PATIENT DECLARATION I understand that the long-term side-effects of medicinal cannabis are unknown. I understand that medicinal cannabis is an unregistered medicine in Australia. I understand that the quality, safety, and efficacy of medicinal cannabis have not been assessed by the Australian government’s Therapeutic Goods Administration I understand that the prescribing doctor will report my treatment outcomes to the government. I understand that the cost of medicinal cannabis is solely my responsibility. I understand that THC can be detected in urine for several days after the last dose of medicine containing THC. If I drive under these circumstances, I am breaking the law. I understand that a legally issued prescription does not provide a defence to such an offence. I understand the risks and complications associated with medicinal cannabis treatment. I agree to follow my doctor’s recommendation regarding dosing. I agree to report any adverse effects I experience from taking medicinal cannabis, including but not limited changes in the levels of sedation, lethargy, fatigue, dry mouth, nausea, vomiting, diarrhoea, drowsiness, dizziness, disorientation, agitation, balance problems, changes in memory, paranoid delusions, or hallucinations. I understand that there is a possibility of unknown risks and side effects. I understand that medicinal cannabis might interact with my other medications, and doses may need to be adjusted accordingly. I agree to keep a log of my doses and changes in symptoms due to medicinal cannabis. I agree to attend regular follow-up consultations in the clinic or over the phone as directed by my medical practitioner or doctor. I agree that I will not use any form of cannabis other than that prescribed by my doctor, including any illicit form of cannabis (marijuana). I agree to notify my prescribing doctor of any changes in my other medications. I agree to share my clinical outcomes for research purposes. I declare that all answers in this Consent Form are true and correct to the best of my knowledge and belief.
Patient Consent Form:Medical Cannabis, like all other medications comes with the potential for risk and adverse side-effects including, but not limited to, sedation, appetite changes, paranoid delusions, vertigo, psychosis, euphoria, depression, confusion and other unknown side-effects. Plant based medications in Australia are scheduled medications and regulated by the Therapeutic Goods Administration (TGA). The information provided on this website does not, and is not intended to, constitute legal or medical advice; instead, all information, content, and materials available on this site are for general informational purposes only. Details about plant-based medications as a scheduled drug can be found on the Therapeutic Goods Administration (TGA) website. The medical cannabis treatment includes: · Ensure to maintain a healthy lifestyle that will help my illness. · Regular monthly reviews · Regular blood tests · Following my GPs advice on dosage & frequency of use · Ensuring I report to my GP if I suffer any adverse event or side-effect. · Avoid the use of illicit and unprescribed medication that may interact with Medical Cannabis · Avoid the use of alcohol that may interact with Medical Cannabis · Avoid driving or use of machinery if the Medical Cannabis causes any symptoms that may affect my judgement. · Report to my GP any clinical benefits of Medical Cannabis · Report to my GP if Medical Cannabis does not work for me. I understand that using marijuana while under the influence of alcohol is not recommended. Additional side effects may become present when using both alcohol and medical cannabis. Medical Cannabis drugs are experimental / investigational drugs. Cannabis treatment drugs are still in an experimental phase of testing. There may be side effects and risks which are currently unknown. In the event that my treatment is ongoing I may need to be updated with any significant information regarding previously unknown risks. Medical Cannabis drugs are not registered in Australia for use in your condition by the Therapeutic Goods Administration of the Australian Department of Health and Ageing. Therefore, arrangements to access / import the drugs need to be made through a Special Access Scheme
I acknowledge that potentially all costs of importing and accessing the medical cannabis drug(s) (including the cost of the drug itself) are my personal responsibility. The government and private health insurance may not contribute to any of the costs. I confirm that my doctor has provided me with: · information concerning the treatment/ procedure; · information about the medicinal cannabis product, its concentration, its dosage, how to use it, when to take it, how to store the medicinal cannabis product and the proposed duration of treatment. Note, the medicinal cannabis is stored at room temperature away from sunlight; · information about the risks and complications, including those specific to my individual circumstances. · advice that I cannot drive or operate machinery while undergoing treatment with medicinal cannabis containing tetra-hydro cannabinol, which I agree to. · advice that research has shown a patient may test positive (for marijuana / cannabis) to a random drug test while being treated with medicinal cannabis and will be subject to current laws which prohibit driving under the influence of cannabis · information about available alternative treatment options; and · has answered my specific questions and concerns about the chosen treatment / procedure. · I acknowledge that I will need to attend my regular reviews as discussed with my doctor and report any benefits and/or side effects that I may encounter. · I acknowledge that there is no guarantee that this treatment will improve my condition. · I understand that this medical cannabis product is not registered for use in Australia, but an application will be made for access approval under the provisions of the Special Access Scheme and Authorised Prescribers Scheme. I understand and agree if I provide any dishonest or untruthful information I will be discharged. The Therapeutic good association 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. I understand this and understand the impacts to me. 