We are in a process of updating QRDA product for 2020 Measurement Period based on HL7 CDA® R2 Implementation Guide: Quality Reporting Document Architecture Category I (QRDA I), Release 1, STU Release 5.1.

1) For CMS50 Measure Id Patient Name 0_Cheryl_Welch, Communication Performed template is included with Reason attribute but with typeCode <REFR> as below. We checked the guide and not seeing this requirement mentioned for this template. Where is <REFR> coming from?

2) Reason is MAY condition. Hence we tried removing reason from the patient file and validated on Cypress, but its failing without Reason attribute. Please see attached sample file.

<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.24.3.88" extension="2017-08-01"/>
<id root="1.3.6.1.4.1.115" extension="5e1df4afdfe4bd03bf0743d4" />
<code code="77301-0" codeSystem="2.16.840.1.113883.6.1" displayName="reason" codeSystemName="LOINC"/>
<statusCode code="completed"/>
<!-- QDM Attribute: Code -->
<value xsi:type="CD" code="11488-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC">
<translation code="371530004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMEDCT"/>
</value>
</observation>
</entryRelationship>

3) Code tag (above Status Code) is nullflavor. Since Code is a SHALL condition, is it valid to put nullflavour for code tag?