Need a sample letter from PCP

I need a sample letter from my PCP. Who does it go to? My surgeon or the insurance company? I am going to see my pcp on Thursday 10/18 and want to give her a sample so it will contain all the pertinent information needed.I am sure this has been asked before but I can't seem to find a sample of the letter. Please either e-mail to me or answer here thanks. [email protected]

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