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RotaCare Volunteer Forms

Below are links so you can download the forms necessary to be a volunteer at any of the RotaCare Bay Area Inc. clinics. Please make sure that you speak to the Volunteer Coordinator of the clinic prior to reading and filling out these forms. 

Note that some of the items below are for your review, while others will need to be provided and/or completed, signed and returned to the volunteer coordinator of the clinic. It is important that you read all of the forms carefully and discuss any questions you may have with the volunteer coordinator. 

Thank you for your interest in becoming a volunteer with RotaCare Bay Area Inc.

VOLUNTEER HANDBOOKS & REQUIRED READINGS

1.  Purpose of Volunteer Handbook
2.  Volunteer Manual/Handbook
3.  Abuse Policy Handbook
5.  HIPAA Presentation
6.  HIPAA Basics

VOLUNTEER FORMS AND REQUIRED DOCUMENTATION


1.  Volunteer Application

2.  Documentation of initial negative TB test result and if positive, a subsequent chest x-ray with negative                       findings must be provided. ***Tests must be within 12 months of volunteer start date***
3.  TB Questionnaire
4.  COVID-19 Screening Questionnaire
5.  Waiver of Liability for Providing Volunteer Services Form
6.  Documentation of mandatory current seasonal influenza vaccination
7.  On the Job Injuries Release Form
8.  Proof of most current updated COVID-19 vaccination
9.  Orientation Checklist
10.  Abuse Reporting Responsibilities Form
11.  Receipt & Acknowledgement of Volunteer Handbook
12.  Volunteer Confidentiality Agreement
13.  HIPAA Compliance Attestation Form
14.  Standard Model Release Form
D. For Medical Providers:
1. Medical Provider Application  (MD, DO, PA, NP ONLY)
2. Physician Certificate Check Off List
3. Peer Reviews (if applicable)
4. NPI number
E.  Nurse Practitioner Standardized Procedures Policy and Statement of Approval and Agreement
F.  Physician Assistant Practice Agreement
G. All licensed and certified volunteers must provide evidence of current license/certificate

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