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Critical Life-Sustaining Medical Equipment and Medical Emergency Form

This form is to be completed by the customer, patient or legal guardian, and the licensed medical personnel. Once enrolled, Moorhead Public Service (MPS) will flag the account with a medical alert. Placing the account on the medical alert list does not guarantee uninterrupted service. If the individual using life-sustaining equipment cannot be without power for any length of time, MPS recommends developing alternate plans. The medical certification is valid for six months from certification date.


Please click here for the PDF.

 
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