Providence Ambulance eOrders – Ambulance Transport Order Portal

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Entry ID	109
eOrder Submission Date	09/27/2023
eOrder Submission Time	09:41 AM
Requester Information
Ordering Facility	Providence Little Company of Mary Medical Center San Pedro
Title	Discharge Planner
Requester Department	CANCER
Requester Phone	(310) 644-0500
Requester Email	Email hidden; Javascript is required.
Service Needs Information
Service Level	EMT Basic Life Support
Trip Type	Wait and Return
Bariatric Patient?	No
Ambulance Transfer Reason(s)	In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date	09/29/2023
Response Type	Stat Transport
Standing Order	No
Pickup Location Information
Pickup Location	Providence St. Jude Medical Center
Pickup Location Department/Unit Name	cancer center
Pickup Location Patient Room/Bed No.	10 A
Pickup Location Department Phone	(626) 482-4191
Pickup Location Contact Name	ROSE LOPEZ
Drop Off Location Information
Drop Off Location	Providence Little Company of Mary Medical Center Torrance
Drop Off Receiving Department/Unit Name	radiation
Drop Off Patient Room/Bed No.	1550
Drop Off Receiving Department Phone	(310) 646-1354
Reimbursement Information
Patient Information
Patient Name	TEST PATIENT
Patient Sex	Male
Patient Date of Birth	05/11/1973
Patient Age	50
Spoken Language	English/spanish
Interpreter Required?	No
Patient Medical Information
Isolation Precaution	Yes
COVID-19 Status	Positive
Medical Necessity Certification
Is Patient Bed-confined?	Yes
Medical Needs During Transport
Required Equipment and Care	Other
Accompanying Documents	Please upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date	09/27/2023