Neil, there is an exemption for vital signs, recognizing that certain specialty fields don't need vital signs in their practice of medicine. When you submit to the attestation procedure on the CMS website you will see what I'm referring to. It should be no big deal for you. For every criteria question on the CMS attestation website, there is an exemption status question. On each question, you are asked simply if your practice is exempt from the criteria. It lists specific reasons why you are saying you are exempt. You click the button attesting to this fact you are exempt for that criteria and move on to the next question.