Health care provider Request to Access Electronic Recommendation Form

Electronic Recommendation Access Request Form

Instructions:

Please fill in all required fields. Once submitted, program staff will verify the validity and status of your professional license or certification. Please allow up to three (3) business days to complete.

Upon completion, you will receive a "Notice of Determination". If approved, your notice will include instructions for how to create a program account and access the recommendation form.

To ensure prompt receipt, please add our email address (medicalcannabis@dc.gov)to your safe senders list, address book, or contact list.

Program details are available 24/7 at abca.dc.gov. Phone and email inquiries are responded to Monday-Friday from 8:30 a.m.-4:00 p.m.

* Indicates a required field

Healthcare Professional Information
Medical Specialty
First Name
Middle Initial
Last Name
DC Medical License #
Reenter DC Medical License Number
DC Controlled Substance License #
Specialty/area of clinical practice
DOB
SSN Last 4 Digits
Phone
Email
Reenter Email
Practice Information
Business Name
Business Street Address
Apt/Suite
City
State
Zip
Business Phone
Signature
By typing my name and the date below, I verify that I am the person identified above and that all information provided is true to the best of my knowledge. I am acknowledging that I am aware of District of Columbia Medical cannabis Laws and Regulations.
Opt In
First and Last Name
Date

Except as provided in section 8 of the Act, a health care provider shall not be subject to any penalty, including arrest, prosecution, or disciplinary proceeding, or denial of any right or privilege, for advising a qualifying patient about the use of medical cannabis or recommending the use of medical cannabis to a qualifying patient pursuant to the Act and the rules issued pursuant to the Act.
The United States Congress has determined that marijuana is a controlled substance and has placed cannabis in Schedule I of the Controlled Substance Act. Growing, distributing, and possessing cannabis in any capacity, other than as a part of a federally authorized research program, is a violation of federal laws. The District of Columbia’s law authorizing the District’s medical cannabis program will not excuse any person from any violation of the federal laws governing cannabis or authorize any registrant to violate federal laws.

Electronic Recommendation Access Request Form

Healthcare Professional Information

Practice Information

Signature