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Information for Physicians





Guidance for the Medical Marijuana Physician Certification FormArkansas Medical Marijuana logo

In November 2016 Arkansas voters approved medical marijuana through the passage of a constitutional amendment, known as Amendment 98, the Arkansas Medical Marijuana Act of 2016. The law allows qualifying patients to purchase and use medical marijuana from a licensed dispensary if certain criteria are met. One of the requirements is a physician certification of qualifying conditions.

Q. Am I required to complete a physician certification for a patient?

  • No. Physicians are not required to complete and sign the certification for a patient.

Q. Am I mandated to sign this form?

  • Yes. If a physician is willing to complete a physician certification form for a patient to use medical marijuana obtained from a licensed dispensary, a physician must sign the form.

Q. What am I actually certifying on this form?

  • You are certifying that you have completed a patient assessment.
  • That the patient DOES have one of the qualifying conditions.
  • That you are a medical doctor or doctor of osteopathy with a current, unrestricted license to practice in Arkansas.
  • That you have a current DEA number.

Q. Is there an approved form?

  • Yes. There is an approved form from the Arkansas Department of Health ( ADH)
  • This form cannot be substituted with a letter or other type of certification.
  • This form is available to print from the ADH website. You can make blank copies of the form.

Q. Do I need any special training or certification to sign the form?

  • There is no specific medical marijuana training required by law to complete the form.

Q. Completing the form:

  • All portions of the form must be filled out completely.
  • Do not leave the form blank anywhere in the content areas.
  • Complete the patient demographic portion at the top of the form. The patient must be an Arkansas resident.
  • Identify if the patient is disabled or under the age of 18.  This is necessary for determining their need for a certified caregiver who will be authorized by law to purchase and transport medical marijuana for the patient.  If an adult patient will need a caregiver, their form must be marked as ‘yes’ for the disabled.
  • Check the correct time frame box for the patient. It may be up to 12 months, or less depending on your determination for the patient.
  • Fully fill out all physician information. Do not leave any portion blank.
  • The patient’s parent/guardian must sign the form if the patient is a minor.

Q. What are the qualifying conditions?

  • The form has a complete list of the qualifying conditions.
  • No other conditions are approved at this time.(New conditions are added through a petition process)
  • Mark the applicable condition(s) for the patient.
  • ADH will not accept applications that have additional write-in conditions.

Q. Will these forms be verified?

  • Yes, the agency may contact the physician to verify the signature.
  • The physician’s license will be verified to be current and unrestricted.

Q. Do I keep a medical record of the visit?

  • Yes. You should keep a record of the visit.
  • The physician certification form may be copied and placed in the patient’s medical record as part of your documentation.
  • All aspects of this process are covered by HIPAA.

Q. Am I allowed to complete a certification for a minor?

  • Yes. You may complete certification for a minor who has a qualifying condition.
  • The parent/guardian must be present, and they must sign the form.
  • Remember to certify that the patient is under 18 on the form.

Q. What is a designated caregiver?

  • A designated caregiver is a person who may purchase and transport medical marijuana from an Arkansas dispensary, for a qualified patient who is either a minor or is physically disabled.
  • Minors are required to have a parent/ guardian as a designated caregiver. Physically disabled patients may have one if they so choose.
  • Designations of age or physical disability must be marked on the certification form before a caregiver application can be processed. 
  • Physicians do not have to see a caregiver unless the patient is a minor, and then they must review the form with the minor patient’s parent/guardian.

Q. How does ADH get this certification?

  • The applicant will send the certification to ADH as part of their application. They may do this via mail or through ADH’s online application system.

Q. When does this physician certification expire?

  • The physician certification is valid for 30 days.
  • If a patient gets a certification and fails to submit it to ADH within 30 days, they must get a new certification.
  • A patient’s registration identification card is valid for no more than one year from issuance.
  • If you as the physician wish for the patient’s registration identification card to be valid for less than one year, please note that on the form in the area marked “issue registry card for”.

Q. What happens after I see the patient?

  • The patient must submit their completed application and payment online or via mail.
  • The application is reviewed within 14 working days, and it is either approved or returned for corrections.  If the physician’s certification is incomplete, it will be returned to the patient for corrections.  Any corrections to this form must be initialed by the physician. 
  • If all requirements are met, a registry card will be issued.
The card will expire based on the date recommended on the physician certification.
Physician Written Certification

If you have further questions, you may call Toll Free 1-833-214-8619 or 501-682-4982, or email your questions here.

Public Health Accrediation Board
Arkansas Department of Health
© 2017 Arkansas Department of Health. All Rights Reserved.
4815 W. Markham, Little Rock, AR 72205-3867