Medical Marijuana Consent Form

The qualified patient, or the patient's parent or legal guardian if the patient is a minor, must read each section of this consent form and must sign and date the informed consent form to indicate if the patient/guardian understands and accepts the information. 

Please read and answer this evaluation form. The physician will make a recommendation based on the information you have provided herein. Please answer the questions below truthfully. It shall be your responsibility to be informed regarding the state and federal laws regarding the possession, use, sale, and distribution of marijuana. 

BENEFITS

Much information about the benefits of medical marijuana is based on personal experiences shared by patients. Marijuana may be an effective treatment for nerve and muscle pains and can reduce nausea, vomiting, including those effects by chemotherapy. This includes the benefit of relaxation, having more sleep, and increased appetite.

RISKS

Marijuana is classified as a Schedule I controlled substance. This means it is highly susceptible to abuse with no currently accepted medical use in the United States. It also lacks the qualification as an accepted safety for use under medical supervision. 

The Food and Drug Administration has not approved the marketing of Marijuana as a drug. No standard is set for its quality control. Thus, marijuana may contain contaminants, impurities, or unknown substances.

Being under the influence of marijuana can affect coordination, motor skills, and cognition. These can affect one's mental alertness, ability to think, and reason. Thus, it is highly prohibited for one to operate heavy machinery or engage in activities that require one to think quickly as this may endanger one's self or others.

Smoking marijuana may cause respiratory problems such as bronchitis, emphysema, or laryngitis. Marijuana is high in tar and thus, may cause other respiratory diseases. It is not lawful to smoke or combust marijuana in Pennsylvania, therefore only vaporization is allowed.

Thus, federal law prohibits the manufacture, distribution, and possession of marijuana.

SIDE EFFECTS

Potential side effects of marijuana include, but are not limited to, the following:

• Anxiety
• Short term memory impairment
• dizziness
• sedation
• low blood pressure
• euphoria
• suppression of the body’s immune system
• short term attention span
• impaired motor skills
• paranoia or restlessness
• may exacerbate schizophrenia
• increased appetite

Some medical authorities claim that persons younger than 25 years old may have learning and development problems due to abuse. Thus, the use of marijuana must be only for the relief of ailments.

CANNABIS AS CURE CLAIMS

Although there are many claims that cannabis helps in treating cancer, however, there is insufficient scientific evidence to support or refute the conclusion. There is, however, conclusive evidence that oral cannabinoids are effective antiemetics in minimizing the side effects of chemotherapy such as nausea and vomiting.

There is likewise lacking evidence from clinical trials to prove that cannabis treats epilepsy, as an effective treatment of glaucoma, curing post-traumatic stress disorders, that it is an effective treatment for Crohn's Disease, Parkinson's.

There is substantial evidence that oral cannabinoids are effective in treatment against multiple sclerosis, but limited clinical evidence for it.

There is limited literature detailing that cannabis is effective in the increase of appetite and decreasing weight loss associated with HIV/AIDS

There is considerable proof that cannabis is successful in the treatment of chronic pain, although there is very little information in controlled clinical trials. Thus, the efficacy, dosage, routine, or side effects are currently not well documented. 

Overall, to this day, the risks and benefits of marijuana is still not fully understood. Some mixture of medications may cause or lead to further harm or consequences. Thus, before undergoing treatment using marijuana, one must consult with his/her physician.

One must consult with the pharmacist on staff at his/her dispensary for the best product recommendations based on needs and symptoms. 

I have read through this form and I have had the opportunity to discuss any contents I find difficult understanding with my physician and/or her executive staff. I was given answers that satisfy my concerns. I acknowledge that I have been recommended other treatments, including no treatment. 

I understand the risks, benefits and possible complications and I understand that this method of treatment may not yield the expected results. I knowingly and consciously accept this information and wish to proceed with the medical marijuana program.