Delmarva Power Delaware Certification of Medical Need

Delmarva Power's Certification of Medical Need gives a Delaware household Medical Alert status when a licensed physician, physician assistant or advanced nurse practitioner certifies that terminating electric or gas service would adversely affect a patient's health or recovery. Once Delmarva approves it, the certification lasts 120 days. The customer stays responsible for all charges on the account.

Who completes it

The customer and patient complete page 1 (account, service address, patient name) and sign under oath, with a parent or guardian signing for a minor. The medical provider completes page 2: name, state license number, practice, office address and phone, and a signed certification.

Submitting and payment

How to submit it
Return the entire completed form to Delmarva Power's Revenue Recovery department by mail, fax or email.
Who pays
The form lists no fee for the provider's certification, and Medical Alert status does not reduce the customer's charges.

Good to know

  • By signing, the provider acknowledges they may be called to testify in any proceeding Delmarva brings to challenge the patient's medical need.
  • The provider also certifies under oath that the patient's address matches the primary residence in the provider's files.
  • The customer certifies the patient lives at the address full time and requires electric or gas service for a medical need.
  • Delmarva Power's Maryland customers use the state's Form PSC-801 instead of this Delaware certification.

Get the official form

Download the current version from the source each time; forms change without notice.

Certification of Medical Need

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

How this list is checked

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.

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Frequently asked questions

How long does Delmarva's Delaware Medical Alert last?

120 days from Delmarva's approval of the certification. During that time the customer is still responsible for charges on the electric or gas account; Medical Alert status does not remove the obligation to make payments.

Who can sign the Delmarva Certification of Medical Need?

A licensed physician, physician assistant or advanced nurse practitioner who has the patient under their care. The provider certifies under oath that the patient is so ill that terminating electric or gas service would adversely affect their health or recovery, and acknowledges they may be called to testify.