*Note* - This form cannot be completed by a practitioner other than who originally certified the patient.If the patient's original healthcare practitioner certifies them for additional THC, after the patient has participated in the program.For any patient certified for a terminal illness (a healthcare practitioner may indicate more THC per 90-days at the time of certification).There are two exceptions to the '4.5g per 90-day purchase limit, below: '4.5g THC per 90-days' Waiver Form and Submission If no email was provided with the application, patients will receive their permanent card at the address provided with their application.If applicants provided an email with their application, they will receive a temporary card via email, and their permanent card will be mailed to the address provided in their application.Copy of proof of receipt of Supplemental Security Income Payment (SSI receipt).Copy of Social Security Disability Benefit notice (SSDI notice).$25, when scanned proof of any of the following is provided:.$100, unless the patient is applicable for the reduced fee.
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