1. (a) The department shall accept written certifications for the therapeutic use of cannabis only from providers who possess, at the time of signing the certification, the following:

   1. (1) For providers in New Hampshire, an active license, in good standing, pursuant to RSA 329 for physicians, pursuant to RSA 326-B:18 for advanced practice registered nurses, pursuant to RSA 328-D for physician associates, or pursuant to the appropriate state statute for any other New Hampshire-licensed provider authorized by RSA 126-X:1, VII(a)(5);
   2. (2) For providers in Maine, Massachusetts, and Vermont, an active license, in good standing, pursuant to the relevant state licensing laws in Maine, Massachusetts, or Vermont, except that a license for a naturopathic doctor shall not be acceptable; and
   3. (3) For all providers in (1) and (2) above, an active registration from the United States Drug Enforcement Administration to prescribe controlled substances.

2. (b) A provider issuing a written certification shall:

   1. (1) Have a provider-patient relationship with the patient, as defined in He-C 401.02(j);
   2. (2) If a provider licensed in Maine, Massachusetts, or Vermont, be primarily responsible for the patient’s care related to the patient’s qualifying medical condition, pursuant to RSA 126-X:1, VII(a)(3);
   3. (3) If a physician associate, be consistent with their collaboration agreement, pursuant to RSA 126-X:1, VII(a)(4), if one is required under RSA 328-D:3-b;

   4. (4) Conduct a full assessment of the patient’s medical history and current medical condition which includes:

      1. a. An in-person physical examination of the patient, which shall not be via telemedicine, except that telemedicine shall be allowed for providers for follow-up visits related to cannabis certification and treatment, and for recertifications and extensions completed by the same certifying provider;
      2. b. A medical history of the patient, including a prescription history;
      3. c. A review of laboratory testing, imaging, and other relevant tests;
      4. d. Appropriate consultations;
      5. e. A documented diagnosis of the patient’s current medical condition; and
      6. f. The development or documentation of a treatment plan for the patient appropriate for the provider’s specialty;

   5. (5) Explain the potential health effects of the therapeutic use of cannabis:

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

   6. (6) Provide counseling:

      1. a. To each patient who is a woman of child-bearing age, and to the patient’s custodial parent or legal guardian if the patient is a minor, about the risks of cannabis use during pregnancy and while breastfeeding; and
      2. b. To each patient who is an adolescent 25 years of age or less, and to the patient’s custodial parent or legal guardian if the patient is a minor, about the risks of cannabis use in adolescence;
   7. (7) Follow the patient clinically at appropriate intervals at the discretion of the provider to provide follow-up care and treatment to the patient for the patient’s qualifying medical condition including, but not limited to, physical examinations, to determine the health effects of cannabis for treating the patient’s qualifying medical condition or associated symptom for which the written certification was issued;
   8. (8) Maintain medical records for all patients for whom the provider has issued a written certification which support the written certification;
   9. (9) Make a copy of such records which support the written certification available to the department, and otherwise provide information to the department upon request about the patient’s qualifying medical condition, to ensure compliance with RSA 126-X and He-C 401; and
   10. (10) If the provider has recommendations or instructions for the therapeutic use of cannabis for the patient, be permitted to send such recommendations or instructions to the patient’s ATC(s), either directly or via the department. Such recommendations shall be securely transmitted.
3. (c) A provider shall not consider a patient to have a qualifying medical condition if a patient who has had a diagnosis of a qualifying medical condition in the past no longer actively has a qualifying medical condition, unless the symptoms related to such qualifying medical condition are mitigated by the therapeutic use of cannabis.
4. (d) Providers shall not issue a written certification for themselves or for the provider’s immediate family members.

