The Division of Quality Assurance (DQA) is issuing Statements of
Deficiencies (SOD) electronically using email addresses provided by health
care providers. The provider is able to use a Plan of Correction (POC)
form to electronically submit this information to DQA. This web page
provides information and instructions for the e-SOD/e-POC process.
For most providers the Provider Agreement form is completed at the time
of an on-site survey. An authorized representative for a health care provider signs and dates
the Provider Agreement form and agrees to accept the results of a survey
including Statements of Deficiency (SODs) electronically using an email
address they provide. They also agree to submit the Plan(s) of
Correction (POCs) using the supplied form and emailing this document back
Assisted living providers refer to
DQA Memo 13-002 for information to participate in the e-SOD/e-POC
The email sent from DQA containing the e-SOD and attachments will be
emailed encrypted to the provider.
Memo 10-031 provides information for how to view an encrypted email by
either creating an account with the CISCO Registered Envelope Service (CRES)
or establishing a Transport Layer Security (TLS) connection.
Also available is online
email encryption training for partners, providers and constituents.
e-Mail and Attachments
The e-mail sent by DQA will identify documents that are attached and will
include basic instructions for saving these files and for returning
It is important for the provider to confirm receipt of the email and
attachments by opening this email and emailing a reply to the DQA sender of the email.
The effective date of service for SODs is the date the transmitting
email message is sent from the Division of Quality Assurance to the
authorized representative identified on the Provider Agreement form.
Listed below are files that may be attached to an email to a provider
following a survey.
- Statement of Deficiency Cover Letter - A letter from DQA
providing information about a recent survey.
- Statements of Deficiency (SODs) - Form CMS-2567 identifies each
citation being issued. Federal and State citations are issued on separate
SODs. The first page of the federal SOD must be signed and dated and faxed
to the number identified in the email or scanned and emailed back to DQA.
- Plan of Correction (POC) Form (F-00344) - The provider uses this
form to document their plan of correction for each citation listed on the
- Identifier Key (F-62552) - Confidential Information. Lists names
of residents, patients, clients, staff, complainants, family
members. Do NOT email this document back to DQA.
To save email attachments:
Right click on an attachment in the email and then select Save
As... on the pop-up menu.
To the right of the Save In: box, identify a drive and folder on
your computer to
save the file to.
Then click on Save.
- Repeat these steps for each attachment.
Completing the Electronic Plan of Correction
Open the saved Plan of Correction Form (F-00344) in Word. Do not
alter the format of this form. Do not handwrite your plan of correct -
use Word or other word processing software to enter information.
Enter the respective tag number(s) as listed in the first column
(x4) of the SOD in the first column (x4) of the ePOC form.
In the second column, Provider's Plan of Correction, describe the
corrective action(s) that have or will be taken to address this
deficient practice referenced by this tag number. The cells in
the Word form are formatted to expand as necessary to allow entry of
multiple lines of text.
Enter the completion date for that corrective action in the third
Complete this process for all tags issued entering them in the same
order as they are listed on the SOD. The first tag should be entered
in the first row, the second tag should be entered in the second row,
etc. (Do not complete a separate page per tag.)
- Save and close the document.
If multiple SODs are issued, a separate Plan of Correction Form
(F-00344) should be completed for each SOD requiring a plan of
Save regularly throughout entry of the POC to avoid loss of
E-Mailing the Plan of Correction
Open the email sent by DQA containing the e-SOD and Reply to this
Attach the completed e-POC form.
For Federal SODs Only - If issued a SOD containing one or
more federal deficiencies (including Life Safety Code), print only page one
of the SOD and sign and date where
indicated. Then either:
- Send the email.
Survey Process - Acceptable Plan of Correction
Refer to the Statement of Deficiency letter for required
elements in your plan of correction.
Listed below are links to Survey Guides by provider type. These
guides provide information about the survey process including the contents
for an acceptable Plan of Correction.
Living Facility Survey Guide (PDF, 118
and Mental Health Program Certification Survey Guide (PDF,
Serving People with Developmental Disabilities Survey Guide (PDF,
Health and Hospice Licensure and Certification Survey Guide
(PDF, 50 KB)
and Other Health Services Providers Survey Guide (PDF,
Long Term Care Facilities Survey
Guide (PDF, 142 KB)
CLIA Providers - See the Statement of Deficiency letter for required
elements in your plan of correction.
The plan of correction must describe the corrective action the provider
will take to address the cited violation or deficiency. Although a
provider may include in its plan of correction a
statement that it disagrees with the survey findings, a provider may not
use the plan of correction to malign the survey team or an individual
Informal Dispute Resolution (IDR)
Informal Dispute Resolution is available for nursing homes and
facilities for the developmentally disabled, and Independent IDR is also
available for certified nursing homes. Please review the the
following DQA memorandums for additional information.
Memo 12-003, dated April 3, 2012
Memo 14-001 (PDF, 110 KB) dated January 7, 2014
Provider Search Application - SODs/POCs
Statements of Deficiency (SODs) and Plans of Correction (POCs) will be
available to the public soon after an acceptable POC has been received, even
for providers that choose not to participate in the e-SOD/e-POC process.
Survey information and other provider demographic information can be
accessed using the DQA Provider Search
Contact for Assistance
Division of Quality
P.O. Box 2969
Madison, WI 53701-2969
Phone: (608) 266-8481
Fax: (608) 267-0352
Last Updated: March 04, 2014