Providence Ambulance eOrders

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Entry ID190
eOrder Submission Date04/26/2024
eOrder Submission Time14:42 PM
Requester Information
Ordering FacilityProvidence St. Jude Plaza Radiation Oncology
Requester DepartmentRAD ONC
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 Date04/29/2024
Response TypeScheduled Transport
Pickup Time12:10 PM
Appointment Time12:50 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name5N
Pickup Location Patient Room/Bed No.4108
Pickup Location Department Phone1714992-3000 EXT. 7520
Drop Off Location Information
Drop Off LocationProvidence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit NameRADIATION ONCOLOGY
Drop Off Patient Room/Bed No.SUITE 1500
Drop Off Receiving Department Phone1714446-5632
Drop Off Receiving Contact NameJUAN TORRES
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
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date04/26/2024