Providence Ambulance eOrders – Ambulance Transport Order Portal

Entry ID	34
eOrder Submission Date	06/26/2023
eOrder Submission Time	16:37 PM
Requester Information
Ordering Facility	Providence St. Jude Medical Center
Title	Case Manager
Requester Department	654
Requester Phone	(616) 551-6161
Requester Email	Email hidden; Javascript is required.
Service Needs Information
Service Level	EMT Basic Life Support
Trip Type	One-Way
Bariatric Patient?	No
Ambulance Transfer Reason(s)	In-patient inter-campus transfer.
Trip Schedule Information
Pickup Date	06/01/2023
Response Type	Next Available - Patient Ready Now
Standing Order	No
Pickup Location Information
Pickup Location	Providence St. Jude Medical Center
Pickup Location Department/Unit Name	984
Pickup Location Patient Room/Bed No.	7
Pickup Location Department Phone	(545) 461-6516
Pickup Location Contact Name	John Doe
Drop Off Location Information
Drop Off Location	Providence St. Jude Medical Center
Drop Off Receiving Department/Unit Name	7
Drop Off Receiving Department Phone	(615) 651-6515
Drop Off Receiving Contact Name	John Doe
Reimbursement Information
Patient Information
Patient Name	John Doe
Patient Sex	Male
Patient Date of Birth	06/12/2023
Patient Age	52
Spoken Language	English
Interpreter Required?	No
Patient Medical Information
Isolation Precaution	No
Medical Necessity Certification
Is Patient Bed-confined?	No
Medical Needs During Transport
Required Equipment and Care	Airway Monitoring
Accompanying Documents	Please upload accompanying transfer documents.
Order Submission Certification
Signature
eOrder Submission Date	06/26/2023