Montana Code 16-12-509. Written certification — accompanying statements
16-12-509. Written certification — accompanying statements. (1) The written certification provided by a physician must be made on a form prescribed by the department and signed and dated by the physician. The written certification must:
Terms Used In Montana Code 16-12-509
- Debilitating medical condition: means :
(a)cancer, glaucoma, positive status for human immunodeficiency virus, or acquired immune deficiency syndrome when the condition or disease results in symptoms that seriously and adversely affect the patient's health status;
(b)cachexia or wasting syndrome;
(c)severe chronic pain that is a persistent pain of severe intensity that significantly interferes with daily activities as documented by the patient's treating physician;
(d)intractable nausea or vomiting;
(e)epilepsy or an intractable seizure disorder;
(f)multiple sclerosis;
(g)Crohn's disease;
(h)painful peripheral neuropathy;
(i)a central nervous system disorder resulting in chronic, painful spasticity or muscle spasms;
(j)admittance into hospice care in accordance with rules adopted by the department; or
(k)posttraumatic stress disorder. See Montana Code 16-12-102
- Department: means the department of revenue provided for in 2-15-1301. See Montana Code 16-12-102
- Marijuana: means all plant material from the genus Cannabis containing tetrahydrocannabinol (THC) or seeds of the genus capable of germination. See Montana Code 16-12-102
- Person: means an individual, partnership, association, company, corporation, limited liability company, or organization. See Montana Code 16-12-102
- Referral physician: means an individual who:
(a)is licensed under Title 37, chapter 3; and
(b)is the physician to whom a patient's treating physician has referred the patient for physical examination and medical assessment. See Montana Code 16-12-502
- Registry identification card: means a document issued by the department pursuant to 16-12-503 that identifies an individual as a registered cardholder. See Montana Code 16-12-102
- Standard of care: means , at a minimum, the following activities when undertaken in person or through the use of telemedicine by a patient's treating physician or referral physician if the treating physician or referral physician is providing written certification for a patient with a debilitating medical condition:
(a)obtaining the patient's medical history;
(b)performing a relevant and necessary physical examination;
(c)reviewing prior treatment and treatment response for the debilitating medical condition;
(d)obtaining and reviewing any relevant and necessary diagnostic test results related to the debilitating medical condition;
(e)discussing with the patient and ensuring that the patient understands the advantages, disadvantages, alternatives, potential adverse effects, and expected response to the recommended treatment;
(f)monitoring the response to treatment and possible adverse effects; and
(g)creating and maintaining patient records that remain with the physician. See Montana Code 16-12-502
- Telemedicine: has the meaning provided in 37-3-102. See Montana Code 16-12-502
- Treating physician: means an individual who:
(a)is licensed under Title 37, chapter 3; and
(b)has a bona fide professional relationship with the individual applying to be a registered cardholder. See Montana Code 16-12-502
- Written certification: means a statement signed by a treating physician or referral physician that meets the requirements of 16-12-509 and is provided in a manner that meets the standard of care. See Montana Code 16-12-502
(a)include the physician’s name, license number, and office address and telephone number on file with the board of medical examiners and the physician’s business e-mail address, if any; and
(b)the name, date of birth, and debilitating medical condition of the patient for whom the physician is providing written certification.
(2)A treating physician or referral physician who is providing written certification for a patient shall provide a statement initialed by the physician that must:
(a)confirm that the physician is:
(i)the patient’s treating physician and that the patient has been under the physician’s ongoing medical care as part of a bona fide professional relationship with the patient; or
(ii)the patient’s referral physician;
(b)confirm that the patient suffers from a debilitating medical condition;
(c)describe the debilitating medical condition, why the condition is debilitating, and the extent to which it is debilitating;
(d)confirm that the physician has assumed primary responsibility for providing management and routine care of the patient’s debilitating medical condition after obtaining a comprehensive medical history and conducting a physical examination, whether in person or, in accordance with subsection (4), through the use of telemedicine, that included a personal review of any medical records maintained by other physicians and that may have included the patient’s reaction and response to conventional medical therapies;
(e)describe the medications, procedures, and other medical options used to treat the condition;
(f)confirm that the physician has reviewed all prescription and nonprescription medications and supplements used by the patient and has considered the potential drug interaction with marijuana;
(g)state that the physician has a reasonable degree of certainty that the patient’s debilitating medical condition would be alleviated by the use of marijuana and that, as a result, the patient would be likely to benefit from the use of marijuana;
(h)confirm that the physician has explained the potential risks and benefits of the use of marijuana to the patient;
(i)list restrictions on the patient’s activities due to the use of marijuana;
(j)specify the time period for which the use of marijuana would be appropriate, up to a maximum of 1 year;
(k)state that the physician will:
(i)continue to serve as the patient’s treating physician or referral physician; and
(ii)monitor the patient’s response to the use of marijuana and evaluate the efficacy of the treatment; and
(l)contain an attestation that the information provided in the written certification and accompanying statements is true and correct.
(3)A physician who is the second physician recommending marijuana for use by a minor shall submit:
(a)a statement initialed by the physician that the physician conducted a comprehensive review of the minor’s medical records as maintained by the treating physician or referral physician;
(b)a statement that in the physician’s professional opinion, the potential benefits of the use of marijuana would likely outweigh the health risks for the minor; and
(c)an attestation that the information provided in the written certification and accompanying statements is true and correct.
(4)A physician who is providing written certification through the use of telemedicine:
(a)shall comply with the administrative rules adopted for telemedicine by the board of medical examiners provided for in 2-15-1731; and
(b)may not use an audio-only visit unless the physician has first established a physician-patient relationship through an in-person encounter.
(5)If the written certification states that marijuana should be used for less than 1 year, the department shall issue a registry identification card that is valid for the period specified in the written certification.
(6)The department shall provide the board of medical examiners with the name of any physician who provides a written certification for 39 or more patients within any given calendar year. The board of medical examiners shall review the physician’s practices in order to determine whether the practices meet the standard of care. The physician whose practices are under review shall pay the costs of the board’s review activities.