Forms
Medical Cannabis Personal Production Application
Medical Cannabis Program - Form
June 14, 2019
Qualified Patients with current valid enrollment who want to produce medical cannabis for themselves may complete the Personal Production Application and submit it with a copy of your New Mexico driver's license or state identification card and the license fee.
Medical Cannabis Caregiver Application
Medical Cannabis Program - Form
June 14, 2019
To enroll as a personal caregiver for an existing medical cannabis patient(s), you must complete this application and submit it with a copy of your New Mexico driver's license or state identification card and background check.
Medical Cannabis Patient Application
Medical Cannabis Program - Form
June 14, 2019
The application for first time and returning patients is the same. Please complete this form and submit it with a copy of your current New Mexico driver's license or state identification card. Temporary ID’s are not accepted. You must provide documentation to support diagnosis of the medical condition, past treatments, potential health benefit vs. risk of Medical Cannabis and the date(s) of service.
Medical Cannabis Patient Info Change or Card Replacement
Medical Cannabis Program - Form
June 10, 2019
If your personal information has changed, you have moved, new phone number, stopped using Medical Cannabis, you have lost or damaged your card, you must complete this form and submit it with your current Patient ID Card and/or Personal Production License Card and a copy of your New Mexico driver's license or state identification card.
Medical Cannabis Program Complaint and/or Injury Report Form
Medical Cannabis Program - Form
August 22, 2018
The Medical Cannabis Program Complaint Form, is utilized to assist in resolution of outstanding issues, regarding, Licensed Non Profit Producers, Dispensaries, Manufacturers and Laboratories.
Medical Cannabis License ID Card Request
Medical Cannabis Program - Form
April 9, 2018
This form should be used to request a card for all new Licensed Nonprofit Producer employees, Board Members, or contract worker or to request a replacement card for one of these staff members. For a new employee card please ensure you submit the items requested on the form.
Medical Cannabis HIPAA Authorization
Medical Cannabis Program - Form
March 22, 2013
This authorization allows the Department of Health (DOH) to disclose confidential health information about you. The authorization may be revoked. It will remain in effect for six (6) months unless a different time is stated. You are entitled to a copy of the completed authorization. There may be fees charged for any copying associated with this request.