Providence Ambulance eOrders – Ambulance Transport Order Portal

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Entry ID	183
eOrder Submission Date	04/23/2024
eOrder Submission Time	14:09 PM
Requester Information
Ordering Facility	Providence St. Joseph Hospital Orange
Title	Other
Other Title	dispatch
Requester Department	comm
Requester Phone	3106440500
Requester Email	Email hidden; Javascript is required.
Service Needs Information
Service Level	EMT Basic Life Support
Trip Type	One-Way
Bariatric Patient?	No
Ambulance Transfer Reason(s)	Patient requires admission to a locked unit.
Trip Schedule Information
Pickup Date	04/23/2024
Response Type	Next Available - Patient Ready Now
Standing Order	No
Pickup Location Information
Pickup Location	Providence St. Josseph Hospital Orange
Pickup Location Department/Unit Name	test
Pickup Location Patient Room/Bed No.	test
Pickup Location Department Phone	test
Pickup Location Contact Name	test test
Drop Off Location Information
Drop Off Location	Providence St. Josseph Hospital Orange
Drop Off Receiving Department/Unit Name	test
Drop Off Patient Room/Bed No.	test
Drop Off Receiving Department Phone	test
Drop Off Receiving Contact Name	test test
Reimbursement Information
Primary Insurance Carrier	test
Member ID No.	test
Payor Authorized?	No
Patient Information
Patient Name	test test test
Medical Record No.	test
Patient Sex	Female
Patient Date of Birth	04/01/2024
Patient Age	0
Spoken Language	English
Interpreter Required?	No
Patient Home Address	1 Mission Viejo Rd Mission Viejo, California 92679 United States Map It
Patient Medical Information
Isolation Precaution	No
Description of Patient's Current Chief Complaint/Medical Condition Requiring an Ambulance	test
Medical Necessity Certification
Is Patient Bed-confined?	No
Ambulance Medical Necessity Reason(s)	Unable to sit in a chair or wheelchair due to Grade II or greater decubitis ulcers on buttock.
Medical Needs During Transport
Required Equipment and Care	Airway Monitoring
Accompanying Documents	Please upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date	04/23/2024