Letters from your Primary Care Provider, Endocrinologist, Psychiatrist, and Urologist.
Will look something like the following.
On Your Clinics Letterhead
12345 Broadway
Seattle, Washington 12345
(206) 123-4567
Dated: 00/00/2007
To: Department of Social and Health Services.
Health and Recovery Services Administration.
Division of Medical Management.
Attention: Kerry Dansereau
PO Box 45506,
Olympia, WA. 98504-5506
Re: Request for additional Information
For: Mr./Ms. Your Name
DSHS PIC: #__.
Dear Kerry,
I am a care provider for Mr./Ms. Your Name on January 00, 2007. I preformed a general exam. In
talking with Mr./Ms.Your Name, and my own research on gender identity disorder. I feel in the best
interest of Mr./Ms.Your Name, for His/her physical, and mental health treatment of transsexualism (Profound GID). In my professional opinion, this is a necessary surgical treatment.
My recommendation for Mr./Ms. Your Name is, sex reassignment surgery for her. Sex Reassignment is Effective and Medically Indicated in Severe GID. In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. This is medically indicated and medically necessary. Sex reassignment is not "experimental," "investigational," "elective," "cosmetic," or optional in any meaningful sense. It constitutes very effective and appropriate treatment for transsexualism or profound GID.
The long term treatment for Mr./Ms.Your Name is to lower hormone levels, which will help to guard against heart and or liver disease. Lessen frequency of mental health visits. Lower cost in long term medical care, and prescription coverage. Mr./Ms. Your Name will be incongruent with his/her body and mind. More self confidence. His/Her ability to become a productive member of society.
If you require any further information please contact me at,
The CLINIC, 1234 Broadway, Seattle WA. 98000, Ph: (206) 123-4567, Fax: (206) 123-4567.
Sincerely. __________________________________ .
Dr. His/Her Name, and Profession.
Mind you this is only an example of one letter needed. It will be up to your doctor to determine the
necessary verbiage for your required treatment. We have only laid out the base format.
You may copy & paste this page for your Doctor.
Statements made in the above information are my personal understanding,
I am not an attorney. I can not legally advise you.
___________________________________________________________________________________
In addition to your four letters you will also need.
An evaluation and recommendation, from one of the following Centers of Excellence is required:
University of Washington, Seattle, Wa.
Sacred Heart Medical Center of Spokane, Wa.
Oregon Health Sciences University in Portland, Or.
Children's Hospital and Regional Medical Center in Seattle, Wa
Mary Bridge Children's Hospital and health Center in Tacoma, Wa.
Copyright © 2005-2008 The STHN Group Last modified: March 21, 2007