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MAR/30/2009/MON 09:30 AM FAX No. P. 002 • ·Mar. 17. 2009 2:41PM Sco! t l. Havsy, OO,DAAPM No; 1144 P. 1/3~l(-~n ... r~~:~'~ -, TO: 125347305'45 ~t STJoTlilOFWASHIIIGTCH ...., DEJ'AR'lM!NT OF 'CC'fm;CTlONS' Madlclna' Use' of M4rijua~a VerificatIon o..r Pr$$OfIber, .'. . .'. • By 5tars lilah.rbJ ifle Washlngton ·State-~ent·of Correctrons is ~d' with the respol1llbllTty Ie aUpeMsft some . • ~~[1 SIler t1Iey haye been convIded of a felany. ~ ~ nmnsd pallen( III currently und!r $Uperv"lSiOt'I by ~ . oep~ent Sl.lpervllllon til .de!t~d to help th~ o1f&nder zvokl thelll ~nvtronmen1l! or sltUS.UO,.. tI\~t lead to tJ1eJr criminal bohlWlo!'· Often Illicit-drug ul!6i:!l.a col'lictbullng fatter In an individual'. aimlmllity. Accordingly ~'. usual tltllt tho C01.In or till Depattr!l8lll or Correclions wflIlmpcse I eol'!dl!!c~ of 8up.rvtslOR !hat the offMdar not 'Use, wllCUvn IlJk;It d~, lnd'udlng rnarflU!3J'l8. . This offender tla claimed that they hay. II concloon fcrwhich Ihl! mediclnaIl U$e ofmarijtrans'nas ~"" rlQ;1mm';l'Idod. Tho tlillQW ve!'iflcatiQn "to determine the leg'lllmacy of iIleir clarm. /hank.)'tIu In advanca for your .'Illianes. 1f)'OI.I nave questions pleae feal free' '" panrollZllly ~nlJlC'lIhe Medtcal Director at' the 'C)eparfmentat (360) ·"~:!~~~·r;.iti.n;·~nd'j:yo~·-~re7·"·"""··"··"·· ........ .... i .• :-....................................... -~ :·-lj:JN~· ........ :: ................. .. 2. Are you l'GCommel)/IIns medical marijuana fer hi~ pali~t ~ to I dll1Sl'losls of .Acquired Immunodeflcfeney S~dmme (AIDS) . • • '8. I1the snswer.lo qtle~ 2 is "Yes", does he/s~ have anoraxia . D. If lhG anS't\lQr to C!~rion. 2a ii "Ye~·. doe; h$/$~ naYil ~I~ht Ion . 3. ke YD\! recommending medical mQl'ljIJana for tI'Ilf pmlent due to.nsusea and wrnlling atiaoc::l* ~ft cancarcl'lemalherapy '.. iii. If the answarto que&l1on S Is "YtlS", Mathe petlel'll fane
MAR/30/200S/MON OS :·31 AM FAX No, P,003 Mar,'n, 2009 2:42PM Scott L Havsy, DO,OAAPM No, 1144 p, 2/3 Prei@tiQiJs Nam. (PliI1t). - "if\ii;iiiis;;;;;n;.,er:;;:. sir.i~=:;;-------- 'UQaJise iF:. .. 1Jf I /Uf,{rf P(Ut.riber's Address . ;r- lfoenn type: .. Medical Oirecwr HHlth S.tvlefli C(vltdan WllshtngtQn state Department of CorreetI.onS PO BoX41123 Olymp~, WA ga504-~11"3 __ ~"';"";' _____ -'---______ SCOIt LH",vsy. D0, OMPIY 3716 PacificA'Ienue S . ----- To "filled out by DeC Phy.siClan: ,Ta~ma, WA 9841a f ulte E I have mlswed tills VGr!flcaag(.form and find Iha~ us. Qf medloel ~erUue". by thIs. patl"nt ',...:. ..... (~on.)Ia;;r1l o Ie not ~. col\sl$tent with <strong>DOC</strong> F'oIkY. .. SCD±\: '~V
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STATE OF WASHINGTON DEPARTMENT OF C
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RECORDS PROVIDED WITH REDACTIONS ~~
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i ( Documentation of Physician Auth
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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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. ! STATE OF WASHINGTON DEPARTMENT
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STATE OF WASHINGTON .DEPARTMENT OF
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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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Scott L. Havsy, DO, DAApM -Board Ce
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