Providence Ambulance eOrders

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Entry ID124
eOrder Submission Date10/06/2023
eOrder Submission Time14:56 PM
Requester Information
Ordering FacilityProvidence St. Joseph Hospital Orange
TitleCase Manager
Requester DepartmentSUPER ER
Requester Phone323232323232332
Requester EmailEmail hidden; Javascript is required.
Service Needs Information
Service LevelNICU Transport
Trip TypeWait and Return
Bariatric Patient?Yes
Patient Weight500
Patient Height5'1
Ambulance Transfer Reason(s)
  • In-patient inter-campus transfer.
  • Services required not available at sending facility, patient being transferred for out-of-facility services but will remain an in-patient of sending facility.
  • Services required not available at sending facility, patient being discharged and admitted to another facility.
  • HMO Authorized Service
  • Patient requires admission to a locked unit.
  • Other
Other Transfer ReasonHOSPICE
Trip Schedule Information
Pickup Date10/06/2023
Response TypeStat Transport
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Josseph Hospital Orange
Pickup Location Department/Unit NameMORGUE
Pickup Location Patient Room/Bed No.FREEZER 2
Pickup Location Department Phone323232323233232
Pickup Location Contact NameDR ACULA
Drop Off Location Information
Drop Off LocationProvidence Holy Cross Medical Center Mission Hills
Drop Off Receiving Department/Unit NameCAFETERIA
Drop Off Patient Room/Bed No.FRY STATION
Drop Off Receiving Department Phone212121212121212
Drop Off Receiving Contact NameALBERT FISH
Reimbursement Information
Patient Information
Patient NameVIC TIM
Medical Record No.69420
Patient SexMale
Patient Date of Birth06/06/2006
Patient Age55
Spoken LanguageEnglish
Interpreter Required?Yes
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
  • Oxygen
  • Cardiac Monitoring
  • IV Fluid Administration Monitoring
  • IV Saline Lock Monitoring
  • Patient Restraints (5150 Patient)
  • Female Attendant
  • Suctioning
  • Ventilator
  • Bariatric Gurney
  • Stair Chair
  • Other
Number of IV Drips9
Other Needed Equipment or ServicesDYSON VACUUM
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date10/06/2023