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Includes a caregiver application checklist with completed signed forms, federal background check covering all 50 states, and copies of New Mexico photo ID. Requires release of medical information, parental consent and birth certificate for minors, and medical power of attorney when applicable. Includes signature acknowledgments covering reimbursement limits, cannabis property, and restrictions on caregiver production.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/caregiver-application-packet-mcp-caregiverpacket/305985/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/caregiver-application-packet-mcp-caregiverpacket/305985.png","ImageObject",442,249,{"name":88,"@type":89},"eBook King","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-12","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What must the primary caregiver include to complete the caregiver application?","Question",{"text":109,"@type":110},"The packet requires a fully completed caregiver application form signed by the patient, caregiver, and certifying medical provider, plus a federal background check and a copy of the caregiver’s New Mexico issued photo ID or driver’s license.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How should the federal background check be completed and sent?",{"text":114,"@type":110},"It must be completed by a national criminal background check company online and cover all 50 states based on name and date of birth. The background check must be sent directly to you, not directly to the NM Department of Health or the Medical Cannabis Program.",{"name":116,"@type":107,"acceptedAnswer":117},"What happens if a qualified patient revokes the medical information release to the caregiver?",{"text":118,"@type":110},"Revocation must be made in writing to the Medical Cannabis Program Coordinator and may result in the program being unable to certify the patient. The revocation does not apply to information already released under the authorization.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},305985,1790135055,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":47,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},962088006270,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Please keep a copy of all application documents foryour records.  \n1. Caregiver Application Form filled out completely. It must be signed by the:  \nO Patient  \nO Caregiver, and  \nO Certifying medical provider  \n2. Federal background check  \no This can be completed by any National Criminal Background Check Company online and must be of all 50 States, based on name and date ofbirth. This typeof background check can generally be done through the internet. Make sure you have the background check sent directly to you. DO NOT have it sent directly to the NM Department of Health or the Medical Cannabis Program.  \n(Please note: the NM Medical Cannabis Program cannot provide a recommendation for any specific companies)  \n3. A copy of the caregiver’s valid New Mexico issued photo ID or driver’s license  \n4. Release of medical information to caregiver form, must be signed by enrolled patient.  \n5. For minors, parental consent form and a copy of birth certificate.  \n6. If application is signed by a Power of Attorney please attach medical power attorney.  \nSend Completed Applications to:  \nMedical Cannabis Program  \nNew Mexico Department of Health  \n1190 St. Francis Drive, S3400  \nPO Box 26110  \nSanta Fe, NM 87502-6110  \nPrimary Caregiver Information  \nPlease attach a copy of the caregiver’s New Mexico ID to this application and a complete national criminal background check. For minors please include a copy of a birth certificate.  \n\n| Caregiver First and Last Name | Telephone Number | Date ofBirth |  |\n| --- | --- | --- | --- |\n|  |  |  |  |\n| If renewal Current Caregiver Number: |  | Expiration Date: |  |\n|  |  |  |  |\n| Mailing Address: | City: | State: | Zip Code |\n|  |  |  |  |\n| Physical Address | City | State | Zip Code |\n|  |  |  |  |\n\nIndividuals convicted of a felony violation of Section 30-31-20, 30-31-21, or 30-31-22 NMSA 1978, or a violation of any equivalent out-of-state statute in any jurisdiction, are prohibited from serving as a primary caregiver. See Caregiver Application Checklist for more information.  \nBy signing below, I acknowledge that: 1.) A qualified patient shall only reimburse their primary caregiver for the cost oftravel, supplies or utilities associated with the possession of medical cannabis by the primary caregiver for the qualified patient. 2.) No other cost associated with the possession of medical use cannabis by the primary caregiver for the qualified patient, including the cost of labor, shall be reimbursed or paid. 3.) All medical cannabis possessed by a primary caregiver for a qualified patient is the property of the qualified patient. 4.) The primary caregiver of a qualified patient who holds a personal production license may assist the qualified patient to produce medical cannabis only at the designated licensed location, identified on the  \nqualified patient’s personal production license. 5.) The primary caregiver may not independently produce medical cannabis.  \nCaregiver Signature:   Date:    \nPatient Information  \n\n| Patient First and Last Name | Telephone Number | Date ofBirth |  |\n| --- | --- | --- | --- |\n|  |  |  |  |\n| If renewal Current Patient Number: |  | Expiration Date: |  |\n|  |  |  |  |\n| Mailing Address: | City: | State: | Zip Code |\n|  |  |  |  |\n| Physical Address | City | State | Zip Code |\n|  |  |  |  |\n\nBy signing below, the qualified Patient agrees that this primary caregiver-applicant is necessary to take responsibility for managing the well-being of the Patient with respect to the use of medical cannabis in accordance with the Lynn and Erin Compassionate e Use Act.  \nQualified Patient signature:   Date:    \nCertifying Medical Provider  \n\n| Certifying Provider First and Last Name | Telephone Number | Medical License Number |  |\n| --- | --- | --- | --- |\n|  |  |  |  |\n| Mailing Address: |  |  |  |\n|  |  |  |  |\n| City | State | Zip Code |  |\n|  |  |  |  |\n| Medical Justification for Caregiver |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n\nBy signing below,","cbCaik5rtXx7hpiL","https://ap.wps.com/l/cbCaik5rtXx7hpiL","pdf",463918,"English","# Caregiver Application Requirements\n## Signed Forms and Identity Documents\n## Background Check and Submission Address\n## Primary Caregiver Information (Form Fields)\n## Patient Information (Form Fields)\n## Certifying Medical Provider Information (Form Fields)\n## Prohibitions and Reimbursement Acknowledgment\n# Release of Medical Information to Caregiver Form\n## Purpose and Authorization\n## Revocation and Effect","[{\"question\":\"What must the primary caregiver include to complete the caregiver application?\",\"answer\":\"The packet requires a fully completed caregiver application form signed by the patient, caregiver, and certifying medical provider, plus a federal background check and a copy of the caregiver’s New Mexico issued photo ID or driver’s license.\"},{\"question\":\"How should the federal background check be completed and sent?\",\"answer\":\"It must be completed by a national criminal background check company online and cover all 50 states based on name and date of birth. The background check must be sent directly to you, not directly to the NM Department of Health or the Medical Cannabis Program.\"},{\"question\":\"What happens if a qualified patient revokes the medical information release to the caregiver?\",\"answer\":\"Revocation must be made in writing to the Medical Cannabis Program Coordinator and may result in the program being unable to certify the patient. The revocation does not apply to information already released under the authorization.\"}]","Caregiver Application Packet - MCP-CaregiverPacket | PDF",1789831738]