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Medical History

To ensure we provide you with quality care, we will need to collect some details about your medical history

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Patient Consent Form

Almost there, ! Your understanding and consent are crucial for the safe and effective use of medicinal cannabis. Please read each statement carefully and indicate your understanding and agreement.

Name:
Date:
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I understand that medicinal cannabis is an unregistered medicine in Australia and that its quality, safety, and efficacy have not been fully assessed by the Australian government’s Therapeutic Goods Administration (TGA).
I understand there may be risks associated with medicinal cannabis treatment. I agree to report any adverse effects I experience from taking medicinal cannabis to my regular treating doctor. In the case of a medical emergency, I agree to present to my nearest Emergency Department.
I understand that the cost of medicinal cannabis is solely my responsibility.
I understand that I must not drive or operate heavy machinery with the presence of any THC in my system. If I drive under these circumstances, I am breaking the law and a legally issued prescription does not provide a defence to such an offence.
I understand that medicinal cannabis might interact with my other medications. I agree to notify my PLNTD prescribing doctor of any changes to my medication list, and that I will not use any form of cannabis other than that prescribed, including any illicit form of cannabis.
I agree to follow my doctor’s recommendation regarding dosing and to attend regular follow-up consultations as directed by my doctor.
I understand that I am not to use medical cannabis if pregnant, trying to get pregnant, or breastfeeding.
I understand that I am not to use medical cannabis if I have a history of psychosis, psychotic illness, or a recent worsening change of a mental health condition.
I have read and understood all the information provided in this consent form. I acknowledge the potential risks and responsibilities involved in using medicinal cannabis.
I agree to follow the recommendations and guidelines provided by my doctor at PLNTD. I give my consent to start medicinal cannabis treatment under these terms and conditions.
Schedule 8 Medications Access Waiver - I confirm that I will not access, or attempt to access, Schedule 8 medicinal cannabis medications from any other healthcare provider while a patient of PLNTD.
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