Terminally ill applicants with a life expectancy of 6 months or less can apply for free. Their card will
be processed quickly in two weeks’ time and will be valid for 6mo.
Terminally ill minors may also apply for the same cost as adults with one free caregiver included.
You cannot submit an application online
A physician’s form must be signed within 90 days of submitting the application and must be signed
in BLUE ink.
Find more information and request an application at: Bit.ly/Terminal_Illness
Veterans who receive their health services at a Veterans Administration facility are not required to
obtain a physician’s written certification
You must submit 12 months of VA records to the Department with the application.
Electronic VA medical records can be found here: www.myhealth.va.gov