diff --git a/interface/modules/zend_modules/module/Carecoordination/src/Carecoordination/Model/CarecoordinationTable.php b/interface/modules/zend_modules/module/Carecoordination/src/Carecoordination/Model/CarecoordinationTable.php
index 7e364c261f4..58af6cea796 100644
--- a/interface/modules/zend_modules/module/Carecoordination/src/Carecoordination/Model/CarecoordinationTable.php
+++ b/interface/modules/zend_modules/module/Carecoordination/src/Carecoordination/Model/CarecoordinationTable.php
@@ -22,14 +22,18 @@
 use Laminas\Config\Reader\ReaderInterface;
 use Laminas\Config\Reader\Xml;
 use Laminas\Db\TableGateway\AbstractTableGateway;
+use OpenEMR\Common\Command\Trait\CommandLineDebugStylerTrait;
 use OpenEMR\Services\Cda\CdaTemplateImportDispose;
 use OpenEMR\Services\Cda\CdaTemplateParse;
 use OpenEMR\Services\Cda\CdaValidateDocuments;
 use OpenEMR\Services\Cda\XmlExtended;
 use OpenEMR\Services\CodeTypesService;
+use Symfony\Component\Console\Style\SymfonyStyle;
 
 class CarecoordinationTable extends AbstractTableGateway
 {
+    use CommandLineDebugStylerTrait;
+
     public const NPI_SAMPLE = "987654321";
     public const ORGANIZATION_SAMPLE = "External Physicians Practice";
     public const ORGANIZATION2_SAMPLE = "External Health and Hospitals";
@@ -51,6 +55,11 @@ public function __construct()
         $this->validationIsDisabled = $GLOBALS['ccda_validation_disable'] ?? false;
     }
 
+    public function getImportService(): CdaTemplateImportDispose
+    {
+        return $this->importService;
+    }
+
     /*
      * Fetch the category ID using category name
      *
diff --git a/src/Common/Command/CcdaImport.php b/src/Common/Command/CcdaImport.php
index 8ed1bdff56b..2ebacc66261 100644
--- a/src/Common/Command/CcdaImport.php
+++ b/src/Common/Command/CcdaImport.php
@@ -18,6 +18,7 @@
 use Symfony\Component\Console\Input\InputInterface;
 use Symfony\Component\Console\Input\InputOption;
 use Symfony\Component\Console\Output\OutputInterface;
+use Symfony\Component\Console\Style\SymfonyStyle;
 
 class CcdaImport extends Command
 {
@@ -30,6 +31,7 @@ protected function configure(): void
             ->setDefinition(
                 new InputDefinition([
                     new InputOption('document_id', null, InputOption::VALUE_REQUIRED, 'Document id that will be imported into the ccda table'),
+                    new InputOption('debug', null, InputOption::VALUE_NONE, 'Turns on debug mode.'),
                     new InputOption('site', null, InputOption::VALUE_REQUIRED, 'Name of site', 'default'),
                 ])
             )
@@ -44,6 +46,16 @@ protected function execute(InputInterface $input, OutputInterface $output): int
         }
 
         $GLOBALS['modules_application']->getServiceManager()->build(CarecoordinationTable::class)->import($input->getOption('document_id'));
+        $symfonyStyler = new SymfonyStyle($input, $output);
+
+        $careCoordinationTable = $GLOBALS['modules_application']->getServiceManager()->build(CarecoordinationTable::class);
+        if ($careCoordinationTable instanceof CarecoordinationTable) {
+            if ($input->getOption('debug') !== false) {
+                $careCoordinationTable->setCommandLineStyler($symfonyStyler);
+                $careCoordinationTable->getImportService()->setCommandLineStyler($symfonyStyler);
+            }
+            $careCoordinationTable->import($input->getOption('document_id'));
+        }
         return 0;
     }
 }
diff --git a/src/Common/Command/CcdaNewpatient.php b/src/Common/Command/CcdaNewpatient.php
index 75bf8c9885b..7acc99527b7 100644
--- a/src/Common/Command/CcdaNewpatient.php
+++ b/src/Common/Command/CcdaNewpatient.php
@@ -18,6 +18,7 @@
 use Symfony\Component\Console\Input\InputInterface;
 use Symfony\Component\Console\Input\InputOption;
 use Symfony\Component\Console\Output\OutputInterface;
+use Symfony\Component\Console\Style\SymfonyStyle;
 
 class CcdaNewpatient extends Command
 {
@@ -31,6 +32,7 @@ protected function configure(): void
                 new InputDefinition([
                     new InputOption('am_id', null, InputOption::VALUE_REQUIRED, 'The master audit table id of patient that will be imported as a new patient'),
                     new InputOption('document_id', null, InputOption::VALUE_REQUIRED, 'The ccda document id that was imported into the audit table'),
+                    new InputOption('debug', null, InputOption::VALUE_NONE, 'Turns on debug mode.'),
                     new InputOption('site', null, InputOption::VALUE_REQUIRED, 'Name of site', 'default'),
                 ])
             )
@@ -49,6 +51,16 @@ protected function execute(InputInterface $input, OutputInterface $output): int
         }
 
