DOC request three complete - Cannabis Defense Coalition

More documents

Recommendations

Info

04/15/2009 18:28 ~258696378 THCF PAGE 04/~4 . Prescriber's Name (Print) Cate b " . I t r W\Co'\"''i ~ .. License#:,{'i'V'.. . S< li\C~\~:'rY( 0-1~t'L~ LlcEi.nsetype:. _. ____________ ""-__ 'Prescriber's Address . ...l'S 15'1') 1'"36;'-" ~(.. IVt. ~ 2.ll> '.' Pho~e ~umber .eI.\e....."\~ twA- ·&\govS.. . ·Presc.rlber: please return 'this 'f~rm ant! the patient's Release:of Information to: ~edical Director . .' Health Services DivisiQn Washington State Department of Corrections . . ' . . PO BoxA1'123 . . Olympia, WA 98504-2113 To' bEiill,ed out by .DOC 'PhY8ician: I have fevie~ed this ve~~cati~n'~~ }I'lc(find that use. ~f medicar ma~j~ana by this. patient '. ".'1.. '(¢hecl< one) lOis 'lkd'1s oot'. lit,.· .' consistent with DOC Policy. '. '. J! 11_. . . Physiclarr.s·Name (Print) ~~ Physician's Signature .' Oate Instr.uctlons·to D.OC P~ysician: When form. is ~cniplete: . . . 1. Email your finding above to the Assistant Secretary for .community Corrections. . . . 2. 'File'this:fo~m and the acco.!'TlpanYing·Releas~ of I~fonnaticin in.Lib~rty as a Community Corrections Health Record. 'State law (Rc:W70.D2i RCN 70.24.105; RCWj1.05:390) and/or federal regulatit;ms (42 Ci'R. Part 2j 45 CF.R Part"164) .prohlblt 'disclosure ofthls infonnirtion wit~out·th9 specific written conss\'It of the person to whom It per1alns, or. as otherwise. pormllt=d by law. . . . DOC 14-05~ .(Rev. 3/16f09) DOC 380.200 '. PDU-6655-3 000205
04/15/2009 18:28 4258696378 THCF PAGE 01/04 Fax Cover Sheet THCF Medical Clinic Thomas Orvald, M.D. 1813 130 fu Avenue NE, Suite 210 Bellevue~ WA 98005, Phone: (425) 869-6186 Fax: (425) 869-6378 I I , ! 'From: () {' t--- Attention:, --~--~-------- Phone: _____________ ~ Phone: ________ __ Fax: _~_.......:..---___:_-.....o.--- Pages:' "S '+ (oj-v" ~e: SI' 'l ' i \- l../",,") P (e~s~ c.C-il\ 'I~ ~ " . . Notes: ~ .~ '- PDU-6655-3 000206
Page 1 and 2:
STATE OF WASHINGTON DEPARTMENT OF C
Page 3 and 4:
RECORDS PROVIDED WITH REDACTIONS ~~
Page 5 and 6:
(".- " ~"""'":.~ Inr ... ~ STATEOFW
Page 7 and 8:
i ( Documentation of Physician Auth
Page 9 and 10:
OCT/ Oct. B. LUO~, 11: ::J9AM T ~co
Page 11 and 12:
, ( .....,-.\ ') ',. . ~'. ;' '-UVi
Page 13 and 14:
... ""'"'''' f~ STATEOFWA$HINGTON ~
Page 15 and 16:
Page 17 and 18:
Distefano, Monica J. (DOC) From: Se
Page 19 and 20:
eRR Medical, Il1c 3115 E. Mission A
Page 21 and 22:
Fax : ' 3115,E. Mission Ave Spokane
Page 23 and 24:
Or-FENDER 1.0. DATA, j' STATE OF WA
Page 25 and 26:
DoCumentation of Medical AuthoriZat
Page 27 and 28:
'.!, To: C!6R MedicaO,. h'IlC 31)5
Page 29 and 30:
STATE OF WASHINGTON DEPA'RTMENTOF C
Page 31 and 32:
.' .or", g u:,Se J f 'D. G4A() ~~ P
Page 33 and 34:
311S'E. Mission Ave Spokane, WA 992
Page 35 and 36:
''' .. r.~ l~} STATEOFWASHINGTON "1
Page 37 and 38:
j I Documentation of MedicarAuthcir
Page 39 and 40:
, • J ' -1. d; z.. 00 g-' /Vo v.
