diff --git a/tests/test_sync.py b/tests/test_sync.py
index 8bee21eb..47b4c0ad 100644
--- a/tests/test_sync.py
+++ b/tests/test_sync.py
@@ -76,6 +76,12 @@ def internal_patient_duplicate_active_match(datadir):
     return load_json(datadir, "internal_patient_duplicate_active_match.json")
 
 
+@fixture
+def internal_patient_duplicate_mismatch(datadir):
+    return load_json(datadir, "internal_patient_duplicate_mismatch.json")
+
+
+
 @fixture
 def internal_patient_duplicate_inactive_match(datadir):
     return load_json(datadir, "internal_patient_duplicate_inactive_match.json")
@@ -85,10 +91,8 @@ def test_new_upsert(
     mocker,
     faux_token,
     external_patient_search,
-    external_patient_search_active,
     internal_patient_miss,
     new_patient,
-    new_patient_active
     ):
     """Without finding a matching patient, should insert new and return"""
 
@@ -108,7 +112,47 @@ def test_new_upsert(
     assert result == new_patient
 
 
-    """Finding inactive patient, user specified to not restore, should insert new and return"""
+def test_new_upsert_active(
+    client,
+    mocker,
+    faux_token,
+    external_patient_search_active,
+    internal_patient_miss,
+    new_patient_active
+    ):
+    """Without finding a matching patient, should insert new and return"""
+
+    # Mock HAPI search failing to find a matching patient
+    mocker.patch(
+        "patientsearch.models.sync.requests.get",
+        return_value=mock_response(internal_patient_miss),
+    )
+
+    # Mock POST to generate new patient on HAPI
+    mocker.patch(
+        "patientsearch.models.sync.requests.post",
+        return_value=mock_response(new_patient_active),
+    )
+
+    result = sync_bundle(faux_token, external_patient_search_active)
+    assert result == new_patient_active
+
+
+def test_upsert_inactive(
+    client,
+    mocker,
+    faux_token,
+    external_patient_search_active,
+    internal_patient_miss,
+    new_patient_active
+    ):
+    """Finding a matching inactive patient, user chose to generate new patient"""
+
+    # Mock HAPI search finding a matching inactive
+    mocker.patch(
+        "patientsearch.models.sync.requests.get",
+        return_value=mock_response(internal_patient_miss),
+    )
 
     # Mock POST to generate new patient on HAPI
     mocker.patch(
@@ -135,10 +179,7 @@ def test_existing(
     mocker, 
     faux_token, 
     external_patient_search, 
-    external_patient_search_active,
     internal_patient_match, 
-    internal_patient_active_match, 
-    internal_patient_inactive_match
 ):
     """Finding a matching patient, return existing"""
 
@@ -151,6 +192,14 @@ def test_existing(
     result = sync_bundle(faux_token, external_patient_search)
     assert result == internal_patient_match["entry"][0]["resource"]
 
+
+def test_existing_active(
+    client, 
+    mocker, 
+    faux_token, 
+    external_patient_search_active,
+    internal_patient_active_match, 
+):
     """Finding a matching active patient from active external search, return existing"""
 
     # Mock HAPI search finding a matching active patient
@@ -162,10 +211,18 @@ def test_existing(
     result = sync_bundle(faux_token, external_patient_search_active)
     assert result == internal_patient_active_match["entry"][0]["resource"]
 
-    """Finding a matching inactive patient from active external search, return existing restored/new"""
+
+def test_existing_inactive(
+    client, 
+    mocker, 
+    faux_token, 
+    external_patient_search_active,
+    internal_patient_inactive_match
+):
+    """Finding a matching inactive patient from active external search, return existing restored"""
 
     # Mock HAPI search finding a matching inactive patient 
-    # when the service is called to create to be restored
+    # when the service is called for the patient to be restored
     mocker.patch(
         "patientsearch.models.sync.requests.get",
         return_value=mock_response(internal_patient_inactive_match),
@@ -175,8 +232,6 @@ def test_existing(
     assert result == internal_patient_inactive_match["entry"][0]["resource"]
 
 
-
-
 def test_existing_modified(
     client,
     mocker, 
@@ -220,10 +275,7 @@ def test_duplicate(
     mocker,
     faux_token,
     external_patient_search,
-    external_patient_search_active,
     internal_patient_duplicate_match,
-    internal_patient_duplicate_active_match,
-    internal_patient_duplicate_inactive_match
 ):
     """Finding a matching patient with duplicates, handle well"""
 
@@ -237,14 +289,70 @@ def test_duplicate(
     result = sync_bundle(faux_token, external_patient_search)
     assert result == internal_patient_duplicate_match["entry"][0]["resource"]
 
+
+def test_duplicate_active(
+    client,
+    mocker,
+    faux_token,
+    external_patient_search_active,
+    internal_patient_duplicate_active_match,
+):
+    """Finding a matching active patient with duplicates, handle well"""
+
+    # Mock HAPI search finding duplicate matching patients
+    mocker.patch(
+        "patientsearch.models.sync.requests.get",
+        return_value=mock_response(internal_patient_duplicate_active_match),
+    )
+
     # Shouldn't kill the process, but return the first
     result = sync_bundle(faux_token, external_patient_search_active)
     assert result == internal_patient_duplicate_active_match["entry"][0]["resource"]
 
