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OlJ/25120l111 15:49 FAX 253 473 9667 Excel Business Sys"tems 141 004/004 prcii6E!t'$ Nama (Print) /-c9l-;!aO; Oate l.icense#: WA OCD[(oi gO LIcense type: i ,..- . Prescriber's Addressd/.3 t0M· ArE .1/£ . -z;{a/dti£ \/ZPf ' Prescriber: .please return tfuS'TO'rin anc!'tlle patient's Release of Information to: Medical· Director Health Services Division Phone Number / To • e filled out by <strong>DOC</strong> Physician: . [ have reviewed this ve~lfication fO~J~d that I.lse 0(J;dical marijuana by this patient (check one) I D is IJd'1s not consistent with <strong>DOC</strong> Policy. . !/VA,.., 1 .. // •• CURn III". l/l(/l]tI~ -l=P.h~~~i~oia~n~~~~~,g~~~w~re~------------------- PhysiCi
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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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, • J ' -1. d; z.. 00 g-' /Vo v.
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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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•• I ! 3115 E. Mission Ave Spok
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OFFENDER 1.0. DATA: STATE OF WASHIN
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I I l- I I tV!. tier f!! (VLA I 4.
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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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"'.... ~ . OFFENOeR 1.0. OATA: fnrt
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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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\"'Ior"'.~ OFFENDER 1.0. DATA: I f
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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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- ...-------------- _._.-- _ ..----
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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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FW: 380200 COInmunity Supervision o
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Distefano, Monica J. (DOC) · From:
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Distefano, Moriica J. (DOC) From: .
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j I Distefano, Monica J. (DOC) From
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E.... KIOSK reporting may be used i
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RE: 380 200 Community Supervision o
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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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FW: 380200 Community Sup_ervision o
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.... #"""" .... 'l~ STATE OF WASHIN
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Distefano. Monica J. (DOC) From: Di
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" \ Prescriber's Name (Print) PreSC
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Nov, 26, 2008 4:39PM CBR Medical In
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I OFFENDER 1.0. DATA: ..# ....""..'
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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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I:--- j ! -_. Distefano, MonicaJ. (
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Dec .. l0. 2008 1:34PM CBR Medical
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~ec,.10, 2008 1:35PM CBR Med ic"a 1
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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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I. 1 Distefano, Monica J. (DOC) Fro
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STATE OF WASHINGTON . DEPARTMENT OF
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No,7218 pP, 3 , UUj C81'\SS #: lice
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OCT/08/2008/WED 01: 39 PM Tael FAX
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.Distefano, Monica J. (DOC) From: S
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~ec. 23. 2UUB 9:U,PM' (;~K Medj'cal
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Dec.23. 2008 5:07PM ,CBR Medical In
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., FAX No. 509-921-2346 P.' 004 Pr~
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.. " , Prescriber's Name (Print) Da
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STATE OF WASHINGTON DEPARTMENT-OF C
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04/15/2009 18:28 4258696378 THCF PA
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Fax 36027706511· Apr 20 2009 04;31
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MAR/30/200S/MON OS :·31 AM FAX No,
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I. STATE OF WASHINGTON DEPARTMENT O
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MAR/18/200S/WED 03:05 PM FAX No, MA
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OFFENDER I.D. DATA: , I . I· .j i
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Page 255 and 256: ·· ! Jan. 23. 2009 11 :49AM CBR M
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Page 259 and 260: ,_. ! j 1 Distefano, Monica J. (DOC
Page 261 and 262: 63/64/2609 14:08 2654185559 CBR MED
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Page 269 and 270: 3115 E. Mission Ave Spokane, WA 992
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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: Documentation of Medical Authorizat
Page 295 and 296: ---_._.-» " Distefano, Monica J. (
Page 297 and 298: STATE O~ WASHItIIGTON DEPARTMENT OF
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Page 313 and 314: Distefano, Monica J. (DOC) From: Se
Page 315 and 316: Prescriber's Name (Print) License #
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Page 319 and 320: OFFENDER I.D. DATA: STATE OFWASHING
Page 321 and 322: 1813 Born Avenue NE, Suite'#210 Bel
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#fOr~ . .,;f ~ . {rri'~l STATEOFWAS
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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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Jan, 14, 2009 9:53PM CBR Medical In
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Ja n,. 14,2009 9:54PM CBR Med i ca
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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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-.." OFFENDER 1.0. O"TA: jDE~ . i ~
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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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STAT!: OF WASHING"ON DEPART1\lIENT
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Dec. 12. 200 8 4 : 03 PM C B R Md i
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I I , Smith, Sherri K. (DOC) From:
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February 17, 2009 STATE OF WASHINGT
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Jan. 4. 200912:40PM CBR Medical Inc
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Jan, 4, 2009 12:41PM CBR Medical In
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Dec.30. 2008 12:20PM CBR Medical In
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Documentation of Medical Authorizat
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