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DE Green Medical Marijuana
Medical Marijuana Doctors DE
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Home
Our Team
EPAT Pain Treatment
Patient Forms
New Patient Intake
Patient Re-certification Survey
Reviews
Shop
Find Us
Doctor Recertification
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Doctor Recertification
Name
First
Last
Date of Birth
History of Present Illness
Present Condition
How many years has the patient been using medical cannabis?
1 Year
2 Years
3 Years
4 Years
5 Years
Has the medical cannabis improved your overall quality of living?
Yes
No
Have you been weaned off of narcotics?
Yes
No
Have you had any adverse effects from using medical cannabis?
Yes
No
Does medican cannabis help you with any other problems?
Yes
No
If So, What?
Assessment
Patient's medical condition has been relieved by medical marijuana
Yes
No
Re-certification reccomendation
Yes
No
Physician/Patient Relationship Established:
*
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