Arizona's medical-marijuana law takes effect Thursday, but patients already have been lining up to pay hundreds of dollars in some cases for pot recommendations from clinics that opened in recent weeks for just that purpose.

Health officials are concerned that so-called certification mills could quickly turn a medical program into a recreational one, but they have limited recourse.

Starting today, people can apply with the state Department of Health Services for permission to use marijuana to treat debilitating medical conditions, including cancer, glaucoma, HIV/AIDS and Alzheimer's disease.

The online-only application requires a photo of the patient, a copy of his or her driver's license, a signed statement promising not to give the marijuana to anyone and certification from a physician that the patient would benefit from using pot.

State rules finalized last month by DHS require a health professional licensed by one of four Arizona boards - allopathic, osteopathic, naturopathic or homeopathic - to conduct a physical exam, review one year of medical records, confirm a debilitating diagnosis and check the patient's other prescriptions through an online database.

While much of the attention in the marijuana debate has focused on dispensaries, which won't go online until later this year, a small industry has sprouted to help patients qualify.

DHS Director Will Humble said the rules were written to regulate the industry as tightly as possible without running afoul of the law voters passed in November as Proposition 203. But he said it will only take a handful of physicians writing casual recommendations to explode the program.

"What I'm afraid of is there will be enough of them that just check the boxes but don't really do it (a thorough exam). Or do a cursory drive-by . . . collect the money and move on to the next patient," Humble said.

"I'm concerned that enough of them will end up turning this into a program that we didn't intend for it to become."

Humble said the health department will work with the Arizona Medical Board and other licensing boards to check up on doctors who appear to be issuing medical-marijuana recommendations outside the law. Red flags might be similar demographics or medical conditions, he said.

The first draft of rules required physicians to have a one-year relationship with a patient, but now a doctor could recommend pot to someone the same day they meet.

"What appears to be happening already is you've got a small group of doctors who are doing exclusive medical-marijuana recommendations to patients who are new to them," said Lisa Wynn, executive director of the Arizona Medical Board. "They're arriving at the answer before they've even met the patient."

Sue Sisley, a Scottsdale internist in private practice, supported Proposition 203 but believes many doctors will opt out of the recommendation business for fear of jeopardizing their practices.

"I know tons of docs who won't come near this program," said Sisley, whose practice doesn't include anyone who would qualify. "That's what lends itself to these certification mills. That's what we were hoping to avoid by the rule-making."

Jay Reis, director of Arizona Medical Marijuana Certification Centers, runs three clinics in Scottsdale, Tucson and Cottonwood and is the process of opening three more. The centers charge $150 for a same-day certification but require three years of patient records, though the law only requires one.

Reis said he launched the business in January because he believes medical marijuana can bring relief to suffering patients. He said he's offended by mobile-certification outfits set up in hotel rooms or trailers by newcomers to Arizona, who give clinics like his a bad name.

"They're coming in here, putting doctors in a hotel room and not even giving you a physical," he said. "They're just here for the money."

Humble said he doesn't care where the exams are done, only that all the requirements are complied with.

"I don't care whether the assessment happens in the park," Humble said. "The question is, is the physician acting in the best interest of the patient?"

The DHS will have 15 working days to process the applications and has hired 10 temporary workers in hopes of avoiding a backlog.

Humble said the agency can handle up to 500 applications a day. Patients whose certifications aren't processed within the timeframe will have the $150 health-department fee waived.

Since there are not yet any licensed dispensaries in Arizona, patients who receive medical-marijuana ID cards also will have authorization to grow their own pot.

Patients can cultivate up to 12 marijuana plants. The plants must be grown indoors in a locked room or outdoors surrounded by a concrete wall and a locked steel gate.