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To be completed by a registered physician, advanced practice registered nurse (aprn), or physician assistant (pa). Web thank you for partnering with us to certify your patient’s serious illness or infant protection status through our medical web portal at eversource.com/mdform. For your protection, all activity is logged. To get started, your patient must provide you with their utility billing account.
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This will require the registered physician, aprn or pa to use either eversource’s medical web portal at eversource.com/mdform or obtain a hard copy of the medical certification of illness form to submit to the utility. Each authorized staff person must create an individual. To get started, your patient must provide you with their utility billing account number and mailing Web.
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Web to access the portal, you will need an eversource.com user id and password. To be completed by a registered physician, advanced practice registered nurse (aprn), or physician assistant (pa). This will require the registered physician, aprn or pa to use either eversource’s medical web portal at eversource.com/mdform or obtain a hard copy of the medical certification of illness form.
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