Form Cdph 9044 PDF Details

The CDPH 9044 form is an important document for any cannabis business in California. This form is used to report information about your cannabis products, including the test results of those products. Failing to submit this form can result in hefty fines, so it's crucial that you understand and comply with all requirements. In this blog post, we'll walk you through everything you need to know about the CDPH 9044 form. We'll explain what information is required, and we'll provide step-by-step instructions on how to complete the form. So if you're a cannabis business owner in California, make sure to read this blog post!

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)

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