Thank you for your inquiry regarding CMS986v4, the Malnutrition Care Score (MCS). In the example provided, the Total Malnutrition Composite Score Eligible Occurrence will be equal to 4. The presence of the Hospital Dietitian Referral meets one of the two parameters established to move the calculation forward to Measure Observation #2. Therefore, in this case, Measure Observation #6 would be calculated as 4/4 = 100%. Below is a thorough explanation of the rationale. For condition 1: If ("Encounter with Malnutrition Screening Not At Risk Result" contains Encounter)  and not ("Encounter with Hospital Dietitian Referral" contains Encounter) then 1 Although the scenario contained a Malnutrition screening of Not At Risk it does not meet this condition because it contains a Dietitian Referral. For condition 2: Else if (("Encounter with Malnutrition Screening At Risk Result" contains Encounter)  or ("Encounter with Hospital Dietitian Referral" contains Encounter))  and "Encounter with Nutrition Assessment Status Not or Mildly Malnourished" contains Encounter  or not ("Encounter with Nutrition Assessment and Identified Status" contains Encounter) then 2 Although your scenario contains a Dietitian Referral it does not meet this condition because it has a Nutrition Assessment Status of Moderately Malnourished. The logic in this case defaults to the else clause, which assigns: Total Malnutrition Composite Score Eligible Occurrences = 4.