MCF Physician Letter Confirm Dx
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Physician Letter Certification of Diagnosis Letterhead Physician’s Full Name Address Specialty Medical License Number Date Dear Maryland Cancer Fund Coordinator: This letter is to certify that ________________________________ has been Patient Name □ diagnosed with _______________________________, on ___________________or Type of Cancer □ Date of Diagnosis is being treated for ____________________________, and began treatment on Type of Cancer ___________________, or Date Treatment began □ has finding suggestive of ____________________ and needs to obtain a cancer diagnosis..
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