Report Of Lost Stolen Or Damaged Registry Card
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Medical Marijuana Registry
Report of Lost, Stolen or Damaged Registry Card
A. You must submit:
1. Complete, notarized form MMR1004 Report of Lost, Stolen or Damaged Registry Card.
2. Government-issued driver’s license, photo ID or military ID.
B. Proof of identity requirements:
1. Government-issued ID must be readable and valid. A temporary Colorado-issued driver’s
license or identification card may be submitted with a copy of your most current state-issued
photo ID. Approval of temporary ID is subject to verification by the Colorado Department of Motor
Vehicles. To ensure your photo ID is readable, please enlarge it 150% to 200% and lighten
background by 50%. Damaged, expired or tampered IDs are not valid.
2. If you do not have a U.S. government-issued driver’s license, photo ID or military ID, contact
our office at 303-692-2184, extension 3, for other secure and verifiable identity documents.
3. Patient social security numbers are used to confirm identity and protect confidentiality.
C. For patients under the age of 18:
1. All proof of identity documents must be in the primary parent’s full name. A copy of the
patient’s birth certificate was provided during the application process as proof of the
patient’s identity.
2. The primary parent or legal guardian’s signature is required on all forms for patients under
the age of 18.
D. For patients with legal guardians or an authorized representative:
1. Provide a copy of the guardian’s or authorized representative’s ID.
2. Make sure a copy of the legal documentation granting legal guardianship or authorized
representation is on file with the Registry. Acceptable documents include court-certified
guardianship documents, power of attorney or medical power of attorney. Medical care rights
must be included as a responsibility of the guardian/agent in order to contact the Registry
regarding patient records and care.
E. Submit paperwork by mail or deliver to the Registry’s drop-box:
1. Mail: Change Request, CDPHE, HSV-8608, 4300 Cherry Creek Dr S, Denver, CO 80246-1530
2. Deliver to drop-box: 710 S Ash St, southeast entrance, Monday-Friday, 7:00 a.m. to 6:00 p.m.
The drop box is on the wall inside the first set of glass doors. Your paperwork must be in a
sealed envelope. You will not receive a receipt. If you wish to have a proof of submission,
please mail your paperwork by certified mail.
F. Processing time:
Allow 5 weeks from the date the Registry receives your paperwork for complete processing.
4300 Cherry Creek Dr S, HSV-8608, Denver, CO 80246 | P 303-692-2184 | F 303-758-5182
medical.marijuana@state.co.us
|
MMR1004 Lost/Stolen Report | Revised November 2014 | Page 1 of 2
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