DOC request three complete - Cannabis Defense Coalition

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STATE OF WASHINGTON DEPARTMENT Of CORRECTIONS P.o. Box 41100' Olympia, Washington 98504·1100 January 26, 2009 I. I I Seattle, W A 98118 . Dear l\1r._ Y9ur Medicinal Use of Marijuana request was received on January 14,2009. Upon review by the Department of Corrections' Health Services physician, your reques~ has been denied. . . You may appeal this decision by sending your written request within 15 business days of this letter, which is on or before February 16, 2009. Please send your request to the address below: Karen Daniels, Assistant Secretary Community Corrections Division 'Department of Correcti~ns P.O. Box 41126 Olympia, WA 98504-1126 " Your request must previde additionalinfonnation that was not included with your original request Appeals that do not contain new information will be denied. You will receive a response to your appeal request within 30 days of receipt. . / Sinp~ ~. C) ~~v§/ . tare:r0E>aniels, Assistant Secretary Community COl1'ections Division KD:md cc: Misi Nimese Liulamaga, Community CorrectionsSuperyisor . Erin O'Donnell, Community Correction::; Officer Field File Physician's Office: Attn: Melissa Leggee CBR Medical 3H5 E. Mission Ave. Spokane,WA 99202 .. " Working Together for SAFE Communities" PDU-6655-3 000045
OFFENDER 1.0. DATA: STATE OF WASHINGTON DEPARTMENT OF CORRECTIONS AUTHORIZATION FOR DISCL,OSURE hereby authorize the use or disclosure of my health information following individual or organization is authorized to make the disclosure: . NAME: CJ3 R L=1ed>ctJ;..f .;in C ADDRESS: .3 /15" e. ,11/1/;5$,,1 a Av'e. . !' (RCW 70.02: RGW70.24.10S: RCW 71.05.390) andlorftderol regttlations (42 CF'RPart2; 'IS CFR Part 1(4) prohibirdL!C/o5UI" , a/thiS in/ormation without th. specific ",UWl CO/1sent oflhe person to whom it pertains, or as athenYise permitted by law. DOC 13-0lS (0511912008) POL DDC380.200 DOC 600.020 DOC 640,020 DOC G7O,020 LEGAL ./ I i. i I I i, , r r PDU-6655-3 000046
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 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
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Page 33 and 34: 311S'E. Mission Ave Spokane, WA 992
Page 35 and 36: ''' .. r.~ l~} STATEOFWASHINGTON "1
Page 37 and 38: j I Documentation of MedicarAuthcir
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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: •• I ! 3115 E. Mission Ave Spok
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Page 53 and 54: ~ra.4~ OFFENOcR 1.0. DATA: { ~ STAT
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
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Page 93 and 94: Interpretation of Medical Marijuana
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Page 97 and 98: NIELSEN TO COME UPSTAIRS. CCO NIELS
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February 17, 2009 STATE OF WASHINGT
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