Volunteer Activity Report -Virtual Visit or Call to Patient
Volunteer's Full Name
*
First Name
Last Name
Volunteer's ID Number
*
County
*
Please Select
Manatee
Sarasota
Charlotte
Desoto
Date of Service
*
-
Month
-
Day
Year
Date Picker Icon
Patient ID Number
*
Patients's Full Name
*
First Name
Last Name
Start and End Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
15
30
45
Minutes
AM
PM
AM/PM Option
until
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
15
30
45
Minutes
AM
PM
AM/PM Option
Family Involvement
*
Please Select
yes
no
Volunteer Services Role
*
Please type in your Volunteer Services Role
Task Completed and/or Observations
0/144
Electronic Signature
*
Please Select
I electronically sign this form
Submit
Should be Empty: