Thank you for your inquiry into CMS 986v3, Global Malnutrition Composite Score. The medical diagnosis should be made and documented by an appropriate provider according to federal, state, and local regulations. This is most often a physician but may be another provider based on specific facility circumstances. Facility billing, documentation, and privileging policies and procedures should guide practice to ensure compliance with all appropriate regulatory bodies. The answer on JIRA ticket CQM- 6880 ( https://oncprojectracking.healthit.gov/support/browse/CQM-6880 ) may also be helpful in resolving this inquiry.