Yes! You can use AI to fill out Medical Baseline Allowance Application (Used for Medical Baseline Enrollment and Re-Certification)
Don't type 71 fields by hand. Tell our AI about yourself, or upload your insurance card, and it fills every field in seconds. You check it, then download, print or sign.
The AI does the filling. You just check it.
No typing into boxes, nothing to install.
What this form asks for
The AI fills all of it, from your answers or your documents.
The AI checks your answers before you download
14 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.
Verifies that essential customer details in Part 1, including 'Customer’s Name', 'SCE Customer Account No.', 'Service Address', 'Customer Signature', and 'Signature Date', are all filled out. Missing any of this core information makes it impossible to identify the account or validate the customer's consent. The application would be considered incomplete and returned to the customer for correction.
Ensures all required fields in Part 2 are completed by the medical professional, including their name, state license number, signature, and the date of signature. This section provides the medical justification for the allowance. An incomplete certification invalidates the medical claim, leading to the application's rejection.
This check validates that if the 'Name of Medical Baseline Patient at Residence (if different)' field is filled in Part 1, it matches the patient's first and last name entered in Part 2. This consistency is crucial to ensure the application is for the correct individual throughout both sections. A mismatch would require clarification and delay the approval process.
This check validates that if the 'Name of Medical Baseline Patient at Residence (if different)' field in Part 1 is left blank, the patient's name entered in Part 2 matches the 'Customer's Name' from Part 1. This logic correctly assumes the account holder is the patient unless specified otherwise. A mismatch would indicate a data entry error and require clarification before the application can be processed.
This check validates that if the medical professional indicates 'Yes' for 'Requires use of electrically-operated medical devices', at least one device name is specified in the subsequent fields. Without a device listed, the 'Yes' certification is unsubstantiated. Failure to provide device details will result in the application being flagged for clarification or rejection.
Validates that for the duration of need in Part 2, either the 'Permanently' checkbox is selected OR the 'No. of Years' checkbox is selected and a corresponding number is entered, but not both. This prevents ambiguity regarding the re-certification schedule. An invalid, dual, or empty selection would require clarification and delay processing.
And 8 more checks
- Valid and Plausible Signature Dates
- Logical Chronology of Signatures
- SCE Account Number Format Validation
- Conditional Provision of Outage Notification Details
- Valid E-mail Address Format
- Mutually Exclusive Selections in Certification Questions
- Dependent Field Completion for Tenant/Complex
- Standard Phone Number Structure
Let AI fill out your SCE 14-746
No typing. Every field filled in seconds, checked, ready to sign.
How to Fill Out SCE 14-746 Online for Free in 2026
What the AI walks you through.
- Navigate to Instafill.ai and upload or select the SCE 14-746 Medical Baseline Allowance Application.
- Use the AI assistant to fill out Part 1 with your SCE customer account information, service address, and contact details.
- If you are a tenant or live in a multi-unit complex, provide the requested information for your landlord or complex manager.
- Indicate your preferred method for receiving outage notifications from SCE, such as by phone, text message, or email.
- Review the customer certification, then electronically sign and date the application in Part 1.
- Securely share the partially completed form with your licensed medical provider (MD, DO, PA, or NP) for them to complete and sign Part 2, certifying the medical need.
- Once both parts are complete, download the final document and mail it to the Southern California Edison Medical Baseline Department at the address provided on the form.
Common Mistakes in Completing SCE 14-746
The ones the AI is built to catch.
Entering an Incorrect Account Number
Customer Name Does Not Match Utility Bill
Submitting an Incomplete Medical Certification (Part 2)
Missing Doctor's Signature or License Number
Confusing Service Address with Mailing Address
Forgetting the Customer Signature and Date
Misunderstanding the Heating/Cooling Allowance Criteria
Vague or Unspecified Medical Device Information
Incorrectly Filling the 'Billed By Someone Other Than SCE' Section
Incomplete Outage Notification Setup
Submitting an Illegible Handwritten Form
Frequently Asked Questions About SCE 14-746
Is it really free for 7 days?
Can I fill other forms too?
How do I cancel?
How does the AI fill out SCE 14-746?
What happens to my information?
