Get Compassionate Use Registry Identification Card Application

This guide provides clear and detailed instructions for filling out the Compassionate Use Registry Identification Card Application online. By following these steps, you can ensure that your application is completed accurately and efficiently.

Follow the steps to complete your application online.

1. Click ‘Get Form’ button to access the Compassionate Use Registry Identification Card Application form.
2. Fill out the patient information section. You will need to provide the patient's first and last name, date of birth, city, telephone number, social security number, mailing address, state, zip code, county, and email address (optional).
3. Next, complete the legal representative information section. This includes the legal representative's first and last name, date of birth, city, telephone number, social security number, mailing address, state, zip code, county, and email address (optional).
4. Attach a 2x2 inch full-face, passport-type color photograph of the patient, taken within the last 90 days. Ensure the photo meets the specified requirements for size and appearance.
5. Review all information for accuracy and completeness. Confirm that the application has all necessary documents including proof of legal representation.
6. Sign and date the application where indicated, acknowledging that all information provided is accurate.
7. Finalize your application by saving changes, downloading, printing, or sharing the completed form as required.
8. Mail the completed application to the Florida Department of Health, ensuring it is addressed to the Office of Compassionate Use.

Get started and complete your Compassionate Use Registry Identification Card Application online today.