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About IDPH

Terminal Illness

Forms

Persons diagnosed with a terminal illness with a life expectancy of six (6) months or less may apply for a medical cannabis registry identification card valid for six months. There is no application fee.

If you currently have or had a 6-month Terminal Illness Registry Card, DO NOT start a Terminal Illness application. You must complete a Qualifying Medical Cannabis on-line application. Call 855-636-3688 and ask to speak to a Terminal Illness Specialist or email dph.terminalill@illinois.gov for assistance.

Qualifying patients (Adults and Persons under age 18)

  • Be a resident of the State of Illinois at the time of application and remain a resident during participation in the program
  • Have been diagnosed with a terminal illness with a life expectancy of six (6) months or less
  • Submit a complete on-line application
  • Make sure your Health Care Professional completes the on-line certification confirming the terminal diagnosis. The in-person physical examination must take place within 90 days of the application submission date.
  • Not hold a school bus permit or Commercial Driver’s License
  • Not be an active duty law enforcement officer, correctional officer, correctional probation officer, or firefighter.
  • Select up to three caregivers.

Veterans receiving care at a U.S. Department of Veterans Affairs (VA) Facility

  • Submit a copy of your DD-214 showing dates of service and character of service (type of discharge)
  • Provide a copy of your medical records from the VA facility for the last 12 months.
  • Complete the Veteran Attestation of Terminal Illness provided in the application. This form must be notarized.

Persons whose diagnosis is no longer terminal after a period of six months, and their caregivers, may submit an application for a one, two, or three-year registry identification card.

Forms