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Get an Appointed Representative
We are Ohio's Medicare Quality Improvement Organization, working with healthcare professionals to improve the quality of care for Ohio's 1.8 million Medicare beneficiaries.Our site offers resources and quality improvement information for providers, patients, and families. Welcome!


Any person you appoint, such as a family member, friend, or your doctor, may help you:
  • Request a coverage determination or an appeal
  • File a quality of care concern
You must first complete the “Appoint a Representative” form (Form Number 1696). For additional guidance, read the instructional document.
If you have questions about appointing a representative, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.





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