All patients and legal representatives must complete an application.
Along with the application you must submit
- A copy of your Florida driver license, Florida identification card, or other proof of residency.
- A $75 check or money order (application fee) made out to Florida Department of Health.
- A passport-style, color photograph (2x2 inches in size) taken within the 90 days immediately preceding application.
If you are applying for a child under the age of 18, you must also include:
- A designated legal representative.
- A Compassionate Use Registry Identification Card Legal Representative Application.
- A copy of the parent’s or designated legal representative’s proof of residency.
Application packets should be mailed to:
Florida Department of Health
ATTN: Office of Compassionate Use
4052 Bald Cypress Way
Tallahassee, FL 32399