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 Pge Medical Baseline 2018

Pge Medical Baseline 2018

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Baseline Allowance Self-Certification Request Form STEP 1 Account and Customer Information (please print) I understand that: PG&E CUSTOMER ACCOUNT NO 1. If the doctor certifies the resident’s medical condition is permanent, PG&E will require completion of a form self-certifying continued resident’s eligibility for Medical Baseline every two years. CUSTOMER NAME (as it appears on PG&E bill) MEDICAL BASELINE RESIDENT’S NAME (if different) SERVICE ADDRESS CITY APT # STATE CUSTOMER...
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