         $GLOBALS['modules_application']->getServiceManager()->build(CarecoordinationTable::class)->insert_patient($input->getOption('am_id'), $input->getOption('document_id'));
+        $symfonyStyler = new SymfonyStyle($input, $output);
+
+        $careCoordinationTable = $GLOBALS['modules_application']->getServiceManager()->build(CarecoordinationTable::class);
+        if ($careCoordinationTable instanceof CarecoordinationTable) {
+            if ($input->getOption('debug') !== false) {
+                $careCoordinationTable->setCommandLineStyler($symfonyStyler);
+                $careCoordinationTable->getImportService()->setCommandLineStyler($symfonyStyler);
+            }
+            $careCoordinationTable->insert_patient($input->getOption('am_id'), $input->getOption('document_id'));
+        }
         return 0;
     }
 }
diff --git a/src/Common/Command/CcdaNewpatientImport.php b/src/Common/Command/CcdaNewpatientImport.php
index 2c270fd8691..5e741ed19e3 100644
--- a/src/Common/Command/CcdaNewpatientImport.php
+++ b/src/Common/Command/CcdaNewpatientImport.php
@@ -18,6 +18,7 @@
 use Symfony\Component\Console\Input\InputInterface;
 use Symfony\Component\Console\Input\InputOption;
 use Symfony\Component\Console\Output\OutputInterface;
+use Symfony\Component\Console\Style\SymfonyStyle;
 
 class CcdaNewpatientImport extends Command
 {
@@ -30,6 +31,7 @@ protected function configure(): void
             ->setDefinition(
                 new InputDefinition([
                     new InputOption('document', null, InputOption::VALUE_REQUIRED, 'File (path) that will be imported to create the new patient'),
+                    new InputOption('debug', null, InputOption::VALUE_NONE, 'Turns on debug mode.'),
                     new InputOption('site', null, InputOption::VALUE_REQUIRED, 'Name of site', 'default'),
                 ])
             )
@@ -50,7 +52,18 @@ protected function execute(InputInterface $input, OutputInterface $output): int
         // get around a large ccda data array
         ini_set("memory_limit", -1);
 
-        $GLOBALS['modules_application']->getServiceManager()->build(CarecoordinationTable::class)->importNewPatient($input->getOption('document'));
+
+
+        $symfonyStyler = new SymfonyStyle($input, $output);
+
+        $careCoordinationTable = $GLOBALS['modules_application']->getServiceManager()->build(CarecoordinationTable::class);
+        if ($careCoordinationTable instanceof CarecoordinationTable) {
+            if ($input->getOption('debug') !== false) {
+                $careCoordinationTable->setCommandLineStyler($symfonyStyler);
+                $careCoordinationTable->getImportService()->setCommandLineStyler($symfonyStyler);
+            }
+            $careCoordinationTable->importNewPatient($input->getOption('document'));
+        }
         return 0;
     }
 }
diff --git a/src/Common/Command/Trait/CommandLineDebugStylerTrait.php b/src/Common/Command/Trait/CommandLineDebugStylerTrait.php
new file mode 100644
index 00000000000..064bdeeea5c
--- /dev/null
+++ b/src/Common/Command/Trait/CommandLineDebugStylerTrait.php
@@ -0,0 +1,44 @@
+<?php
+
+/**
+ * Facilitates adding a debug flag and a cli input/output styler useful for debugging commands.
+ *
+ * @package   OpenEMR
+ * @link      https://www.open-emr.org
+ * @author   Stephen Nielson <snielson@discoverandchange.com>
+ * @copyright Copyright (c) 2024 Discover and Change, Inc. <snielson@discoverandchange.com>
+ * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
+ */
+
+namespace OpenEMR\Common\Command\Trait;
+
+use Symfony\Component\Console\Style\SymfonyStyle;
+
+trait CommandLineDebugStylerTrait
+{
+    /**
+     * @var SymfonyStyle CLI styler used for debug mode to help in identifying issues during the import process.
+     */
+    protected SymfonyStyle $styler;
+
+    /**
+     * @var bool Whether to add additional logging / debug output to the system
+     */
+    protected bool $cliDebug = false;
+
+    public function setCommandLineStyler(SymfonyStyle $symfonyStyler)
+    {
+        $this->cliDebug = true;
+        $this->styler = $symfonyStyler;
+    }
+
+    public function isCliDebug()
+    {
+        return $this->cliDebug;
+    }
+
+    public function getCommandLineStyler(): SymfonyStyle
+    {
+        return $this->styler;
+    }
+}
diff --git a/src/Services/Cda/CdaTemplateImportDispose.php b/src/Services/Cda/CdaTemplateImportDispose.php
index d263bd3357b..67d9b9cda21 100644
--- a/src/Services/Cda/CdaTemplateImportDispose.php
+++ b/src/Services/Cda/CdaTemplateImportDispose.php
@@ -17,6 +17,7 @@
 use Application\Model\ApplicationTable;
 use Carecoordination\Model\CarecoordinationTable;
 use Document;
+use OpenEMR\Common\Command\Trait\CommandLineDebugStylerTrait;
 use OpenEMR\Common\Database\QueryUtils;
 use OpenEMR\Common\Logging\SystemLogger;
 use OpenEMR\Services\CodeTypesService;
@@ -28,6 +29,8 @@
 
