If you disagree, explain why you disagree. State which exhibits support your
argument and explain why they do.
II. Were you convicted of an offense for which exclusion is required?
The I.G. argues that he must exclude you, because your conviction related to the
neglect or abuse of patients in connection with the delivery of a health care item or
service.
Do you disagree with the I.G.’s argument?
If you disagree, explain why you disagree. State which exhibits support your
argument and explain why they do.
III. Do you believe that an in-person hearing is necessary to decide your
case?
Do you have any testimony that you wish to offer at an in-person hearing?
If you have testimony that you wish to offer, provide the following:
No
Yes
No
Yes
No
Yes