All of the requirement statements outlined by the commenter are correct and are in line with the measure developers intent. The key piece that we were trying to account for are instances where a patient is seen multiple times within the flu season and their problem list is updated or their allergy status changes.             SCENARIO:             If a patient is seen 1/3/2012 [during MP] AND 2/7/2012 – patient has a documented egg allergy with start/stop dates of 4/2/2010 and 2/1/2012.             At 1/3/2012 visit, the patient would qualify as an exception. At the 2/7/2012 visit, the patient would not fall into the exceptions and should be considered for influenza vaccination. Since this measure is considered a patient-based measure (and not an episode-based measure), the allergy would need to be true until the end of the flu season, otherwise they should be considered a candidate for the influenza vaccine. To specifically address requirement #3, an exception that starts after the flu season but during the MP will not qualify as a valid exception, and therefore is not outlined as an allowable exception. The assumption is that the allergy was not present during the flu season, therefore the patient should be considered a candidate for the influenza immunization. We hope this response highlights our rationale, thank you for your comment.