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Medical Marijuana Registry System 6.0.0Physician CerticationTo add your provider certication to your application please follow the steps below:- Select your provider certication from the "Provider Certication Number" drop down- Click "Save" to save the certication to your application. IMPORTANT:- Only provider certications created by your provider within the last six months will be available. If you have seen your provider within the last six months and are not able to select a new provider certication from the drop down next to "Provider Certication Number," please click on the "Patient Registration" tab and check that your date of birth and social security number are correct on your application. If both of these are correct on your application, please contact your provider&#Street Address
Exam/Issuance Date 07/23/2024In your opinion, is this patienthomebound?NoThe patient has been diagnosed with and is currently undergoing treatment or the condition produces one or more of the following which in the provider's professional opinion, may be alleviated by the medical use of marijuana.Disabling ConditionDebilitating Condition  Severe PainEtiology and additional informationSelect "Additional Information" to typepatient address, maximum THC potency,directions for use, and other etiology. Additional Information Arthritis/Degenerative Joint Disease Degenerative Disk Disease TraumaAdditional Information Patient address: 9195 W, Phillips Dr., Littleton, CO 80128 Maximum THC potency: To be titrated for oral forms of medical cannabis, 100% THC maximum THC maximum, concentrates 100% maximum, oral dosing 100% THC maximum Patient may tailor Rx regimen to requirements and may use inhaled treatment if needed. Recommended product: Iovia tincture or transdermal cream, dose to be titrated for effect, orally dosed by Wyld, Incredibles, or other per patient preference. Dose HS 2.5 to 200 mg prn.Other etiology: Bilateral shoulder injuries in fall rx'd surgically; traumatic lumbar DD Plant Count Standard Amount 6 plants/2 ouncesIncreased Plant Amount, if ApplicableIncreased Ounces, if ApplicableReason for Increased Plant Count, IfApplicableProvider License Number 33551Provider Last Name ShackelfordProvider First Name AlanProvider Address 2257 South BroadwayProvider City DenverProvider State COProvider Zip 80210Provider Phone PHONE NUMBER AVAILABLEProvider Email EMAIL AVAILABLEProvider Signature Alan Shackelford MDTotal Recommendation Period 365Certication Status ActiveAmended DateRevoke DateCreated By ROBERTS, CHRISTOPHERCreated Date 07/23/2024 05:13 PMUpdated ByUpdated Date