PG&E customers use this two-part application to enroll in or recertify for the Medical Baseline Program, which adds a monthly energy allotment at the lowest price on their rate and extra alerts before Public Safety Power Shutoffs. A clinician meets it when a patient relies on a home medical device or needs added heating or cooling. The practitioner's Part B certification decides eligibility and how often the household recertifies.
The customer completes and signs Part A (Steps 1 to 4). A licensed physician, osteopathic physician, nurse practitioner or physician assistant completes and signs Part B (Step 5), the Medical Practitioner's Certification.
The customer enters the PG&E account number, their name as on the bill, the name of the resident with the medical condition, and the service address. Step 2 covers tenants billed by a mobile home park or apartment complex. Step 3 sets outage contact preferences for Public Safety Power Shutoffs, and Step 4 is the customer's signature certifying the resident lives at the address full time.
Part B opens with the patient's last and first name, then asks the practitioner to check Yes or No for whether the patient is on in-home hospice care. The patient named here should be the resident with the medical condition named in Part A, who must live at the service address full time.
Check Yes or No, then list up to three life-support devices used in the residence and mark whether each runs on electricity or gas. PG&E defines a qualifying device as one used to sustain life or relied on for mobility, such as oxygen concentrators, hemodialysis or kidney dialysis machines, suction machines, nebulizers, IPPB machines and motorized wheelchairs. Therapy devices do not qualify.
Standard allowances apply for heating or cooling when the patient has paraplegia, quadriplegia, hemiplegia, multiple sclerosis or scleroderma, or a compromised immune system, life-threatening illness or other condition where added heating or cooling is medically necessary to sustain life or prevent deterioration. Check Yes or No separately for additional heating and for additional cooling.
Certify how long the devices or additional heating or cooling will be required: enter a number of years or select Permanently. This choice drives recertification. A non-permanent certification means a new application with a practitioner's signature every two years, while a permanent one lets the customer self-certify every four years.
Print your name, phone number and office address, enter your medical state license or military license number, then sign and date. The footnote confirms that a licensed physician, a person licensed under the Osteopathic Initiative Act, a nurse practitioner or a physician assistant may certify. The customer's PG&E account number is repeated at the bottom of the page.
Download the current version from the source each time; forms change without notice.
Medical Baseline Program Application (For Medical Baseline Program Enrollment and Recertification)
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Sources for this guide
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Licensed physicians and surgeons, persons licensed under the Osteopathic Initiative Act, and nurse practitioners can certify Part B. Under PG&E's current practice, a licensed physician assistant working as part of the customer's physician team may also certify a patient as having a life-threatening condition or illness. Part B asks for a state or military license number.
The patient applies online and receives an email with a confirmation number of letters and numbers, which is case sensitive. The patient shares it with the practitioner, who goes to pge.com/medicalpractitioner, opens the application with that number, completes the required fields, signs and submits. PG&E then notifies the customer once enrollment is complete.
It depends on the duration the practitioner certifies in item 3. For a condition that is not permanent, the customer files a new application with practitioner certification every two years. For a permanent condition, the customer self-certifies every four years that the resident still lives at the address, with no practitioner signature needed.
PG&E lists paraplegic, hemiplegic or quadriplegic conditions, multiple sclerosis or scleroderma with heating or cooling needs, life-threatening illness or a compromised immune system needing added heating or cooling, and asthma or sleep apnea. Use of a qualifying life-support or mobility device, such as a respirator, dialysis machine or motorized wheelchair, also qualifies.