Pepco's Emergency Medical Equipment Notification Program in the District of Columbia uses this two-part form to identify customers who rely on electric medical equipment. The treating physician certifies the equipment, the condition it treats, daily use, backup power, and whether a power failure would place the patient in an immediate life-threatening emergency. Pepco uses it for outages, interruptions and terminations of service.
The account holder completes the Customer's Certification: account number, service location, patient name and signature. The treating physician completes the Physician's Certification: name, license, specialty, office details, last exam date, equipment and supplier, condition, hours and days of use, backup and manual operation, the required life-threatening checkbox, signature and date.
Download the current version from the source each time; forms change without notice.
Emergency Medical Equipment Notification Program (Customer's Certification and Physician's Certification)
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The treating physician. The certification states that the signer is a treating physician with personal knowledge of whether the patient has a serious illness or condition requiring electric medical equipment or life support, or one that interruption or termination of electric service would aggravate.
No. The program gives advance notice of planned outages and storms. It does not guarantee restoration priority or prevent disconnection for nonpayment. Pepco uses the certification to judge whether special circumstances apply to outages, interruptions or terminations, so the customer should still keep the account current.