DOC request two, part 1/5 - Cannabis Defense Coalition

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OFFENDER 1.0. DATA:·STATE OF WASHINGTONDEPARTMENT OF CORRECT.IONSMedidnal Use of Marijuana Verification.To be filledPatient's NDear Prescriber, .' . ,By state statute the Washington State. Department of Corr~ctions is charged with the responsibility to supervise some.offenders after they ha\fe been convicted of a felony. The above named patient is currently under supervision by theDepartment. Supervision is designed to help the offender avoid those environments or situations that lead to their criminalbehavior. Often illicit drug use is a contdbutingfactor in an individual's criminality. Accordingly it's usual that the court orthe Department of Corrections will impose a condition of supervision that the offender not use, or possess iIIicitdrugs,including marijuana. This offender has claimed that they have a condition for which the medicinal use of marijuana hasbeen recommen·ded. The below verification is to determine the legitimacy oftheir claim. Thank you in advance foryo'ur.assistance ... If you have questions, please contactthe C()mmunity Corrections Assistant Secr E3tary at (360) 725-8787 ...1.Is this patient under your care?DYes·DNo2.Are'you rec;ommending medical marijuana for this patient due to a diagnosis of AcquiredImmunodeficiency Sypdrome (AIDS)? .a. If the answer to question 2 is "Yes", does he/she have anorexia?b. If the answer to question 2a is "Yes", does he/she haye weight loss?DYesDYesDYesDNoDNoDNo3.Are you recommending medical marijuana for thi~ patieht due to nausea and vomitingassociated with cancer chemotherapy?'DYesDNoa. If the answer to question 3 is "yes .... has the patient failed to respond to conventional 0 Yes' 0 Noantiemetic treatments? .b. If the answer to.questiOli 3a is "Yes", please describe what those treatments were (medication, dose,duration): . ,c..What is the planned schedule'of chemotherapy?4.If you answered "No" to items 2 & 3 above; what is the reason you are recommending medicinal use ofmarijuana?-)a.Please provide evidence published in a peer.:.reviewed scientific publicalion to support the medicihal use ofmarijuana for this purpose. ' .. 5. The patient's accompanying Release of Information authorizes you to provide theDepartment with current and future iriformation related to this issue. Do you agree to notifythe Department's Medical Director of any changes in your answers above?DYesDNo1DOC 14-0'53 (Rev. 3/16/09) . DOC 380.200000003
,.STATE OF WASHINGTONDEPARTMENT OF CORRECTIONSP.O. Box 41100 • Olympia~ Washington 98504-1100January 26,2009Your Medicinal Use of Marijuana request was received on January 8, 2009. Upon review by theDepartment or Corrections' Health Service~ physician, your request has been denied. .. !You may appeal this' decision by sending your written request within 15 business days of this letter,which is on or before February 16, 2009. Please send your request to .the address below: .Karen Daniels, Assistant SecretaryCommunity Corrections DivisionDepartment of CorrectionsP.O. Box 411~6Olympia, WA 98504-1126Your request must provide additional information that was.not included with your original request.Appeals that do not contain new information will be denied. You will receive a response to your .appeal request within 30 days of receipt:.~ Si c ely, ... ..... '/. \·.-t,~O; are Danie s, Assistant SecretaryCommunity 'Corrections DivisionKD:mdcc: JohnKopf; Comm~nity Con'ections SupervisorDon Swanson, Community Corrections OfficerField File' .Physician's Office:. Dr, Rod Krehbiel, MDLCDC in Hood River849 Pacific Ave.Hood River, OR 97031~~~~~~~\D}FEB 0 2 20D9 :DEPARTMENiOF'CORRECT10NS.SKAMANIA COUNTYOFFICEtI Working Together forSA,FE Communities"0000043. .."-I recycled p:lJlcr .It'\l\ 1.\ }-"l" .::J.' ·7." ,. Dq
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DOC request two, part 1/5 - Cannabis Defense Coalition

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