65-6b05.Same; written informed request.The "written informed request" referred to in this act shall be on a formprepared by, and obtained from the state board of healing arts and shallbe in substance as follows:
WRITTEN INFORMED REQUEST FOR PRESCRIPTIONOF AMYGDALIN (LAETRILE) FOR MEDICAL TREATMENT
(a) That the federal food and drug administration has determined amygdalin(laetrile) to be an "unapproved new drug" and that federal law prohibitsthe interstate distribution of an "unapproved new drug."
(b) That neither the American cancer society, the American medical association,the Kansas medical society nor the Kansas association of osteopathic medicinerecommends use of amygdalin (laetrile) in the treatment of any malignancy,disease, illness or physical condition.
(c) That there are alternative recognized treatments for the malignancy,disease, illness or physical condition from which I suffer which my physicianhas offered to provide for me including: (Here describe)
That notwithstanding the foregoing, I hereby request prescription anduse of amygdalin (laetrile) (a) in the medical treatment of the malignancy,disease, illness or physical condition from which I suffer [ ], (b) as adietary supplement [ ] or (c) both in the medical treatment of the malignancy,disease, illness or physical condition from which I suffer and as a dietarysupplement [ ] (check (a), (b) or (c)).
_____________________________________Patient or person signing for patient
ATTEST:
_____________________________________
Prescribing Physician
A copy of such written informed request shall be forwarded forthwith afterexecution thereof to the medical care facility or other health care facilityand the state board of healing arts.
65-6b05.Same; written informed request.The "written informed request" referred to in this act shall be on a formprepared by, and obtained from the state board of healing arts and shallbe in substance as follows:
WRITTEN INFORMED REQUEST FOR PRESCRIPTIONOF AMYGDALIN (LAETRILE) FOR MEDICAL TREATMENT
(a) That the federal food and drug administration has determined amygdalin(laetrile) to be an "unapproved new drug" and that federal law prohibitsthe interstate distribution of an "unapproved new drug."
(b) That neither the American cancer society, the American medical association,the Kansas medical society nor the Kansas association of osteopathic medicinerecommends use of amygdalin (laetrile) in the treatment of any malignancy,disease, illness or physical condition.
(c) That there are alternative recognized treatments for the malignancy,disease, illness or physical condition from which I suffer which my physicianhas offered to provide for me including: (Here describe)
That notwithstanding the foregoing, I hereby request prescription anduse of amygdalin (laetrile) (a) in the medical treatment of the malignancy,disease, illness or physical condition from which I suffer [ ], (b) as adietary supplement [ ] or (c) both in the medical treatment of the malignancy,disease, illness or physical condition from which I suffer and as a dietarysupplement [ ] (check (a), (b) or (c)).
_____________________________________Patient or person signing for patient
ATTEST:
_____________________________________
Prescribing Physician
A copy of such written informed request shall be forwarded forthwith afterexecution thereof to the medical care facility or other health care facilityand the state board of healing arts.
65-6b05.Same; written informed request.The "written informed request" referred to in this act shall be on a formprepared by, and obtained from the state board of healing arts and shallbe in substance as follows:
WRITTEN INFORMED REQUEST FOR PRESCRIPTIONOF AMYGDALIN (LAETRILE) FOR MEDICAL TREATMENT
(a) That the federal food and drug administration has determined amygdalin(laetrile) to be an "unapproved new drug" and that federal law prohibitsthe interstate distribution of an "unapproved new drug."
(b) That neither the American cancer society, the American medical association,the Kansas medical society nor the Kansas association of osteopathic medicinerecommends use of amygdalin (laetrile) in the treatment of any malignancy,disease, illness or physical condition.
(c) That there are alternative recognized treatments for the malignancy,disease, illness or physical condition from which I suffer which my physicianhas offered to provide for me including: (Here describe)
That notwithstanding the foregoing, I hereby request prescription anduse of amygdalin (laetrile) (a) in the medical treatment of the malignancy,disease, illness or physical condition from which I suffer [ ], (b) as adietary supplement [ ] or (c) both in the medical treatment of the malignancy,disease, illness or physical condition from which I suffer and as a dietarysupplement [ ] (check (a), (b) or (c)).
_____________________________________Patient or person signing for patient
ATTEST:
_____________________________________
Prescribing Physician
A copy of such written informed request shall be forwarded forthwith afterexecution thereof to the medical care facility or other health care facilityand the state board of healing arts.
