DOC request three complete - Cannabis Defense Coalition

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Prescriber: please return this form and the patient's Release of Information to: Medical Director Health Services Division WashingtC!n State Department of Corrections PO Box 41123 Olympia, WA 98504-2113 To be filled out by DOC Physician: I have revie~ed this verificatiofl: ~~d find that use of medical marijuana by this patient " (check one) lOis IB is not . ,. consistent with DOC Policy_ if 0 ./.' . . ail •• ut- ~~ Physician's Name (Print) Physician's Signature Date Instructions to DOC Physician: When form is complete: 1. Email your finding above to the Assistant Secre~ary for Community Corrections 2. File this form and the accompanying Release of Information in Liberty as a Community Corrections Health Record. State law (RCW 70.02; RCW i0.24.105; RCW 7/.05.390; and/or federal regulations (42 CFR Part 2; 45 CFR Part 164) prolribit disc/ostlre of tlris in/ormatiOIl witlrout the specific i
Distefano. Monica J. (DOC) From: Distefano, Monica J. (DOC) Sent: To: Tuesday, December 09,20089:31 AM Ohman, Holly L. (DOC); Ohly, Frank C. (DOC) Subject: FW: MM Authorization Request ·FYI- This offender's request was dened. Monica Distefano Executive Secretary to Karen Daniels, Assistant Secretary Community Corrections Division 7345 Linderson Way SW Tumwater, WA 98501 MS: 41126 (360) 725-Cl796 mjdistefano@doc1.wa.gov From: Sent: To: Subject: Hammond, G. Steven (DOC) Monday, December 08, 2008 4:39 PM !:Janiels. Karen R. _ MM Authorization Request No~ consistent with DOC policy· G. Steven Hammond PhD, MD, MHA Director of Medical Services Health Services Division Department of Corrections POB 41123 . Tumwater, WA98504~1123 360-725-8700 1 PDU-6655-3 000138
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