The Online Resource for Massachusetts Poverty Law Advocates

Request for Fair Hearing Form

Date: 
09/13/2007

Fair Hearing Request Form [FHR-1 (09/10)]

A form used by applicants and members who want to ask for a fair hearing.

Fair Hearing Request Form [English] (PDF)

How to Ask for a Fair Hearing/Fair Hearing Request Form [FHR/MCO-PCCBH-SCO (09/10)]

A form used by members who want to ask for a fair hearing and are enrolled in a managed care plan, managed care organization, the Primary Care Clinician (PCC) Plan's Behavioral Health Program, or a Senior Care Organization.

How to Ask for a Fair Hearing/Fair Hearing Request Form [English] (PDF)