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Helpful Forms

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MMCC New Condition Approval Petition

 

​MMCC New Condition Approval Petition

The MMCC may add a qualifying condition if: (1) the medical condition is debilitating, (2) the pain, suffering, and disability of the medical condition can reasonably be expected to be relieved by medical cannabis; and (3) other medical treatments have proven ineffective in providing relief. COMAR 10.62.07.06

If you have any questions please contact, Rebecca Jackson, Research Education analyst, rebeccaw.jackson@maryland.gov​​.​

File a Complaint

 

​Complaint Form​ (Complaints can be filed anonymously and discretely.)

  • This form can be used by qualifying patients, qualifying caregivers, licensees, registered agents, medical facilities, third-party businesses, etc. to file a complaint with the Commission regarding a non-health-related issue related to a medical cannabis product, business, or individual.

Report a Serious Adverse Event*

 

​* A Serious Adverse Event is as an undesirable experience associated with the use of medical cannabis where the outcome caused hospitalization, disability, permanent damage (or required intervention to prevent permanent impairment or damage), congenital anomaly/birth defect, death, life-threatening illness, or any other important medical issue. COMAR 10.62.01(B)(34)

Serious Adverse Event Reporting Form 

  • This form can be used by qualifying patients, qualifying caregivers, licensees, registered agents, and medical facilities to report any serious adverse event they, or someone they know, have experienced as a result of a medical cannabis product.

Patients

 

​HIPPA Authorization Form (Qualifying Adult Patient) 

  • A qualifying adult patient or their caregiver must submit this form to authorize the Commission to release their medical information to a specific person or provider.


HIPPA Authorization Form (Qualifying Minor Patient)​  

  • A qualifying minor patient or their caregiver must submit this form to authorize the Commission to release their medical information to a specific person or provider.

Providers

 

​Certifying Provider Compensation Request Form

  • A certifying provider, who wants to receive compensation from a licensee, must submit this form to request* Commission approval for the compensation. COMAR 10.62.03.02
    • A certifying provider must disclose the specific type of compensation, specific amount or value of compensation, and the services for which the compensation will be paid. COMAR 10.62.03.02(B)(1)
    • A certifying provider must also sign an attestation that the compensation does not violate the Maryland Medical Practice Act or the Patient referral laws. COMAR 10.62.03.02 (B)


Note: A certifying provider may not receive compensation* unless approved by the Commission.

* Compensation includes promotion, referral, recommendation, advertising, subsidized rent, or anything of value from a licensed grower, licensed processor, or a licensed dispensary. COMAR 10.62.03.02(A)

Licensees

 

​Secure Medical Cannabis Transport Vehicle Registration

  • This form can be used to register or deregister a secure medical cannabis transport vehicle with the Commission.
  • Secure medical cannabis transport vehicles must be owned or leased by a licensee or secure transport company for the purpose of transporting medical cannabis and products containing medical cannabis. COMAR 10.62.18

Secure transport vehicles MUST conceal medical cannabis or products containing medical cannabis from view or identification from outside of the vehicle AND be equipped with either: 

  • A secure area within the body or compartment of the vehicle containing solid or locking metal partitions, cages, or high strength shatterproof acrylic; OR
  • Locked and secure storage container(s) anchored to the inside of the vehicle.


Change of Business Name Request Form (Business name changes include conversion to LLC, C Corp., etc.)

  • A licensee (Grower, Processor, Dispensary) or registrant (Independent Testing Laboratory, Security Guard Agency, Secure Transport Company, or Waste Disposal Company) must submit this form to request* Commission approval to change their business name.
* Because the Commission issues a license or registration to the business name that was included in the initial application materials, a licensee or independent laboratory testing registrant must submit a business name change request and wait for approval.

Note: Within five business days of receiving Commission approval, a licensee or registrant must apply for a new license or registration certificate and pay the replacement fee ($100).


