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Disclosure of ownership form

Ownership disclosure form omma 2025

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The document is a Disclosure of Ownership, Business Transactions & Exclusions Statement for Providers, which outlines the requirements for providers to disclose ownership interests, significant business transactions, and any exclusions from government health care programs. It includes instructions for submission, identifying information, ownership details, significant business transactions reporting, and certification of accuracy. The document emphasizes the need for transparency in ownership and control interests related to healthcare services.

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Click ‘Get Form’ to open the ownership disclosure form omma in the editor.
Begin by filling out the Identifying Information section. Enter your legal name as per IRS records, DBA (Doing Business As), address, NPI, and contact details accurately.
In the Structure section, select the appropriate entity type that describes your business structure from the provided options.
For Ownership & Control Interests, list each person with an ownership interest. Provide their full legal name, address, percentage of ownership interest, SSN or FEIN, driver's license number, and relationship to you.
Complete the Significant Business Transactions section by reporting any transactions exceeding $25,000 with subcontractors over the past year. If none exist, indicate 'N/A'.
Answer questions regarding Excluded Individuals or Entities honestly. If applicable, provide names and reasons for any exclusions.
Finally, certify that all information is accurate by signing and dating the certification section at the end of the form.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can I go to a dispensary before my card arrives in Oklahoma?

You can walk in but you cannot purchase without a card. Recreational marijuana use is illegal in Oklahoma.

Can a felon own a dispensary in Oklahoma?

Applicants with a nonviolent felony conviction in the last two (2) years, any other felony conviction in the last five (5) years, inmates in the custody of the Department of Corrections or any person currently incarcerated shall not qualify for a medical marijuana dispensary license.

Can you get a temporary Oklahoma medical card?

A temporary medical marijuana license shall be granted to any medical marijuana license holder from other states, provided that the state has a state-regulated medical marijuana program, and the applicant can prove he or she is a member of such program. Temporary licenses shall be issued for thirty (30) days.

Can a job not hire you if you have a medical card in Oklahoma?

Beyond the listed exceptions and reasons for testing, no employer can discriminate against you for being a medical card holder or testing positive for cannabis on a drug test.

Can a cop see if you have a medical card?

Police officers do not see your medical marijuana status when they look up your drivers license or vehicle registration. To access the registry, they usually need a valid reason, like a warrant, a court order, or reasonable suspicion that a crime is taking place.

ownership disclosure statement

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Can you get a medical card in Oklahoma if you dont live there?

You dont have to be a resident to get a medical card in Oklahoma. Patients with valid med cards from other states can apply for an Oklahoma out-of-state medical card. That way, they can use and buy medical marijuana during their stay.

How long does it take for my medical card to arrive after approval?

California: The state has 30 days to process your application, after which time it must provide your card within five days.

How long does it take for Oklahoma medical card approval?

OMMA processes patient license applications within 14 business days, and commercial license applications within 90 business days.