New Medical Marijuana Authorization Form

Dear Healthcare Practitioners,

Attached is a sample of the new Medical Marijuana Authorization Form that goes into effect July 31, 2017. This document replaces the current form available on the department’s web site.

You will note that the new form is one page and is fillable online. The form is still required to be printed on 8.5”x 11” tamper resistant paper that will now have a medical marijuana seal pre-printed in the bottom right corner. You may order this paper from the same vendor that you currently order your prescription pads. Note: Though the form is available July 31, 2017, the requirement to begin using it exclusively does not go into effect until January 1, 2018. This allows those practitioners who may have pre-printed the current form onto tamper-resistant paper to use up their current stock.

In addition, we have attached the Medical Marijuana Authorization Form Guidance which outlines healthcare practitioner expectations, as well as those of the patient and the patient’s designated provider (if any). In addition, the guidance has information about the medical marijuana database and what is required of the patient in order to receive a medical marijuana recognition card. Please provide this guidance to patients and designated providers when issuing the medical marijuana authorization.

If you have any questions or would like more information, please contact us.

Cathie Tedrick, MBA
Medical Marijuana Program Coordinator
Washington State Department of Health P.O. Box 47852,
Olympia, WA 98504 360-236-4632
medicalmarijuana@doh.wa.gov
Learn more at: www.doh.wa.gov/medicalmarijuana