|
FORM |
REQUIREMENTS |
INFORMATION |
|---|
Background Check Request Form | - Must be submitted for all persons listed on an application for a medical marijuana dispensary.
- Must be submitted in support of request to
add a new PRD.
- For details, visit the
Background Check page.
| All persons listed on an application for a medical marijuana dispensary registration must complete a background check request form. PRDs must submit separate background check request forms for each dispensary site they propose to serve. |
|
Electronic Fingerprint Authorization Form | - You are not required to submit your fingerprints electronically. If you do, you must use this form.
-
For details, visit the
Background Check page.
| You are not required to submit your fingerprints electronically. If you do, you must use one of these
 approved electronic fingerprinting locations. |
Individual History Form | - Must be submitted within
30 calendar days of new application payment.
| Required for each person listed on the application. |
|
School Proximity Affirmation Form | - Must be submitted within 30 calendar days of new application payment.
| This form attests that the PRD has canvassed the area surrounding the proposed facility in an effort to locate schools that may not appear on the
School Locator Map. |
|
Notification of Dispensary Readiness Form | - Must be submitted within
60 days of notification from OHA that an application meets initial criteria.
- By 5:00 pm on the prescribed deadline, the form must be
uploaded to the application online or emailed to
medmj.dispensaries@dhsoha.state.or.us.
- Alternately, form may be mailed, postmarked by the prescribed deadline, to:
Oregon Medical Marijuana Dispensary Program
P.O. Box 14450
Portland, OR 97293
| Do not submit this form prior to notification of meeting initial criteria. |
|
Extension Request for Dispensary Readiness Form | - Must be submitted before your 60-day readiness deadline expires.
| The extension request must be for a reason outside your control, and you must provide supporting documents. |
Remove or Change of PRD Form | A PRD
Remove or Change Form must be submitted to remove or change the designation of a PRD or Primary PRD. For details, visit the
PRD page. | Failure to notify the Authority of a change of PRD, or if a PRD has resigned his/her position, may result in revocation of a dispensary registration. |
|
Add a PRD Form | A PRD
Add Form must be submitted to add Primary PRD or additional PRDs. For details, visit the
PRD page. | Failure to notify the Authority of any additional PRD’s may result in revocation of a dispensary registration. |
|
Transfer Authorization Form | Must be used whenever unused marijuana is transferred by a grower or caregiver to a registered dispensary. | This form authorizes a specific person such a caregiver or grower to transfer unused marijuana on behalf of card holder. |
|
Transfer Authorization Form - Processor to Processor or Dispensary | Must be used whenever a medical marijuana processing site transfers cannabinoid concentrate, extract, edible, transdermal patch, or suppository to a registered medical marijuana dispensary or processing site. | This form authorizes a medical marijuana processing site to transfer cannabinoid concentrate, extract, edible, transdermal patch, or suppository to a registered medical marijuana dispensary or processing site. |
|
Continuation of Operations by a Secured Party Form | In the event of Foreclosure or Cessation of Operations, a Secured party may continue operations. This form allows you to appoint such secured party. | |
|
Request to Change Premises Form | Must be submitted to seek approval from the Authority
before making any physical changes that could substantially alter the premises from plans the Authority originally viewed. | A floor or plot sketch must be attached with this request under OAR 333-008-1040(6)(b). |
|
Business Change Form | Must be used whenever a registrant proposes to
change its corporate structure, ownership structure or financial interest with an individual. | |
|
Intake Form - Dispensary | This form is required as the Dispensary Intake Form. It must be used in order to adhere to the intake transfer documentation rule requirements OAR 333-008-1230(4). | |