Arizona Public Service uses this bilingual application to enroll households in its Medical Care Program, which sends advance notice of planned outages. A household qualifies when a member depends on life-sustaining medical equipment that would be especially dangerous to lose for more than four hours, or has a condition that substantially limits self-care or self-protection. The application must be renewed every year and after any move.
The customer completes section 1 (account, service address, phones, optional extra contact). A licensed medical professional, meaning an allopathic or osteopathic physician, registered nurse practitioner or physician assistant, completes section 2: patient name, eligibility met or not met, printed name, phone, date, signature, and state and license number.
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A licensed medical professional: an allopathic or osteopathic physician, a registered nurse practitioner, or a physician assistant. Section 2 asks for the professional's state and license number, phone number, signature and date, and a circled choice of eligibility criteria met or not met.
No. It notifies the household about planned outages, their status and the estimated restoration time. APS states it is not a discount program and does not guarantee uninterrupted service, and customers must keep paying their monthly bills to remain enrolled.
Yes. The PDF is bilingual, with the English application on page 1 and the Spanish Solicitud del Programa de Cuidado Médico on page 2. Both versions have the same customer section and licensed medical professional verification.