Montefiore Health Opportunities Program (Monte H.O.P.) Volunteer Processing Instruction

Transcription

1 Montefiore Health Opportunities Program (Monte H.O.P.) Volunteer Processing Instruction All students accepted into the program must be processed and cleared through Montefiore Medical Center s Volunteer Department and Occupational Health Services (OHS). This process must be completed within one month of being accepted into the program. Please contact the program manager immediately if you encounter any obstacles that will interfere with making this deadline. Please read the instructions carefully. It is the student s responsibility to ensure she/he has all the required paperwork/identification required to complete this process. The two required forms are found below. You will be presenting to two different Montefiore Medical Center (MMC) Departments. You must be cleared by the MMC Volunteer Department first, then contact the program Manager Ms. Carol Whittaker, who will schedule you for MMC s OHS. *** Depending on the time of year, some students may be sent directly from the volunteer office to OHS on the same day. This is acceptable. If this occurs please inform Ms. Whittaker immediately and she will update your Monte H.O.P. acceptance records. Volunteer Department Clearance: You need to present to the Montefiore Medical Center Volunteer Department as a walk in to start the volunteer application process. No appointment is necessary. Volunteer Department Information Montefiore Medical Center (MMC), Main Hospital 3334 Kossuth Avenue, Brown Zone, Ground Floor (off Gunhill Road) (Past the elevators midway down the hall) Hours: 8:30am to 11:30am or 1:00pm to 3:00pm. Monday through Thursday (NO FRIDAYS) Steps to getting cleared by Volunteer Department and OHS Volunteer Department Clearance: 1. Present to the Volunteer Dept. at the above address to obtain the MMC Volunteer application. You will complete the application that day (bring all documents below on this day). 2. Bring all of your original identification documents (Volunteer dept wants to see them all). a. NYS photo ID or passport (if available) ** If you don t have a driver s license or passport you can get a non-drivers ID card at any Dept of Motor Vehicles. The Dept of MVA will give you a paper stating you have applied for this card. Bring this form with you to the volunteer dept. You must bring the official ID card to the volunteer department when you receive it to complete your processing. b. Original social security card. They will not accept a laminated card. ** If card is laminated you must go to a Social Security (SS) Department and apply for a new one. The SS Dept. will give you a letter stating that you have applied for a new one. You will need to bring that paper to the Volunteer Dept as proof of application. When you get the original card you must take it to the Volunteer Dept to complete your processing.

2 c. Permanent Residents: must present their Green Card. 3. Bring this Physical Exam form (use this form only) completed by your Physician. 1. Your Physician must document your negative PPD or CXR results on the form. 2. Labs (blood titers) should be done by your Physician or can be done by the OHS Dept at MMC, at no cost to you. If you would like the blood work to be done at MMC, after being cleared by the Volunteer dept please inform OHS and they will send you to the Monte lab with the appropriate paperwork. 4. You must take a handwritten essay to the Volunteer Dept explaining why you want to do volunteer work. (We recommend you hand write the essay you submitted with your application for the Monte H.O.P. program.) 5. Must take proof of a Tetanus shot within 10 years (usually on vaccination card, if not done within 10 years you must get vaccinated by your Physician and bring proof of vaccination). 6. The flu shot is recommended BUT NOT REQUIRED. 7. If scheduled to do urine drug screening you must go to the site they refer you to within the time frame they give you, often only 48 hrs, NO EXCEPTIONS. Failure to present within that timeframe will result in dismissal from the program. Make arrangements to go as early as possible. 8. Students under 18: in addition to the above you will need to submit the following: a. Parent Consent Form (the Volunteer office will give you that form and you have to get signed by one of your parents/legal guardian and either your Guidance Counselor OR your Principal. You must return this form to MMC Volunteer Dept to complete your processing. b. Possible additional documentation that may be requested: 1) working papers; and 2) birth certificate Occupational Health Clearance (OHS): Once the Volunteer Department clears you, you will be sent to OHS (either by the volunteer dept or by the Program Manager, Ms. Whittaker). When you present to OHS you will need to ask for the office manager, Ms. Margie Mora. You will need to let her know you are a student from the Monte H.O.P. program and need medical clearance. She will expedite your processing. 1. Once cleared by OHS they will give you a yellow or pink slip. You must make a copy of that slip for Monte H.O.P. and take the original slip back to Montefiore s Volunteer Department on that same day. 2. Bring the copy of the slip to the Monte HOP Program Manager, Ms. Whittaker (3544 Jerome Avenue, Bx, NY, 2 nd Floor, ; 2 blocks from the hospital, under the L train). Please let us know if you have any questions. Sincerely, Dr. Elizabeth Natal Program Director Ms. Carol Whittaker Program Manager

3 VOLUNTEER & STUDENT SERVICES 3334 KOSSUTH AVENUE, BRONX, NY REQUIREMENTS Originals and Non-Laminated Documents Only 1. Bring New York State Picture ID and Social Security Card, United States work authorization documents (VISA, Passport) 2. File an application 3. Physical Examination (Performed by applicants physician) within 1 year (form below- Volunteer Dept form) 4. IPPD skin TB test within 1 year. If positive make sure to attach the written interpretation of chest X-ray from Doctor also within 1 year. (Performed by applicant s physician). 5. Influenza Vaccine and H1N1 vaccine provided by your own physician. (recommended but not required) 6. Blood tests can be provided by Montefiore Medical Center at no cost to applicant after physical form is completely filled out by physician. Minimum of 4 hours per day/3 days a week and 200 hours commitment within 6 months or summer term. Must be medically and administratively cleared including but not limited to background screening and drug testing. JUNIOR VOLUNTEERS - IN ADDITION TO THE ABOVE: 16 years of age Parental consent Guidance Counselor s Recommendation Working papers Birth Certificate Hand written essay The application process takes an average of fifteen to twenty business days during the academic year and twenty five to thirty business days during the summer months. General Information Located in Moses Main Building 3334 Kossuth Avenue Brown Zone Ground Floor Office Hours: Monday - Friday Applications/Questions: Monday - Thursday 8:00 a.m. - 4:30 p.m. 8:30 a.m. 11:30 a.m. 1:00 p.m. 3:30 p.m.

4 THE HENRY AND LUCY MOSES DIVISION VOLUNTEER SERVICES DEPARTMENT VOLUNTEER PRE-PLACEMENT EXAMINATION REPORT PLEASE PRINT NAME: (First) (Last) (M.I.) D.O.B. ADDRESS: SOCIAL SECURITY #: TELEPHONE #: For Physician/NP/PA use only: 1. I certify that I performed a physical exam on this applicant on. There is no evidence of contagious illness or other disability that would interfere with his/her volunteering at Montefiore Medical Center. 2. Has the applicant any physical, medical or emotional conditions that need to be considered when making an assignment? / / Yes / No If yes, please state the restriction below: 3.REQUIRED PROCEDURES: (WITHIN ONE YEAR) 1. IPPD: Date Placed: Date Read: Result: 2. Chest X-Ray: MUST ATTACH OFFICIAL WRITTEN REPORT (CXR only if history shows conversion or if IPPD is positive). Date: Result: 4. Influenza Vaccine/Date: H1N1 Vaccine/Date 5. REQUIRED IMMUNIZATIONS: (Dates of vaccination are NOT acceptable; must provide copy of titers/lab report.) TEST TITER IMMUNE (yes or no) a.) Rubella (German Measles) b.) Rubeola (Measles) c.) Hepatitis HBsAg d.) Hepatitis HbsAB e.) Varicella f.) Mumps f.) Diphtheria-Tetanus (within 10 years) Date: 6.List name(s), dosage, and frequency of all medications taken: (prescribed or OTC): Last medical examination: How long have you known this patient? Date:, MD/PA/NP Signature Please stamp or print name, license number Address and phone

5 Volunteer Services Department Junior Representative OCCUPATIONAL HEALTH SERVICES CONSENT FOR TESTING PLEASE PRINT NAME: LAST FIRST SS# ADDRESS: DATE OF BIRTH: PHONE: The Montefiore Medical Center Occupational Health Services is authorized to administer the tests to me/ to my child for infectious diseases indicated below, so that I/she/he may perform volunteer services at the medical center. In the event of a request by the private physician, I will authorize the release of the test results to: Physician s Name: Date Address: Signature: Parent Signature (if applicant is under 18): NAME: SS# TEST REQUIRED: IPPD Hepatitis (HbsAG/Anti HbsAg) Measles (Rubeola) German Measles (Rubella) Chicken Pox (Varicella) Other (Specify) Volunteer Services Department Signature Occupational Health Services/Date