mission of mercy: index of sample forms/materials · Montpelier Gift Bags/Items - $2,950 Patient Registration $2,400 $6,308 Office Supplies $200 $1,375 ... Mission of Mercy In-Kind

mission of mercy: index

of sample forms/materials

This booklet contains a compendium of information compiled from various Mission of Mercy (MOM) events to help you plan and organize a MOM event in your area. It is intended to supplement the MOM “Model That Made It” implementation guidebook developed by the Virginia Health Care Foundation (VHCF). The sample forms and materials contained here are organized by Committee and correspond to those cited in the MOM implementation guidebook. We hope these materials will be helpful to you in creating your own MOM event. Visit the Virginia Health Care Foundation website at www.vhcf.org to download any of these materials, and to find the MOM implementation guidebook. If you have suggestions for additions or changes to this information, we encourage you to share them. Please email [email protected] with any comments or ideas for improvement. Thank you to the following individuals for contributing to these materials:

Terry Dickinson, DDSExecutive Director, Virginia Dental Association

Barbara RollinsMOM Project Director of Logistics, Virginia Dental Association Foundation

Mary Foley HintermannPiedmont Regional Dental Clinic, Co-Chair Piedmont Regional MOM

Pat YoungProject Director, Roanoke Mission of Mercy

Sandee BaileyWeb Content Manager, Virginia Health Care Foundation

Table of Contents Page

Finance Committee •SampleBudget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 •SampleReimbursementForm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 •SampleIn-kindDonationTrackingForm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Volunteer Committee •KeyVolunteerPositionDescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-8 •SampleVolunteerApplication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 •SampleVolunteerInformationPacket . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-13

Health Screening Committee •MedicalDirectorPositionDescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 •HealthScreeningVolunteerPositionDescription . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 •HealthScreeningStationInstructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 •MedicalSupplyList . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Dental Services Committee •DentalServicesVolunteerPositionDescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 •DentalDirectorPositionDescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 •BloodBornePathogensProtocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 •DentalChargeForm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 •Pharmacy/ExitProtocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Logistics Committee •SampleLettertoProcureVDOTCompressor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 •PharmacyVoucher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 •KeyPositionDescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Patient Registration Committee •PatientRegistrationPoliciesandProcedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-27 •DeemedConsentForm(English and Spanish) . . . . . . . . . . . . . . . . . . . . . . . . . 28-29 •PatientWaiver(English and Spanish) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-31 •PatientRecord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32-33 •KeyPositionDescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34-35

Food & Beverage Committee •KeyPositionDescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 •SampleFoodList . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Public Relations Committee •SamplePressRelease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38-39 •SampleTalkingPoints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40-41 •PublicRelations101 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42-43 •TipsforHandlingaMediaInterview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 •CommunicationsTechniquesandStrategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45-48 •SampleExecutiveSummaryfromPiedmontRegionalMissionofMercy . . . . .49-53

Mission of Mercy: Index of Sample Forms/Materials

Finance Committee – 3

Item/Service Cost Basis Estimated Cost Actual Cost

Volunteers $6,245 $7,341

Hotel Rooms for VCU Students 32 Rooms at Holiday Inn Orange @ $108.90/ea $3,168 $3,703Hotel Rooms 10 Room for VDA Reps @$115/ea $575 $1,500Hotel Rooms 1 Room for 2 Truck Drivers @ $115/ea $115 -T-Shirts for Volunteers 350 shirts of various colors @ $5.25/ea $1,837 $1,874Key Volunteer Travel Expenses Est 5 Key Volunteers @ Avg Mileage 200 x $.55 $550 $264

Dental Services $14,000 $9,555

Dental Supplies - Local $2,000 $665Dental Supplies - VDA 600 patients @ $15/ea $9,000 $6,390Equipment Usage 1 Day (5/1/10) $3,000 $2,500

Medical Services $6,100 $1,630

Medical Supplies $1,500 -Pharmacy $4,500 $1,530Needle Disposal $100 $100

Logistics $7,050 $10,059

Stone Fire Station Deposit and Charge for On-site Staff $250 $250Stone Fire Station Rental (4/30/10) $175 $175Security/Parking $1,890 $500Truck Driver 2 Drivers @ $150/ea $300 $150Truck Mileage Est 200 Miles Each x 2 x $.55 $220 $370Fire Station Useage Event Location (2-Day Cost) $500 $2,000Storage $1,080 $540Trash Clean-up and Removal $300 -Insurance $400 $300Port-a-Pottie Rental 11 Units, 1 Handicapped & 1 Washing Basin $1,000 $1,050Tent 60x40 tent $800 $1,153Generator/Compressor Compressor, 2 Back-up Generators, Diesel Fuel $135 $1,000Dumpster - -OCFC Staff Support Paid 1/2 Salary of Development Asst. Local Free Clinic - $1,421Chair Rental - $275Scanning Equipment & Supplies - $500Light Tower Generators - $375

Public Relations $1,300 $4,201

Gifts to MOM Notables Madison Commemorative Plates $200 $550Postage $300 $503Shipping $250 -Newspaper Ads & Donor Recognition $200 $199Event Photographer $350 -Montpelier Gift Bags/Items - $2,950

Patient Registration $2,400 $6,308

Office Supplies $200 $1,375Printing/Signage/Design/Forms $2,000 $3,519Misc Supplies $200 $1,414

Food & Beverage $3,500 $6,812

Food 250 Volunteers @ Est $14/ea Food/Beverage $3,500 $5,937Ice Reefer Rental - $110Ice & Chest - $390Water Barrel Rental - $200Flowers - $175

