The Of Dominion form represents a critical tool for customers with serious medical conditions, ensuring they have the necessary support and extensions for their utilities in emergencies. This document outlines a process wherein individuals can apply for a 10-day extension on their utility account if they, or a family member residing with them, rely on medical technology such as ventilators, dialysis machines, or enteral or parental nutrition support for their survival and well-being. By contacting Dominion Virginia/North Carolina Power at 1-866-DOM-HELP, customers initiate the submission of the Serious Medical Condition Certification Form by their physician, delineating the nature and extent of the medical necessity. The form serves multiple vital functions: it facilitates a temporary safeguard against the termination of electric service, while also stipulating that the possession of a medical note on an account doesn't absolve the customer of their financial obligations to the utility company. Moreover, it underscores the importance of having alternate care plans due to the unpredictable nature of service outages, especially during severe weather conditions. The document is meticulously designed to protect the interests of individuals with severe medical needs, offering a structured approach for applying for extensions, while also making provisions for financial hardships by encouraging customers to communicate with Dominion to explore possible payment arrangements. This approach not only empowers customers during challenging times but also highlights Dominion's commitment to accommodating the unique needs of its customer base.
| Question | Answer |
|---|---|
| Form Name | Form Of Dominion |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | serious medical condition form dominion power, dominion energy medical pdf form, dominion power form for medical, dominion medical condition online |