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| Appeal Type | [field-value] |
|---|
| Appeal Type |
|---|
Appellant And Respondent
Select the client lodging the appeal or indicate if it is the Organization.
| Appellant | Organization |
|---|
Select the client responding to the appeal or indicate if it is the Organization.
| Respondent | Organization |
|---|
Appealed Case Details
| Date Received |
| Receipt Method | |||
|---|---|---|---|---|---|
| Reason | Emergency | ||||
| Effective Date |
| Difficulty | |||
| Issue Receipt Notice |
| Continue Benefits |
|---|