TOTAL $40,595 $45,905

Sample Budget (Orange MOM 4/21/10 Version)

4 – Finance Committee

Mission of MercyRequest for Reimbursement

Name: _____________________________________________________________________________________________

Address: ___________________________________________________________________________________________

City, State, Zip: ______________________________________________________________________________________

Amount Requested: _________________________________________________________________________________

Date of Purchase: __________________________________________________________________________________

Please attach all receipts to this “Request for Reimbursement”

Purpose of Purchase: ________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

Signature of person seeking reimbursement: __________________________________________________________

Date: ______________________________________________________________________________________________

Project Manager Approval (signature): _______________________________________________________________

Date: ______________________________________________________________________________________________

Finance Officer Approval (signature): _________________________________________________________________

Date: ______________________________________________________________________________________________

Finance Committee – 5

Mission of Mercy In-Kind Donation Tracking Form

Organization Name Contact Name Mailing Address Good/Service Donated Estimated Value

6 – Volunteer Committee

General Volunteer Job Descriptions

Position Description: Food Volunteer To ensure that volunteers and patients have the food/beverages that they need during project hours

Responsibilities/Activities: •AssisttheFoodandBeverageCommitteeinsettingupfooddistributionarea • Preparefoodforpatients/volunteers •Distributefoodtopatients/dentists

Timeframe: • Four-hourshiftsonprojectdays

Supervision: • FoodandBeverageCommitteeChief

Training: •Anynecessarytrainingwillbeprovidedon-site

____________________________________________________________________________________________________

Position Description: Interpreter Toensurenon-Englishspeakingpatientsgettheinformationandservicestheyrequire

Responsibilities/Activities: •Assistnon-Englishspeakingpatientsthroughtheclinicprocess,providingtranslationservicesas needed


Supervision: •VolunteerCommitteeChief


____________________________________________________________________________________________________

Volunteer Committee – 7

Position Description: Patient Escort Tomanagepatientflow

Responsibilities/Activities: •Assistpatientsthroughregistrationprocess,medical/dentalscreenings,procedures,andexitingthe clinic




____________________________________________________________________________________________________

Position Description: Patient RegistrationTo register patients for services

Responsibilities/Activities: •Answerpatientquestionsaboutregistrationprocess •Collectnecessaryinformationforpatientcharts •Directpatientstoappropriateseatingarea •Collectdataaspatientexits • Ensurecompletedrecordsarefiledproperly


Supervision: • PatientRegistrationChief

Training: •Anynecessarytrainingwillbeprovidedon-sitebypatientregistrationleaders

____________________________________________________________________________________________________

8 – Volunteer Committee

Position Description: Parking/Security Volunteer Provide guidance for purposes of parking and other assistance as needed for attendees, staff, and others during MOM project events

Responsibilities/Activities: •Guidanceofvehiculartrafficforparkinginpre-definedandappropriateareas •Oversightofasafeandsecureareaforattendeesandstaffinpre-definedparkingareas •AssistancethroughguidanceandinformationforMOMprojectattendees

Timeframe: • Four-hourshiftsonprojectdates

Supervision: • Parking/SecuritySectionChief

Qualifications: •Abilitytostandforlongperiodsandworkininclementweather

Training: • Tobeprovidedduringorientation

____________________________________________________________________________________________________

Please note:Generalvolunteersareaskedtobeflexible.Duetotheunknownsoftheproject(client numbers),volunteersmaybeusedindifferentcapacitiesdependingontheneed.Volunteerscouldbeaskedtoserveasplaceholdersforclients,tofilepatientrecords,etc.


Mission of Mercy General Volunteer Application

Name:

Organization:

Email:

Shift Available (please circle all available shifts):

Friday (set-up) Saturday Sunday (tear-down)

6:00a.m.-9:00a.m. 4:00a.m.-8:00a.m. 8:00a.m.-Noon

9:00a.m.-Noon 8:00a.m.-Noon

Noon-3:00p.m. Noon-4:00p.m.

3:00p.m.-6:00p.m. 4:00p.m.-8:00p.m.

I am able to stand for long periods of time: Yes No

Iamabletoliftboxesheavierthan15lbs: Yes No

I speak Spanish: Yes No

Piedmont Regional Mission of MercyTriage: April 30Clinic: May 1

Barboursville Fire Station5251SpotswoodTrail

Barboursville,VA22923

ConvenientlylocatedonRt.33betweenRuckersvilleandBarboursville

ThankyouforjoiningusatthefirstMissionofMercyprojecttobeheldinthePiedmont. Weappreciateyourcommitmentoftimeandcaring.

Just for Dental Volunteers

What to Bring

The Piedmont is a rural area and our facilities are small. In order for you to feel as comfortable as possible, we suggest you bring some items of your own, For example: • Lightingisprovidedbutifyouareusedtoworkingwithaheadlight,pleaseconsiderbringingone. • Somedoctorsprefertobringtheirowncompositematerials,instrumentsandburs.Ingeneral,everyeffortwill be made to have the instruments available to do operative procedures. •Scrubsandcomfortableshoeswillbeappropriatetowearduringtheproject. •Ifyouhaveacomfortabledoctor’sseatorassistantstoolthatyouwouldprefertouse,pleasebringit.Youcan unload it at the front of the fire house before you park.

Orientation BBQ

Fridaynight,April30,pleasejoinusat6:30p.m.foranorientation/welcomeBBQattheStonefireStation receptionhalladjacenttothefirehouse.

PleaseverifythatthenumberofBBQattendeesyouindicatedatregistrationisstillcorrect.

