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I 1 I CBK Medical lnc, No, 2825 p, 1133 I Fax: CBR MedIcal, Inc q115 E. MisslOh AVe Spokane, WA99202 From: mehQSfA.~@ C Be ,---.... ........... ~:......:::d...::..~~~~r",.---=D:::at:::G~ '/,; ;orp:{\L,_~_ Pages: , ! ' Cl Urgent o For Rev(ow o Please Comment 0 Please Reply r:IPlease Recycle , -Comments; '-~--'. --.-- CI3R Medical, Inc.· 3115 F., Mission Avs, Spokane, We 99202 ' ," '. Seat\le Phone 206w774-6493 Fax 20B-41M659 Spokane Phone 509-:-242.-862.4 Fax 509-340-271Q Tri.CiCes Phone 5094 '\ 6~2267 Fax 5D9-~4Q-2710 Vancouver Phone 3130-635-6464 raJ( 206-418-6650 CONFlOENT1Alr;-y NOTICE: "This communicatioh is intended , for \he sole use of the individual and entity to whom it is addressed, and may contaIn infonnation that is privileged, or confidential and exempt from disclcsLlre under applIcable law. You are hereby notified that any dissaminatlon. distribution, or duplication of this comf.l1unicatlon by someone other than the intended addressee or its designated agent \q striGtly prohipited. All Information is Protected Ul1d$r U.s, Federal Law PDU-6655-3 000187
~ec. 23. 2UUB 9:U,PM' (;~K Medj'cal lnc. No. 2829 P. 2133 /"'.... . oI'fENDJ:R ~tl.ll' .. rA! (~ STATE OflWASHINGTON . ~ DEPARTMENT 01' CORREC1'lOI\l$ AUTHORIZATION FOR DISCLOSURE hereby authorize the· use or disclosure of my health Information as described below. The following individual or organization Is authorized to malce the disclosure; . Nf\ME: C 8 K j.{e.A i c., (L/ b Co " ADDRESs.: .'-2' I I "":r t"-- , A/Ir' 50 -:;" cJ ' . ADDRESS:;Y' ~r ~jZ;eX 'ft5jtJ Y1 ! understand that I have a right to revoke this authorization at any time. I understand that if I revoke this . authorization! must do so in writing and present my written revoGation to the Health Information M
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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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STATE OF WASHINGTON DEPA'RTMENTOF C
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311S'E. Mission Ave Spokane, WA 992
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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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.~. :.' '. ATTEN1':tON LAW ENFORCEM
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\"'Ior"'.~ OFFENDER 1.0. DATA: I f
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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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Let me know if you have questions f
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Interpretation of Medical Marijuana
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From: Sent: To: Duggan, Brenda J. (
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NIELSEN TO COME UPSTAIRS. CCO NIELS
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Date & Tirpe Created: 12/16/2008 11
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PRIMARY CARE PHYSICIAN AND LOOKED O
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Distefano, Monica J; (DOC) From: Se
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3. High Non-Violent 4. Moderate, an
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, ' ~. With Community Corrections S
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I FW: 380200 Community Supervision
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FW: 380200 COInmunity Supervision o
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Distefano, Monica J. (DOC) · From:
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Distefano, Moriica J. (DOC) From: .
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j I Distefano, Monica J. (DOC) From
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E.... KIOSK reporting may be used i
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RE: 380 200 Community Supervision o
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RE: 380200 Community Supervision of
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to be processed now. If this was re
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FW: 380200 Community Supervision of
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FW: 380200 Community Sup_ervision o
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Page 153 and 154: Distefano. Monica J. (DOC) From: Se
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Page 157 and 158: I:--- j ! -_. Distefano, MonicaJ. (
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Page 163 and 164: Distefano, Monica J. (DOC) From: Se
Page 165 and 166: Stern, Marc F. 'Dir Hlth Svc' (~OC)
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Page 169 and 170: I J i Date License type: Prescriber
Page 171 and 172: Distefano, Monica J: (DOC) From: Se
Page 173 and 174: STATE OF WASHINGTON DEPARTMENT OF C
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Page 189: .Distefano, Monica J. (DOC) From: S
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Page 197 and 198: THCF.MedlcaI ·Clinics· '"9,-J, .
Page 199 and 200: ., FAX No. 509-921-2346 P.' 004 Pr~
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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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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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MARIJUANA MEDICINE- EVAlUATtON CENT
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Distefano, Monica J. (DOC) From: Ha
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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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I Prescriber's Name (Print) License
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Documentation of Medical Authorizat
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