Page 41 and 42:
Chapter 69.51 A RCW: Medical marij1
Page 43 and 44:
Chapter 69.S1A RCW: Medical marijua
Page 45 and 46:
Chapter 69.511). RCW: Medical111ari
Page 47 and 48:
•• I ! 3115 E. Mission Ave Spok
Page 49 and 50:
OFFENDER 1.0. DATA: STATE OF WASHIN
Page 51 and 52:
I I l- I I tV!. tier f!! (VLA I 4.
Page 53 and 54:
~ra.4~ OFFENOcR 1.0. DATA: { ~ STAT
Page 55 and 56:
Prescriber's Name (Print) License#:
Page 57 and 58:
3115 E. Mission Ave Spokane, WA 992
Page 59 and 60:
. ! STATE OF WASHINGTON DEPARTMENT
Page 61 and 62:
STATE OF WASHINGTON .DEPARTMENT OF
Page 63 and 64:
T.)' ~x.. MARIJUANA MEDICINE'· 'EV
Page 65 and 66:
.,.,... ..,..,.~ f~J STATE OF WASHI
Page 67 and 68:
"'.... ~ . OFFENOeR 1.0. OATA: fnrt
Page 69 and 70:
-----------------------_ Brown, Dam
Page 71 and 72:
Nov. 26. 2008 4:37PM CBR Medical In
Page 73 and 74:
No'v, 26, 2008 4:48PM CB R Me d i c
Page 75 and 76:
.~. :.' '. ATTEN1':tON LAW ENFORCEM
Page 77 and 78:
\"'Ior"'.~ OFFENDER 1.0. DATA: I f
Page 79 and 80:
Wheeler, Judine L. (DOC) From: Sent
Page 81 and 82:
OMNI: Chrollos Quick Search , •
Page 83 and 84:
-...... THCF MEDICAL CLINICS 1813 1
Page 85 and 86:
Prescdbar's Name (pnnt) . Prasc~jje
Page 87 and 88:
- ...-------------- _._.-- _ ..----
Page 89 and 90:
I I do ncit want to ruffle feathers
Page 91 and 92:
Let me know if you have questions f
Page 93 and 94:
Interpretation of Medical Marijuana
Page 95 and 96:
From: Sent: To: Duggan, Brenda J. (
Page 97 and 98:
NIELSEN TO COME UPSTAIRS. CCO NIELS
Page 99 and 100:
Date & Tirpe Created: 12/16/2008 11
Page 101 and 102:
PRIMARY CARE PHYSICIAN AND LOOKED O
Page 103 and 104:
Distefano, Monica J; (DOC) From: Se
Page 105 and 106:
3. High Non-Violent 4. Moderate, an
Page 107 and 108:
, ' ~. With Community Corrections S
Page 109 and 110:
Page 111 and 112:
I FW: 380200 Community Supervision
Page 113 and 114:
FW: 380200 COInmunity Supervision o
Page 115 and 116:
Distefano, Monica J. (DOC) · From:
Page 117 and 118:
Distefano, Moriica J. (DOC) From: .
Page 119 and 120:
j I Distefano, Monica J. (DOC) From
Page 121 and 122:
E.... KIOSK reporting may be used i
Page 123 and 124:
RE: 380 200 Community Supervision o
Page 125 and 126:
RE: 380200 Community Supervision of
Page 127 and 128:
'---.- .... _-- _.,,-.... Distefano
Page 129 and 130:
to be processed now. If this was re
Page 131 and 132:
Page 133 and 134:
FW: 380200 Community Supervision of
Page 135 and 136:
FW: 380200 Community Sup_ervision o
Page 137 and 138:
----_.--_........_.-.._._---------_
Page 139 and 140:
.... #"""" .... 'l~ STATE OF WASHIN
Page 141 and 142:
Distefano. Monica J. (DOC) From: Di
Page 143 and 144:
" \ Prescriber's Name (Print) PreSC
Page 145 and 146:
Nov, 26, 2008 4:39PM CBR Medical In
Page 147 and 148:
,_._ ....... __ .. _._.- - ..... --
Page 149 and 150:
I OFFENDER 1.0. DATA: ..# ....""..'
