DOC request three complete - Cannabis Defense Coalition

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THCF MEDICAL CLINICS
1813 130 th Avenue NE Suite 210 .
~eI1evue, WA 98005
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D,;~umei.tation of Medicaf .Al!t~:y~,;.zation to Possess Marijuana.
for Medical Purposes m Wasbingto~ State,
The te:ct -of this form was reCommended by the Washlngton State Medical Association.,
Patient
r, Thomas Orvald" am a physician licenSed in the State ofWashingtoll. I. am.
treating the above-named patient for a terminal ilkI~is or a debilitating condition as defined
in RCW 69.51 A.01D. !'have advised the above nt'Pned patient about the potential risks and
b~nefits ofth~ n:edical u~e. ofm~j1;lana .. I ~avei~~~~e~ the above n~ed p.a*nt·s medica!
hlst~ry and medlca~.~nchtlon. It.IS my me~B~p' '\ .. !;mthatthlfP!lt~~l~~'~~S oithe .'
medICal use ofmanJt1ana would likely outwelgl1:t • ealth rlslci forthis patient!.
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Sign~tuTe ofPhysici~;
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ThomasO. Onaid, M.D. WAif MD 00016180
Tooay's date: l;L ~ l L.l- ZtoB Expiration date: ll- l Y -200 9
Risks and benefits ofmedica]marljuana:
Un.der Washington·state law, the use of meaical marijuana is now permissible for some patients
with. temUnal or debi1itlrtmg illnesses. The law regulating this (RCW 69.51A) allows physicians
to advise patients about the risks and benefits of 'the medic~ use of marijuana.
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