OHA 2585 Organization or Facility Caregiver Consent Form, ENGLISH OHA 9240 Medical Marijuana Program-2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Medical marijuana patient name' and 'Date of birth' fields. Ensure accuracy as this information is crucial for identification.
3. Next, provide the 'Organization name', 'Organization state licensing agency', and 'Organization state license number'. This verifies your organization’s legitimacy.
4. Complete the contact details including 'Organization phone number' and 'Organization address'. This ensures that communication can be established if needed.
5. Identify the person responsible for purchasing or transporting marijuana for the patient. Fill in their full name, title, date of birth, government ID number, issuing agency, and expiration date.
6. In the signature section, attest your authority to consent by printing your name, providing a phone number, title of signee, and signing with the date.
7. Once completed, save your form and follow instructions to mail it to OHA/OMMP at the provided address.

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