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State of Illinois Illinois Department of Public Health Illinois Medical Cannabis Pilot Program Application for Registry Identification Card for Qualifying Patients INSTRUCTIONS Qualifying patients.

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How to fill out the Illinois Medical Cannabis Pilot Program Application for registry identification card online

This guide provides a detailed, step-by-step approach to filling out the Illinois Medical Cannabis Pilot Program Application for a registry identification card. Designed for a broad audience, this resource aims to support users through the online application process, ensuring all necessary information is accurately completed.

Follow the steps to successfully complete your application

  1. Click 'Get Form' button to access the application form and open it for editing.
  2. Indicate whether this is a new application or a renewal by selecting the appropriate check box.
  3. Provide your qualifying patient information, including your full name, date of birth, address, and contact details. Ensure all fields are accurately filled out.
  4. Complete the physician information section by entering the physician's name, practice details, and contact information.
  5. Prepare proof of residency by attaching copies of required documents such as a utility bill or bank statement.
  6. Include a recent photograph that conforms to specified requirements regarding size and background.
  7. Ensure the physician has completed the Physician Written Certification Form, and prepare any additional documents if applicable (for veterans).
  8. Submit the UCIA fingerprint consent form as part of your application, including details on how to obtain fingerprints.
  9. Select a medical cannabis dispensary zone by checking one of the listed districts.
  10. Include the appropriate application fee on the form, and specify the payment method.
  11. Review the certifications section carefully. Sign and date the application to attest that the information provided is true and accurate.
  12. After completing the form, save your changes and consider downloading or printing a copy for your records before submitting it.

Begin your application process online today to secure your registry identification card.

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410 ILCS 130/ Compassionate Use of Medical Cannabis Program Act.

It is one of 11 conditions approved by a board made up of doctors, nurses, patients and a pharmacist. At a public meeting in Chicago, the board also recommended migraine, neuropathy and post-traumatic stress disorder be added to the list of qualifying conditions, but not anxiety or diabetes.

The Medical Cannabis Alliance of Illinois (“MCAI”) is a trade association representing cultivation centers and dispensary organizations, who are licensed by the State through the Compassionate Use of Medical Cannabis Pilot Program.

Medical Cannabis Program representatives are available by phone at 1-855-636-3688 Monday through Friday, 9:00 AM to 4:00 PM.

Get an Illinois Medical Card application completed in just two telemedicine visits! REQUEST APPOINTMENT. Fill out the form above and one of our schedulers will reach out to you ASAP. ... SCHEDULE APPOINTMENT. An intake specialist will contact you to schedule your appointments. ... PHYSICIAN CERTIFICATION FORM. ... SUBMIT APPLICATION.

Patients and caregivers may register with the Illinois Medical Cannabis Patient Program. For any questions regarding patient and caregiver registration, call or email the DPH Division of Medical Cannabis at 855-636-3688 or DPH.MedicalCannabis@illinois.gov.

Compassionate Use of Medical Cannabis Program The Medical Cannabis Registry Program is a statewide program that allows patients access to medical marijuana who meet one of the qualifying conditions.

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