Priya Raman

Needs a human

61 F · MRN TCPT-0048109 · Recurrent SCC left base of tongue, p16−, rT2 N0 M0 (prior CRT 2021)

Aetna Open Access PPO (Commercial) · W284019376

Ordered by R. Lee, MD · Sep 21, 2026 · CPT 77525 · C01 Malignant neoplasm of base of tongue

Priya Raman · Aetna Open Access PPO

Supporting records pulled from G2

ACE read every document in the G2 chart and pulled only what Aetna policy AET-PBRT-DEMO asks for. Each record below says why it is in the packet, what was extracted from it and which criteria it satisfies. Everything else stays in the chart and is listed at the bottom.

Read

documents in G2

Pulled

into the packet

Pages out

sent to the payer

Tab	Document	Why it is in the packet	State
1	Surgical pathology — left base of tongue biopsy Jul 30, 2026 · US Oncology Pathology · Pathology report · 1 p (tab p. 1) G2 › Raman, Priya › Results › Pathology › 2026-07-30 Surgical pathology Satisfies: Diagnosis	Histologic confirmation of the recurrence. Extracted. Recurrent SCC, left base of tongue (07/30/2026)	Ready
2	PET/CT skull base to mid-thigh — restaging Aug 14, 2026 · Baylor Radiology · Imaging report · 2 pp (tab pp. 2–3) G2 › Raman, Priya › Imaging › PET-CT › 2026-08-14 PET-CT restaging Satisfies: Restaging	Restaging imaging within 60 days showing no distant disease. Extracted. rT2 N0 M0 (PET/CT 08/14)	Ready
3	Nursing assessment Sep 3, 2026 · K. Duran, RN · Nursing assessment · 1 p (tab p. 4) G2 › Raman, Priya › Nursing › Intake › 2026-09-03 Nursing assessment Satisfies: Performance	Documents Karnofsky performance status. Extracted. KPS 80	Ready
4	Head and neck tumor board Sep 15, 2026 · H&N Multidisciplinary Tumor Board · Tumor board note · 1 p (tab p. 5) G2 › Raman, Priya › Conference Notes › Tumor Board › 2026-09-15 H&N tumor board Satisfies: Tumor board	Multidisciplinary recommendation for re-irradiation. Extracted. Tumor board 09/15: salvage re-RT with protons	Ready
5	Medical physics plan review — re-irradiation IMPT Sep 18, 2026 · D. Okafor, PhD · Physics note · 1 p (tab p. 6) G2 › Raman, Priya › Treatment Planning › Physics › 2026-09-18 Physics note Satisfies: Prescription	Documents the re-irradiation prescription and plan QA. Extracted. 60 Gy(RBE) / 30 fx	Ready
6	Comparative plan report — re-irradiation IMPT vs IMRT Sep 17, 2026 · K. Bhatt, CMD · Comparative dosimetry report · 3 pp (tab pp. 7–9) G2 › Raman, Priya › Treatment Planning › Dosimetry › 2026-09-17 Comparative plan report Satisfies: IMRT comparison	Comparative IMRT plan showing reduced dose to previously irradiated organs. Extracted. Cord Dmax 8.9 vs 21.7 Gy; brainstem 6.2 vs 18.4 Gy (this course)	Ready
7	Radiation treatment summary — Gulf Coast Cancer Center (outside, 2021) Jun 4, 2021 · Gulf Coast Cancer Center (E. Marsh, MD) · Outside RT treatment summary · 2 pp (tab pp. 10–11) G2 › Raman, Priya › Outside Records › Radiation Oncology › 2021-06-04 Gulf Coast Cancer Center treatment summary Satisfies: Prior course	Primary source for prior course dates, dose, fractionation and site. Extracted. Prior RT 70 Gy/35 fx, 04/12–05/28/2021, L oropharynx + neck Outside records scanned into G2	Ready
8	Radiation oncology consultation — re-irradiation Sep 3, 2026 · R. Lee, MD · Consult note · 3 pp (tab pp. 12–14) G2 › Raman, Priya › Clinical Notes › Radiation Oncology › 2026-09-03 Re-irradiation consult Satisfies: Interval	Documents the recurrence, prior treatment history and re-irradiation plan. Extracted. Prior course ended May 2021 → ~64 months (inferred)	Ready
9	Head and neck surgical oncology consultation Aug 20, 2026 · S. Whitaker, MD (Head and Neck Surgery) · Consult note · 2 pp (tab pp. 15–16) G2 › Raman, Priya › Clinical Notes › Head and Neck Surgery › 2026-08-20 Surgical oncology consult Satisfies: Surgical evaluation	Surgical evaluation: salvage surgery not feasible without major functional loss; declined. Extracted. Salvage surgery declined (would require TGL)	Ready
10	Letter of medical necessity — proton re-irradiation Sep 23, 2026 · R. Lee, MD · Letter of medical necessity · 1 p (tab p. 17) G2 › Raman, Priya › Clinical Notes › Radiation Oncology › 2026-09-23 Letter of medical necessity Satisfies: Medical necessity	Signed letter of medical necessity required by §IV.A. Extracted. LMN signed 09/23/2026	Ready

