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Get Nicor Medical Certificate 2018-2024

A. Name and contact information for the certifying party b. Service address and name of patient c. A statement that the patient resides at the premises in question d. A statement that the disconnection of utility service will aggravate an existing medical emergency or create a medical emergency for the patient e. A Medical Professional is required to complete this form to prohibit disconnection of natural gas service to a residential customer due to certified medical necessity. Nicor Gas Accou.

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