Please email any changes to Barbara Rollins at [email protected].

10–Volunteer Committee

Schedule

Friday, April 30 9:00 a.m. Set up begins Noon VDA arrives 2:00 p.m. Triage begins 6:30p.m. Orientation/WelcomeBBQ

Saturday, May 1 5:30 a.m. Firehouse opens 6:00 a.m. Dr. Brooks meeting with VCU students; pre-registered patients seated 6:30 a.m. *Orientation for all dental professionals* *This is an important orientation session including information on the operation of the clinic, how to deal with medical emergencies, patient flow, communications and security. 7:00 a.m. Clinic opens; Same day patient registration begins

Dental Professionals:

Have you faxed a copy

of your license to VDA

at 804-261-1660?

Deadline: April 22, 2010


12–Volunteer Committee

For All Volunteers

Parking:Youmaydropoffandpickupyoursuppliesandequipmentatthemainfirehouse.However,after dropping off your supplies you must move your car and park in the grass field immediatelyadjacenttothefirehouse.Bothparkingareaswillbestaffedbyattendantstofacilitateparkingandtrafficandtodirectyoutheentiretime.

Volunteer Check In:Volunteerentranceisatthecenterbackofthebuilding.Volunteercheckinisstraightaheadofvolunteerentrancejustbeforethefoodtent.CliffDeMersfromRoanokeishandlingnametagsandcheck-inashehasdonesogenerouslyforotherMOMprojects.Allvolunteerswillneedtocheckinandcheckoutatthevolunteercheckindeskeachdayyouwork.T-shirts,badges,instructionsandawarmwelcomeawaityouatvolunteercheck-in.

Reminders: • Foodwillbeprovidedforallvolunteersstartingwithacontinentalbreakfastat5:30a.m.Saturday • Jeansandcomfortableshoesareappropriate • Spanishtranslatorswillbeavailable • Ifitrains,bringanextrasetofshoesforwhenyouareoutdoors. • Pleasecheckinandcheckoutatthevolunteerdeskeachday.It’seasy;it’srightbythefood!

Volunteers can be identified by t-shirt color: Dental–personalscrubsorlavendert-shirt Medical–greent-shirt TeamLeaders–bluet-shirts Translators–oranget-shirts General–yellowt-shirts VCUStudentLeaders–Redt-shirt


Important Addresses and Driving Instructions:

MOM Venue/The Barboursville Firehouse 5251SpotswoodTrail Barboursville,VA22923

Stonefire Station ( Friday night BBQ) 5361SpotswoodTrail Barboursville,VA22923

Holiday Inn Express, Orange 750 Round Hill Drive Orange,VA22960

James Madison’s Montpelier 11407ConstitutionHighway MontpelierStation,VA22957

Best Western Charlottesville Airport Inn & Suites 5920SeminoleTrail Ruckersville,VA22968-0900

From Richmond:Take64WtoUS-15. Exit136towardsGordonsville.Takearight onJamesMadisonHwy/US-15N.EnternextroundaboutandtakesecondexittoUS-33/SpotswoodTrail.Firehouseonyourright.

From Charlottesville:TakeRt20NandturnleftontoSpotswoodTrail/US-33.Drivehalf amileandFireHousewillbeonyourright.

From Culpeper:TakeUS-15StoOrange andthenfollowdirectionsfromOrange.

From Orange:TakeHwy20S.TurnrightontoUS-33/SpotswoodTrail.FireHousewillbelessthanaquartermileonyourright.

Still have [email protected].

14–Health Screening Committee

Health Screening Job Descriptions

Position Description: Medical Director

The Medical Director provides consultation for Health Screening services offered at the Roanoke Mission ofMercyproject.Healthscreeningservicesareprovidedduringtheeventtoidentifypatientswhomaypresentamedicalrisk(s)fordentalprocedures.TheHealthScreeningservicesinclude: •Bloodpressurescreenings •Bloodglucosescreenings •BodyMassIndex(optional and self-reported) •Medicationevaluation • ProthrombinTime/InternationalNormalizedRation(PT/INR) screenings (when indicated) • Post-exposureevaluationforpotentialbloodbornepathogensexposures

Pre-event Activities: •WorkingdirectlywiththechairpersonoftheHealthScreeningCommitteeandtheDentalDirectorto establishacceptable“screeningparameters”fortheaboveservices. •WorkingdirectlywiththechairpersonoftheHealthScreeningCommitteeinapprovingan“Exposure ControlPlanforBloodBornePathogens”and“Post-exposureProcedures”forsourcepatientand volunteers. •Recruitvolunteerphysiciansand/ormid-levelproviderswhoareavailableformedicalconsultation on-siteduringtheevent.Determineorientationneedsforthesevolunteers.AssisttheHealthScreening chairpersonincreatingaproviderworkschedulefortheevent.

