Montana adults applying to the Cannabis & Alcohol Regulation Division for a registry card must include this physician statement. The physician initials whether they are the treating physician or a referral physician who has assumed primary responsibility, checks the qualifying conditions, describes the condition, treatments tried and activity restrictions, and sets the period of use, up to one year.
A Montana-licensed MD or DO, as treating physician or as referral physician who assumed primary responsibility after a full history, exam and records review, completes all three pages and signs. The patient completes the application in TAP.
Download the current version from the source each time; forms change without notice.
Physician Statement for a Debilitating Medical Condition
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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The statement must be submitted with the patient's application within 60 days of the physician's assessment date. Statements submitted more than 60 days after the assessment are not accepted. Cards are issued from the application approval date for the period the physician specifies.
Yes. The form asks the physician to mark whether the assessment was conducted via telemedicine under 16-12-502(2) and 16-12-509(2)(d) and (4), MCA. The physician still certifies a full assessment of history and current condition and a review of all medications and supplements.
No. The form states that completing it does not constitute a prescription for marijuana. The physician certifies the debilitating condition, that benefits likely outweigh risks, and that they will continue as treating physician, supervising use and evaluating efficacy.