How complex is SCE 14-746 to fill out?
What is the purpose of the SCE Medical Baseline Allowance Application?
Who needs to fill out this form?
What benefit does the Medical Baseline Allowance provide?
Where can I find my SCE Customer and Service Account numbers?
How often do I need to re-apply for this program?
Does this program guarantee my power will not be shut off during an outage?
What if I live in an apartment and my landlord pays the SCE bill?
What kind of medical equipment qualifies for the allowance?
Where do I send the completed application?
Can AI tools help me fill out this form?
How can I fill this form out online if it's a PDF?
What should I do if the PDF form I downloaded is not fillable?
How will I be notified of power outages if I'm on this program?
Get your SCE 14-746 filled out by AI
$0 today. Cancel before Nov 18 and you pay nothing.
Other forms like this one
medical forms: Form OWCP-915, Claim for Medical Reimbursement, Form 8994, Employer Credit for Paid Family and Medical Leave, Form OF-178, Certificate of Medical Examination, Form N-648, Medical Certification for Disability Exceptions, U.S. Coast Guard Form CG-719K, Application for Medical Certificate, The Department of Medical Assistance Services Applied Behavior Analysis Preservice Service Authorization Request Form (Effective Dates of Service 09/01/2025 and after), State of Illinois Department of Children and Family Services Medical Report on an Adult in a Child Care Facility (CFS 602), Carer Payment and Carer Allowance – Medical Report (SA431) for a child under 16 years, Medically Prescribed Treatment (Non-Medication) Form — Provider Treatment Order Form | Office of School Health | School Year 2025–2026, VA Form 10-7959f-2, Foreign Medical Program (FMP) Claim Cover Sheet, Department of Medical Assistance Services Applied Behavior Analysis (97155, Et al.) Initial Service Authorization Request Form, Applied Behavior Analysis Concurrent Service Authorization Request Form (CPT Codes 97153, 97154, 97155, 97156, 97157, 97158, 0373T) – Virginia Department of Medical Assistance Services, Department of Medical Assistance Services Enhanced Services Individual Service Plan (ISP) Template, Form DS-1843, Medical History and Examination for Individuals Age 12 and Older, Scheduled Medical Leave of Absence (MLOA) - BLET 13, Admissions Application, School of Diagnostic Imaging, Mills-Peninsula Medical Center, Albany Medical Center 2024 Benefits Guide, Form BWC-1141, Request for Medical Information, VA Form 21P-8416, Medical Expense Report, Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, CMS-855S
VA medical forms: Form OWCP-915, Claim for Medical Reimbursement, Form 8994, Employer Credit for Paid Family and Medical Leave, Form OF-178, Certificate of Medical Examination, Form N-648, Medical Certification for Disability Exceptions, U.S. Coast Guard Form CG-719K, Application for Medical Certificate, The Department of Medical Assistance Services Applied Behavior Analysis Preservice Service Authorization Request Form (Effective Dates of Service 09/01/2025 and after), State of Illinois Department of Children and Family Services Medical Report on an Adult in a Child Care Facility (CFS 602), Carer Payment and Carer Allowance – Medical Report (SA431) for a child under 16 years, Medically Prescribed Treatment (Non-Medication) Form — Provider Treatment Order Form | Office of School Health | School Year 2025–2026, VA Form 10-7959f-2, Foreign Medical Program (FMP) Claim Cover Sheet, Department of Medical Assistance Services Applied Behavior Analysis (97155, Et al.) Initial Service Authorization Request Form, Applied Behavior Analysis Concurrent Service Authorization Request Form (CPT Codes 97153, 97154, 97155, 97156, 97157, 97158, 0373T) – Virginia Department of Medical Assistance Services, Department of Medical Assistance Services Enhanced Services Individual Service Plan (ISP) Template, Form DS-1843, Medical History and Examination for Individuals Age 12 and Older, Scheduled Medical Leave of Absence (MLOA) - BLET 13, Admissions Application, School of Diagnostic Imaging, Mills-Peninsula Medical Center, Albany Medical Center 2024 Benefits Guide, Form BWC-1141, Request for Medical Information, VA Form 21P-8416, Medical Expense Report, Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, CMS-855S
