Whether negationInd is required or not depends on the measure definition and the specific data elements you are reporting. negationInd is used to indicate "not done". Use CMS72v4 as an example, if you are submitting data to satisfy this logic, because it is "Medication, Administered" in this measure criteria, negationInd should not be set to true for that data instance. OR: Union of: "Medication, Administered: Thrombolytic (t-PA) Therapy" "Procedure, Performed: Intravenous or Intra-arterial Thrombolytic (t-PA) Therapy" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: Emergency Department Visit" OR: "Medication, Administered: Thrombolytic (t-PA) Therapy" satisfies all starts after start of "Occurrence A of Encounter, Performed: Emergency Department Visit" starts before end of Occurrence A of $EncounterInpatientNonElective However, if you are submitting data to satisfy "Medication, Administered not done" in the logic below, because it is "not done", negationInd must set to be true. AND: Union of: "Medication, Order not done: Medical Reason" for "Antithrombotic ingredient specific" "Medication, Administered not done: Medical Reason" for "Antithrombotic Therapy" "Medication, Order not done: Patient Refusal" for "Antithrombotic ingredient specific" "Medication, Administered not done: Patient Refusal" for "Antithrombotic Therapy" <= 1 day(s) starts after start of "Occurrence A of Encounter, Performed: Emergency Department Visit"