​ Thank you so much for your question on CMS50v11, Closing the Referral Loop: Receipt of Specialist Report. Find responses to each question below: 1) Is this measure only for referrals from our practice to other practices or both sent and received referrals? This measure is only concerned with the encounter during which a patient is referred to another clinician (see relevant logic statement below). Further clarification is included in the Guidance: “The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure.” Initial Population "Has Encounter during Measurement Period" and "First Referral during First 10 Months of Measurement Period" is not null   2) Exact documentation required to fulfill the measure. Does the referral report have to be a certain way? or do we only need to document that the referral occurred in the notes? The numerator is fulfilled when “the referring clinician receive[s] a report from the clinician to whom the patient was referred”. This is captured by the “Consultant Report” value set (2.16.840.1.113883.3.464.1003.121.12.1006), a comprehensive collection of LOINC and SNOMEDCT codes, pulled from information included in the patient’s electronic health record. Detailed information about this value set can be found at: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.121.12.1006/expansion/Latest Referring Clinician Receives Consultant Report to Close Referral Loop exists ( ["Communication, Performed": "Consultant Report"] ConsultantReportCommunicated with "First Referral during First 10 Months of Measurement Period" FirstReferral such that FirstReferral.identification in ConsultantReportCommunicated.relatedTo and ConsultantReportCommunicated.receivedDatetime after FirstReferral.dateIntervention and ConsultantReportCommunicated.receivedDatetime during "Measurement Period"