DOC request three complete - Cannabis Defense Coalition

Documentation of Medical Authorization to Possess Marijuana
for Medical Purposes in Washington State
PATIENT NAME: ___ _
DATE OF BIRTH:~
I, Dr: Mohammad H. Said , am a physician licensed in the State of Washington
and I am treating the above patient for a terminal illness or a debilitating condition as defined by
RCW 69.51A010. . . .
·1 have advised the above named patient about the potential risks and benefits of the medical use
of marijuana. I 'have 'assessed the above named patient's medical history and medical condition.
It is my medical opiniori that the potential benefits of tI]~ medical use of marijuana may outweigh
the health risks for this patient. .... . ..
Physician Name: ~_'D::::.r:.:. .:.::M.:.::o~h=a!..!.m!!..!mc!.::a:.::d:..!H..!.:.:..!S::.::a:.::id::...-__ WA License Number:, __.:.:M:.:.:D~0:..:0:..:0..:.1.:.83=-1.:...;1_
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Ignature: _,--..£.f_ -_... ---:~______ Date: _-'-. ~02:::.;/2==2::..:/2::..:0:..::;O,;:.9 __.--:.
This re~ommendation expires on: 02/22/2010
Risks and banaf(ts of medical marijuana
Under Washington law, the lise of medical marijuana is now permissible for some patients
with terminal or debilitating illnesses. Tlie law regulating this (RCW 69.51 A) allows physicians
to advise patients about the risks and benefits 'of the medical use of marijuana.
The medical and scientific evidence supporting the use of medical marijuana remains
controversial in the medical community. Not all health care providers believe that medical
marijuana is safe or effectjve arid"~ome providers' feel that it is 'a dangerous drug.
According totO$:! Wa$hihgti.:m State law the benefits of medical marijl,.lana may include
treating nausea ancfvoniiting fr'Om chemotherapy, AIDS wasting syndrome, severe mus~le
spasms from multiple sclerosis or other spasticity disorders, glaucoma, am:,1 some types of
intractable pain: ,
Some of the risks of medical marijuana may include possible long-term effects of the brafn in
the areas of memory, coordination and cognition; impairment of the ability to drive or operate
heavy machinery; respiratory damage; possible lung cancer; and physical or psychological
dependence.
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Recommendation
As this patient's ;'60 Day Supply", as,'stipulated ,by RCW 69.51A.040 (3)(b) and
------WAC246-7-5-Q.:1.Q,this-Qualify.ir:Jg-l2atier.lt-car.l-t:6aSor:lably..expect,.to_ba~e..in...their.Eoses.sioJLao.d'__ ~ __ i--_
Need a total of no more than 24 Ounces of "Useable Marijuana" and no, more than 15 Plants.
CBR Medical, Inc.
. Administrative Office
3115 E. Mission Ave, Spokane, WA99202
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Spokane: 509-242~624 Fax:509-340-2710
Seattle: 206-774-6493 Fax: 206-418-6659
EMERGENCY OR LAW ENFORCEME;NT ONLY
CALL 509-570-2886 OR 509-570-6943
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PDU-6655-3 000281