Providence Ambulance eOrders

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Entry ID112
eOrder Submission Date09/27/2023
eOrder Submission Time09:55 AM
Requester Information
Ordering FacilityProvidence St. Jude Medical Center
TitleDischarge Planner
Requester DepartmentCANCER GOING FOR TREATMENT
Requester Phone(626) 685-4365
Requester EmailEmail hidden; Javascript is required.
Service Needs Information
Service LevelAMI-Stroke Stat Transport
Trip TypeOne-Way
Bariatric Patient?Yes
Patient Weight340
Patient Height5'11"
Ambulance Transfer Reason(s)
  • Services required not available at sending facility, patient being transferred for out-of-facility services but will remain an in-patient of sending facility.
Trip Schedule Information
Pickup Date10/02/2023
Response TypeScheduled Transport
Pickup Time10:00 AM
Appointment Time11:30 AM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence Little Company of Mary Medical Center San Pedro
Pickup Location Department/Unit NameCANCER UNIT
Pickup Location Patient Room/Bed No.54
Pickup Location Department Phone(626) 546-5435
Pickup Location Contact NameANA LOPEZ
Drop Off Location Information
Drop Off LocationProvidence Little Company of Mary Medical Center Torrance
Drop Off Receiving Department/Unit NameRADIATION
Drop Off Patient Room/Bed No.65
Drop Off Receiving Department Phone(310) 646-4135
Reimbursement Information
Payor Authorized?Yes
Patient Information
Patient NameTEST PATIENT
Patient SexMale
Patient Date of Birth09/12/1950
Patient Age73
Spoken LanguageEnglish/SPANISH
Interpreter Required?No
Patient Medical Information
Isolation PrecautionYes
COVID-19 StatusPositive
Medical Necessity Certification
Is Patient Bed-confined?Yes
Medical Needs During Transport
Required Equipment and Care
  • Airway Monitoring
  • Cardiac Monitoring
  • Bariatric Gurney
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date09/27/2023