Fill the Form

Enter your citation details and facility information

Pay $99

One-time per citation — secure Stripe checkout

AI Generates

Our AI writes polished, CMS-ready language in ~20 seconds

Download & Submit

Professional Word doc ready to review and send

What you get with Generator Pro

Word Document (.docx) Professional formatting, ready to edit and submit

AI-Written Language Not templates — actual CMS-ready prose from your inputs

Facility Branding Your name, address, admin, and medical director pre-filled

All 5 CMS Elements Complete, structured PoC format CMS requires

✓

Compliance Language Tone and structure surveyors expect to see

Print-Ready Clean layout for your state portal or paper submission

Generator Pro vs. Basic Drafter

Feature	Basic Drafter ($39)	Generator Pro ($99)
CMS 5-Element Format	✓ Yes	✓ Yes
Word Document (.docx)	✗ Text only	✓ Professional .docx
AI-Written Language	✗ Templates from your inputs	✓ AI-authored prose
Facility Header & Branding	✗ Basic	✓ Full facility details
Administrator / Medical Director	✗ Not included	✓ Included in doc
Signature Lines	✗ Not included	✓ Included in doc

Facility Information For Word Doc

Facility Name *

Please enter your facility name.

CMS Certification Number (CCN) Optional — will appear in document header

Facility Address Street address, city, state, ZIP

Administrator Name Will appear in signature block

Medical Director Name Will appear in signature block

Citation Details

Cited F-Tag * Select the F-tag from your Statement of Deficiencies (CMS-2567)

Loading F-tag data…

Please select the cited F-tag.

Survey Date * Date the survey was conducted

Please enter your survey date.

Scope & Severity Code From CMS-2567 (e.g., D, E, F, G, H, J, K, L)

What Was Found

Describe the Deficiency Finding * What did the surveyor observe or document? (from the Statement of Deficiencies)

Please describe the deficiency finding.

Residents Directly Affected How were affected residents identified, and what immediate action was taken for them?

Corrective Actions

How Other Residents Were Identified * How did you check whether other residents were potentially affected?

Please describe how you identified other affected residents.

Corrective Actions Taken or Planned * What specific steps has the facility taken (or will take) to correct this deficiency?

Please describe the corrective actions.

Systemic Changes to Prevent Recurrence * What process, policy, or training change will prevent this from happening again?

Please describe systemic changes.

Accountability & Monitoring

Person(s) Responsible * Name and title overseeing corrective action

Please enter the responsible person(s).

Target Completion Date * Within the required CMS timeframe (10-day window)

Please select a completion date.

Ongoing Monitoring Plan * How will the facility monitor to ensure the problem doesn't recur? Be specific about frequency.

Please describe your monitoring plan.

Ready to Generate Your Submission-Ready PoC?

Our AI will write polished, CMS-compliant language for every section — then package it as a professional Word document.

✦ AI-Written Content

✦ Word Document (.docx)

✦ All 5 CMS Elements

✦ Facility Branding

✦ Signature Block

$99

one-time · per citation

Secure checkout · Word doc ready in ~20 seconds after payment · No subscription

Common Questions

What's different about Generator Pro vs. the Basic Drafter?

Generator Pro uses AI to write professionally crafted, CMS-compliant language for every section — not just fill-in templates. It also delivers a properly formatted Word document (.docx) with your facility's branding, administrator details, and signature blocks, ready to submit or share with your team.

What does the Word document look like?

The Word document has a professional header with your facility name, address, CCN, and citation details. Each of the 5 CMS-required elements is clearly labeled with proper headings. It includes a signature block for your Administrator and Medical Director. Ready to submit directly or edit in Microsoft Word or Google Docs.

How long does generation take?

Typically 15–30 seconds after payment confirms. The AI writes and formats everything in real time. You'll stay on the results page while it runs — you'll see a progress indicator.

Do I need to edit the generated draft?

Always review before submitting. The AI produces professional, CMS-ready language based on your inputs — but you should verify every detail is accurate for your facility's specific situation. Your DON or administrator should sign off before submission.

What if I was cited for multiple F-tags?

Each PoC is generated per F-tag. For multiple citations, run the generator once per tag. Each generation is $99.

Is this for Immediate Jeopardy citations?

You can use this tool for IJ citations, but we strongly recommend also consulting a healthcare regulatory attorney for IJ situations given the higher stakes and accelerated timelines.

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