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How do I fill this out?
To fill out this application, gather your personal and medical information beforehand. Carefully follow each section, ensuring all required fields are completed accurately. Review the application before submission to ensure all information is correct.
How to fill out the Southern California Edison Medical Baseline Allowance?
1
Gather personal information such as your name and address.
2
Complete the medical information section with details about the patient.
3
Provide doctor verification of the medical condition.
4
Choose your preferred contact method for notifications.
5
Sign and date the application before submission.
Who needs the Southern California Edison Medical Baseline Allowance?
1
Individuals with chronic illnesses requiring medical devices.
2
Patients who use electricity for life-support machines.
3
Seniors who require additional heating or cooling for health.
4
Families with members suffering from severe medical conditions.
5
Residents with disabilities that need consistent power for medical reasons.
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1
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2
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4
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What are the instructions for submitting this form?
To submit the completed application, mail it to Southern California Edison Medical Baseline Department at P.O. Box 9527, Azusa, CA 91702-9954. Alternatively, you can also fax your completed application to 1-626-572-4218. Ensure to check the SCE website for any online submission options that might be available.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, stay updated on any changes or deadlines regarding the Medical Baseline Allowance application to ensure timely submission.
What is the purpose of this form?
The purpose of the Southern California Edison Medical Baseline Allowance Application is to provide households with additional support in energy consumption related to medical needs. This form enables eligible residents to apply for a supplemental energy allowance essential for health-related equipment. By completing this application, households can ensure they receive the necessary assistance for continued medical care.
Tell me about this form and its components and fields line-by-line.
- 1. SCE Customer Account Number: Your account number with Southern California Edison.
- 2. Service Account Number: Your specified service account number.
- 3. Customer's Name: Name of the customer as it appears on the bill.
- 4. Medical Baseline Patient Name: Name of the patient receiving the allowance.
- 5. Service Address: Address where the service is provided.
- 6. Mailing Address: If different, provide the mailing address.
- 7. Home Phone: Primary contact number.
- 8. Alternate Phone: Secondary contact number, if applicable.
- 9. Complex Details: Information for customers living in mobile home or apartment complexes.
- 10. Medical Device Requirements: Information regarding medically necessary electrical devices.
- 11. Doctor's Certification: Verification from a licensed medical practitioner.
- 12. Signature: Signature of the applicant certifying the information is accurate.
What happens if I fail to submit this form?
Failing to submit the form may result in the loss of essential financial assistance for your medical baseline needs. It is crucial to ensure that your application is correctly filled out and submitted on time to avoid interruptions in service.
- Loss of Medical Allowance: Not submitting the form can lead to the inability to receive a vital energy allowance.
- Interruption of Essential Services: Patients may experience power issues affecting their medical devices due to lack of assistance.
- Ineligibility for Future Assistance: Failure to re-certify may jeopardize your eligibility for future energy assistance.
How do I know when to use this form?
- 1. Initial Application for Medical Baseline: To apply for the Medical Baseline Allowance for the first time.
- 2. Annual Re-Certification: To confirm continued eligibility based on medical conditions.
- 3. Change of Resident or Address: Submit whenever there is a change in residence or the qualifying patient.
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You can download the application as a PDF after editing.
How can I ensure my application is complete?
Review the filled sections carefully; all mandatory fields must be filled.
What if I need to fill out the form for someone else?
You can complete the application on behalf of another person, but ensure accuracy.
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Download the finalized document and follow the submission instructions provided.
Are there fees associated with using PrintFriendly?
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What is the contact method for any application support?
You can reach out to SCE's customer service listed on the application for assistance.
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