Cardholder Petition for Exception to Monthly Purchase Limits

February 25, 2022

A registered cardholder may use this form to petition the department for an exception to the monthly limit on purchases.

The request must be accompanied by a confirmation from the physician who signed the cardholder’s written certification that the cardholder’s debilitating medical condition warrants purchase of an amount exceeding the monthly limit.

Completion of this form does not constitute a prescription for marijuana.

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Year: v1 2/2022

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File Version Date Modified Download Current
Cardholder Petition for Exception to Monthly Purchase Limits
v1 2/2022 25-02-2022 15:13 Download
Cardholder Petition for Exception to Monthly Purchase Limits
7 31-12-2022 17:26 Download