N.H. Admin. Code § He-C 401.07

Current through Register No. 50, December 12, 2024

Section He-C 401.07 - Written Certification Requirements

(a) The certifying provider shall complete a "Written Certification for the Therapeutic Use of Cannabis" form, which includes the following:

(1) Indication whether it is an initial or renewal certification;

(2) The following patient information:

a. Full name;

b. Mailing address;

c. Telephone number; and

d. Date of birth; and

(3) The following provider information:

a. Full name;

b. Name of medical practice;

c. Office mailing address;

d. Office telephone and fax numbers;

e. Optional email address;

f. State license number;

g. Indication that the provider is a physician, an advanced practice registered nurse, or a physician assistant;

h. Active US Drug Enforcement Administration registration number; and

i. Medical specialty, as appropriate for the provider type.

(b) On the "Written Certification for the Therapeutic Use of Cannabis" form, the provider shall:

(1) Certify that the patient has a qualifying medical condition, as defined in He-C 401.02(j) and RSA 126-:1, I(a) or (b)X, by:

a. Providing the patient's name;

b. Indicating which condition(s) the patient has; and

c. Signing and dating the certification;

(2) Indicate whether the written certification is based on an in-person physical examination that was conducted via telemedicine;

(3) Certify that the provider has a provider-patient relationship with the patient, as follows:

"I have completed a full assessment of my patient's medical history and current medical condition in accordance with He-C 401.06(b)(4) made in the course of a provider-patient relationship";

(4) Certify that the provider explained the potential health effects of the therapeutic use of cannabis:

a. To the patient; or

b. In the case of a patient who is a minor, to the patient's custodial parent or legal guardian with responsibility for health care decisions for the patient, which shall be inclusive of the potential risks and benefits of the therapeutic use of cannabis;

(5) Certify that the provider possesses an active license in good standing with the state of New Hampshire or the state of Maine, Massachusetts, or Vermont and is either:

a. A physician, an advanced practice registered nurse, or a physician assistant licensed in New Hampshire to prescribe drugs to humans under RSA 329, RSA 326-B:18, or RSA 328-D, respectively, and who possesses an active registration from the United States Drug Enforcement Administration to prescribe controlled substances; or

b. A physician or an advanced practice registered nurse licensed in Maine, Massachusetts, or Vermont to prescribe drugs to humans under the relevant state licensing laws, who possesses an active registration from the United States Drug Enforcement Administration to prescribe controlled substances, and who is primarily responsible for the patient's care related to the patient's qualifying medical condition;

(6) Certify that the facts as stated in the written certification are accurate to the best of the provider's knowledge and belief and that the provider understands that any false statements made on the written certification are punishable as unsworn falsification under RSA 641:3; and

(7) Indicate the duration for which the registry identification card shall be valid, if for a shorter duration than one year from the effective date of the card, except that if this is not indicated, the card shall default to a duration of one year.

N.H. Admin. Code § He-C 401.07

Adopted byVolume XXXIV Number 33, Filed August 14,2014, Proposed by #10646, Effective 8/1/2015.

Amended by Volume XXXV Number 45, Filed November 12, 2015, Proposed by #10964, Effective 11/2/2015, Expires 11/2/2025.

Amended by Volume XLI Number 32, Filed August 12, 2021, Proposed by #13220, Effective 7/1/2021, Expires 7/1/2031.