Medical baseline allowance application - Customer Signature: Date: The standard medical baseline allowance is 0.822 therms of natural gas per day, which is in addition to your daily standard baseline allocation. If this allowance does not meet your medical needs, please contact SoCalGas at 1-800-427-2200 to discuss additional amounts. Hearing impaired customers who are unable to use …

 
The standard medical baseline allowance is 0.822 therms of natural gas per day, which is in addition to your daily standard baseline allocation. If this allowance does not meet your medical needs, please contact SoCalGas at 1-800-427 …. Mb motorwerks

Medical Baseline Allowance. Learn how to apply. Jobs/Careers. Find out about jobs at PG&E. Outages. View/Report Outage ... Learn about Medical Baseline. Vulnerable Customer Status. Is your health or safety at risk if your electric or gas service is disconnected? We’re here to help.Even with a O2 Pump working it's not close to what's used. $5 to $10 for XPAP and $20 for the O2 unit Max. My Electric bill is high, and it's $1400 a year ( With Air, Gas Heat) Jim. Use data to optimize your xPAP treatment! "The art of medicine consists in amusing the patient while nature cures the disease."Medical Baseline Allowance can apply to electricity and/or gas depending on what power is needed for the device and independent living needs. Customers who are eligible for Medical Baseline receive an additional allotment of electricity and/or gas per month.By Your Bill. Add a monthly fixed donation amount to your bill (ie. $5) or make a one-time donation in any amount. Call 1-800-205-8596. Expose as Block. No. Add Horizontal line. Off. Southern California Edison partners with the United Way to help qualified customers pay their electric bills – apply or donate today.Once you’ve completed an application and obtained verification from your licensed physician, surgeon or osteopath, an additional monthly medical allowance of 25 therms will be provided at the lowest (baseline) rate for hemiplegic / paraplegic / quadriplegic persons, multiple sclerosis / scleroderma patients and persons who are being treated for a life-threatening illness and have a ...Are you planning to apply for temporary disability benefits? Whether you are facing a medical condition or recovering from an injury, temporary disability benefits can provide cruc...The Standard Medical Baseline Allowance is 16.438 kWh of electricity and/or 0.82192 therms of natural gas per day, which is in addition to your daily standard Baseline Allocation. If this allowance does not meet your medical needs, please contact PG&E at 1 800 743 5000 to discuss additional amounts.Life insurance companies request medical records for the purpose of underwriting and verifying information that is contained on an application for insurance. Life insurance compani... For gas, it is 0.82192 therms per day (approx. 25 therms per month), an additional amount equal to three-quarters of the daily consumption of an average gas household. If these Medical Baseline allowances do not meet your medical energy needs, please contact PG&E at 1-800-743-5000. More information about the Medical Baseline program can be ... Apply Online. Download Medical Baseline Allowance Application. Download Medical Baseline Allowance Application (Spanish) To learn more, contact your local Liberty office at 800-481-9190 (electric customers only).Apply for or renew coverage | Washington State Health Care Authority. Find information about how to apply for or renew Apple Health (Medicaid) coverage.Achilles tendinitis occurs when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achill...YouTube Accounts - YouTube accounts, called YouTubers, allows people to upload, comment on and rate videos. Learn more about some of the different types of YouTube accounts. Advert...Qualifying Medical-Based Need ; Help Someone Avoid Disruption of Service ; Assistance for Those with Limited Vision; Referrals to Social Services Agencies ; One-time Assistance Bill Assistance ; Low Income Federal Financial Aid for Qualifying Customers ; Savings Center. Overview; Tips. Home Electrification; Take a Home Energy Survey ...Download and complete Part 1 of the application form. Ask your medical provider to complete Part 2 of the application. Send in the completed application form. Mail: SDG&E Medical Baseline Allowance Program Manager P.O. Box 129831 San Diego, CA 92112-9831 Email: [email protected]Looking to cash in on the summer’s coming travel boom, Amtrak is offering another buy-one-get-one-free discount for its roomette sleeper accommodation, which allows you to book a c...According to MedicineNet, NPO is a medical abbreviation that means nil per os, or nothing by mouth. It means that a patient isn’t allowed any food or drink for medical reasons, as ...Are you interested in a career that allows you to work remotely and offers great job security? Look no further than remote medical coding jobs. With the increasing demand for