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License#: Prescriber's Address Medicar Director Health Services Dili'isi.on . Washington State Department of COllections PO Box 41123· Olympia, WA 98504-2113 I have reviewed this verificatin f0r-~.1nd find that use of medical marijuana by, this p
Documentation of Medical Authorization to Possess Marijuana for Medical Purposes in Washington State PATIENT NAME: _~_ DATE OF BIRTH: ~ I, Antoine Johnson ,am a physician licensed in the state of Washington and I am treating the above patient for a tenllinal illness or. a debilitating condition .as d~fined by RCW 69.51 A.01 O. .' ,,-' .... '-~'- .. I have advised the above named patient about the potll1ti·a1'risks and enefits of the medical use of marijuana. 1.l18ve assessed the above named p..liliient's medical h' tory and medical condition. It is my medical opinion that the potential benefits of the medical u of marijuana may outweigh the health risks for this patient. .'." ,. . . f .. Physician Name: Dr, Antoine John's~1l . WA Lice'h~e Number: Mb00039048 . ,/ .. , Physician SignatLlre: ___ '-:>/'>.i Date: 04/1312008 ------~----------~,~,~~ -----~~~~--~-- 04/13/2009// .I.' ... ; " Risl(s and benefits of medicai marijuana ,/. Undel'.washington law, the use of m ieal madjuana is now p~rmissible for some patients . with lermhialol' debilitating Illnesses. he law,{egulatlng this (RCW 69:51 A) allows physicians / . to advise patients about the risks a benefifs of the medical use of marijuana. . The medical and scientific evi .nce s~Ip'f'1orting the use of ri1!Odicai marijuana remains contro\(ersial in the medica. I ~orr unity/'Not aUllaslth care providers believe that medical marijuana is safe or effective d so;:rie providers feel that it is a dangerous drug. According to the Washing n Mite law the benefits of medicsl marijuana may include treating nausea and vomitin . m chemotherapy, AIDS wasting syndrome, severe musc!e spasms from multiple ~clero IS or. other spasticity disorders, glaucoma, and some types of intra«table pain. . Some of the risks of medical marijl.lana may include possible long-term effects of the brain in . the areas of memory, coordination and cognition; impairment of the ability tb drive or operate heavy machinery; respiratory daiTl1'1ge; possible lung cancer; and physical or psychological dependence,' . . . This re~omme'ndation'expireJ~n: , Recommendation As this patient's "60 day supply", as stip'ulated by RCW 69.S1A(2)(b), I re~ommend 24 ounces of dried, cured marijuana anti as many plants as the patient feels necessary to maintain this "60 day supply", Rovisyu -, /07 PDU-6655-3 000492
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STATE OF WASHINGTON DEPARTMENT OF C
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RECORDS PROVIDED WITH REDACTIONS ~~
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(".- " ~"""'":.~ Inr ... ~ STATEOFW
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i ( Documentation of Physician Auth
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Distefano, Monica J. (DOC) From: Se
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eRR Medical, Il1c 3115 E. Mission A
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Fax : ' 3115,E. Mission Ave Spokane
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Or-FENDER 1.0. DATA, j' STATE OF WA
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DoCumentation of Medical AuthoriZat
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STATE OF WASHINGTON DEPA'RTMENTOF C
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311S'E. Mission Ave Spokane, WA 992
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j I Documentation of MedicarAuthcir
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Chapter 69.51 A RCW: Medical marij1
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Chapter 69.S1A RCW: Medical marijua
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Chapter 69.511). RCW: Medical111ari
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OFFENDER 1.0. DATA: STATE OF WASHIN
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Prescriber's Name (Print) License#:
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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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T.)' ~x.. MARIJUANA MEDICINE'· 'EV
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Wheeler, Judine L. (DOC) From: Sent
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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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3. High Non-Violent 4. Moderate, an
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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
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3115 E. Mission Ave Spokcme, WA 992
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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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OFFENDER 1.0. DATA: STATE OF WASHIN
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Scott L. Havsy, DO, DAApM -Board Ce
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