Providence Ambulance eOrders

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Entry ID148
eOrder Submission Date03/13/2024
eOrder Submission Time15:37 PM
Requester Information
Ordering FacilityProvidence St. Jude Plaza Radiation Oncology
TitleOther
Other TitleRadiation Therapist
Requester DepartmentRadiation Oncology
Requester Phone714-446-5632
Requester EmailEmail hidden; Javascript is required.
Service Needs Information
Service LevelParamedic Advance Life Support
Trip TypeWait and Return
Bariatric Patient?No
Ambulance Transfer Reason(s)
  • In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date03/14/2024
Response TypeScheduled Transport
Pickup Time12:50 PM
Appointment Time01:50 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name4 North West Tower
Pickup Location Patient Room/Bed No.4107
Pickup Location Department Phone7149923000
Drop Off Location Information
Drop Off LocationProvidence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit NameRadiation Oncology
Drop Off Receiving Department Phone7144465632
Reimbursement Information
Patient Information
Patient NameGary Carnes
Patient SexMale
Patient Date of Birth01/23/1966
Patient Age58
Spoken LanguageEnglish
Interpreter Required?No
Patient Medical Information
Isolation PrecautionNo
Medical Necessity Certification
Is Patient Bed-confined?Yes
Medical Needs During Transport
Required Equipment and Care
  • Cardiac Monitoring
  • Other
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date03/13/2024