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Patient Name:Date:Habits Tobacco? Regularly ? Rarely ? Never Explain Alcohol? Regularly ? Rarely ? Never Explain Caffeine? Regularly ? Rarely ? Never Explain Exercise? Regularly ? Rarely ? Never Explain
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Marijuana is okay from certain legal dispensaries and with a prescription.
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The purpose of filing for marijuana use is to ensure that it is being used legally and for medical purposes.
The form must include personal information, medical history, and details of the prescription for marijuana.
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