Iowa residents need this certification from a health care practitioner to get a medical cannabis registration card from the Bureau of Cannabis Regulation. The practitioner checks the qualifying debilitating conditions, initials six statements on the relationship, primary care role, medical judgment, patient education, annual review and program rules, and signs under penalty of perjury.
An Iowa-licensed MD or DO, a PA or ARNP who is the patient's primary care provider, or a podiatrist completes pages 2 to 4. The caregiver designation on the last page is completed only when a caregiver is designated, with the practitioner signing the designation.
Download the current version from the source each time; forms change without notice.
Medical Cannabis Health Care Practitioner Certification
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A health care practitioner licensed in Iowa: an MD or DO, a physician assistant or advanced practice registered nurse who is the patient's primary care provider, or a podiatrist. The form defines primary care provider as any practitioner involved in diagnosing and treating the patient's debilitating condition.
The Bureau of Cannabis Regulation must receive the certification within 60 days of the practitioner's signature date. The registration card that results is valid for one year, and renewing it requires recertification by a practitioner, the same forms and payment.
No. The attestation states that the certification does not by itself authorize a registration card. The patient must also submit the application, a copy of a driver's license or non-operator ID and the fee, and a designated caregiver files a separate application.