Rishi Consultative Care · Clinical reference
The in-person pharmacist consult
A credentialed pharmacist, physically present at the dispensary, delivers the consultation Pennsylvania already requires — form, dose, titration, route and interaction screening — for a patient who already holds a medical card.
What it is
Pennsylvania § 1181a.27(c)(7) makes a form/dosage/modality/product-selection consult mandatory where the certifying practitioner did not specify form and dosage. This service supplies the professional who delivers it: a PharmD or physician, contracted to the door, working from an approved protocol library with citations the reviewer can check.
The dispensary is the customer. The patient is the recipient, never the account. The one sentence the whole arrangement rests on: Rishi supplies the professional, the protocol and the paperwork; the dispensary keeps the patient, the product and the PHI.
What it is not
- Not certification. 28 Pa. Code § 1161a.25(e): a practitioner or physician, while at the facility, may not issue a patient certification. The patient already holds a card before this consult happens.
- Not diagnosis. The pharmacist works a condition cluster the certifying practitioner already named. She does not diagnose.
- Not treatment of disease. No entry in the library carries a disease-treatment claim. Every entry carries an explicit what_this_protocol_does_NOT_claim field, and it is rendered as prominently as the recommendation.
- Not telemedicine — in person only, by design. PA § 1161a.25(a) would permit synchronous remote interaction. The service does not use it. Being narrower than the statute is the point; it is also the noncompete decision made visible.
The four things the consult produces
- 01
A form and a starting dose
Route-first, potency-second. Oral oil is the titration backbone; inhaled is a rescue route with no validated dosing and it is said so.
- 02
A titration plan with stop rules
Verbatim increments and intervals from the protocol — and the reassessment window, so the patient knows when he is allowed to judge it.
- 03
A named interaction finding
Not a clearance. The honest statement is a flag and a referral: “your INR needs checking, your cardiologist needs to know.”
- 04
The products actually on that door’s shelf today
Drawn from this location’s observed shelf inside a freshness window, ranked on measured cannabinoid ratio and form. Never on strain name, indica/sativa or terpenes.
The evidence posture
Every recommendation carries a grade. Grade D is never recommended — it is not a discouragement
but a structural impossibility: a grade-D protocol can never reach approved status, and the
recommender returns NO_APPROVED_PROTOCOL for its condition code. The
formulary is published in full below, including the eighteen exclusions it refuses and the rows of
the interaction screen where the honest answer is no evidence of interaction. Where a
figure could not be verified against the on-disk corpus it is omitted or marked UNVERIFIED —
never carried from memory.
Read the document
- The Procedure The complete eleven-step in-person consult, what the patient is told, what he is not told, and the gaps this document does not hide.
- The Formulary All 33 entries with ratios, verbatim titration numbers, contraindications, interaction flags, grades and citations.
- What We Refuse The complete Grade-D exclusion tables with the reason for every exclusion, and the scripts for declining professionally.
Also: the consolidated interaction screen — eleven medication rows, the documented magnitudes, and the two rows where no signal was found.