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.
|Acquired Immune Deficiency Syndrome||Cachexia|
|Alzheimer’s Disease||Chemotherapy-induced anorexia|
|ALS||Constant or severe nausea|
|Cancer||Moderate to severe vomiting|
|Chronic Pancreatitis||Elevated intraocular pressure|
|Ehlers-Danlos Syndrome||Wasting syndrome|
|Epilepsy||Severe, persistent muscle spasms|
|Glaucoma||Severe pain for which other treatment options produced serious side effects.|
|Hepatitis C, must be currently receiving anti-viral treatments||Severe pain not responding to previously prescribed medications or surgical procedures|
|HIV||Agitation of Alzheimer's Disease|
|Moderate or Severe Post-Traumatic Stress Disorder|
|Moderate to Severe Chronic Pain|
|Spinal Cord Injury/Disease|
|Traumatic Brain Injury|
|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]|
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.