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      Tacoma, WA 98405-3926. Phone: (253) 441-4742. Fax: (253) 442-8790 _ December 6, 2019. Re: Preferred name (Legal name) Last name. DOB: 00/00/0000. Preferred pronouns: She/Her. To whom it may concern: I am writing on behalf of the abovementioned patient whom I would like to refer for gender affirming breast augmentation.

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