Providence Ambulance eOrders

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Entry ID121
eOrder Submission Date10/03/2023
eOrder Submission Time15:18 PM
Requester Information
Ordering FacilityProvidence St. Joseph Hospital Orange
TitleOther
Other TitleDispatcher
Requester DepartmentDispatch
Requester Phone(310) 644-0500
Requester EmailEmail hidden; Javascript is required.
Service Needs Information
Service LevelNurse-Staffed Specialty Care Transport
Trip TypeWait and Return
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. Josseph Hospital Orange
Pickup Location Department/Unit Namemed surg
Pickup Location Patient Room/Bed No.3311
Pickup Location Department Phone(714) 771-8000
Drop Off Location Information
Drop Off LocationProvidence St. Joseph Hospital - Orange Center for Cancer Prevention and Treatment
Drop Off Receiving Department/Unit NameRADIATIOIN/ONCOLOGY
Drop Off Receiving Department Phone(714) 734-6250
Reimbursement Information
Patient Information
Patient NamejOHN DOE
Patient SexMale
Patient Date of Birth01/01/1963
Patient Age63
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
Description of Patient's Current Chief Complaint/Medical Condition Requiring an Ambulance

Dx: BRAIN CANCER, Hx CHF

Medical Necessity Certification
Is Patient Bed-confined?Yes
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