(a) A person who seeks an identification card shall pay the fee, as provided in Section 11362.755, and provide all of the following to the county health department or the county’s designee on a form developed and provided by the department:

1. (1) The name of the person and proof of his or her residency within the county.
2. (2) Written documentation by the attending physician in the person’s medical records stating that the person has been diagnosed with a serious medical condition and that the medicinal use of cannabis is appropriate.
3. (3) The name, office address, office telephone number, and California medical license number of the person’s attending physician.
4. (4) The name and the duties of the primary caregiver.
5. (5) A government-issued photo identification card of the person and of the designated primary caregiver, if any. If the applicant is a person under 18 years of age, a certified copy of a birth certificate shall be deemed sufficient proof of identity.

(b) If the person applying for an identification card lacks the capacity to make medical decisions, the application may be made by the person’s legal representative, including, but not limited to, any of the following:

1. (1) A conservator with authority to make medical decisions.
2. (2) An attorney-in-fact under a durable power of attorney for health care or surrogate decisionmaker authorized under another advanced health care directive.
3. (3) Any other individual authorized by statutory or decisional law to make medical decisions for the person.