Section 1. Basic description of patient

• Patient name not required. Exact location not required. 
• Need age, sex, region of the state

Section 2. Description of medical condition

• Date of first diagnosis and description of the diagnosis 
• Can be written with medical terminology or not
• Describe development of the condition up to the present time, or until condition ended 

Section 3. Description of prescription drugs used

• Name of drugs prescribed and their effects (good or bad)

Section 4. Description of marijuana's effect

• How marijuana affected the condition 
• How marijuana's affect compared to the effects of prescription drugs

Section 5. Explain how the person reached the decision to try marijuana

• Did a physician or other medical practitioner recommend marijuana? 
• What factors influenced the patient's decision to try marijuana? 

Section 6. (Optional) Give any details about this person's life that shows his/her respectability, standing in the community, reliability at a job, etc. The purpose of this section is to show that in spite of marijuana use, this person is an upstanding citizen.

Other information that may help build this person's story is welcome.  Raw material may be edited for length. All stories will be compiled into a booklet. The booklets will be available to patients, supporters, and activists and will be distributed to key elected officials, community leaders, and others in an effort to educate about the legitimate uses of marijuana as medicine.

Also, it would be very good if the person who collects the story has a statement notarized, swearing that each story is an accurate record of the story told by the patient.

Questions and completed interviews should be directed to:
Denele Campbell, ARDPArk, 1155 W. 6th St., PMB A17, Fayetteville, AR 72701
 alliance@ardpark.org