Providence Ambulance eOrders

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Entry ID16
eOrder Submission Date06/23/2023
eOrder Submission Time17:05 PM
Requester Information
Ordering FacilityProvidence St. Jude Medical Center
TitleOther
Other TitleTest
Requester DepartmentED
Requester Phone(310) 644-5300
Requester EmailEmail hidden; Javascript is required.
Service Needs Information
Service LevelEMT Basic Life Support
Trip TypeOne-Way
Bariatric Patient?No
Ambulance Transfer Reason(s)
  • In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date06/23/2023
Response TypeNext Available - Patient Ready Now
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Nameed
Pickup Location Patient Room/Bed No.14
Pickup Location Department Phone(310) 749-6141
Pickup Location Contact NameJoseph Diaz
Drop Off Location Information
Drop Off LocationProvidence St. Jude Medical Center
Drop Off Receiving Department/Unit Name3rd floor
Drop Off Patient Room/Bed No.312
Drop Off Receiving Department Phone(310) 749-6141
Drop Off Receiving Contact NameJoseph Diaz
Reimbursement Information
Patient Information
Patient NameJoseph Diaz
Medical Record No.5628678148
Patient SexMale
Patient Date of Birth01/02/1986
Patient Age38
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
  • Oxygen
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date06/24/2023