Certifying a patient requires a physician to submit a PHYSICIAN CERTIFICATION FORM to IDPH on behalf of the eligible patient. This form must be mailed in by the physician from their office to the IDPH – Division of Medical Cannabis as the address on the form states.
This is not a prescription or suggestion for medical cannabis. Instead, the physician is certifying these facts to IDPH:
1. I have established a bona-fide physician-patient relationship with the qualifying patient applicant.
2. The qualifying patient is under my care, either for his/her primary care or for his/her debilitating medical condition, as specified on this form.
3. This bona-fide physician-patient relationship is not limited to the preparation of a written certification for the patient to use medical cannabis or a consultation simply for that purpose.
4. I have conducted an in-person physical examination of the qualifying patient within the last 90 calendar days.
5. I completed an assessment of the qualifying patient’s current medical condition, including symptoms, signs and diagnostic testing, related to the debilitating medical condition I diagnosed or confirmed.
6. I understand the Illinois Department of Public Health may request additional confirmation of the assessment(s) performed for this qualifying patient’s debilitating medical conditions.
7. I have completed an assessment of the qualifying patient’s medical history, including the review of medical records from other treating physicians from the previous 12 months. I have established a medical record for the qualifying patient related to the patient’s debilitating condition and continued treatment for the condition(s) under my care.
8. I hereby certify I am a physician duly licensed to practice medicine in the state of Illinois. The qualifying patient has the debilitating medical condition(s) specified, and the patient is under my treatment or management for the debilitating condition(s) and/or their primary care. I attest the information provided in this written certification is true and correct.