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Distefano. Monica J. (DOC) From: Distefano, Monica J. (DOC) . Sent: Tuesday, December 23,200812:22 PM To: Hub~); Young, Dianne M. (DOC) Subject: FW: ___ mm request . FYI Monica Distefano Executive Secretary to Karen Daniels, Assistant Secretary Community Con'ections Division 7345 Linderson Way SW Tumwater, WA 98501 MS: 41126 (360) 725-8796 mjdistefano@doc1.wa.gov From: Hammond, G. Steven (DOC) Sent: Friday, December 19, 2008 9:58 AM To: Daniels, Karen R. Monica J: (DOC) Cc: Subject: mm request Mr _ case does not meet o'OC criteria for approval of me~ical marijuana. G. Steven Hammond PhD, MD, MHA Chief Medical Officer Health Services Division .Department of Corrections . POB 41123 Tumwater, WA 98504-1123 360~725-8700 1 . PDU-6655-3000145
I OFFENDER 1.0. DATA: ..# ....""..'.~ , I[J£ f ~~~~~~~S~~NC~~:ECTIONS Medicinal Use of Marijuana Verification To be filled out by Prescriber: Dear Prescriber, By state statute the Washington State Department of Corrections is charged with the responsibility to supervise some offenders after they have been convicted of a felony. The above named patient is currently under supervision by the Department. Supervision is designed to help the offender avoid those environments or situations that lead to their criminal behavior. Often illicit drug use is a contributing factor in an individual's criminality. Accordingly it's usual that the court or the Department of Corrections will impose a condition of supervision that the offender not use, or possess illicit drugs, including marijuana. This offender has claimed that they have a condition for which the medicinal use of marijuana has been recommended. The below verification is to determine the legitimacy of their claim. Thank you in advance for your assistance. If you have questions please feel free to personally ~ontact the Medical Director of tr'e Department at (360) 725-8700. 1. Is this patient under your care ~Yes' DNo 2. Are you recommending medical marijuana for his patient due to a diagnosis of Acquired Immunodeficiency Syndrome (AIDS) ....',,' . . . a. b. If the answer to question 2 is "Yes', does he/she have anqrexia If the answer to question 2a is "Yes", does he/she have weight loss DYes~o DYes DNa DYes DNo 3. Are you recommending medical marijuana for this patient due to nausea and vomiting associated with cancer chemotherapy ·a. If the answer to question 3 is "Yes·, has the patient failed to respond to conventional . antiemetic treatments b. DYes DYe~ If the answer to question 3a is "Yes", please describe what those treatments were (medication, dose, duratioQ): . . DNo· c. What is the planned schedule of ch(7}motherapy 4. If you answered "No" to items 2 & 3 above, what is the reason you are recommending medicinal use of marijuana A\JtONoM\C- N€V~~A"G'Ay ~""~ C~{l.t)N\( /Dt.~!f."ITA.tJ'4h (f\VS-\'-VlO Sl('~l~"t-~(. . [:)~JA/'" . a. Please provide evidence published in a peer-reviewed scientific publication to support the medicinal use of marijuana for this purpose . ',-- A "TV f:) . ------------'-. 5-tte-~C-W--b-£f ... -'S-~tl-(t/ .. 'O:.....--L~ .. ------ . . . R
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