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Starting A Caregiver Business PDF
Starting A Caregiver Business PDF
Caregiver Business
________________________________________________________________________
Ill take you step by step thru everything you need to know
before you start your quest to become a Medical Marijuana
Caregiver.
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Table of Contents
Introduction
Conclusion
Q & As
_________________________________
Introduction
Why I wrote this book
I wrote this book to help you get started in your quest to become a
medical marijuana caregiver. After going thru the process of
becoming a caregiver myself, I realized how many holes and hurdles
that were in the way and wished I had a guide to help me. After
searching for such a guide I found nothing. I spent much time and
hassle that could have easily been avoided with a little help and
guidance.
This book is not a grow guide, there are literally hundreds of them on
the market, if you are looking for growing techniques and tips, there
are plenty of great books to choose from. We are specifically going to
talk about how to become a medical marijuana caregiver.
Many people can give you growing tips and advice, but this book is
designed to ensure that you are successful in this business. Yes, I said
it, I called it a business, and if you are going to care for someone you
need to consider it a business. It needs to be run as a business from
day one, and if you want to be successful you need to start with a
good foundation and build on it.
Im not trying to show you all the short cuts and money saving tips,
some of my suggestions will add cost to your operation, but it will also
add to the quality of your product. Some of my suggestions might
seem a bit overboard, again, I would rather be safe than sorry. On
the other hand I will give you some tips that will allow you to save
hundreds of dollars in areas that make sense to save. So although
you may spend a little more in some areas, I will show you how to
save when possible.
For the purposes of this book we are going to assume that you are just
getting started as a caregiver, no patients, no grow room, no
business. I will walk you thru each process step by step, starting with
the considerations to becoming a marijuana caregiver, designing your
grow room, starting your business, getting a patient, delivering your
product, and we will finish up with staying legal. Here we go
Step 1: Considerations to Becoming a Medical Marijuana
Caregiver
Water You will need to supply your plants with water frequently,
having a fresh water supply near your room is great to avoid excess
hauling of water jugs.
Security - Your grow room MUST be under lock and key by law. Also
consider any windows that may give snoopy neighbors, thieves,
government officials, etc a sneak peak or easy access to your grow
room.
So in this guide we will give you the inside scoop to what you really
need and what you can live without. Some of you would prefer to
walk out of the store ready to go, theres nothing wrong with that but
your gonna pay for it, those of you willing to do a little work and be
creative will save $$$.
Grow lights
Growing mediums
Nutrients
Miscellaneous buckets and growing containers
Fans for air circulation
Venting and equipment
pH meter
PPM meter
Thermostat
Humidistat
Timers
C02 (optional for maximum yields)
Scale (to provide accurate weight for your patient and yourself
and staying within the law)
If you are going to grow hydro you are going to need to choose a
system. Hands down the simplest system to get started for beginners
would be the Ebb and Flow system also known as the flood and drain
system. This will be the system we focus on in this book. There are
many systems out there, they all have benefits and weaknesses
however we are focusing on Ebb and Flow because it is low
maintenance and easy to use, perfect for the beginning grower. The
fundamentals are basically the same for most other types of
hydroponic systems if you decide to go with something else.
Reservoir/with lid
Flood table
Air pump
Air stone
Timer
Fill and drain fittings
Submersible pump
Miscellaneous air tubing
Electrical System
Your electrical system needs to be able to handle the new load you are
going to place on it with lights, pumps and accessories. You will
definitely want to have a dedicated circuit for your grow room. The
general rule of thumb is that you only want to use 75% of your total
amperage available for one circuit. So for example if you have a
20amp circuit your maximum draws should equal no more than
15amps. If you run your lights on a 240v circuit instead of a 120v
circuit you can cut your amp draw considerably so you may want to
consider running a dedicated 240v circuit for your lights and a 120v
circuit for your smaller pumps, timers and supplemental lights.
Contact your local electrician to inspect your current system or help
you install a new circuit.
Your Time
The typical day will require about 15min to 30min of your time
watering, adjusting nutrients and water levels, and looking your plants
over for deficiencies, disease and insects. If you are growing hydro
you will also need to change the water and clean out your reservoir
once a week to prevent nutrient and mineral buildup which may take
you as much as an hour. As you get towards the end of your flowering
cycle you can also expect to spend a bit more time trimming plants
and removing dead leaves. When it comes to harvesting your plants
you can plan on spending several hours per pound of marijuana,
experienced trimmers can harvest up to 2 pounds a day, I have found
that the average person will struggle to harvest 1 pound in a full 8
hour day. Make sure you are going to be able to keep up with the
schedule before getting started.
