Thank you for inquiring about the Closing the Referral Loop: Receipt of Specialist Report measure. Note that the measure is not prescriptive on how the consultant report documentation is received. It only requires that the documentation is present in the record with a structured date and time stamp to extract for quality measurement. You must coordinate with your electronic health record vendor to ensure the appropriate area for retrieving documentation of consultant reports is mapped to the data element for retrieval and measure reporting. Regarding your internal processes for “referral” workflow, that appears to be a vendor-specific inquiry about the appropriateness of the open referral when sending electronic documentation. If your organization is the specialist to which patients are referred, when you forward the consultant report to the referring provider, that original provider reports the measure performance. Per measure guidance, “The clinician to whom the patient was referred is responsible for sending the consultant report that will fulfill the communication. Note: this is not the same clinician who would report on the measure."