DHSS accepts qualifying patient and primary caregiver applications in the online registry portal at mopublic.mycomplia.com. Applicants must first register for an account to complete an application. Qualified patients must have a physician or nurse practitioner who has submitted an Electronic Physician Certification Form on their behalf prior to applying. Application requirements include:
Individual Identifying Information
- Full Legal Name, Date of Birth, Social Security Number
- E-mail Address & Phone Number
- Residence Address AND Mailing Address
Physician Certification Form
- As part of the application process, Qualifying Patients must obtain a Physician Certification issued no more than thirty days prior to the date the application is submitted.
- A Physician Certification Form must be completed, signed, and submitted by either:
- A Missouri-licensed Physician, active, and in good standing; OR
- A Nurse Practitioner who is licensed and in good standing as an advanced practice registered nurse, or successor designation, under Chapter 335 of the Revised Statutes of Missouri.
- Certifying physicians and nurse practitioners will submit the form electronically through the online registry portal. Qualifying Patients will then select the form within the patient application.
Additional Required Documentation
- A clear, color photo of the applicant’s face taken within the prior three (3) months. This cannot be a photo of a driver’s license or passport.
- For non-emancipated qualifying patient applicants: A Parental/Legal Guardian Consent Form.
- For Caregiver applicants: A completed Patient Authorization Form.
- A legible copy of the applicant’s photo identification card issued by a state or federal government entity.
Additional Information
- At the option of the applicant, a statement indicating whether the qualifying patient is currently eligible for any Missouri low-income assistance programs and, if so, which programs.
- If the applicant is seeking authority to cultivate medical marijuana, details about the cultivation location, security, and access will be required within the “Questions” tab of the application.
- Attestation statements, signature, and date of the application, & all applicable fees.