Physical Requirements
The physical requirements include a lot of bending over, squatting,
carrying water jugs, lifting plants and arranging your grow room, and
dont forget about your harvest time. Harvesting your crop can take
several days and long hours especially in the beginning, soon enough
you will be a pro but until then set aside a long weekend for
harvesting. This can be back breaking work and if you suffer from
severe pain as it is you may want to consider hiring a good trimmer to
harvest your crop for you, this can cost about $250 per pound.
Security
Depending on your location security could be an issue. The law
requires that your grow room be locked, any kind of lock will do to
meet the laws requirements, there is no specific lock type required at
the time of this writing. If you have kids, especially teenagers in the
house you may want to have a nice deadbolt or master lock on the
room.
You should also be aware of the pot snatchers. These people would
gladly break into your home to snatch your dope and possibly your
equipment. A basic home security system or even a good dog is
generally enough to keep these types of people out.
When throwing away equipment boxes, clippings, growing mediums,
etc. you want to conceal this in a black garbage bag, some people
even suggest taking that garbage out on the day of trash pickup rather
than the night before. This will protect you from snooping neighbors,
thieves, and government officials.
Of course you are going to be excited about your new enterprise, but I
warn you, dont talk more than you need to. Simply telling the wrong
people or your friends telling the wrong people can get unwanted
visitors easier than anything else. A good grower is a quiet grower.
Your security and well being may depend on it.
Services Offered
As a caregiver there are many different services to offer. Some
patients will require more services than others. Some of the most
common services include delivering the product, supplying baked
goods and rolling joints, getting supplies like papers or pipes, making
hash oil or hash, and Im sure there are others. Just be sure to talk to
your patients about the services they will require and be absolutely
certain that you are capable of providing that service. These services
will be part of your patient caregiver contract; the services will be
listed as part of the contract, if you fail to provide the services agreed,
you could lose your patient and your license to grow.
Family Considerations
If you have a family you really need to sit down and discuss this
business with your partner and possibly children if you feel it is
appropriate. All of the considerations above should be talked about
and make sure everyone is on board and supportive. Like any
business, if your family is supportive it is much easier to run.
The Law
Dont forgetits still a felony to grow marijuana based on FEDERAL
LAW in the US! What does this mean to you, well, from what I have
been told it means that you are not protected 100%. I spoke to
several marijuana lawyers across the US and asked many different
questions about many different aspects of being a medical marijuana
caregiver and their basic answer to my questions was the laws are
grey, not definitive, cant give you an exact answer. What it came
down to is this, when it comes down to it, youre not protected from
the federal government, if the FED's want you, they can get you.
You could get raided, you can be put in jail, you could have to go to
court and defend yourself, there is still a very real risk surrounding this
business. My suggestion is to keep low key, dont make a big scene
about it all and you should be okay. The FEDs dont want some small
time caregiver, they want large scale growers. So although you are
still at risk, I believe the risk is very low.
As for your local police, you have to keep abreast of local ordinances
etc. If your state has passed laws allowing for medical marijuana to
be grown by caregivers and you have obtained a license you are still
not necessarily safe. You still have to be aware of your local and city
laws. If you operate as a business, you are open to local and city
ordinances. If there is a ban placed on growing medical marijuana in
your city, you are out of business, if you continue growing you could
be breaking the law and open yourself up to raids and harassment.
So the bottom line is that you need to check your local laws, you
should definitely speak with a lawyer in your area and get advice. I
would not start growing before taking counsel with a lawyer who is up
to date with your local marijuana laws.
Monthly Expenses
The law states that you are entitled to reasonable compensation for
your services rendered to each patient. So the first step in
determining what is reasonable is determining your costs of
equipment, supplies, electricity, water, and your time.
The PDF below is my personal expense sheet for your review. This
should act as a guide for you to develop your own expense sheet. This
is something you must do right in the beginning as it only gets more
difficult to put this together as time goes on. Without this simple form
you won't have a clue what your total costs are, that means that you
won't have any evidence that supports your "reasonable
compensation".