Event Activities: • Provideon-siteconsultationwithHealthScreeningchairperson/dentalservices/participantintheevent participantexceedssafemedicalscreeningparameters •ConsultationwithPT/INRstaff/dental/participantintheeventparticipantexceedssafeparameters • Supportandidentificationofactualbloodbornepathogenexposures

Post-event Activities: •Attenddebriefingmeeting

Health Screening Committee –15

Position Description: Health Screening Volunteer

Candidates: RN (Registered Nurse), LPN (Licensed Practical Nurse),EMT(Emergency Medical Technician), FNP (Family Nurse Practitioner), PA (Physician Assistant), CNA (Certified Nursing Assistant)

Note: LicensurewillbeverifiedbyMedicalDirector

Job Description: Tosupportthismissionbybeingabletoprovideallofthefollowingbasicmedicalscreeningsforeachparticipant: • identifyparticipantscurrentlyonbloodthinners • reviewmedicalhistoryfordrugallergiesandcompleteness •bloodpressurereading(use of manual sphygmomanometer/cuffs) •bloodglucosevalue(using lancets and Precision Xtra blood glucose monitor) •pulsemeasurement •highlightandrecordvalues;tobeusedindentaltriageprocess

16–Health Screening Committee

Health Screening Station Instructions – Sample

Function: Tosupportthismissionbyprovidingbasichealthscreeningsforeachparticipant;toincludeblood pressureandbloodglucosescreeningsandtohighlightfordentaltriagethoseparametersbelowthatmaybeofconcernpriortoandregardingdentaltreatment. 1.Anticoagulant Medication Check – Please ask prior to screening participant •AREYOUONANYANTICOAGULANTSUCHASCOUMADIN/WARFARIN?IFYES,documentand highlight name of anticoagulant on registration form AND refer participant to nursing supervisor for PT/INR evaluation before performing any further screening

2.Drug Allergies – ASK, DOCUMENT AND HIGHLIGHT IF ANY DRUG Allergies On Registration Form

3.Blood Glucose – OSHArequireschangeofglovespriortoservingeachparticipant.Placeused lancets ONLY into dirty sharps containers; all other refuse place in regular trash •Documentbloodglucosevalueonparticipantcopy,registrationformandticsheet • 200andabove?Pleasehighlightelevatedvalueonallforms •Below70mg/dl?Toolow,asdefinedbytheAmericanDiabetesAssociation(Diabetes Forecast, April 2009, Checking Your Blood Glucose by Erika Gebel, PhD)Ifcomplaintsoflowbloodsugar symptoms, (shakiness, fainting)pleasenotifynursingsupervisor-snacksavailablebasedon medical need

IFELEVATEDBLOODGLUCOSE,PLEASEASK: •Doyouhavediabetes? •Areyouonanydiabeticmedicines?Haveyoutakenmedstoday?Recordansweronregistration form;example:dxDiabetes,ondiabeticmeds,takentoday,ORondiabeticmeds,nottakentoday

4.Blood Pressure–cleanstethoscopeearpieceswithalcoholwhenpassingequipmentontothenextshift •Documentbloodpressurereadingonparticipantcopy,registrationformandticsheet • 165/100andabove?Repeatbloodpressurereadingafterseveralminutes,documentand highlight all elevated readings on all forms

IFELEVATEDBLOODPRESSURE,PLEASEASK: •Doyouhavehighbloodpressure? •Areyouonbloodpressuremedicine;Haveyoutakenittoday?Recordansweronregistration form;example:dxHypertension,onhypertensionmeds,takentoday,ORonhypertensionmeds, not taken today

5.Pulse – document on registration form and highlight if irregular

Health Screening Committee – 17

Sample Health Screening Supply List (One Day MOM)

8PrecisionXtraGlucometers

83VMedical#2032Batteries

8Boxes/#100(Total 355) Lancets

6Sleeves/#200(Total 12002x2)GauzeSpongesforscreening,recheck

7Boxes/#200(Total 1400)Alcoholwipesforscreening,recheck

7Boxes/#100(Total 700)Band-Aidsforscreening,recheck

Gloves:

•3boxes/#100(Total 300) SMALL

•8boxes/#150(Total 1200)MEDIUM

•3boxes/#100(Total 300)LARGE

8 Dirty Sharps Containers

1EyewashStation(unused/2 bottles)

8 Trash Cans

75 Trash Can Liners

1580zHandSanitizer

9RollsPaperTowels

750PrecisionXtraBloodGlucoseTestStrips(Electrodes)

PDISani-ClothPlusGermicidalDisposableClothCanisters(for wiping blood spills)

Centrifuge (need electrical outlet)

8 Large Adult Cuffs/covers

8 Regular Adult Cuffs/covers

8 Stethoscopes

5boxessealablesandwichbags

18–Dental Services Committee

Dental Services Job Descriptions

Position Description: Dental Services Volunteers

1. Patient Escorts: Assist & direct patients from one service area to another. In Triage Station: •Managewaitingarea.Directpatienttotriage. • Escortpatientfromtriagetox-ray. • Escortpatientfromtriagetodentalhygiene.

In X-ray: •Managewaitingarea.Directpatienttox-ray. • Escortpatientfromx-raybacktotriageortorestorations,surgicalwaitingareas.

In Hygiene: •Managewaitingarea.Directpatienttohygienechairs. • EscortpatientfromhygienetoExit.

In Restoration-Surgery: •Managewaitingarea.Directpatienttodentalchair. • EscortpatientfromhygienetoExit.

2. Sterilization: •Cleanandsterilizesurgicalinstruments.

3. Biohazardous Wastes: •Collectanddiscardliquidandsolidbiohazardouswastes. • PrepareSci-Medwastecontainersforpick-upandtransporttodesignatedarea.

Dental Services Committee –19

Position Description: Dental Director

TheDentalDirectorworksinconsultationwiththeVirginiaDentalAssociationFoundationLeadershiptodetermine:dentalservicesprovidedattheMOMProject,eventlayoutandemergencyprotocols.He/shewillalsoworkdirectlywiththevolunteerchairandtheVDAFtorecruitdentalprofessionalstovolunteerpriortotheevent(eventplanning)andduringtheevent.

