Get Il Dph Ioci 17-8 2016

Filling out the IL DPH IOCI 17-8 form online is essential for registered debilitating patients who wish to request a waiver for an increased supply of medical cannabis. This guide will provide you with clear and concise instructions to successfully complete each section of the form, ensuring a smooth submission process.

Follow the steps to fill out the IL DPH IOCI 17-8 form online accurately.

1. Press the ‘Get Form’ button to access the IL DPH IOCI 17-8 form, which will open in your chosen editor.
2. Begin by entering the qualifying patient information. Fill in the first name, middle name, last name, home address, apartment or suite number, city, state (Illinois), ZIP code, date of birth in mm/dd/yyyy format, gender, and the Qualifying Patient Registry Identification Number.
3. Next, provide the qualifying debilitating condition information in the designated field.
4. Proceed to the physician information section. Enter the physician's first name, middle name, last name, office address, suite number, office city, state (Illinois), office telephone number, e-mail address, Illinois physician license number, Illinois controlled substances license number, and the length of time the patient has been under their care (in years/months).
5. Insert the date of the in-person medical examination related to the waiver in mm/dd/yyyy format.
6. In the following section, the physician must provide a written certification. The physician should write the patient's name and the recommended quantity of ounces per 14-day period they believe necessary to alleviate the patient's condition.
7. Additionally, the physician should explain the reasons for the recommendation in the designated space.
8. Ensure that the physician provides their signature in the appropriate area, as no stamps are accepted, along with the date of signature in mm/dd/yyyy format.
9. After completing all sections, save any changes made to the form. You may also choose to download, print, or share the form as needed.

Complete your IL DPH IOCI 17-8 form online today to ensure your request is processed efficiently.