1. (a) A patient applying for a registry identification card under AS 17.37.010 must provide to the department

   1. (1) a completed application on a form provided by the department that includes the following:

      1. (A) the applicant's name, address, date of birth, and social security number;
      2. (B) the name, address, and telephone number of the patient's physician;
      3. (C) the name and address of the patient's primary care-giver, if one is designated at the time of application; and
      4. (D) the applicant's signature;

   2. (2) if the applicant is a minor, a statement in writing by the minor's parent or legal guardian residing in Alaska, if any, that the parent or guardian

      1. (A) consents to serve as the minor's primary care-giver; and
      2. (B) gives the parent or guardian's permission for the minor to engage in the medical use of marijuana;
   3. (3) the original of written documentation signed by the qualified physician stating that the patient has been diagnosed with a qualifying debilitating medical condition and the conclusion of the patient's physician that the patient might benefit from the medical use of marijuana or a certified copy of that documentation; and
   4. (4) the application fee required under 7 AAC 34.080.
2. (b) The applicant for a registry identification card is responsible for keeping a copy of the application materials submitted to the department and for documenting submission or delivery of the application to the department.
3. (c) An authorization to use marijuana for medicinal purposes issued by another state, territory, or jurisdiction does not satisfy the requirements of AS 17.37.010 or this section for issuance of a registry identification card.

(Eff. 6/1/99, Register 150)

Authority: AS 17.37.010, AS 17.37.050, AS 18.05.040