APS Medical Care Program
* required information

Your health and safety is a top priority at APS.

We make special provisions for medical conditions that could be jeopardized by an interruption of electrical service. If you or someone living in your home relies on electrically-operated medical equipment, please let us know today, so we can send you information to prepare you in the event of an electrical outage.

* APS account number (nine digits)
* Your first name	* Your last name
* Service address line 1
Service address line 2
* City, state, zip ,
* Daytime phone number - -	E-mail address
* Patient's first name	* Patient's last name

* Medical condition
* Medical equipment Choose medical equipment Concentrator - Oxygen Cycler Dialysis Feeding - Intravenous Infusion Pump Left Ventricular Assist Device (LVAD) Nebulizer Suction Equipment Terminally Ill Ventilator Information not available Not applicable	* Frequency/duration of use Choose frequency/duration of use Continuously Hourly Daily Weekly Monthly Not applicable
* Attending physician
* Attending physician phone number - -
* Attending physician mailing address line 1
Attending physician mailing address line 2
* City, state, zip ,
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