I hereby grant Southern 7 County Medical Reserve Corps permission to use my likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of Southern 7 County Medical Reserve Corps and will not be returned.

I hereby irrevocably authorize Southern 7 County Medical Reserve Corps to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Southern 7 County Medical Reserve Corps programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product,
including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.

I hereby hold harmless and release and forever discharge Southern 7 County Medical Reserve Corps from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons
acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

Each employee, volunteer, or intern working for the health department is a representative of this agency. In many cases, because of the nature of field visits and community programming, you may be the only representative of this agency a person comes in contact with. The public's perception of this agency is based not only on the services we provide to the community, but also on the conduct and personal appearance of our staff. In order for this agency to have positive public relations, we need to ensure that we provide quality services in a friendly and professional manner.

It is the responsibility of each employee to contribute to S7HD public relations in the following ways:

Provide quality services

Perform your job duties according to existing agency procedures and policies. Share through appropriate means any ideas you may have for improving the quality of services provided by this agency.

Conduct yourself in a helpful and professional manner

The key here is to focus on treating the public with respect-Le., the way we ourselves would want to be treated. The following were voted on by staff as key points to remember when working with the public:

• Smile!
• Be friendly and courteous, yet professional
• Acknowledge presence of public waiting to be served (even if on the phone)
• Listen actively and with empathy
• Be helpful in directing requests for service or information, even if not directly within your area of responsibility

Project a professional image

Each employee's appearance is an important part of this agency's public relations. Employees are expected to report to work looking clean, tidy, and in clothing and accessories that do not detract from your job duties. The goal is to have the public remember us for our quality service and helpful manner. The appropriateness of certain attire is somewhat dependent on that day's job duties. If you have questions regarding appropriate attire, please discuss those with your supervisor.

I understand the following policies:

S7MRC members are expected to:

As a MRC volunteer, I will:

By signing below, I recognize that I have a responsibility to adhere to the rules and procedures of S7MRC and the items outlined in this S7MRC Volunteer Code of Conduct, Policies & Procedures document. Failure to do so or failure to satisfactorily perform my S7MRC volunteer assignment(s) may cause me to be subject to dismissal.

Volunteer Protection Statutes

A director or officer of a non-profit is not liable for damages resulting from the exercise of judgment in their official duties. Volunteers are included as employees in the State Employee Indemnification Act. Court-appointed special advocates are
immune from civil and criminal liability. A volunteer rape counselor who discloses authorized records is immune from civil liability. A volunteer firefighter is not liable in civil suit for damages or injuries caused while in his performance of duties, and the fire department is liable for the damages. A certified person who performs CPR or uses a defibrillator machine on a person in need in an emergency is not liable for civil damages. A certified dentist or physician who renders emergency care is not liable for civil damages. A volunteer who provides services at a free medical clinic is not liable for civil damages.

805 ILCS 105/108. 70, Limited liability of directors, officers and persons who serve without compensation

No director or officer of tax exempt nonprofit organized under the state nonprofit corporation act shall be liable and no cause of action may be brought for damages resulting from the exercise of judgment or discretion in connection with the duties and responsibilities of such director unless: the director earns in excess of $5,000 per year from his duties as director (other than reimbursement for actual expenses) or the act or omission involved willful or wanton conduct. Exception: the director or officer earns in excess of$5,000 per year, other than reimbursement for actual expenses, or the act or omission involves willful or wanton conduct. No person who, without compensation other than reimbursement for actual
expenses, renders service to or for a corporation organized under the state nonprofit corporation act to a tax Nonprofit Risk Management Center-(202) 785-3891 -www.nonprofitrisk.org
37 exempt nonprofit shall be liable, and no cause of action may be brought, for damages resulting from an act or omission in rendering such services
Exception: the act or omission involved willful or wanton conduct.

5 ILCS 350/1, "Employee" includes volunteers for State Employee Indemnification Act
For purposes of the State Employee Indemnification Act, the term "employee" includes people who perform volunteer services for the state and people who volunteer for non-profit organizations as long as the volunteer relationship is in writing.

705 ILCS 40512-17.1, Court-appointed special advocate
A court-appointed special advocate who serves as a volunteer without compensation and acts in good faith within the scope of duty has immunity from civil and criminal liability. The good faith of a court appointed special advocate will be presumed.
Exceptions: willful and wanton misconduct.

735 ILCS 5/8-802.1, Rape-crisis volunteer
A volunteer rape crisis counselor who participates in good faith in the disclosing of particular records and communications has immunity from civil, criminal or any other liability that may arise from the action.

740 ILCS 75/1, Volunteer firefighter
If a volunteer firefighter causes injury to person or property while engaged in the performance of duty, and the injured person does not contribute to the negligence, the fire district or incorporated fire organization that the firefighter is working for is liable for the injury. A volunteer firefighter may enter upon land to carry out his duties and is not civilly or criminally liable. A volunteer firefighter is not liable in damages for injury to person or property caused by him during the performance of duties. Exceptions: injury resulted from willful and wanton misconduct.

