Southern California Edison customers use this application to enroll in or recertify for the Medical Baseline Allowance, an extra 16.5 kWh of electricity per day at the lowest baseline rate plus automatic outage notifications. Clinicians meet it when a household member uses electrically operated medical equipment or needs heating or cooling for a medical condition. The practitioner's Part 2 decides eligibility and how often the household recertifies.
The customer completes and signs Part I on page 1. A licensed MD, DO, PA or NP completes and signs Part 2 on page 2, and SCE reserves the right to verify the information with the authorizing practitioner.
The customer gives the SCE customer and service account numbers, their name as on the bill, the Medical Baseline patient's name if different, the service and mailing addresses, and phones. Tenants billed by a mobile home park or apartment complex add the complex details. The customer picks outage alert methods (phone, text or email) and signs to confirm the resident lives at the address full time.
After printing the patient's last and first name, check Yes or No, then list up to three devices used in the patient's home and mark whether each runs on electricity or gas. SCE's list of qualifying devices includes respirators, oxygen generators and concentrators, dialysis machines, infusion pumps, suction machines, nebulizers, CPAP and apnea monitors, LVADs and motorized wheelchairs.
Check Yes or No separately for whether the patient requires the Standard Medical Baseline Allowance for heating and for cooling. The form explains these allowances are available when medically necessary to sustain the patient's life or prevent deterioration of the medical condition, that the device must run on SCE-supplied gas or electricity, and that therapy devices do not qualify.
Item 3 asks whether the patient is under hospice care, and item 4 whether the equipment is for life-support purposes; check Yes or No for each. Answer item 4 based on the devices listed in item 1, since SCE separates life-support equipment from devices used for therapy, which do not qualify.
Certify that the medical devices and/or added heating or cooling will be required for approximately a stated number of years, or check Permanently. This answer sets the recertification cycle: a non-permanent condition means a new application with a practitioner's certification every two years, while a permanent one lets the household self-certify every four years.
Print your name, phone and office address, then your state license or military license number. Sign on the line marked MD, DO, PA, NP signature only, and date it in mm/dd/yy format. The page notes that SCE reserves the right to verify information on the application with the authorizing physician.
Download the current version from the source each time; forms change without notice.
Medical Baseline Allowance Application (Used for Medical Baseline Enrollment and Re-Certification)
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.
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.
Sources for this guide
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Part 2 must be completed by a licensed Medical Doctor (MD), Doctor of Osteopathy (DO), Physician Assistant (PA) or Nurse Practitioner (NP). The signature line reads MD, DO, PA, NP signature only, and the practitioner gives a state license or military license number. SCE may verify the information with the authorizing practitioner.
When the customer applies online, they enter the medical professional's email address and SCE's DocuSign system emails the practitioner a request to complete and sign. SCE asks customers to alert their practitioner that the email is coming. Online recertification for non-permanent conditions also requires the practitioner's signature through the same route.
Recertification is required every two to four years. If the practitioner certifies the condition as not permanent, the household submits a new application with practitioner certification every two years. If certified permanent, the household self-certifies every four years on form 14-747, online or by phone, and no doctor's signature is needed.
SCE tells Kaiser Permanente members to use the mail application: download the form, complete all required fields including the medical device information, and submit it to their local KP Release of Information department. Members who started online are pointed to the same mail-in process.