SDG&E customers use this application to enroll in or renew the Medical Baseline Allowance, which adds 16.5 kWh of electricity or 0.822 therms of gas per day at the lowest rates, on top of standard baseline. Clinicians meet it when a patient depends on a home medical device or needs added heating or cooling. SDG&E will not process it without the signed practitioner section on page 2.
The customer, or the applicant if SDG&E does not bill them directly, completes and signs Part 1. A licensed MD, DO, nurse practitioner or physician assistant completes Part 2: practitioner details, the device checklist, five Yes or No questions and the signature.
Page 1 explains the program and sets the rules for filling out page 2. Answers must be printed clearly and inside each answer box, and the application must be signed. Use black or dark blue pen or dark pencil, and fully erase or white out mistakes, because crossed-out answers cannot be read. Incomplete or missing information prevents the application from being considered.
The customer gives the first 12 digits of the account number (including leading zeros), the account holder's name, and the patient's name if different. Customers not billed by SDG&E name their mobile home or apartment complex. The customer signs to certify that the Medical Baseline resident lives full time at the service address and requires the allowance.
The practitioner prints their name, medical license number, office address and phone number at the top of Part 2. The footnote confirms that a licensed MD, DO, nurse practitioner or physician assistant may certify. These details must match the signature at the bottom, since the form states that the medical license and signature must match the medical provider name.
Print YES inside the box for every electric-operated device the patient requires and leave inapplicable boxes blank. The grid lists compressors, apnea monitor, air mattress or hospital bed, nebulizers, electric nerve stimulator, feed pump, dialysis machines, IPPB machines, motorized wheelchair, cough assist vest, defibrillator, infusion pumps, oxygen concentrator, pacemaker monitor, pressure pads and pumps, respirator and suction machine, with a line for other electronic devices.
Print Yes or No for whether any of the checked devices are required for life support, and whether the patient can survive more than 2 hours without using life support equipment. SDG&E defines life support as a device used to sustain life or relied on for mobility that runs on gas or electricity from SDG&E or a Community Choice Aggregator.
Answer whether additional heating, and separately additional cooling, is necessary to sustain the patient's life or prevent deterioration of their medical condition. The last question asks whether the devices and/or added heating or cooling are required permanently. A Yes on permanence moves the household to four-year self-certification; a No means a renewal application with your certification every two years.
The statement reads 'I certify the medical condition and need of my patient.' Typing your name creates an electronic signature that the form treats as the legal equivalent of a manual signature. Add the date. On paper, sign clearly in dark ink inside the signature box, since signatures outside it may cause application errors.
Download the current version from the source each time; forms change without notice.
Medical Baseline Application (For Enrollment and Recertification)
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
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Yes. Part 2 states that a licensed Medical Doctor (MD), Doctor of Osteopathy (DO), nurse practitioner or physician assistant may certify a patient's eligibility. The practitioner enters their name, medical license number, office address and phone, and the form requires the license number and signature to match the named provider.
Yes. The certification line says that by typing your name you are signing the application electronically, and that the electronic signature is the legal equivalent of a manual one. The page also asks for signatures in dark ink inside the signature box when signing on paper, so either method must stay inside the box.
The checklist includes compressors, apnea monitors, air mattresses or hospital beds, electric nebulizers, electric nerve stimulators, feed pumps, hemodialysis and kidney dialysis machines, IPPB machines, motorized wheelchairs, cough assist vests, defibrillators, infusion pumps, oxygen concentrators, pacemaker monitors, pressure pads and pumps, respirators, suction machines and ultrasonic nebulizers. Therapy-only devices do not qualify.
SDG&E posts a Spanish fact sheet and application, and its program page also links versions for Chinese, Tagalog and Vietnamese speakers plus a large-font English form. The current English application carries the revision code S2570071 ENG 1125 and the tariff number 132-150.