Thank you for your question regarding CMS816v4, Hospital Harm- Severe Hypoglycemia. For this measure, the inpatient hospitalization period includes time in the emergency department (ED) and observation status when the transition between discharge from these encounters and the start of the inpatient encounter is one hour or less. Since the example does not include an ED discharge date/time, we are unable to determine whether the ED encounter would be considered part of the inpatient encounter. If the ED discharge date/time is one hour or less before the IP admission (i.e. one hour or less before the IP admission on 5/27/2025 @00:10), then the patient would qualify for the initial population, specified in the logic for definition ‘Encounter with Hypoglycemic Medication Administration’ (see below). Encounter with Hypoglycemic Medication Administration "Qualifying Encounter" EncounterInpatient   with "Hypoglycemic Medication Administration" HypoglycemicMedication     such that Global."NormalizeInterval" ( HypoglycemicMedication.relevantDatetime, HypoglycemicMedication.relevantPeriod ) starts during Global.HospitalizationWithObservation ( EncounterInpatient ) Further, if the ED encounter is counted as part of the inpatient encounter, the encounter would also qualify for the numerator, as specified in nested logic for definition ‘Encounter with Severe Hypoglycemic Harm Event’, This is evidenced by a glucose test with result < 40 mg/dL (5/26/2025 @23:18), which is a result of a hypoglycemic medication being administered within 24 hours before the start of the severe hypoglycemic event (5/26/2025 @19:56), with no subsequent repeat test with result > 80 mg/dL, taken within five minutes of the result of < 40 mg/dL.