This is key because the laws clearly state that even if you are a
licensed medical marijuana caregiver
Did you catch that, Ill say it again, YOU CANNOT SELL MARIJUANA!!!
$20.00 per hour is a minimum for everything you are doing. This is
my personal opinion; I'm not saying this would hold up in a court of
law, it's just what I suggest.
The rest of the expenses are pretty black and white, anything you use
in your grow room from paper towels and rubber gloves to lighting and
electricity is an expense that will be hard to argue. Dont claim 100%
of your electric bill as an expense, but do account for the amount that
your bill goes up compared to bills in the past.
The space in your home is also an expense, the way to determine the
value of your space is to check around and see what the going rate per
square foot of commercial space in your area, thats what I like to
charge for rent for each patients space.
Here's the deal, if you are going to run this as a business you need to
be meticulous in your record keeping, this can keep you out of jail. If
you are illegal in terms of the amount of "usable product" and you
keep records of that, it could also put you in jail. I have heard
everything from a straight out yes, you need to keep track of the
weight and cost you supply your patients to the other end of the scale
with people saying don't keep track of anything. I personally keep
track of the weight that I provide but not the amount of compensation.
You have to stay legal with you plants and usable product, if you are
thinking even for a second that you can get away with growing a little
extra to give or sell your friends or if you are thinking one extra plant
is no big deal think again. Listen, you are talking about jail time here,
it's not worth it. Study the laws and stay 100% legal or dont waste
your time.
Basic Accounting
I feel that some basic accounting is very helpful in coming up with
your expenses. If you are not going to pay taxes on the money you
collect then you can't write off expenses either. So this is something
you have to decide up front.
For one patient you wont need much space, but odds are once you get
started and word spreads, others will be asking you to be a caregiver
for them and for the purposes of this book we are going to assume
that your goal is to provide for at least 2 patients and yourself for a
total of 3 patients and 36 plants.
Once you get more than one patient I feel it is important to have each
patients plants separated from each other. This will protect disease
from spreading to other patients crops and from a male plant
pollinating your entire crop. Can you have everyones plants in one
space, yes, but it's not the optimum setup in my opinion especially
when patients require different strains which could require different
flowering and vegetation periods.
What I recommend is that you break up your one large space into
sections to provide specific space for each patient. You can accomplish
this with the use of prefab grow tents which you can buy online fully
loaded for about $2,000 (hydro) or $1,300 (soil) for a 4x8 tent.
These grow tents are great but keep in mind that the tent is just for
the flowering and vegetation cycle. They do however include
everything from lighting and venting to controllers and pumps, they
truly are complete setups.
You will still need a separate germination space for seeds or a cloning
space as well as a work space for mixing nutrients. Also the tents are
pretty expensive as you can see so you could simply build a light
blocking wall in your room with a 2x2 frame lined with Mylar. If you
really want to save money use a simple emergency solar blank found
in any camping section for under $3.00 in place of the Mylar. This will
give you great light reflection for maximum yields.
Buying your equipment/supplies
Hydro shops are popping up all over the place with the boom of
medical marijuana, so take your pick, between the online shops and
your local hydro shop you should be able to get everything you need.
Without circulation you will have zones of cold air at the floor level and
hot humid air at the ceiling. This can cause your plants to wilt and in
severe cases die. Your circulation fans should also be placed as high
in your room as possible and you should have a minimum of 2 fans to
circulate air throughout the room.
Safety
Every grow room should have a fire extinguisher near by. You will
have many high power lights and chemicals in this area and precaution
must be taken. When mixing nutrients gloves and eye protection are
strongly advised. High power LEDs produce very strong light similar to
a welding torch and a pair of welding glasses will protect your eyes
from the intense light. While handling marijuana you should always
wear gloves to prevent the THC from being absorbed thru your skin.
Step 4: Getting a Patient to Name YOU as their caregiver
Get Noticed
Social Networking can be done by posting comments on blogs or by
following a forum discussion and placing a comment that you are
interested in providing caregiver services. Chat rooms can be another
way to drop a line about your business and some of the services or
even the quality that you can provide.
Consider taking a cheap add out in the local newspaper, it can turn up
big numbers. To beat that try placing a free add on Craigs list, again
giving a description on some of the services you are willing to provide.
Even by joining a Compassion club you can find your way into a pool
of potential patients that can use your services right away.
In the end by telling the right people, word of mouth can by far be
more then enough to get you your maximum amount of marijuana
patients. Keeping in mind youre trusting the people you tell and the
people they will tell, and so on. In an earlier chapter we mentioned
keeping quiet; this is where common sense and trust come into play.
I always advise you to keep as quiet as possible, however when
getting started it may be beneficial to spread the word a bit. Just use
caution.
I also use the interview process to talk to the patient about his or her
requirements and services needed. Make sure you can provide the
services needed and supply the amount of product. Some patients
require a large amount of product; you have to be able to supply them
with confidence.
This is also a good time to talk about a strain. See what ailments they
have and what they are looking for in terms of feeling and the type of
high that helps them most. It's your job to match the patient up with
a strain that you can provide and will give them maximum benefit.
This is where good research is required on your part.
Note: Some things you should have at the interview include, your
states marijuana caregiver form printed off and filled out with
photocopy of your id if required, your caregiver contract, your break
down price sheet so they can see what the expense of growing and
your services are.
Choosing a Strain
It is your job to know what strains can help with your patients medical
condition. Some good fundamentals of a Sativa, Indica, and hybrids
are a must. I have found that most patients can use the benefits of
both a Sativa & Indica.
By using the Sativa in the day and switching to an Indica at night your
patient can feel energized and awake during the day and sleep loss
can be a thing of the past at night. I feel this makes growing hybrid
marijuana strains a very popular choice in caregivers grow rooms
around the globe.
The taste of the marijuana strain can be just as big of an issue to the
patient as the high. Keep all these factors in mind when making that
finale pick with your patient. Also keep in mind that you may have to
test multiple strains before you find the best one for the patient.
Furthermore patients can build up a tolerance to a specific strain and it
may be necessary to change things up from time to time. So be
prepared to provide different strains.
I found that it makes more sense to buy feminized seeds to ensure the
work and money put into the plant is going to produce a female plant.
Cutting out the painful process of seeking and destroying your male
marijuana plants can easily save you the extra up front expense of
buying feminized seeds.
If you are going to grow marijuana in your house rather it's one plant
or 100 plants it's best to contact a lawyer and go over any "gray
areas". Find out what your rights are. At the very least you should find
a marijuana lawyer in your state and get his card with all his contact
numbers just in case a problem arises. I strongly advise being
proactive in this area, better to over prepare than to get caught
without a clue.
Get Involved
Your local laws can change from one month to another easily making
you the bad guy who is breaking the new zoning law. This is why I
can't say it enough, a good caregiver stays on-top of all the new laws
and zoning bills they might pass around your town. Getting involved in
your local town meetings and city counsel meetings is a great idea. If
you are going to get involved in the growing process you should also
get involved in the activist side of things. Protect what you have
invested in. Believe me, once you get started you will have invested a
decent amount of money and time. Getting shut down a week later
because of a new zoning bill sucks. So get involved and stand up for
your rights.
Stay Organized
When it comes to your grow room there are some basic things I advise
to help out in the case of a raid or search. I have taken a copy of my
patient and caregiver cards and taped them to the front of my grow
room along side of my states medical marijuana laws. In case of a
police raid on my grow room, they will be able to see that I'm a law
obeying citizen and comply with all local and state laws even if I'm not
at home.
Well, you followed all the laws, you are completely legal, your
paperwork is in order, you know there are no new zoning bills passed,
whats the harm in letting them in
If you dont learn anything else from this entire book be sure to pay
close attention to this next section and it will be well worth it.
Unless the police provide a valid warrant and you have no other option
but to let them inDO NOT LET THEM IN YOUR HOUSE!
Ok, I hope that was clear enough. The bottom line is that the police
are going to want to come in, the jig is up, they know what youre up
to and they want to catch you doing something illegal. The police do
not want to be your friend. They are not there to learn the newest
growing techniques. They are not patients looking for a caregiver. I
dont care what they tell you, unless they have a VALID WARRANT and
you have no other option DO NOT LET THEM IN!
This should be something that you go over with your entire family,
especially your wife and kids if they are old enough to make that
decision. The police love to wait until the man of the house leaves and
come knocking. Most women dont have the courage to stand up to
the police and they know this so they will target your wife or your kids
if the kids are old enough to allow a search (check the laws in your
state).
I know what some of you are thinking right now, this guy hates cops.
