Patient
ID Center Membership Page
Membership Application Procedure
To apply for membership you will need the following :
1) Valid current ID from the following list:
California
Drivers License
California
ID
2) Completed physicians
form (which must meet the following)
-
must be currently dated, usually
within the last six months
-
be signed by
an MD certified in California
-
have the
physician's phone number for verification
-
have a
diagnosis of your condition
- state that the
physician recommends/approves of the patient's use of cannabis
- indicate the
physician has discussed the advantages and disadvantages of using medical
cannabis and agrees to monitor the patient's use of
cannabis
3) Completed Authorization for Release of Patient Status form
The
physician
may write their own letter or use ours. After we receive your
documentation it
will take several days to process it. When your medical
information is
verified, we will call you to inform you that you may come in and
complete the
enrollment process. Please do not call us unless you do not
hear from
us within
five business days.
Processing
your
membership takes several business days. If you are coming
from
far
away, please
mail or fax your documentation before your visit so that you are
verified when
you arrive. Be sure to include your phone number and your
doctor's
phone
number. Our membership fee is $40.00 for first time members,
and
$30.00
for renewal. This is a yearly fee is paid when you come in to
get
your ID card issued or renewed (ID Card expiration date is set from the
date of your Doctor's
recommendation no more then one year).
4) You can also renew your ID card by mail without having to come in and visit the Patient ID Center office.
To renew by mail you need to submit the following:
a) An updated and current recommendation faxed or mailed into us.
b) Your Patient ID Center Member Number form your old ID card and your current telephone number.
c) Renew by mail fee of $35 (can be paid by Cashier's Check, Money Order, Visa or Mastercard).
d) Once our office has verified your new
recommendation, our staff will contact you to complete the process
to receive ID Card.
Northern California Patient ID
Services
Patient
ID Center
1733 Broadway, Oakland, CA 94612-2105
P.O. Box 70401, Oakland, CA 94612 -0401
Tel: (510) 832-5346 Fax: (510) 986-0534
Southern California Patient ID
Services
Patient ID Center
470 S. San Vicente Blvd. Los Angeles, CA 90048-4107
Tel: (323) 852-1039 Fax: (323) 852-1051
Patient ID Center
Membership Protocol
The Oakland
Cannabis Buyers' Cooperative operates pursuant to and in accordance
with the statewide mandate of Proposition 215 (Exhibit A)
and Resolutions passed unanimously by the Oakland City Council (Exhibit B).
Its operating procedures have been consolidated as these
Protocols.
I. Admission and
Membership Requirements
A person seeking
membership of
the Oakland CBC must, at the threshold, provide a note from a treating
physician assenting to cannabis therapy for a medical condition listed
on the Medicinal Cannabis User Initial Questionnaire (Exhibit C).
Upon acceptance of the note by intake staff, the prospective member
will undergo an extensive screening and such questioning as shall
establish that the candidate meets the Medical Admissions Criteria (Exhibit D),
including, without being limited to, the Cannabis Buyers' Cooperative
Information Form (Exhibit
E).
If, upon the screening by staff members, the candidate does not appear
to qualify, he or she will be denied membership with a statement of
reasons for his or her being screened out.
If the candidate appears to qualify for membership, intake staff will
give ask that the candidate sign our Authorization for Release of
Patient Status form (Exhibit
F)...
... and then take our Physician Statement (Exhibit G),,
and (if the candidate would nominate a caregiver) our Patient's Caregiver Statement
with a request that the candidate's treating physician sign it.
When we receive completed form(s), our intake staff will verify the
physician's approval by telephone.
No person under the age of eighteen
shall be
admitted to membership without the written consent of parents, in
addition to meeting all other requirements.
II.
Responsibilities of Membership
All members must
sign a Membership Agreement (Exhibit
H), whereupon they will receive a Membership Card (Exhibit I).
Members agree to conduct themselves discreetly, in accordance
with the Statement of Safe Use of Cannabis (Exhibit J)
and the Principles of Responsible Cannabis Use (Exhibit K).
III.
Other Provisions
A.
Purpose. The purpose
of the Oakland CBC is to help provide medicine for people who need it.
Accordingly, it shall be operated as a non-profit organization.
B.
Privacy of members.
The staff of the Cooperative shall take steps to protect the privacy
and identity of members. However, neither the Cooperative nor its staff
shall be liable for any breach thereof.
C.
Changes. These
Protocols, and all medical protocols, are subject to change without
notice from time to time in the sole discretion of management.
D.
Cooperative operation.
a. No smoking of anything on premises. b. Members shall observe
additional house rules as may be posted by management. c. Management
may eject any person at any time.
Exhibits
A.
Proposition 215
B.
Oakland City Council Resolutions
C.
Medicinal
Cannabis User Initial Questionnaire
D.
Medical Admissions Criteria
E.
Information Form
F.
Authorization for Release of Patient Status
G.
Physician Statement
H.
Membership Agreement
I.
Membership Card
J.
Statement of Safe Use of Cannabis
K.
Principles of Responsible Cannabis Use
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