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. , I I Fax . CBR Medical, Inc 3115 E. Mission Ave Spokane, WA 99202 , ·1 \ j D Urgent D For Review D Please Comment D Pleasl~ Reply D Please Recycle -Comments: . CBR Medical, Inc, - 3115 E. Mission Ave.. Spokane, Wa 99202 Seattle Phone 206-774-6493 Fax 206-418-6659 Spokane Phone 509-242-8624 Fax 509·340·2710 • Tn-CIties Phone 509-416-2267 rax 509·340-2710 Vancouver Phone 3IS0-635-6464 Fax 206-418-6659 CONFIDENTIALITY NOTICE:. This communication is intended for the sole use of the individual and. entity to whom It is addressed, and may contain information that is privileged. or confidential and exempt from disclosure under applicable law_ You are hereby notified that any dissemination, distribution, or duplication of this communication by someone other ihan the intended addressee 01" its deSignated agent is strictly prohibited. . . : AU lilfonnation is .Protected .Under U.S. Federal \...aw PDU-6655-3000061
.,.,... ..,..,.~ f~J STATE OF WASHINGTON ...., DEPARTMENT OF CORRECTIONS Medicinal Use of Marijuana Verification OFFENDER 1.0. DATA: j. I , r· Dear Prescriber, By state statute the Washington State Department of Corrections is charged with the responsibility to supervise some offenders after they have been convicted 'of a felony. The above named patient is currently under supervision by the Department. Supervision is designed to help the offender avoid thOse environments or situations that lead to their criminal behavior. Often illicit drug Use is a contributihg factor in an individual's criminality. Accordingly it's usual that the court or the Department of Corrections will impose a condition of supervision that the offender not use, or possess illicit drugs, including marijuana. This offender has claimed that they have a condition for which the medicinal use of marijuana has been recommended. The below verification is to determine the legitimacy of their claim. Thank you in advance for your' assistance. If you have ql!estions please feel free to personally contact the Medical Director of the Department at (360) 725-8700. 1. is this patient under your care 2. Are you recommending medical marijuana for his patient due to a' diagnosis of Acquired Immunodeficiency Syndrome (AIDS) . a. If the answer to question 2 is'"Yes'', does he/she have anorexia b. Ifthe answer to question 2a is "Yes", does he/she have weight loss 3. Are you recommending medical marijuana for this patient due to nausea and vomiting associated with cancer chemothe~py a. If the answer to question 3 is "Yes·, has the patient failed to respond to conventional antiemetic treatments Gives DYes DYes DYes DYes DYes b. If the answer to question 3a is "Yes", please describe what those treatments were (medication, dose, duration): rJ(V' c. What is the planned schedule of chemothera~YII\---- . . . ONe B< ~ ~ ~. ~. 4. If you. answered "No" to items 2 & 3 a!;love, what is the reason you are recommending medicinal use of marijuana ~,'Vr9%. ~_ ~tU h 9,~! If . a. Please provide evidence published in a peer-reviewed scientific pub icatien to support the medicinal use of marijuana for this purpose' F-t.. 'e... . M,....."-
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Page 83 and 84: -...... THCF MEDICAL CLINICS 1813 1
Page 85 and 86: Prescdbar's Name (pnnt) . Prasc~jje
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Page 93 and 94: Interpretation of Medical Marijuana
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Page 99 and 100: Date & Tirpe Created: 12/16/2008 11
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I J i Date License type: Prescriber
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OFFENDER 1.0. DATA: STATE OF WASHIN
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OFFENDER 1.0. DATA: STATE OFWASHING
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