Form Cdph 9044 PDF Details

The State of California, through its Health and Human Services Agency and the California Department of Public Health's Medical Marijuana Program, has established a form known as CDPH 9044. This essential document is specifically designed for those needing to document the medical necessity of marijuana use due to serious health conditions. Although not mandatory, when completed by an attending physician, the CDPH 9044 form serves as an official record indicating a patient's diagnosis with a serious medical condition and the physician's endorsement of medical marijuana as a fitting treatment. Conditions listed include, but are not limited to, chronic pain, cancer, AIDS, severe nausea, and multiple sclerosis. Filing a copy of this form in the patient's medical records is a critical step, and it plays a significant role if the patient seeks to obtain a Medical Marijuana Identification card. Health departments use this form to verify the patient's condition directly with the attending physician, ensuring the process aligns with the regulations set forth in the Health & Safety Code, Section11362.72 (a)(3). It accommodates various medical professionals licensed in California, covering both the Medical Board of California and the Osteopathic Medical Board of California, highlighting the state's comprehensive approach to accommodating and documenting medical marijuana use for therapeutic purposes.

QuestionAnswer
Form NameForm Cdph 9044
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescdph written form, cdph medical marijuana records get, california marijuana form, 9044 form

Form Preview Example

State of California—Health and Human Services Agency

California Department of Public Health

Medical Marijuana Program

WRITTEN DOCUMENTATION OF PATIENT’S MEDICAL RECORDS

(Please Print)

Note to Attending Physician: This is not a mandatory form. If used, this form will serve as written documentation from the attending physician, stating that the patient has been diagnosed with a serious medical condition and that the medical use of marijuana is appropriate. A copy of this form must be filed in the attending physician’s medical records for the patient. If the patient chooses to apply for a Medical Marijuana Identification card through the county health department or its designee, the agency will call the attending physician to verify the information contained on this form, in accordance with Health & Safety Code, Section11362.72 (a)(3).

Attending physician name

 

 

 

California medical license number

 

 

 

 

 

Service mailing address (number, street)

 

 

 

Office telephone number

 

 

 

 

(

)

 

 

 

 

 

City

 

State

ZIP code

Office fax number

 

 

 

 

(

)

 

 

 

 

 

 

Licensed by (CHECK ONE):

 

 

 

 

 

Medical Board of California

Osteopathic Medical Board of California

 

 

is a patient under the medical care and supervision of the above

Patient’s name

named physician who has diagnosed the patient with one or more of the following medical conditions:

1.Acquired Immune Deficiency Syndrome (AIDS)

2.Anorexia

3.Arthritis

4.Cachexia

5.Cancer

6.Chronic pain

7.Glaucoma

8.Migraine

9.Persistent muscle spasms, including, but not limited to, spasms associated with multiple sclerosis

10.Seizures, including, but not limited to, seizures associated with epilepsy

11.Severe nausea

12.Any other chronic or persistent medical symptom that either:

a.Substantially limits the ability of the person to conduct one or more major life activities as defined in the Americans with Disabilities Act of 1990.

b.If not alleviated, may cause serious harm to the patient’s safety or physical or mental health

ATTENDING PHYSICIAN STATEMENT:

This patient has been diagnosed with one or more of the foregoing medical conditions and the use of medical marijuana is appropriate.

Attending physician’s signature

Telephone number

Date

Original—Patient

Copy—Patient’s File

CDPH 9044 (1/09)

How to Edit Form Cdph 9044 Online for Free

Working with PDF files online is definitely very simple with this PDF tool. You can fill out ca marijuana form here within minutes. To make our editor better and simpler to utilize, we constantly implement new features, taking into account feedback coming from our users. Here is what you will need to do to get started:

Step 1: Simply press the "Get Form Button" above on this webpage to access our form editor. This way, you'll find everything that is needed to work with your file.

Step 2: The editor will allow you to modify nearly all PDF forms in a variety of ways. Enhance it with any text, correct what's already in the file, and place in a signature - all within the reach of several clicks!

Pay close attention while filling in this pdf. Make certain each and every blank is filled out correctly.

1. Before anything else, when filling in the ca marijuana form, start out with the page containing next fields:

california marijuana documenatation completion process described (portion 1)

2. Now that the previous section is finished, you're ready to put in the necessary particulars in Attending physicians signature, Telephone number, Date, CDPH, and OriginalPatient CopyPatients File in order to move on to the third stage.

Part number 2 for filling in california marijuana documenatation

Be extremely careful while filling in Telephone number and CDPH, since this is the part where most people make mistakes.

Step 3: Look through all the information you have typed into the blanks and then press the "Done" button. After getting a7-day free trial account at FormsPal, you'll be able to download ca marijuana form or email it promptly. The form will also be readily accessible in your personal account page with all your modifications. FormsPal is invested in the personal privacy of our users; we make certain that all personal information put into our system continues to be secure.

Form Cdph 9044 isn’t the one you’re looking for?

Related Documents