You won't believe the solution !!

I needed to change the send instructions with the clone object, pOutput, and NOT the HL7 message object, pRequest.

Example:

ElseIf (tMessageType="ORM") {
            //$$$ThrowOnError(..SendRequestAsync(..VistaTarget, pRequest, 1, "OutputCernerToVistaORM"))
            //  03272025 Must make a new command that uses the clone object instead of the HL7 message object which is immutable
            $$$ThrowOnError(..SendRequestAsync(..VistaTarget, pOutput, 1, "OutputCernerToVistaORM")) // Must use the object for the clone

This is resolved.

Now, I need to add the CR/LF

I also tried this outside the loop;  Do pOutput.%Save()