1. I will follow the instructions given by the staff membersupervising me.2. I will be sure to notify the correct staff members if I willnot be able to come in to my assigned shifts.3. I will follow all rules and guidelines set forth by the clinic.4. I will be respectful of all St. Luke’s Free Medical Clinicstaff, patients, and volunteers.5. I will complete 50 hours within my first year of volunteering at St. Luke's. 6. I am not an active patient nor do I have a family member who is an active patient at St. Luke's6. I understand that not following the above guidelines canresult in me being removed from my position, or no longerbeing a volunteer at St. Luke’s Free Medical Clinic.I, First Name* Last Name* , understand and agree to the terms above.
I, First Name* Last Name* , volunteer at St. Luke’s Free Medical Clinic,release and forever discharge and hold harmless St. Luke’s Free Medical Clinicfrom any and all liability, claims, and demands of any nature, either in law or inequity, that arise or may hereafter arise from the volunteer services providedon-site at St. Luke’s Clinic. I understand and acknowledge that this Releasedischarges St. Luke’s Free Medical Clinic from any liability or claim I may haveagainst the Clinic with respect to personal or bodily injury, death or propertydamage that may result from volunteer services I provide or that occur while I amproviding volunteer service.I am not experiencing a this time: fever, sore throat, cough, stuffy nose or any othersymptom related to COVID-19.I have not been in contact with anyone exhibiting any such symptoms asmentioned above within the last 14 days.I have not traveled internationally within the past month.
Confidential information is defined as privileged information found in a patient’s medical record. All information relating to a patient’s care, treatment, condition, or in information contained in the patient’s record constitutes confidentialinformation.Employees or volunteers shall never discuss a patient’s condition or financial circumstances with friends or family members or other outside individuals. Disclosure that a patient is seen in our clinic could also indicate the nature of the patient’s circumstances, and therefore, should not be release without proper authorization.Every effort should be made to protect patient confidentiality. Any discussion of patient information is subject to discharge from employment or volunteer service in the Clinic.I HAVE READ AND AGREE TO THE ABOVE POLICY RELATING TOCONFIDENTIALITY OF PATIENT RECORDS AND PATIENTINFORMATION.First Name* Last Name*