DOC request three complete - Cannabis Defense Coalition

Documentation of Medical Authorization to Possess Marijuana
for Medical Purposes in Washington State
I
I
I
I
I
I
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 terminaZilines debilitating condition as defined by
RCW 69.51A.OiO.
'
I have advised the above named patient about! e potentia risks and benefits of the, medical use
of marijuana. I have assessed the above n !'fled patient's edical history and medical condition.
It is my medical opinion that the potentia enefits of the edical use of marijuana may outweigh
the health risks for this patient.
'
Physician Name: --::.:.:..:..:!.!==r==~---I-
MD00039048
Physician Signature: __-+____/_-+_-:::=_
0812412008
This recommendation eXPlr{s on:·"""';:'=::"'::':=joz:;.. __ _
Risks and benefits of medicalmarljuan . .
Under Washington law, the use of ~. al marijuana is now permissible for some pafieh~
with terminal or debilitating iIlnesse . T law regulating this (RCW 89.51A) allows physicians
to advise patients about the risks n~ nefits of the medical use of marijuana.
The medical and scientific e denc supporting the use of medical marijuana remains
controversial in the medical c m~ ty~ Not all health care providers believe that medical
marijuana is safe or effectiv and s me providers feel that it is a dangerous drug.
According. to the Washi ton ate law the benefits of medical marijuana may include
treating nausea and vomit" 9 fro chemotherapy, AIDS wasting syndrome, severe muscle
spasms from multiple sci rosis r other spasticity disorders, glaucoma, and some types of
intractable pain. . .
Some of the risks of edi I marijuana may include possible long-term effects bf the brain in
the areas of memory, or' 'ation and cognition;. impairment of the. ability to drive or operate
heavy machinery; raspi ry damage; possible lung cancer; and physical or psyChological
dependence. .
.J .
. Recommendation
As this patienfs "60 day supply", as stipulated by RCW 69.51A(2)(b), I recommend 240lAnces
.of dried, cured marijuana and as many plants 1'1S the patient feelS necessary to maintain this "60
day supply". .
CBR Medical, Inc.
Administrative Office
3115 E. Mission Ave
Spokane, WA 99202
Spokane: 509-242-8624
Seattle: 206-774-6493
Revised 7/07
~IQS.\vI\,)
SE~
;.,JlUQ8.
...'.;'"
··~ECt\t3~'
OE.~T 0XkP~~bD e~f;:\~i
SH€.i:.T ~::,,~
. i
PDU-6655-.3 000071