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We present the following text for reference. We will not process from this text.
Health & Safety Code 11362.5
certifies that _________________________, is a patient under my medical
care and supervision for the treatment of ____________________.
I have have discussed the medical benefits and risks of cannabis
use with the patient as a treatment for these medical conditions. I recommend cannabis use for my patient.
If my patient chooses to use cannabis therapeutically, I will
continue to monitor his/her condition, providing advice on his/her
I understand and agree that I may be contacted to verigy the
information in this letter. My patient authorizes me to discuss their
medical condition and the contents of this letter, for verification
purposes only. I am a physician licensed to practice medicine in the
state of California.
Physician's CA License #
Physician's name (printed)
City, State, Zip Code
Patient's Member Number _________
Physician's area code and phone number