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Prescriber's Name (Print) LI'cense #. '("f-.O "'''''~ . P\- . . ense type: \ p
j I Documentation of MedicarAuthcirization to Possess Marijuana for Medical Purposes in Washington State PATIENT NAME: __ ----' OATEOFBIRTH:~ 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 ri'sks and benefits of the medical lIs'e of marijuana. I have assessed the above mimed patient's medical history arid medical condition. It is my medical opinion that the pote~C\1 benefits of the medical use of marijuana may outweigh the health risks for this patient. ~l ' Physician Name: Dr. AntoinehJhnson WA License Number: 'MD00039048 , / I I 1 Physician Signature: ' I /i Date: 01/11/2009 I / ' This recommendation expire~/on: ~06/2009 Risks and benefits of medical mari./(Jf3na " , , ' Under Washington law, the use tff medical marijuana is now permiss'ible for some patients with terminal or debilitating iIInesse~,. The law regulating this (RCW 69 . .51 A) allows physicians to ,advise pati,ents about the risks a . benefits of the medical use of marijuana. ' : " The medical and scientific evide e supporting the use of medical marijuana remains . controversial in the medical commu ity. Not all health care providers beHeve that medical marijuana is safe or effective and some providers feel that it is a dangerous drug. According to the Washington State l;3.w the benefits 'of medical marijuana may include treating nausea and vomiting from chemotherapy, AIDS wasting syndrome, severe muscle spasms from multiple sclerosis or other spasticity disorders, glaucoma, and some types of intractable pain. . . Some of the risks of medical marijuana may include possible long-term effects of, the brain 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, ' Recommendation As this patient's "60 Day Supply", as stipulated by RGW 69.51A.040 (3)(b) and WAC 246.75-010, this Qualifying Patient can reasonably expect to have in their Posession and 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, WA 99202 Spokane: 509-242-8624 Fax:509-340-2710 Seattle: 206-774-6493 Fax: 206-418-6659 EMERGENCY OR LAW ENFORCEMENT ONLY CALL 509-570-2886 OR 509-570-6943 PDU-6655-3 000034
Page 1 and 2: STATE OF WASHINGTON DEPARTMENT OF C
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 13 and 14: ... ""'"'''' f~ STATEOFWA$HINGTON ~
Page 15 and 16: STATE OF WASHINGTON DEPARTMENT OF C
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
Page 27 and 28: '.!, To: C!6R MedicaO,. h'IlC 31)5
Page 29 and 30: STATE OF WASHINGTON DEPA'RTMENTOF C
Page 31 and 32: .' .or", g u:,Se J f 'D. G4A() ~~ P
Page 33 and 34: 311S'E. Mission Ave Spokane, WA 992
Page 35: ''' .. r.~ l~} STATEOFWASHINGTON "1
Page 39 and 40: , • J ' -1. d; z.. 00 g-' /Vo v.
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
Page 51 and 52: I I l- I I tV!. tier f!! (VLA I 4.
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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
Page 65 and 66: .,.,... ..,..,.~ f~J STATE OF WASHI
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Page 79 and 80: Wheeler, Judine L. (DOC) From: Sent
Page 81 and 82: OMNI: Chrollos Quick Search , •
Page 83 and 84: -...... THCF MEDICAL CLINICS 1813 1
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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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Distefano, Monica J. (DOC) From: Se
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to be processed now. If this was re
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Distefano. Monica J. (DOC) From: Di
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Nov, 26, 2008 4:39PM CBR Medical In
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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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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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STATE OF WASHINGTON DEPARTMENT OF C
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.Distefano, Monica J. (DOC) From: S
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Dec.23. 2008 5:07PM ,CBR Medical In
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. I, Offender Name STATE OF WASHING
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. CBR iViedicai, inc •• 3115 E.
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ST,\T: OF WAS"INGTON DEPARTMENT OF
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3115 E. Mission Ave Spokane, WA 992
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OFFENDER I.D. DATA: STATE OFWASHING
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1813 Born Avenue NE, Suite'#210 Bel
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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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MARIJUANA MEDICINE- EVAlUATtON CENT
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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 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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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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