-    # Shouldn't kill the process, but return the first, restoring/initiating new patient
+
+def test_duplicate_inactive(
+    client,
+    mocker,
+    faux_token,
+    external_patient_search_active,
+    internal_patient_duplicate_inactive_match,
+):
+    """Finding a matching inactive patient with duplicates, handle well"""
+
+    # Mock HAPI search finding duplicate matching patients
+    mocker.patch(
+        "patientsearch.models.sync.requests.get",
+        return_value=mock_response(internal_patient_duplicate_inactive_match),
+    )
+
+    # Shouldn't kill the process, but return the first
     result = sync_bundle(faux_token, external_patient_search_active)
-    assert result == internal_patient_duplicate_inactive_match["entry"][0]["resource"]
+    assert result != internal_patient_duplicate_inactive_match["entry"][0]["resource"]
 
-    # # TODO: test inactive/active configuration, should return active one?
-    # result = sync_bundle(faux_token, external_patient_search_active)
-    # assert result == internal_patient_duplicate_inactive_match["entry"][1]["resource"]
+
+def test_duplicate_mismatch(
+    client,
+    mocker,
+    faux_token,
+    external_patient_search_active,
+    internal_patient_duplicate_mismatch,
+    internal_patient_duplicate_active_match,
+):
+    """Finding mistmatching active/inactive patient with duplicates, handle well"""
+
+    # Mock HAPI search finding duplicate matching patients
+    mocker.patch(
+        "patientsearch.models.sync.requests.get",
+        return_value=mock_response(internal_patient_duplicate_mismatch),
+    )
+    # TODO: add logic to handle if true is not first
+    
+    # Shouldn't kill the process, but return the first
+    result = sync_bundle(faux_token, external_patient_search_active)
+    # First duplicate is true, should be the same
+    assert result == internal_patient_duplicate_active_match["entry"][0]["resource"]
+
+    # Shouldn't kill the process, but return the first
+    result = sync_bundle(faux_token, external_patient_search_active)
+    # Second duplicate is false, should not be the same
+    assert result != internal_patient_duplicate_active_match["entry"][1]["resource"]
diff --git a/tests/test_sync/internal_patient_duplicate_mismatch.json b/tests/test_sync/internal_patient_duplicate_mismatch.json
new file mode 100644
index 00000000..f0e129ef
--- /dev/null
+++ b/tests/test_sync/internal_patient_duplicate_mismatch.json
@@ -0,0 +1,83 @@
+{
+  "resourceType": "Bundle",
+  "id": "c865c9ee-2432-4f6d-87bd-3a6d5243bd77",
+  "meta": {
+    "lastUpdated": "2020-06-19T13:04:43.062+00:00"
+  },
+  "type": "searchset",
+  "total": 2,
+  "link": [
+    {
+      "relation": "self",
+      "url": "http://localhost:8080/hapi-fhir-jpaserver/fhir/Patient?family=skywalker"
+    }
+  ],
+  "entry": [
+    {
+      "fullUrl": "http://localhost:8080/hapi-fhir-jpaserver/fhir/Patient/1102",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1102",
+        "meta": {
+          "versionId": "1",
+          "lastUpdated": "2020-06-19T12:54:39.363+00:00"
+        },
+        "text": {
+          "status": "generated",
+          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><div class=\"hapiHeaderText\">luke <b>SKYWALKER </b></div><table class=\"hapiPropertyTable\"><tbody><tr><td>Date of birth</td><td><span>12 January 1977</span></td></tr></tbody></table></div>"
+        },
+        "active": true,
+        "name": [
+          {
+            "family": "skywalker",
+            "given": [
+              "luke"
+            ]
+          }
+        ],
+        "gender": "male",
+        "birthDate": "1977-01-12"
+      },
+      "search": {
+        "mode": "match"
+      },
+      "response": {
+        "status": "201 Created",
+        "etag": "W/\"1\""
+      }
+    },
+    {
+      "fullUrl": "http://localhost:8080/hapi-fhir-jpaserver/fhir/Patient/1103",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "1103",
+        "meta": {
+          "versionId": "1",
+          "lastUpdated": "2020-06-19T12:54:39.363+00:00"
+        },
+        "text": {
+          "status": "generated",
+          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><div class=\"hapiHeaderText\">luke <b>SKYWALKER </b></div><table class=\"hapiPropertyTable\"><tbody><tr><td>Date of birth</td><td><span>12 January 1977</span></td></tr></tbody></table></div>"
+        },
+        "active": false,
+        "name": [
+          {
+            "family": "skywalker",
+            "given": [
+              "luke"
+            ]
+          }
+        ],
+        "gender": "male",
+        "birthDate": "1977-01-12"
+      },
+      "search": {
+        "mode": "match"
+      },
+      "response": {
+        "status": "201 Created",
+        "etag": "W/\"1\""
+      }
+    }
+  ]
+}