DOC request three complete - Cannabis Defense Coalition

No'v, 26, 2008 4:48PM CB R Me d i ca 1 Inc, No, 2425 p, 4/5
Documentation of Medical Authorization to Possess M~rUlJana
for Medical Purposes in Washington state
PATIENTNAME: ______ DATEOFBIRTH:~
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I, Antoine Joh!l~!l. __,___.., am a physician licensed in the State of Washington'
and I am treating the above patient for a tetminaJ illn~$..ar·ajdebilitating condition as defined b¥
RCW 69.51A.010. . ./. J '.
I have advised the above named patient about.tlie potentiaVrisks'and beMfits of the medical use
of marijuana. I have assessed the above nartied patlent'sAnedical history and medical condition,
It is my medical opinion that the potentiaU:5enefits of the rhedical use of marijl.lana may outweigh'
the health risks f9r tfiis patient.
Physician Name: _· __ .gL~n~oine..:.johnson
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/ WA License Number: __ Mtl00039048
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Physician Signature: .: ..L.~" Daie: 08/24/2008
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This re·com.mendation eXPir~s on: _...QB/27;1!:~/-·-'--
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Risks and benefits of medir-al marfiuanV :-" - .
. Under Washington law, the US~Of edreal marijuana is now permissible for some patients
with terminal or debilitating ilInesse " T1fe law regulating this (Rew 69.51A) allows physicians
to advise patients C1Pout the risks nd qenefits of the medical use of marijuana,
. The medical and scienlific e.lden~~ supporting the use of medical marijuana remains.
controversial in the medical cytmnuOlty, Not 0111 health care prov(dets believe tllat medical
marijuana is safe or effet:tivrand s.ome providers feel that it is a c1angerous drug.
According to the WElshil)!lton State law the benefits of medical marij~lana may include
treating nausea and vomiting from chemotherapy, AIDS wasting syndrome, severe muscle
spasms from multiple scl¢rosis or other spasticity disorders, glaucoma, and some types of
intractable pain. f" • .
Some ·of the risks Of~llhedical marijuana may include possible long.:(erm effects of the brain .in
the areas of memory, c orqiha\ion and cognition; impairment of the.. ability to drive or operm.te .
heavy. machinery; respl ataTY damage; possible lung cancer; and physical or pE;ychologlcal
dependence. '-:'. .
Recommendation .
As this patient's "60 day s~lpply", as stipulated by RCW 69,S'IA(2)(b), I recommend 24 ounces
of dried, cured marijuana and as meny plants as the patient feels necessary to maintain this "60
day supply·.
CBR Medical, Inc.
Administrative Office
3115 E, Mission Ave
Spokane, WA99202
Spokane: 509-242-8624
Seattle:. 206-774-6493
RevIsed 7/07
PDU-6655-3 000070·