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----------------------------detach here------------------------------------- Documentation of Medical Authorization to Possess Marijuana for Medical Purposes in Washington State Patient Name ____________________ Date of Birth ____________________ I am a physician licensed in the State of Washington.  I am treating the above named patient for a terminal illness or debilitating condition as defined in RCW69.51A.010. I have advised the above named patient about the potential risks and benefits of the medical use of marijuana.  I have assessed the above named patient's medical history and medical condition.  It is my medical opinion that the potential benefits of the medical use of marijuana would likely outweigh the health risks for this patient. Signature of Physician: _________________________ Printed Name of Physician: ______________________ Risks and benefits of medical marijuana Under Washington state law, the use of medical marijuana is now permissible for some patients with terminal or debilitating illnesses.  The law regulating this (RCW69.51A) allows physicians to advise patients about the risks and benefits of the medical use of marijuana. The medical and scientific evidence supporting the use of medical marijuana remains controversial in the medical community.  Not all health care providers believe that medical marijuana is safe or effective and some providers feel that it is a dangerous drug. According to the Washington state law the benefits of medical marijuana may include treating nausea and vomiting from chemotherapy; AIDS wasting syndrome; severe muscle spasms from multiple sclerosis or other spasticity disorders; glaucoma; and some types of intractable pain. Some of the risks of medical marijuana may include possible long-term effects of the brain in the areas of memory, coordination and cognition; impairment of the ability to drive or operate heavy machinery; respiraatory damage; possible lung cancer; and physical or psychological dependence. Text on this form provided by the Washington State Medical Association. -------------------------------detach here--------------------------------- We encourage everyone to go to the one who knows them the best (the one you would call with the flu or for check-ups).  The health care provider signing the authorization documentation can be a Nurse Practioner, General Practice/Family Doctor, or a specialist.  As long as it is one you see on a regular basis concerning your health care.  The Doctor must be liscensed in the State of Washington be licensed under RCW 18.71 or RCW 18.57 in order to sign the authorization to possess medical marijuana.  After your Doctor has signed the authorization form, make copies.  Place the original in a safe location and keep one on you just in case you need it. Keep your faith - what ever it may be.  Good things do happen.  Wait and see. The form above has been added for you convience.  This is the "authorization" documentation the physcian signs.  When you are talking about the use of Medical Marijuana to your provider, the correct words are important.  REMEMBER, the physicians cannot furnish you with a "marijuana prescription".  That IS against the law, and the Doctor CAN get into difficulties by doing so.  Please use the proper terms and educate those around you.  Thanks a bunch!!!

Documenting Medical Marijuana Keep a journal of your use.  Example:  Woke up with migraine at 9 am, took medications prescribed by doctor, took 30 min to take effect.  9:45 became ill and could not keep anything down.  Noon used marijuana. 12:15 nausea stopped and became hungry. Ate ate 12:25 with no negative results.  List both the positive and the negative about ALL medications you use.  If you are not honest with yourself and your physician, you are doing a dis-service to both of you. Make an appointment for a physical examination with a physician of your choice who is licensed to practice in the State of Washington.  Be sure to have any and all pertenate medical records and tests from previous physicians you have consulted with concerning your particular problem or illness.  (Try and furnish the physician with records that are as complete as possible, including a list of all previous medications and treatments you have had in the past and their success and/or failure).  Honestly explain the benefits you experience from your use of cannabis (marijuana).  Remember, the more complete and honest you are, the better the medical decisions for your health care is.  The doctor cannot support you by signing the paperwork except after noting that nothing else works as well. 3.  When completing any patient information form, list "marijuana" under 'current medications' if you use it.  Politely ask for the doctor to consider signing the documentation for medical marijuana.  The physician may then sigh your consent form because it limits their liability. 4.  If all else fails, and as the last resort, request a copy of your medical history file (especially any pages that states that you use marijuana as a medicine).  Keep a copy in your files at home and on your person having it available to show law enforcement personnel if necessary.  The more documentation you have concerning your personal consumption of medical marijuana the better chance you have with the law enforcement officials determining if your marijuana is you medicine.  Use what you have learned from your own medical experiences to protect yourself.