View
220
Download
0
Category
Preview:
Citation preview
8/11/2019 Volunteer Packet Revised July 2014
1/15
8/11/2019 Volunteer Packet Revised July 2014
2/15
completing &tep 35 +efer to &upplement 3 for information on how to complete the training5hen finished, print out the certificates and return to Deb to -eep in your file5
Step 5: During your orientation, you will receie final details about olunteering, training,and a uniform5 e will also wor- with you to schedule the days and times on which youolunteer so that they are conenient for you5 Orientation should ta-e no longer than acouple of hours we would li-e to do a tour of our beautiful facility and introduce you to asmany of our caregiers as possible if you hae the time5
*Please notify Deb Olson when you complete steps in the process. We are very excited tohave you become a member of our family here at the Stephenson Cancer Center.
Volunteers brin so much to the patient experience! and we than" you for ma"in a place
in your heart and in your life for our patients#
8/11/2019 Volunteer Packet Revised July 2014
3/15
Volunteer Information Sheet
Date: ________________
Mr./Mrs./Ms.____________________________________________________________________
(first) (middle) (last)
Present Address: _______________________________________________________________
(street)
_________________________________________________________________________(city) (state) (zip)
Cell Phone: _______________________ Home Phone: __________________________
E-mail Address: ____________________________________________________________
Date of Birth: ___________________
Name of Spouse: ______________________ Cell Phone: _____________________________
Have you had previous volunteer experience? [ ] Yes [ ] No
If yes, name of organization: _____________________________________________________
From ______________to________________
Are you currently a student? [ ] Yes [ ] No Where? ______________________________
Special skills and interests: _______________________________________________
Computer literate? [ ] Yes [ ] No Foreign languages: _______________________
Reason for wanting to volunteer: ___________________________________________
Name of physician: ______________________________________________________
Form 1
8/11/2019 Volunteer Packet Revised July 2014
4/15
City, State and Phone number: __________________________________________________
Limitations related to health? ___________________________________________________
Are you allergic to any drugs? [ ] Yes [ ] No If so, what? _____________________
If case of emergency, contact: ________________________Relationship: _______________
Address: ________________________________________________________________________
(street) (city) (state) (zip)
Cell Phone: __________________________Home Phone: ____________________________
I agree to and have signed the Volunteer Waiver and Release of Liability Form.
Signature of Applicant: _____________________________________ Date: ______________
If you have any questions, please contact:
PLEASE RETURN TO:
Stepenson .ancer .enter Volunteer Ser/ices+ttn: eb !lson 00 3$$ 10tStreet' "m &050 !laoma .it6' !# 7%104
Telephone: (405) 271-8384 Fax: (405) 271-5797Attention: Deb Olson
Opportunities for volunteers are provided without regard to race, color, national origin,
sex, age, religion, political affiliation, disability, or veteran status.
8/11/2019 Volunteer Packet Revised July 2014
5/15
8/11/2019 Volunteer Packet Revised July 2014
6/15
Form 2
8/11/2019 Volunteer Packet Revised July 2014
7/15
ni/ersit6 o8 !laoma ealt Sciences .enter .ampus+V" and "9+S o8 9+B9T
Tis ai/er and "elease o8 9iabilit6 (;+,reementuries orlosses 6ou ma6 cause or sustain as a result o8 6our decision to per8orm' =itoutcompensation /olunteer tass (;Ser/ices
8/11/2019 Volunteer Packet Revised July 2014
8/15
"elease 8rom 9iabilit6' ndemni8ication +,reementand .o/enant 3ot to Sue
0o the fullest etent permitted by law, on behalf of myself, my spouse, heir, representaties, eecutors, administrators andassigns, # agree to foreer +("(@&(, #*D(*#F
8/11/2019 Volunteer Packet Revised July 2014
9/15
3V"ST ?*9! +9T S"V.S
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA*atient 3ame (*lease print)
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVolunteerAAAAAAAAAAAAAAAate o8 Birt +,e T6pe o8 ob
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAome +ddress .it6 State Cip .ode
(AAAA)AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA( )AAAAAAAAAAAA AAome *one
or *one
SA? A ? F AA
?arital Status "ace SeD
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA (AAA)AAAAAAAAAAAAAAAAAAAmer,enc6 .ontact *erson "elationsip Telepone
Aebora !lsonAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAA(405)271-%4AAA?ana,erEs name Telepone
A*atient Ser/icesAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAStepenson .ancer .enterepartment.linic name 9ocation
0his is to certify that #, the undersigned, consent to the performance of procedures deemed necessary in the opinion ofthe attending physician5 # reBuest and authori?e 'niersity (mployee )ealth &erices to hae access to the informationand medical documentation relating to my isits at 'niersity (mployee )ealth &erices5
I hereby authorize University Employee Health Services to release all or any portion of my records, including x-rays and laboratory
results regarding my diagnosis, care and treatment rendered by University Employee Health Services. his authorization includes, but
is not limited to, my employer, insurance companies and !or"ers# compensation carriers.
