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Doctor Checking a Form

Serious Medical Condition Form

"Serious medical condition" means a physical or psychiatric condition that requires medical intervention to prevent further disability, loss of function, or death. Such conditions are characterized by a need for ongoing medical supervision or the consultation of a physician. A serious medical condition carries with it a risk to health beyond that experienced by the majority of children and adults in their day-to-day minor illnesses and injuries. Individuals with a serious medical condition may require administration of specialized treatments and may be dependent on medical technology such as ventilators, dialysis machines, enteral or parenteral nutrition support, or continuous oxygen. Medical interventions may include medications with special storage requirements, use of powered equipment, or access to water.”

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The Code of Virginia 20VAC5-330 established guidelines or limitations on the termination of electric service to persons with serious medical conditions and provides the utility with a completed Serious Medical Condition Form. If you feel that you or a family member living with you qualify as having a serious medical condition you may print this form and have your physician complete the information required. The completed form must be returned to Prince George Electric Cooperative. Any form returned that is not complete will be returned to the customer.

Office & Mailing Address

Headquarters

7103 General Mahone Highway

Waverly, VA  23890

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DropBox

5718 Courthouse Rd

Prince George, VA  23875

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Walk-in Office Hours

Monday through Friday

9 a.m. to 4 p.m.

Contact

Phone:  804-834-2424

Fax: 804-834-8217

info@pgec.coop

Mailing Address

P.O. Box 168

Waverly, VA  23890

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©2023 by Prince George Electric Cooperative Electric Utility Provider in Waverly, VA

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