| Entry ID | 146 |
|---|---|
| eOrder Submission Date | 03/12/2024 |
| eOrder Submission Time | 11:14 AM |
| Requester Information | |
| Ordering Facility | Providence St. Jude Plaza Radiation Oncology |
| Title | Other |
| Other Title | Radiation Therapist |
| Requester Department | St Jude Radiation Oncology |
| Requester Phone | 714-446-5632 |
| Requester Email | Email hidden; Javascript is required. |
| Service Needs Information | |
| Service Level | EMT Basic Life Support |
| Trip Type | Wait and Return |
| Bariatric Patient? | No |
| Ambulance Transfer Reason(s) |
|
| Trip Schedule Information | |
| Pickup Date | 03/12/2024 |
| Response Type | Scheduled Transport |
| Pickup Time | 12:45 PM |
| Appointment Time | 01:45 PM |
| Standing Order | Yes |
| Standing Order Details | Will continue radiation thru Friday 3/15 Wednesday March 13 appt @ 10:20am pick up at 9:20am Thursday March 14 appt @ 10:20am pick up at 9:20am Friday March 15 appt @ 11:40am pick up at 10:40am Thank you |
| Pickup Location Information | |
| Pickup Location | Providence St. Jude Medical Center |
| Pickup Location Department/Unit Name | 4113 |
| Pickup Location Patient Room/Bed No. | 4113 |
| Pickup Location Department Phone | 714-992-3000 ext: 7520 |
| Drop Off Location Information | |
| Drop Off Location | Providence St. Jude Plaza Radiation Oncology |
| Drop Off Receiving Department/Unit Name | Suite 1500 |
| Drop Off Patient Room/Bed No. | Radiation Oncology |
| Drop Off Receiving Department Phone | 714-446-5632 |
| Reimbursement Information | |
| Patient Information | |
| Patient Name | Tsai Nancy |
| Medical Record No. | 20018551448 |
| Patient Sex | Female |
| Patient Date of Birth | 07/24/1962 |
| Patient Age | 61 |
| 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 |
|
| Other Needed Equipment or Services | none |
| Accompanying Documents | Please upload accompanying transfer documents. |
| Order Submission Certification | |
| eOrder Submission Date | 03/12/2024 |