Providence Ambulance eOrders

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Entry ID202
eOrder Submission Date05/16/2024
eOrder Submission Time17:40 PM
Requester Information
Ordering FacilityProvidence St. Jude Plaza Radiation Oncology
TitleRadiation Therapist
Requester Department1500
Requester Phone714-446-5632
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 Date05/17/2024
Response TypeScheduled Transport
Pickup Time01:00 PM
Appointment Time01:40 PM
Standing OrderNo
Pickup Location Information
Pickup LocationProvidence St. Jude Medical Center
Pickup Location Department/Unit Name5 Nw
Pickup Location Patient Room/Bed No.5120
Pickup Location Department Phone7149923000
Drop Off Location Information
Drop Off LocationProvidence St. Jude Plaza Radiation Oncology
Drop Off Receiving Department/Unit Name1500
Drop Off Receiving Department Phone7144465632
Reimbursement Information
Patient Information
Patient NameChristopher benison
Patient SexMale
Patient Date of Birth09/09/1949
Patient Age74
Spoken LanguageEnglish
Interpreter Required?No
Patient Medical Information
Isolation PrecautionNo
Medical Necessity Certification
Is Patient Bed-confined?No
Medical Needs During Transport
Required Equipment and Care
  • Other
Accompanying DocumentsPlease upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date05/16/2024