CiteNote — The coordination record that should have existed.

The coordination record
that should have existed.

For physicians who coordinate complex care. For attorneys who need to prove it.

Built for high-risk obstetrics. In Pennsylvania alone, OB malpractice premiums run $100–200K per physician per year. CiteNote creates the record that changes claim outcomes.

See it in action

Coordination happens.
Proof doesn't exist.

Every year, thousands of high-risk pregnant patients are discharged after complex medication decisions — transplant immunosuppression, fetal antiarrhythmics, anticoagulation — with no verified record that the right questions were asked.

The chart says "transplant aware." That is not a legal defense. CiteNote creates the record that should have existed.

Real cases from MFM rounding
Heart transplant patient, 37 weeks gestation
No documented peridelivery tacrolimus plan
Fetal SVT discharged on flecainide
No documented mirror syndrome surveillance protocol
Sickle cell patient, postpartum
No documented answer on prophylactic anticoagulation
01

Evidence retrieval

Queries FDA DailyMed, PubMed, LactMed, and specialty society guidelines (SMFM, AHA, AAN, ACR) for the specific drug-indication pair.

02

Structured synthesis

Four-domain clinical analysis: placental transfer, maternal outcomes, neonatal outcomes, and evidence gaps — with honest confidence tiering.

03

Ownership assignment

Generates specific, operationally precise questions for each consulting specialty team and notifies them via SMS or email.

04

Cryptographic seal

SHA-256 signed packet with a tamper-evident verification endpoint. Any modification after signing produces a different hash.

The discovery question that determines case value.

CiteNote coordination records are timestamped, cryptographically sealed, and physician-attributed. They answer the question directly: was the coordination documented, or wasn't it?

The PENDING banner, the specialist questions, and the response record are visible in a single URL — no chart review required. Any modification to the packet after signing produces a different hash. Non-repudiation is built in.

Request a sample packet for a case type you are currently litigating.

See a sample coordination packet →
What the record establishes

What evidence was available at the time of the clinical encounter — FDA label, PubMed literature, specialty society guidelines, LactMed

Which specialist teams were contacted and what specific questions were transmitted to each

Whether answers came back before care concluded — the PENDING or COMPLETE status is part of the sealed record

Who attested — physician name, role, and timestamp are covered by the SHA-256 signature and cannot be altered

Tacrolimus — 37-week cardiac transplant
Peer-reviewed evidence Signed & verified
Placental transfer
Crosses placenta; fetal levels ~50% of maternal. Neonatal immunosuppression risk documented in transplant registries.
Maternal outcomes
Therapeutic range narrows peridelivery. Peridelivery trough monitoring is recommended as delivery approaches, with frequency guided by transplant team protocol.
Neonatal outcomes
Transient renal impairment reported. NICU notification protocol recommended regardless of maternal level at delivery.
Evidence gaps
No RCT data on optimal trough target in third trimester. Current guidance extrapolated from registry series.
Transplant nephrology Confirm peridelivery trough target and dose adjustment protocol if level drops below 6 ng/mL Answered
Neonatology Confirm NICU acceptance criteria and neonatal immunosuppression monitoring plan Pending
MFM Document delivery timing decision relative to tacrolimus level trajectory Answered
SHA-256 a3f8c2d1e7b094...3f2a1c8d  ·  Verified  ·  Generated 2026-05-08T14:32:11Z

The analogy

"S&P doesn't do the investing — it certifies that financial instruments meet a standard of accountability. CiteNote does the same for clinical coordination."

The technical term

"Non-repudiation: cryptographic proof that a coordination event occurred, that cannot be altered after the fact. No EMR progress note provides this. A CiteNote packet does."

26+
Drug-indication combinations in evidence library
13
Real MFM inpatient cases validated against
4M+
High-risk obstetric consultations annually in the US
0
Existing tools that provide non-repudiation for clinical coordination
$8M–$32M
Recent PA OB malpractice verdict range
BL
Blake Laham PhD
Founder & CEO

I spent seven years at Princeton and Stanford discovering that pregnancy doesn't fail from a single cause — it fails when systems stop talking to each other. Coordination is everything, and medicine works the same way. When a high-risk patient has a transplant, a fetal arrhythmia, a clotting disorder — her outcome depends on whether the right specialists talked, reviewed the right evidence, and made a plan together. Right now, that coordination happens by phone call and text message, leaving no record of what was reviewed, no proof of what was decided, and no way to know if the standard of care was met. CiteNote makes that coordination visible, verifiable, and defensible — for the physicians who deserve credit for doing it right, and for the patients whose lives depend on it.

Request a 15-minute demo

We're launching our first clinical pilot with Philadelphia MFM practices. If you're an MFM physician, practice administrator, malpractice carrier, or attorney, we want to talk.

Thanks! We'll be in touch within 24 hours to schedule your demo.

Common questions

Is a CiteNote record part of the medical chart?
CiteNote generates a coordination summary designed to be pasted into the progress note, making it part of the chart. The signed packet with its verification URL can also be attached as a supplemental document. The treating physician controls what enters the chart.
Is this a clinical decision support tool subject to FDA regulation?
CiteNote is a coordination documentation tool. It retrieves evidence, generates questions for specialist teams, and creates a tamper-evident record of the coordination event. Every clinical decision is made and attested by a licensed physician. The system presents structured vocabulary for physician judgment — it does not make recommendations. CiteNote coordinates independent clinical validation of response options against cited evidence before they are presented to specialist physicians.
What happens when a specialist submits a response?
The specialist's response is sealed into a child packet linked to the original coordination record by hash. Their specialty, title, selected options, free-text guidance, and attestation timestamp are all cryptographically signed. The PENDING banner on the original record updates to show the response has been received. Both packets are accessible at their respective verify URLs.

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