EMC - Volunteer Form

EPIC Medical Clinic - Volunteer Form
Requirements to volunteer at EPIC Medical Clinic.

Please note applying for volunteering does not garantee the opportunity as we have to verify the requirments put forth.

Thank you for filling out the form. Please review/agree to and complete the following requirements, so we can start the process.

Here are the requirements

1- Please complete the HIPAA certification. Complete this training and send me the certification.
https://courseforhipaa.com

2- Minimum age required to volunteer is 18 years.

3- We require scrubs for all staff (except MDs). You can purchase one from Walmart and the cost is about $12 for both shirt and pants. The color could be black or dark blue.

4- We require you to do one entire session, where you will shadow another MA and review and see if this is a good fit.

5- You are required to take at least 10 shifts in the course of 12 months. One each month, so you are more frequent and aware of all the changes and updates.

If you meet the above you can proceed to fill this form.
Name *

First Name Last Name
Volunteer As *
E-mail *
Date of Birth *

Month Day Year
Date
Contact Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Preferred Day *
How many hours are you available to volunteer per month *
Describe a time when you made a mistake and how you corrected it. *
Describe your medical experience (if any) *
Describe a time where you exceeded expectations. *
Describe an event when you handled a situation under stress. *
What motivates you to commit to volunteering with EMC *
Have you worked with any of these EHR (Electronic Health Record) Systems *
Anything you would like to share about yourself that would beneficial for this position *
Please attach your resume. *

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EPIC Medical Clinic - Volunteer Form