💡 Fax a Utility Shutoff Medical Form

Fax your medical form, $2.99

Call the Utility First

Before you send anything, call the customer service number on your bill or shutoff notice. Tell them that someone in the household is seriously ill and that a medical certificate is coming, and ask exactly where to send it, by fax, email or another route. Maryland's Office of People's Counsel gives the same advice: call your utility, ask where to send the certification, and then confirm that it is on file.

In Pennsylvania, this phone call matters on its own. If a utility worker is told before a shutoff that a household member is seriously ill and a certificate is on its way, the shutoff may not happen for at least 3 days. That gives you and your doctor a little time to get the form completed and faxed.

Who May Sign the Certificate

Each state sets its own rule for who may sign. In Pennsylvania and Maryland, it must be signed by a physician, a nurse practitioner or a physician assistant. In New York, the certification comes from a doctor or the local board of health. In Ohio, a licensed medical professional signs the 30-day medical certificate. If you live in another state, ask your utility or your state utility commission which professionals may sign.

In Pennsylvania, the certificate must be in writing, but it may be sent electronically, and electronic signatures are valid. It must show the account holder's name and address, the name of the ill person and their relationship to the account holder, how long the illness is expected to last, and the certifier's name, office address, phone number and signature. The state's guidance also asks for the certifier's license number. The utility may have its own form, but it may not be mandatory.

Fax your medical form, $2.99

How Long the Protection Lasts

Protection is limited in time. In Pennsylvania, one certificate lasts up to 30 days, and if the customer is not paying bills, the household is limited to two 30-day renewals for the same unpaid balance. In New York, if the condition lasts beyond 30 days, the doctor must renew the certification and you must show that you cannot pay. In Ohio, the 30-day certificate can be used up to three times in a rolling 12 months, and if it is received before 3:30 p.m., service is restored the same day.

Winter brings separate protections. In Pennsylvania, electric and gas utilities may not shut off customers with household income at or below 250% of the federal poverty level from December 1 through March 31. New York's cold weather period runs from November 1 to April 15. Use the protection period to set up a payment plan; in Pennsylvania the utility must offer one payment arrangement.

What to Put on the Cover Page and Each Page

Your cover page should show the utility's name and the department you were told to send it to, the account holder's name, the service address, the account number from the bill, your phone number, the words "Medical certificate to prevent shutoff", and the page count. If you received a shutoff notice, add it after the certificate so the utility can match the two.

Write the account number on each page and number the pages, for example 2 of 4. Keep the medical details on the certificate itself, not on the cover page. Your doctor's office may also fax the form directly to the utility; Pennsylvania's guidance says you or your medical professional should fax or email it directly to the utility.

Fax your medical form, $2.99

How to Send It, the Cost and Your Record

Open OverseasFax, select United States, and type the 10 digits of the utility's fax number with no leading 1. The +1 is added for you, a typed 1 is removed, and the pay button turns on only at 10 digits. The price is $2.99 for up to 3 pages and $0.99 for each extra page, so 4 pages cost $2.99 + $0.99 = $3.98. There is no account, and nothing is printed on your document. For phone users, see faxing from an iPhone or faxing from Android.

Delivery usually takes a few minutes. The confirmation email shows the destination number, the page count and the time it went through, in US Eastern Time, which is your record of exactly when it was sent. Call the utility afterward to confirm the certificate is on file. If the fax cannot be delivered, the full amount goes back to your card automatically. OverseasFax is not HIPAA compliant and does not sign a business associate agreement; it is meant for households sending their own form.

If the utility wants to fax you a payment agreement, our sister service GetAFax.com gives you a private US fax number for 24 hours for $5, for up to 30 pages, and each fax arrives in your email as a PDF.

Help With the Bill and State Contacts

For help paying a heating or cooling bill, apply through your local LIHEAP office. The federal LIHEAP office does not have application forms and does not accept applications; its referral hotline at (866) 674-6327 can point you to your local office. Each state sets its own rules, and some offices take online applications while others require you to come in person, so ask whether they accept fax before you send anything. For other housing paperwork, see faxing housing authority documents and faxing SNAP recertification documents.

If the utility will not accept your certificate, contact your state commission. In Pennsylvania, the PUC is at 1-800-692-7380. In New York, the PSC helpline is 800-342-3377 and the emergency hotline is 800-342-3355. In Ohio, the PUCO call center is 1-800-686-7826. More US forms are listed in the US fax guide.

Frequently Asked Questions

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