Custom GPT: Build a Hospice Documentation Assistant

For Hospice Coordinators

Tools: ChatGPT {{tool:ChatGPT.plan}} | Time to build: 1-2 hours | Difficulty: Intermediate-Advanced Prerequisites: Comfortable using ChatGPT for recertification narratives — see Level 3 guide: "Draft Recertification Narratives with ChatGPT"

What This Builds

Instead of starting every ChatGPT session with the same context-setting paragraph about CMS requirements, this Custom GPT has all that context baked in permanently. Every conversation starts with a fully briefed AI that knows hospice documentation requirements, your preferred writing style, CMS eligibility language for common diagnoses, and what not to include (PHI, unsupported clinical claims). You open it, paste your patient data, and get a compliant draft in seconds.

Prerequisites

• {{tool:ChatGPT.plan}} subscription ({{tool:ChatGPT.price}}) — Custom GPTs require a paid plan
• Comfortable using ChatGPT for basic documentation tasks (Level 3)
• 1-2 hours for setup and testing
• Optional: a few examples of your agency's approved recertification narrative style to upload

The Concept

A Custom GPT is like a specialized version of ChatGPT that you configure once with specific instructions, knowledge, and personality. Think of it as training a new documentation assistant who already knows all the CMS rules and your agency's style — you never have to explain the basics again. You share the Custom GPT link with your colleagues and they all get the same benefit.

Build It Step by Step

Part 1: Open the Custom GPT builder

1. Log into ChatGPT at {{tool:ChatGPT.url}} with your {{tool:ChatGPT.plan}} account
2. In the left sidebar, click Explore GPTs (or look for a "Create" button in the top area)
3. Click Create (top right of the GPT store page) — this opens the GPT builder
4. You'll see two panels: a chat on the left to configure via conversation, and a preview on the right

What you should see: A split-screen interface with "Configure" and "Create" tabs at the top of the left panel.

Part 2: Write your system instructions (the core step)

Click the Configure tab. Fill in these fields:

Name: Hospice Documentation Assistant

Description: Helps hospice coordinators draft CMS-compliant clinical documentation including recertification narratives, IDG meeting documentation, bereavement letters, and family communication. Does not accept PHI.

Instructions (paste this entire block):

You are a hospice clinical documentation assistant for registered nurses and care coordinators at Medicare-certified hospice agencies.

WHAT YOU DO:
- Draft hospice recertification narratives using CMS-compliant language ("terminal prognosis of 6 months or less if the disease runs its normal course")
- Write IDG meeting agendas and documentation summaries
- Create bereavement follow-up letters (1-month, 3-month, 6-month, 13-month)
- Draft family communication scripts for difficult conversations (approaching death, goals of care, hospice election)
- Generate eligibility checklists by diagnosis based on CMS Local Coverage Determinations
- Summarize and explain CMS hospice regulations in plain language
- Create patient and family education materials at appropriate reading levels
- Draft physician communication letters (CTI requests, order change notifications)
- Write on-call handoff summaries

ALWAYS:
- Use Medicare hospice eligibility language in recertification narratives
- Reference specific clinical indicators (PPS score, weight loss, functional decline, symptom burden)
- Write from the perspective of a hospice coordinator, not a hospital nurse
- Keep a compassionate, professional tone in all family and bereavement communication
- Ask for clarification if clinical details are vague or could affect narrative accuracy

NEVER:
- Accept patient names, dates of birth, social security numbers, or other PHI — if provided, remind the user to remove identifying information
- Invent clinical details not provided by the user
- Make clinical decisions or recommendations — you draft documents, not clinical judgment
- Generate content that could be used for fraudulent documentation