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. I agree to contact prescribing practitioner if I experience any of the side effects listed above, or if I become depressed or psychotic, have suicidal thoughts, or experience crying spells. I will also contact prescribing practitioner if I experience respiratory problems, changes in my normal sleeping patterns, extreme fatigue, increased irritability, or begin to withdraw from my family and/or friends Smoking marijuana may cause respiratory problems such as bronchitis, emphysema, or laryngitis. Thus, may cause other respiratory diseases I agree to follow the medical practitioners’ and pharmacists instructions on how to take medicinal cannabis I understand Commonwealth law prohibits the manufacture, distribution, and possession of marijuana. Potential side effects of marijuana are the following: · Asthenia (abnormal physical weakness or lack of energy) · Confusion, Disorientation, Dizziness, Drowsiness, Vertigo, Sleepiness (Avoid machinery and driving if this occurs ) · Avoid concomitant use of alcohol, drugs of addiction, and medication that may aggravate these side-effects should they occur · Balance problems, coordination · Memory problems · Diarrhoea · Dry Mouth · Fatigue · Hallucinations · Vomiting or Nausea · 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 · Possible social dysfunction may result at work or motor vehicle accidents Possible chronic effects may include: · cannabis use disorder · cognitive impairment · chronic bronchitis [if inhaled - not advised] Some medical authorities claim that persons younger than 18 years old may have learning and development problems due to abuse. Thus, the use of marijuana must be only for the relief of ailments. I have read through this form, and I have had the opportunity to discuss the contents of this document with the medical practitioner for which those I find difficult understanding and I was given answers that satisfy any and all of my concerns. I acknowledge that I have been recommended other treatments, including no treatment and I choose to go ahead with medical marijuana and am of sound mind to make that decision. The risks, benefits, and complications have been explained to me and I understand that this method of treatment may not yield the expected results. 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. I hereby declare that I understand that Medical Marijuana Treatment is an experimental drug offered for specific medical conditions or symptoms. By signing this form, I declare that I accept the risk and benefits of using marijuana. I have read and I understand the information provided in this form and by which I have had the opportunity to discuss the matters with my physician including those which I have difficulty understanding. I have had the opportunity to ask my physician questions, and which have been answered to me to my satisfaction. I have been oriented to the recommended treatment using medical marijuana as well as other recommendations and by which I freely choose this method for treatment I do not experience any of the following: A Drug dependence or substance abuse, Mood disorder or severe anxiety cardio-respiratory disease, Psychosis or bipolar disorder. I am not pregnant, breastfeeding, or considering pregnancy. I will tell my practitioner if this changes I have been advised and understand individuals may develop a tolerance to, and/or dependence on, marijuana. I understand that if I require increasingly higher doses to achieve the same benefit or if I think that I may be developing a dependency on marijuana, I should contact prescribing practitioner and my general practitioner. Signs of withdrawal can include Feelings of depression, sadness, irritability, insomnia, restlessness, agitation, loss of appetite, trouble concentrating, sleep disturbances and unusual tiredness. I will tell my practitioner if I experience any of these changes. Symptoms of marijuana overdose include, but are not limited to, nausea, vomiting, hacking cough, disturbances in heart rhythms, numbness in the hands, feet, arms or legs, anxiety attacks and incapacitation. If I experience these symptoms, I agree to contact the prescribing practitioner immediately or go to the nearest emergency room If the practitioner, staff or doctor subsequently learns that the information I have furnished is false or misleading, the recommendation for marijuana may no longer be valid. I agree to promptly meet with the prescribing practitioner and/or provide additional information in the event of any inaccuracies or misstatements in the information I have provided. I have had the opportunity to discuss these matters with the physician and to ask questions regarding anything I may not understand or that I believe needed to be clarified. I acknowledge