(1) A
qualifying patient shall apply for a registry identification card in a manner
prescribed by the department, which may include an online application. An
applicant for a registry card shall submit the required fee and all of the
following:
(a) An original completed
application that is signed by the qualifying patient and dated within 6 months
of the date the application is received. The original completed application
must include all of the following information:
(i) The legal name, mailing address, and date
of birth of the qualifying patient. The address for the qualifying patient must
be a physical address located in this state. A qualifying patient who is
homeless is not required to provide a physical address, but he or she shall
provide a mailing address where the department can send correspondence
regarding the patients registry status.
(ii) The physicians name as it appears on his
or her Michigan physicians license, mailing address, and telephone number of
the qualifying patient's physician who provided the written
certification.
(iii) The legal
name, mailing address, and date of birth of the patient's primary caregiver, if
applicable. A qualifying patient may designate 1 primary caregiver to assist
with his or her medical use of marihuana.
(iv) A designation of whether the qualifying
patient or the patient's primary caregiver, if applicable, will be allowed to
possess marihuana plants for the qualifying patient's medical use.
(v) An attestation by the primary caregiver
named on the application that he or she agrees to serve as the patient's
primary caregiver. The attestation must be signed by the primary caregiver and
dated within 6 months of the date the application is received. The attestation
must authorize the department to use the information provided on the
application or as part of the attestation to secure the primary caregivers
criminal conviction history and determine if he or she has been convicted of
any of the offenses provided under section 3(k) of the act, MCL
333.26423.
(vi) The department may
require the attestation required under paragraph (v) of this subdivision to be
submitted as part of the supporting documents and information required under
subdivision (b) of this subrule.
(b) The supporting documents and information
required under section 6 of the act, MCL 333.26426, which must include all of
the following:
(i) Proof of the patients
Michigan residency. For the purposes of this paragraph, an applicant shall be
considered to have proved legal residency in this state if he or she provides
the department with either of the following:
(A) A copy of a valid, lawfully obtained
Michigan driver license issued under the Michigan vehicle code, 1949 PA 300,
MCL 257.1 to 257.923, or an official state personal identification card issued
under 1972 PA 222, MCL 28.291 to 28.300. The department may waive this
requirement if the department is able to verify the applicants Michigan driver
license or personal identification card online through the department of
state.
(B) A copy of a valid
Michigan voter registration. A patient who submits a copy of a valid Michigan
voter registration shall also submit a copy of a government-issued document
that includes the patients name and date of birth for verification purposes, as
required in section 6(c) of the act, MCL 333.26426.
(ii) A written certification, as defined in
section 3(q) of the act, MCL 333.26423, signed by a licensed physician in the
course of a bona fide physician- patient relationship as defined in section
3(a) of the act, MCL 333.26423, and dated within 6 months of the date the
application is received. If the qualifying patient is under the age of 18,
written certifications from 2 physicians are required. The physician shall
include the legal name and date of birth of the qualifying patient, the
physicians name as it appears on his or her physicians license, physicians
license number, mailing address, and telephone number on the written
certification.
(iii) If the
qualifying patient is under the age of 18, a declaration of person responsible
form.
