Portland General Electric's medical certificate program uses Form 143034, which Oregon rule OAR 860-021-0410 says only a licensed physician, nurse practitioner or physician assistant may complete and sign. The clinician documents the diagnosed condition, the electrical equipment or services needed, and how losing them would significantly endanger the patient's physical health. Enrolled customers get outage outreach, backup planning help and more flexible payment arrangements.
The customer enters name, address, PGE account number and phone. Sections A to H are completed by the licensed medical professional: credential, patient name and relationship to the customer, diagnosis, severity choice, equipment or services, how loss would endanger health, and name, license, signature, phone and date.
Download the current version from the source each time; forms change without notice.
Emergency Medical Certificate
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Only a qualified medical professional under OAR 860-021-0410: a licensed physician, nurse practitioner or physician assistant authorized to diagnose and treat. Section A asks the signer to check which of the three they are, and Section H records their name, title, license number and signature.
PGE says anyone whose qualified medical provider can affirm a medical need for electricity qualifies, including customers using equipment such as oxygen, those who need power to refrigerate medication such as insulin, and customers with extreme health risks or mobility concerns.
Yes. The same PDF includes the Spanish version, Certificado Médico de Emergencia, on page 2, with the same sections A through H for the licensed medical professional and the same submission options.