| Entry ID | 172 |
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| eOrder Submission Date | 04/11/2024 |
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| eOrder Submission Time | 15:12 PM |
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| Requester Information | |
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| Ordering Facility | Providence St. Jude Plaza Radiation Oncology |
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| Title | Other |
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| Other Title | Radiation Therapist |
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| Requester Department | Rad Once |
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| Requester Phone | 7144465632 |
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| Requester Email | Email hidden; Javascript is required. |
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| Service Needs Information | |
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| Service Level | EMT Basic Life Support |
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| Trip Type | Wait and Return |
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| Bariatric Patient? | No |
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| Ambulance Transfer Reason(s) | - In-patient inter-campus transfer.
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| Trip Schedule Information | |
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| Pickup Date | 04/12/2024 |
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| Response Type | Scheduled Transport |
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| Pickup Time | 09:00 AM |
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| Appointment Time | 09:50 AM |
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| Standing Order | No |
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| Pickup Location Information | |
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| Pickup Location | Providence St. Jude Medical Center |
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| Pickup Location Department/Unit Name | 5NWT |
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| Pickup Location Patient Room/Bed No. | 5113 |
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| Pickup Location Department Phone | 7144465632 |
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| Drop Off Location Information | |
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| Drop Off Location | Providence St. Jude Plaza Radiation Oncology |
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| Drop Off Receiving Department/Unit Name | SUITE 1500 |
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| Drop Off Receiving Department Phone | 7144465632 |
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| Drop Off Receiving Contact Name | Hang Tao Tao |
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| Reimbursement Information | |
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| Patient Information | |
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| Patient Name | Steve Lee |
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| Medical Record No. | 20015623475 |
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| Patient Sex | Male |
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| Patient Date of Birth | 04/18/1943 |
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| Patient Age | 80 |
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| Spoken Language | Korean |
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| Interpreter Required? | No |
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| Patient Medical Information | |
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| Isolation Precaution | No |
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| Medical Necessity Certification | |
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| Is Patient Bed-confined? | Yes |
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| Medical Needs During Transport | |
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| Required Equipment and Care | |
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| Other Needed Equipment or Services | N/A |
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| Accompanying Documents | Please upload accompanying transfer documents. |
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| Order Submission Certification | |
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| eOrder Submission Date | 04/11/2024 |
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