Just y opinion.
When you create immed need, there are some data in table immd_needs (include create_date_time and sku_id). When someone receive LPN and confirm 'No' for immediate needs, there is no record as I know. But, if someone confirm 'Yes' for immediate needs, you can see new data row in table immd_needs with different immd_need_id. That last row contain spesific case_nbr (immd_needs.case_nbr) and has different create date time.
So, I think you can check immd_needs.create_date_time with immd_needs.case_nbr not null. That create date time compare with immd_needs.create_date_time with immd_needs.case_nbr = *.
Then you can pull all LPN created between those 2 times. We can said those LPN declined by user.