CMS 50 question attached with screen shot

CMS 50 Guidance says “If there are multiple referrals for a patient during the measurement period, use the first referral.”

• Does this statement mean the very FIRST referral documented during the reporting period?
For example, there are 3 referrals documented, one on each 1/1/2013, 1/2/2013, and 1/3/2013 encounters. So the First referral we are capturing would be on 1/1/2013.

OR

• Do you mean the very FIRST referral from the 3 referrals ordered with consult report received during the measurement period. For example, there are 3 referrals documented, would the referral on the 2nd encounter be the FIRST referral?:
o 1st encounter: 1/1/2013- referral ordered with NO Consult Report.
o 2nd encounter: 1/2/2013- referral ordered WITH Consult Report.
o 3rd encounter: 1/3/2013- referral ordered with NO Consult Report.

PLEASE SEE ATTACHMENT FOR SCREENSHOT OF GUIDANCE referred to in question. Thank you.