that the consulting practitioner has informed me of the nature of a recommended treatment, including but not limited to, any recommendation regarding medical marijuana. The practitioner also informed me of the risks, complications and expected benefits of any recommended treatment, including its likelihood of success and failure. I acknowledge that the consulting practitioner informed me of any alternatives to the recommended treatment, including the alternative of no treatment, and the risks and benefits. It is required that I return to the consulting practitioner for a review of my medical condition and an update of the recommendation on a regular basis or at least every six months. Any prescription issued by a hyDRalyfe practitioner or Partner Doctor will be dispensed by a Partner Pharmacist. A printable copy of your prescription is available on request. We are not responsible for the failure of our delivery partners to deliver medicines to the correct address, the method of delivery used by our delivery partners or their failure to deliver medicines within any particular timeframe. We and/or a Partner Pharmacist may contact the healthcare provider who issued your prescription in relation to that prescription. We may also contact the pharmacist and collect your prescription. We may arrange delivery on your behalf, we will always use best endeavours to meet your expectations, we are not in control of all factors influencing deliveries (i.e. traffic conditions etc.). 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This liability waiver and release extends to the hyDRalyfe entity together with all owners, partners, and employee’s. Website may include hyperlinks or other references to other party’s websites. We do not monitor or review the content of other party’s websites which are linked to from this website. Products or services offered by other websites shall be subject to the applicable Terms and Conditions of those third parties. Opinions expressed or material appearing on those websites are not necessarily shared or endorsed by us. We will not be responsible for any privacy practices or content of these sites. You bear all risks associated with the use of these websites and any related third-party services. We will not accept any responsibility for any loss or damage in whatever manner, however caused, resulting from your disclosure to third parties of personal information. You also accept our Terms & Conditions and Privacy Policy by clicking I agree What is Medical Cannabinoid? Cannabinoids are substances found in the buds or flowers of a Cannabis plant, otherwise called as Marijuana. This is a regulated substance which is believed that when people ingest or inhale cannabis, cannabinoids are the ones giving the effects. There have been early studies for the benefits and potential harms of cannabinoids. Thus, the intake of this substance is regulated by authorities, or in some countries, prohibited. Risks Potential harms exist in using cannabinoids. This document intends to outline the considerations for you to understand the risks and benefits of this substance. Having this put into consideration, your physician may consider whether this method of therapy is suitable for you.
During this time, cannabinoids should be viewed as a trial for treatment. Thus, if the intended goal for the treatment using cannabinoids is not realized, the usage of the substance should be stopped. The following are some of the recognized risks for use of this substance: 1. Psychiatric Disturbance, including but not limited to the development of schizophrenia 2. Numbness 3. Speech disorders 4. Muscle disorders 5. Drowsiness 6. Cognitive and Memory Impairment 7. Short term memory Benefit The following are alleged to be the efficacy of marijuana to treat the qualifying conditions but still require further study. Caveat: there is not much literature for study or very little evidence on these areas that cannabinoids are the cure to these illnesses: 8. Cancer 9. Chronic benign pain 10. Crohn's disease 11. Epilepsy 12. Glaucoma 13. Acquired immune deficiency syndrome 14. Post-traumatic stress disorder 15. Amyotrophic lateral sclerosis 16. Multiple sclerosis 17. Parkinson's disease Laws and Regulations
There are laws and regulations regarding the use of cannabinoids that your practitioner has to adhere to. The following requests are considered standard best practice and help this healthcare practice and you comply with these laws and regulations. Acknowledgment In consideration of being allowed to consume Medical Cannabinoid, I hereby agree that during the period that I am experiencing the side effects of such use, I will not drive any vehicle or operate any heavy machinery within 8 hours. I understand that the intake of alcohol is not recommended and dangerous and therefore I shall not take both together. I agree to comply with the requirements set forth by the medical practitioner, doctor, partner doctor or pharmacist and shall not use marijuana in an unregulated manner. I likewise agree to use marijuana only as prescribed by my doctor. I agree not to give, sell, or share the marijuana with anyone else. I agree to store the marijuana in my possession safely, properly, and away from the view of anyone, including children. I shall not take the marijuana outside the country, nor should I bring it with me for travel to any other country or state. I understand that if in any case my condition worsens or unusual or unknown side effects happen, I shall notify my physician immediately.