Seems like the operation isn't working as it should; you may want to take this up with the WRC.

Looks like HealthConnect/IRIS for Health doesn't supply ISO-8859-4 ("Northern European"), or its successor ISO-8859-10. You can try forcing other character sets by preceding them with an exclamation point in the operation's Default Char Encoding property, but there may be characters that translate incorrectly:

Here's how I would approach this using a DTL ...

1. Create a counter variable to hold the number of occurrences of "Item Number:"
2. Use a for each action to iterate over the OBX segments
3. In the for each, create an if action that checks for the presence of "Item Number:" in OBX:5 (using ..Contains())
4. If the action is true, increment the counter variable

Example:

On completion of the for each, you should have a value that indicates the presence of more than one "Item Number." Next, update the OBXs:

1. Create another counter variable to track occurrences of "Item Number" to be used for comparison
2. Add another for each action to perform the modifications to the OBX segments
3. Use the $REPLACE() or ..Replace() functions to replace "REASON FOR REQUEST:" in each OBX:5 with an empty string
4. Add an if action to check the OBX:5 field for "Item Number:"; increment the new counter variable if found
5. Add an if action to evaluate the new counter variable against the original; if it's less than the original, add a line break (not actual $C(13)/$C(10) characters, but escaped representation such as \.br\ or \X0D\\X0A\; likely vendor-dependent)

Example: