Cancer, glaucoma, positive status for human immunodeficiency virus, acquired immune deficiency syndrome, hepatitis C, amyotrophic lateral sclerosis, muscular dystrophy, Crohn’s disease, multiple sclerosis, chronic pancreatitis, spinal cord injury or disease, traumatic brain injury, epilepsy, lupus, Parkinson’s disease, Alzheimer’s disease, ulcerative colitis, Ehlers-Danlos syndrome, or one or more injuries or conditions that has resulted in one or more qualifying symptoms below

AND

A severely debilitating or terminal medical condition or its treatment that has produced at least one of the following: elevated intraocular pressure, cachexia, chemotherapy-induced anorexia, wasting syndrome, agitation of Alzheimer’s disease, severe pain that has not responded to previously prescribed medication or surgical measures or for which other treatment options produced serious side effects, constant or severe nausea, moderate to severe vomiting, seizures, or severe, persistent muscle spasms

OR

“Qualifying medical condition” also means:

• Moderate to severe chronic pain.
• Severe pain that has not responded to previously prescribed medication or surgical measures or for which other treatment options produced serious side effects.
• Moderate or severe post-traumatic stress disorder.

Consult with your provider provider or APRN.

If your provider agrees you are a good candidate for the program, have them fill out the state-issued provider form.

Complete and submit the following forms and documentation:

• State-Issued Provider Form
• State-Issued Patient Application Form (here)
• Proof of NH Residency

Mail the $50 Application Fee, payable by check to “Treasurer, State of New Hampshire”, to:

NH Department of Health & Human Services
Therapeutic Cannabis Program
29 Hazen Drive
Concord, NH, 03301

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