• Complete all of Part A.
  
  
• You must provide a  clear, legible copy of your current Oregon photo ID card to show that you are an Oregon resident.
  
  
• If the information or expiration date on the front of your ID is not current, please copy the back of the card if the back shows that it is current.

Part B - Designated Primary Caregiver
A designated primary caregiver is a person age 18 or older who has significant responsibility for your care (your physician cannot be your designated primary caregiver).

• Part B of the application allows you to designate a primary caregiver.
  
  
• You do not have to designate a primary caregiver unless you are under age 18.
  
  
• If you choose to list a primary caregiver, that person must provide a copy of his or her current photo ID, as well as his or her date of birth, address, and phone number.
  
  
• There is no additional fee for a primary caregiver registry identification card.
  
  
• If you remove your caregiver, it is your responsibility to tell the caregiver that they are no longer protected under the Oregon Medical Marijuana Act.

• You must list the name, date of birth and mailing address of the person responsible for the marijuana grow site. That person must also provide a copy of his or her current Oregon photo ID.
  
  
• Person responsible for the Grow site must sign a release to check for felony convictions.
  
  
• You must list the physical address of where your marijuana is to be produced.  This information is required under Oregon Administrative Rule (OAR) 333-008-0025.
  
  
• You may list only one (1) grow site address.
  
  
• A person responsible for a grow site may be someone other than you or your caregiver.
  
  
• A PO Box is not acceptable for a grow site address.
  
  
• If you remove your grower, it is your responsibility to tell the grower that they are no longer protected under the Oregon Medical Marijuana Act.
  
  

• The fee for a NEW application is $100 or $20 if you are on the Oregon Health Plan (OHP) or if you are receiving monthly Supplemental Security Income (SSI) benefits.
  
  
• The fee for a RENEWAL application is $100 or $20 if you are on the Oregon Health Plan or if you are receiving monthly Supplemental Security Income (SSI) benefits.
  
  
• See the back page of the application forms and OAR 333-008-0020 for OHP or SSI eligibility requirements.
  
  
• Please make your check or money order out to “OMMP” or “DHS/State of Oregon”.  Do not send cash.

• Part E requires you to sign your name and date the application form. The form must be signed and dated by the applicant, not the caregiver.
  
  
• If a proxy is signing the application for you, please note this on your application.

• Clearly print the patient's full name, address, telephone number and date of birth.

• Clearly print the physician's name, mailing address and telephone number.

• The physician must complete this section by checking the boxes to indicate your qualifying debilitating medical condition.
  
  
• The physician must sign and date the form. The date must be current within 3 months of the date of your application or card expiration.

• You are his or her patient;
  
  
• You have been diagnosed with a debilitating medical condition covered by the Oregon Medical Marijuana Act; and
  
  
• (For a new application) the medical use of marijuana may mitigate the symptoms or effects of your condition.
  
  
• This documentation must also be current within  90 days of the date of your application or current card expiration.