CTR Practice Site Address

When you applied for a Certificate to Recommend medical marijuana (CTR) in eLicense.ohio.gov, you were given the option to designate a mailing address and a public address. Your public address is the location in which you practice medicine, and under Ohio law, the Medical Board is required to publish the practice address of all physicians with an active CTR. The board recognizes that your CTR office location may differ from your main practice location. To ensure the correct information is captured and published for the Ohio Medical Marijuana Control Program, we’ve created a survey for you to confirm the addresses you wish to list on the medical marijuana physician locator.

1) Name of Practice Site

2) Street Address

3) City

4) State

5) ZIP Code

6) County

7) Practice Settings

Hospital – Inpatient Hospital – Outpatient Hospital – Emergency Department Office/Clinic – Single Specialty Group Office/Clinic – Multi Specialty Group Office/Clinic – Partnership Office/Clinic – Solo Practice Telemedicine Federal/State/Community Health Center

Other, please specify

8) Add Additional Addresses

9) Ohio MD/DO License Number (example: 35.12345CTR)

10) Name

11) Email Address