diff --git a/packages/sdc-populate/src/SDCPopulateQuestionnaireOperation/utils/removeEmptyAnswers.ts b/packages/sdc-populate/src/SDCPopulateQuestionnaireOperation/utils/removeEmptyAnswers.ts
index ac7900a1..5f67900c 100644
--- a/packages/sdc-populate/src/SDCPopulateQuestionnaireOperation/utils/removeEmptyAnswers.ts
+++ b/packages/sdc-populate/src/SDCPopulateQuestionnaireOperation/utils/removeEmptyAnswers.ts
@@ -37,25 +37,36 @@ export function removeEmptyAnswersFromResponse(
     return questionnaireResponse;
   }
 
+  const newQuestionnaireResponse: QuestionnaireResponse = { ...questionnaireResponse, item: [] };
   for (const [i, topLevelQRItem] of topLevelQRItems.entries()) {
     const qItem = topLevelQItems[i];
     if (!qItem) {
       continue;
     }
 
+    // If QR item don't have either item.item and item.answer, continue
+    if (!qrItemHasItemsOrAnswer(topLevelQRItem)) {
+      continue;
+    }
+
     const newTopLevelQRItem = removeEmptyAnswersFromItemRecursive(qItem, topLevelQRItem);
-    if (newTopLevelQRItem && questionnaireResponse.item) {
-      questionnaireResponse.item[i] = { ...newTopLevelQRItem };
+    if (newTopLevelQRItem && newQuestionnaireResponse.item) {
+      newQuestionnaireResponse.item.push(newTopLevelQRItem);
     }
   }
 
-  return questionnaireResponse;
+  return newQuestionnaireResponse;
 }
 
 function removeEmptyAnswersFromItemRecursive(
   qItem: QuestionnaireItem,
   qrItem: QuestionnaireResponseItem
 ): QuestionnaireResponseItem | null {
+  // If QR item don't have either item.item and item.answer, return null
+  if (!qrItemHasItemsOrAnswer(qrItem)) {
+    return null;
+  }
+
   const qItems = qItem.item;
   const qrItems = qrItem.item;
 
@@ -120,3 +131,12 @@ function answerIsEmpty(qrItem: QuestionnaireResponseItem) {
 
   return false;
 }
+
+/**
+ * Check if a QuestionnaireResponseItem has either an item or an answer property.
+ *
+ * @author Sean Fong
+ */
+function qrItemHasItemsOrAnswer(qrItem: QuestionnaireResponseItem): boolean {
+  return (!!qrItem.item && qrItem.item.length > 0) || (!!qrItem.answer && qrItem.answer.length > 0);
+}
diff --git a/packages/smart-forms-renderer/src/utils/calculatedExpression.ts b/packages/smart-forms-renderer/src/utils/calculatedExpression.ts
index ed7722f8..bc2a5ceb 100644
--- a/packages/smart-forms-renderer/src/utils/calculatedExpression.ts
+++ b/packages/smart-forms-renderer/src/utils/calculatedExpression.ts
@@ -34,6 +34,7 @@ import { getQrItemsIndex, mapQItemsIndex } from './mapItem';
 import { updateQrItemsInGroup } from './qrItem';
 import cloneDeep from 'lodash.clonedeep';
 import dayjs from 'dayjs';
+import { qrItemHasItemsOrAnswer } from './manageForm';
 
 interface EvaluateInitialCalculatedExpressionsParams {
   initialResponse: QuestionnaireResponse;
@@ -186,9 +187,16 @@ export function initialiseCalculatedExpressionValues(
   }
 
   // Populate calculated expression values into QR
+  const qItemsIndexMap = mapQItemsIndex(questionnaire);
+  const topLevelQRItemsByIndex = getQrItemsIndex(
+    questionnaire.item,
+    populatedResponse.item,
+    qItemsIndexMap
+  );
+
   const topLevelQrItems: QuestionnaireResponseItem[] = [];
   for (const [index, topLevelQItem] of questionnaire.item.entries()) {
-    const populatedTopLevelQrItem = populatedResponse.item[index] ?? {
+    const topLevelQRItemOrItems = topLevelQRItemsByIndex[index] ?? {
       linkId: topLevelQItem.linkId,
       text: topLevelQItem.text,
       item: []
@@ -196,7 +204,7 @@ export function initialiseCalculatedExpressionValues(
 
     const updatedTopLevelQRItem = initialiseItemCalculatedExpressionValueRecursive(
       topLevelQItem,
-      populatedTopLevelQrItem,
+      topLevelQRItemOrItems,
       calculatedExpressionsWithValues
     );
 
@@ -207,7 +215,7 @@ export function initialiseCalculatedExpressionValues(
       continue;
     }
 
