Providence Ambulance eOrders

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Entry ID191
eOrder Submission Date04/26/2024
eOrder Submission Time15:00 PM
Requester Information
Ordering FacilityProvidence St. Jude Plaza Radiation Oncology
Requester DepartmentRAD ONC
Requester Phone1714446-5632
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 Date04/29/2024
Response TypeScheduled Transport
Pickup Time10:00 AM
Appointment Time10:40 AM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name5N
Pickup Location Patient Room/Bed No.4128
Pickup Location Department Phone1714922-3000 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 NameJUAN SANCHEZ
Patient SexMale
Patient Date of Birth10/22/1949
Patient Age74
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