Medical marijuana registry application form

    • [PDF File]Instructions for Paper Application

      https://info.5y1.org/medical-marijuana-registry-application-form_1_654402.html

      Michigan Medical Marijuana Program Application/Renewal Instructions and Checklist ... Any use of white-out on or alterations to the Application Form will result in the denial of your application. If you are acting as either the legal guardian or Medical Durable Power of Attorney (MDPOA) for the ... Application Form for Registry Identification Card.

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    • [PDF File]PATIENT REGISTRATION PACKET

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      Marijuana Registry [fax] 802-241-5230 [email] DPS.MJRegistry@vermont.gov Page 1 (Revised 08/2018) _____ PATIENT REGISTRATION PACKET Includes Patient application, Caregiver application, Health Care Professional Verification Form, & Mental Health Care Provider Form Instructions: Carefully review all …

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    • [PDF File][email] DPS.MJRegistry@vermont.gov www.medicalmarijuana ...

      https://info.5y1.org/medical-marijuana-registry-application-form_1_143da6.html

      Marijuana Registry [phone] 802-241-5115 ... Carefully review the appropriate check list below prior to submitting your application to the Vermont Marijuana Registry (VMR), incomplete applications will be returned for completion and may delay processing. ... I declare under pains and penalty of perjury that the information provided on this form ...

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    • Medical Marijuana Registry Patient Application

      qualif ying patient in the medical use of marijuana and will control the acquisition of the marijuana, dosage and the frequency of the medical use of marijuana by the qualifying patient and will register as a designated caregiver. Signature Parent Custodian Legal Guardian Date . Print Name . 20170829

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    • [PDF File]State of Illinois Illinois Department of Public Health QP

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      Illinois Medical Cannabis Pilot Program Application for Registry Identification Card for Qualifying Patients REQUIRED DOCUMENTS Place the following items in an envelope and attach to fingerprint consent form: Non-refundable application fee (Check or Money Order to Illinois Department of Public Health) Photograph • Taken in the last 30 days

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    • [PDF File]Compassionate Use Registry Identification Card Application ...

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      Form DH8009-OCU-10/2016 Compassionate Use Registry Identification Card Application Instructions for Qualified Patients In order to apply for a Compassionate Use Registry Identification Card each patient must: be a Florida resident, be diagnosed with a qualifying condition, and must have been added to the Compassionate Use Registry (and

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    • [PDF File]Nevada Medical Marijuana Registry

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      Nevada Medical Marijuana Registry Application Request Complete this form. Send completed form to the address below. Include copies of the front and back of the patient’s driver’s license or State ID. If there is a caregiver, also include copies of the front and back …

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    • [PDF File]MEDICAL MARIJUANA PATIENT APPLICATION - Delaware

      https://info.5y1.org/medical-marijuana-registry-application-form_1_92ace8.html

      This form will allow the Medical Marijuana Program staff to verify information with the certifying physician(s) relating to your qualified medical condition. This form must be submitted with your patient enrollment application. If this form is omitted, your application will be …

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    • [PDF File]Medical Marijuana Program APPLICATION/RENEWAL

      https://info.5y1.org/medical-marijuana-registry-application-form_1_cba7d9.html

      the use of medical marijuana for one or more serious medical conditions you suffer from as specified in number 3 below. It is your option to designate a primary caregiver and apply for their identification card at the time you submit your application.

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    • [PDF File]Medical Marijuana Registration Application

      https://info.5y1.org/medical-marijuana-registry-application-form_1_4720f3.html

      If you do not receive your card or a letter from the registry within 35 days email: medical.marijuana@state.co.us . Medical Marijuana Registration Application Colorado Medical Marijuana Registry New and renewal applicants Mail this form Receive response in 35 days

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