Providence Ambulance eOrders

← Go back

Entry ID175
eOrder Submission Date04/15/2024
eOrder Submission Time10:09 AM
Requester Information
Ordering FacilityProvidence St. Jude Plaza Radiation Oncology
TitleRadiation Therapist
Requester DepartmentRadiation Therapy
Requester Phone7144465632
Requester EmailEmail hidden; Javascript is required.
Service Needs Information
Service LevelEMT Basic Life Support
Trip TypeRound Trip
Bariatric Patient?No
Ambulance Transfer Reason(s)
  • In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date04/15/2024
Response TypeScheduled Transport
Pickup Time01:30 PM
Appointment Time02:30 PM
Return Pickup Date04/15/2024
Return Pickup Time02:45 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name4n
Pickup Location Patient Room/Bed No.4108
Pickup Location Department Phone17149923000
Pickup Location Contact NameERICA BANALES
Drop Off Location Information
Drop Off LocationProvidence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit NameRadiaiton Therapy
Drop Off Patient Room/Bed No.rad onc
Drop Off Receiving Department Phone7144465632
Drop Off Receiving Contact NameDaryl Lee
Reimbursement Information
Patient Information
Patient NameERICA BANALES
Patient SexFemale
Patient Date of Birth11/03/1975
Patient Age48
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
  • Other
Other Needed Equipment or ServicesN/A
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
eOrder Submission Date04/15/2024