Providence Ambulance eOrders – Ambulance Transport Order Portal

Entry ID	165
eOrder Submission Date	04/05/2024
eOrder Submission Time	10:12 AM
Requester Information
Ordering Facility	Providence St. Jude Medical Center
Title	Other
Other Title	dispatch
Requester Department	communications
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	04/05/2024
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	test
Pickup Location Patient Room/Bed No.	test
Pickup Location Department Phone	1234567890
Drop Off Location Information
Drop Off Location	Providence St. Josseph Hospital Orange
Drop Off Receiving Department/Unit Name	test
Drop Off Receiving Department Phone	123456787
Reimbursement Information
Patient Information
Patient Name	test test test
Patient Sex	Female
Patient Date of Birth	04/01/2024
Patient Age	0
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	Airway Monitoring
Accompanying Documents	Please upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date	04/05/2024