New Hampshire Card

Find Out If You Qualify

We understand the difficulties involved with determining patient eligibility which is why we have made it easy for New Hampshire residents! Read through the checklists below to determine if you qualify as a patient.

Do you have at least one of the following conditions? (Click to Open)

One or more injuries that significantly interferes with daily activities


Acquired immune deficiency syndrome


ALS


Alzheimer's disease


Cancer


Chronic pancreatitis


Crohn's disease


Epilepsy


Glaucoma


Hepatitis C currently receiving antiviral treatment


Lupus


Multiple sclerosis


Muscular dystrophy


Parkinson's disease


Positive status for HIV


Spinal cord injury/disease


Traumatic brain injury


Ulcerative colitis


If yes, please review symptoms.

AND

Do you have at least one of the following symptoms? (Click to Open)

Severe pain for which other treatment options produced serious side effects


Severe pain not responding to previously prescribed medications or surgical procedures


Elevated intraocular pressure


Cachexia


Chemotherapy-induced anorexia


Wasting syndrome


Constant or severe nausea


Moderate to severe vomiting


Seizures


Severe, persistent muscle spasms


Agitation of Alzheimer's


If yes, please continue below.

Great! Here’s How You Can Register

Step 1

Speak with your physician or Advanced Practice Registered Nurse about therapeutic cannabis.

If your physician agrees, have them fill out the physician form.

You can view the physician form here. Effective June 10, 2016 (read more here), physicians and advanced practice registered nurses licensed in the states of ME, MA, and VT are permitted under NH state law [RSA 126-X:I, VII(a)(3)] to issue a “Written Certification for the Therapeutic Use of Cannabis” to their patients who are residents of New Hampshire.

You must have a three-month pre-existing patient-provider relationship.*

*There is an exception to the 3-month duration requirement [He-C 401.06(b)(1)b.].
A medical relationship between the provider and the patient may be less than 3 months duration provided that the provider certifies on the Written Certification:

That the onset or diagnosis of the patient’s qualifying medical condition occurred within the past 3 months; and


The certifying provider is primarily responsible for the patient’s care related to his or her qualifying medical condition.

Step 2

Access the government-issued application forms at the DHHS website.

You can access the applications forms here, or you can view the full patient application instructions here.

Review all patient instructions.

Complete the application and submit the following:

Written certification completed by provider


Digital photograph (see patient application instructions)


Upload proof of NH residency


Enclose $50 check to Treasurer, State of New Hampshire


Mail or hand-deliver application to:

  • New Hampshire Department of Health and Human Services
  • Therapeutic Cannabis Program
  • Brown Building
  • 129 Pleasant Street
  • Concord, NH, 03301

Start Your Journey to Wellness Today

Find out if you're qualified to be a patient and get started on your journey to wellness today!