MCA NEW CONDITION APPROVAL PETITION

The Maryland Cannabis Administration (MCA) is authorized to approve additional qualifying conditions that certifying providers are encouraged to treat with medical cannabis.

The MCA may add a qualifying condition if: (1) the medical condition is debilitating, (2) the pain, suffering, and disability of the medical condition can reasonably be expected to be relieved by medical cannabis; and (3) other medical treatments have proven ineffective in providing relief.

Md. Code Regs. 14.17.04.08

Petitioner's Information

Petitioner's Phone Number

Petitioner's Email Address

(a) Medical Condition You Are Petitioning Be Added

Name of Condition

Diagnostic Code

ICD-10-CM Code

DSM-IV Code (ICD-9-CM)

(b) Condition Information

Description

Symptoms

Progression

Complications

Prevalence

Please upload a detailed description of the medical condition and include its symptoms, progression, complications, and prevalence.

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(c) Conventional Medical Treatment Information

Treatment(s)

Effectiveness

Side-Effect(s)

Please upload a detailed description of the treatments that are currently available for this condition and include their effectiveness and any associated side-effects.

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(d) Benefits From Medical Cannabis

Benefits

Peer-reviewed, controlled clinical research and studies

Please upload any medical research studies or peer-reviewed published journals that provide evidence to support that the use of medical cannabis provides a benefit to patients by alleviating pain, suffering, disability, or symptoms of the medical condition. (Provide Citations)

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(e) Possible Risks Or Adverse Effects From Medical Cannabis

Summary of Risks or Adverse Effects

Please upload any information or studies that discuss risks or adverse effects related to the use of medical cannabis for the treatment of this medical condition. (NOTE: You must demonstrate that you made an effort to seek information about potential harms or adverse effects related to the use of medical cannabis for the treatment of this medical condition.)

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(f) Letters of Support

Summary of Letter of Support

Please upload letters of support from physicians, licensed health care professionals, and/or researchers who are knowledgeable about this medical condition, disease, or treatment.

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Sign Here

First Name

Last Name

Choose how to sign

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By signing electronically, I acknowledge that I am petitioning the Maryland Cannabis Administration (MCA) to add a new medical qualifying condition or disease.