Providence Ambulance eOrders

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Entry ID176
eOrder Submission Date04/15/2024
eOrder Submission Time12:28 PM
Requester Information
Ordering FacilityProvidence St. Jude Plaza Radiation Oncology
Requester DepartmentRADIATION ONCOLOGY
Requester Phone7144465632
Requester EmailEmail hidden; Javascript is required.
Service Needs Information
Service LevelParamedic Advance Life Support
Trip TypeWait and Return
Bariatric Patient?No
Ambulance Transfer Reason(s)
  • In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date04/15/2024
Response TypeScheduled Transport
Pickup Time02:20 PM
Appointment Time03:20 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name373
Pickup Location Patient Room/Bed No.373-01
Pickup Location Department Phone7149923000 ext 1710
Drop Off Location Information
Drop Off LocationProvidence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit Nameradiaition oncology
Drop Off Receiving Department Phone7144465632
Reimbursement Information
Patient Information
Patient NameRandolph Faver
Medical Record No.20015054023
Patient SexMale
Patient Date of Birth09/08/1960
Patient Age63
Spoken LanguageEnglish
Interpreter Required?No
Patient Medical Information
Isolation PrecautionNo
Medical Necessity Certification
Is Patient Bed-confined?No
Medical Needs During Transport
Required Equipment and Care
  • Cardiac Monitoring
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date04/15/2024