Virginia's State Corporation Commission developed Form SMCC under 20VAC5-330 so customers of regulated electric and water utilities can delay disconnection when a household member has a serious medical condition. A physician certifies the diagnosis, required treatment, prescribed equipment and expected duration. With the form on file, the utility must delay termination at least 30 days beyond the notice's expiration.
The customer completes account and contact details and signs; the patient, guardian or power of attorney authorizes the physician to release information to the utility and SCC. The physician (MD or DO) completes name, contacts, license number and state, diagnosis, treatment, equipment checklist, expected duration and signature.
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Serious Medical Condition Certification Form
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A physical or psychiatric condition that requires medical intervention to prevent further disability, loss of function or death, with a need for ongoing medical supervision or physician consultation. It may involve specialized treatments, dependence on technology such as ventilators or dialysis, medications with special storage, powered equipment, or access to water.
A physician, either an M.D. or D.O. The physician provides their current license number and licensing state, office contacts, the diagnosis, required treatment, any prescribed equipment and the expected duration, then signs. The patient's authorization lets the utility and SCC ask the physician related questions.
With the form filed, the utility must delay termination at least 30 calendar days beyond the expiration of the disconnection notice. A customer may use the delay twice within 12 months, and the two 30-day delays may run consecutively.