AAAAAAAA
Form #5
Form 5a
8/11/2019 Volunteer Packet Revised July 2014
10/15
*atient Si,nature ate
8/11/2019 Volunteer Packet Revised July 2014
11/15
*+ST ST!": (a/e 6ou e/er ad an6 o8 te 8ollo=in, conditionsG)
AA+nemia AA.arpal Tunnel AAearin, loss AA9un, in8ectionsAA+n,ina pectoris AA.olitis AAeart isease AA?i,rainesAA+rtritis AA.olor Blindness AAepatitis AA3er/ous Breado=nAA+stma AAiabetes AAi, blood pressure AA*rior =or in>ur6AABac strain AAmp6sema AAi/es AA"uptured discAABleedin, trouble AA@out AAaundice AASeiHuresAA.ancer AAa6 8e/er AA#idne6 disease AASmoin,
*"S!3+9 +BTS:
.ircle i8 6ou e/er smoed: .i,arettes *ipe .i,ars
3umber per da6:AAAAAAAAAAA o= man6 6ears did 6ou smoe:AAAAAAAAAAAA
+re 6ou currentl6 a smoer: es 3o
+99"@S:
S"!S 3"S: (9ist and ,i/e approDimate dates)
!S*T+9 ST+S-!"-!*"+T!3S: (9ist and ,i/e approDimate dates)
?.+T!3S: (.ec all 6ou are currentl6 tain,)
AA+stma=eeHin, medicine AAormonesBirt control pillsAAStomaculcer medicine AAnsuliniabetic pillsAA+spirinT6lenol+d/il3uprin AA+ntibioticsAABlood tinners AASeiHure medicineAABlood pressure pills AA6e dropsAA.ou, medicine AAT6roid medicineAA.ortisone*rednisone AAVitaminsAAi,italiseart medicine AAei,t reducin, pillsAASleepin, pillstranIuiliHers AAater pillsdiureticsAA.olesterol reducin, medicine
Form 5b
8/11/2019 Volunteer Packet Revised July 2014
12/15
o!thbo!n" #he$e % 77 (&$oa"#a' xtension) beo*es +-235:
Take the Oklahoma Health Center/University of Oklahoma Health Sciences Center Exit
1! to "E 1$thStreet
T%rn left on "E 1$th Street
T%rn ri&ht at the 'e&&y ( Charles Ste)henson Cancer Center
*alet assistance an+ )arkin& &ara&e is strai&ht ahea+
,estbo!n" +-44
Supplement 1TB Test andVaccinations
Supplement 2
How to find the Volunteer office:
Enter through the Peggy & Charles Stephenson Cancer Center
parking garage located at 800 NE 10thStreet.
Pull up to the gates and the gate will open automatically.
Park on the 1, 2, or 3 floor and enter the building from the parking
garage.
Please notify the greeter at the front desk on the first floor (not LL)
Form 6Peggy & Charles
Stephenson Cancer
Center and adjacent
parking garage
8/11/2019 Volunteer Packet Revised July 2014
13/15
8/11/2019 Volunteer Packet Revised July 2014
14/15
,estbo!n" on +-40 :
Exit at the Oklahoma Health Center Exit 139 onto ,375
Take the University of Oklahoma Health Sciences Center Exit 16 secon+
exit on the ri&ht; .hich ecomes 0incoln o%levar+
Contin%e north to "E 1$th Street
T%rn ri&ht on "E 1$th Street
T%rn ri&ht at the 'e&&y ( Charles Ste)henson Cancer Center
*alet assistance an+ )arkin& &ara&e is strai&ht ahea+
.i/h#a' 3 ast onnetin/ to +-44 eastbo!n":
From ,-- take roa+.ay Extension so%th2 .hich ecomes ,375
Take the Oklahoma Health Center/University of Oklahoma Health Sciences CenterExit 1!
T%rn left on "E 1$th Street
T%rn ri&ht at the 'e&&y ( Charles Ste)henson Cancer Center
*alet assistance an+ )arkin& &ara&e is strai&ht ahea+
Supplement 2
8/11/2019 Volunteer Packet Revised July 2014
15/15
!o to the .esite:htt)://...o%hsce+%/hi))a/
to com)lete the H,' trainin&
Call or Email 6e Olsonto otain yo%r Trainee ,6
3o%hsce+%
Supplement 3
mailto:deborah-olson@ouhsc.edumailto:deborah-olson@ouhsc.eduRecommended