DOC request three complete - Cannabis Defense Coalition

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Distefano, Monica J. (DOC) Froin: Sent: To: Cc: Subject: Johnson, Deborah A. (DOC) on behalf of Hammond, G. Steven (DOC) Friday, March 27, 2009 3:22 F>M . . . Distefano, Monica J. (DOC); Daniels, Karen R. (DOC) ~) ____ MM Request for authorization for use of medical marijuana does not meet criteria for medical necessity. 9 PDU-6655-3000219
MAR/18/200S/WED 03:05 PM FAX No, MAR 252009 Dept of Cprrectioras Health Servic~s To be flJI~ out by Prescriber:, Pear Prescriber, ' , By state statute the Washington State Department of-Corrections is charged with the responsibility to supervise some offenders after they have been 'convicted of a felony. The above named patlent Is currently under supervision by '!he Department Supervision Is designed to help the offender avoid thOS& environments or situations that lead to their qriminaJ behavior, Often Illicit drug use is a contributing factor in an Individual's criminality. Accordingly it's usual that the court or the Department of Corrections will Impose a condition of supervision that the offender not use, or possess Illicit drugll, Including marijuana Thls 6ffen~er has claimed that they have acOndll1on for Which the mediansl use of marijuana has bean recommended. The below verification is 10 determine the legitimacy of their claim. T.!'Jank you In edvaFlc8 for your 3sslstanee. If you have questions please feel ITeS to per-lonally contact th~ Medlcal Director ofthe DepartmeDt at (360) , 725-8700. ' 1. [s thls,patlent under your care 2. Are you recommending medical mariJu~na for hIs patient dUe to a diagnosis of Acquired [mmu!lodeflclency Syndrome (AIDS) a. If the answarto question 215 "(es·, does he/she have anorexia b. If the answer til question 2!i is "Yes",does he/she ha~e weight JO$$ 3. Are' you recommending medical marijuana {or this patient due to nausea i!lnd v~miting associated with cancer chemothQrapy B'Y'es DY~ 'DYes DYes DYes ONo DNo, a. If the answer to question 3 Is "Yes", hasl:he patient failed 10 respond to conventionel 0' Yes 0 No ~ntlemetle t.-eatments b. If the answer to questlon,3a is "YI;lS·, please describe what thoss lreatments were (medi~t1on, dose, duration): c. What js the pl:;Jnned schedUle of chemotherapy 4. If you answered °No" to items 2 & a above, what Is th~ raason you are n~commendIng medfcinaf use of marijuana!' , \, ' , C. ~'fc.{\,k.. ~iY\, CiI. Please provide evidenc~ published in a peer-reviewed scientIfic publ!eatlon to support the medicinal ).lse of manjuana for thIs purpose, '" ,5. While on community supervision ('parole' thlil Department of Corr,eotitll)s 'only authorIZes the ' use of the ora! synthetre formulation of marlj~aoa,~!fjbe_Dapar.tr.net:lt..autl:ior.lzBs-tf:1is-patieflt's-El-y.$S---~0 '--u"',s""e""'or meoicaJ marijuana, Will you be prescribing only the oralsynthettcfcrmulation . S. The patienfs accompanying Release of Information authorizes you to provlde'the Department with ourrent and future irn9rmation related to thIs issue. Do you agree to notify the Department's Medical Oireotor of any ohanges in your answers aoove DYes ~o, ooc 14-01)3 (Rev. 7I31106j OOC3B0..200 PDU-6655-3 000220
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STATE OF WASHINGTON DEPARTMENT OF C
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February 17, 2009 STATE OF WASHINGT
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