Providence Ambulance eOrders – Ambulance Transport Order Portal

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Entry ID	108
eOrder Submission Date	09/27/2023
eOrder Submission Time	09:13 AM
Requester Information
Ordering Facility	Providence Little Company of Mary Medical Center San Pedro
Title	Registered Nurse
Requester Department	ER
Requester Phone	(310) 644-0500
Requester Email	Email hidden; Javascript is required.
Service Needs Information
Service Level	Paramedic Advance Life Support
Trip Type	One-Way
Bariatric Patient?	No
Ambulance Transfer Reason(s)	In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date	09/27/2023
Response Type	Next Available - Patient Ready Now
Standing Order	No
Pickup Location Information
Pickup Location	Providence Little Company of Mary Medical Center San Pedro
Pickup Location Department/Unit Name	ER
Pickup Location Patient Room/Bed No.	01
Pickup Location Department Phone	(123) 456-7890
Pickup Location Contact Name	TEST TEST
Drop Off Location Information
Drop Off Location	Providence Little Company of Mary Medical Center Torrance
Drop Off Receiving Department/Unit Name	ER
Drop Off Receiving Department Phone	(111) 444-5555
Reimbursement Information
Patient Information
Patient Name	TEST PATIENT
Patient Sex	Male
Patient Date of Birth	01/01/2000
Patient Age	23
Spoken Language	English
Interpreter Required?	No
Patient Medical Information
Isolation Precaution	No
Medical Necessity Certification
Is Patient Bed-confined?	No
Medical Needs During Transport
Required Equipment and Care	Oxygen Cardiac Monitoring
Accompanying Documents	Please upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date	09/27/2023