Oregon Medical Marijuana Program applicants need their attending provider to attest that they have a debilitating medical condition and that medical marijuana may mitigate its symptoms or effects. The patient submits this statement with the OMMP application (le9240) within 90 days of the provider's signature. Instead of the statement, the provider may give the patient relevant portions of the medical record containing the same information.
An Oregon attending provider with primary responsibility for the patient's care, as primary care provider, specialist or consultant, signs the whole form: an MD or DO, physician associate, nurse practitioner, clinical nurse specialist, CRNA or naturopathic physician. The patient completes the OMMP application.
Download the current version from the source each time; forms change without notice.
Attending Provider Statement (APS)
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First-time applicants must submit the statement, or the relevant medical records, within 90 days of the attending provider's signature. For renewals, application materials are due within 90 days of the card's expiration date, and the statement must be signed within that same 90-day period.
Yes. Oregon's list of attending providers includes MDs and DOs, physician associates, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and naturopathic physicians. The provider must have primary responsibility for the patient's care, as the primary care provider, a specialist, or a consultant asked to treat the patient.
Yes. OHA allows the attending provider to give the patient relevant portions of the medical record instead, as long as they contain the same information: a diagnosed debilitating medical condition and a statement that medical marijuana may mitigate its symptoms or effects. The same 90-day submission window applies.