Thank you for your question for CMS71 STK-3 and CMS104 STK-2. Both measures account for patient refusal and is a denominator exception noted in the human readable and the logic. CMS71: Denominator Exception- Inpatient hospitalizations for patients with a documented reason for not prescribing anticoagulation therapy at discharge Measure Logic Denominator Exceptions "Denominator" Encounter   with "Documented Reason for Not Giving Anticoagulant at Discharge" NoDischargeAnticoagulant     such that NoDischargeAnticoagulant.authorDatetime during Encounter.relevantPeriod Documented Reason for Not Giving Anticoagulant at Discharge ["Medication, Not Discharged": "Anticoagulant Therapy"] NoAnticoagulant   where NoAnticoagulant.negationRationale in "Medical Reason For Not Providing Treatment"     or NoAnticoagulant.negationRationale in "Patient Refusal" CMS104: Denominator Exception- Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge Measure logic Denominator Exceptions "Encounter with Documented Reason for No Antithrombotic At Discharge"   union "Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge" Reason for Not Giving Antithrombotic at Discharge ["Medication, Not Discharged": "Antithrombotic Therapy for Ischemic Stroke"] NoAntithromboticDischarge   where NoAntithromboticDischarge.negationRationale in "Medical Reason For Not Providing Treatment"     or NoAntithromboticDischarge.negationRationale in "Patient Refusal"