Medical Marijuana: Step One the History and Physical

As medical dispensaries become more commonplace patients with a wide variety of conditions will naturally seek certification to receive and legally use marijuana. This is series to examine tools and compliance with state regulations. Minimum requirements are to do the following: Examine the patient Establish a medical record Review previous medical records Make or confirm the diagnosis Discuss risks & benefits of medical use of marijuana Check the Qualified Patient’s profile in the Controlled Substance Rx Monitoring Program Database Complete & sign the Physician Certification form Give the form to the Qualified Patient to submit We will break this down over the next 8 weeks to offers suggestions for compliance with each area. I. Examine the patient. Before you examine the physician should take a detailed history on the patient. This should include a past medical history including names of former providers. The history should include dates for all prevsious hospitalizations, surgeries or serious illnesses. Also, your history taking should include a family medical history and a social history regarding tobacco, alcohol and drug use. The history should include date and times for all diagnostic tests such as mammogram or colonoscopy or other radiological studies. The physician must take a detailed history regarding the present illness. If the patient seeks medical marijuana for chronic pain, documentation should include the location, quality, severity by scale, duration, timing context, associated signs and symptoms and modifying factors. You should also note whether the patient has an advanced directive, and whether immunizations are up to date. So does the standard of care require you to


on information gleaned from the history unrelated to the patient’s request for physician certification. The answer is yes. If your patient divulges information requiring immediate work up you have two choices. First, you can either undertake care and treatment of that issue directly or you can refer the patient back to his/her primary care provider. If you refer, be sure to document instructions to the patient and send a letter to the primary care provider regarding your concern.