healt...No, The Medical Baseline Allowance is not a discount. All residential customers receive an allotment of energy every month at the lowest price available on their rate. This is called the Baseline Allowance. Customers who are eligible for Medical Baseline receive an additional allotment of electricity and/or gas per month. This helps to ensure ... Once you’ve completed an application and obtained verification from your licensed physician, surgeon or osteopath, an additional monthly medical allowance of 25 therms will be provided at the lowest (baseline) rate for hemiplegic / paraplegic / quadriplegic persons, multiple sclerosis / scleroderma patients and persons who are being treated for a life-threatening illness and have a ... Medical Baseline resident lives full-time at this address . Call phone number 2: and requires the Medical Baseline Program. I agree to allow Text mobile number 1: PG&E to verify this information. I also agree to notify PG&E promptly if the qualified resident moves or the resident no . Text mobile number 2: longer needs the Medical Baseline Program. The Standard Medical Baseline Allowance is 16.5 kilowatt-hours of electricity per day (0.822 therms of natural gas per day), which is in addition to your standard Baseline Allocation. If this allowance does not meet your medical needs, please contact An Internet application, sometimes called a rich Internet application, is typically an interactive program that can be accessed through a web browser. Different tools allow develop...Handy tips for filling out Sce medical baseline application online. Printing and scanning is no longer the best way to manage documents. Go digital and save time with airSlate SignNow, the best solution for electronic signatures.Use its powerful functionality with a simple-to-use intuitive interface to fill out Sce com medical baseline online, e-sign them, …The medical baseline forms agreed to by the joint utilities and DRA are the revised and newly titled Form No. 62-3481 - Medical Baseline Allowance Application, and the new Form No. 61-0502- Medical Baseline Allowance Self-Certification. The joint utilities and DRA agree that the existing Form No. 62-3481 - Declaration of Eligibility for a ...The Standard Medical Baseline Allowance is 16.5 kilowatt-hours of electricity per day (0.822 therms of natural gas per day), which is in addition to your standard Baseline Allocation. If this allowance does not meet your medical needs, please contact SCE at 1-800-447-6620 to discuss additional amounts. SCE 14-746 REV 1/19.Medical Baseline Allowance Program Overview. The Medical Baseline Allowance Program provides an additional amount of gas and electricity at the lowest rates for residential customers. It is not a discount or a rebate. Anyone who uses certain medical devices or needs space heating or air conditioning because of a medical condition may qualify.Medical Baseline program customers who are enrolled in an income-qualified program, such as the California Alternate Rates for Energy (CARE) or Family Electric Rate Assistance (FERA) programs, and live in a high fire risk area are also now eligible for the Critical Care Backup Battery Program, which provides a free, portable …The Standard Medical Baseline Allowance is 16.438 kWh of electricity and/or 0.82192 therms of natural gas per day, which is in addition to your daily standard Baseline Allocation. If this allowance does not meet your medical needs, please contact PG&E at 1 800 743 5000 to discuss additional amounts.The Medical Baseline Program, also known as Medical Baseline Allowance, is an assistance program for residential customers who depend on power for certain medical needs. Learn more in a short video. Customers interested in the program will find eligibility and application details on this page.2. If the doctor certifies the resident’s medical condition is not permanent, PG&E will require completion of a resident’s eligibility for Medical Baseline each year and completion of a new application with a doctor’s certification every two years. 3. If the resident has a vision disability, I may contact PG&E to request special ...Qualifying Medical-Based Need ; Help Someone Avoid Disruption of Service ; Assistance for Those with Limited Vision; Referrals to Social Services Agencies ; One-time Assistance Bill Assistance ; Low Income Federal Financial Aid for Qualifying Customers ; Savings Center. Overview; Tips. Home Electrification; Take a Home Energy Survey ... Calculate your Baseline Allowance for a billing cycle: Your daily amount of energy. x. The number of billing days. = Your Baseline Allowance for a billing cycle. Find the daily amount of energy allotted for your Baseline Allowance in the table below. Find the number of billing days on page 3 of your energy statement . View a sample statement. How to Apply. Apply Online. Download Medical Baseline Allowance Application. Download Medical Baseline Allowance Application (Spanish) To learn more, contact your local