| 001 | Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) | Claims, Electronic Health Record, Cms Web Interface, Registry |
| 024 | Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older | Claims, Registry |
| 039 | Screening for Osteoporosis for Women Aged 65-85 Years of Age | Claims, Registry |
| 047 | Advance Care Plan | Claims, Registry |
| 048 | Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older | Registry |
| 116 | Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis | Registry |
| 126 | Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy - Neurological Evaluation | Registry |
| 130 | Documentation of Current Medications in the Medical Record | Registry, Electronic Health Record |
| 134 | Preventive Care and Screening: Screening for Depression and Follow-Up Plan | Claims, Electronic Health Record, Cms Web Interface, Registry |
| 155 | Falls: Plan of Care | Claims, Registry |
| 182 | Functional Outcome Assessment | Registry |
| 243 | Cardiac Rehabilitation Patient Referral from an Outpatient Setting | Registry |
| 374 | Closing the Referral Loop: Receipt of Specialist Report | Electronic Health Record, Registry |
| 431 | Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling | Registry |
| 438 | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | Electronic Health Record, Cms Web Interface, Registry |
| 475 | HIV Screening | Electronic Health Record |
| 487 | Screening for Social Drivers of Health | Registry |
| 488 | Kidney Health Evaluation | Registry, Electronic Health Record |
| 493 | Adult Immunization Status | Registry |
| 497 | Preventive Care and Wellness (composite) | Registry |
| 498 | Connection to Community Service Provider | Registry |
| 503 | Gains in Patient Activation Measure (PAM) Scores at 12 Months | Registry |
| 001SSP | Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) | Registry |
| 134SSP | Preventive Care and Screening: Screening for Depression and Follow-Up Plan | Registry |
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