Illinois Medical Cannabis Pilot Program
Application for Registry Identification Card for Qualifying Patients
• Qualifying patients whose last name begins with the letters A though L may apply from September 2, 2014 through October 31, 2014.
• Qualifying patients whose last name begins with the letters M though Z may apply from November 1, 2014 through December 31, 2014.
To qualify for a patient registry identification card, a qualifying patient must:
• be a resident of the state of Illinois at the time of application and remain a resident during participation in the program;
• have a qualifying debilitating medical condition;
• have a signed physician certification for the use of medical cannabis;
• complete the fingerprint-based background check and not have been convicted of an excluded offense (a felony under the Illinois
Controlled Substances Act, Cannabis Control Act or Methamphetamine Control and Community Protection Act, or similar
provisions in a local ordinance or other jurisdiction), unless the Department waives such a conviction(s); and
• be at least 18 years of age.
A complete application must include all of the following:
• A signed and completed application form.
• Proof of residency.
• Proof of identity of the qualifying patient.
• Proof of age of the qualifying patient.
• Photograph of the qualifying patient (Contact the Department’s Division of Medical Cannabis if a photograph would be in
violation of or contradictory to the qualifying patient or designated caregiver’s religious convictions).
• Physician written certification or appropriate documentation for veterans receiving medical care at a U.S. Department
of Veterans Affairs facility; your physician must mail in this form.
• Designated caregiver information, if applicable.
• Copy of the fingerprint consent form.
• Excluded offense waiver, if applicable.
• Selection of medical cannabis dispensary or zone.
• Application fee.
If mailing, this application must be submitted to:
Illinois Department of Public Health
Division of Medical Cannabis
535 West Jefferson Street
Springfield, Illinois 62761-0001
Patients may now apply!
Patients (with last names beginning “A” through “L”) and caregivers may now register with the Illinois Medical Cannabis Pilot Program. For any questions regarding patient and caregiver registration, please refer to our FAQ’s . You may also call or email the DPH Division of Medical Cannabis at 855-636-3688 or DPH.MedicalCannabis@illinois.gov. Patients may also print applications from mcpp.illinois.gov and mail their applications to DPH at:
Illinois Department of Public Health, Division of Medical Cannabis,535 West Jefferson Street, Springfield, Illinois 62761-0001.
For more information about dispensaries and cultivation center applications, please click here
Requirements for Getting a Medical Marijuana Card in Illinois
BE AN ILLINOIS RESIDENT
1. You must be Illinois resident and have a State issued driver license or valid Illinois Photo Id to get a Illinois Medical Marijuana Card
2. You must be over the age of 18 to apply for a Medical Marijuana Card in the State of Illinois. State issued identification with your photo is required
YOUR MEDICAL CONDITION
3. Your recent medical records must be reviewed by our doctors under the Illinois State Medical Marijuana Laws and must have a qualifying medical condition.
MAKE YOUR APPOINTMENT
4. After our Doctors review your medical records within the last 12 months, you will be Pre-Certified before your appointment. Don’t have your records? We can get them for you.