DOC request three complete - Cannabis Defense Coalition

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J . Nov, 26, 2008 4: 40PM CBR Medical Inc, No, 2426 p, 4/5
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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" ./
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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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