Edison medical baseline application: Fill out & sign online

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Click ‘Get Form’ to open the sce medical baseline application in the editor.
Begin by filling out Part I, which includes your SCE Customer Account Number and Service Account Number. Ensure that all information matches what appears on your bill.
Provide the customer’s name, service address, and mailing address if different. Include home and alternate phone numbers for contact purposes.
If applicable, complete the section for customers billed by someone other than SCE, including details about the mobile home or apartment complex.
In the alternate contact information section, select your preferred method of receiving outage notifications and provide the necessary contact details.
Review the understanding section carefully. Confirm that you understand the requirements for certification and sign at the bottom of Part I.
If required, have a licensed medical professional complete Part II of the form, certifying your medical needs and device usage.

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Versions	Form popularity	Fillable & printable
2019	4.9 Satisfied (52 Votes)
2015	4.3 Satisfied (88 Votes)
2013	4.3 Satisfied (283 Votes)
2012	4.2 Satisfied (141 Votes)

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