Please read the instructions provided on form OHA 9241A BEFORE filling out form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your patient information. Fill in your name, mailing address, city, phone number, state, ZIP code, date of birth, gender, and county. Ensure all details are accurate and legible.
3. If you wish to change or add a caregiver, complete that section by providing their name, date of birth, mailing address, gender, city, state, ZIP code, county, phone number, and government-issued photo ID number. Check the box if you want to remove a caregiver.
4. For grower information, follow similar steps as for the caregiver. If removing a grower or grow site is necessary, check the appropriate boxes.
5. Complete the grow site information section with the physical address and zoning details. Remember to check one option regarding zoning and enclose any required documentation.
6. Answer all questions related to your grower/grow site designation carefully. Incomplete answers may lead to application denial.
7. Finally, sign and date the form at the bottom to confirm that all information is true.

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