We participate in one or more Health Information Exchanges. Your healthcare providers can use this electronic network to securely provide access to your health records for a better picture of your health needs. We, and other healthcare providers, may allow access to your health information through the Health Information Exchange for treatment, payment or other healthcare operations. This is a voluntary agreement. You may opt-out at any time by notifying the Health Information Management Services/Medical Records Department OR the office administrator. I, the undersigned, acknowledge that I have had access to a copy of the NOTICE OF PRIVACY PRACTICES. I consent to your disclosure, which you deem necessary in connection with my condition. By signing below, you acknowledge that you have read, understand, and agree to the following policies; An annual appointment is required to renew medical marijuana recommendation letters by state law. Cost for office appointment for initial evaluation and assessment for medical marijuana is $249. A written recommendation for medical marijuana cannot exceed 90 days. Ohio mandates a OARRS query be done on all patients. Parental consent must be obtained for all recommendations to minors. Prescription refill requests must be called at least 72 hours in advance and may require an appointment.