Helpful Forms
-Serious Adverse Event Reporting Form (A Serious Adverse Event is as an undesirable experience associated with the use of medical cannabis where the outcome caused hospitalization, disability, permanent damage (or required intervention to prevent permanent impairment or damage), congenital anomaly/birth defect, death, life-threatening illness, or any other important medical issue. COMAR 10.62.01 (B)(34))
- This form can be used by qualifying patients, qualifying caregivers, licensees, registered agents, and medical facilities to report any serious adverse event they, or someone they know, have experienced as a result a medical cannabis product.
-HIPAA Authorization Form
(Qualifying Adult Patient)
- A qualifying adult patient or their caregiver must submit this form to authorize the MCA to release their medical information to a specific person or provider.
-HIPAA Authorization Form
(Qualifying Minor Patient)
- A qualifying minor patient or their caregiver must submit this form to authorize the MCA to release their medical information to a specific person or provider.
-Patient/Caregiver Inactivation Request Form
- A qualifying adult patient or caregiver must submit this form to authorize the MCA to inactivate their registration
-Patient/Caregiver Change of Address Request Form
- A qualifying adult patient or caregiver must submit this form to authorize the MCA to change/update the address that is currently listed on the registration.
-Patient/Caregiver Change of Name Form- A qualifying patient or caregiver must submit this form to authorize the MCA to update their name.
-MCA New Condition Approval Petition- This petition can be used to request that a new condition be added to the list of qualifying conditions that certifying providers are encouraged to treat with medical cannabis.
- Click
here to review the MCA's Petition Guidance.
The MCA may add a qualifying condition if: (1) the medical condition is debilitating, (2) the pain, suffering, and disability of the medical condition can reasonably be expected to be relieved by medical cannabis; and (3) other medical treatments have proven ineffective in providing relief. COMAR 10.62.07.06
- This form can be used by qualifying patients, qualifying caregivers, licensees, registered agents, medical facilities, third-party businesses, etc. to file a complaint with the MCA regarding a non-health-related issue related to a medical cannabis product, business, or individual.
See
Patient FAQs for more information.
See
Provider FAQs for more information.
Maryland Provider & Clinical Director Education
TMCIGlobal: Medical Use of Cannabis: This course is designed for providers in the State of Maryland seeking to gain basic knowledge about the use of medical cannabis. This product contains a state-specific CME/CE-certified activity.
