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, \ , Nov, 26, 2008 4:39PM CBR Medical lnc, No, 2426 p, ·3/5 //~ '-\-,:.': "".:. c) \ ,'\'...... pre~~rrn:r(Print) 7""'· ."'~ 7-'. --- License #: ,:.':' f.' ~"""'-1 '\'-\;( _,' .. _ .. __ .~ ensetype:. . •. ' (~~J)~ __ ---,,.-__ , ... -..... "...,... ) V\-.,.·""I\.(
,_._ ....... __ .. _._.- - ..... ----.. -.. . J . Nov, 26, 2008 4: 40PM CBR Medical Inc, No, 2426 p, 4/5 I i Documentation of Medical A~lthorization to Possess Marijuana . for Medical purposes in Washington State PATIENTNAME;.:~--:_· _:...... __ _ DATE OF BIRTH: _980 I, Antoine Johnson ____, ama physician licensed in U18 State of Washington and I am tJ'eating the above patient for a terminal iIIn,es..or-ajdebilitating condition as defined by RCW 69.51A.010_ '.,. I . I have advised the above named patient about .. th·e potentiaVrisks and benefrts of the medical use of marijuana. I have assessed the above named patient'::d'rledical history and medical condition. It i!::! my mecHcal opinion that the potenfia.!.Ij·enefits of the ~edical use of marijuana may outweigh the health risks for this patient" ./ J :" Physician Name: ~.,0-rtoine:....::;']:..:o:.:..:h;.,:.;ns;;;::o.:.:.n ___/_ WA License NUrllber: ___ M_D_O __ OO __ 3 __ 9 __ 0_48_ PllYsician Signature: __ ---:-___ ' /' _....:..../_.,.",.., .::.,.,,~-:--'-6~;e; 08/24/2008 This recommendation expir~~ on: 08/24/2QO£'/..... ' /
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STATE OF WASHINGTON DEPARTMENT OF C
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RECORDS PROVIDED WITH REDACTIONS ~~
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(".- " ~"""'":.~ Inr ... ~ STATEOFW
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i ( Documentation of Physician Auth
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OCT/ Oct. B. LUO~, 11: ::J9AM T ~co
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... ""'"'''' f~ STATEOFWA$HINGTON ~
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Distefano, Monica J. (DOC) From: Se
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eRR Medical, Il1c 3115 E. Mission A
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Fax : ' 3115,E. Mission Ave Spokane
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Or-FENDER 1.0. DATA, j' STATE OF WA
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DoCumentation of Medical AuthoriZat
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'.!, To: C!6R MedicaO,. h'IlC 31)5
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STATE OF WASHINGTON DEPA'RTMENTOF C
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311S'E. Mission Ave Spokane, WA 992
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''' .. r.~ l~} STATEOFWASHINGTON "1
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j I Documentation of MedicarAuthcir
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Chapter 69.51 A RCW: Medical marij1
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Chapter 69.S1A RCW: Medical marijua
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Chapter 69.511). RCW: Medical111ari
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OFFENDER 1.0. DATA: STATE OF WASHIN
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Prescriber's Name (Print) License#:
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3115 E. Mission Ave Spokane, WA 992
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. ! STATE OF WASHINGTON DEPARTMENT
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STATE OF WASHINGTON .DEPARTMENT OF
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T.)' ~x.. MARIJUANA MEDICINE'· 'EV
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Nov. 26. 2008 4:37PM CBR Medical In
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No'v, 26, 2008 4:48PM CB R Me d i c
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Wheeler, Judine L. (DOC) From: Sent
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OMNI: Chrollos Quick Search , •
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-...... THCF MEDICAL CLINICS 1813 1
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Prescdbar's Name (pnnt) . Prasc~jje
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I I do ncit want to ruffle feathers
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Interpretation of Medical Marijuana
Page 95 and 96: From: Sent: To: Duggan, Brenda J. (
Page 97 and 98: NIELSEN TO COME UPSTAIRS. CCO NIELS
Page 99 and 100: Date & Tirpe Created: 12/16/2008 11
Page 101 and 102: PRIMARY CARE PHYSICIAN AND LOOKED O
Page 103 and 104: Distefano, Monica J; (DOC) From: Se
Page 105 and 106: 3. High Non-Violent 4. Moderate, an
Page 107 and 108: , ' ~. With Community Corrections S
Page 109 and 110: Distefano, Monica J. (DOC) From: Se
Page 111 and 112: I FW: 380200 Community Supervision
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Page 151 and 152: Documentation of Medical Authorizat
Page 153 and 154: Distefano. Monica J. (DOC) From: Se
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Page 159 and 160: Dec .. l0. 2008 1:34PM CBR Medical
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Page 165 and 166: Stern, Marc F. 'Dir Hlth Svc' (~OC)
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Page 171 and 172: Distefano, Monica J: (DOC) From: Se
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THCF.MedlcaI ·Clinics· '"9,-J, .
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Fax 36027706511· Apr 20 2009 04;31
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MAR/30/200S/MON OS :·31 AM FAX No,
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03/04/2009 14:08 2064186659 CBR MED
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STATEOFWASHINGTON . DEPARTMENT OF C
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Documentation of Medical Authorizat
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OFFENDER I.D. DATA: STATE OFWASHING
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1813 Born Avenue NE, Suite'#210 Bel
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Distefano. Monica J. (DOC) From: Se
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;lan.14. 2009 9:52PM CBR Medical In
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3115 E. Mission Ave Spokcme, WA 992
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OFFENDGR I,D, DATA: STATE OF WASHIN
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.IL , Documentation of Medical Auth
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J STATE OF WASHINGTON DEPARTMENT OF
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3115 E. Mission Ave 'Spokane, WA 99
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OFFENDER 1.0. OA·I.o.: STATE OF WA
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MARIJUANA MEDICINE- EVAlUATtON CENT
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~flor~1I .J''; ~. I l ~ATE OF WASHI
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March 23, 2009 STATE OF. WASHINGTON
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OFFENDER 1.0. DATA: STATE OF WASHIN
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OFFENDER 1.0. DATA: STATE OFWASHING
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Scott L. Havsy, DO, DAApM -Board Ce
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Documentation of Medical Authorizat
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