HCVN ALS Appeal Form

Fill this form including all requirements you want to appeal. To do this, you must click on the “Add another response” tab at the end of this page for each additional requirement you want to appeal. Note ALS will process only one Appeal form (with all appealed requirements included) per submission.

Information on the Case

First Name

Last Name

Email

Report Title

Case Number

Type of Report

Version of report evaluated by Quality Panel

Appeal processed by

Appeal Detail

Please fill in the following fields for any Key Issue requirement you want to appeal:

Key issue.

Contested Quality Panel requirement.

Please copy/paste the verbatim QP requirement that is being contested and its number, for the Key Issue selected, into this box. Only one requirement per box.

Grounds for contesting the feedback.

Requirement raised by QP goes beyond what is required by relevant normative or guidance document (e.g. ALS manual, ALS report template, HCVRN Common Guidance, HCSA Toolkit)Requirement raised by QP contradicts relevant normative document or guidance document ((e.g. ALS manual, ALS report template, HCVRN Common Guidance, HCSA Toolkit)Information requested from the QP feedback is already present in the report

Explain why requirement raised by the QP is not relevant – quoting normative document(s) with page numbers.

Detailed justification (limit text to 800 words). Links can be for maps or images. Do not include links to text.

Directly quote guidance or normative document contradicted by the QP feedback including source and page number.

Detailed justification (limit text to 800 words). Links can be for maps or images. Do not include links to text.

Indicate page and paragraph (or figure) where the information is located in the contested Key Issue.

Detailed justification (limit text to 800 words). Links can be for maps or images. Do not include links to text.