Medical Cannabis Patient Application


Medical Cannabis Registry Applications

Applicants should consider discussing medical cannabis with their physician prior to beginning an application.  All applicants, except for veterans receiving care at a VA facility, must provide written certification from their physician for the use of medical cannabis.

Patients and caregivers may now submit medical cannabis registry applications online through a secure website.

Persons unable to use the online application may mail application materials to:

Illinois Department of Public Health
Division of Medical Cannabis
535 W. Jefferson St.
Springfield, IL 62761-0001

Required application materials:

Veterans:

If you are a veteran receiving care from a Veterans Affairs facility, rather than a physician recommendation form you will need to request VA Form 10-5345, to authorize the release of your medical records, and VA Form DD214 to certify character and dates of service.


Medical Cannabis Registry Applications – TERMINAL ILLNESS

Persons diagnosed with a terminal illness with a life expectancy of six (6) months or less may apply for a medical cannabis registry identification card valid for six months. There is no application fee.

Applications cannot be submitted on-line.

Qualifying patients (Adults and Persons under age 18):

  • Be a resident of the State of Illinois at the time of application and remain a resident during participation in the program
  • Have been diagnosed with a terminal illness with a life expectancy of six (6) months or less
  • Submit a complete application
  • Make sure your physician completes and signs the physician confirmation of diagnosis of terminal illness. This form must be signed in blue ink. The in-person physical examination must take place within 90 days of the application submission date.
  • Not hold a school bus permit or Commercial Driver’s License
  • Not be an active duty law enforcement officer, correctional officer, correctional probation officer, or firefighter.
  • Select a caregiver, if desired (persons under age 18 may have two caregivers)

Veterans receiving care at a U.S. Department of Veterans Affairs (VA) Facility:

  • Submit a copy of your DD-214 showing dates of service and character of service (type of discharge)
  • Provide a copy of your medical records from the VA facility for the last 12 months.
  • Complete the Attestation of Terminal Illness (page 6 of the application package). This form must be notarized.

Required application materials:


Frequently Asked Questions

Tips for Successfully Applying for a Patient Registry Card

Department of Public Health – Division of Medical Cannabis
535 W. Jefferson Street
Springfield, Illinois 62761-0001
Toll-free (855) 636-3688
(217) 782-3300 or
TTY (hearing impaired use only) 800-547-0466
Email: DPH.MedicalCannabis@illinois.gov

Department of Revenue
Email: Rev.MCPP@illinois.gov


Approved Conditions

  • Multiple Sclerosis
  • Arnold-Chiari Malformation and Syringomelia
  • Spinocerebellar Ataxia (SCA)
  • Parkinson's Disease
  • Tourette’s Syndrome
  • Myoclonus
  • Dystonia
  • Reflex Sympathetic Dystrophy, RSD (Complex Regional Pain Syndromes Type I)
  • CRPS (Complex Regional Pain Syndromes Type II)
  • Cachexia/Wasting Syndrome
  • Seizures (Including Those Characteristic of Epilespy)
  • Positive Status for Human Immunodeficiency Virus (HIV)
  • Acquired Immune Deficiency Syndrome (AIDS)
  • Chronic Inflammatory Demyelinating Polyneuropathy
  • Neurofibromatosis
  • Causalgia
  • Sjogren's Syndrome
  • Lupus
  • Interstitial Cystitis
  • Post-Traumatic Stress Disorder
  • Terminal Illness (6 months)
  • Cancer
  • Glaucoma
  • Amyotrophic Lateral Sclerosis
  • Hepatitis C
  • Crohn's Disease
  • Agitation of Alzheimer's Disease
  • Myasthenia Gravis
  • Hydrocephalus
  • Residual Limb Pain
  • Nail-Patella Syndrome
  • Muscular Dystrophy
  • Severe Fibromyalgia
  • Spinal Cord Disease: Damage to the Nervous Tissue of the Spinal Cord with Objective Neurological Indication of Intractable Spasticity. (Including but not limited to Arachnoiditis)
  • Tarlov Cysts
  • Hydromyelia
  • Rheumatoid Arthritis (RA)
  • Fibrous Dysplasia
  • Spinal Cord Injury
  • Syringomyelia
  • Traumatic Brain Injury (TBI) And Post-Concussion Syndrome