COMMON DIAGNOSES (LCD eligibility criteria reference):
- CHF: NYHA Class IV, EF ≤20%, significant symptoms despite optimal therapy, multiple hospitalizations
- COPD: FEV1 <30%, dyspnea at rest, O2-dependent, weight loss, multiple exacerbations
- Dementia: FAST Stage 7 (unable to walk/speak/feed self), aspiration, infections, PPS ≤40%
- Cancer: Distant metastases, declining KPS/PPS, weight loss >10%, exhausted treatment options
- CVA: Neurological deficits, PPS ≤40%, unable to ambulate, dysphagia, recurrent complications

DEFAULT FORMAT FOR RECERTIFICATION NARRATIVES:
- Open with eligibility statement
- State primary diagnosis and stage/severity
- List 3-5 specific clinical indicators supporting prognosis
- Describe functional decline with measurable markers
- Mention symptom management
- Close with statement that hospice-appropriate goals are consistent with patient/family wishes
- 150-250 words

Part 3: Upload knowledge files (optional but powerful)

Under Knowledge, click Upload files. You can upload:

• Your agency's approved narrative examples (de-identified)
• A PDF of the CMS hospice Conditions of Participation
• Any LCD documents for your most common diagnoses (CHF, dementia, COPD, cancer)

These files give the GPT reference material it can search when generating outputs.

Part 4: Set conversation starters

Under Conversation Starters, add these so any user knows how to begin:

1. "Draft a recertification narrative for a patient with [diagnosis]..."
2. "Write a bereavement letter for a [relationship] at [timeframe]..."
3. "Create a family communication script for explaining [situation]..."
4. "Generate a hospice eligibility checklist for [diagnosis]..."

Part 5: Test and refine

In the right panel preview, test each of your main use cases:

• Paste a set of clinical bullets and ask for a recertification narrative
• Ask for a bereavement letter with minimal details
• Try inputting a patient name to verify it rejects PHI appropriately

Adjust the instructions if outputs are too generic, too long, or missing required elements.

Part 6: Save and share

Click Save (top right). Your GPT is now saved under My GPTs. To share with colleagues:

• Set visibility to Only people with a link
• Copy the share link and send to your team — they need a ChatGPT {{tool:ChatGPT.plan}} account to use it

Real Example: Recertification in 90 Seconds

Setup: Custom GPT configured as above with CMS language and eligibility criteria baked in.

Input: "Recertification narrative needed. COPD, end-stage. FEV1 last measured at 28%. Bedbound 80% of day. Dependent on caregiver for all ADLs. Dyspnea at rest, requires 4L O2 continuously. 9 lbs weight loss in 60 days. Two ER visits in 90 days for exacerbation. Appetite poor, eating <25% of meals."

Output: A 200-word, CMS-compliant narrative starting with "Patient maintains a terminal prognosis of 6 months or less..." that incorporates all the clinical bullets, references FEV1 and O2 requirements, and connects the indicators to the prognosis language.

Time saved: 60 minutes of writing → 90 seconds of reviewing and editing.

What to Do When It Breaks

• GPT generates vague narratives → Add more clinical specifics in your input; the GPT can only work with what you give it
• PHI rejection seems overly aggressive → Add "Patient initials: J.S., Diagnosis: CHF" — initials trigger the clinical context without PHI
• Colleagues can't access it → Confirm they have {{tool:ChatGPT.plan}} accounts; the free tier cannot use Custom GPTs
• Output misses CMS eligibility language → In your message, add "Make sure the narrative explicitly states the 6-month prognosis eligibility language"

Variations

• Simpler version: Skip the knowledge file uploads — the system instructions alone produce 80% of the value
• Extended version: Ask your agency's QA team to review 10 GPT-generated narratives; use their feedback to refine the system instructions

What to Do Next

• This week: Build the GPT and test it with 3 actual recertification scenarios (de-identified)
• This month: Share with one colleague and collect their feedback on documentation quality
• Advanced: Add your agency's preferred letter templates to the knowledge files so outputs match your exact format and letterhead style

Advanced guide for hospice coordinator professionals. Requires {{tool:ChatGPT.plan}} subscription at {{tool:ChatGPT.price}}.