DOC request three complete - Cannabis Defense Coalition

D.ec.23. 2008 4:43PM CBR Medical Inc. No. 2824 P. 5/28
Documentation of Medical Authorization to Possess Marijuana
for Medical Purposes in Washingto.n State
PATIENf NAME: _~_ __ ._ DATE'OF BIRTH: ~
I. Antoine Johnson , am a physician licensed in the State of Washington
and I am treating the a.bove patient for a terminal illness or a debilitating condition as defined by
RCW 69_51 A.01 0_ . . .
. 1 have advised the above named patient about the poten!j.a~-{SkS and benefits·otthe medical use
of marijuana. I have. assassec,l the above named p!'Jiieni's
edical history and medical condition.
It is my medical opinion that the potential ben~fjtiOf the 'Y dical use of marijuana may outweigh
the health r1sks for this patient. . /,,-, I ' .
Physician Name: ' Dr. Antoi~e J9r{~~'~n ' /'WA License Nu~ber: MD00039048
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Physician Signature:. I ......