6. (1) The medical declaration under paragraph 4(2)(b) must indicate
(a) the medical practitioner’s name, business address and telephone number, facsimile transmission number and e-mail address if applicable, the province in which the practitioner is authorized to practise medicine and the number assigned by the province to that authorization;
(b) the name of the applicant, the applicant’s medical condition, the symptom that is associated with that condition or its treatment and that is the basis for the application and whether the symptom is a category 1 or 2 symptom;
(c) for the purpose of determining, under subsection 11(3), the maximum quantity of dried marihuana to be authorized, the daily amount of dried marihuana, in grams, and the form and route of administration that the applicant intends to use;
(d) the anticipated period of usage, if less than 12 months;
(e) that conventional treatments for the symptom have been tried or considered and have been found to be ineffective or medically inappropriate for the treatment of the applicant; and
(f) that the medical practitioner is aware that no notice of compliance has been issued under the Food and Drug Regulations concerning the safety and effectiveness of marihuana as a drug.
(2) In the case of a category 2 symptom, the medical declaration must also indicate
(a) if the medical practitioner making the medical declaration is a specialist, the practitioner’s area of specialization and that the area of specialization is relevant to the treatment of the applicant’s medical condition; and
(b) if the medical practitioner making the medical declaration is not a specialist,
(i) that the applicant’s case has been assessed by a specialist,
(ii) the name of the specialist,
(iii) the specialist’s area of specialization and that the area of specialization is relevant to the treatment of the applicant’s medical condition,
(iv) the date of the specialist’s assessment of the applicant’s case,
(v) that the specialist concurs that conventional treatments for the symptom are ineffective or medically inappropriate for the treatment of the applicant, and
(vi) that the specialist is aware that marihuana is being considered as an alternative treatment for the applicant.
- SOR/2005-177, s. 4.
7. [Repealed, SOR/2003-387, s. 3]
8. A medical declaration under paragraph 4(2)(b) must be dated and signed by the medical practitioner making it and must attest that the information contained in the declaration is correct and complete.
- SOR/2003-387, s. 4;
- SOR/2005-177, s. 5.
9. [Repealed, SOR/2005-177, s. 6]
10. The photograph required under paragraph 4(2)(c) must clearly identify the applicant and must
(a) show a full front-view of the applicant’s head and shoulders against a plain contrasting background;
(b) have dimensions of at least 43 mm × 54 mm (1 11/16 inches × 2 1/8 inches) and not more than 50 mm × 70 mm (2 inches × 2 3/4 inches), and have a view of the applicant’s head that is at least 30 mm (1 3/8 inches) in length;
(c) show the applicant’s face unobscured by sunglasses or any other object; and
(d) be certified, on the reverse side, by the medical practitioner making the medical declaration under paragraph 4(2)(b) to be an accurate representation of the applicant.
- SOR/2003-387, s. 5;
- SOR/2005-177, s. 7;
- SOR/2007-207, s. 3.
- Date modified: