​​Thank you for your question on CMS154v11. The language in the header specifying the numerator exclusion for an active prescription of antibiotics reads the following: "URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection." In the example given in the question, since the antibiotic was not ordered on or 3 days after the date of the URI encounter, it will count against the physician for this measure.