CTR Physician Survey
Ohio Administrative Code 4731-32-03 requires each physician with a certificate to recommend to submit an annual report to the board that describes their observations regarding the effectiveness of medical marijuana in treating patients. Completion of this survey will satisfy the requirement in the rule. Please answer the questions below to the best of your ability.
required 1) Have you made any medical marijuana recommendations?

required 2) Ohio Administrative Code 4731-32-03 (E) states that the physician recommending treatment with medical marijuana shall be available to provide follow-up care and treatment to the patient, including physical examinations relevant to the patient’s condition. Do you require your medical marijuana patients to have an in-person appointment more than once per year?

3) If you answered "Yes" or "Sometimes" to question 2, please select the reason below. Check all that apply.



required 4) According to 4731-32-03 (B)(11) a physician may confirm a previously diagnosed qualifying condition made by an Ohio licensed physician, if certain conditions are met. How often do you make a recommendation based on a confirmed diagnosis of a qualifying condition made by another physician instead of making the original diagnosis?



5) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with AIDS?

6) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with amyotrophic lateral sclerosis?

7) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with Alzheimer's disease?

8) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with cancer?

9) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with chronic traumatic encephalopathy?

10) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with Crohn's disease?

11) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with epilepsy or another seizure disorder?

12) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with fibromyalgia?

13) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with glaucoma?

14) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with hepatitis C?

15) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with inflammatory bowel disease?

16) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with multiple sclerosis?

17) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with pain that is either chronic and severe or intractable?

18) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with Parkinson's disease?

19) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with positive status for HIV?

20) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with post-traumatic stress disorder?

21) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with sickle cell anemia?

22) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with spinal cord disease or injury?

23) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with Tourette's syndrome?

24) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with traumatic brain injury?

25) In your observations, how satisfied are you with the effectiveness of medical marijuana in treating your patients with ulcerative colitis ?

26) How would you describe the level of difficulty of navigating the Patient & Caregiver Registry?



required 27) Name

28) Name of Practice Site

29) Practice Site Address (example: 123 Practice Way, Columbus, OH 12345)

30) Additional Practice Addresses

required 31) Ohio MD/DO License Number (example: 35.12345CTR)

required 32) Month and year of CTR issuance (example: March 2020)

33) Additional Comments


required Please provide your email