5. (e) A provider shall not:

   1. (1) Accept, solicit, or offer any form of pecuniary remuneration from or to an ATC, or other business engaged in the cultivation, manufacture, or sale of cannabis, except if the provider is employed by an ATC or other such business;
   2. (2) Offer a discount or other thing of value to a patient who uses or agrees to use a particular ATC or other location where cannabis is sold or distributed;
   3. (3) Examine a patient in relation to issuing a written certification at a location where cannabis is sold or distributed;
   4. (4) Hold any economic interest in an ATC, or other business engaged in the cultivation, manufacture, or sale of cannabis, including but not limited to employment at an ATC, or other such business, if the provider issues written certifications to patients; or
   5. (5) Refer or recommend a patient to a cannabis dispensary or other location where cannabis is sold or distributed that is located outside of New Hampshire.

6. (f) Providers may rescind or otherwise withdraw a written certification which they have previously issued, for cause, including, but not limited to, the provider making a determination that the patient:

   1. (1) No longer has a qualifying medical condition;
   2. (2) Should discontinue using cannabis;
   3. (3) Falsified information that was the basis of the provider’s written certification;
   4. (4) Did not adhere to the provider’s treatment plan for the patient; or
   5. (5) Should no longer be certified for the therapeutic use of cannabis for another compelling reason.

7. (g) To rescind or otherwise withdraw a previously issued written certification, the certifying provider shall submit the following information on the “Written Certification Withdrawal” form:

   1. (1) Qualifying patient name;
   2. (2) Qualifying patient date of birth;
   3. (3) Certifying provider name;
   4. (4) Medical practice phone number;
   5. (5) Reason for withdrawal of the written certification; and
   6. (6) Certifying provider’s dated signature of a statement of withdrawal for the reason in (5) above.

8. (h) Providers may extend the duration of a written certification, as follows:

   1. (1) If a written certification has been previously issued for fewer than 3 years, per He-C 401.07(b)(8), the provider who issued that written certification may extend the written certification, provided that the total duration of the written certification, including any extensions, shall not exceed 3 years;
   2. (2) A written certification extension shall be signed and dated no later than the expiration date of the qualifying patient’s registry identification card;
   3. (3) A written certification extension signed in accordance with (1) and (2) above shall be received by the department no later than one month after the expiration of the qualifying patient’s registry identification card;
   4. (4) A written certification extension shall not require the submission of a new written certification, a new patient application, or a new fee; and
   5. (5) Notwithstanding (1) and (4) above, a provider in the same medical practice as the provider who issued the written certification may extend the original provider’s certification if documentation that the original provider has permanently left the practice and that care of the patient has been transferred to the new provider is submitted. In such cases, both a written certification and a written certification extension shall be completed by the new provider and submitted to the department.

9. (i) To extend the duration of a written certification, the certifying provider shall provide to the department the following information on the “Written Certification Extension” form:

   1. (1) Qualifying patient name;
   2. (2) Qualifying patient date of birth;
   3. (3) Certifying provider name;
   4. (4) Certifying provider license number;
   5. (5) Medical practice phone number;
   6. (6) Expiration date of the qualifying patient’s current registry identification card, if known;
   7. (7) Length of extension; and
   8. (8) Certifying provider’s dated signature.

10. (j) Upon receipt of the completed written certification extension in (i) above, which meets the requirements in (h) above and which was submitted by either the certifying provider or the qualifying patient, the department shall issue:

    1. (1) To the qualifying patient, a new registry identification card with a new expiration date; and
    2. (2) To the qualifying patient’s designated caregiver, a new registry identification card with a new expiration date, if the qualifying patient has a designated caregiver with a non-expired registry identification card.
11. (k) The department shall track written certification extensions to ensure that no qualifying patient or designated caregiver receives an extension in excess of the maximum of 3 years from the first effective date of the current registry identification card.

Source. (See Revision Note #1 at part heading for He-C 401) #10646, eff 11-2-15; ss by #13220, eff 7-1-21 (see Revision Note #2 at part heading for He-C 401); ss by #13567, eff 5-1-23; ss by #14386, eff 10-1-25, EXPIRES: 10-1-35