Providence Ambulance eOrders

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Entry ID120
eOrder Submission Date10/03/2023
eOrder Submission Time10:45 AM
Requester Information
Ordering FacilityProvidence Mission Hospital Laguna Beach
TitleRegistered Nurse
Requester DepartmentER
Requester Phone(123) 456-7890
Requester EmailEmail hidden; Javascript is required.
Service Needs Information
Service LevelNurse-Staffed Specialty Care Transport
Trip TypeOne-Way
Bariatric Patient?No
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 Date10/04/2023
Response TypeScheduled Transport
Pickup Time11:00 AM
Appointment Time12:00 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit NameMEDSURGE
Pickup Location Patient Room/Bed No.4105
Pickup Location Department Phone(714) 871-3280
Pickup Location Contact NameDALTON DEAN
Drop Off Location Information
Drop Off LocationProvidence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit NameRADIOLOGY
Drop Off Patient Room/Bed No.STE 1500
Drop Off Receiving Department Phone(714) 446-5632
Reimbursement Information
Patient Information
Patient NameTAYLOR SWIFT
Patient SexFemale
Patient Date of Birth12/03/1989
Patient Age33
Spoken LanguageEnglish
Interpreter Required?No
Patient Home Address1 Mission Viejo Rd
Mission Viejo, California 92691
United States
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Patient Medical Information
Isolation PrecautionNo
Medical Necessity Certification
Is Patient Bed-confined?No
Ambulance Medical Necessity Reason(s)
  • Unable to maintain erect sitting position in a chair for time needed for transport.
Medical Needs During Transport
Required Equipment and Care
  • Oxygen
  • Cardiac Monitoring
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date10/03/2023