-    if (updatedTopLevelQRItem) {
+    if (updatedTopLevelQRItem && qrItemHasItemsOrAnswer(updatedTopLevelQRItem)) {
       topLevelQrItems.push(updatedTopLevelQRItem);
     }
   }
@@ -217,48 +225,44 @@ export function initialiseCalculatedExpressionValues(
 
 function initialiseItemCalculatedExpressionValueRecursive(
   qItem: QuestionnaireItem,
-  qrItem: QuestionnaireResponseItem | undefined,
+  qrItemOrItems: QuestionnaireResponseItem | QuestionnaireResponseItem[] | null,
   calculatedExpressions: Record<string, CalculatedExpression[]>
-): QuestionnaireResponseItem[] | QuestionnaireResponseItem | null {
+): QuestionnaireResponseItem | QuestionnaireResponseItem[] | null {
+  // For repeat groups
+  const hasMultipleAnswers = Array.isArray(qrItemOrItems);
+  if (hasMultipleAnswers) {
+    return qrItemOrItems;
+  }
+
+  const qrItem = qrItemOrItems;
   const childQItems = qItem.item;
   if (childQItems && childQItems.length > 0) {
-    // iterate through items of item recursively
     const childQrItems = qrItem?.item ?? [];
-    // const updatedChildQrItems: QuestionnaireResponseItem[] = [];
-
-    // FIXME Not implemented for repeat groups
-    if (qItem.type === 'group' && qItem.repeats) {
-      return qrItem ?? null;
-    }
 
     const indexMap = mapQItemsIndex(qItem);
     const qrItemsByIndex = getQrItemsIndex(childQItems, childQrItems, indexMap);
 
     // Otherwise loop through qItem as usual
     for (const [index, childQItem] of childQItems.entries()) {
-      const childQrItem = qrItemsByIndex[index];
-
-      // FIXME Not implemented for repeat groups
-      if (Array.isArray(childQrItem)) {
-        continue;
-      }
+      const childQRItemOrItems = qrItemsByIndex[index];
 
-      const newQrItem = initialiseItemCalculatedExpressionValueRecursive(
+      const updatedChildQRItemOrItems = initialiseItemCalculatedExpressionValueRecursive(
         childQItem,
-        childQrItem,
+        childQRItemOrItems ?? null,
         calculatedExpressions
       );
 
       // FIXME Not implemented for repeat groups
-      if (Array.isArray(newQrItem)) {
+      if (Array.isArray(updatedChildQRItemOrItems)) {
         continue;
       }
 
-      if (newQrItem) {
+      const updatedChildQRItem = updatedChildQRItemOrItems;
+      if (updatedChildQRItem) {
         updateQrItemsInGroup(
-          newQrItem,
+          updatedChildQRItem,
           null,
-          qrItem ?? { linkId: qItem.linkId, text: qItem.text, item: [] },
+          updatedChildQRItem ?? { linkId: qItem.linkId, text: qItem.text, item: [] },
           indexMap
         );
       }
@@ -287,7 +291,7 @@ function getCalculatedExpressionAnswer(
 
 function constructGroupItem(
   qItem: QuestionnaireItem,
-  qrItem: QuestionnaireResponseItem | undefined,
+  qrItem: QuestionnaireResponseItem | null,
   calculatedExpressions: Record<string, CalculatedExpression[]>
 ): QuestionnaireResponseItem | null {
   const calculatedExpressionAnswer = getCalculatedExpressionAnswer(qItem, calculatedExpressions);
@@ -317,7 +321,7 @@ function constructGroupItem(
 
 function constructSingleItem(
   qItem: QuestionnaireItem,
-  qrItem: QuestionnaireResponseItem | undefined,
+  qrItem: QuestionnaireResponseItem | null,
   calculatedExpressions: Record<string, CalculatedExpression[]>
 ): QuestionnaireResponseItem | null {
   const calculatedExpressionAnswer = getCalculatedExpressionAnswer(qItem, calculatedExpressions);
diff --git a/packages/smart-forms-renderer/src/utils/manageForm.ts b/packages/smart-forms-renderer/src/utils/manageForm.ts
index 9fd0b927..f799e0e4 100644
--- a/packages/smart-forms-renderer/src/utils/manageForm.ts
+++ b/packages/smart-forms-renderer/src/utils/manageForm.ts
@@ -1,4 +1,4 @@
-import type { Questionnaire, QuestionnaireResponse } from 'fhir/r4';
+import type { Questionnaire, QuestionnaireResponse, QuestionnaireResponseItem } from 'fhir/r4';
 import {
   questionnaireResponseStore,
   questionnaireStore,
@@ -120,3 +120,12 @@ export function removeEmptyAnswersFromResponse(
     enableWhenExpressions
   });
 }
+
+/**
+ * Check if a QuestionnaireResponseItem has either an item or an answer property.
+ *
+ * @author Sean Fong
+ */
+export function qrItemHasItemsOrAnswer(qrItem: QuestionnaireResponseItem): boolean {
+  return (!!qrItem.item && qrItem.item.length > 0) || (!!qrItem.answer && qrItem.answer.length > 0);
+}
diff --git a/packages/smart-forms-renderer/src/utils/removeEmptyAnswers.ts b/packages/smart-forms-renderer/src/utils/removeEmptyAnswers.ts
index a8a29d2a..1422f212 100644
--- a/packages/smart-forms-renderer/src/utils/removeEmptyAnswers.ts
+++ b/packages/smart-forms-renderer/src/utils/removeEmptyAnswers.ts
@@ -24,6 +24,7 @@ import type {
 import type { EnableWhenExpressions, EnableWhenItems } from '../interfaces/enableWhen.interface';
 import { isHiddenByEnableWhen } from './qItem';
 import cloneDeep from 'lodash.clonedeep';
+import { qrItemHasItemsOrAnswer } from './manageForm';
 