Liberty office at 1-800-782-2506 (electric customers only). for additional electricity at the baseline rate. Customers on the TOU-D PRIME rate may qualify for a flat 11% discount. For further information, you can visit sce.com or contact SCE by dialing 1-800-655-4555. How do I apply for MBL? You can apply to the Medical Baseline Allowance Program online, by mail, or with our assistance by phone. Application can be done online or by downloading and mailing the SCE Medical Baseline Allowance form. Participating in the program can help save on energy costs. Customers …1-800-DIAL-DWP (1-800-342-5397) Hearing/Speech Impaired (TDD) (1-800-432-7397) Send us an email. A discount on electric bills are available to customers who provide verification by a state-licensed physician that a full-time member of the household has a qualified medical condition.Achilles tendinitis occurs when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achill...Multiple Japanese medical schools were found to have been doctoring the scores of applicants to accept fewer females. Last year, news that a Tokyo university had for over a decade ...The Standard Medical Baseline Allowance is 16.5 kilowatt-hours of electricity per day, which is in addition to to your daily Standard Baseline Allocation. MORENO VALLEY UTILITY MEDICAL BASELINE ALLOWANCE APPLICATION (Used for Medical Baseline Enrollment and Re-Certification) PART 2: TO BE COMPLETED BY A LICENSED …Calculate your Baseline Allowance for a billing cycle: Your daily amount of energy. x. The number of billing days. = Your Baseline Allowance for a billing cycle. Find the daily amount of energy allotted for your Baseline Allowance in the table below. Find the number of billing days on page 3 of your energy statement . View a sample statement. The standard medical baseline allowance is 0.822 therms of natural gas per day, which is in addition to your daily standard baseline allocation. If this allowance does not meet your medical needs, please contact SoCalGas at 1-800-427-2200 to discuss additional amounts. MEDICAL BASELINE ALLOWANCE APPLICATION (Used for Medical Baseline Allowance Program Enrollment and Recertification) I understand that: 1. If a licensed …Medical Baseline program customers who are enrolled in an income-qualified program, such as the California Alternate Rates for Energy (CARE) or Family Electric Rate Assistance (FERA) programs, and live in a high fire risk area are also now eligible for the Critical Care Backup Battery Program, which provides a free, portable backup battery ...Customers who reside in high fire risk areas and are currently enrolled in our Medical Baseline Allowance program, and who require the regular use of electrically powered medical equipment or another qualifying medical device, are eligible for the Critical Care Backup Battery program.. If we have contacted you about this program, you may be …The standard medical baseline allowance is 0.822 therms of natural gas per day, which is in addition to your daily standard baseline allocation. If this allowance does not meet your medical needs, please contact SoCalGas at 1-800-427-2200 to discuss additional amounts.Overview. Benefits. Eligibility Requirements. Financial Criteria. Medical Criteria. Qualifying When Over the Limits. How to Apply. Before You Apply. Application …If you or someone in your household has a qualifying medical condition or a need for certain medical devices, you may qualify for the Medical Baseline Allowance Program. Apply today to see if you can receive more …Life insurance companies request medical records for the purpose of underwriting and verifying information that is contained on an application for insurance. Life insurance compani... MEDICAL BASELINE ALLOWANCE APPLICATION (Used for Medical Baseline Allowance Program Enrollment and Recertification) *A licensed Medical Doctor (M.D.), Doctor of Osteopathy (D.O.), Nurse Practitioner or Physician Assistant . may certify a patient’s eligibility as having a life-threatening condition or illness. For other languages: 1-888-427-1345. Hearing impaired (TDD): 1-800-252-0259. Eligibility requirements apply; see the program conditions for details. The Medical Baseline Allowance program provides additional natural gas at the lowest baseline rate for individuals with a serious health condition.The Standard Medical Baseline Allowance is 16.5 kilowatt-hours of electricity per day, which is in addition to to your daily Standard Baseline Allocation. MORENO VALLEY UTILITY MEDICAL BASELINE ALLOWANCE APPLICATION (Used for Medical Baseline Enrollment and Re-Certification) PART 2: TO BE COMPLETED BY A LICENSED …rate’s baseline price to support your qualifying medical devices. If you are on an electric rate without a baseline, you may be eligible to receive a flat 12% D-MEDICAL discount. If these Medical Baseline allowances do not meet your medical energy needs, please contact PG&E at 1-800-743-5000. More information about the Medical Baseline ...The Standard Medical Baseline Allowance is 16.5 kilowatt-hours of electricity per day, which is in addition to to your daily Standard Baseline Allocation. MORENO VALLEY UTILITY MEDICAL BASELINE ALLOWANCE APPLICATION (Used for Medical Baseline Enrollment and Re-Certification) PART 2: TO BE COMPLETED BY A LICENSED … The Standard Medical Baseline Allowance is 16.5 kilowatt-hours of electricity per day (0.822 therms of natural gas per day), which is in addition to your standard Baseline Allocation. If this allowance does not meet your medical needs, please contact SCE at 1-800-447-6620 to discuss additional amounts. SCE 14-746 REV 1/12. Once they sign off on the application, the baseline allowance will be added to your account. You can also print out a PDF copy of the application and complete it by hand. It will to be signed by a medical practitioner to certify the medical condition. Mail the completed and signed application form to: PG&E Attention: Medical Baseline P.O. Box 8329 Medical Baseline Allowance This program provides an increase in the baseline allowance, the amount of energy that is charged at the lowest possible rate. ... Both the customer and their doctor must complete a Medical Baseline Application. To learn more, call 760-247-6484. https://california.libertyutilities.com. Pacific Gas & Electric 1-800-743 ... Date Received: Medical Baseline Allocation: Electric unit(s) Gas unit(s) Recertification: c Self-certify every two years c Self-certify annually; medical provider’s certification every two years MAIL APPLICATION TO: SoCalGas Medical Baseline Allowance Program M. L. GT19A1 P.O. Box 513249 Los Angeles, CA 90051-1249 Fax: 213-244-4665 Applying for SSI requires 2 steps. You will need to complete the online Child Disability Report AND, with the help of a Social Security representative, complete an Application …The cervix is the lower end of the womb (uterus). It is at the top of the vagina. It is about 2.5 to 3.5 centimeters (1 to 1.3 inches) long. The cervical canal passes through the c...1-800-DIAL-DWP (1-800-342-5397) Hearing/Speech Impaired (TDD) (1-800-432-7397) Send us an email. A discount on electric bills are available to customers who provide verification by a state-licensed physician that a full-time member of the household has a qualified medical condition.Medical Baseline Allowance Application (Used for Medical Baseline Allowance Program Enrollment and Recertification) Part 2: To be completed by a licensed Medical Practitioner* (all of sections 1-5 must be filled out) I certify the medical condition and needs of my patient (please print): Patient’s Last Name: First Name: Customer Address: 1.Distilled water is a type of purified water that has undergone a distillation process to remove impurities and contaminants. This highly purified form of water is commonly used in ...agree to promptly notify SCE if the qualified resident moves or no longer requires the Medical Baseline Allowance. The Standard Medical Baseline Allowance is 16.5 kilowatt-hours of electricity per day (0.822 therms of natural gas per day), which is in addition to your standard Baseline Allocation. If you are on an electric rate without a ... Once you’ve completed an application and obtained verification from your licensed physician, surgeon or osteopath, an additional monthly medical allowance of 25 therms will be provided at the lowest (baseline) rate for hemiplegic / paraplegic / quadriplegic persons, multiple sclerosis / scleroderma patients and persons who are being treated for a life-threatening illness and have a ... Medical Baseline Allowance. If you or someone in your household uses electrically powered medical equipment, you may qualify for the Medical Baseline Allowance. This funding provides for an additional 16.5 kilowatt-hours (kWh) of electricity per day at the lowest baseline rate to help offset the cost of operating your medical equipment. Learn …promptly notify SCE if the qualified resident moves or no longer requires the Medical Baseline Allowance. The Standard Medical Baseline Allowance is 16.5 kilowatt-hours of electricity per day (0.822 therms of natural gas per day), which is in addition to your standard Baseline Allocation. If this allowance does not meet your medical needs ...MEDICAL BASELINE ALLOWANCE APPLICATION PAGE 9 OF 10 (Continued next page) X 2. Requires heating and cooling: Standard Medical Baseline Allowances are available for heating if patient is paraplegic, quadriplegic, hemiplegic, has multiple sclerosis or scleroderma. Standard Medical Baseline Allowances are also available if patient has a compromised1-800-DIAL-DWP (1-800-342-5397) Hearing/Speech Impaired (TDD) (1-800-432-7397) Send us an email. A discount on electric bills are available to customers who provide verification by a state-licensed physician that a full-time member of the household has a qualified medical condition.Customers who reside in high fire risk areas and are currently enrolled in our Medical Baseline Allowance program, and who