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Nevada Medical Cannabis Attending Provider Statement

Nevada's Medical Cannabis Patient Cardholder Registry requires every applicant to have a healthcare provider sign this statement, confirming a chronic or debilitating medical condition and setting the registration term of one or two years. It comes inside the application packet issued to the applicant rather than as a standalone public form. The Division of Public and Behavioral Health runs the registry.

Who completes it

Any healthcare provider currently licensed to write a prescription for the chronic or debilitating condition and in good standing with their Nevada board completes the statement. The applicant completes the rest of the packet, including signed Waiver and Acknowledgment forms and a copy of their state ID.

Submitting and payment

How to submit it
Return the signed statement to the applicant, who scans and uploads the completed packet in the registry portal or mails it in; the applicant gets the packet online or through the Application Request Form.
Who pays
The applicant pays the registry fee for the term the provider selects, one year or two, and the registry says the fee cannot be waived, paid in installments or covered by insurance.

Good to know

  • The registration term is set by the provider and written on the statement, and it determines which registry fee the applicant pays.
  • Under NRS 678C, the applicant must have a qualifying condition such as cancer, glaucoma, seizures, severe or chronic pain, or autism spectrum disorder.
  • Online registration is unavailable for patients aged 0 to 17; a custodial parent contacts the registry and uses the Minor Application Request Form instead.
  • Once approved, the applicant's approval letter can be used at dispensaries for 60 days from issue, and the card usually arrives by mail within 7 to 10 business days.

Get the official form

Download the current version from the source each time; forms change without notice.

Attending Healthcare Provider Statement

Official page

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can sign Nevada's Attending Healthcare Provider Statement?

Any healthcare provider who is currently licensed to write a prescription for the applicant's chronic or debilitating medical condition and is in good standing with their Nevada board. The registry does not refer patients to providers, so applicants arrange the visit themselves before submitting the packet.

Where does a patient get the Attending Healthcare Provider Statement?

It comes inside the application packet, not as a separate public download. Applicants create a profile online and download the packet, or send a written request with a copy of the front and back of their Nevada ID. Parents of minors contact the registry and use the Minor Application Request Form.