Complete each section of this Petition and attach all supportive documents. All attachments must include a title referencing the Section letter to which it responds. Any Petition that is not fully or properly completed will not be returned:
- Each petition is limited to a single medical condition or disease.
- Each petition must include:
- The specific name and brief description of the proposed debilitating medical condition or disease, including any applicable ICD-10 diagnostic codes.
- The extent to which the debilitating medical condition or disease itself, and/or the treatments, cause severe suffering and impair a person’s daily life.
- A description of the conventional medical therapies, other than those that cause suffering available to alleviate the suffering caused by the proposed debilitating medical condition or disease.
- A description of the proposed benefits from the medical use of marijuana specific to the proposed debilitating medical condition or disease.
- Evidence generally accepted by the medical community and other experts that the use of medical marijuana alleviates suffering caused by the debilitating medical disease and/or treatment.
- Letters of support for the use of medical marijuana from physicians and/or other licensed health care professionals knowledgeable about the condition or disease, including, if applicable, a letter from the physician with whom the petitioner has a bona-fide physician-patient relationship along with any medical, testimonial, or scientific documentation.
Upon review of the petition, the program will determine whether:
- The petition does not meet the standard for submission and if so, the petition will be denied. The Department will notify the petitioner who may correct any deficiencies and resubmit the petition; or
- The petition meets the standards for submission and if so, the program will accept the petition for further review.
If the petition meets all requirements, it will be referred for a public hearing. Petitioners will be notified in advance of the date, time, and location of the public hearing, and will be allowed to offer verbal or written comments, as will other members of the public. Notice of the public hearing shall conform.
Petitions must be sent by U.S. mail to:
Arkansas Department of Health
Medical Marijuana Section
4815 West Markham Slot 50
Little Rock, AR 72205
