MEDICAL PROVIDER- PATIENT RELATIONSHIP
Today we are establishing [or re-establishing if renewing] a bona fide medical provider-patient relationship. This means we have a relationship in which Sara Dayon, CNP or her designated nurse practitioner is the treating medical provider who will have ongoing responsibility for the assessment, care, and treatment of you as a qualifying patient with a debilitating medical condition with respect to the medical use of marijuana.
Plan of care: Today this medical provider will evaluate that the length of time that the medical use of marijuana is needed for the treatment of your debilitating medical condition will be at least one year. Prior to issuing you a written certification, this medical provider hereby certifies that it is this provider's professional opinion that you as the patient are likely to receive therapeutic benefit from the medical use of marijuana to treat or alleviate your debilitating medical condition as detailed separately. This provider is not assuming responsibility for any other aspect of your medical care. You must continue to have routine medical care and specialized care by your usual primary care providers and specialists. This provider is participating in your medical care as your medical marijuana recommendation provider. This provider is available to you for ongoing monitoring of your progress and re-attestation of continued need for marijuana products at least once annually. You attest you have been offered one on one counseling services to discuss specific product and dosing recommendations to help treat your qualifying conditions. Alternative therapies for your conditions will be discussed if applicable. If you are suffering from a substance use disorder and need help, please let the practitioner know.
If you [the qualifying patient] have a name change or address change, you must secure an updated written certification from the provider with the correct name and or address on it. Any written certification that has not been updated within 30 days to correct outdated patient information is considered in-valid.
All of the statements and comments made in this notice are subject to change AND interpretation by the Maine Court system, Federal Law, and Federal Court system. At no point are we giving legal advice or making determinations on the law of the State of Maine or the United States. Please consult a lawyer if you have any questions regarding the medical use of cannabis or any derivation thereof. Any legal statement made hereunder is the law as is understood by your cannabis professional and not as it would be interpreted by the courts of the state of Maine or federal jurisdictions.
At no point is your medical cannabis provider promising any beneficial effects from the use of cannabis, nor are they guaranteeing medical benefit from their product. As with any prescribed therapy, it may help, but they cannot know for certain what will work and what will not.
You signature confirms agreement with above