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.
Note that some of the items below are for your review, while others will need to be provided and/or completed and signed. It is important that you read all of the forms carefully and discuss any questions you may have with the volunteer coordinator if you are selected.
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
4. HIPAA Presentation
5. HIPAA Basics
VOLUNTEER FORMS AND REQUIRED DOCUMENTATION
2. Tuberculosis (TB) Screening
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Please provide medical documentation of a negative TB test within 12 months of your onboarding.
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If you've tested positive for TB, please provide:
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Documented proof of the positive TB test result.
AND
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Medical documentation of a Chest Radiograph Report (Chest X-Ray) indicating negative TB result within 12 months of your onboarding.
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4. COVID-19 Screening Questionnaire
5. Waiver of Liability for Providing Volunteer Services Form
6. Influenza Vaccine - most recent/current flu vaccine
7. On the Job Injuries Release Form
8. COVID-19 Vaccine - most recent/current COVID vaccine
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