Pre-event activities: •WorkingdirectlywiththechairpersonoftheHealthScreeningcommitteetoestablishacceptable outcomelevelsforbloodpressureandglucosescreenings. •WorkingdirectlywiththechairpersonoftheHealthScreeningcommitteeinapprovingan“Exposure ControlPlanforBloodBornePathogens”and“Post-exposureProcedures”forsourcepatientand volunteers. •Recruitvolunteerdentists,hygienistsanddentalassistantstoprovidecareduringtheevent.In consolationwithVDAF,determineorientationneedsforthesevolunteers.WiththeVDAF,createa providerworkschedulefortheevent.

Event activities: • Providedentalcare • Provideconsultationtostudentsandvolunteers •Oversee,withVDAFdentalservices

Post-event activities: •Attenddebriefingmeeting


Prevention of Blood Borne Pathogen Exposure

1. Wash hands prior to beginning shift and when ending shift 2. Change gloves with each patient3. Handle waste properly. Use RED BIOHAZARD CONTAINERS for dirty sharps and REGULAR TRASH CANS for used gauze, bandaids and alcohol wipes. 4. Clean spills with germicidal wipes wearing gloves; place that refuse in biohazard container

Definition of regulated waste:liquidorsemi-liquidorotherpotentiallyinfectiousmaterials;contaminateditemsthatwouldreleasebloodorotherpotentiallyinfectiousmaterialsinaliquidorsemi-liquidstateifcompressed;itemscakedwithdriedbloodorotherpotentiallyinfectiousmaterialsandarecapableof releasingthesematerialsduringhandling;contaminatedsharps;anpathologicalandmicrobiologicalwastescontainingbloodandotherpotentiallyinfectiousmaterials.

PROTOCOL FOR TREATMENT FOLLOWING BLOOD AND OR BODY FLUID EXPOSURES

Definition of blood or body fluid exposure: a percutaneous injury (needlestick or cut with a sharp object), contactwithmucousmembranes,orcontactofskin(particularly when exposed skin is chapped, abraded, or afflicted with dermatitis or contact is prolonged and extensive)withblood,tissues,orotherbodyfluids.Potentially infectious bloody fluids include blood, bloody fluids, semen, vaginal secretions, cerebrospinal fluid,synovialfluid,pleuralfluid,peritonealfluid,pericardialfluidandamnioticfluid.

1.Cleanwoundwithsoapandwater2.LABSMUSTBEDRAWNONTHESOURCEPATIENTIMMEDIATELYatbloodbornepathogenexposure station (Roanoke City Health Dept) •Orderexposurepanelonadowntimeform(done at Carilion Clinic) • Getsourcename,phonenumberandaddress.3.Notifythenursingsupervisor4.FilloutemployeeeventformONLYifCarilionEmployee5.Reporttobloodbornepathogenexposurestation/MissionofMercymedicaldirector.6.Ifexposureisdeterminedbymedicaldirector,proceedtoCarilionClinicemergencyroomforfurther evaluationandtreatment.

If Carilion Employee; post exposure counseling is provided thru Employee Health, Occupational Medicine, or the Infectious disease Physician. Follow up with the Worker’s Compensation office is required.

If NOT Carilion Employee;followupwithyourdoctorforpostexposurecounseling.

Dental Services Committee – 21

Mission of Mercy

Patient Name ______________________________________________ MRN # ________________________________

EXAMINATION/DIAGNOSTIC

D0140 OralExam–Limited/EmergencyD0272 X-Ray–Bitewing–2FilmsD0274 X-Ray–Bitewing–4FilmsD0210 X-RayIntraoralCompleteD0240 X-RayOcclusalFilmD0220 X-Ray–Periapical–1stFilmD0230 X-Ray–Periapical–Ea.Addl.FilmD0330 X-Ray–Panelipse

SURGERY

D9110 Palliative(Emergency) Pain TXD7140 Extsimple-eruptedtoothorexposedrootD7210 SurgicalExtractionofEruptedToothD7220 Surg.ExtractionImpacted–SoftTissueD7230 Surg.ExtractionImpacted–PartBoneyD7240 Surg.ExtractionImpacted–CompBoneyD7250 Surg.Extraction–RootRemovalD7310 Alveoloplasty/Quad–W/Extract1-3TeethD7311 Alveoloplasty/Quad–W/Extract4+TeethD7286 BiopsySoftTissue(Code by Site)D4211 Gingivectomy/PlastypertoothD4210 Gingivectomy/PlastyperquadD7510 Inc./DrainabscessD7471 RemoveExostosis PROSTHETICS

D5120 DentureCompleteLowerD5110 DentureCompleteUpperD5211 PartialAcrylicUpperD5212 PartialAcrylicLowerD5213 PartialDent-UpperCastBase/ResinD5214 PartialDent-LowerCastBase/ResinD5410 DentureAdjust–UpperCompleteD5411 DentureAdjust–LowerCompleteD5421 DentureAdjust–UpperPartialD5422 DentureAdjust–LowerPartial DENTAL HISTORY & TRIAGE

UnderDoctor’sCare GumsBleedWhenBrushing/FlossingSensitive to Hot/Cold Wears Partial, Bridge, Dentures

RESTORATIVE

D2140 Amalgam1Surface–PermanentD2150 Amalgam2Surface–PermanentD2160 Amalgam3Surface–PermanentD2161 Amalgam4Surface–PermanentD2330 Resin1surfaceAnteriorD2331 Resin2surfaceAnteriorD2332 Resin3surfaceAnteriorD2335 Resin4ormore/InvIncisalAngleD2391 Resin1surfacePosteriorD2392 Resin2surfacePosteriorD2393 Resin3surfacePosteriorD2394 Resin4ormoresurfacePosteriorD2940 Sedative/TemporaryFillingD2950 CoreBuildup,includingPinsD2951 PinRentention–perToothD2954 Prefab.Post&CoreD9910 AppofDesensitizingMedicaments