require the regular use of electrically powered medical equipment or another qualifying medical device, are eligible for the Critical Care Backup Battery program.. If we have contacted you about this program, you may be …To apply for the Medical Baseline Allowance, your service must already be established. As a new customer, you can go online and follow these steps: Go to START OR STOP SERVICE and select New to PG&E. Provide your name and identification. Date Received: Medical Baseline Allocation: Electric unit(s) Gas unit(s) Recertification: c Self-certify every two years c Self-certify annually; medical provider’s certification every two years MAIL APPLICATION TO: SoCalGas Medical Baseline Allowance Program M. L. GT19A1 P.O. Box 513249 Los Angeles, CA 90051-1249 Fax: 213-244-4665 For gas, it is 0.82192 therms per day (approx. 25 therms per month), an additional amount equal to three-quarters of the daily consumption of an average gas household. If these Medical Baseline allowances do not meet your medical energy needs, please contact PG&E at 1-800-743-5000. More information about the Medical Baseline program can be ...Applying for SSI requires 2 steps. You will need to complete the online Child Disability Report AND, with the help of a Social Security representative, complete an Application …Medical Baseline Allowance Application (Used for Medical Baseline Allowance Program Enrollment and Recertification) Part 2: To be completed by a licensed Medical Practitioner* (all of sections 1-5 must be filled out) I certify the medical condition and needs of my patient (please print): Patient’s Last Name: First Name: Customer Address: 1.What is the Medical Baseline Allowance Program? The Medical Baseline Allowance Program provides an additional amount of gas and electricity at the lowest rates for residential customers. It is not a discount or rebate. In addition to your standard baseline allocation, the allowance received with the program is 16.5 kWh of electricity per day orof a form self-certifying continued resident’s eligibility for Medical Baseline Allowance each year and completion of a new . application with a medical provider’s certification every two years. 3 If the resident has a vision disability, the resident may contact SoCalGas to request special notification when either . re-certification (to ...To apply for the Medical Baseline Allowance program, fill out the customer section (Part 1) of the attached application. Next, have the patient’s qualifying medical professional complete and sign the remaining section (Part 2). Review the application to make sure it is complete and return it to: Southern California Edison Medical Baseline ...of a form self-certifying continued resident’s eligibility for Medical Baseline Allowance each year and completion of a new application with a medical provider’s certification every two years. 3 If the resident has a vision disability, the resident may contact SoCalGas to request special notification when either re-certification (to ...Qualifying Medical-Based Need ; Help Someone Avoid Disruption of Service ; Assistance for Those with Limited Vision; Referrals to Social Services Agencies ; One-time Assistance Bill Assistance ; Low Income Federal Financial Aid for Qualifying Customers ; Savings Center. Overview; Tips. Home Electrification; Take a Home Energy Survey ...Learn about the Medical Baseline Allowance, a program that helps eligible customers with medical conditions pay lower energy bills.MEDICAL BASELINE ALLOWANCE APPLICATION (Used for Medical Baseline Allowance Program Enrollment and Recertification) Part 2: To be completed by a licensed Medical Practitioner* (all of sections 1-5 must be filled out) I certify the medical condition and needs of my patient (please print): Patient’s Last Name: First Name: Customer …Become a member of the Psych Central medical network! Allow clients to find you with unique custom filters, including: Psych Central’s comprehensive medical integrity team will vet...Medical Baseline is a financial assistance program for eligible residential customers who have additional energy needs due to certain qualifying medical conditions. The Medical Baseline Program will increase a customer's baseline allotment, allowing them to use more energy at the lowest price for their chosen rate. If you are on a rate program ...your paper application to: PG&E Billing Center Medical Baseline, P.O. Box 8329, Stockton, CA 95208. STEP 4 Signature I certify the above information is correct. I also certify the Medical Baseline resident lives full-time at this address and requires or continues to require the Medical Baseline program.Medical Baseline Allowance Application (Used for Medical Baseline Allowance Program Enrollment and Recertification) Part 2: To be completed by a licensed Medical Practitioner* (all of sections 1-5 must be filled out) I certify the medical condition and needs of my patient (please print): Patient’s Last Name: First Name: Customer Address: 1.

