Patients aged 17 or younger in Delaware need this certification, on page 3 of the Pediatric Medical Marijuana Patient Application, before they can receive a pediatric registry card. A pediatric specialty practitioner identifies the medical condition(s) qualifying the child, and the parent or guardian submits it with the application, the attestations and the fee.
A Delaware-licensed pediatric neurologist, gastroenterologist, oncologist, palliative care specialist, psychiatrist or developmental pediatrician (MD, DO, APN or PA) completes the entire section and signs. The parent or guardian(s) complete and initial pages 1 and 2.
Download the current version from the source each time; forms change without notice.
Pediatric Health Care Practitioner Certification
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.
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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Only a pediatric specialty practitioner licensed in Delaware: a pediatric neurologist, pediatric gastroenterologist, pediatric oncologist, pediatric palliative care specialist, pediatric psychiatrist or developmental pediatrician. Accepted license types are MD, DO, APN and PA, and the specialty is entered on the form.
The application must be received by the Medical Marijuana Program within 90 days of the practitioner's signature date. Partial applications are refused, and faxed or electronic copies are not accepted, so the family mails the signed original with the rest of the application.