test/removeRepeatId.test.ts
+++ b/packages/smart-forms-renderer/src/test/removeRepeatId.test.ts
@@ -78,6 +78,86 @@ describe('removeRepeatId', () => {
       expect(result.text).toBe('Test item text');
     });
 
+    it('should preserve definition from qItem when present', () => {
+      const qItem: QuestionnaireItem = {
+        linkId: 'test-item',
+        type: 'boolean',
+        text: 'Has triple negative breast cancer',
+        definition: 'http://example.org/fhir/StructureDefinition/IsTNBCFeature#Observation.value[x]'
+      };
+
+      const qrItem: QuestionnaireResponseItem = {
+        linkId: 'test-item',
+        definition:
+          'http://example.org/fhir/StructureDefinition/IsTNBCFeature#Observation.value[x]',
+        text: 'Has triple negative breast cancer',
+        answer: [{ valueBoolean: true }]
+      };
+
+      const result = removeInternalRepeatIdsRecursive(qItem, qrItem) as QuestionnaireResponseItem;
+
+      expect(result.definition).toBe(
+        'http://example.org/fhir/StructureDefinition/IsTNBCFeature#Observation.value[x]'
+      );
+    });
+
+    it('should preserve definition on nested group and child items', () => {
+      const qItem: QuestionnaireItem = {
+        linkId: '1',
+        type: 'group',
+        text: 'IsTNBCFeature',
+        definition: 'http://example.org/fhir/StructureDefinition/IsTNBCFeature',
+        item: [
+          {
+            linkId: '1.1',
+            type: 'boolean',
+            text: 'Has triple negative breast cancer',
+            definition:
+              'http://example.org/fhir/StructureDefinition/IsTNBCFeature#Observation.value[x]'
+          }
+        ]
+      };
+
+      const qrItem: QuestionnaireResponseItem = {
+        linkId: '1',
+        definition: 'http://example.org/fhir/StructureDefinition/IsTNBCFeature',
+        text: 'IsTNBCFeature',
+        item: [
+          {
+            linkId: '1.1',
+            definition:
+              'http://example.org/fhir/StructureDefinition/IsTNBCFeature#Observation.value[x]',
+            text: 'Has triple negative breast cancer',
+            answer: [{ valueBoolean: true }]
+          }
+        ]
+      };
+
+      const result = removeInternalRepeatIdsRecursive(qItem, qrItem) as QuestionnaireResponseItem;
+
+      expect(result.definition).toBe('http://example.org/fhir/StructureDefinition/IsTNBCFeature');
+      expect(result.item![0].definition).toBe(
+        'http://example.org/fhir/StructureDefinition/IsTNBCFeature#Observation.value[x]'
+      );
+    });
+
+    it('should not include definition property when qItem has none', () => {
+      const qItem: QuestionnaireItem = {
+        linkId: 'test-item',
+        type: 'string',
+        text: 'No definition here'
+      };
+
+      const qrItem: QuestionnaireResponseItem = {
+        linkId: 'test-item',
+        answer: [{ valueString: 'answer' }]
+      };
+
+      const result = removeInternalRepeatIdsRecursive(qItem, qrItem) as QuestionnaireResponseItem;
+
+      expect(result).not.toHaveProperty('definition');
+    });
+
     it('should handle empty answers correctly', () => {
       const qItem: QuestionnaireItem = {
         linkId: 'test-item',
diff --git a/packages/smart-forms-renderer/src/utils/removeEmptyAnswers.ts b/packages/smart-forms-renderer/src/utils/removeEmptyAnswers.ts
index 882a7f155..286dcd762 100644
--- a/packages/smart-forms-renderer/src/utils/removeEmptyAnswers.ts
+++ b/packages/smart-forms-renderer/src/utils/removeEmptyAnswers.ts
@@ -145,6 +145,7 @@ function removeEmptyAnswersFromItem(
 
   return {
     linkId: qItem.linkId,
+    ...(qItem.definition && { definition: qItem.definition }),
     ...(qItem.text && { text: qItem.text }),
     ...(childQrItems.length > 0 && { item: childQrItems }),
     ...(updatedAnswers.length > 0 && { answer: updatedAnswers })
diff --git a/packages/smart-forms-renderer/src/utils/removeRepeatId.ts b/packages/smart-forms-renderer/src/utils/removeRepeatId.ts
index 9da89d6e1..7e1a7c27e 100644
--- a/packages/smart-forms-renderer/src/utils/removeRepeatId.ts
+++ b/packages/smart-forms-renderer/src/utils/removeRepeatId.ts
@@ -106,6 +106,7 @@ function removeInternalRepeatIdsFromItem(
 
   return {
     linkId: qItem.linkId,
+    ...(qItem.definition && { definition: qItem.definition }),
     ...(qItem.text && { text: qItem.text }),
     ...(childQrItems.length > 0 && { item: childQrItems }),
     ...(updatedAnswers.length > 0 && { answer: updatedAnswers })