Qualifications for the Medical Baseline Allotment include: Dependent on life-support equipment used in the home. A paraplegic, hemiplegic, quadriplegic, or multiple sclerosis patient with additional heating and/or air-conditioning needs. A scleroderma patient with additional heating needs. Being treated for a life-threatening illness .... 60 yard dash times by age

medical baseline allowance application

If someone in a household has multiple sclerosis, a life-threatening illness, is a paraplegic, quadriplegic, or requires regular use of life-support equipment, they may qualify for this additional allowance of electricity at the lower rate. Both the customer and their doctor must complete a Medical Baseline Application.The Standard Medical Baseline Allowance is 16.5 kilowatt-hours of electricity per day, which is in addition to to your daily Standard Baseline Allocation. MORENO VALLEY UTILITY MEDICAL BASELINE ALLOWANCE APPLICATION (Used for Medical Baseline Enrollment and Re-Certification) PART 2: TO BE COMPLETED BY A LICENSED …* La asignación estándar de Medical Baseline Allowance para los usuarios de gas de Santa Catalina Island será de 0.822 termias por día. Si usted o un integrante de su hogar requiere del uso regular de equipos médicos u otros dispositivos médicos elegibles que funcionan con electricidad, nuestro programa Medical Baseline AllowanceShare them with your qualified medical practitioner and explain that you need help with your application. Three: Your medical practitioner will use your unique code to complete their portion. Four: Once your application is processed, you’ll be enrolled in the program. Certain electric rate plans may be excluded.How to Apply. Apply Online. Download Medical Baseline Allowance Application. Download Medical Baseline Allowance Application (Spanish) To learn more, contact your local Liberty office at 1-800-782-2506 (electric customers only).Apply Now . Medical Baseline Allowance Application Form; Submit completed application: By Email: [email protected] By Fax: 877.349.3870 By Mail: MVU Payment Processing 380 N. San Jacinto St. Hemet, CA 92543 In Person: 14331 Frederick St. Suite 2 Moreno Valley Map LinkMEDICAL BASELINE ALLOWANCE APPLICATION PAGE 9 OF 10 (Continued next page) X 2. Requires heating and cooling: Standard Medical Baseline Allowances are available for heating if patient is paraplegic, quadriplegic, hemiplegic, has multiple sclerosis or scleroderma. Standard Medical Baseline Allowances are also available if patient has a …Medical Baseline Allowance. If you or someone in your household requires the regular use of electrically powered medical equipment or other qualifying medical devices, you may be eligible for our Medical Baseline Allowance program. This program provides an additional 16.5 kilowatt-hours (kWh) of electricity per day.Apply Now . Medical Baseline Allowance Application Form; Submit completed application: By Email: [email protected] By Fax: 877.349.3870 By Mail: MVU Payment Processing 380 N. San Jacinto St. Hemet, CA 92543 In Person: 14331 Frederick St. Suite 2 Moreno Valley Map LinkThe Standard Medical Baseline Allowance provides extra energy at the lowest price. Medical baseline allowances are added to your standard rate plan Baseline allocation. For electricity, it is 16.438 kWh per day (500 kWh per month). This additional amount is equal to the daily consumption of an average electric household.Your. medical practitioner will need to complete your paper application. Mail application to: PG&E Billing Center Medical Baseline P.O. Box 8329 Stockton, CA 95208. To request a paper application in large print or braille, please call. 1-800-743-5000. The Standard Medical Baseline Allowance is 16.438 kWh of electricity and/or 0.82192 therms of natural gas per day, which is in addition to your daily standard Baseline Allocation. If this allowance does not meet your medical needs, please contact PG&E at 1 800 743 5000 to discuss additional amounts. The Standard Medical Baseline Allowance is 16.5 kilowatt-hours of electricity per day, which is in addition to to your daily Standard Baseline Allocation. MORENO VALLEY UTILITY MEDICAL BASELINE ALLOWANCE APPLICATION (Used for Medical Baseline Enrollment and Re-Certification) PART 2: TO BE COMPLETED BY A LICENSED ….

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