Providence Ambulance eOrders – Ambulance Transport Order Portal

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Entry ID	170
eOrder Submission Date	04/10/2024
eOrder Submission Time	08:21 AM
Requester Information
Ordering Facility	Providence St. Jude Medical Center
Title	Radiation Therapist
Requester Department	RADIATION THERAPY
Requester Phone	7144465632
Requester Email	Email hidden; Javascript is required.
Service Needs Information
Service Level	EMT Basic Life Support
Trip Type	Round Trip
Bariatric Patient?	No
Ambulance Transfer Reason(s)	In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date	04/10/2024
Response Type	Scheduled Transport
Pickup Time	11:10 AM
Appointment Time	12:10 PM
Return Pickup Date	04/10/2024
Standing Order	No
Pickup Location Information
Pickup Location	Providence St. Jude Medical Center
Pickup Location Department/Unit Name	4108
Pickup Location Patient Room/Bed No.	4108
Pickup Location Department Phone	714992300
Pickup Location Contact Name	Daryl Lee
Drop Off Location Information
Drop Off Location	Providence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit Name	1500
Drop Off Receiving Department Phone	7144465632
Reimbursement Information
Patient Information
Patient Name	ERICA BANALES
Patient Sex	Female
Patient Date of Birth	11/03/1975
Patient Age	48
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	Other
Other Needed Equipment or Services	PATIENT IS BLS
Accompanying Documents	Please upload accompanying transfer documents.
Order Submission Certification
eOrder Submission Date	04/10/2024