Thank you for your inquiry about CMS156v9 (Use of High-Risk Medications in Older Adults). The narrative guidance and the logic are both correct.   As noted in the guidance section the intent of the measure is to assess if the reporting provider ordered the high risk medications. The guidance reflects that a provider would not report on high risk medications ordered by another provider unless the reporting provider also ordered a high risk medication.   If provider A ordered a high-risk mediation and provider B (the reporting provider) did not order a high-risk medication, provider B should not include this patient in their numerator. If provider A ordered a high-risk medication and provider B also ordered the same high-risk medication, this results in the patient receiving at least two orders for the same high-risk medication on different days. Provider B should include this case in their numerator.   The measure as currently designed represents a stricter patient safety standpoint where two orders for the patient meets numerator compliance regardless of providers. Any point at which a provider orders high-risk medications for a patient represents an opportunity to review the patient's medications to ensure they are not placed on high-risk medications inappropriately. The logic captures whether the same high risk medications were ordered on different days within the measurement period but is not able to attribute the orders to specific providers. We appreciate your questions and will re-evaluate this approach for a future version.