PREVENTIVE

D1204 FluorideTopicalApplication–AdultD1110 Prophylaxis–Adult D4355 Full Mouth Debridement D4342 Perioscale1-3TeethperQuadD4341 Perioscale4+teethperquad ENDODONTICS

D3110 PulpCap–DirectD3120 PulpCap–IndirectD3310 RootCanal–AnteriorD3320 RootCanal–BicuspidD3330 Root Canal – Molar

3

3

3

3

3

3

3

TOOTH #s

or QUAD

TOOTH #s

or QUAD

TOOTH #s

or QUAD

TOOTH #s

or QUAD

TOOTH #s

or QUAD

TOOTH #s

or QUAD

Triage Notes:

RX?Name&Amount:___________________________________________

Triage Dentist: ___________________________________________

Date: ___________________________________________

LIST ADDITIONAL SERVICES HERECode Indicating Tooth Number, Surface, etc

Treatment/Comments:Restorative:RecordTooth#andServiceAbove.NoteAnesthesia,andRelativeNotesOralSurgery:RecordTooth#andServiceAbove.NoteAnesthesia,andRelativeNotes

RX?Name&Amount:___________________________________________

Attending Dentist: ___________________________________________

Date: ___________________________________________


Pharmacy Duties for Mission of Mercy/Exit Protocol

Attheexittables,pleaseassisteachpatientbythefollowingduties:

Revieweachprescriptionforaccuracy,DEAnotedoneachcontrolprescription,patientallergies,druginteractions.

Notify Terri Bryant for approval for any medication not on approved list: •Amoxicillin •Acetaminophenwithcodeine#3 •Cephalexin •Clindamycin150mg •DarvocetN100 • Erythromycin250mg • Ibuprofen • Lortab5/500 • PenVK500mg •GenericPeridex • Percocet5/325 •VicodinES

Counselpatientsonproperusageofmedications.Noprescriptionrefillswillbeauthorized.The prescriptionexpiresoneweekafteritiswritten.

Offer Medical Center Pharmacy and three CVS pharmacies (Hollins,Towers and 9th Street) as sites of free medications.Providemaps.Please note: Medical Center Pharmacy will honor any prescriptions written as a result of a follow-up visit the week of March 29 to April 2, 2010.

Handoutblankprofilesheetstoshortenwaittimesatpharmacies

AskforMedicaidandVAPremierinsurancecardstopresentatpharmacies.Thesearetheonlyinsuranceswewillinquireabout.Focusisonswiftserviceandeaseforeachpharmacy.

DirectpatientstodisplaytablesuponexitingtheCivicCenter.

Iwillbeavailablethroughoutthetwo-dayeventprovidingpre-opmedicationsandansweringanyofyourquestions.

ThankyouforvolunteeringwithMissionofMercy.Wecouldnotdothiswithoutyou!Callthroughouttheday for questions on my cell (761-1753).

Terri Bryant

Logistics Committee – 23

Sample Letter to Procure VDOT Compressor

January 6, 2010

Mr. Richard L. CaywoodDistrict AdministratorVirginia Department of TransportationP O Box 3071Salem, VA 24153

Dear Mr. Caywood:

IhavebeencontactedbyPatYoung,projectmanageroftheRoanokeMissionofMercy(MOM) projecttobeheldattheRoanokeCivicCenterMarch26-27,2010.Asyouareaware,thesemissionsare held to provide dental care and medical screening to underserved uninsured adults in Southwest Virginia and several other areas in the Commonwealth. The urgency of this type of service was clearly demonstrated in 2007 and 2008 year when over 2000 uninsured adults stood in line for hours to receive dental services in Roanoke. Volunteer dentists expect to serve over 1,000 patients again at MOM 2010.

I understand that VDOT donated an air compressor and fuel to run the dental units at the Roanoke MissionofMercy2007and2008andatsimilarprojects.IwouldhopeVDOTcoulddothesamefornextyear’sprojectinRoanoke.Ms.YoungisrequestingaVDOTcommercialaircompressor,setat 100 psi, with a 100 foot long ½ inch hose and sufficient fuel to allow for continuous running 12 hours each of the two days of the event. The air compressor would be needed the afternoon of March 25 at 1:00 p.m. and could be removed after 5:00 p.m. on Saturday, March 27, or could remain there until the following Monday morning. Arrangements can be made by contacting Bobby Baker at 540-776-4015.

Thank you for your kind attention to this request. I hope VDOT will be able to assist our communities in this very worthwhile mission.

Sincerely,

John S. Edwards

JSE:arb

cc:PatYoung

24–Logistics Committee

Date:

Name:

YouhavebeengivenaprescriptionformedicationinconjunctionwithdentaltreatmentataMissionofMercydentalfair.PleasetakeyourprescriptionandthisvoucherwithinTWO days tooneofthepharmacieslistedontheattachedformandyouwillnotbechargedforyourprescription.Ifyoudonothaveyourprescription,youwillnotreceivemedication.Ifyoudonothavethisvoucher,youwillbechargedforyourprescription.

