Insurance Appeal Document Submission Log PDF
Track every submission to your insurer during an appeal with dates, methods, and confirmation numbers.
Submission log
Table layout only. Track what you sent, when, and how.
| Submission Date | Insurance Company | Appeal / Claim ID | Document Submitted | Submission Method | Confirmation / Reference # | Notes | Actions |
|---|---|---|---|---|---|---|---|
Add or remove rows as needed. Keep every submission documented.
🔒 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.