Physician Medical Form
It is important to us to serve the water needs of all of our customers. However, some customers have special needs that require a continuous supply of water for medical reasons. An interruption to that water supply could have serious health consequences.
To minimize the possibility of such a situation from occurring, the Authority has established a policy for identifying the needs of those who have critical care needs. The purpose of this policy is to convey in written form the criteria required to become a customer with a “Medical Alert” status.
Definition of Critical Care Need
For purposes of this policy, a critical care need for water is defined as stated below:
- “Critical” means that a continuous supply of potable water is necessary in order to maintain life and/or public health or safety. Life support systems, kidney dialysis facilities, home dialysis patients, hospitals and surgical centers are examples of customers who qualify for “Medical Alert” status.
Registering a Critical Care Need
In order to be considered for “Medical Alert” status, an application must be completed by you and your physician. The Authority will make the final determination if a “Medical Alert” status is warranted. All applications must be returned to email@example.com, or at the Authority office located at 11325 Brown Bridge Rd, Covington, GA 30016.
It is important that you notify the Authority with any contact information changes. The “Medical Alert” status will be reviewed and updated annually.
If a customer who has a “Medical Alert” status becomes delinquent and faces disconnection, they will receive an automatic twenty-four-hour extension in order to make sufficient payment. If no payment, or arrangement is made within that twenty-four-hour period, The Authority may place a flow restrictive device on the service, which will limit the amount of flow accessible to the home. This device will remain on the service until the account has been paid current. If the account remains delinquent and sufficient payments are not made, the account could then be terminated and the service locked.
For more information about our Medical Alert Policy, contact the Authority at 770-787-1375, or email firstname.lastname@example.org.