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3 i 15 E. Mission Ave Spokane, WA 99202 o Urgent o For Review . D Please Comment 0 Please lReply 0 Please ~·scycne -Comments: - . {. ~ L/VL,.cjL\j!.-/ ) ) . U . "-'j ;YlJ~~ ;hr ---:---.----:---~-...::...-~5" e--c-r- '5 -;; 0 .,) 'i' " f CBR Medical, Inc. - 3115 E.-Mission Ave, Spokane, Wa. 99202 Seattle Phone 206-774-6493 Fax 206-418-6659 Spokane Phone 509-242-8624 Fax 509-340-2710. Tri-Cities Phone 509-416-2267 Fax 509-340-2710 Vancouver Phone 360-635-6464 Fax 206-418-6659 ! I ! I , I ; I CONFIDENTIALITY NOTICE: This communication is intended for the sole use of the individual and entity to whom it is addressed, and may contain information that is privileged, or confidential and exempt from disclosure under applicable law. You are hereby notiiied that any dissemination, distribution, or duplication of this communication by someone other than the intended addressee or its deSignated agent is strictly prohibited. Alllnformaiioll is Protected Under U.S. Federal Law PDU-6655-3000339
i I Documentation of Medical Authorization to Possess Marijuana for Medical Purposes in Washington State PATIENT NAME: __ _ _ __ ,DATE OF BIRTH: -..!!!!!!!!!!!!I!!!I!!!!.::..::..:....:=-- I. Antoine Johnson . 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 69.51A.010. ' I have advised the above named patient about the potential risks and benefits of the medical use of marijuana, I have assessed tlleabi:Jve named patient's medicql histolY and medical condition. It is my medical opinion that the potential~efits of the medical Lise of marijuana may outweigh the [lealth risks for this patient. / / .' Physician Name: Dr, Antoine J,chns/n WA License Number: MD00039048 ,I / Physician Signature: .1,"+--- 1 Dale: 01/09/2009 This recommendation expires on: 72/05/2009' . Risks and benefits of medical marijulna ' , Under Washington law, the use 0, medical marijuana IS now permiSSible for soma patients with terminal or debilitating illnesses, The law regulating this (RCW 69.51A) allows physicians to advise patients about the ris/
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i ( Documentation of Physician Auth
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eRR Medical, Il1c 3115 E. Mission A
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DoCumentation of Medical AuthoriZat
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j I Documentation of MedicarAuthcir
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Chapter 69.51 A RCW: Medical marij1
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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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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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