Get Mmr1012 Caregiver Acknowledgment - Colorado.gov - Colorado

The MMR1012 Caregiver Acknowledgment form is essential for caregivers to register and acknowledge their role in supporting medical marijuana patients in Colorado. This guide will provide step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the MMR1012 Caregiver Acknowledgment form, which you can open in your preferred document editor.
2. Begin filling out the patient details. Provide the patient’s social security number (optional), date of birth, and name, including last name, first name, and middle initial.
3. Next, enter the caregiver's information. Fill in the caregiver's last name, first name, and middle initial, as well as their mailing address, including apartment or suite number, city, state, zip code, and telephone number.
4. You may also provide an email address (optional) and answer the question regarding how many patients the caregiver currently serves, excluding the patient in question.
5. Indicate whether the caregiver cultivates marijuana for their patients and if they are requesting a waiver to serve more than the standard five patients.
6. Answer the series of follow-up questions regarding the caregiver’s relationship with the patient, including time spent weekly with the patient, proximity to the patient’s residence, and how far they live from the nearest medical marijuana center.
7. Address any additional issues affecting the patient's access to necessary services, describe the growing environment for cultivation, and explain how the waiver will benefit the patient’s health, safety, and welfare.
8. After filling out the form, ensure that all corrections are initialed by a notary public, as this is necessary for the validity of the document.
9. Finally, sign and date the form in the designated section, providing the notary with the necessary information to complete their certification.
10. Once all information is complete, save your changes, download, print, or share the form as required.

Complete your documents online today to ensure your caregiver acknowledgment is submitted correctly.