Change of Location Request Form

  • A licensee (Grower, Processor, Dispensary) or Independent Testing Laboratory must submit this form along with the change of location fee ($7,000), to request Commission approval to change their business location. COMAR 10.62.35.01 (A)(10)(b)


Note: A licensee may not begin cultivating, processing, or dispensing medical cannabis at a new location until they have passed all inspections. COMAR 10.62.08.09, 10.62.19.08, 10.62.25.09


  • A registrant (Security Guard Agency, Secure Transport Company, or Waste Disposal Company) must submit this form to notify the Commission that their business location has changed.


Change of Mailing Address Notification Form

  • A licensee or registrant must submit this form to notify the Commission that their mailing address has changed.


Change of Authorized Point-of-Contact Notification Form​

  • A licensee or registrant must submit this form to notify the Commission that their authorized point-of-contact(s) has changed. Up to two Authorized Point-of-Contacts per licensee or registrant are permitted.


Registrants

 

Medical Facility Registration 

  • A form for Medical Facilities that want to register through MMCC in order to administer medical cannabis to its qualifying patients/caregivers.


WHAT YOU’LL NEED TO PROVIDE: (We encourage you to preview the registration form in order to better prepare required information and documents)

  • General Information about the Facility - Facility name, OHCQ license number, address, contact information.
  • Operating plan - Patient verification method, safety protocols for receiving/storing/administering medical cannabis, tracking methods, and diversion prevention. 
  • Complete and Notarized Forms - Authorization for Release of Information, Affidavit of Representative Applicant, and Acknowledgment and Disclosure.


Third Party Business Registration

  • A form for Third Party Businesses that want to register through MMCC in order to work in conjunction with a Licensed Grower, Processor, or Dispensary.


WHAT YOU’LL NEED TO PROVIDE: (We encourage you to preview the registration form in order to better prepare required information and documents)

  • General Information about the Business - Business name(s), address, contact information, business information, and authorized point-of-contact information. 
  • Incorporation/Formation Information - Incorporator/Founder details, Maryland SDAT, Status of Good Standing.
  • Business History - General information, diagram of premises and designated areas, diagram of limited access areas, diagram of security equipment areas, agreements with anyone who will share in the profits or proceeds of the business, conditional or contingent agreements related to profits/sales/etc. 
  • Ownership Structure - Detailed ownership information, details about previous or existing cannabis licenses or registrations anywhere, details about previous or existing cannabis business ownership anywhere.
  • Criminal History - Details about any previous or existing legal matters the business, owners, or employees have been involved in.
  • Financial History - Details about any existing or previous payment delinquencies, existing or previous violations of trust or security law (documents to show resolution of the issue), legal matters the business or any of its members have been involved in the previous five years, audited/unaudited financial statements for the past two years, financial statements for the past two years, detailed list of operating and investment accounts, detailed list of outstanding loans and financial obligations.
  • Business Plan - Detailed long-term operating plan including facility description, scope of activities, budget and resources, operations timeline, employee working conditions/benefits/training, any other documents to demonstrate business’ ability to quickly and successfully enter the market.
  • Required Uploads (if applicable):
    • Appendix A: Independent Testing Laboratory (if applicable)
    • Appendix B: Security Guard Agency (if applicable)


Secure Medical Cannabis Transport Vehicle Registration

  • This form can be used to register or deregister a secure medical cannabis transport vehicle with the Commission.
  • Secure medical cannabis transport vehicles must be owned or leased by a licensee or secure transport company for the purpose of transporting medical cannabis and products containing medical cannabis. COMAR 10.62.18

Secure transport vehicles MUST conceal medical cannabis or products containing medical cannabis from view or identification from outside of the vehicle AND be equipped with either: 

  • A secure area within the body or compartment of the vehicle containing solid or locking metal partitions, cages, or high strength shatterproof acrylic; OR
  • Locked and secure storage container(s) anchored to the inside of the vehicle.​