Application for Category One (Please
L.C.C.C. is a non-profit resource center established for the benefit of people suffering from
incurable conditions such as HIV, AIDS, cancer, multiple sclerosis, muscular dystrophy, glaucoma,
epilepsy, fibromyalgia, arthritis, insomnia, anorexia, intractable pain, paraplegia and
Your patient is requesting a letter of diagnosis from you on your behalf. The purpose of the letter is
simply to document, for our records, that this person has been diagnosed with one of the above-
mentioned ailments. We have provided a sample letter for you to use as a guide.
Please keep a copy of this letter and the accompanying Release of Confidential Medical Information in
your patient's file as someone from L.C.C.C. will call to quickly verify the validity of the letter.