Not true, but Im not going to lose my freedom because of an
overzealous cop. Cops are just doing their jobs, and believe me, I
wouldnt want that job. They want to find people breaking the law and
then bust them. Thats their job. You dont want to get busted, your
patient cant afford it and neither can you. If there is no warrant the
police have no right to come in your home and no reason either.
I have heard stories of cops showing up, acting all cool like nothing is
wrong, trying to be friendly, acting interested in the growing process,
etc. They are professionals in deception, they get trained to gain trust
and get people to talk and the average person doesnt stand a chance.
Im asking you not to be average here. Too many people decide that
since they are legal and there shouldnt be any problem and they want
to cooperate and they dont want to make trouble so they let the cops
in. This is a major mistake. Cops are not there to be cool and just
take a look around, they are looking for ways to bust you or they
wouldnt be there. Keep them out of your house at all costs. My
father taught me a good lesson when I was a kid and it kept me out of
trouble more than once, he said
if you ever get stopped by the police keep your mouth shut, dont fess
up to anything. Its their job to figure out what happened, stay out of
the way and let them do their job, but keep your mouth shut.
So what if they say yescall your lawyer and then say it with
meKEEP YOUR MOUTH SHUT. They will probably start trashing your
grow room and collecting evidence, try to take a mental note of
everything they are taking and when you get a chance write it all
down. This will be a stressful time, but it is key to keep a solid statem
of mind and try to be smart. Write down everything they took, the
condition of the plants (if taken) and any other information for your
lawyer.
The next steps are in your lawyers hands, at this stage you have done
everything you can. I hope none of you ever have to go thru this but if
you do it will help to have a plan. I would actually go as far as to act
this out a time or two so you are sure everything is in place. You
know, like a fire drill or something. It is easier to deal with once you
have done it a few times.
Conclusion
Dont forget to check out our resources below for some great info.
Q & As
A: Your patient could use a vaporizer which heats the plant matter to
a high enough temperature to allow it to release vapors without
releasing particulate smoke. Also a patient could ingest marijuana
extracted into butter or other fats, oil, alcohol, glycerin, or made into
just about any form of food he or she prefers.
A: Marijuana laws are not the same in every state so make sure to
follow up on your laws frequently.
A: Depends on the state. In most states there are at least two cards,
one for patients and one for caregivers. Other states also have one for
growers. Check local laws.
Contact Info By State
ALASKA: For more information on Alaskas medical marijuana law,
please contact:
California NORML
2215-R Market Street #278
San Francisco, CA 94144
(415) 563-5858 (415) 563-5858
http://www.canorml.org/
MONTANA: www.dphhs.mt.gov/medicalmarijuana/
NEW JERSEY:
New Jersey NORML
http://www.normlnj.org
Coalition for Medical Marijuana New Jersey
http://www.cmmnj.org/
NEW MEXICO: For more information contact the Medical Cannabis
Program Coordinator at:
http://egov.oregon.gov/DHS/ph/ommp/index.shtml
RHODE ISLAND:
http://www.health.state.ri.us/
VERMONT:
Marijuana Registry
Department of Public Safety
03 South Main Street
Waterbury, Vermont 05671
(802)-241-5115 or (802)-241-5115
Growing Supplies
Nutrients
Cloning Cost Notes
CloneX Gel - 1/2oz Pack $6.00 1/2oz. pack each cycle.
CloneX Cloning Solution $8.00 25 tsp to 1/3 of 1.1qt bottle per cycle. Cost of full bottle is $25 bucks 1
bottle should last 3 growth cycle's
Thrive Alive B-1 $0.50 3 tsp growth cycle. Cost of full bottle $10. 1bottle last over a year, should
replace bottle each year.
