Mass. Medical Marijuana Forms
The new Massachusetts medical marijuana law protects patients, doctors and caregivers from state penalty or punishment if they follow the state law. The law went into effect on January 1, 2013 and instructs the Department of Public Health to issue the regulations by May 1, 2013. When the Department of Public Health issues final regulations for implementing the law, official forms will likely be promulgated, and doctors and patients will be advised to use those forms. Be sure to check the Department of Public Health website for updated rules and official forms. For now, as a service to the community, Vicente Sederberg, Attorneys at Law, along with our colleagues at EvansCutler Attorneys, are providing the following forms which are unofficial suggestions, based on the text of the new law.
Until further rules are promulgated, in order to become a qualifying patient protected under Massachusetts law, all you need is a written certification from your doctor. We provide a sample form for a written certification below. Your doctor can use our sample form or another format.
Once you are a protected patient, until further rules are promulgated, you may cultivate your own personal supply of medical marijuana. Or, if you choose to, you may also designate a caregiver to assist you in obtaining marijuana. This caregiver may grow your personal supply of medical marijuana for you.
Below, we provide three unofficial forms:
(1) Physician’s Written Certification
(2) Caregiver Agreement and Designation
(3) Patient’s Application for Caregiver Cultivation Registration
Again, for qualifying patients who grow their own medicine, no cultivation registration is required until the DPH issues final regulations. Until then, the Physician’s Written Certification constitutes a limited cultivation registration.
The possession, use, production, and distribution remains illegal under federal law even in compliance with the text of Question 3. Additionally, many issues related to the Massachusetts medical marijuana law are not clear, so please take a conservative approach to the unanswered questions.
Form 1: Physician’s Written Certification
The Physician’s Written Certification documents a doctor’s determination that a patient qualifies to use medical marijuana. This document is not a prescription. The Massachusetts medical marijuana law contains no authority for doctors to prescribe marijuana. Instead, it is a statement by the physician that in his or her professional opinion, the potential benefits of the medical use of marijuana would likely outweigh the health risks for the patient, with whom the physician has a good faith doctor-patient relationship.
The form’s reference to federal constitutional rights acknowledges rights of physicians under Conant v. Walters, 309 F.3d 629 (9th Cir. 2002, cert. denied, 540 U.S. 946, 2003). That decision, allowed by the U.S. Supreme Court to stand as controlling federal law, ruled that a doctor’s advising a patient about the medical use of marijuana (including the provision of a recommendation, used by the patient to obtain state-legal medical marijuana) constituted protected free speech which federal agencies or prosecutors could not punish.
When the new law is implemented by the DPH, the patient will submit a Physician’s Written Certification to the DPH, pay a likely fee and obtain a registration card, which will give patients the right to buy and possess medical marijuana from a Medical Marijuana Treatment Center (dispensary). Until the DPH issues patient registration cards, the Physician’s Written Certification alone protects a patient having no more than a sixty-day supply from interference by state law enforcement. A sixty-day supply is not yet defined.
When you see your doctor, you may want to bring a copy of the Massachusetts medical marijuana law, which you can find here, so that your doctor can read the sections of the law which allow him or her to write certifications.
Instructions: Doctor and patient sign three copies, with the physician retaining one original and the patient retaining two originals.
Download the Physician’s Written Certification form here.
Form 2: Caregiver Agreement and Designation
A “Personal Caregiver” is a person who has agreed to assist with a qualifying patient’s medical use of marijuana. The law does not require that the agreement be in writing, but the existence of such an agreement, and its terms, are more evident if in writing, hence a written agreement is strongly recommended.
Instructions: Patient and the Personal Caregiver sign two copies, with each retaining an original.
Download the Caregiver Agreement and Designation here.
Form 3: Patient’s Application for Personal Caregiver’s Cultivation Registration
This document aims to protect a Personal Caregiver, who is cultivating medical marijuana for a qualifying patient, from interference by state and local law enforcement, provided the cultivation of medical marijuana is in compliance with state law.
- Patient and Personal Caregiver sign duplicate originals of the Patient-Personal Caregiver Agreement and Designation, each retaining one.
- Patient completes and signs the Application for Personal Caregiver Cultivation Registration and makes two photocopies of the completed, signed Application.
- Patient puts one signed Application and the Physician’s Written Certification in an envelope and mails it Certified Mail, Return Receipt Requested, to the Department of Public Health, retaining proof of mailing (the white certified mail receipt). Before sealing the envelope, insert the Certified Mail number on the Application.
- When the “return receipt” (the green card) comes back from the USPS with a DPH signature or stamp, patient gives the Personal Caregiver a photocopy of the Application, the original green card, and an original Physician’s Written Certification. Patient should retain copies of all documents.
- Personal Caregiver retains those three documents (original green card, original Physician’s Written Certification, and photocopy of the application), plus the Personal Caregiver Agreement and Designation bearing the original signatures of patient and Personal Caregiver, and should be prepared to show them if questioned by any law enforcement official. Photocopies of all four documents should be posted on the wall of the enclosed, locked facility where the marijuana is cultivated.
Download Patient’s Application for Personal Caregiver Cultivation Registration here.