How to Apply - Patient Information
NEW! Click below to apply or to update an approved application
Patient/CaregiverApplication Registration What application
should I submit?
Click on the Patient/Caregiver Application Registration blue box located under the photograph to apply for your identification card. If a “Warning-Exiting Site” pop-up box appears, click “Yes” to proceed to the registry. Only applications submitted through the on-line registry will be accepted. For more information, review 19 CSR 30-95.030. Qualifying Patient/Primary Caregiver.
For information on how to enter and register patient and caregiver data into the on-line application, open the Patient Registry User Guide.
NEW: 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.
Patient Forms
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. If your physician/NP has already submitted an electronic form, a tutorial is available here to assist you with submitting the electronic form within your patient application.
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
Once patients have registered, an application can be completed by logging into the Complia portal, clicking “+Create New Application” and “New Patient”.
Once caregivers have registered, an application can be completed by logging into the Complia portal, clicking “+Create New Application” and “New Caregiver”.