Per Article XIV of the Missouri Constitution, a qualifying medical condition is:

• Cancer
• Epilepsy
• Glaucoma
• Intractable migraines unresponsive to other treatment
• A chronic medical condition that causes severe, persistent pain or persistent muscle spasms, including but not limited to those associated with multiple sclerosis, seizures, Parkinson’s disease, and Tourette’s syndrome
• Debilitating psychiatric disorders, including, but not limited to, post-traumatic stress order, if diagnosed by a state licensed psychiatrist
• Human immunodeficiency virus or acquired immune deficiency syndrome
• A chronic medical condition that is normally treated with a prescription medications that could lead to physical or psychological dependence, when a physician determines that medical use of marijuana could be effective in treating that condition and would serve as a safer alternative to the prescription medication
• A terminal illness
• In the professional judgment of a physician, any other chronic, debilitating or other medical condition, including, but not limited to, hepatitis C,
• amyotrophic lateral sclerosis, inflammatory bowel disease, Crohn’s disease, Huntington’s disease, autism, neuropathies, sickle cell anemia, agitation of Alzheimer’s disease, cachexia, and wasting syndrome.

Qualifying patients and caregivers can electronically submit applications through the Department’s secure electronic registry.  Only applications submitted through the on-line registry will be accepted.  A sample form of the application and questions has been made available for educational purposes only and should not be completed as the Department will not accept mailed or hand-delivered qualifying patient or caregiver applications.  For more information, review 19 CSR 30-95.030 Qualifying Patient/Primary Caregiver.

Qualifying Patient on-line applications must include:

1. Identifying information: name, date of birth, social security number;
2. Residence: residence address, mailing address or place where qualifying patient can receive mail;
3. Proof of Missouri residency: a copy of a valid Missouri driver’s license, a Missouri Identification Card, a current Missouri motor vehicle registration, or a recent Missouri utility bill;
4. E-mail address;
5. Physician Certification Form.  As part of the application process, Patients must obtain a Physician Certification that is issued no later than thirty days from the time patient submits their application:
6. Patients should download the Physician Certification Form and take it with them to their medical examination.
7. A Missouri-licensed physician, active and in good standing, is required to complete and sign the certification.
8. The patient will then photograph or scan the Physician Certification Form and submit it with his or her application.
9. A legible copy of the qualifying patient’s photo identification issued by a state or federal government entity;
10. A Parental/Legal Guardian Consent Form for non-emancipated qualifying patient;
11. A clear, color photo of the qualifying patient’s face taken within the prior three (3) months;
12. At the option of the applicant, a statement indicating whether the qualifying patient is currently receiving assistance from any Missouri programs for low-income individuals, and if so, which programs;
13. If the patient is seeking authority to cultivate medical marijuana;
14. Attestation statement;
15. Signature and date of the application; and
16. All applicable fees.