Human Immunodeficiency Virus (HIV) Acquired Immune Deficiency Syndrome (AIDS)
Amyotrophic Lateral Sclerosis (ALS) Crohn's Disease Agitation of Alzheimer's Disease
Cachexia or Wasting Syndrome Severe and Chronic Pain
Seizures, Including Those Characteristic of Epilepsy
Severe or Persistent Muscle Spasms, Including Characteristics of Multiple Sclerosis
1. Arizona ID, Drivers License or US Passport.
2. Provide Records Verifying Your Condition From MD. No Records No Problem. Please Call
3. Written Certification From MD or NMD
4. Upload Documents To AZDHS
5. Payment $150 State Fee
A qualifying patient, who has been diagnosed with one of the debilitating medical conditions will need to get a written certification from a physician (medical doctor, osteopath, naturopath, or homeopath licensed to practice in Arizona) with whom he/she has a physician-patient relationship. The written certification has to be on a form provided by the Arizona Department of Health Services (Department) within 90 days before submitting an application for a registry identification card. After obtaining the written certification from the physician, the qualifying patient can apply online for a registry identification card, after April 14, 2011.
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