HHS Federal External Review Request Form – Please use this form to provide general information on your request for an external review:
HHS-Administered Federal External Review Request Form
HHS Federal External Review Process Appointment of Representative Form – If you would like to have another person make an external review request on your behalf, both you and your authorized representative will need to complete and sign this form. Section 1 of the form is an Appointment of Representative section that must be completed and signed by you, the Claimant. Section 2 of the form is an Acceptance of Appointment section that must be completed and signed by the representative.
Appointment of Representative Form