 class CdaTemplateImportDispose
 {
+    use CommandLineDebugStylerTrait;
+
     protected $codeService;
     protected $userauthorized;
 
@@ -822,31 +825,35 @@ public function InsertImmunization($imm_array, $pid, CarecoordinationTable $care
                 $appTable->zQuery($qc_insert, array($value['cvx_code_text'], $value['cvx_code'], $ct_id));
             }
 
-            $q1_unit = "SELECT * FROM list_options WHERE list_id='drug_units' AND title=?";
-            $res_q1_unit = $appTable->zQuery($q1_unit, array($value['amount_administered_unit']));
-            foreach ($res_q1_unit as $val) {
-                $oid_unit = $val['option_id'];
-            }
-            if ($res_q1_unit->count() == 0) {
-                $lres = $appTable->zQuery("SELECT IFNULL(MAX(CONVERT(SUBSTRING_INDEX(option_id,'-',-1),UNSIGNED INTEGER))+1,1) AS option_id FROM list_options WHERE list_id = ?", array('drug_units'));
-                foreach ($lres as $lrow) {
-                    $oid_unit = $lrow['option_id'];
+            if (!empty(trim($value['amount_administered_unit'] ?? ''))) {
+                $q1_unit = "SELECT * FROM list_options WHERE list_id='drug_units' AND title=?";
+                $res_q1_unit = $appTable->zQuery($q1_unit, array($value['amount_administered_unit']));
+                foreach ($res_q1_unit as $val) {
+                    $oid_unit = $val['option_id'];
                 }
-                $q_insert_route = "INSERT INTO list_options
-                           (
-                            list_id,
-                            option_id,
-                            title,
-                            activity
-                           )
-                           VALUES
-                           (
-                            'drug_units',
-                            ?,
-                            ?,
-                            1
-                           )";
-                $appTable->zQuery($q_insert_route, array($oid_unit, $value['amount_administered_unit']));
+                if ($res_q1_unit->count() == 0) {
+                    $lres = $appTable->zQuery("SELECT IFNULL(MAX(CONVERT(SUBSTRING_INDEX(option_id,'-',-1),UNSIGNED INTEGER))+1,1) AS option_id FROM list_options WHERE list_id = ?", array('drug_units'));
+                    foreach ($lres as $lrow) {
+                        $oid_unit = $lrow['option_id'];
+                    }
+                    $q_insert_route = "INSERT INTO list_options
+                               (
+                                list_id,
+                                option_id,
+                                title,
+                                activity
+                               )
+                               VALUES
+                               (
+                                'drug_units',
+                                ?,
+                                ?,
+                                1
+                               )";
+                    $appTable->zQuery($q_insert_route, array($oid_unit, $value['amount_administered_unit']));
+                }
+            } else {
+                $oid_unit = null; // don't insert anything if the unit administered is an empty value
             }
 
