Thank you for submitting your question. The value set “$NoVTEProphylaxisPatientRefusal <= 1 day(s) starts after end of” is located in the numerator thus moving the record to the numerator if it meets criteria. The “Data Criteria (QDM Variables)” section of the measure defines the variable $NoVTEProphylaxisPatientRefusal as: •$NoVTEProphylaxisPatientRefusal = ◦Union of: ◾"Medication, Administered not done: Patient Refusal" for "Low Dose Unfractionated Heparin for VTE Prophylaxis" ◾"Medication, Administered not done: Patient Refusal" for "Low Molecular Weight Heparin for VTE Prophylaxis" ◾"Medication, Administered not done: Patient Refusal" for "Injectable Factor Xa Inhibitor for VTE Prophylaxis" ◾"Medication, Administered not done: Patient Refusal" for "Warfarin" ◾"Medication, Order not done: Patient Refusal" for "Unfractionated Heparin for VTE prophylaxis ingredient specific" ◾"Medication, Order not done: Patient Refusal" for "Low Molecular Weight Heparin for VTE prophylaxis ingredient specific" ◾"Medication, Order not done: Patient Refusal" for "Injectable factor Xa inhibitor for VTE prophylaxis ingredient specific" ◾"Medication, Order not done: Patient Refusal" for "Warfarin-only ingredient specific" ◾"Device, Applied not done: Patient Refusal" for "Intermittent pneumatic compression devices (IPC)" ◾"Device, Applied not done: Patient Refusal" for "Venous foot pumps (VFP)" ◾"Device, Applied not done: Patient Refusal" for "Graduated compression stockings (GCS)" ◾"Device, Order not done: Patient Refusal" for "Intermittent pneumatic compression devices (IPC)" ◾"Device, Order not done: Patient Refusal" for "Venous foot pumps (VFP)" ◾"Device, Order not done: Patient Refusal" for "Graduated compression stockings (GCS)" Therefore, refusal of only one form of prophylaxis (medication or mechanical) is needed , as patient refusal of either the medication or mechanical prophylaxis satisfies the logic.