Dear Prospective Volunteer:

Transcription

1 Dear Prospective Volunteer: Thank you for your interest in volunteering at Astria Sunnyside Hospital. This packet will provide you with an overview of our Volunteer Program and the application process. Once paperwork is completed please call to schedule an interview. Please note that all applicants must bring the bulleted items with them at the time of the interview: Completed volunteer application A valid identification An immunization record A reference letter (between ages 16-25) Signed parent authorization form if applicable All applicants must be at least 16 years of age and available to volunteer a minimum of 4 hours per week for at least three months. Volunteers are trained in their specific area either by a trained volunteer or a staff member. Astria Sunnyside Hospital values the dedication and the many hours of service, its volunteers give each year. Thank you for your interest in being a part of our dedicated team of people helping other people. Thank you and enjoy your experience. Sincerely, Elizabeth Cerrillo Coordinator, Volunteer Services Astria Sunnyside Hospital

2 VOLUNTEER SERVICES STUDENT VOLUNTEER PROGRAM PARENT/GUARDIAN INFORMATION & CONSENT FORMS Dear Parent or Guardian: Your child has indicated an interest in becoming a student volunteer at Astria Sunnyside Hospital. This program s purpose is twofold: To provide a satisfying experience for young people in worthwhile community service and to provide an opportunity for observing careers in healthcare. The following facts concerning student volunteers will be of interest to you: 1) Teens must be at least 16 years of age and commit to a minimum of 3 months of service. 2) Student volunteers are expected to report to the assignment as scheduled and be at the assigned area for the full time unless prior arrangements have been made with the Director. If you would like your child to become a student volunteer, please review the attached documents, sign where appropriate and have your child contact Volunteer Services at to set up a personal interview. We will then be able to place them when appropriate volunteer opportunities arise. Please call me if you have any questions or concerns. Thank You. Sincerely, Elizabeth Cerrillo Volunteer Coordinator Volunteer Servicers

3 CONSENT FOR MINOR TO PARTICIPATE IN VOLUNTEER ACTIVITIES I am the parent/guardian of I understand that my child would like to participate in the student volunteer program at Astria Sunnyside Hospital. I understand that volunteers are not employed by Astria Sunnyside Hospital and that there will be no financial remuneration for services contributed by volunteers. I further understand that in order for my child to participate, this parental consent must be signed and returned to the Director of Volunteer Services. I agree that may participate in the student volunteer program at Astria Sunnyside Hospital and that she / he will abide by all policies, procedures, and regulations that will affect he / him as volunteer. Signature, Parent/Guardian Phone Number Date AUTHORIZATION TO CONSENT TO TREATMENT OF MINOR In the event my child is injured while volunteering at Astria Sunnyside Hospital and we are unable to reach you, do you want your child treated at Astria Sunnyside Hospital? YES I/We, Parent / Guardian, of, a minor, do hereby authorize Astria Sunnyside Hospital to provide hospital care, which is deemed advisable by and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act on the medical staff of Astria Sunnyside Hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of the parent/guardian to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable. NO I do not want my child treated at Astria Sunnyside Hospital. I wish my child treated at. Signature, of Parent / Guardian Date MINOR CONSENT / RELEASE FORM I, the undersigned, authorize Astria Sunnyside Hospital Occupational Health Department staff to administer a pre-placement QuantìFERON - G (QFT-G) to my child as required by Washington State law and Astria Sunnyside Hospital policy. Name of Minor Signature, of Parent / Guardian Date

4 10 th & Tacoma * P.O. Box 719 * Sunnyside, WA (509) * Fax (509) VOLUNTEER APPLICATION Name: Today s Date: Address: Telephone: City State: Zip: Emergency Contact #1: Relationship: Telephone: Alternate Phone: Emergency Contact #2: Relationship: Telephone: Alternate Phone: AVAILABILITY Please indicate the days and times you are available to volunteer: Monday Tuesday Wednesday Thursday Friday Saturday Sunday AM PM EVE SKILLS/PREFERENCES Helping Visitors Helping Patients Mailings/Special Projects Typing/Filing Computer Errands/Delivery Crochet/Knitting Gift Shop

