DOC request three complete - Cannabis Defense Coalition

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STATE OF WASHINGTON DEPARTMENT OF CORRECTIONS P.o. Box 41100· Olympia, Washington 98504~1100 January 26, 2009 . OCt;lan Park, WA 98640 Dear Mr._ Your Medicinal Use of Marijuana request was received on January 14, 2009. Upon review by the Department of Corrections' Health Services physician, your request has been denied. You may appeal this decision by sending your written request within 15 business days of this letter, which is on or before February 16, 2009. Please send your request to the address below: Karen Daniels, Assistant Secretary Community Corrections Division .Department of Corrections ' P.O. Box 41126 . Olympia, WA 98504-1126 Your request must provide additional information that was not included with your original request. Appeals that do not contain new information will be denied. You will receive a response to your appeal request within 30 days of receipt. I i 'j i j, I ! j' Sin~cJelY" . . '. ~Danio '. AWtant S"","", Community Corrections Divi~ion .'~ KD:md cc: David Phillips, Community Corrections Supervisor Linda Tolliver, Community Corrections Officer, Field File Physician's Office: Attn: Melissa Leggee CBRMedical 3115 E. Mission Ave. Spokane,WA 99202 " Working Together for SAFE Communities"· I . I I l -G n:cyclcd poper PDU-6655-3 000025
STATE OF WASHINGTON DEPA'RTMENTOF CORRECTIONS AUTHORIZATION FOR DISCLOSURE OF HEALTH INFORMATION Or-FENDER I.D. DATA: hereby authorize the use or disclosure of my health information The following individual or organization is authorized to make the disClosure: NAME: 'C;BiR A1e.d(~C4j .;£1'1 C· . ADDRESS -::> / J ~ - nA - , 1 . JL L : .J h C:, /Vlf .-S $l.d ,1 a:Ve. The type and date(s) of information to be used or discloSed is as follows: V f' ~. r~ '-;;;~J' 11; .. U S~ =~ R~ "0& =1: : /~ tlj(;i7;fi:;-fd;] 5---{·qrTe _ . . . U . -{ r. C.." I OVl t ..p . (U C "'L- ( I . 'I q 1/1 "L-: Purpose for disclosure: V.e ~:f';' C et-r.'on 0 f' f.e "\.:
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Page 3 and 4: RECORDS PROVIDED WITH REDACTIONS ~~
Page 5 and 6: (".- " ~"""'":.~ Inr ... ~ STATEOFW
Page 7 and 8: i ( Documentation of Physician Auth
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Page 17 and 18: Distefano, Monica J. (DOC) From: Se
Page 19 and 20: eRR Medical, Il1c 3115 E. Mission A
Page 21 and 22: Fax : ' 3115,E. Mission Ave Spokane
Page 23 and 24: Or-FENDER 1.0. DATA, j' STATE OF WA
Page 25 and 26: DoCumentation of Medical AuthoriZat
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Page 41 and 42: Chapter 69.51 A RCW: Medical marij1
Page 43 and 44: Chapter 69.S1A RCW: Medical marijua
Page 45 and 46: Chapter 69.511). RCW: Medical111ari
Page 47 and 48: •• I ! 3115 E. Mission Ave Spok
Page 49 and 50: OFFENDER 1.0. DATA: STATE OF WASHIN
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Page 55 and 56: Prescriber's Name (Print) License#:
Page 57 and 58: 3115 E. Mission Ave Spokane, WA 992
Page 59 and 60: . ! STATE OF WASHINGTON DEPARTMENT
Page 61 and 62: STATE OF WASHINGTON .DEPARTMENT OF
Page 63 and 64: T.)' ~x.. MARIJUANA MEDICINE'· 'EV
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Interpretation of Medical Marijuana
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NIELSEN TO COME UPSTAIRS. CCO NIELS
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3115 E. Mission Ave 'Spokane, WA 99
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OFFENDER 1.0. DATA: STATE OF WASHIN
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February 17, 2009 STATE OF WASHINGT
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