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i I I Jan. 23. 2009 11:50AM CBRMedical Inc. " l' /" No.3192 P. 4/6 ",'" l i ,I /,•• r . //_., ;' ~ /I.)'f... 10., ~. /' .......---:.... ~ l I ~ ..... Jfe- .... PreScriber'sSignatl I -.-"~"•. ' ....., 1._ I ~/. .6ale / I License#: /i--;,p..."..,._';.:o~"\,. ~ t,
clan, 23, 2009 11: SOAM CBR Me~ical Inc, No,3192 p, 5/6. Documentation of Medical Authorization to Possess ivlarijuana for Medical Purposes in W~$hjngtan State PATIENT NAME: ___ ~ DATEOF·BIRTH:~ -', I, ____ Antoine Johnson ,am a physician Ji\::ensed in the State of Washington and I am treating th~ abrNH pRti'mt for !1 terminal illness or a debilitating condition as defined by RCW 69.S'IA.OiD. I have advised the above named pati~nt about the potential risks and benefits of the medical use of marijuana, I have assEissp-d thA !1bOVfl n!1med patient's medical hi~tory ~ncl mAdir.;o1 I!9nditiqn. It is my medical opinion thatthe potential benefits af the medical use of marijuana may outweigh·· . the health risks for this patient. Physician Name: _...-:0:.:[,-,. A,-,n'""t~oi.:..:n::
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STATE OF WASHINGTON DEPARTMENT OF C
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RECORDS PROVIDED WITH REDACTIONS ~~
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(".- " ~"""'":.~ Inr ... ~ STATEOFW
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i ( Documentation of Physician Auth
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OCT/ Oct. B. LUO~, 11: ::J9AM T ~co
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... ""'"'''' f~ STATEOFWA$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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'.!, To: C!6R MedicaO,. h'IlC 31)5
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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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''' .. r.~ l~} STATEOFWASHINGTON "1
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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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~ra.4~ OFFENOcR 1.0. DATA: { ~ STAT
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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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.,.,... ..,..,.~ f~J STATE OF WASHI
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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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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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Distefano, Monica J. (DOC) · From:
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Distefano, Moriica J. (DOC) From: .
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E.... KIOSK reporting may be used i
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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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Distefano. Monica J. (DOC) From: Di
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Documentation of Medical Authorizat
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Distefano. Monica J. (DOC) From: Se
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11/06/2008 13:05 - PAGE ./"""-1. II
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Dec .. l0. 2008 1:34PM CBR Medical
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Stern, Marc F. 'Dir Hlth Svc' (~OC)
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I J i Date License type: Prescriber
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Distefano, Monica J: (DOC) From: Se
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STATE OF WASHINGTON . DEPARTMENT OF
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Prescriber's Name (Print) License #
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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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Prescriber's Name (Print) Prescripe
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3115 E. Mission Ave . Spokane, WA 9
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i I Documentation of Medical Author
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3115 E. Mission Ave Spokane, WA 992
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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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OFFENDER 1.0. OA·I.o.: STATE OF WA
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MARIJUANA MEDICINE- EVAlUATtON CENT
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~flor~1I .J''; ~. I l ~ATE OF WASHI
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GBN Medical lnc, No, 2826 p, 1/20 I
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March 23, 2009 STATE OF. WASHINGTON
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· I, Karen Hamilton, am a physiCia
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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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Page 1 of3 Distefano, Monica J. (CO
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Page 3 of3 To: Checo, Ana V. (DOC),
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PageZ of3 . 253-372-6463 office 253
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Jan. ::lU. :.1UU9 1 L: U~PM ~cott L
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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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Living &: WeUness Centerss P.S. 371
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February 17, 2009 STATE OF WASHINGT
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Documentation of Medical Authorizat
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