Page 151 and 152:
Documentation of Medical Authorizat
Page 153 and 154:
Distefano. Monica J. (DOC) From: Se
Page 155 and 156:
11/06/2008 13:05 - PAGE ./"""-1. II
Page 157 and 158: I:--- j ! -_. Distefano, MonicaJ. (
Page 159 and 160: Dec .. l0. 2008 1:34PM CBR Medical
Page 161 and 162: ~ec,.10, 2008 1:35PM CBR Med ic"a 1
Page 163 and 164: Distefano, Monica J. (DOC) From: Se
Page 165 and 166: Stern, Marc F. 'Dir Hlth Svc' (~OC)
Page 167 and 168: !---.-_..- ..._.. _._....__......._
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
Page 175 and 176: I. 1 Distefano, Monica J. (DOC) Fro
Page 177 and 178: STATE OF WASHINGTON . DEPARTMENT OF
Page 179 and 180: leT/li od. 8. 200~) 1: 3BAM O/llJVO
Page 181 and 182: No,7218 pP, 3 , UUj C81'\SS #: lice
Page 183 and 184: OCT/OS/200S/WED 01:39 PM Tael FAX N
Page 185 and 186: OCT/08/2008/WED 01: 39 PM Tael FAX
Page 187 and 188: ---------_........_........ .. A i
Page 189 and 190: .Distefano, Monica J. (DOC) From: S
Page 191 and 192: ~ec. 23. 2UUB 9:U,PM' (;~K Medj'cal
Page 193 and 194: Dec.23. 2008 5:07PM ,CBR Medical In
Page 197 and 198: THCF.MedlcaI ·Clinics· '"9,-J, .
Page 199 and 200: ., FAX No. 509-921-2346 P.' 004 Pr~
Page 201 and 202: ..' ...... M" •••••••
Page 203 and 204: .. " , Prescriber's Name (Print) Da
Page 205 and 206: STATE OF WASHINGTON DEPARTMENT-OF C
Page 207: . I I 04/15/2009 18: 28 4258595378
Page 213 and 214: Fax 36027706511· Apr 20 2009 04;31
Page 217 and 218: I ' , ..... MARI3DI2009/MON . 09:30
Page 219 and 220: MAR/30/200S/MON OS :·31 AM FAX No,
Page 221 and 222: I. STATE OF WASHINGTON DEPARTMENT O
Page 223 and 224: MAR/18/200S/WED 03:05 PM FAX No, MA
Page 225 and 226: OFFENDER I.D. DATA: , I . I· .j i
Page 227 and 228: 1 Distefano, Monica J. (DOC) i From
Page 229 and 230: [,,'B-' 5fi1/#1 '{iYlQ prescriber's
Page 231 and 232: Distefano, Monica J. (DOC) From: ,
Page 233 and 234: " \) /"", ·\~\.oyv\~" Or ve,.. l.d
Page 235 and 236: . I, Offender Name STATE OF WASHING
Page 237 and 238: :--:7:;'~!;.~:1::7"'!:'·· I i I !
Page 239 and 240: PDU-6655-3 000236
Page 241 and 242: 5j(B L C W~SEM5 . . ; cm:~EVANS, TR
Page 243 and 244: _ _ ••• M nr Ln;:,l:.I':.Jl:.
Page 245 and 246: CBR iviedicai~ inc 3115 E, Mission
Page 247 and 248: I I J OFFENDER 1.0. DATA: STATE OFW
Page 253 and 254: .------.----:--.-~.- ..-.....__.._.
Page 255 and 256: ·· ! Jan. 23. 2009 11 :49AM CBR M
Page 257 and 258: clan, 23, 2009 11: SOAM CBR Me~ical
Page 259 and 260:
,_. ! j 1 Distefano, Monica J. (DOC
Page 261 and 262:
63/64/2609 14:08 2654185559 CBR MED
Page 263 and 264:
03/04/2009 14:08 2064186659 CBR MED
Page 265 and 266:
. CBR iViedicai, inc •• 3115 E.