Designated MOM Volunteer:

This Voucher is good until July 29, 2010

Logistics Committee – 25

Logistics Position Descriptions

Position Description: Parking/Security Volunteer Provide guidance for purposes of parking and other assistance as needed for attendees, staff, and others during MOM project events

Responsibilities/Activities: •Guidanceofvehiculartrafficforparkinginpre-definedandappropriateareas •Oversightofasafeandsecureareaforattendeesandstaffinpre-definedparkingareas •AssistancethroughguidanceandinformationforMOMprojectattendees

Timeframe: • Four-hourshiftsonprojectdates

Supervision: • Parking/SecuritySectionChief

Qualifications: •Abilitytostandforlongperiodsandworkininclementweather

Training: • Tobeprovidedduringorientation

____________________________________________________________________________________________________

Please note: Generalvolunteersareaskedtobeflexible.Duetotheunknownsoftheproject(client numbers),volunteersmaybeusedindifferentcapacitiesdependingontheneed.Volunteerscouldbeaskedtoserveasplaceholdersforclients,tofilepatientrecords,etc.

26–Patient Registration Committee

Patient Registration, Patient Exit, Data Entry Policies and Procedures

Greeting PatientsAllvolunteersareremindedtogreetpatientsgraciouslyandrespectfully.

Patient Registration • 8tablesforpatientregistrationintheSpecialEventsCenter(SEC) (see attached event map) • 2registrationvolunteers/table • 1patientescortvolunteer/table • Seeattachedvolunteerschedule

Patient Flow: • PatientswillbeseatedinthePatientRegistrationWaitingareainnumericorderhoweveronce patientbeginsreceivingservices,thenumericorderisnolongerapplicableaspatient’stimeateach station/serviceareawillvary. •Whileseated,patientswillreceiveaclipboardandbeaskedtocomplete the following: • PatientRecord(demographic information) (available in English/Spanish) • PatientWaiver(available in English/Spanish) • PatientDeemedConsentforTesting(available in English/Spanish) • Patientwillbeescortedtopatientregistrationtableintheordertheyareseated. •Registration volunteers will review for completeness: • PatientRecord(Demographic Information) (English/Spanish) • PatientWaiver(English/Spanish) • PatientDeemedConsentforTesting(English/Spanish) •A patient chart is created.Thepatient’s“lineticket”numberwillbecomethemedicalrecordnumber. Recordpatient’slastnameandfirstnameonthechart’stab. •Verifywhetherthepatientison“BloodThinners”orhasa“LatexAllergy.”Ifyes,attachedared stickeronthechart’stab.

Sticker Color Reason

RED Patient is on blood thinners

BLUE Patienthasalatexallergy

Please note patients on Blood Thinners should be escorted directly to the PT/INR testing table at Health Screenings.

•Patient will receive a wrist bandwiththemedicalrecordnumberonit.Wristbandsarecolor-coded basedondateofservice.(See attached wrist band color codes) •Handicapped/specialneedspatientsmayhaveoneescortaccompanythem.Awristbandwillbegiven totheseescortsthatlinksthemtothehandicapped/specialneedspatient. • Interpretive services (Spanish primarily, sign and limited other languages)areavailableasneeded. •Whenregistrationiscomplete,avolunteerwillescortthepatienttotheHealthScreeningswaiting area.

Patient Registration Committee – 27

Patient Exit • 2patientexittables(2 volunteers/table)

Patient Flow: • PatientswillpresentwiththeircharttoExittableattheendofthedentalvisit. •Volunteerwillreviewchartforcompleteness.Ensuredentalencounterformiscompleteandpatient receivedfollow-upcareinstructionsasindicated. • Patientswhohadextractionsorothersurgicalprocedureswillbegivenapost-surgicalpack(gauze, OTC pain reliever, and follow-up instructions)bythevolunteer. •AllpatientsgivenprescriptionswillbedirectedtothepharmacystationattheExittable. •Volunteerswillfilepatientchartwhencomplete.

Data Entry •Volunteerswillenterpatientdemographics,healthscreeningsanddentaltreatmentdataintoanExcel spreadsheet. •WorkshouldbesavedperiodicallythroughoutthedayandattheendofeachshiftontoaFlashdrive. TheseflashdriveswillbecollectedbythePatientRegistrationChiefattheendofeachday.


Mission of MercyNotice of Deemed Consent for HIV, Hepatitis B or C Testin

IfanyMissionofMercyhealthcareprofessionalvolunteershouldbedirectlyexposedtoyourbloodorbodyfluidsinawaythatmaytransmitdisease,yourbloodwillbetestedforinfectionwithhuman immunodeficiency virus (HIV),aswellasforHepatitisBandC.Aphysicianorotherhealthcareproviderwilltellyoutheresultofthetest.UnderVirginiaCode32.1-45.1(A), you are deemed to have consented to the releaseofthetestresultstothepersonexposed.

InyoushouldbedirectlyexposedtobloodorbodyfluidsofaMissionofMercyhealthcareprofessionalvolunteerinanywaythatmaytransmitdisease,thatperson’sbloodwillbetestedforinfectionwithHIVaswellasHepatitisBandC.Aphysicianorotherhealthcareproviderwilltellyouandthatpersontheresultofthetest.

I certify that I have consented to HIV, Hepatitis B and C testing as described above.

_____________________________________________________________________ ________________________SignatureofPatient,Parent/LegalGuardian Date

_____________________________________________________________________ Relationship (if signature is not patient)

_____________________________________________________________________ ________________________Signature of Person Obtaining Consent Date


Mission of MercyNotificación of Autorización para Examen de HIV, Hepatitis B ó C

SialgunodelosprofesionalessanitariosvoluntariosdeMissionofMercyfueraexpuestodirectamenteasusangre o líquidos corporales en cualquier forma que se pueda transmitir una enfermedad, su sangre será examinadaporVIH,tambiénHepatitisByC.Unmedicouotroproveedorsanitarioledaráelresultado delexamen.BajoelCódigodeVirginia32.1-45.1 (A), se considera que usted ha dado permiso para dar a conocerlosresultadosdelexamenalapersonaexpuesta.