Vegetative Growth
Sensi Grow Part A $8.00 15 gal reservoir you would go thru half the bottle on a 8 week veg. 1 bottle
= 1.1qt $16
Sensi Grow Part B $8.00 15 gal reservoir you would go thru half the bottle on a 8 week veg. 1 bottle
= 1.1qt $16
H2O2 $1.00 I use a drop a gallon when I change the resv. 1 bottle is about $12
Bat Guano $1.00 1 bag last 10 grows. 1 bag 2.2lbs $10
PH Up $0.05 1 bottle will last me a couple of years. at that time I would replace it for a
fresh bottle. But I use a couple of drops every cycle. 1 bottle cost $12
PH Down $3.00 1/4 bottle used each veg cycle. 1 bottle cost $12
Flowering Growth
Sensi Bloom Part A $16.00 1 full bottle will be used during flowering stage. Cost of 1.1qt bottle part A
$16
Sensi Bloom Part B $16.00 1 full bottle will be used during flowering stage. Cost of 1.1qt bottle part B
$16
Cal Mag Plus $20.00 1 full bottle (half in veg the other half in flower) 1.1qt bottle $20
H2O2 $1.00 I use a drop a gallon when I change the resv. Cost of 1qt bottle $12
Overdrive $20.00 almost half a bottle in one flower cycle. Cost for 1.1qt bottle is $40
PH Up $0.05 1 bottle will last me couple of years. Replace it then. But I use a couple of
drops every cycle 1 bottle cost $12
PH Down $1.50 1/8 bottle used each flowering cycle. Cost of 1 bottle is $12
Growing Mediums
4" Rockwool $17.00 I will use 12 - 4in rockwool blocks and then place them on top of 12 -
6x6in rockwool blocks.
6" Rockwool $40.00 12-6x6in blocks
Hydroton - Expanded Clay Pellets $10.00 40lb bag cost $40 and can be reused.
Miracle Grow Moisture Control $50.00 40lb bag cost $25 need two 40lb bags for 12 plants
Jiffy Starter $2.50 25pk jiffy plugs cost $5 use when cloning.
Equipment
Lights
T5 Florescent Light $20.00 4 foot with 8 bulbs. I'm running 5 blue bulbs and 3 red bulbs - $280 comes
with blue bulbs need to buy the red ones.
Red Bulbs for T-5 $36.00 Bulbs last ?
400 watt High Pressure Sodium Light $24.00 Initial Cost $360 with 1 bulb
400 watt Bulb $20.00 After every 3rd 8 week flowering cycle the bulb needs to be replaced.
New bulb cost $60
600 watt High Pressure Sodium Light $30.00 Initial Cost $440 with 1 bulb
600 watt Bulb $33.00 After every 3rd 8 week flowering cycle the bulb needs to be replaced.
New bulb cost $100
_____ I the patient will provide seeds, clones, and plants to my caregiver
_____ I authorize the caregiver to acquire all seeds, clones, and plants for me when
needed. For a total of $________
_____ I authorize the caregiver to acquire ____seeds, ____clones, ____plants for
me. For a total of $________
_____ I the patient will possess and cultivate my plants with the assistance of the
caregiver.
_____ I authorize the caregiver to possess and cultivate all plants, clones, even
seeds for me.
Terms of Cultivation
_____ I the patient will harvest and cure the plants by myself.
_____ I the patient will harvest and cure the plants with the assistance of the
caregiver.
_____ I authorize the caregiver to harvest and cure my plants for me.
_____ I the patient will come and get my marijuana from the caregiver.
_____ I the patient authorize the caregiver to deliver my marijuana to me at
___________________________
___________________________
___________________________
_____ I the patient will contact the caregiver to make pick up or delivery
arrangements each time.
The terms of transfer includes time and date, location, how much is being
transferred, and the method of Compensation:
Third Party Transfers
_____ I the patient do not authorize the caregiver to transfer any of my plants,
clones, or seeds or parts of plants to anyone.
_____ I the patient authorize the caregiver to transfer my plants, clones, seeds,
even parts of my plants to other patients or caregivers. This should include all
trades, swaps and donations.
SUMMARY OF AGREEMENT
Both patient and caregiver have the right to terminate this agreement with a
minimum of seven (7) days notice. Both patient and caregiver agree to respect the
right of each others privacy. The patient designates the caregiver listed on this
agreement to be his/her Primary Caregiver as defined in the Act, and will supply
the caregivers information to the MDCH on their application. The caregiver listed on
this agreement affirms that he/she will act as the patients Primary Caregiver as
defined in the Act, and will obey the guidelines established by the Act.
Exchange Information
Patient Information
Name: _______________________________
Address: ______________________________
City: ________________________________
Zip: _________ Phone: ___________________
_ _ _ _ _ _ _ _ _ _ _ _ _ cut on line_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Caregiver Information
Name: _______________________________
Address: ______________________________
City: ________________________________
Zip: _________ Phone: ___________________