5 REFERENCES Please list 2 people other than relatives who would be willing to serve as a personal reference. Reference #1: Telephone: Address: Alternate Phone: City State: Zip: Relationship: Reference #2: Telephone: Address: Alternate Phone: City State: Zip: Relationship: Believing that Astria Sunnyside Hospital has need of my services as a volunteer, I agree to: Hold as absolutely confidential all information, which I may obtain directly or indirectly concerning patients, doctors, or personnel and I will not seek confidential information in regard to a patient. My services are donated to Astria Sunnyside Hospital without contemplation of compensation or future employment and given with humanitarian or charitable reasons. Applicant s signature Date

6 10 th & Tacoma * P.O. Box 719 * Sunnyside, WA (509) * Fax (509) STATEMENT OF CONFIDENTIALITY I, as an (Employee, Volunteer, Staff Member, Board Member, Contract Employee, Student) of Astria Sunnyside Hospital & Astria Health Centers, understand that Washington State privacy laws and federal Health Insurance Portability and Accountability Act (HIPAA)/Health Information Technology and Clinical Health (HITECH) regulations, as well as the policies of this facility, prohibit the unauthorized disclosure of personal, demographic, patient insurance, financial, and medical information, including a patient s medical history, mental or physical condition, or treatment, whether or not the information is contained in the patient s medical record. I understand that unauthorized viewing of a patient s Protected Health Information (PHI), or viewing information without a legitimate need to know, is also prohibited. When there is a legitimate need to know PHI, I will disclose or ask for only the minimum necessary information for the situation. If I am a nurse (RN, LPN, NAC, NAC/HUC, MA or student), however, I may access all PHI on any patient I am directly treating. If I am aware of an inappropriate disclosure of a patient s PHI, or have a question or concern regarding a patient s privacy rights, I will notify the HIPAA Privacy Officer and/or the CEO. I understand that I am not to access any patient records unless that patient has a valid clinical registration at the clinic or department where I am employed or stationed, and/or I have a jobrelated need to access it. I further understand that I am not to access my own patient record or that of an immediate family member. Our patient records are to be obtained by written request through Medical Records or the clinic where we are being treated. I also understand that the law and the policies of this facility prohibit the accessing and disclosure of other confidential information, including but not limited to information about members of the medical staff, the facility s employees, and the facility s finances. I understand it is my duty and obligation to maintain confidentiality of all such information, and I shall do so throughout and after the tenure of my services at this facility. I further understand that any accidental or intentional violation of confidentiality may lead to serious consequences, up to and including termination of my employment, discontinuance of my volunteer services at this facility, legal action, or other appropriate action as deemed necessary by the employer. Name Date Signature Witness Date

7 BENEFITS Volunteer name badge. Volunteer will be allowed one 15 minute break in each four hour work period. If you volunteer: 2 4 hours = One 15 minute break 6 hours = Two 15 minute breaks 8 hours = Two 15 minute breaks and 30 minute lunch Meal breaks are not counted toward volunteer hours. Rest periods of fifteen minutes are included as hours worked. Volunteers may not leave the premises during break periods. Breaks Include: 1 snack and 1 beverage. SNACK: (Choose 1): BEVERAGE: (Choose 1): (1) Cookie (1) Canned pop (1) Fresh fruit, fruit cup or applesauce (1) Carton of milk (1) Muffin or Danish (1) Frozen yogurt (1) Sugar free pudding (1) Complimentary coffee and tea (1) Bag of chips The hospital pharmacy will fill prescription for volunteers and their spouse/dependents at cost plus 10%. 20% discount on café purchases. Must have badge and notify cashier with each selection. Invitation to Volunteer Recognition Luncheon. Invitation to hospital picnics, barbecues, etc. Documentation of hours served for school applications and job resumes. In turn you benefit: A chance to develop new interests. A chance to learn new skills. A chance to make new friends, meet employees from other areas of the hospital as well as people from your own community. A chance to show off your expertise. AND MOST OF ALL: A chance to enjoy the rare satisfaction that comes from helping others.

