Section 11.14 - Form and Manner of Request for External Review(1) Requests for external review submitted by the Patient or the Patient's Authorized Representative shall:(a) Be on a form prescribed by the Office of Patient Protection;(b) Include the signature of the Patient or the Patient's Authorized Representative consenting to the release of medical information; and(c) Include a copy of the written resolution of the internal appeal issued by the RBPO or ACO.Adopted by Mass Register Issue 1373, eff. 9/7/2018.