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Note: Refer to the Registration Instructions when completing this form.
Please check boxes to confirm that you have the following information/documents to register as a caregiver:
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    The caregiver must upload a copy of his/her valid US government-issued photo ID, such as a driver's license, passport or military id. If the government ID you are providing is not a Maryland driver’s license or MVA ID card, then you must also provide proof of a Maryland address or proof that your patient is in the State to receive medical treatment. Please refer to the MMCC website for more information.
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    You must provide the last four digits of your SSN to register as a caregiver.
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    This must be a clear, color photo of the caregiver’s unobscured face taken within the last six months to reflect the caregiver’s current appearance with a plain white or off-white background. The caregiver must be directly facing the camera and should have a neutral facial expression or natural smile with both eyes open. Generally, the photo should look like a driver’s license or passport photo. The file must be an image (.jpg, .png or .gif) no larger than 3 MB in size and may not be digitally enhanced or altered in a way that changes the caregiver’s appearance. Please refer to the Registration Instructions for more information concerning the photo requirements.

    If your photo does not meet our guidelines, your application will be returned.
    An example of an acceptable photo is shown here.
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    The Commission will use the email address you provide on your registration application to communicate with you regarding your registration. You must provide an email address to which you have access in order to receive those communications.