Application for patient license

(a) The application for a patient license shall be on the Department 2021.11.23_OSDH681_OMMARulesChapterAsAmended 16 issued form and shall include at a minimum: (1) The applicant's first name, middle name, last name and suffix, if applicable; (2) The applicant's valid mailing address; (3) The applicant's date of birth; (4) The applicant's telephone number and email address; (5) The signature of the applicant attesting the information provided by the applicant is true and correct; and (6) The date the application was signed. (b) An application must be submitted within thirty (30) days of signature or it will be rejected by the Department. (c) A complete application shall include the following documentation or the application will be rejected: (1) Documents establishing the applicant is an Oklahoma resident as established in OAC 310:681-1-6 (relating to proof of residency). (2) Documents establishing proof of identity as established in OAC 310:681-1-7 (relating to proof of identity). (3) A digital photograph as established in OAC 310:681-1-8 (relating to applicant photograph). (4) A certification and recommendation from an Oklahoma Physician dated within thirty (30) days of the date of submission of the application to the Department, on the form provided by the Department, which includes the following: (A) The physician's name and medical license number including an identification of the physician's license type; (B) Office address on file with the physician's licensing board; (C) Telephone number on file with the physician's licensing board; (D) The patient/applicant's date of birth; (E) The physician's signed and dated attestation of the following: (i) The physician has established a medical record and has a bona fide physician-patient relationship; (ii) The physician has determined the presence of a medical condition(s) for which the patient/applicant is likely to receive therapeutic or palliative benefit from use of medical marijuana; (iii) The patient/applicant is recommended a medical marijuana license according to the accepted standards a reasonable and prudent physician would follow for recommending or approving any medication as described at OAC 310:681-1-9.1 (relating to recommending physician standards); (iv) If applicable, the patient/applicant is homebound and unable to ambulate sufficiently to allow them to regularly leave their residence; and the physician believes the patient/applicant would benefit from having a caregiver with a caregiver's license designated to manage the patient's medical marijuana on the patient's behalf; (v) The information provided by the physician in the certification is true and correct; and (vi) Stating the method by which the physician verified the patient's identity as provided in OAC 310:681-1-7 (relating to 2021.11.23_OSDH681_OMMARulesChapterAsAmended 17 proof of identity). (d) Payment of the application fee as established in 63 O.S. § 420 et seq. is required unless the applicant is insured by Medicaid or Medicare. (1) If the applicant is insured by Medicaid or Medicare, the applicant must provide a copy of their insurance card or other acceptable verification. (2) Upon receipt of this verification the Department may attempt to verify the applicant is currently insured by the insuring agency. (3) If the Department is unable to verify the insurance, the application shall be rejected until verification is obtained. (4) All applicants who are verified as being insured by Medicaid or Medicare shall pay a reduced application fee as established in 63 O.S. § 420 et seq. (5) Application fees are nonrefundable. (e) An applicant who can demonstrate his or her status as a one- hundred-percent-disabled veteran shall pay a reduced application fee of $20.00 and shall have the opportunity to submit the license application and payment by means other than solely online and in a manner approved by the Department. In order to qualify, an applicant must submit with his or her application a letter or other official documentation from the U.S. Department of Veteran Affairs or an agency of the U.S. Department of Defense, signed within six (6) months of submission of the application, establishing that the applicant is a veteran with a service disability and stating the percent of the disability is one-hundred percent. (f) An applicant who can meet the requirements for a patient license established in OAC 310:681-2-1 but whose physician recommendation for medical marijuana is only valid for sixty (60) days shall be issued a short-term medical marijuana license. A short-term medical marijuana license shall be valid for sixty (60) days. The initial license and renewal fee shall be $100.00, unless the applicant can prove he or she is insured by Medicaid or Medicare in accordance with OAC 310:681-2- 1(d) or is a one-hundred-percent-disabled veteran in accordance with OAC 310:681-2-1(e), in which case applicant shall pay a reduced fee of $20.00.