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PREGNANCY VERIFICATION LETTER

To Whom It May Concern:

On this ____ day of ________________________, 20___ the patient known as
_______________________________ had a positive pregnancy test.

Based on the date of her last menstrual period, her Estimated Date of Delivery (EDD) is
the ____ day of ________________________, 20___.

Additional Information (if any):
______________________________________________________________________
______________________________________________________________________

Sincerely,

Signature ________________________ Title ________________________

Printed Name ________________________ Phone ________________________

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