Medi-Cal forms: Form OWCP-915, Claim for Medical Reimbursement, Form 8994, Employer Credit for Paid Family and Medical Leave, Form OF-178, Certificate of Medical Examination, Form N-648, Medical Certification for Disability Exceptions, U.S. Coast Guard Form CG-719K, Application for Medical Certificate, The Department of Medical Assistance Services Applied Behavior Analysis Preservice Service Authorization Request Form (Effective Dates of Service 09/01/2025 and after), State of Illinois Department of Children and Family Services Medical Report on an Adult in a Child Care Facility (CFS 602), Carer Payment and Carer Allowance – Medical Report (SA431) for a child under 16 years, Medically Prescribed Treatment (Non-Medication) Form — Provider Treatment Order Form | Office of School Health | School Year 2025–2026, VA Form 10-7959f-2, Foreign Medical Program (FMP) Claim Cover Sheet, ABA Authorization Request (Medi-Cal) – Initial and Concurrent Requests, Department of Medical Assistance Services Applied Behavior Analysis (97155, Et al.) Initial Service Authorization Request Form, Applied Behavior Analysis Concurrent Service Authorization Request Form (CPT Codes 97153, 97154, 97155, 97156, 97157, 97158, 0373T) – Virginia Department of Medical Assistance Services, Department of Medical Assistance Services Enhanced Services Individual Service Plan (ISP) Template, Form DS-1843, Medical History and Examination for Individuals Age 12 and Older, Scheduled Medical Leave of Absence (MLOA) - BLET 13, Admissions Application, School of Diagnostic Imaging, Mills-Peninsula Medical Center, Albany Medical Center 2024 Benefits Guide, Form BWC-1141, Request for Medical Information, VA Form 21P-8416, Medical Expense Report
enrollment forms: Form CMS-855O, Medicare Enrollment Application, Form CMS-4040, Request for Enrollment in Medicare Part B, Form CMS-40B, Application for Enrollment in Medicare Part B, Providence Health Plan Out-of-Area Dependent Enrollment Form, Empower Enrollment Form, Empower Enrollment Form, Principal Life Insurance Company UCTIE INTERNATIONAL UNION 401(K) SAVINGS PLAN Enrollment Form, Enrollment Application, Northwell Residents Open Enrollment Benefits Guide 2026, University of Colorado 403(b) Plan – DSW Scudder Enrollment and Beneficiary Designation Form, Merrill Funds Transfer Service Enrollment Form, Funds Transfer Service Enrollment Form, Standing Letter of Authorization / Instruction Enrollment Form, Merrill RMD Service Enrollment and Authorization Form, Fidelity Investments Account Application/Enrollment Form and Beneficiary Designation, MyMerrill® Client Order Entry Enrollment Form, CMS-855I, Medicare Enrollment Application for Physicians and Non-Physician Practitioners, Form CMS-855R, Medicare Enrollment Application - Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits
enrollment application forms: Form CMS-855O, Medicare Enrollment Application, Form CMS-40B, Application for Enrollment in Medicare Part B, Enrollment Application, Fidelity Investments Account Application/Enrollment Form and Beneficiary Designation, CMS-855I, Medicare Enrollment Application for Physicians and Non-Physician Practitioners, Form CMS-855R, Medicare Enrollment Application - Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, CMS-855S, CMS-855B, Medicare Enrollment Application for Clinics/Group Practices and Other Suppliers, CMS-855A, Medicare Enrollment Application for Institutional Providers, Form CMS-855A, Medicare Enrollment Application for Institutional Providers, Medicare Enrollment Application - Medicare Diabetes Prevention Program (MDPP) Suppliers, Form CMS-20134, Form HFS 2243, Provider Enrollment Application Illinois Medical Assistance Program, Provider Enrollment Agreement (OHA 3975), Oregon Medicaid ID Application Form, Blue Cross and Blue Shield of Texas Group Enrollment Application/Change Form, Form CMS-40B, Application for Enrollment in Medicare Part B (Medical Insurance) (01/24), Form CMS-18-F-5, Application for Medicare Part A (Hospital Insurance)
