PRINTMEDICAL VERIFICATION FORMACCOUNT NUMBER:(14digit Number from City of Lubbock Utilities bill)ACCOUNT NAME:SERVICE ADDRESS:DAYTIME PHONE:StreetCityStateZip(Area code) xxxxxxI certify that the termination of electric service would disrupt the use of life support equipment and would createa medical emergency forDOBPatient Namewho is a permanent (mm/dd/yyyy)resident at the above address.Type of equipment utilized:Number of hours in use per day:Physician Name:Physician Phone Number:P.
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How to fill out the TX Medical Verification Form - Lubbock City online
Filling out the TX Medical Verification Form for Lubbock City is an essential step for individuals who rely on life-sustaining medical equipment. This guide provides clear, step-by-step instructions to help you navigate the online form with confidence.
Follow the steps to complete the form accurately and efficiently.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In the first section, enter your account number, which is a 14-digit number found on your City of Lubbock Utilities bill. This information is essential for identifying your utility account.
- Next, fill in the account name as it appears on the utility bill, along with the full service address, ensuring that each field is completed accurately.
- Provide your daytime phone number, including the area code, in the designated section for quick contact if needed.
- In the medical verification section, certify the necessity of continued electric service due to the use of life support equipment. Enter the full name of the patient and their date of birth in the specified formats.
- List the type of equipment utilized and indicate the number of hours it is in use each day, giving a clear picture of the medical necessity.
- Input the physician's name, phone number, and license number to ensure all medical claims are verified by qualified personnel.
- Date the form and have the physician sign it to validate the information, ensuring it is completed before submission.
- Review all entries for accuracy and completeness. Once verified, you can save changes, download, print, or share the completed form according to your needs.
Complete the TX Medical Verification Form online today to ensure your medical needs are met.
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What is the phone number for the city of Lubbock customer service?
Report Services The 311 Call Center is open Monday through Friday from 7:30 a.m. to 5:30 p.m. 311 customer service representatives are knowledgeable, friendly and ready to help!
How do I report an issue to the city of Lubbock?
311 is an easy-to-remember telephone number that connects citizens with specially-trained customer service representatives ready to assist with City service requests: potholes, stray animals, downed street signs, trash collection or other City requests.
What number is 806 775-2509?
Electric 24-hour Emergency Service: Text or email your name, address and outage information to LightsOut@LPandL.com or call 806-775-2509. Due to increased call volume in the event of an outage, customers may experience longer than normal hold times. We encourage customers to text or email.
How do I check the status of my power outage in Texas?
You can report a power outage or check the status of a previously reported power outage via our online reporting tool. You can also call us at 888.313.4747. If you have signed up for My Oncor Alerts, text OUT to 66267 (ONCOR).
How do I report an outage to the city of Lubbock?
ELECTRIC OUTAGE: To report an electric outage, email or text Lubbock Power & Light at LightsOut@LPandL.com or you may call (806) 775-2509.
What is the phone number for City of Lubbock utilities payment?
Welcome to City of Lubbock Utilities If you have your account number, call 806-775-3409 to use the automated EZ-PAY system, or click "Pay My Bill" below to pay online. No waiting required, and available 24/7 at home or on the go.
What number is 806-775-2509?
Electric 24-hour Emergency Service: Text or email your name, address and outage information to LightsOut@LPandL.com or call 806-775-2509. Due to increased call volume in the event of an outage, customers may experience longer than normal hold times. We encourage customers to text or email.
How do I report a power outage near me?
If a utilities issue and you are in Los Angeles Department of Water & Power (LADWP) territory (City of Los Angeles), visit LADWP.com Outage Information page or call 1(800) 342-5397.
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