Grievances & Appeals
Appointment of Representative
If you would like someone to represent you in your dealings with Medicare, you must sign and submit a written statement to Social Security. You may use Appointment of Representation CMS Form 1696 for this purpose. Appointment of Representation CMS Form 1696 (PDF)
For Participants, family members or their representative that may have questions about the enrollment process or status of their enrollment, please call (918) 949-9969. Download the LIFE PACE enrollment agreement here.