Question on this statement in the guidance "If there are multiple referrals for a patient during the measurement period, use the first referral."  This is a patient-based measure so is it truly the first referral made in the year?  What if a provider refers the patient to multiple places throughout the year?  What if they refer to the same place several times in the year and are able to get a consultation report for the 2nd time they sent the patient, not the first time?

Is that statement to mean if there is more than 1 referral to different providers in the year, only use the 1st referral for the year?

Or is it to mean, if there is more than 1 referral to the same provider during the year, only use the first referral for each unique provider to which you have referred?

This statement in the guidance doesn't seem to clarify if it's only for the first referral in the year to any outside provider or if it's for each unique referral  "The consultant report that will successfully close the referral loop should be related to the first referral for a patient during the measurement period. If there are multiple consultant reports received by the referring provider which pertain to a particular referral, use the first consultant report to satisfy the measure."