Missouri

Only the following licensed medical professionals may certify patients for the Missouri medical cannabis program:

• Medical Doctors (MD) holding a current license to practice medicine, who are active and in good standing with the State Board of Registration for the Healing Arts
• Doctors of Osteopathy (DO) holding a current license to practice osteopathy who are active and in good standing with the State Board of Registration for the Healing Arts
• Nurse Practitioners (NP/APRN) who hold a current Missouri or compact RN license, maintain national certification in a population focus, and are recognized by the Missouri State Board of Nursing as an advanced practice registered nurse

No other type of health care professional is authorized to certify patients. 

All physicians and nurse practitioners must register with DCR and be verified before submitting patient certifications. 

Registration process:

• Review the Physician/Nurse Practitioner Account Registration information on the DCR website
• Create an account in the DCR online registry portal and submit a Physician Registration application type
• Await verification by DCR; you may not submit patient certifications until verification is complete
• Once verified, certifications are submitted electronically through your approved account in the registry portal

• Cancer
• Epilepsy
• Glaucoma
• Intractable migraines unresponsive to other treatment
• A chronic medical condition causing severe, persistent pain or muscle spasms, such as multiple sclerosis, seizures, Parkinson's disease, or Tourette's syndrome
• Debilitating psychiatric disorders diagnosed by a licensed psychiatrist, such as post-traumatic stress disorder (PTSD)
• HIV/AIDS
• Crohn's disease
• Ulcerative colitis
• Agitation associated with Alzheimer's disease or dementia
• Autism spectrum disorder with associated behaviors
• Sickle cell anemia
• Terminal illness with a life expectancy of less than 12 months
• Hepatitis C
• Amyotrophic lateral sclerosis (ALS)
• Any other chronic, debilitating, or medical condition that, in the professional judgment of a physician, would benefit from medical cannabis

Certifying physicians and nurse practitioners may certify patients with any other chronic, debilitating, or medical condition for which, in their professional judgment, the patient would benefit from medical cannabis. They may also certify patients whose chronic condition is normally treated with a prescription medication that could lead to physical or psychological dependence, where medical cannabis would be effective and would serve as a safer alternative. For the current official list, visit the DCR Qualifying Medical Conditions page.

Step 1: Confirm your DCR registration is complete.

Verify you are registered and verified with DCR through the registry portal before submitting certifications. Certifications submitted by unregistered practitioners will not be accepted.

Step 2: Evaluate the patient.

Evaluate the patient for a qualifying medical condition. Per DHSS Guidance for Certification Appointments, you must be able to truthfully attest to all of the following as part of the certification form:

• You met with and examined the qualifying patient
• You reviewed the qualifying patient's medical records or medical history, current medications, and allergies
• You discussed the qualifying patient's current symptoms
• You created a medical record for the qualifying patient regarding the meeting
• You discussed with the qualifying patient the risks associated with medical cannabis, including any known contraindications applicable to that patient
• You discussed the risks of medical cannabis use to fetuses and to breastfeeding infants, if applicable
• In the case of a non-emancipated patient under 18, you received the prior written consent of a custodial parent or legal guardian who will serve as the qualifying patient's primary caregiver before certifying

Telemedicine appointments are permitted if the standard of care does not require an in-person encounter and if you can truthfully complete all of the above attestations based on a telemedicine examination. 

Step 3: Submit the electronic physician or nurse practitioner certification form.

Submit the completed electronic certification form through your approved account in the DCR registry portal. Certifications must be submitted no earlier than 30 days before the date the patient will apply for or renew their patient identification card. The patient must then use their own registry account to submit their application, and they must do so within 30 days of the date of your signature on the certification form.

If you determine the patient requires more than the standard 6-ounce monthly purchase limit, you must state on the certification form the amount the patient requires and provide compelling reasons why that greater amount is necessary.

Step 4: Maintain records.

Document your evaluation and certification in the patient's medical record as required by 19 CSR 100-1.050(2)(B)(8)(B).

Missouri patient identification cards are valid for 3 years. A new physician or nurse practitioner certification is required with every patient renewal application.

Recertification requirements:

• The certification must be signed no more than 30 days before the patient submits their renewal application
• The same attestations required for initial certification apply to recertification: you must be able to confirm you met with and examined the patient, reviewed their records and current medications, discussed current symptoms, created a medical record, and discussed applicable risks
• The certification is submitted electronically through your approved DCR registry portal account
• The patient then completes and submits their renewal application within 30 days of your signature date

If a patient's purchase limit needs to be increased after their initial card has been issued, the patient must submit a request to DCR to increase the limit within 30 days of your signature date on the updated certification. DCR has 30 days to approve or deny the request, and the increase does not take effect until DCR approves it.

Medical professionals have a legal right to recommend cannabis as a treatment in any state, as protected by the Medical Marijuana and Cannabidiol Research Expansion Act (Title III section 301) which became law on December 2, 2022, and the First Amendment (established by a 2004 United States Supreme Court decision to uphold earlier federal court rulings that doctors, and their patients have a fundamental Constitutional right to freely discuss treatment options).

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