             $value['completion_status'] = $value['reason_status'] ?: $value['completion_status'];
@@ -910,6 +917,35 @@ public function InsertImmunization($imm_array, $pid, CarecoordinationTable $care
                         WHERE external_id=? AND patient_id=?";
                 $res_q_sel_imm = $appTable->zQuery($q_sel_imm, array($value['extension'], $pid));
             }
+            if ($this->isCliDebug()) {
+                $yesContinue = xl('Yes continue');
+                do {
+                    $printDebug = xl('Print debug information');
+                    $choice = $this->getCommandLineStyler()->choice(
+                        "Proceed with creating immunization for cvx code " . $value['cvx_code'] . "?",
+                        [$yesContinue, $printDebug],
+                        $yesContinue
+                    );
+                    if ($choice == $printDebug) {
+                        $this->getCommandLineStyler()->info("Displaying CDA Value");
+                        var_dump($value);
+                        $this->getCommandLineStyler()->info("Displaying immunization values");
+                        var_dump([
+                            'pid' => $pid
+                            , 'immunization_date_value' => $immunization_date_value
+                            , 'cvx_code' => $value['cvx_code']
+                            , 'route' => $value['route_code_text']
+                            , 'administered_by_id' => $provider_id
+                            , 'amount_administered' => $value['amount_administered']
+                            , 'amount_administered_unit' => $oid_unit
+                            , 'manufacturer' => $value['manufacturer']
+                            , 'completion_status' => $value['completion_status']
+                            , 'external_id' => $value['extension']
+                            , 'refusal_reason' => $option['option_id'] ?? ''
+                        ]);
+                    }
+                } while ($choice !== $yesContinue);
+            }
             if (empty($value['extension']) || $res_q_sel_imm->count() == 0) {
                 $query = "INSERT INTO immunizations
                   ( patient_id,
@@ -1029,69 +1065,80 @@ public function InsertPrescriptions($pres_array, $pid, CarecoordinationTable $ca
                 $provider_id = $this->insertImportedUser($value, true);
             }
 
-            //unit
-            if ($revapprove == 1) {
-                $value['rate_unit'] = $carecoordinationTable->getListTitle($value['rate_unit'], 'drug_units', '');
-            }
-
-            $unit_option_id = $carecoordinationTable->getOptionId('drug_units', $value['rate_unit'], '');
-            if ($unit_option_id == '' || $unit_option_id == null) {
-                $q_max_option_id = "SELECT MAX(CAST(option_id AS SIGNED))+1 AS option_id
-                              FROM list_options
-                              WHERE list_id=?";
-                $res_max_option_id = $appTable->zQuery($q_max_option_id, array('drug_units'));
-                $res_max_option_id_cur = $res_max_option_id->current();
-                $unit_option_id = $res_max_option_id_cur['option_id'];
-                $q_insert_units_option = "INSERT INTO list_options
-                           (
-                            list_id,
-                            option_id,
-                            title,
-                            activity
-                           )
-                           VALUES
-                           (
-                            'drug_units',
-                            ?,
-                            ?,
-                            1
-                           )";
-                $appTable->zQuery($q_insert_units_option, array($unit_option_id, $value['rate_unit']));
-            }
+            //unit, only process if we have a value
+            if (!empty(trim($value['rate_unit'] ?? ''))) {
+                if ($revapprove == 1) {
+                    $value['rate_unit'] = $carecoordinationTable->getListTitle($value['rate_unit'], 'drug_units', '');
+                }
 
-            //route
-            $q1_route = "SELECT *
-                       FROM list_options
-                       WHERE list_id='drug_route' AND notes=?";
-            $res_q1_route = $appTable->zQuery($q1_route, array($value['route']));
-            foreach ($res_q1_route as $val) {
-                $oid_route = $val['option_id'];
+                $this->getCommandLineStyler()->info("rate unit is " . $value['rate_unit']);
+                $this->getCommandLineStyler()->confirm("Proceed?");
+
+                $unit_option_id = $carecoordinationTable->getOptionId('drug_units', $value['rate_unit'], '');
+                if ($unit_option_id == '' || $unit_option_id == null) {
+                    $q_max_option_id = "SELECT MAX(CAST(option_id AS SIGNED))+1 AS option_id
+                                  FROM list_options
+                                  WHERE list_id=?";
+                    $res_max_option_id = $appTable->zQuery($q_max_option_id, array('drug_units'));
+                    $res_max_option_id_cur = $res_max_option_id->current();
+                    $unit_option_id = $res_max_option_id_cur['option_id'];
+                    $q_insert_units_option = "INSERT INTO list_options
+                               (
+                                list_id,
+                                option_id,
+                                title,
+                                activity
+                               )
+                               VALUES
+                               (
+                                'drug_units',
+                                ?,
+                                ?,
+                                1
+                               )";
+                    $appTable->zQuery($q_insert_units_option, array($unit_option_id, $value['rate_unit']));
+                }
+            } else {
+                $unit_option_id = null; // leave it empty as we have no data to import here.
             }
 
