cannabisstandard.com

Medical Document

To be completed by your healthcare practitioner

This Medical Document is to be completed by your healthcare practitioner, such as a family doctor, specialist, or in some provinces and territories, a nurse practitioner. In order to be eligible to provide this Medical Document to you, the healthcare practitioner must have you under their professional care. Your healthcare practitioner will use his/her professional judgment and may use this Medical Document to authorize you to use medical cannabis for medical purposes.

Should you choose to access medical cannabis from a licensed producer, this form must be sent directly to the licensed producer of your choice. You may choose any licensed producer that is authorized to sell medical cannabis to registered clients.

Please see the Health Canada website for a list of licensed producers. Should you wish to switch from one Health Canada licensed producer to another, you can request that your licensed producer transfer this Medical Document to a new licensed producer of your choice.

Should you choose to produce your own medical cannabis, or designate someone to produce it for you, the original of this document must be sent to Health Canada with your Registration Application Form.

Patient information (Unique ID: )

Healthcare practitioner information

Order for Medical Cannabis



Note: The College of Family Physicians of Canada (CFPC) in their guidance document commonly recommends a maximum THC concentration of 9%. Prescribers are advised to use their discretion when prescribing the dose and THC concentration for patients.

Certification by Healthcare Professional

By signing this document, the healthcare practitioner is attesting that the information contained in this document is correct and complete.

This Medical Document cannot be used to register an individual or place an order for medical cannabis unless completed and signed by an authorized healthcare practitioner. In completing and signing this form, the healthcare practitioner must use their professional judgment and consider any applicable standard of practice. Although the Cannabis Standard will take reasonable steps to ensure that the information contained in this Document is current and does not contain inaccuracies, the Cannabis Standard does not warrant the quality, accuracy or completeness of the information

For more information : askus@cannabisstandard.com

Note for my Doctor

Your patient answered a series of questions related to a specific medical condition, and symptoms they are experiencing. Based on what indicated and interest expressed, may be a good candidate for the use of medical cannabis. Medical cannabis is in a class of medicines called cannabinoid-based medicine (CBM). We are of the view that there is good quality evidence to support use of medical cannabis in combination with other treatments, based on a thorough review of clinical literature by our committee of experts.
reported having . indicated that is the predominant symptom. Our expert committee of healthcare professionals suggests that cannabis may be a good option for this patient.
To manage these symptoms, the recommended product is , at a dose of . selected produced by , which meets our guidelines.

Dosing and Titration guidance

Although we ask that you use your professional skill and judgment in considering dosing for your patient, we provide the following recommendation based on our expert committee findings:

This recommendation is based on the advice of our committee of experts. If you believe that another product, dose, and/or titration is more appropriate for your patient, we would encourage you to adjust accordingly.

Additional guidance