Providence Ambulance eOrders

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Entry ID188
eOrder Submission Date04/25/2024
eOrder Submission Time16:24 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 Date04/26/2024
Response TypeScheduled Transport
Pickup Time01:20 PM
Appointment Time02:20 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name4108
Pickup Location Patient Room/Bed No.4108
Pickup Location Department Phone7144469000 ext 7520
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 NameErica Banales
Medical Record No.20015861183
Patient SexMale
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 Servicesgurney
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date04/25/2024