(a) in the case of a certified patient:
(i) the patient's certification, a new written certification shall be provided with a renewal application if required by the office;
(ii) the name, address, and date of birth of the patient;
(iii) the date of the certification;
(iv) if the patient has a registry identification card based on a current valid certification, the registry identification number and expiration date of that registry identification card;
(v) the specified date until which the patient would benefit from medical cannabis, if the certification states such a date;
(vi) the name, address, and telephone number of the certifying practitioner;
(vii) any recommendation or limitation by the practitioner as to the form or forms of medical cannabis or dosage for the certified patient;
(viii) if the certified patient designates a designated caregiver, the name, address, and date of birth of the designated caregiver, and other individual identifying information required by the board;
(ix) if the designated caregiver is a cannabis research license holder under this chapter, the name of the organization conducting the research, the address, phone number, name of the individual leading the research or appropriate designee, and other identifying information required by the board; and
(x) other individual identifying information required by the office;
(b) in the case of a designated caregiver:
(i) the name, address, and date of birth of the designated caregiver;
(ii) if the designated caregiver has a registry identification card, the registry identification number and expiration date of that registry identification card; and
(iii) other individual identifying information required by the office;
(c) a statement that a false statement made in the application is punishable under section 210.45 of the penal law;
(d) the date of the application and the signature of the certified patient or designated caregiver, as the case may be;
(e) any other requirements determined by the board. 3. Where a certified patient is under the age of eighteen or otherwise incapable of consent:
(a) The application for a registry identification card shall be made by the person responsible for making health care decisions for the patient.
(b) The designated caregiver shall be: (i) a parent or legal guardian of the certified patient; (ii) a person designated by a parent or legal guardian; (iii) an employee of a designated caregiver facility, including a cannabis research license holder; or (iv) an appropriate person approved by the office upon a sufficient showing that no parent or legal guardian is appropriate or available. 4. No person may be a designated caregiver if the person is under twenty-one years of age unless a sufficient showing is made to the office that the person should be permitted to serve as a designated caregiver. The requirements for such a showing shall be determined by the board. 5. No person may be a designated caregiver for more than four certified patients at one time; provided, however, that this limitation shall not apply to a designated caregiver facility, or cannabis research license holder as defined by this chapter. 6. If a certified patient wishes to change or terminate his or her designated caregiver, for whatever reason, the certified patient shall notify the office as soon as practicable. The office shall issue a notification to the designated caregiver that their registration card is invalid and must be promptly destroyed. The newly designated caregiver must comply with all requirements set forth in this section. 7. If the certification so provides, the registry identification card shall contain any recommendation or limitation by the practitioner as to the form or forms of medical cannabis or dosage for the certified patient. 8. The office shall issue separate registry identification cards for certified patients and designated caregivers as soon as reasonably practicable after receiving a complete application under this section, unless it determines that the application is incomplete or factually inaccurate, in which case it shall promptly notify the applicant. 9. If the application of a certified patient designates an individual as a designated caregiver who is not authorized to be a designated caregiver, that portion of the application shall be denied by the office but that shall not affect the approval of the balance of the application. 10. A registry identification card shall:
(a) contain the name of the certified patient or the designated caregiver as the case may be;
(b) contain the date of issuance and expiration date of the registry identification card;
(c) contain a registry identification number for the certified patient or designated caregiver, as the case may be and a registry identification number;
(d) contain a photograph of the individual to whom the registry identification card is being issued, which shall be obtained by the office in a manner specified by the board in regulations; provided, however, that if the office requires certified patients to submit photographs for this purpose, there shall be a reasonable accommodation of certified patients who are confined to their homes due to their medical conditions and may therefore have difficulty procuring photographs;
(e) be a secure document as determined by the board;
(f) plainly state any recommendation or limitation by the practitioner as to the form or forms of medical cannabis or dosage for the certified patient; and
(g) any other requirements determined by the board. 11. A certified patient or designated caregiver who has been issued a registry identification card shall notify the office of any change in his or her name or address or, with respect to the patient, if he or she ceases to have the condition noted on the certification within ten days of such change. The certified patient's or designated caregiver's registry identification card shall be deemed invalid and shall be promptly destroyed. 12. If a certified patient or designated caregiver loses his or her registry identification card, he or she shall notify the office within ten days of losing the card. The office shall issue a new registry identification card as soon as practicable, which may contain a new registry identification number, to the certified patient or designated caregiver, as the case may be. 13. The office shall maintain a confidential list of the persons to whom it has issued registry identification cards. Individual identifying information obtained by the office under this article shall be confidential and exempt from disclosure under article six of the public officers law. 14. The board shall verify to law enforcement personnel in an appropriate case whether a registry identification card is valid and any other relevant information necessary to protect patients' rights to medical cannabis by confirming compliance with this article. 15. If a certified patient or designated caregiver willfully violates any provision of this article as determined by the board, his or her certification and registry identification card may be suspended or revoked. This is in addition to any other penalty that may apply. 16. The board shall make regulations for special certifications, which shall include expedited procedures and which may require the applicant to submit additional documentation establishing the clinical basis for the special certification. If the board has not established and made available a form for a registry application or renewal application, then in the case of a special certification, a registry application or renewal application that otherwise conforms with the requirements of this section shall not require the use of a form.