Providence Ambulance eOrders

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Entry ID159
eOrder Submission Date03/25/2024
eOrder Submission Time16:55 PM
Requester Information
Ordering FacilityProvidence St. Jude Plaza Radiation Oncology
TitleRadiation Therapist
Requester Departmentst jude radiation oncology
Requester Phone7144465632
Requester EmailEmail hidden; Javascript is required.
Service Needs Information
Service LevelEMT Basic Life Support
Trip TypeWait and Return
Bariatric Patient?No
Ambulance Transfer Reason(s)
  • In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date03/26/2024
Response TypeScheduled Transport
Pickup Time10:00 AM
Appointment Time11:00 AM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name4nw
Pickup Location Patient Room/Bed No.4107
Pickup Location Department Phone714-992-3000
Drop Off Location Information
Drop Off LocationProvidence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit Name1500
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?No
Medical Needs During Transport
Required Equipment and Care
  • Other
Other Needed Equipment or ServicesBLS only
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date03/25/2024