77 Ill. Adm. Code 2085.EXHIBIT A
A DASA Form 229-1
Section 2085
Section 2085.EXHIBIT A DASA
Form 229-1
(Hospital
Letter Head)
Chief of Licensing
Department of Alcoholism and
Substance Abuse
300 N. State Street–Suite 1500
Chicago, Illinois 60610
Sir:
We hereby apply for
authorization from the Department to conduct research with
Delta-9-Tetrahydrocannabinol. Enclosed is a copy of Form DEA–225 "New
Application for Registration under Controlled Substances Act of 1970", and
a copy of our application to the National Cancer Institute (NCI) to participate
in their research study. The research will be conducted under the NCI approved
Protocol I 80-12 "Group C Guidelines for the Use of
Delta-9-Tetrahydrocanncbinol NSC 134454 for Nausea and Vomiting Induced by
Antineoplastic Chemotherapy". Applications for the individual physicians
who have been approved by this hospital to issue the research order for
medication are also enclosed.
We agree to comply with all
pertinent Federal and State regulations and protocols concerning the use of
THC. We will notify the Department in writing of any new physician enrolled,
or any who no longer wish to participate in the research study.
Sincerely,
Director of Pharmacy
Services
Hospital Administrator