Providence Ambulance eOrders – Ambulance Transport Order Portal

Entry ID	178
eOrder Submission Date	04/15/2024
eOrder Submission Time	17:35 PM
Requester Information
Ordering Facility	Providence St. Jude Plaza Radiation Oncology
Title	Radiation Therapist
Requester Department	st jude rad oncology
Requester Phone	714-446-5632
Requester Email	Email hidden; Javascript is required.
Service Needs Information
Service Level	EMT Basic Life Support
Trip Type	Wait and Return
Bariatric Patient?	No
Ambulance Transfer Reason(s)	In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date	04/16/2024
Response Type	Scheduled Transport
Pickup Time	08:50 AM
Appointment Time	09:40 AM
Standing Order	No
Pickup Location Information
Pickup Location	Providence St. Jude Medical Center
Pickup Location Department/Unit Name	5 north
Pickup Location Patient Room/Bed No.	5113-01
Pickup Location Department Phone	714-992-3000
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	714-446-5632
Reimbursement Information
Patient Information
Patient Name	steve lee
Patient Sex	Male
Patient Date of Birth	04/18/1943
Patient Age	80
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	Oxygen
Accompanying Documents	Please upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date	04/15/2024