Medical Cannabis Authorization Form

Authorization Form

To be a Washington state medical cannabis patient, you must be a resident of the state under the care of a health care practitioner for your qualifying medical condition and provided a Medical Cannabis Authorization Form from your health care practitioner allowed to authorize cannabis for medical purposes.

Authorization form requirements

Effective January 1, 2020, all medical cannabis authorizations must be completed on the revised form (DOH 623-123 November 2019). The Department of Health has revised the medical cannabis authorization form to support House Bill 1094-Compassionate Care Renewals. A health care practitioner can now indicate patient eligibility on the revised form. See details below.

All authorizations must be completed and signed by the patient's health care practitioner. The form must be printed on 8.5 x 11 inch authorization tamper-resistant paper as defined in RCW 69.51A.010.

Important note: Authorization forms printed on tamper-resistant paper containing the Pharmacy Commission seal are not valid and will prevent a patient from being entered into the Medical Cannabis Authorization Database.

Please read the Medical Cannabis Authorization Form Guidelines (PDF) before downloading the Medical cannabis authorization form (PDF) – (for doctor use only).
Do not mail, fax, or email medical cannabis authorization forms to the Department of Health. The department doesn't request, receive or retain authorization forms or register or issue medical cannabis recognition cards for patients. If a patient wants to register with the authorization database, they can schedule an appointment with a medical cannabis consultant at a medically-endorsed store.

To learn more, visit the Medical Cannabis Program's most frequently asked questions webpage.