The initial examination should be a confidential, face-to-face session with the patient. The recommended time of consultation is a minimum of 45 minutes for the initial visit and 30 minutes for follow-up visits.
Term of Recommendation
Recommendations for medical cannabis are made for what is medically appropriate and in accordance with relevant law. Annual follow-up visits are advised, though more frequent follow up is advisable when conditions require.
Extensions may be granted by the approving physician. Unless otherwise stated, the patient can expect to remain in a consultative relationship with the doctor for future follow up (unless the patient has been notified in writing of the termination of the relationship).
Documentation Supporting the Diagnosis
The patient is expected to have an appropriate medical condition for which cannabis has been shown to be therapeutic. Adequate documentation of both the condition and conventional medical treatment is advisable. In cases of a de novo diagnosis of a patient’s medical condition, the physician should expect to maintain accepted standards of medical responsibility in arriving at that conclusion, such as initiating a work-up or making a referral for an appropriate evaluation.
Appropriate medical conditions
- Cancer, migraines, glaucoma, AIDS- related illnesses, or a positive status for human immunodeficiency virus;
- A medical condition or treatment for a medical condition that produces, for a specific patient, one or more of the following:
- anorexia and/or cachexia;
- chronic pain, intractable pain or pain which can meaningfully interfere with work, play or sleep;
- seizures, including but not limited to seizures caused by epilepsy; and/or
- persistent muscle spasms.
- Mental conditions, including but not limited to PTSD (Mikuriya; Bearman), panic and anxiety disorders (Kathuria et al;Nicoll et al), bipolar disorder, depression, OCD, ADD/ADHD (Bearman), and Tourette's Syndrome;
- Any other medical condition or treatment for a medical condition adopted by the relevant department by rule; and/or
- any other medical condition considered to be responsive to cannabis therapy, based on cannabinoid laboratory studies, clinical trials, clinical experience, and/or population surveys.
Ongoing Medical Care
The physician should make clear with the patient whether they are functioning as a primary care provider (PCP) or a consultant in their role as the authorizing provider. If the patient does not have a primary care physician, it is strongly recommended that the patient establish care with a primary or specialist physician for appropriate follow-up care prior to booking an appointment with the cannabinoid medicine specialist, excepting those circumstances when the patient has a clear diagnosis, long history of ineffective conventional treatment and/or established use of cannabis for the benefit of the condition. Follow up by a PCP or referral to specialist may also be appropriate.
The initial and subsequent evaluations of the patient should be documented in the patient's medical records. The patient's name, sex, birth date, social security number or driver's license number, address, phone number, date of examination, relevant history and physical examination should be included.
It is also recommended that the physician:
- Note a ICD-9-CM diagnosis in the medical records, as it relates to that chief complaint;
- Note the amount of cannabis that is recommended or that the patient reports needing, especially when that quantity exceeds the guidelines within the patient's state or county of residence;
- Document a mental health history and/or have adequate documentation from a mental health professional when the patient's primary complaint is a mental disorder; and
- Discuss and document other therapeutic options and referrals as appropriate to the proper care and supervision of the patient.
The physician declares a willingness to communicate with law enforcement, CPS, attorneys, public health officers, or other physicians, CPS as needed, to verify the validity of the recommendation.
Medical and Legal Advice
The physician declares a willingness to provide adequate information about the medical and legal aspects of cannabis use. The physician should help prepare the patient to understand the ramifications of using a federally controlled substance. This may require time in answering questions on the law, state and regional guidelines, and providing useful information about cannabis history, uses, preparations and the science of cannabinoid medicine. The use of educational handouts and/or videos on these topics is recommended.
The physician declares a willingness to testify in support of the patient in a court of law. Though the physician has expressed his/her willingness to testify on behalf of the patient, the costs of travel and testifying in court or any other legal proceedings need not be included in the usual consultation fees.
Primary Care Reports
The physician makes no claim of willingness to handle written reports, disability evaluations, or other documents appropriately performed by the patient’s primary physician. Should the physician include these additional services as part of the practice, they are not included in the usual costs of the consultation.
The physician declares that he/she does not cross-refer to cannabis dispensaries. The physician’s office must not be on the premises of a cannabis dispensary. The physician has no fiscal relationship with the dispensaries, and the physician must act independently of cannabis dispensaries. In accordance with federal law, the physician is unable to provide cannabis to the patient, or aid or abet the patient in acquiring cannabis.
Should the physician utilize advertising in his/her practice, it should be professional and not misleading.
The physician agrees to abide by accepted medical ethics standards. When seeing a patient who is a minor, the doctor will make all reasonable efforts to obtain written authorization from the legal guardian(s).