If you need this service within 24 hours, please call our office at 800-201-7121 for personal assistance. Thanks for choosing Continental Interpreting Services for your language needs. Please send us the following information about your on-site interpreting assignment. This is a secure form. Ordering PartyYour First Name* Your Last Name* Your Phone Number*Section 1: Assignment InfoMedical Center Area/MOB Names* Address of Appointment* Street Address Address Line 2 City ZIP Code If necessary include building number, floor number, etc.Department Name*KP Contact Person*KP Contact Phone Number*Preferred method of contact for confirmation*PhoneFaxEmailKP Contact Fax Number*Email address* Enter Email Confirm Email Type of Appointment*(i.e. RX Consult, Pre-Op Consult, Mammogram)Language*SelectAmerican Sign LanguageAmharicArabicArmenianArmenian-EasternArmenian-RussianArmenian-WesternBengaliBulgarianCambodianCantoneseChineseCreoleCroatianCzechEnglishEthiopianFarsiFrenchFrench-CanadianGermanGujaratiHebrewHindiHmongHungarianIlocanoIndonesianIranianItalianJapaneseKoreanLaotianLebaneseMandarinPersianPolishPortuguesePunjabiRussianSomaliSpanishSwedishTagalogTaiwaneseThaiTonganTurkishUkrainianVietnameseOtherInterpreter Gender Preference*FemaleMaleFemale or MaleIf gender preference not available, ok to send available gender for appointment?*YesNoDate of Service* Date Format: MM slash DD slash YYYY mm/dd/yyyyStart Time* : HH MM AM PM Ending Time* : HH MM AM PM Spanish = 1 hour minimum; other languages = 2 hour minimum. Interpreters must stay the entire duration unless released by a KP representative.Patient Name*Medical Record Number*Section 2: Billing InformationPlease provide your cost center.Business Unit Number*080-#### (Region-Entity)Department Code*4-DigitsLocation Code*5-DigitsFDA Approver Name (Manager)*FDA Approver's Fax Number*FDA Approver's Email*FDA Approver NUID Number*Begins with a letter followed by 6-digitsCommentsThis field is for validation purposes and should be left unchanged.