Oakland Cannabis Buyers' Cooperative

Please don't print this page, don't crop this page,
don't edit this page, don't use it for your doctor to sign.

Please, instead, download (right-click),
or view & print (left-click)
this link to our preferred Physician's Statement.

Adobe's pdf viewer
(available without charge from Adobe).


We present the following text for reference. We will not process from this text.

Exhibit G

Health & Safety Code 11362.5

Physician Statement

 

This 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 progress.

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.

____________________________________________
Patient's signature

____________________________________________
Physician's signature

____________________________________________
Physician's CA License #

____________________
Date

____________________________________________
Physician's name (printed)

____________________________________________
Address

____________________________________________
City, State, Zip Code

Patient's Member Number _________

____________________________________________
Physician's area code and phone number

HOME   MISSION   POLITICAL ACTIVITY   SERVICES/CALENDAR   EMAIL   ANNOUNCEMENT & NEWS   MEDICAL CANNABIS   MEMBERSHIP   LINKS TO RELATED SITES