-            if ($res_q1_route->count() == 0) {
-                $lres = $appTable->zQuery("SELECT IFNULL(MAX(CONVERT(SUBSTRING_INDEX(option_id,'-',-1),UNSIGNED INTEGER))+1,1) AS option_id FROM list_options WHERE list_id = ?", array('drug_route'));
-                foreach ($lres as $lrow) {
-                    $oid_route = $lrow['option_id'];
+            //route, only process if we have a value
+            if (trim($value['route'] ?? '') != '') {
+                $q1_route = "SELECT *
+                           FROM list_options
+                           WHERE list_id='drug_route' AND notes=?";
+                $res_q1_route = $appTable->zQuery($q1_route, array($value['route']));
+                foreach ($res_q1_route as $val) {
+                    $oid_route = $val['option_id'];
                 }
 
-                $q_insert_route = "INSERT INTO list_options
-                           (
-                            list_id,
-                            option_id,
-                            notes,
-                            title,
-                            activity
-                           )
-                           VALUES
-                           (
-                            'drug_route',
-                            ?,
-                            ?,
-                            ?,
-                            1
-                           )";
-                $appTable->zQuery($q_insert_route, array($oid_route, $value['route'],
-                    $value['route_display']));
+                if ($res_q1_route->count() == 0) {
+                    $lres = $appTable->zQuery("SELECT IFNULL(MAX(CONVERT(SUBSTRING_INDEX(option_id,'-',-1),UNSIGNED INTEGER))+1,1) AS option_id FROM list_options WHERE list_id = ?", array('drug_route'));
+                    foreach ($lres as $lrow) {
+                        $oid_route = $lrow['option_id'];
+                    }
+
+                    $q_insert_route = "INSERT INTO list_options
+                               (
+                                list_id,
+                                option_id,
+                                notes,
+                                title,
+                                activity
+                               )
+                               VALUES
+                               (
+                                'drug_route',
+                                ?,
+                                ?,
+                                ?,
+                                1
+                               )";
+                    $appTable->zQuery($q_insert_route, array($oid_route, $value['route'],
+                        $value['route_display']));
+                }
+            } else {
+                $oid_route = null;
             }
 
             //drug form
@@ -1128,7 +1175,41 @@ public function InsertPrescriptions($pres_array, $pid, CarecoordinationTable $ca
                 $res_q_sel_pres_r = $appTable->zQuery($q_sel_pres_r, array($pid, $value['drug_text']));
                 $res_q_sel_pres_r_cnt = $res_q_sel_pres_r->count();
             }
-
+            if ($this->isCliDebug()) {
+                $yesContinue = xl('Yes continue');
+                do {
+                    $printDebug = xl('Print debug information');
+                    $choice = $this->getCommandLineStyler()->choice(
+                        "Proceed with creating prescription for drug " . $value['drug_text'] . "?",
+                        [$yesContinue, $printDebug],
+                        $yesContinue
+                    );
+                    if ($choice == $printDebug) {
+                        $this->getCommandLineStyler()->info("Displaying CDA Value");
+                        var_dump($value);
+                        $this->getCommandLineStyler()->info("Displaying prescription values");
+                        var_dump([
+                            'pid' => $pid
+                            , 'date_added' => $value['begdate']
+                            , 'date_ended' => $value['enddate']
+                            , 'active' => $active
+                            , 'drug' => $value['drug_text']
+                            , 'size' =>    $value['rate']
+                            , 'form' =>  $oidu_unit
+                            , 'dosage' => $value['dose']
+                            , 'route' => $oid_route
+                            , 'unit' => $unit_option_id
+                            , 'indication' => $value['indication']
+                            , 'prn' => $value['prn']
+                            , 'rxnorm_drugcode' => $value['drug_code']
+                            , 'provider_id' => $provider_id
+                            , 'external_id' => $value['extension']
+                            , 'medication' => 0
+                            , 'request_intent' => ($value['request_intent'] ?? null)
+                        ]);
+                    }
+                } while ($choice !== $yesContinue);
+            }
             if ((empty($value['extension']) && $res_q_sel_pres_r_cnt === 0) || ($res_q_sel_pres_cnt === 0)) {
                 $query = "INSERT INTO prescriptions
                   ( patient_id,