Providence Ambulance eOrders – Ambulance Transport Order Portal

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Entry ID	110
eOrder Submission Date	09/27/2023
eOrder Submission Time	09:45 AM
Requester Information
Ordering Facility	Providence St. Jude Medical Center
Title	Discharge Planner
Requester Department	ER
Requester Phone	(323) 453-2347
Requester Email	Email hidden; Javascript is required.
Service Needs Information
Service Level	EMT Basic Life Support
Trip Type	One-Way
Bariatric Patient?	No
Ambulance Transfer Reason(s)	In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date	09/01/2023
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.	9
Pickup Location Department Phone	(323) 453-2347
Pickup Location Contact Name	ROD KNEE
Drop Off Location Information
Drop Off Location	Providence Cedars-Sinai Tarzana Medical Center
Drop Off Receiving Department/Unit Name	ICU
Drop Off Patient Room/Bed No.	1
Drop Off Receiving Department Phone	(323) 123-4567
Drop Off Receiving Contact Name	KNEE ROD
Reimbursement Information
Patient Information
Patient Name	RODN TEST OCHA
Medical Record No.	0000000123
Patient Sex	Male
Patient Date of Birth	05/05/1990
Patient Age	33
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	Airway Monitoring Oxygen Cardiac Monitoring IV Fluid Administration Monitoring IV Saline Lock Monitoring Patient Restraints (5150 Patient) Female Attendant Suctioning Ventilator Bariatric Gurney Stair Chair
Number of IV Drips	0
Accompanying Documents	Please upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date	09/27/2023