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,- ...._..._._... -_......- .... ... ....••........._... 0;3/.04/2009 14:08 2064186659 CBR MEDICAL PAGE 01 I Fax ·111 CBR Medical, Inc 3115 E. Mission Ave Spokane, WA 99202 o Urgent 0 For Review 0 Please Comment D Please Reply D Please Recycle ._----_._. ---._-----_._--- ._---------- CBR Medical, 1110. - 3115 E. Mission Ave, Spokane, INa 99202 Seattle Phone 206·774-6493 F:'OX 206-416-6659 Spokane Phone 509-2.42-6624 Fax 509-340.:2.710 Tn-Cities Phone 509·416-2267 Fax 509·340·2710 'Vanoouver Phone 3S0.-635·S464 Fax 206-418-6669 CONFIDENilALlIY NOTICE: This communic:ation is intended fa!' the sole use of the individuai and entity to whom it is addressed, and may contain information that is privileged, or confidential and' exempt froln disclo5Llre under apPlIcable law. You are hereby notified that any dissemination, distribution, or duplication of this communication by someone other than the intended addressee or its designated agent ts strictly prohibited. - Ail Information is Protected Utid~r U.S. Federall..aw PDU-6655-3 000257
63/64/2609 14:08 2654185559 CBR MEDICAL . PAGE 62 (~ STATe OF WASHINc;lTON . IJiULf DEPA~TMENT OF CORRECTIONS AUTHORIZAiiON FOR DISCLOSURE ~'W"r .. OF,,"NO~R 1.0. ~~TA: hereby authorize the use or disclosure of my health' information as described below. The following individual or organization is authorized .to make the discloslJre: NAME; ADDRESS; C2B R A1edr-~( '''-£'1. c. " 1 J - .- M I rI ,'22z>farl'; 1j CFI1Parllt51) prDhibirdl~~/tlSllr. , "[INs InjiJl'malion withour tilt sptci/k !Vrim" CbHla"1 o/th. p'fJon ta II'lwm It pertains, or as atlImvi .. permille
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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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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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STATE OF WASHINGTON DEPA'RTMENTOF C
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. ! STATE OF WASHINGTON DEPARTMENT
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STATE OF WASHINGTON .DEPARTMENT OF
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Wheeler, Judine L. (DOC) From: Sent
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Prescdbar's Name (pnnt) . Prasc~jje
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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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Documentation of Medical Authorizat
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