certification forms: Form HS 200, Licensure & Certification Application, W-9, Request for Taxpayer Identification Number and Certification, Form WH-380-E, Certification of Health Care Provider, Form WH-385, Certification for Serious Injury or Illness, Form WH-380-F, Certification of Health Care Provider, Form WH-385-V, Certification for Serious Injury or Illness, Form 8802, Application for U.S. Residency Certification, Form I-905, Application for Authorization to Issue Certification for Health Care Workers, Form N-648, Medical Certification for Disability Exceptions, Form 01-339, Texas Sales and Use Tax Resale Certificate / Texas Sales and Use Tax Exemption Certification, Dakota County CDA New Admissions Informal Review Request Form (Housing Choice Voucher Program) and HUD Form 5382, Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking, and Alternate Documentation, NJ Department of Labor & Workforce Development Form MW-562, Payroll Certification for Public Works Projects (Contractor and Subcontractor’s Weekly and Final Certification), ROTC Cadet Academic Plan / Degree and Credit Hour Worksheet (Student Identification, Term-by-Term Courses, GPA Summary, and Completion Certification), Certification for Special Assessment (Office of Building, Planning, & Code Compliance, City of Knox, Indiana), Outpatient Behavioral Health (BH) – ABA Treatment Request: Required Information for Precertification (GR-69017-4), Form W-9, Request for Taxpayer Identification Number and Certification, 401(k) Program Rollover Certification, WTIA 401(k) Plan Rollover Contribution Employee Certification, Trust Certification and Trustee Powers, Form GR-68831, Precertification Information Request Form
medical enrollment forms: Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, CMS-855S, Form HFS 2243, Provider Enrollment Application Illinois Medical Assistance Program, Form CMS-40B, Request for Enrollment in Medicare Part B (Medical Insurance), Form CMS-40B, Application for Enrollment in Medicare Part B (Medical Insurance) (01/24), Form CMS-18-F-5, Application for Medicare Part A (Hospital Insurance), Form CMS-855O, Medicare Enrollment Application
EDI enrollment forms: Medicaid Alaska EDI Enrollment - Provider Information Submission Agreement, Form CMS-855O, Medicare Enrollment Application, Form CMS-4040, Request for Enrollment in Medicare Part B, Form CMS-40B, Application for Enrollment in Medicare Part B, CMS-855I, Medicare Enrollment Application for Physicians and Non-Physician Practitioners, Form CMS-855R, Medicare Enrollment Application - Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, CMS-855S, CMS-855B, Medicare Enrollment Application for Clinics/Group Practices and Other Suppliers, CMS-855A, Medicare Enrollment Application for Institutional Providers, Form CMS-855A, Medicare Enrollment Application for Institutional Providers, Medicare Enrollment Application - Medicare Diabetes Prevention Program (MDPP) Suppliers, Form CMS-20134, Medicaid of Alaska Provider Electronic Remittance (835) Authorization and Claims Enrollment Form, Form HFS 2243, Provider Enrollment Application Illinois Medical Assistance Program, Medicaid of Minnesota (Administered by HealthPartners of Minnesota) EDI Trading Partner Enrollment Form, Form CMS-40B, Request for Enrollment in Medicare Part B (Medical Insurance), Form CMS-40B, Application for Enrollment in Medicare Part B (Medical Insurance) (01/24), Form CMS-18-F-5, Application for Medicare Part A (Hospital Insurance)

Let AI fill out your SCE 14-746
Your trial starts once a card is added. You pay nothing before Nov 18.
Your bank declined that card, so the trial did not start and nothing was charged. Please try another card.
Our AI already knows this form, all 71 fields of it. Skip the typing: tell it about yourself, or upload what you have, and it fills the whole form in seconds.
- AI fills every field on both pages, tables and checkboxes included
- No typing into boxes: answer a few questions, or upload your insurance card, an old copy of this form, a photo of a document
- The AI checks the answers; you review and change anything before you download
- Download the finished PDF, print it, or sign it online
- Encrypted, and never used to train AI
Cancel before Nov 18 and you pay nothing.
A card is needed to start the trial. We check it with a $19.99 hold that is released right away. Cancel in two clicks from your account.
Terms · Privacy