Patient Certification

Pre-filled Form Request

How do I certify a patient for the program?


A physician may recommend the use of medical cannabis to a qualifying patient if the physician:

1) Is in a bona-fide physician-patient relationship with the qualifying patient. The bona-fide physician-patient relationship may not be limited to a certification for the patient to use medical cannabis or a consultation simply for that purpose.

2) Complies with generally accepted standards of medical practice, the Medical Practice Act of 1987 and applicable State and federal rules specific to physician practice (e.g., HIPAA rules).

3) Has responsibility for the ongoing care and treatment of the qualifying patient’s debilitating condition.

4) Has completed an in-person full assessment of the patient’s medical history and current medical condition, including a personal physical examination, not more than 90 days prior to making the certification for medical cannabis.

5) Certifies that the qualifying patient is under the physician’s care, either for the qualifying patient’s primary care or for his or her debilitating medical condition.

6) Confirms that he or she completed an assessment for the qualifying patient’s medical history, including reviewing medical records from other treating physicians from the previous 12 months.

7) Explains the potential risks and benefits of the medical use of cannabis to the qualifying patient.

  • Recommending physicians must establish a medical record for the qualifying patient with regard to his or her medical condition and his or her continued treatment for the condition or conditions under the physician’s care.  Such records must be kept for a minimum of three years after the physician last sees the patient.
  • To certify that the qualifying patient is recommended for the use of medical cannabis, the recommending physician must complete the following form.