Providence Ambulance eOrders

← Go back

Entry ID193
eOrder Submission Date04/30/2024
eOrder Submission Time10:26 AM
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 Date05/01/2024
Response TypeScheduled Transport
Pickup Time11:30 PM
Appointment Time03:10 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name5N
Pickup Location Patient Room/Bed No.4128-02
Pickup Location Department Phone7149223000 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 Phone7144465632
Drop Off Receiving Contact NameJUAN A 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 Date04/30/2024