 interface removeEmptyAnswersParams {
   questionnaire: Questionnaire;
@@ -60,21 +61,31 @@ export function removeEmptyAnswers(params: removeEmptyAnswersParams): Questionna
     return updatedQuestionnaireResponse;
   }
 
-  topLevelQRItems.forEach((qrItem, i) => {
+  const newQuestionnaireResponse: QuestionnaireResponse = { ...questionnaireResponse, item: [] };
+  for (const [i, topLevelQRItem] of topLevelQRItems.entries()) {
     const qItem = topLevelQItems[i];
+    if (!qItem) {
+      continue;
+    }
+
+    // If QR item don't have either item.item and item.answer, continue
+    if (!qrItemHasItemsOrAnswer(topLevelQRItem)) {
+      continue;
+    }
+
     const newTopLevelQRItem = removeEmptyAnswersFromItemRecursive({
       qItem,
-      qrItem,
+      qrItem: topLevelQRItem,
       enableWhenIsActivated,
       enableWhenItems,
       enableWhenExpressions
     });
-    if (newTopLevelQRItem && questionnaireResponse.item) {
-      questionnaireResponse.item[i] = { ...newTopLevelQRItem };
+    if (newTopLevelQRItem && newQuestionnaireResponse.item) {
+      newQuestionnaireResponse.item.push(newTopLevelQRItem);
     }
-  });
+  }
 
-  return questionnaireResponse;
+  return newQuestionnaireResponse;
 }
 
 interface removeEmptyAnswersFromItemRecursiveParams {
@@ -90,6 +101,11 @@ function removeEmptyAnswersFromItemRecursive(
 ): QuestionnaireResponseItem | null {
   const { qItem, qrItem, enableWhenIsActivated, enableWhenItems, enableWhenExpressions } = params;
 
+  // If QR item don't have either item.item and item.answer, return null
+  if (!qrItemHasItemsOrAnswer(qrItem)) {
+    return null;
+  }
+
   const qItems = qItem.item;
   const qrItems = qrItem.item;
 
diff --git a/packages/smart-forms-renderer/src/utils/repopulateIntoResponse.ts b/packages/smart-forms-renderer/src/utils/repopulateIntoResponse.ts
index 32b80bda..936d7105 100644
--- a/packages/smart-forms-renderer/src/utils/repopulateIntoResponse.ts
+++ b/packages/smart-forms-renderer/src/utils/repopulateIntoResponse.ts
@@ -8,6 +8,7 @@ import type { ItemToRepopulate } from './repopulateItems';
 import { getQrItemsIndex, mapQItemsIndex } from './mapItem';
 import { isSpecificItemControl } from './itemControl';
 import { questionnaireResponseStore, questionnaireStore } from '../stores';
+import { qrItemHasItemsOrAnswer } from './manageForm';
 
 /**
  * Re-populate checked items in the re-population dialog into the current QuestionnaireResponse
@@ -67,7 +68,7 @@ export function repopulateItemsIntoResponse(
       continue;
     }
 
-    if (updatedTopLevelQRItem) {
+    if (updatedTopLevelQRItem && qrItemHasItemsOrAnswer(updatedTopLevelQRItem)) {
       topLevelQrItems.push(updatedTopLevelQRItem);
     }
   }
@@ -79,7 +80,7 @@ function repopulateItemRecursive(
   qItem: QuestionnaireItem,
   qrItemOrItems: QuestionnaireResponseItem | QuestionnaireResponseItem[] | null,
   checkedItemsToRepopulate: Record<string, ItemToRepopulate>
-): QuestionnaireResponseItem[] | QuestionnaireResponseItem | null {
+): QuestionnaireResponseItem | QuestionnaireResponseItem[] | null {
   // For repeat groups
   const hasMultipleAnswers = Array.isArray(qrItemOrItems);
   if (hasMultipleAnswers) {