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July 14,2008 To: Re: Medical Director Health Services Division Washington State Department of Corrections PO Box 41123 . Olympia, WA 98504-2113' ·lIJ!I!!J!!!ns ii/ __ Medicinal Use of Marijuana Verification I __ BETHANY ROLFE am currentIytreating the above named patient for the following conditions as defined in RCW69.5LOlO. (b) . Intractable pain, limited for the purpose of this chapter to mean pain unrelieved by standard medical treatments and medications. ' . Patient also has a history ~f.the following conditio~: a) Fibromyalgia b) Allergic Rhinitis c) IBS with bowel incontinence d) History of leucopenia e) OA, Right knee, total replacement August 2002 f) Partial hysterectomy due to fibroid tumors g) Depression h) AnxietylPanic attacks i) Carpal Tunnel j) , Migraine headaches k) Restless Leg Syndrome 1) High Blood Pressure m) Fibroid tumors throughout body n) , Left knee, worn out, recommended replacement fall 2008 or spring 2009 0) Insomnia, hard to fall asleep, staying asleep, falling back to sleep ,.' Patient has drug allergiesfmtolerance to the following medicationS: 1. Erythrom'ycin causing difficulty breathing/shortness of breath 2, ' Demerol causing nausea and vomiting , 3. VicodID causing nausea and vomiting 4. Percocet causing nausea and vomiting 5. Penicillin causing hives 6. Morphine. causing blister, rash, itching 7. Sulfa-base drugs causing GI upset, hives and itching 8. Dococycline causingL.:G:;::I:...:u::.tp::::se::;t=--:-_-:-:--__________________ _ ----------,.9;-.----;axycodone causing nausea and vomiting 10. ' Paper Tape causing rash and itching I have advised the above named patient about the potential risks and benefits of the medical Use of Marijuana. I have assessed the patient's medical history and medical conditions. It is my medical opinion that the potential benefits of the use of marijuana may outweigh the health risks for thi,s patient. ' bL&1A-~ JfkL!6 Signature of~hysician:--____ _r_I__--+~---- Bethany RoIfe~ 1596133 Tel: 206965 1000 PDU-6655-3 000391
Distefano. Monica J. (DOC) From: Sent: To: Subject: Distefano, Monica J. (DOC) Monday, February 23, 2009 10;43 AM .Checo 1 Ana V. iiil(evey, Mac B. (DOC) We received an appeal to Mr .••• lmedicinal marjiuana denial from his physician. Please do not proceed with any violations related to the medicinal marijuana until the decision has been made on the appear in the next 30 days. I will let you know the outcome. Thank you! Monica Distefano Executive Assistant to . Karen Daniels, Assistant Secretary Community Corrections Division 7345 Linderson Way SW Tumwater, WA 98501 MS: 41126 . (360) 725-8796 mjdistefano@doc1.wa.gov 1 PDU-6655-3 000392
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