Broward > Grievance/Appeals

For our members convenience we have included the following forms in Adobe Acrobat PDF format. Each form contains instructions on the form submission process.

• Grievance Form
• Exception Process
• Appointment of Representative/
  Designation of Healthcare Surrogate Form
• Medicare Redetermination Request Form
• Request for Medicare Prescription Drug Coverage
  Determination Form

Adobe Reader can be downloaded for free from: http://www.adobe.com/products/acrobat/readstep2.html