Providence Ambulance eOrders – Ambulance Transport Order Portal

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Entry ID	152
eOrder Submission Date	03/20/2024
eOrder Submission Time	08:21 AM
Requester Information
Ordering Facility	Providence St. Joseph Hospital Orange
Title	Other
Other Title	comm
Requester Department	comm
Requester Phone	3106440500
Requester Email	Email hidden; Javascript is required.
Service Needs Information
Service Level	EMT Basic Life Support
Trip Type	One-Way
Bariatric Patient?	No
Ambulance Transfer Reason(s)	In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date	03/20/2024
Response Type	Next Available - Patient Ready Now
Standing Order	No
Pickup Location Information
Pickup Location	Providence St. Josseph Hospital Orange
Pickup Location Department/Unit Name	1
Pickup Location Patient Room/Bed No.	1
Pickup Location Department Phone	3106440500
Pickup Location Contact Name	TEST TEST
Drop Off Location Information
Drop Off Location	Providence Saint Joseph Medical Center Burbank
Drop Off Receiving Department/Unit Name	test
Drop Off Patient Room/Bed No.	test
Drop Off Receiving Department Phone	3106440500
Drop Off Receiving Contact Name	test test
Reimbursement Information
Patient Information
Patient Name	test test test
Patient Sex	Female
Patient Date of Birth	03/12/2024
Patient Age	0
Spoken Language	English
Interpreter Required?	No
Patient Medical Information
Isolation Precaution	No
Medical Necessity Certification
Is Patient Bed-confined?	Yes
Medical Needs During Transport
Required Equipment and Care	Airway Monitoring
Accompanying Documents	Please upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date	03/20/2024