Customers in areas of Texas with retail electric competition use this PUCT-approved application to register a household member as a Critical Care or Chronic Condition Residential Customer. The physician certifies whether the patient depends on an electric-powered medical device to sustain life, or has a serious condition that needs such a device or electric heating or cooling. Approved status brings notices of service interruptions and certain disconnection protections.
The customer completes Part 1 on page 2: account and service details, the ESI ID, an emergency contact, and signatures from both the customer and the patient or guardian. The patient's physician completes Part 2 on page 3, answering both options and signing with a Texas Medical Board license number.
Page 1 lists each TDU with its phone, fax and email for questions and submission, and warns that applications that are incomplete, unreadable or improperly submitted will not be processed. It explains that submission does not automatically grant status, that status does not relieve the customer of paying for service, and that power is not guaranteed. The instructions tell the customer to complete page 2 and give the form to the physician, who completes page 3 and forwards only pages 2 and 3.
The customer enters the name on the electric account and the patient's name; the patient must live permanently at the service address and may be the same person as the customer. Next come the service address and mailing address if different, the ESI ID from the bill, and the TDU, circled from the list of seven-digit ESI ID prefixes. Primary and alternate phone numbers complete the block. All information on this page is required.
Enter an emergency contact's name, mailing address, city, state, ZIP code and phone, or write "I choose not to provide an emergency contact name." The form states the application will be rejected if this is left blank. It also warns that without an emergency contact, the TDU may disconnect service without notice if it cannot reach the customer and the bill is overdue.
The customer signs and dates a certification that the information is correct and that it may be used to decide eligibility for additional notices and protections, and to send notices to the emergency contact. The patient, or the patient's guardian, parent or managing conservator, then signs and dates a separate certification and agrees to release the medical information for these purposes. The form requires this second signature even when the patient and customer are the same person.
Copy the patient's name, customer name and ESI ID from page 2. Option 1 asks yes or no: is the patient dependent on an electric-powered medical device to sustain life? Option 2 asks whether the patient has a serious medical condition requiring an electric-powered medical device or electric heating or cooling to prevent impairment of a major life function through significant deterioration or exacerbation, and, if yes, whether it has been diagnosed as life-long. Answer every question.
Print the physician's name and Texas Medical Board license number, add phone and fax numbers, then sign and date. The closing instruction asks the physician to forward a faxed or electronic copy of the completed, signed application to the utility indicated in Part 1 on page 2, using the fax number or email address listed on page 1. Pages 2 and 3 are the only pages sent.
Download the current version from the source each time; forms change without notice.
Application for Chronic Condition or Critical Care Residential Customer Status
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On page 3, Option 1 asks whether the patient depends on an electric-powered medical device to sustain life, which is the critical care situation. Option 2 asks whether a serious medical condition requires an electric-powered device or electric heating or cooling to prevent impairment of a major life function, and whether that condition has been diagnosed as life-long. The physician answers yes or no to each.
No. The instructions say the application will not be approved unless the physician submits it by fax or email to the applicable TDU. The customer completes page 2 and gives the application to the physician, who completes page 3 and forwards only pages 2 and 3.
Yes. The PUCT's consumer page for chronic condition and critical care customers links both the English application and a Spanish version. Both use the same process: the customer fills in the account section and the physician completes and sends the certification to the utility.
No. Under PUCT rules, critical care or chronic condition status does not relieve the customer of the obligation to pay, and service may be disconnected for failure to pay. The status gives notifications of interruptions or suspensions and certain protections against suspension or disconnection.