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CONFIDENTIAL MEDICAL CERTIFICATE  Form

CONFIDENTIAL MEDICAL CERTIFICATE Form

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Instructions and help about CONFIDENTIAL MEDICAL CERTIFICATE

if you or anyone in your home has a serious illness or uses medical equipment you may be eligible for a medical certification form this form states that determination of utility service in your home would aggravate that serious illness or prevent you from being able to use that important medical equipment this form must be signed by a physician nurse practitioner or a physician assistant and then turn back into your utility company before any service termination while this form does not protect you from service termination indefinitely there are several benefits to having this information on file with your utility company step one is to let your utility company know that there is a serious illness or important medical equipment in your home and then ask them where to send the completed medical certification form next get this form signed by your medical professional and make a few copies for yourself lastly turn in that completed form to your utility company before any service terminat

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