Follow the steps to successfully complete your authorization form.

1. Press the ‘Get Form’ button to obtain the Washington State Medical Marijuana Authorization Form and open it in your preferred PDF editor.
2. Begin by filling out the Patient Information and Attestation section. Provide your full legal name, street address, date of birth, city, state (WA), and zip code. Ensure that all information is accurate.
3. Read the attestation statement regarding the medical use of marijuana carefully. Confirm you understand the risks involved by signing and dating the Patient Signature line.
4. If you have a designated provider, complete the Designated Provider Information and Attestation section with their full legal name, date of birth, street address, city, state (WA), and zip code. If this does not apply, mark 'N/A' in each box.
5. The designated provider must sign and date the attestation, confirming their agreement to serve as your designated provider and acknowledging the associated legal requirements.
6. Proceed to the Authorizing Healthcare Practitioner Information and Attestation section. Fill in the healthcare practitioner's name as it appears on their license, office address, their license number, city, state, and zip code. Also, include their verification phone number.
7. Check the appropriate medical conditions that apply to the patient, based on the healthcare practitioner's assessment. Ensure that you have discussed potential risks and benefits of medical marijuana use with them.
8. The healthcare practitioner must sign and date their attestation, confirming that they have performed an in-person examination and believe the patient may benefit from medical marijuana.
9. If applicable, complete the Additional Plant Authorization. The healthcare practitioner may recommend an increase in the number of plants if necessary, and another signature may be required for this section.
10. Finally, review the entire form for accuracy, then save any changes made. You can download, print, or share the form as required.

Complete your document online to ensure timely processing and to meet legal requirements.