Thank you for your inquiry into CMS2v13, Preventative Care and Screening: Screening for Depression and Follow-up Plan. The measure logic assesses the most recent qualifying encounter where a depression screen was performed. If the patient refused a depression screening in visit 1, and the screening was not performed in visit 2, only visit 1 would be used to meet the measure requirements (as a Medical or Patient Reason was provided [e.g., patient refused]). The measure is not prescriptive as to whether screening is performed. The decision to screen or not screen is ‘Clinical Judgement’ and up to the assessing provider. The measure logic uses the most recent qualifying encounter during the measurement period to evaluate if the patient has met the numerator requirements. If the patient is screened for depression during visit 2, visit 2 would be used to evaluate the measure requirements as it would be the most recent qualifying encounter.