R9-17-203. Amending a Qualifying Patient’s or Designated Caregiver’s Registry Identification Card 2017-02-04T07:33:00+00:00

A. To add a designated caregiver or to request a change of a qualifying patient’s designated caregiver, the qualifying patient shall submit to the Department the following:

1. An application in a Department-provided format that includes:

a. The qualifying patient’s name and the registry identification number on the qualifying patient’s current registry identification card;

b. If applicable, the name of the qualifying patient’s current designated caregiver and the date the designated caregiver last provided or will last provide assistance to the qualifying patient;

c. The name of the individual the qualifying patient is designating as caregiver; and

d. The signature of the qualifying patient and date the qualifying patient signed;

2. For the caregiver the qualifying patient is designating:

a. The designated caregiver’s first name; middle initial, if applicable; last name; and suffix, if applicable;

b. The designated caregiver’s date of birth;

c. The designated caregiver’s residence address and mailing address;

d. The county where the designated caregiver resides;

e. The identifying number on the applicable card or document in subsection (A)(2)(i)(i) through (A)(2)(i)(v);

f. An attestation signed and dated by the designated caregiver that the designated caregiver has not been convicted of an excluded felony offense as defined in A.R.S. § 36-2801;

g. One of the following:

i. A statement that the designated caregiver does not currently hold a valid registry identification card; or

ii. The assigned registry identification number for the designated caregiver for each valid registry identification card currently held by the designated caregiver;

h. A statement in a Department-provided format signed by the designated caregiver:

i. Agreeing to assist the qualifying patient with the medical use of marijuana; and

ii. Pledging not to divert marijuana to any individual or entity who is not allowed to possess marijuana pursuant to A.R.S. Title 36, Chapter 28.1;

i. A copy the designated caregiver’s:

i. Arizona driver’s license issued on or after October 1, 1996;

ii. Arizona identification card issued on or after October 1, 1996;

iii. Arizona registry identification card;

iv. Photograph page in the designated caregiver’s U.S. passport; or

v. Arizona driver’s license or identification card issued before October 1, 1996 and one of the following for the designated caregiver:

(1) Birth certificate verifying U.S. citizenship,

(2) U. S. Certificate of Naturalization, or

(3) U. S. Certificate of Citizenship;

j. A current photograph of the designated caregiver; and

k. For the Department’s criminal records check authorized in A.R.S. § 36-2804.05:

i. The designated caregiver’s fingerprints on a fingerprint card that includes:

(1) The designated caregiver’s first name; middle initial, if applicable; and last name;

(2) The designated caregiver’s signature;

(3) If different from the designated caregiver, the signature of the individual physically rolling the designated caregiver’s fingerprints;

(4) The designated caregiver’s address;

(5) If applicable, the designated caregiver’s surname before marriage and any names previously used by the designated caregiver;

(6) The designated caregiver’s date of birth;

(7) The designated caregiver’s social security number;

(8) The designated caregiver’s citizenship status;

(9) The designated caregiver’s gender;

(10) The designated caregiver’s race;

(11) The designated caregiver’s height;

(12) The designated caregiver’s weight;

(13) The designated caregiver’s hair color;

(14) The designated caregiver’s eye color; and

(15) The designated caregiver’s place of birth; or

ii. If the designated caregiver’s fingerprints and information required in subsection (A)(2)(k)(i) were submitted to the Department as part of an application for a designated caregiver or a dispensary agent within the previou six months, the registry identification number on the registry identification card issued to the designated caregiver as a result of the application; and

3. The applicable fee in R9-17-102 for applying for a designated caregiver registry identification card.

B. To amend a qualifying patient’s address on the qualifying patient’s registry identification card when the qualifying patient or the qualifying patient’s designated caregiver is authorized to cultivate marijuana, the qualifying patient shall submit to the Department the following:

1. The qualifying patient’s name and the registry identification number on the qualifying patient’s current registry identification card;

2. The qualifying patient’s new address;

3. The county where the new address is located;

4. The name of the qualifying patient’s designated caregiver, if applicable;

5. Whether the qualifying patient is requesting authorization for cultivating marijuana plants for the qualifying patient’s medical use because the qualifying patient believes that the qualifying patient resides at least 25 miles from the nearest operating dispensary;

6. If the qualifying patient is requesting authorization for cultivating marijuana plants, whether the qualifying patient is designating the qualifying patient’s designated caregiver to cultivate marijuana plants for the qualifying patient’s medical use;

7. The effective date of the qualifying patient’s new address; and

8. The applicable fee in R9-17-102 for applying to:

a. Amend a qualifying patient’s registry identification card; and

b. If the qualifying patient is designating a designated caregiver for cultivation authorization, amend a designated caregiver’s registry identification card.

C. To request authorization to cultivate marijuana based on a qualifying patient’s current address or a new address, the qualifying patient shall submit to the Department the following:

1. The qualifying patient’s name and the registry identification number on the qualifying patient’s current registry identification card;

2. If the qualifying patient’s address is a new address, the qualifying patient’s:

a. Current address,

b. New address,

c. The county where the new address is located, and

d. The effective date of the qualifying patient’s new address;

3. The name of the qualifying patient’s designated caregiver, if applicable;

4. Whether the qualifying patient is requesting authorization for cultivating marijuana plants for the qualifying patient’s medical use because the qualifying patient believes that the qualifying patient resides at least 25 miles from the nearest operating dispensary;

5. If the qualifying patient is requesting authorization for cultivating marijuana plants, whether the qualifying patient is designating the qualifying patient’s designated caregiver to cultivate marijuana plants for the qualifying patient’s medical use; and

6. The applicable fee in R9-17-102 for applying to:

a. Amend a qualifying patient’s registry identification card; and

b. If the qualifying patient is designating a designated caregiver for cultivation authorization, amend a designated caregiver’s registry identification card.

This is an unofficial version of the Medical Marijuana Program rules. At this time, ADHS does not anticipate making substantive changes to these rules before they are filed with the Office of the Secretary of State. However, technical, organizational, and grammatical changes may be made. The official copy will be posted on www.azsos.gov when filed.