Providence Ambulance eOrders

← Go back

Entry ID184
eOrder Submission Date04/24/2024
eOrder Submission Time08:18 AM
Requester Information
Ordering FacilityProvidence St. Jude Plaza Radiation Oncology
TitleRadiation Therapist
Requester Departmentst jude radiation onc
Requester Phone714-446-5632
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 Date04/24/2024
Response TypeScheduled Transport
Pickup Time11:15 AM
Appointment Time12:10 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name4NWT
Pickup Location Patient Room/Bed No.4108
Pickup Location Department Phone714-992-3000
Drop Off Location Information
Drop Off LocationProvidence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit Name1500
Drop Off Receiving Department Phone714-446-5632
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 ServicesBLS
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date04/24/2024