Thank you for inquiring about the Preventive Care and Screening: Screening for Depression and Follow-Up Plan eCQM. Please note that the medical reason for not screening the patient for depression must be documented during a relevant qualifying encounter each year to count as an exception. An existing or prior diagnosis of cognitive impairment will not automatically be captured as an exception. During each measurement period, a code from the Medical Reason value set must be documented during a relevant qualifying encounter as a reason for not screening for depression in order for the patient to be considered an exception. The logic that denotes this is here:   Medical or Patient Reason for Not Screening Adult for Depression   ["Assessment, Not Performed": "Adult depression screening assessment"] NoAdultScreen   with "Qualifying Encounter During Measurement Period" QualifyingEncounter     such that NoAdultScreen.authorDatetime during QualifyingEncounter.relevantPeriod                         where ( NoAdultScreen.negationRationale ~ “Depression screening declined (situation)”          or NoAdultScreen.negationRationale in "Medical Reason"   )