How to Apply - Patient Information | Missouri Department of Health and Senior Services

Click on the Patient/Caregiver Application Registration link below to apply for your identification card. If a “Warning-Exiting Site” pop-up box appears, click “Ok” to be redirected to the online registry portal. Only applications submitted through the online registry portal will be accepted. For more information, review 19 CSR 100-1.040 Qualifying Patient/Primary Caregiver.

For information on how to enter and register patient and caregiver data into the on-line application, open the Online Registry Portal User Guide.

Application Tutorial Guides
Each video focuses on a specific topic in the application process to assist patients and caregivers with creating and managing their application, such as how to enter physician and condition information or to find and correct a rejected application.

Application Registration

Patient/Caregiver Application Registration
Choose 'OK' to be redirected to the online registry system.

Online Registry Portal

Choosing the Correct Application

What application should I submit?
A guide on choosing the correct application in the online registry system.

View Application Guide

Patient Forms

Parent/Legal Guardian Consent Form

Patient Authorization Form

Steps to Licensure

Get started with the Application Checklist and Patient Registry UserGuide.

Step 1: Forms

Notice: Electronic physician certification forms are available for verified physicians and nurse practitioners to submit for qualifying patients.

To begin, patients will need the Physician Certification Form completed by an MD, DO or NP in good standing in the state of Missouri.

Patients requiring more than the standard six (6) ounces per month will need one (1) physician certification form completed by an MD, DO or NP certifying them for an increased amount above the standard six (6) ounces.

Patients that are under the age of 18 will also need to complete and submit a Parent/Legal Guardian Consent Form with their application. This form must be completed and signed by the Parent/Legal Guardian that is listed in the minor patient’s application. Once the minor patient’s application has been approved, this Parent/Legal Guardian will be required to complete and submit a caregiver application.

Applying caregivers will need a Patient Authorization Form and the patients ID card number, which the patient will receive once their application is approved. This number will begin with PAT.

Step 2: Register

To complete an application, patients will need to register with the department’s secure electronic registration portal.

Step 3: Application

Current ID card holders will be sent notices at intervals of 60, 45, 30 and 15-days prior to the ID card expiration date. These notices will be sent from the online registry portal to the email address used when registering for and logging into the portal. The window for submitting a patient or caregiver renewal is 60-days prior to, but no less than 30 days before, the expiration date. The system will not prohibit the submission of a renewal after the 30 day window, however the Department has 30 days from submission to process an application. Therefore we cannot guarantee a renewal that is received in this time frame will be processed prior to the ID Card expiration date. Please wait 24 hours following the receipt of a 60-day ID card renewal notification before submitting the renewal application in the online registry portal

How to Apply - Patient Information

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Patient Forms

Steps to Licensure