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OR PROVIDER S WITNESS (ES) XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX RECIPIENTS INVLOVED: XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX DEPARTMENT REPRESENTATIVE MICHAEL BAER, MD DEPARTMENT WITNESS(ES) XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX CASE # XXXXXXXXXX DATE ADVERSE ACTION MAILED 4/5/2005 DATE SCHEDULING NOTICE MAILED BHA DOCKET NUMBERS/ISSUE CODES W05-1837/921 DATE APPPEAL RECEIVED DATE APPEAL RECEIVED POSTMARKED AT DPW AT BHA 5/3/2005 5/4/2005.

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