Providence Ambulance eOrders

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Entry ID186
eOrder Submission Date04/24/2024
eOrder Submission Time16:49 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 LevelEMT Basic Life Support
Trip TypeWait and Return
Bariatric Patient?No
Ambulance Transfer Reason(s)
  • In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date04/25/2024
Response TypeScheduled Transport
Pickup Time12:00 PM
Appointment Time01:00 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name4128
Pickup Location Patient Room/Bed No.4128
Pickup Location Department Phone7144469000
Drop Off Location Information
Drop Off LocationProvidence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit NameRadiation Oncology
Drop Off Receiving Department Phone7144465632
Reimbursement Information
Patient Information
Patient NameJuan Sanchez
Medical Record No.20025207745
Patient SexMale
Patient Date of Birth10/22/1949
Patient Age74
Spoken LanguageSpanish
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 Servicespt can't be more then 30 degrees to sit up without back brace
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date04/24/2024