Providence Ambulance eOrders

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Entry ID180
eOrder Submission Date04/17/2024
eOrder Submission Time11:22 AM
Requester Information
Ordering FacilityProvidence St. Jude Plaza Radiation Oncology
TitleRadiation Therapist
Requester DepartmentRadiation Oncology Suite 1500
Requester Phone7144465632
Requester EmailEmail hidden; Javascript is required.
Service Needs Information
Service LevelEMT Basic Life Support
Trip TypeWait and Return
Bariatric Patient?No
Ambulance Transfer Reason(s)
  • In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date04/17/2024
Response TypeScheduled Transport
Pickup Time03:00 PM
Appointment Time03:50 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name4NW
Pickup Location Patient Room/Bed No.4128
Pickup Location Department Phone7144467520
Drop Off Location Information
Drop Off LocationProvidence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit NameRadiation Oncology Suite 1500
Drop Off Receiving Department Phone7144465632
Reimbursement Information
Patient Information
Patient NameJohn Zywocienski
Patient SexMale
Patient Date of Birth04/13/1955
Patient Age69
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
  • Other
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date04/17/2024