Medical Certification

If you or someone in your home has a serious illness or needs medical equipment, you might be able to get a Public Service Commission Medical Certification Form. This form tells the utility company that turning off your service could make a serious illness worse or stop you from using important medical equipment. A doctor, nurse practitioner, or physician assistant needs to sign the form, and then you send it to the utility company.

Having the signed form with the utility company is helpful. The most important thing is that the utility company has to know about the illness before they can turn off your service.

Download the Medical Certification Form.

Watch this 2-minute video to learn how to fill out the form. 

Benefits of a Medical Certification Form

There are benefits to having a Medical Certification Form on file with your utility company.

  • Verifying your well-being and providing assistance to you in the event of a weather-related emergency, as possible. However, submitting this form  won't give you priority to have your electricity turned back on faster.

  • There are extra protections in terms of terminations for non-payment. Termination can not happen until 2 personal attempts are made either:

    • In-person: Visiting and leaving a copy with an adult or if no one is home, leaving a copy at the premises.
    • Telephone: Call during business hours or if no one is home, during the evening after 6pm.
       

  • If you get a notice that your service will be shut off and ask for the Medical Certification Form, it will pause the shut-off for 30 days. During those 30 days, you need to set up a payment plan.

If you or someone in your home is medically vulnerable, you may consider sending this completed form over to your utility company.

 

Steps to get a Medical Certification Form on file with your utility

  1. Call your utility and tell them that there is a medical issue in the home and request a medical certification form.

  2. Get the form filled out and signed by your physician, nurse practitioner, or physicians assistant.

  3. Make at least 3 copies. One for yourself, one for your utility, and one for the Office of Home Energy Programs to include if you decide to apply for assistance.

  4. Call your utility company and tell them that you want to send them a completed medical certification form. Ask them where to send the form.

  5. After you send the utility the completed form, call to confirm with your utility that they have it on file.