In New Mexico's Medical Cannabis Program, only medical providers can start a patient's enrollment application. After an approved Medical Provider application, the provider certifies the patient's qualifying condition and submits the application from their Online Patient Portal account, and the patient completes the remaining steps. There is no paper certification to download.
A practitioner licensed in New Mexico to prescribe and administer controlled substances, such as an MD, DO, CNP or PA, with an approved Medical Provider account completes the provider certification portion. The patient completes the rest of the online application.
Download the current version from the source each time; forms change without notice.
Medical Cannabis Program Medical Provider Certification (online patient application started by provider)
New Mexico Department of Health, Medical Cannabis Program takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
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No. The Department states that only medical providers can start an application. The provider, once approved through a Medical Provider application, certifies the qualifying condition and submits the patient application from the Online Patient Portal; the patient then completes the remaining parts of the enrollment.
Thirty conditions qualify, including Alzheimer's disease, ALS, anxiety disorder, autism spectrum disorder, cancer, Crohn's disease, epilepsy, glaucoma, hepatitis C on antiviral therapy, HIV/AIDS, hospice care, insomnia, obstructive sleep apnea, opioid use disorder, Parkinson's disease, PTSD, severe chronic pain and ulcerative colitis. The patient must be diagnosed with a listed condition.