Thank you for inquiring about the Preventive Care and Screening: Screening for Depression and Follow-Up Plan eCQM. According to the specification, the patient refusal exception only qualifies when the “Patient refuses to participate in or complete the depression screening”. In your scenario, if the provider orders a medication to treat the patient’s depression (regardless of whether the patient has filled the prescription or taken the medication), then the provider’s intended process-based numerator action is considered completed. The same would be true if the patient were referred for psychotherapy—the patient’s active participation is not required for the numerator if the order was placed.