15 Miss. Code. R. 22-2.6 - Application to Participate in the Medical Cannabis Program as a Caregiver

2.6.1 To obtain a Registered Designated Caregiver Card, an applicant shall submit (in a form and manner determined by the Department) the following information:

A. Full legal name and any aliases, such as a nickname (e.g., "Bill" as a nickname for "William");

B. Date of birth;

C. Current physical address and mailing address;

D. Current telephone number and/or email address;

E. Identification issued by the State of Mississippi (driver's license or ID card issued by the Mississippi Department of Motor Vehicles);

F. Current photograph, meeting the following requirements:

1. clear, color photograph of the head and top of shoulders (headshot);

2. in a .jpg, .png, or .gif digital image format;

3. taken in the last six months to reflect the applicant's appearance;

4. taken in front of a plain white or off-white background;

5. taken in full-face view directly facing the camera at eye level with nothing obscuring the face;

6. shall not be digitally enhanced to change the appearance of the applicant (e.g., use of "filters").

G. Name(s), date(s) of birth, and identification number(s) (if available at the time of application) of the patient(s) to whom services are being provided;

H. Identification card nonrefundable fee of $25.00;

I. Fingerprints on a fingerprint card or a live scan fingerprint to be submitted to the Department to conduct a criminal background check;

J. Authorization to conduct state and federal criminal records checks;

K. Caregiver criminal background check nonrefundable fee of $37.00 paid at the time of application to complete the required background check;

L. An attestation that the information provided is true and correct;

M. An attestation, signed and dated by the applicant, pledging not to divert medical cannabis or medical cannabis products to any individual or entity;

N. Designation of Caregiver Form; and,

O. Any other documentation required by the Department such as an acknowledgement of caregiver responsibilities.

2.6.2 In the event that an applicant is applying to become a registered designated caregiver for a qualified patient who is a minor and the caregiver applicant is not the patient's parent and/or legal guardian, the caregiver applicant shall also submit authorization from the patient's parent and/or legal guardian to serve in a caregiver capacity. The form of the authorization may be determined by the Department.

Notes

15 Miss. Code. R. 22-2.6

Adopted 1/13/2024