8 VOLUNTEER SERVICES POSITION DESCRIPTIONS ADM Admitting (Mon-Fri 8am 5pm) Volunteer will greet all patients, escort visitors, and deliver materials to other departments, occasional filing, and locating wheelchairs throughout the hospital. Must have excellent communication skills. AUX Gift Shop (Mon-Sun 9am 5pm) This service is maintained for the convenience of patients, visitors and staff. Duties include cashiering, dusting and stocking shelves. CP Clerical Assistant (Mon-Fri 8am 5pm) Volunteer will bag smaller equipment and take to Central Supply, typing, word processing, filing, making appointments, organizing, checking stock and supplies and restocking. CS Central Supply (Mon, Wed, Fri 8am 11am) Volunteer will fold towels and deliver supplies to ER department. DEB Diabetic Services (Mon Fri) (Flexible hours) Volunteer will assist in typing, organizing files, computer entry and using copy machine. Reminder calls, to patients for appointments. ED Administrative/Clerk (Mon Fri 9am 3pm) Volunteer assists in photocopying, filing, laminating and running supplies to different departments. Making packets for in-service programs. Computer experience needed. ES Environmental Services (Any day of the week) (9am -2pm / 2pm -6pm) Volunteer will unload linen, stock shelves, make beds, stock linen carts, and fold linen, dust mop all main hallways as needed.

9 VOLUNTEER SERVICES POSITION DESCRIPTIONS FBC Clerical Assistant (Flexible) Volunteer will assist nursing staff with answering phones, making charts, filing patient s charts and with any typing and take specimens down to lab. FBC Project Warm Up (Crochet/knit at home) Volunteer will knit/crochet baby booties, hats, afghans and layette sets for newborns leaving the hospital. ICU Intensive Care Unit (One day/week 7-9 pm) Volunteer will answer phone, answer door, call for lab and x-ray reports, take specimens down to lab, and help fill our patient menus, mount EKG strips, check desk supplies and copy charts for patients transfers. MS Clerical Assistant (Mon/Fri 7:30 am 11:30 am) (Sat/Sun 11:30 am 2:30 pm) Volunteer will take apart charts, read to patients, answer phone at nurse s station, sort and deliver magazines, and take specimens down to lab provide washcloths and towels to patients, and answer lights on intercom board. MT Maintenance Assistant (One day/week 4 hrs.) Volunteer will touch-up paint on doors, door jams and wall. Also help with outside work. Volunteer will care for hospital plants. (Watering and trimming) NSA Nursing Administrator Assistant (Mon - Fri) (3:00pm 5:00pm) Volunteers will type accurately and precisely, file and organize for nursing unit. Make copies. Computer skills required. SUR Clerical Assistant (1-2 days a week) Volunteers will do filing, laminating, typing, shredding, mail disbursement computer and organizational skills.

10 VOLUNTEER SERVICES POSITION DESCRIPTIONS KEY TO DEPARTMENTAL CODES ADM AUX CP CS DEB ED ES FBC FBC ICU MS MT NSA SUR ADMITTING AUXILIARY CARIDOPULMONARY CENTRAL SUPPLY DIETICIAN SERVICES STAFF EDUCATION ENVIROMENTAL SERVICES FAMILY BIRTH CENTER FAMILY BIRTH CENTER/ CROCHET/KNIT INTENSIVE CARE UNIT MED SURG UNIT MAINTENANCE ASSISTANT NURSES SERVICES ADMINISTRATOR SURGERY