HOPE Medivan

(Free Mobile Medical Clinic)

of the

Nineveh Outreach Ministry

Document	Status	Date Posted
Volunteer Handbook and Policies	Updated	06/28/10
Job Action Sheets	Updated	06/18/10
Site Forms · Clinic · Triage · Registration · Driver	Updated	07/05/10
Medivan Forms
901 – Primary Language	Final	06/18/10
902 – Waiver of Liability	Final	06/18/10
903 – Medical Linkage	Final	06/18/10
904 – Patient Record	Final	06/18/10
905 – Unusual Occurrence Report	Final	06/18/10
907 – Medical History	Final	06/18/10
908 – Medical Review	Final	07/30/08
909 – Patient Information	Final	06/18/10
910 – Inventory Log	Final	06/18/10
911 – Record Check-out	Final	06/18/10
912 – Clinic Log	Final	06/18/10
913 – Equipment Inspection Log	Final	06/18/10
914 – Medical Release Form	Final	11/04/08
915 – Against Medical Advice	Draft	06/18/10
920 – Suspicious Injury	Final	07/30/08
950 – Lab / X-ray Log	Final	07/30/08
951 – Voucher	Final	07/30/08
952 – Laboratory Log	Draft	07/01/10
ss8572 – Child Abuse Report Form	Final	05/27/09

Volunteer Forms

906 – Job Descriptions	Updated	06/18/10
994 – Hep B Waiver	Final	05/08/09
995 – Employment Verification	Final	05/08/09
996 – Health Screening Report	Final	03/23/09
997 – Volunteer Application	Final	06/18/10
998 – Volunteer Orientation	Final	07/30/08
999 – Volunteer Acknowledgement Form	Final	06/18/10
Training
Volunteer Orientation		04/26/10
1000 – In-service Form	Draft	07/05/10