Illinois Medical Cannabis Program Application For Registry Identification Card For Qualifying Patients Under 18 Years Of Age And Their Designated Caregivers Page 3
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7State of Illinois
Illinois Department of Public Health
Illinois Medical Cannabis Pilot Program
Application for Registry Identification Card for
Qualifying Patients Under 18 Years of Age and their Designated Caregivers
Designated caregiver photograph
Attach a photograph that:
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was taken less than 30 days before application submission;
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was taken against a plain background or backdrop;
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is in natural color;
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was taken in full-face view directly facing the camera with a neutral facial expression and both eyes open
(prescription glasses and religious head coverings not covering any areas of the open face are allowed);
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is at least 2 inches by 2 inches in size; and
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is at least 600 x 600 pixels, but no greater than 1,200 x 1,200 pixels in dimension.
Application Fee
Include payment of $100 by check or money order payable to:
Illinois Department of Public Health
Page 3 of 3
Printed by Authority of the State of Illinois
IOCI 15-164
P.O.#3115001
2M
12/14
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Parent category: Medical