The Minnesota APRN Coalition
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- Mae Lloyd
- 5 years ago
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1 BACKGROUND On July 1 st, 2015 Medical Cannabis (marijuana) became legal in the state of Minnesota. The law allows persons with certain medical conditions to buy medical Cannabis in either pill or liquid form. In order to be enrolled in the Minnesota Medical Cannabis Program patients must have their qualifying condition recertified by a Minnesota licensed physician, physician assistant (PA) or an advanced practice registered nurse (APRN) on an annual basis. Qualifying conditions include the following: Cancer associated with severe/chronic pain, nausea or severe vomiting, or cachexia or server wasting Glaucoma HIV/AIDS Tourette Syndrome Amyotrophic Lateral Sclerosis (ALS) Seizures, including those characteristic of epilepsy Severe and persistent muscle spasms, including those characteristic of multiple sclerosis (MS) Crohn s disease Terminal illness with a probable life expectancy of less than one year As of July 1 st, 2016 Intractable pain will be added as a qualifying condition. The Minnesota APRN Coalition conducted a short 7 question survey to determine APRN participation and interest in the program. The survey was sent via to Minnesota APRNs in the Coalition data base. 793 APRNs completed the survey. The results are reported first for the group and then broken down by certification. Thank you to all who participated! - The Minnesota APRN Coalition
2 GENERAL RESULTS - ALL CERTIFICATIONS YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE 4 <1 % Question 2: Do you currently certify patients for YES- I AM CURRENTLY PARTICIPATING % NO % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE 4 <1 % I AM ALREADY PARTICIPATING % YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % I AM ALREADY PARTICIPATING % YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE 5 <1 %
3 do they provide further guidelines for the use of YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE 4 <1 % Question 6: What is your current certification? CNP % CNS % CNM % CRNA % NO RESPONSE 6 <1 % 159 Responses were received. RESULTS BY CERTIFICATION CNP 644 respondents YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE 0 0 % Question 2: Do you currently certify patients for YES- I AM CURRENTLY PARTICIPATING % NO % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE 1 <1 %
4 I AM ALREADY PARTICIPATING % YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % I AM ALREADY PARTICIPATING % YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE 3 <1 % do they provide further guidelines for the use of YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE 2 <1 % Question 6: What is your current certification? CNP 130 Responses were received.
5 CNS 86 respondents YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE % Question 2: Do you currently certify patients for YES- I AM CURRENTLY PARTICIPATING % NO % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE % I AM ALREADY PARTICIPATING % YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % I AM ALREADY PARTICIPATING % YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE %
6 do they provide further guidelines for the use of YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE % Question 6: What is your current certification? CNS 20 Responses were received. CNM 40 respondents YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % Question 2: Do you currently certify patients for YES- I AM CURRENTLY PARTICIPATING % NO % NOT APPLICABLE TO MY PRACTICE % I AM ALREADY PARTICIPATING % YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE %
7 I AM ALREADY PARTICIPATING % YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % do they provide further guidelines for the use of YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % Question 6: What is your current certification? CNM 5 Responses were received. CRNA 17 respondents YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % NO RESPONSE %
8 Question 2: Do you currently certify patients for YES- I AM CURRENTLY PARTICIPATING % NO % NOT APPLICABLE TO MY PRACTICE % The Minnesota APRN Coalition I AM ALREADY PARTICIPATING % YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % I AM ALREADY PARTICIPATING % YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % do they provide further guidelines for the use of YES % NO % UNSURE % NOT APPLICABLE TO MY PRACTICE % Question 6: What is your current certification? CRNA 3 Responses were received.
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Date: Referring Physician Dr. Phone: Primary Care Physician (if different) Dr. Phone: Patient s Name (last,first,middle): Sex: Birthdate (mo, date, yr) Age: Mailing Address: City: State: Zip: Cell#: Please
Low Country Dermatology
Low Country Dermatology Patient Information Form Date Appt. Date New Patient Former Patient Doctor How did you hear about us Physician Referral Internet Television Radio Newspaper Friend/Family Other Referring
PATIENT INFORMATION. Last Name: First Name: Middle Initial: Sex: M F Preferred Name: Date of Birth (MM/DD/YYYY): Height: Weight: Mailing Address:
PERSONAL INFORMATION PATIENT INFORMATION Last Name: _ First Name: _ Middle : Sex: M F Preferred Name: Date of Birth (MM/DD/YYYY): Height: _ Weight: Mailing Address: City: State: Zip: Social Security #:
PATIENT REGISTRATION FORM
PATIENT REGISTRATION FORM PATIENT INFORMATION Name: Date of Birth: Age: Address : Social Security #: City: Sex: Marital Status: State: Zip: Language: Pt Declines Home Phone#: Race: Pt Declines Work Phone#:
Patient Information Last Name First Name Middle Initial
Patient Information Last Name First Name Middle Initial Street Address Apt# City State Zip Code Social Security # Home Phone Cell Phone Email D.O.B Sex(M/F) Occupation Relation to Insured Self Spouse Child
ENROLLED ACT NO. 64, HOUSE OF REPRESENTATIVES SIXTY-THIRD LEGISLATURE OF THE STATE OF WYOMING 2015 GENERAL SESSION
ORIGINAL HOUSE ENGROSSED AN ACT relating to public health; allowing supervised medical use of hemp extract; providing an exemption from prosecution for possession or use of hemp extract; providing for
Thank you again for choosing Haymarket Chiropractic. We hope to exceed your expectations.
Dear New Patient, The Staff at Haymarket Chiropractic & Rehabilitation (HCR) and I are delighted that you have chosen our facility for your therapy. Our goal is to provide you with a premium level of care