No, you can't attach notes to an e-filed tax return unless it is part of the tax form itself.
Whether or not your note would be read by the temporary employee who types your mailed-in tax return, is anyone's guess, but I doubt it. I don't think mailing in your return with notes will help you avoid an audit.
The astronomical increase in medical costs means that your $60,000 deduction, while large isn't that unusual. In fact, of those who itemize, the average medical deduction is $17,000 per person.
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