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Medical Marijuana
Cannabis has been approved by the State of
Washington for use in various medical
conditions.
RCW 69.51A allows
physicians to provide a “Certificate of Use”
to patients who qualify.
Common conditions that marijuana can be used
for include the treatment of the side
effects of Hepatitis-C; HIV infection,
Chronic Pain conditions such as Arthritis in
Joints, Degenerative Disc Disease of the
spine, Inflammatory Bowel conditions such as
Crohn’s Disease and Ulcerative Colitis, Nausea from
any cause including chemo-therapy, Appetite
and Weight Loss, Headaches and Migraines,
Seizures-Epilepsy, Multiple Sclerosis,
Abdominal Cramping, Fibromyalgia,
Severe-Intractable Pain from any cause,
side-effects from Cancer, Sleep Disorders
and Glaucoma as well as other medical
conditions.
If you do not have your medical records in
your possession, contact your treating
doctors so they can be faxed directly to our
office. Please do not send double sided or
reduced chart notes as the records will not
be reviewed. In addition, physical therapy
notes, IME reports, Judge’s decisions with
Social Security or VA Benefit claims are not
acceptable as we require copies of the
original documents.
If you cannot fax your medical records mail
them directly to our office at: Dr. Havsy
3716 Pacific Ave, Suite E Tacoma, WA 98418.
If your condition is not listed or you have
any questions feel free to call our office
at 253-473-2663.
Once
your records are received, they are logged-in and a
staff doctor reviews the records typically
within 7-10 business days. If additional
records are required, our staff will contact
you and provide you with the information
that is required.
Once
approved, you will notified by our staff at
the phone number you provided. Since May
1, 2010, a $50.00 NON-REFUNDABLE deposit is
required before your appointment is
scheduled. We accept money orders, cash or
credit cards only. If you fail to keep your
appointment or do not provide a 48 hour
notice of cancellation, your deposit will be
forfeited and another deposit will be
required to reschedule your appointment. If
you fail to keep your second appointment,
the full amount of your evaluation fee will
need to be prepaid. We accept money orders,
cash and in-person credit card transactions
for the deposit only.
PLEASE NOTE:
1. Do not send in double sided copies
of records for review.
2. Records sent are the property of
Dr. Havsy whether or not you are approved
for a certificate of use.
3. If you are approved, your records
will then become part of your permanent
medical file in our office.
4. If you are not approved, the
records will be destroyed. Therefore,
do not send original records or records that
you do not have copies of and expect to get
back.
5. If you fail to keep your
appointment or do not cancel within 48
hours, your deposit fee will be forfeited.
The
Department of Health for the State of
Washington has an official Medical Marijuana
Website that provides useful information.
See:
http://www.doh.wa.gov/hsqa/medical-marijuana/.
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Neck pain, upper
back pain, low back pain, joint pain of the
shoulder, elbow, wrist, hip, knee, ankles or
feet:
1.
CT
scans, MRI scans, and X-ray reports of the
area in question.
2.
Orthopedic or neurosurgical consult
3.
Procedures such as spinal injections, or
nerve studies
4.
Surgery reports of the area in question
5.
4
treatment records or notes from a
physician’s office indicating treatment to
that specific area within the last two
years.
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
► Rheumatoid
or osteoarthritis of the shoulders,
elbows, wrists, hips, knees, ankles or feet:
1.
Evaluation from an orthopedic, neurosurgeon
or rheumatologist
2.
Blood
tests indicating you have rheumatoid
arthritis.
3.
CT
scans, MRI scans, and X-ray reports of the
affected area
4.
Treatment records or notes from a
physician’s office indicating treatment to
that specific area within the last two
years.
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
► Hepatitis C:
1.
Blood
tests that show you have Hepatitis C or a
viral load of hepatitis.
2.
Liver
biopsies
3.
Gastroenterology consult
4.
MRI,
CT scans or Ultrasound of the liver.
5.
Four
treatment notes indicating that you have
Hepatitis C from any treating physician over
the past 2 years.
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
► HIV
or AIDS virus:
1.
Blood
test that show you have the AIDS virus.
2.
4
treatment notes with infectious disease
doctor or from a physician who is currently
treating your condition over the past 2
years.
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
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Irritable bowel syndrome/gastro
esophageal reflux or GERD, abdominal pain:
1.
Gastroenterology consult
2.
CT/MRI/Ultrasound
of abdomen
3.
Endoscopy of stomach or colonoscopy report
4.
Upper
or lower GI barium tests
5.
