HOW TO QUALIFY
“Qualifying medical condition” means “the presence of:
(A) Cancer, glaucoma, positive status for human immunodeficiency virus, acquired immune deficiency syndrome, hepatitis C, amyotrophic lateral sclerosis, muscular dystrophy, Crohn’s disease, multiple sclerosis, chronic pancreatitis, spinal cord injury or disease, traumatic brain injury, epilepsy, lupus, Parkinson’s disease, Alzheimer’s disease, ulcerative colitis, Ehlers-Danlos syndrome, or one or more injuries or conditions that has resulted in one or more qualifying symptoms under subparagraph (B); AND
(B) A severely debilitating or terminal medical condition or its treatment that has produced at least one of the following: elevated intraocular pressure, cachexia, chemotherapy-induced anorexia, wasting syndrome, agitation of Alzheimer’s disease, severe pain that has not responded to previously prescribed medication or surgical measures or for which other treatment options produced serious side effects, constant or severe nausea, moderate to severe vomiting, seizures, or severe, persistent muscle spasms;
“Qualifying medical condition” also means:
(A) Moderate to severe chronic pain.
(B) Severe pain that has not responded to previously prescribed medication or surgical measures or for which other treatment options produced serious side effects.
(C) Moderate or severe post-traumatic stress disorder.
HOW TO REGISTER
STEP 1: If you believe you may be a good candidate for the program, download the Provider Form to bring to your physician.
STEP 2: Download and complete the Patient Application.
STEP 3: Submit the following:
- A completed Qualifying Patient Application
- A separate “Written Certification for the Therapeutic Use of Cannabis” form completed by your medical provider.
- Proof of New Hampshire residency, as follows:
- New Hampshire driver’s license (front only); OR
- State or federal government-issued identification that shows your name and NH address; OR
- Any other documentation that contains your name and current NH address, such as a current lease agreement, tax documents from the previous calendar year, or a recent utility bill. Original documents are not required; legible photocopies of original documents are acceptable and preferred.
- A $50 application fee:
- A check or money order made payable to “Treasurer, State of New Hampshire” in the amount of $50.
- The Program cannot accept cash, credit cards, or installment payments.
- All application fees are non-refundable.
Mail or hand-deliver the above documentation to:
NH Department of Health & Human Services
Therapeutic Cannabis Program
29 Hazen Drive
Concord, NH 03301
For technical assistance, please refer to the Qualifying Patients Instructions on the DHHS website, for further guidance.