Insurance Appeal Submission Log
Record when you sent appeal documents, how you sent them, and any confirmation numbers in a narrow, printable log.
Appeal submission log
Narrow column layout. Track what you sent, how, and any confirmation numbers.
| Submission Date | Insurance Company | Policy / Claim # | Appeal Type | Submission Method | Documents Included | Confirmation / Reference # | Status / Notes | Actions |
|---|---|---|---|---|---|---|---|---|
No validation applied. Empty values are allowed for partial records.
🔒 MANDATORY CODEX SAFETY FOOTER (INCLUDE VERBATIM)
Non-Negotiable Guardrails
- Do not modify global layout, header, footer, ads, analytics, or shared components
- Do not import @/components/ui/select or any unverified shadcn components
- Use native HTML inputs only
- Row add/remove buttons must be plain <button>
- No date math, no parsing, no calculations
- PDF builders must return Promise<Uint8Array>
- Always create Blobs using bytesToPdfBlob(bytes) from lib/pdf/bytes.ts
- Never include null in React-PDF style arrays
- No refactors
- Tool may only break itself
Safety notes
- Processing stays in your browser. PDFs generate locally—no uploads or accounts.
- Downloads use a secure PDF blob helper (no raw array buffers or workers required).
- Review details before sending; nothing here is legal advice or a substitute for local forms.