Sam Ferreira

Packet ready

72 M · MRN TCPT-0046915 · Prostate adenocarcinoma, favorable intermediate risk, cT1c N0 M0

Humana Gold Plus HMO (Medicare Advantage) · H55120937

Ordered by R. Lee, MD · Sep 2, 2026 · CPT 77523 · C61 Malignant neoplasm of prostate

Letter of medical necessity · Clinical Notes

Letter of medical necessity

Sep 5, 2026 · R. Lee, MD · 1 page

G2 › Ferreira, Sam › Clinical Notes › 2026-09-05 Letter of medical necessity

Proton beam therapy is medically necessary for this patient. Electronically signed by R. Lee, MD.^C-10