Page 267 and 268:
ST,\T: OF WAS"INGTON DEPARTMENT OF
Page 269 and 270:
Page 271 and 272:
'-"" j ......._.._.......-.- .....-
Page 273 and 274:
Page 275 and 276:
'. : .; ..... '.: ~ ~.;'~". " . OFF
Page 277 and 278:
!. STATE OF WASHINGTON DEPARTMENT O
Page 279 and 280:
".N_ '_'N_' "N /....... . - j .' ,/
Page 281 and 282:
.. Fax CBR Medical, Inc 3115 E. Mis
Page 283 and 284:
J. I OFFENOER 1.0. DATA: , . STATE
Page 285 and 286:
Page 287 and 288:
03/04/2009 14:18 2064186659 CBR MED
Page 289 and 290:
STATEOFWASHINGTON . DEPARTMENT OF C
Page 291 and 292:
t j. 1 l·, r , ! , i ; . 3115 E. M
Page 293 and 294:
Page 295 and 296:
---_._.-» " Distefano, Monica J. (
Page 297 and 298:
STATE O~ WASHItIIGTON DEPARTMENT OF
Page 299 and 300:
...... ,u, .... 1'IL..u.L.\..IHL...
Page 301 and 302:
-- ... --.. _-.- --.---.... J : I .
Page 303 and 304:
,--_._._._.- ...•.._..._...• ,
Page 305 and 306:
I ---~ .......-.- .. ._-_. -.~~- __
Page 307 and 308:
200B-12-16 17:17 • • • • 1.
Page 309 and 310:
•••••••• ~ __ ' •
Page 311 and 312:
j .j I that statement, In conclusio
Page 313 and 314:
Page 315 and 316:
Prescriber's Name (Print) License #
Page 317 and 318:
------·----··-·-···-· .----
Page 319 and 320:
OFFENDER I.D. DATA: STATE OFWASHING
Page 321 and 322:
1813 Born Avenue NE, Suite'#210 Bel
Page 323 and 324:
Page 325 and 326:
Prescriber's Name (Print) Prescripe
Page 327 and 328:
Page 329 and 330:
01/21/2008" 20:06 2534724155 VEHICL
Page 331 and 332:
#fOr~ . .,;f ~ . {rri'~l STATEOFWAS
Page 333 and 334:
3115 E. Mission Ave . Spokane, WA 9
Page 335 and 336:
·STATE OF WASHINGTOI< DEP.~RTI'iIE
Page 337 and 338:
. p(J !/j~1 ·.;IS-.·j / Prescride
Page 339 and 340:
~r.~''''' OFFeNDER 1.0. DATA: ( ~ S
Page 341 and 342:
J\' ~ ", < .-, 0 '1...... . -n=:::,
Page 343 and 344:
i I Documentation of Medical Author
Page 345 and 346:
Page 347 and 348:
;lan.14. 2009 9:52PM CBR Medical In
Page 349 and 350:
Jan, 14, 2009 9:53PM CBR Medical In
Page 351 and 352:
Ja n,. 14,2009 9:54PM CBR Med i ca
Page 353 and 354:
Page 355 and 356:
Page 357 and 358:
3115 E. Mission Ave Spokcme, WA 992
Page 359 and 360:
OFFENDGR I,D, DATA: STATE OF WASHIN
Page 361 and 362:
.IL , Documentation of Medical Auth
Page 363 and 364:
J STATE OF WASHINGTON DEPARTMENT OF
Page 365 and 366:
3115 E. Mission Ave 'Spokane, WA 99
Page 367 and 368:
OFFENDER 1.0. OA·I.o.: STATE OF WA
Page 369 and 370:
Page 371 and 372:
MARIJUANA MEDICINE- EVAlUATtON CENT
Page 373 and 374:
~flor~1I .J''; ~. I l ~ATE OF WASHI
Page 375 and 376:
-.." OFFENDER 1.0. O"TA: jDE~ . i ~
Page 377 and 378:
GBN Medical lnc, No, 2826 p, 1/20 I
Page 379 and 380:
1-------' J Dec.23. 2008 5: 24PM CB
Page 381 and 382:
Uec .. LJ. 2UUB ~:2!JPM No. 2826 P.