Four
treatment notes reflecting your medical
condition over the past 2 years
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
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Headaches/migraines/epilepsy:
1.
Neurological consult
2.
CT
scan or MRI of the brain
3.
EEG
4.
Four
treatment notes from neurologist or primary
care physician reflecting treatment for this
condition over the past 2 years
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required.
Please make sure your phone
number is included with your
records to expedite the review
process. |
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Bladder issues or interstitial cystitis:
1.
Urology consult
2.
Recent
urinalysis
3.
Surgery report/cystoscopy of bladder
4.
Four
treatment records from your primary care
physician or specialist indicating you have
interstitial cystitis over the past 2 years
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
► Cancer of
any origin:
1.
Copy
of consult with your cancer specialist
2.
Surgery reports that reference removal or
attempted removal of your cancer
3.
Chemotherapy reports
4.
Four
treatment notes from your specialist or
primary care provider that indicate
follow-up for cancer over the past 2 years
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
► Anorexia
or weight loss from any cause:
1.
Gastroenterology consult with colonoscopy,
endoscopy, upper or lower GI series
2.
Four
treatment notes indicating anorexia or
weight loss from your primary care doctor or
specialist; or
3.
Psychiatric evaluation with four follow-up
treatment notes
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
► Arm pain/leg
pain/ or neuropathy from diabetes:
1.
Consult with your neurologist, orthopedic
surgeon, neurosurgeon or rheumatologist,
endocrinologist or hormone doctor
2.
Nerve
conduction studies and electromyography/EMG
studies of the upper or lower extremities
3.
Blood
tests indicating you have diabetes
4.
CT
scans or MRI scans of the neck or low back
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
► Glaucoma:
1.
Legible chart notes in the last two years
that document your glaucoma with pressure
readings, the diagnosis of glaucoma and what
medication you are currently taking for that
condition.
2.
As a
vast majority of these records are
handwritten, we may require a letter from
your ophthalmologist indicating that you
have been diagnosed with glaucoma and what
your pressure readings were before you began
the use of medication
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
► Herpes
zoster or shingles:
1.
Blood
tests indicating you have herpes zoster or
shingles
2.
Neurology consult, if any
3.
Nerve
studies
4.
Four
treatment notes from your primary care
physician indicating your condition in the
last 2 years
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
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Pelvic
Pain / Menstrual Cramps:
1. Evaluation
by a gynecologist or medical physician
2. Ultra Sound
of Abdomen / pelvis / uterus
3. Four
treatment notes documenting your condition
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
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Chronic Pain / Fibromyalgia / Muscle
Pain / Lupus:
1.
Rheumatology, orthopedic, neurologist or
neurosurgeon evaluation.
2.
Copies of MRI scans, X rays, CT scans or
affected areas
3.
Copies of blood tests that reflect you
have fibromyalgia
4.
Four treatment notes from your doctor
over the past 2 years that indicate you
have fibromyalgia, chronic pain, muscle
pain or Lupus
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
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Epilepsy /
Seizures:
1.
Neurologist evaluation
2.
Copies of MRI scans or CT scans of the
brain
3.
Copies of EEG's of the brain
4.
Four treatment notes from your doctor
over the past 2 years that indicate you
have seizures
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
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Muscle
Spasm / Spasticity:
1.
Rheumatology, orthopedic, neurologist or
neurosurgeon evaluation
2.
Copies of blood tests that reflect
fibromyalgia
3.
Copies of any EMG or nerve studies
4.
Four treatment notes from your doctor
over the past 2 years that indicate you
have been treated for muscle spasm or
spasticity
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
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Multiple Sclerosis or Parkinson's:
1.
Neurologist evaluation or Primary Care
evaluation
2.
Copies of MRI scans or CT – scans of the
brain
3.
Copies of spinal tap results
4.
Four treatment notes from your doctor
over the past 2 years that indicate you
have multiple sclerosis or Parkinson's
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Please fax your medical
records to 253-473-0545 and
allow 7-10 business days for the
doctor to perform the review.
Our office will then call you
and let you know if you have
been approved or if additional
information is required. Please
make sure your phone number is
included with your records to
expedite the review process. |
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Condition not listed:
Chronic Renal Failure
1. Blood
work indicating your kidneys do not
function (BUN/Creatinine levels).
2. Consult
with Internal Medicine Doctor or
Nephrologist (Kidney Doctor).
3. 4
treatment notes in the last two years
from your doctor who treated you for
kidney failure.
Call our
office for document information
253-473-2663
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