CMS ID 22: The intent of the guidance is to make a connection between the plan of care and the blood pressure. If the patient is coming to the office for a back problem and the Blood Pressure Screening is elevated, there must be a connection between that elevated blood pressure and the follow up. In the guidance example, it demonstrates the patient follow-up is for Blood Pressure Management. In the example given above, if the plan is documented as “refer to primary provider” it cannot be determine if the follow up is related to the back pain or the elevated blood pressure screening. To meet the quality action for this measure, the record must clearly state the referral to the primary care provider is for elevated blood pressure screening. The documentation of life style modifications would meet the part of the quality measure, but the case of the patient who had alcohol counseling, provider also needs to document the follow-up plan for B/P management. “The follow-up” refers to guidance only, not the logic or data elements. The logic does not explicitly tie blood pressure follow-up plans to the Blood Pressure screening results, although the guidance states they should be related. The guidance language will be reviewed at the annual update, and the logic as well. But if the quality actions are in the computer, the provider should not fail. There are no links/concepts that state “follow up for B/P” in the measure output.