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j I i I I ·Dec.23. 2008 5: 07PM CBR Medical Inc. No. 2825 P. 5/33 Document"ation of Medical Authorization to Possess Marijuana for Medical Purposes in Washington state PATIENT NAME: __ _ DATE OF BIRT!-I: _982 . I, Antoine John§..9.!L. I am a physici·an licensed in the State ofWashingtbn and I am treating the above patient for a tenninal iII!'1~:or a debilitating condltio'n as defined by RCW 69~51A.010_ " • ,! I have advised the above named patient abq~l(the pot¢ntial risks and benefits of the medical use of marijuana. ! have assessed the above named pati\int's medical history and medical Gondition_ It is my medical opinion that the potemiii\r"benefits of.jhe medical use of marijuana may outweigh the health risks for this patient. ,:/ . ..:/ . . Physician Name: _----'D::.;r"-.-~A.:..::nt:.;;o.;:.;in'El~,J=oh=n.:..:;s.;:;.on:.!.__ _'__WA License NUrriber:. ___ M_D_O_OO_3_9_0_48- Date: __..:..1.:.:.1/.::..:02!=2::.:0::.::0~8___ .. Risks al7d benefits of medical marijuana / Under Washington law, the use of edi¢al marijuana Is' now permissible 'for some patients with terminal or·debilitating illn~sses_jTh~/law regulating this (RCW a9.51A) allows physicians' to advise patients about the risks an9 be(iefits of the medical Lise of marijuana_ The medIcal and scientific evide~[;e ;;'upporting the use of medical marijuana remains controversial in the medical commupity/ Not an health care providers believe that medical marijuana is safe or effective and s9m~ providers feel that it is a dangerous drug_ . According to the Washington St*tgl8W the benefits of medical marijuana may include treating nausea and vomiting from ~emotherapYI AIDS wasting syndrome, severe muscle spasms frqm multiple sclerosis or o'-Lher spasticity disorders, glaucoma, and some types of intractable pain. . . Some of the risks .of medical marijuana may include possible long-term eIfects of the brain in the areas of memory, coordination and cognition; impairm(mt of the ability to drive or operate heavy machinery; respiratory damage: possible lung cancer; and physical or psychological dependence. Recommendation As this patient's "60 Day Supply", as stipulated by RCW 69_51A.040 (3)(b) and WAC 246-/5-010, this Qualifying Patient can reasonably expect to have in 1heir Posession and -------'I'iJ~efd-ailjtalof·J1bliTore-tharr2"4-e)tmces-of"l:I·seable-Marijrrarrct'-cmd-no-rnore-than-1-5-Plants:-. ------- CBR Medical, Inc. Administrative Office 3115 E_ Mission Ave, Spokane, WA 99202 Spokane: 509"242-8624 Fax:509-340-2710 Seattle: 206-774--6493 Fax: 206--118-66Q9 . EMERGENCY OR LAW ENFORCEMENT ONLY CALL 509-570-2886 OR 509-570-6943 PDU-6655-3 000191
STATE OF WASHINGTON DEPARTMENT OF CORRECTIONS P.O. Box 411 00 • Olympia, Washington98504-11 00 April 29, 2009 Mr ...... (/0 ceo Jon tS DearMr_ . Your Medicinal Use of Marijuana request.was received on April 20, 2009. Upon review by the Department of Corrections' Health Services physician, your request has been denied. . .. You may appeal tbis decision by sending your written request within 15 business days cjf receiving this letter. Please send your request to the address below: . Karen Daniels, Assistant Secretary Community Corrections Division Department of Corrections P.O. Box 41126 Olympia, WA 98504-1126 Your request must provide additional infonnation that was not included with your original request. Appeals that do not contain new infonnation will be denied. You will receive a response to your appeal request within 30 days of receipt . Sincere1Yj . / ~ (j.~". :;b ft./-_/:., .,. ,......::-;,... ~ Karen Daniels, Assistant Secretary . Community Corrections Division KD:md -----,cc:....-.-Geot:geJones,-Communit)LCoJ.:tections-O'ffice.r,~----...:......-------------- Marjorie Owens, Interstate Compact Unit . . Field File-_ . Physician's Office: Dr. Thomas Orvald 1813 l30 th Ave. NE #210 Bellevue, W A 98005 " Working Together for SAFE Communities" -0 recycled paper PDU-6655-3 000192
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STATE OF WASHINGTON DEPARTMENT OF C
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Chapter 69.51 A RCW: Medical marij1
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Documentation of Medical Authorizat
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