DOC request three complete - Cannabis Defense Coalition

I
I.
Documentation of Medical Authorization to Possess Marijuana
for Medical Purposes in Washington State
PATIENT NAME: ___ _ IATE OF BIRTH: ~
f, Dr. Mohammad H. Said , am a physician licensed in the State of Washington
and lam treating the above patient for a terminal illness or a debilitating condition as defined by
RCW 69.5'IA-OiD. . .
! have advised .tile above named patient about the pptential risks and benefits of the medical. use .
of marijuana. I have assessed The above named patient's medical history a'nd medical. condition.
ft is my medical opinion that the potential benefits of the medical use of marijuana may outweigh
the health risks for tilis patient.
Physician Name: __:;;,D",-r
•.:.:M.:.:o:..;,il;::a:;,:m.::.m:.,:;a:;,,:d:;..:...:H:... S:::;a::..;i.::;,d ___/se Number:
MD00018311
Physician Signature: ~'lf ~ c:u...