Get Ar Doh Petition To Add A Debilitating Medical Condition 2017-2025

This guide provides comprehensive, user-friendly instructions for completing the AR DoH Petition To Add A Debilitating Medical Condition online. By following these steps, users can efficiently navigate the form to ensure all necessary information is accurately submitted.

Follow the steps to fill out the petition successfully.

1. Click 'Get Form' button to access the petition and open it in your preferred format.
2. Provide your personal information in the 'Petitioner Information' section. This includes your first name, middle name, last name, home address, city, state, phone number, email address, and zip code.
3. Specify the medical condition, treatment, or disease you are petitioning for and include the corresponding ICD-10 code(s).
4. In Section A, describe how the debilitating medical condition or disease and its treatments result in severe suffering and impair daily life.
5. In Section B, outline the conventional medical therapies that have been used to alleviate suffering caused by the condition or its treatment.
6. In Section C, detail the proposed benefits of using medical cannabis for your named medical condition or disease.
7. In Section D, provide evidence accepted by the medical community that supports the use of medical cannabis in alleviating suffering from your condition. This may include peer-reviewed journal articles or complete medical studies.
8. In Section E, attach letters of support for the use of medical cannabis from qualified physicians or healthcare providers familiar with your condition. Ensure you include any letters from your treating physician.
9. In Section F, attest that the information provided in the petition and attached documents is accurate. Include your signature and date in the specified format (mm/dd/yyyy).
10. Once the form is completed, review all sections for accuracy, save your changes, and prepare the document for submission via U.S. mail to the Arkansas Department of Health at the address provided.

Complete your petition online to ensure a smooth submission process.