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Get Il Health Care Professional Written Certification Form 2019-2025

INSTRUCTIONS Type or print clearly and answer all of the questions. This certification does not constitute a prescription for medical cannabis. HEALTH CARE PROFESSIONAL - GIVE THE COMPLETED and SIGNED FORM TO THE PATIENT This FORM must be included with the qualifying patient application. The qualifying patient shall scan form in .PDF format and upload with application documents on-line https://medicalcannabispatients.illinois.gov or mail WITH application to: Illinois Department of Public Health,.

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