745 ILCS 4912, Legislative intent
The provisions of the Good Samaritan act will be liberally construed to encourage people to volunteer their time and talents.

745 ILCS 49110, CPR volunteer
Any certified person who performs CPR up to generally recognized standards without compensation, in good faith, and on a
person in need of such is not liable for civil damages for an act or omission.
Exceptions: willful and wanton misconduct. Nonprofit Risk Management Center-(202) 785-3891 -www.nonprofitrisk.org
38

745 ILCS 49/12, Defibrillator volunteer
Any certified person who renders emergency medical care using an automatic external defibrillator in good faith and without compensation is not liable for civil damages to the person helped.

(Text of Section after amendment by P.A. 99-42)
Sec. 30. Free medical clinic; exemplion from civil liability for
services performed without compensation. 

(a)A person licensed under the Medical Practice Act of 1987, a
person licensed to practice the treatment of human ailments in any other state or territory of the United States, or a health care professional,
including but not limited to an advanced practice nurse, physician
assistant, nurse, pharmacist, physical therapist, podiatric physician, or social worker licensed in this State or any other state or territory of the United States, who, in good faith, provides medical treatment, diagnosis, or advice as a part of the services of an established free medical clinic providing care to medically indigent patients which is
limited to care that does not require the services of a licensed hospital or ambulatory surgical treatment center and who receives no fee or compensation from that source shall not be liable for civil damages as a result of his or her acts or omissions in providing that medical treatment, except for willful or wanton misconduct.

(b) For purposes of this Section, a ''free medical clinic" is:
(1) an organized community based program providing medical care without charge to individuals unable to pay for it, at which the care provided does not include the use of general anesthesia or require an overnight stay in a health-care facility; or
(2) a program organized by a certified local health department pursuant to Part 600 of Title 77 of the Illinois Administrative Code, utilizing health professional members of the Volunteer Medical Reserve corps (the federal organization under 42 U.S.C. 300hh-15) providing medical care without charge to individuals unable to pay for it, at which the care provided does not include an overnight stay in a health-care facility.

(c) The provisions of subsection (a) of this Section do not apply to a particular case unless the free medical clinic has posted in a conspicuous place on its premises an explanation of the exemption from civil liability provided herein.

(d)The immunity from civil damages provided under subsection (a) also applies to physicians, hospitals, and other health care providers that provide further medical treatment, diagnosis, or advice to a patient upon referral from an established free medical clinic without fee or compensation.

(e)Nothing in this Section prohibits a free medical clinic from
accepting voluntary contributions for medical services provided to a
patient who has acknowledged his or her ability and willingness to pay a portion of the value of the medical services provided. Any voluntary contribution collected for providing care at a free medical clinic shall be used only to pay overhead expenses of operating the clinic. No portion of any moneys collected shall be used to provide a fee or other compensation to any person licensed under Medical Practice Act of 1987.

(f) The changes to this Section made by this amendatory Act of the
99th General Assembly apply only to causes of action accruing on or after the effective date of this amendatory Act of the 99th General Assembly.
(Source: P.A. 98-214, eff. 8-9-13; 99-42, eff. 1-1-16.)

The Southern 7 County Medical Reserve Corps (S7MRC) provides services to our community that may be sensitive in content. Per the Health Insurance Portability and Accountability Act (HIPPA) regulations, we request to you sign and return the following document to your unit coordinator for placement in your file, indicating that you will keep information to which you have access confidential and not discuss it with anyone other than the staff person with whom you are working. Discussing confidential information outside of the scope of work could result in legal action.

In the course of your volunteer duties, you may become aware of confidential information, including but not limited to the addresses, phone numbers, social security numbers, and medical histories of community members. You are obligated as a volunteer of the Southern 7 County Medical Reserve Corps to follow the DHR policy on confidentiality.

Some guidelines to follow include:

1. Follow all training and instructions regarding the collection and management of client information.

2. Keep all client information within your control until transferred to the appropriate personnel.

3. Keep all client information out of the view of others.

4. Never discuss clients or their circumstances with unauthorized personnel including other workers not assigned to that client.

5. Never discuss one client with another.

6. Never discuss clients or their circumstances in areas where it may be possible to overhear the discussion.

7. Treat all client information as privileged and confidential.

 

I, _______________ by my signature below, hereby affirm that I understand the rules of patient confidentiality as governed by the Health Insurance Portability and Accountability Act (HIPPA) and by accepted standards in healthcare, including information about services accessed and/or provided.

I understand that a patient's privacy is to be protected at all times, and that a patient's private personal and health information is to be shared only with other health care and public safety providers who have a need to know such information in order to appropriately assist in or take over the care of said patient.

If I believe an individual being served or another person is in imminent risk of serious injury of death, I agree to consult my supervisor as to my course of action. I understand that my supervisor will inform me if a public health exception is applicable. I further understand that this agreement will remain in effect even after termination of my participation in S7MRC.

I hereby accept my ethical and legal responsibility to protect the privacy rights of patients for whom I provide or assist in medical or personal care. I will share a patient's medical and personal information only with those who must have that information to assist in or take over that patient's care.
Signed: