(a)A certification confirming a patient's debilitating medical condition shall be written on a form provided by the Department of Public Health and shall include, at a minimum, the following:
(1)the qualifying patient's name, date of birth, home address, and primary telephone number;
(2)the certifying health care professional's name, address, telephone number, email address, and medical, advanced practice registered nurse, or physician assistant license number, and the last 4 digits, only, of his or her active controlled substances license under the Illinois Controlled Substances Act and indication of specialty or primary area of clinical practice, if any;
(3)the qualifying patient's debilitating medical condition;
(4)a statement that the certifying health care professional has confir
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(a) A certification confirming a patient's debilitating medical condition shall be written on a form provided by the Department of Public Health and shall include, at a minimum, the following: (1) the qualifying patient's name, date of birth, home address, and primary telephone number; (2) the certifying health care professional's name, address, telephone number, email address, and medical, advanced practice registered nurse, or physician assistant license number, and the last 4 digits, only, of his or her active controlled substances license under the Illinois Controlled Substances Act and indication of specialty or primary area of clinical practice, if any; (3) the qualifying patient's debilitating medical condition; (4) a statement that the certifying health care professional has confirmed a diagnosis of a debilitating condition; is treating or managing treatment of the patient's debilitating condition; has a bona fide health care professional-patient relationship; has conducted an in-person physical examination; and has conducted a review of the patient's medical history, including reviewing medical records from other treating health care professionals, if any, from the previous 12 months; (5) the certifying health care professional's signature and date of certification; and (6) a statement that a participant in possession of a written certification indicating a debilitating medical condition shall not be considered an unlawful user or addicted to narcotics solely as a result of his or her pending application to or participation in the Compassionate Use of Medical Cannabis Program. (b) A written certification does not constitute a prescription for medical cannabis. (c) Applications for qualifying patients under 18 years old shall require a written certification from a certifying health care professional and a reviewing certifying health care professional. (d) A certification confirming the patient's eligibility to participate in the Opioid Alternative Pilot Program shall be written on a form provided by the Department of Public Health and shall include, at a minimum, the following: (1) the participant's name, date of birth, home address, and primary telephone number; (2) the certifying health care professional's name, address, telephone number, email address, and medical, advanced practice registered nurse, or physician assistant license number, and the last 4 digits, only, of his or her active controlled substances license under the Illinois Controlled Substances Act and indication of specialty or primary area of clinical practice, if any; (3) the certifying health care professional's signature and date; (4) the length of participation in the program, which shall be limited to no more than 90 days; (5) a statement identifying the patient has been diagnosed with and is currently undergoing treatment for a medical condition where an opioid has been or could be prescribed; and (6) a statement that a participant in possession of a written certification indicating eligibility to participate in the Opioid Alternative Pilot Program shall not be considered an unlawful user or addicted to narcotics solely as a result of his or her eligibility or participation in the program. (e) The Department of Public Health may provide a single certification form for subsections (a) and (d) of this Section, provided that all requirements of those subsections are included on the form. (f) The Department of Public Health shall not include the word "cannabis" on any application forms or written certification forms that it issues under this Section. (g) A written certification does not constitute a prescription. (h) It is unlawful for any person to knowingly submit a fraudulent certification to be a qualifying patient in the Compassionate Use of Medical Cannabis Program or an Opioid Alternative Pilot Program participant. A violation of this subsection shall result in the person who has knowingly submitted the fraudulent certification being permanently banned from participating in the Compassionate Use of Medical Cannabis Program or the Opioid Alternative Pilot Program.