DOC request three complete - Cannabis Defense Coalition

OCT/08/2008/WED 01: 39 PM Tael FAX No. 12535974352 P.003
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No. 7218 P. 2
p, UUl
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~ ~ STATE OF WASHINGTON
..., ~AfomlI!NT OF eORfU!CTIONS
Medicinal Use of MarfJuana Verlflcatlon
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Dear PresCriber" .
By state stafuls the Washington state Department of Cnrtectfons Is aharged with Ihe rnponslbility 111 ~1ipervise some.
offenders after they have been convicted of a felony. T{le above named,patient Is currenj~ under supervision by the
Department. Supervision Is dealgned 10 help !hI! oIl'ander avoid thOle environments or eltuaUonll that lead !o !heir criminal
behalliol'_ OIIen illicit dfug use Is a contriJlJlinl1 facIDr in an individtr.ll's crlmil'laltty. ~Clrdlngly It's oBtl'Si 1hat lhe co~rt or
Ihe Capartmen~ of corr&etfona wllllmPOs. a condlUon of aupurvi5ian that the affendernot U!le, or possess Ulicit drugs;
including marijuana_ This effendiiii' has daimed thaf they ttave a' eolid!t1on i'ot which lhe medicllil! Lila of maiil~nil hiS
been recommended. The below varfflcatimi& to determine 11:18 legitimacy of iheir claim. Thank you in advance far ytlur
assIstance., It you have Questfons pi$l.se feel free 10 personally contact tile Medlcsl Oil1lotcr of the Department at (360)
725>8700.
1. Is thfs patient under yo~r care
2. ' Are you recommending medical marijuana for his patient due til 9 dlagno$1$ of Acl:jull'ld
.. Immunodefir::ieney Synclro\'l19 (AI~)
lil. If 1he answer to QUe$Uon ~ Is ·Vest. dr;ie$ he/she. have anorexta
b. If tns answer to lIues!JCI1 2. III -Vas", does he/she have weiSht loss
3, Are you recommending m&dlcal mlil'ijl.l&na (or this paDant due to nausea and vomiting
associated wfth cOIIlCer chemotherapy • '. '
ii. ,fflhe iinllwer til ql'Jestlan 3lB '"(8S·, has the patient failed to respond to eonventlone!
~ntlemailc iraalmen!iI
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DYes
ClYes
DYes
C1Yes
DYes
D. If the aoewerto QU8$!IOh 3a 15 "Yes", please describe what those Ire;;lments lIIIere (medicalloo, dose,
duration):
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[JNo
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CJNo
DNa
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DNa
c. What is thlnned sohedule of chem~fherapy ~.. " '., " , .
rtIrJ o./~,,JL-· +f~J.--r-,~, ~4~
4. If you an!i "Ng" 'a Items 2 & 3 above,. what is the reason you are recommendlng inedlclnaluse of
marijuana '¥-~ ~ fte-GB,rl~ fv~
a. Fiease provide evidenee published ~ a peer-revlewed 15clenllllc publication to iUP;ft the medlolrlal IJ.~~! j,
marlluana for this purpose7 TJ'L,J.,...... ~ 'IJ IT f4 ~ 4"''''>.
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. 5. While on community supeMslon ("parole") the Department of Corrections only ~uthorl%e' 1he .;,../._ '
use of !he oral sl'"thetlo formulation tri'marijuana_ If tOe Department authorll:ea thIs patlenl's D Yes V
use of medk:a/ marijuana, will you be prescrlb!ng only the oral synthetic fomiulaUon
6, Thepat1en~s accompanying ~Iaaee Of InformaUon liIUthorizes you to proYlde the .-
Oeparfmentwith currant and Min i1furmation related to this Issue_ 00 you agree to notify, 0 Yes' No" ,
the D~ent'll Medle;i Olrector of any changes in your answers above .
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DOC 14-053