Physician Certification Forms

The Physician Certification Form must be completed and signed by a Missouri licensed Physician or Nurse Practitioner who is licensed to practice in their respective fields and must be in good standing.

A certifying physician must have a current license to practice medicine or osteopathy. Practice of medicine or osteopathy means practice by persons who hold a physician and surgeon license pursuant to Chapter 334, RSMo, including those who are admitted to practice in Missouri by reciprocity pursuant to §334.043, RSMo.
A nurse practitioner must have a current Missouri or compact RN license, maintain national certification in a population focus, and be recognized by the Missouri State Board of Nursing as an advanced practice registered nurse.

As part of the Physician Certification Form, it is recommended that physicians and nurse practitioners review the DHSS Guidance for Certification Appointments, found below, as they will be held to this standard for continued participation in the Missouri Cannabis Regulatory Program.

Once an electronic physician certification form is submitted on behalf of the qualifying patient, the patient must then use their own registry account to submit a new or renewal patient application.

Physician Certification Forms must be submitted with the patient application within 30 days of the certifying physician/nurse practitioner’s signature date on the submitted electronic form.

Physician certifications forms must be submitted electronically by the certifying physician/nurse practitioner within their approved account in the department’s secure electronic registration system. For information on how to establish a physician/nurse practitioner account and to submit an electronic physician certification form on behalf of qualifying patients click here.

Benefits to Electronic Physician Certification Forms

• Security
  • The Department reviews and approves certifying physician/nurse practitioner accounts, verifies identity of the physician/nurse practitioner, and ensures they meet the eligibility requirements of a certifying physician/nurse practitioner.
  • The physician/nurse practitioner has control of their registry account information and others they authorize to access their account, which reduces the potential for fraud related to submission of unauthorized Physician Certification Forms by unauthorized third parties.
  • Electronic Physician Certification Form submissions create efficiencies by reducing patient application requirements, patient errors and department processing time.
  • Physician/nurse practitioner account registration supports direct communication between certifying physicians/nurse practitioners and the Department, strengthening our partnership in working to create a safe and secure program for Missouri medical marijuana patients.

  DHSS Guidance for Certification Appointments

  As part of the certification process, physicians/nurse practitioners will be required to attest that certain statements are true. These attestations provide a framework for the certification process and are the primary way in which the Department has conveyed the standard of care it expects medical marijuana patients will receive. These expectations can be summarized as follows:

  • In the case of non-emancipated individuals under the age of eighteen, physicians/nurse practitioners must receive prior written consent of a custodial parent or legal guardian who will also serve as a primary caregiver for the qualifying patient before certifying that patient.
  • The physician/nurse practitioner must meet with and examine the qualifying patient.
  • The physician/nurse practitioner must review the qualifying patient’s medical records or medical history and current medications and allergies to medications.
  • The physician/nurse practitioner must have a conversation with the qualifying patient (or the qualifying patient’s custodial parent or legal guardian) about the patient’s current symptoms.
  • The physician/nurse practitioner must create a medical record for the qualifying patient regarding the meeting and maintain the qualifying patient’s medical record as required in 334.097, RSMo.
  • The physician/nurse practitioner must have a conversation with the qualifying patient (or the qualifying patient’s custodial parent or legal guardian) about the risks associated with medical marijuana, including any known contraindications applicable to the patient.
  • The physician/nurse practitioner must have a conversation with the qualifying patient (or the qualifying patient’s custodial parent or legal guardian) about the risks of medical marijuana use to fetuses and to breastfeeding infants, if applicable.

  Any physician/nurse practitioner who falsely attests to these things may be subject to sanctions or penalties under applicable laws and regulations.

  For more information regarding physicians and the Physician Certification Form, review rules 19 CSR 100-1.010 and 19 CSR 100-1.050.