Form Oha 9241 - Oregon Medical Marijuana Program Change Form Page 2
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2Change form instructions
General instructions:
Type or print legibly. Do not change the form or use “White Out.” Keep copies of everything you submit to the OMMP.
OMMP may correspond by email.
Do not staple or tape your check or money order to your paperwork.
If law enforcement requests legal documentation of your right to have marijuana and you have not yet received OMMP’s
approval or denial, present a copy of a submitted OMMP change form and proof you sent it. ORS 475B.475(2)
A caregiver is 18 years of age or older and has major responsibility for managing a patient’s well-being.
Contact the OMMP if you would like to name hospice or a palliative, home health care or residential facility as caregiver.
Grower and grow site instructions:
A grower must be 21 years of age or older and may not grow for more than four patients at a time.
The OMMP will conduct a criminal history check on every grower. ORS 475B.420(3)
A grow site must have a physical Oregon address and must not be located at a medical or retail marijuana dispensary.
Proof of zoning is required if the grow site address is located within city limits. Ask the county or city you live in for
documentation of zoning.
All growers will receive a letter regarding online grow site registration fee payment and reporting requirements.
Residency proof instructions:
Patients must prove current Oregon residency by sending one of the following:
Oregon issued identification
Other ID and other residency proof, such as current tax returns, utility bills, lease/mortgage or rental agreements
Replacement card fees
If you do not submit a complete change form or the correct replacement card fee, no changes will be made.
There is no fee to change a mailing address or remove a caregiver or grower and grow site.
Patient replacement card fee: $100 unless patient sends proof of:
Supplemental Security Income (SSI).
$20
(Note: Social Security Disability Income and retirement benefits do not qualify.)
$20 Having served in the U.S. armed forces.
Grow site registration fee:
$200 The grower must submit a $200 grow site registration fee if one or more of the following is true:
The grow site is not the patient’s residence.
The grower is not the patient on this form.
The grow site has more than 12 mature medical marijuana plants.
The grower will be transferring medical marijuana to a dispensary or processing site.
$0 No grow site registration fee is required for patients growing for themselves at their own residence where
there are 12 or fewer mature medical marijuana plants and who will not be transferring medical marijuana
to an OMMP dispensary or processing site.
OMMP fees are non-refundable. Make checks payable to OHA/OMMP. Do not send cash. Growers may pay online
after receiving notification from OMMP with payment instructions.
Mail change form, ID copies, residency proof, zoning documentation as applicable, and check/money order to:
OHA/OMMP, P.O. Box 14450, Portland, OR 97293-0450
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OHA 9241 (10/2016)
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