52 Pa. Code § 55.108
The following form shall be used in providing the 37-day service termination notice required under this subchapter:
SERVICE TERMINATION NOTICE
TO HEALTH CARE FACILITY*
(Name and address of Utility) _______________________________________________________________________________________________
(Date of notice) _______________________________________________________________________________________________
(Customer's name) _______________________________________________________________________________________________
(Customer's billing address) _______________________________________________________________________________________________
(Customer's phone number) _______________________________________________________________________________________________
(Customer's account number) _______________________________________________________________________________________________
Under rules established by the Pennsylvania Public Utility Commission, we are notifying you that we intend to terminate (type of utility service) service to the premises at (address(es) of location(s) where service is to be terminated) on or after (time of day) on (date of scheduled service termination). This action is being taken because your (name of utility) utility service bill is overdue in the amount of $(amount of overdue balance). You may avoid termination of service BY CALLING YOUR ACCOUNT OR CUSTOMER SERVICE REPRESENTATIVE AT (telephone number of utility account representative), OR VISITING OUR OFFICE AT (utility business office address) to make payment arrangements mutually acceptable to you and us.** Contact us at once if you believe for any reason that your service should not be terminated or if you need further information.
If after having discussed with us your billing, payment or other problem, you are not satisfied with the resolution proposed by us, YOU HAVE A RIGHT TO CALL THE PENNSYLVANIA PUBLIC UTILITY COMMISSION AT THIS NUMBER (telephone number of the Commission's Bureau of Consumer Services) FOR FURTHER INFORMATION AND ASSISTANCE. The Commission will have staff available to attempt to mediate your billing problem in order to avoid termination of your service. Mediation or negotiation may take considerable time and should not be postponed until just prior to service termination.
Notice of this termination is being given to the (name of involved regulatory agency) and to the Pennsylvania Public Utility Commission's Bureau of Consumer Services. Please cooperate with them in implementing an orderly shut down plan for your health care facility before the termination date stated above. It is your responsibility to have all patients or residents relocated to other facilities before the scheduled termination date.
Sincerely yours,
* Typeset for heading to be no smaller than 10 point.
** If termination is for a reason other than an overdue bill, e.g., tampering with company equipment, substitute applicable reason and the action the customer can take to avoid termination.
52 Pa. Code § 55.108
This section cited in 52 Pa. Code § 55.104 (relating to required 37-day notice before termination of service).