GS - SHP Transcript Requests

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This form IS ONLY to be used when the Appellant is requesting a transcript to be included with the filing of Exceptions with the Department of Healthcare Policy & Financing's (HCPF) Office of Appeals.

Case Number

Appellant's First Name

Appellant's Last Name

Judge

Hearing Type

Date of Hearing

If Face to Face, indicate Hearing Location:

Hearing Started at:

Hearing Ended at:

The official recording of the hearing will be sent to Aapex Legal Services, LLC, a transcribing agency, to prepare the written transcript. The Department of Healthcare Policy and Financing will pay Aapex for the cost of the transcript and the cost of one copy for the Appellant/Petitioner.

The party stated that they have notified the Office of Appeals in writing (1570 Grant Street, Denver, CO 80203) that they are requesting a transcript and the new due date is:

New Due Date

The party stated that they will notify the Office of Appeals in writing that they are requesting a transcript and will further notify Aapex Legal Services by calling 303-532-7856 of the new due date as soon as it is received.

Prepared By

First Name

Last Name

Middle Initial

Suffix

Company

Address

City

State

ZIP

#####

Phone Number

###-###-####

Email Address

Contact Preference

You have selected traditional mail as your preferred contact method. This may result in delay in receipt of any procedural or final order. If you accept these terms, please check below. If you do not, please select "Email."

I accept

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