Read but left out

35 documents not sent to the payer

6 Administrative — not required by policy
6 Routine labs — not required by policy
3 Scheduling call — not clinical evidence
3 Education record — not required by policy
3 Correspondence — not clinical evidence
3 Chemotherapy planning — not required by policy
3 Setup details — not required by policy
2 Swallow therapy — not required by policy
2 Prior surveillance visit — not required by policy
1 Prior hospitalization — not required by policy
1 Supportive care — not required by this policy
1 Swallow function baseline — not required by policy
1 Social history — not required by policy

Show all 35

Discharge summary — PEG placement (outside, 2021)	Outside Records	May 6, 2021	Prior hospitalization — not required by policy
Dental oncology evaluation	Clinical Notes	Sep 10, 2026	Supportive care — not required by this policy
Modified barium swallow study	Clinical Notes	Sep 5, 2026	Swallow function baseline — not required by policy
Social work assessment	Clinical Notes	Sep 8, 2026	Social history — not required by policy
Nursing phone call	Nursing	Sep 28, 2026	Scheduling call — not clinical evidence
Appointment confirmation	Administrative	Sep 26, 2026	Administrative — not required by policy
Complete blood count	Results	Sep 24, 2026	Routine labs — not required by policy
Comprehensive metabolic panel	Results	Sep 22, 2026	Routine labs — not required by policy
Financial counseling acknowledgment	Administrative	Sep 20, 2026	Administrative — not required by policy
Patient education record	Nursing	Sep 18, 2026	Education record — not required by policy
Records request (outgoing)	Administrative	Sep 16, 2026	Correspondence — not clinical evidence
Medical oncology follow-up	Clinical Notes	Sep 14, 2026	Chemotherapy planning — not required by policy
CT simulation setup note	Treatment Planning	Sep 12, 2026	Setup details — not required by policy
Speech-language pathology note	Clinical Notes	Sep 10, 2026	Swallow therapy — not required by policy
Outside ENT surveillance visit	Outside Records	Sep 8, 2026	Prior surveillance visit — not required by policy
Nursing phone call	Nursing	Sep 6, 2026	Scheduling call — not clinical evidence
Appointment confirmation	Administrative	Sep 4, 2026	Administrative — not required by policy
Complete blood count	Results	Sep 2, 2026	Routine labs — not required by policy
Comprehensive metabolic panel	Results	Aug 31, 2026	Routine labs — not required by policy
Financial counseling acknowledgment	Administrative	Aug 29, 2026	Administrative — not required by policy
Patient education record	Nursing	Aug 27, 2026	Education record — not required by policy
Records request (outgoing)	Administrative	Aug 25, 2026	Correspondence — not clinical evidence
Medical oncology follow-up	Clinical Notes	Aug 23, 2026	Chemotherapy planning — not required by policy
CT simulation setup note	Treatment Planning	Aug 21, 2026	Setup details — not required by policy
Speech-language pathology note	Clinical Notes	Aug 19, 2026	Swallow therapy — not required by policy
Outside ENT surveillance visit	Outside Records	Aug 17, 2026	Prior surveillance visit — not required by policy
Nursing phone call	Nursing	Aug 15, 2026	Scheduling call — not clinical evidence
Appointment confirmation	Administrative	Aug 13, 2026	Administrative — not required by policy
Complete blood count	Results	Aug 11, 2026	Routine labs — not required by policy
Comprehensive metabolic panel	Results	Aug 9, 2026	Routine labs — not required by policy
Financial counseling acknowledgment	Administrative	Aug 7, 2026	Administrative — not required by policy
Patient education record	Nursing	Aug 5, 2026	Education record — not required by policy
Records request (outgoing)	Administrative	Aug 3, 2026	Correspondence — not clinical evidence
Medical oncology follow-up	Clinical Notes	Aug 1, 2026	Chemotherapy planning — not required by policy
CT simulation setup note	Treatment Planning	Jul 30, 2026	Setup details — not required by policy