Page 383 and 384:
March 23, 2009 STATE OF. WASHINGTON
Page 385 and 386:
t. Page 1 ofl ..,,-;...-.... -. ...
Page 387 and 388:
'I ! I i Prescriber's N~rint) , Lic
Page 389 and 390:
· I, Karen Hamilton, am a physiCia
Page 391 and 392:
Distefano, Monica J. (DOC) From: Ha
Page 393 and 394:
OFFENDER 1.0. DATA: STATE OF WASHIN
Page 395 and 396:
Page 397 and 398:
Page 1 of3 Distefano, Monica J. (CO
Page 399 and 400:
Page 3 of3 To: Checo, Ana V. (DOC),
Page 401 and 402:
PageZ of3 . 253-372-6463 office 253
Page 403 and 404:
Jan. ::lU. :.1UU9 1 L: U~PM ~cott L
Page 405 and 406:
OFFENDER 1.0. DATA: STATE OFWASHING
Page 407 and 408:
Scott L. Havsy, DO, DAApM -Board Ce
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
I Prescriber's Name (Print) License
Page 417 and 418:
Living &: WeUness Centerss P.S. 371
Page 419 and 420:
FEB-18-2009 14:56 From: To: 360 586
Page 421 and 422:
M •••• M •• __ • ___
Page 423 and 424:
STAT!: OF WASHING"ON DEPART1\lIENT
Page 425 and 426:
Dec. 12. 200 8 4 : 03 PM C B R Md i
Page 427 and 428:
Dec. 12. 2008 4:04PM I CBR Medical
Page 429 and 430:
. Nov. 2~. 2008 3: 05PM CBR Medical
Page 431 and 432:
"NOV-12-2008 WED 01~45 PM SPOKANE'N
Page 433 and 434:
j " 'NO~:12-2008 WEO 01:44 Pi SPOKA
Page 435 and 436:
"NOV-12-200B wED 01:45 PM 08/'~/lOD
Page 437 and 438:
Page 439 and 440:
·I~I La Crmica tid Carifio ~':./ .
Page 441 and 442:
UCT/l~/ZUUH/WKU Ul:l1 PM Due WE:;)'
Page 443 and 444:
(;tlKlVledlcalln·c, (. I~o, LtlL/
Page 445 and 446:
Dec.23. 2008 ,:31PM GSg Medical Inc
Page 447 and 448:
Dec, 23, 2008 5: 32PM CBR Med i ca
Page 449 and 450:
CO (') -K~ . C c..l)' ,_ .,..,. ADD
Page 451 and 452:
I ,[ .l. L I : I I" i pec. J. 2UUB
Page 453 and 454:
Dec.23. 2008 4:41PM CBR Medical Inc
Page 455 and 456:
Dec.23. 2008 4: 42PM CBR M~dical In
Page 457 and 458:
D.ec.23. 2008 4:43PM CBR Medical In
Page 459 and 460:
Dec.23. 2008 4: 49PM C B'R ·M.e di
Page 461 and 462:
Dec, 23, 2008 4: 50PM CBR Medical I
Page 463 and 464:
Page 465 and 466:
I I , Smith, Sherri K. (DOC) From:
Page 467 and 468:
~- 6S/2e/26ee 12:ae 2538475797 PAGE
Page 469 and 470:
February 17, 2009 STATE OF WASHINGT
Page 471 and 472:
Jan. 4. 200912:40PM CBR Medical Inc
Page 473 and 474:
Jan, 4, 2009 12:41PM CBR Medical In
Page 475 and 476:
Dec.30. 2008 12:20PM CBR Medical In
Page 477 and 478:
Page 479 and 480:
Nov.2[ 2008 '4:52P~ CBR Medical Inc
Page 481 and 482:
j i ! I Naif. 26. 2008' 4: 51 PM CB
Page 483 and 484:
Page 485 and 486:
.' :r Jan. ~ 2009 12:39PM C B R Me
Page 487 and 488:
Jan. 4. 2009 12:40PM CBR Medical In
Page 489 and 490:
Page 491 and 492:
Page 493 and 494:
(i &1 . OEPARTM"ri;;.toF·COruu:CTI
Page 495:
show all

DOC request three complete - Cannabis Defense Coalition

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?