Clínica Mi Salud Volunteer Application

Dear Applicant, Thank you for your interest and willingness to volunteer for Clínica Mi Salud. Please review the following description and requirements before completing the application for CMS Volunteer.

1. Minimum age required to volunteer is 18 years.

2. You must complete the CMS Confidentiality Notice before you start volunteering in the clinic. The link to read and complete that notice is provided below.

3. We encourage and expect that you volunteer on a consistent manner and request you to sign up at least once a month.

4. A non physician volunteer is required to participate in clinic operations for at least 6 months before a letter of recommendation can be issued if needed.

5. Although it is not mandatory but we expect that you have some familiarity or willingness to learn electronic medical records (EMR). You will be given an orientation and training of EMR prior to your start as an CMS volunteer.

6. Please note that submission of this application does not guarantee a volunteer position. We will review your application and get back to you with an answer as soon as possible.

7. Before submitting the application for volunteer at Clínica Mi Salud, you must read and understand the clinic confidentiality notice. Please click on the link below, complete and submit the confidentiality notice and return back to submit your volunteer application. Thank you!

CLINICA MI SALUD CONFIDENTIALITY POLICY

I have reviewed and understood the polices and requirements of Clínica Mi Salud Volunteering.I have reviewed and understood the CMS Confidentiality Notice and I have completed and submitted that notice using the link above.

Name

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

I would like to volunteer as *

Please choose option that best suits your interest

I am able and willing to administer vaccines.*

YesNo

What days of the week are you available to volunteer? (Check all that apply)*

On average, how many hours on a monthly basis do you intend to volunteer at Clínica Mi Salud?*

Less than 3 hours3 - 6 hoursMore than 6 hours

On average, how many hours on a weekly basis do you intend to volunteer at Clínica Mi Salud?*

Less than 3 hours3 - 6 hoursMore than 6 hours

Have your worked with an electronic medical record (EMR) system in the past?*

YesNo

Describe your previous medical experience (if any):

Describe your strength(s) that may benefit Clínica Mi Salud: