Minors applying for a Montana medical marijuana registry card need this four-page physician statement. In Parts A and B the treating or referral physician certifies the qualifying condition, describes it, the treatments used and activity restrictions, and sets the period of use. In Part C a second physician examines the minor and concurs, unless the first physician is an oncologist, neurologist or epileptologist.
A Montana-licensed MD or DO completes Parts A and B and signs; a second physician, after a physical exam and records review, initials and signs Part C. The parent or guardian completes the minor patient application.
Download the current version from the source each time; forms change without notice.
Physician Statement for a Debilitating Medical Condition for Minors
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Always, unless the physician completing Part A is a licensed oncologist, neurologist or epileptologist. Otherwise a second physician must perform a physical exam, review the minor's records kept by the treating or referral physician, and sign Part C concurring with the diagnosis.
The second physician initials three statements: they reviewed the minor's medical records as maintained by the treating or referral physician, the potential benefits likely outweigh the health risks, and the information is true and correct. They then sign, concurring with the diagnosis after an independent exam.