Qualify + Register

HOW TO QUALIFY

You may qualify for the program if you have (1) or more of the conditions listed below AND a severely debilitating or terminal medical condition or its treatment that has produced at least (1) of the symptoms listed below.  Please note that both a condition AND symptom must be present in order to be qualified.

CONDITIONSSYMPTOMS
Acquired Immune Deficiency SyndromeCachexia
Alzheimer’s DiseaseChemotherapy-induced anorexia
ALSConstant or severe nausea
CancerModerate to severe vomiting
Chronic PancreatitisElevated intraocular pressure
Crohn’s DiseaseSeizures
Ehlers-Danlos SyndromeWasting syndrome
EpilepsySevere, persistent muscle spasms
GlaucomaSevere pain for which other treatment options produced serious side effects.
Hepatitis C, must be currently receiving anti-viral treatmentsSevere pain not responding to previously prescribed medications or surgical procedures
HIVAgitation of Alzheimer's Disease
Lupus
Moderate or Severe Post-Traumatic Stress Disorder
Moderate to Severe Chronic Pain
Multiple Sclerosis
Muscular Dystrophy
Parkinson’s Disease
Spinal Cord Injury/Disease
Traumatic Brain Injury
Ulcerative Colitis
Severe pain that has not responded to previously prescribed medication or surgical measures or for which other treatment options produced serious side effect
One or more injuries or conditions that has resulted in one or more qualifying symptoms [listed in the law]

HOW TO REGISTER

STEP 1: If you believe you may be a good candidate for the program, download the Provider Form (here) to bring to your physician.

STEP 2: Download and complete the Patient Application (here).

STEP 3: Submit both forms, proof of NH residency, a digital photograph of your face (for use in registry card), and mail $50 application fee payable by check to “Treasurer, State of New Hampshire”, and mail to:

NH Department of Health & Human Services
Therapeutic Cannabis Program – Brown Building
129 Pleasant Street
Concord, NH 03301

For technical assistance, please refer to the Qualifying Patients Instructions on the DHHS website (here), for further guidance.

HAVE QUESTIONS?

GET IN TOUCH

(888) 298-7746

info@primeatc.com

www.primeatc.com

Opening Spring 2016

380 Daniel Webster Highway, Merrimack, NH 03054