Siustedfueraexpuestodirectamenteasangreolíquidoscorporalesdeunodelosprofesionalessanitariosvoluntarios de Mission of Mercy, en cualquier forma que se pueda transmitir una enfermedad, la sangre deesapersonaseráexaminadaporVIH,tambiénHepatitisByC.Unmedicouotroproveedordesaludlesdaráaustedyaesapersonalosresultadosdelexamen.

Certifico que he dado permiso para hacer eximes de VIH, Hepatitis B y C, come se describe arriba.

_____________________________________________________________________ ________________________FirmadelPaciente,Padre/Guardián,oPersonaactuandoenLocoParentis Fecha

_____________________________________________________________________ Relación(Si la firma no es del Paciente)

_____________________________________________________________________ ________________________Firma de la Persona Obteniendo el Consentimiento Fecha

30 – Patient Registration Committee

Mission of Mercy Patient Waiver

IMPORTANT NOTICE

Mission of Mercyvolunteersmaynotbeabletoprovideyouwithalltheservicesyouneed,butifyouwouldliketoconsultwithourvolunteerteamandreceivethetypeoftreatmentbeingofferedtoday,PLEASE READ THE PATIENT WAIVER BELOW VERY CAREFULLY, AND SIGN IT.

Whilethevolunteerhygienists,dentistsandoralsurgeonsofferhighqualityprocedureswithgood equipment, I understand that, because of the number of people needing to be seen, I might not receive multipleextractionsormultiplefillings.IunderstandthatImighthavecertainmedicalconditionswhichwouldkeepmefromhavingthetypeoftreatmentIamrequesting.Ialsounderstandthatthedentalcareprovidersarevolunteers,somefromout-of-town,andarenotavailableforfollow-upcareintheeventofcomplications.Iagreetoseekanyfollow-upcareImightneedfrommylocaldentist,familyphysician,or ahospitalemergencyroom.

Inconsiderationofthefreedentalcareservicesreceivedonthedatebelow,I,formyselfandanyoneentitled toclaimthroughme,doherebywaiveandreleasetheMissionofMercyoranypersonororganizations acting on their behalf or sponsoring or volunteering at this clinic, from all claims of liability arising out of my acceptance of such free care including but not limited to medical, surgical, dental, and/or vision care or otherhealthcareormedicaladvice.

I grant to the Mission of Mercy and its agents the right to use my picture, voice and other reproductions of myphysicallikenessinconnectionwithadvertisingorpublicizingMissionofMercyservicesanditsactivitiesinallformsofmediainperpetuity.

Ihaveread,orhadreadtome,andunderstandandagreetoalloftheabove.

_____________________________________________________________________ ________________________Patient signature Date

In case of an emergency, please contact:

___________________________________________________ (________) ________________________ Name Telephone number

Aretheyherewithyoutoday?YesorNo


Mission of Mercy Patient Waiver

Anuncio Importante

EsposiblequelosvoluntariosdelMissionofMercynotenganlascapacidadesaprovenirtodoslosserviciosdentales que usted necesita, pero si usted quisiera consultar con nuestro equipo de voluntarios y recibir los tiposdetratamientoqueellosestánofreciendohoy,PORFAVORLEELARENUNCIADEPACIENTESABAJOCONMUCHOCUIDADO.

Nota a los pacientes dentales:Mientrasquelosvoluntariosquesondentistas,higienizasycirujanosoralesofrecenprocedimientosdealtacalidadconequipoqueestáenunacondiciónbuena,yocomprendoqueporquehaymuchaspersonasquenecesitantratamiento,esposiblequenopuedorecibirvariasextracciones yvariascalzas.Yocomprendoqueesposiblequeyotengoalgunascondicionesmedicalesquepueden prohibirmederecibireltipodetratamientodentalqueyoestoypidiendo.También,comprendoquelosvoluntarios (algunas que son visitantes de otras regiones) no están disponibles para continuar cuidado, si hay problemasdespuésdelaclínicahoy.Yoaccedoabuscaralcuidadodentaldespuésdelclínico,sinecesito,deundentistalocal,mimédicodecabeceraoelcuartodeemergenciaenelhospital.

Enconsideraciónalosservicioslibresdetratamientodentalquerecibíenlafechaabajo,yo,paramimismoyalguienquepuedehacerunareclamaciónpormi,yosoyporlapresenterenunciayliberaalMissionofMercy,algunaspersonasoorganizacionesqueactúanenrepresentacióndelMissionofMercyylosque patrocinaovoluntaaestaclínica,detodasreclamacionesderesponsabilidadqueprovenirdemiaceptación decuidadogratisqueincluido,peronoestalimitadoa,cuidadomédico,quirúrgico,dentaly/ocuidado visualootrocuidadooconsejosmédicos.

DoypermisoalMissionofMercyysusagentesladerechaausarfotos,mivoz,yotrasreproduccionesde miretratofísicoenconexiónconlapublicidaddelaclínicaootraspublicacionessobrelosserviciosylas actividadesdelMissionofMercyentodaslasformasdelosmediosdecomunicaciónaperpetuidad.

Yoheleído,ohabíaleídoamí,ycomprendoeacedoatodoqueestáarriba.

_____________________________________________________________________ ________________________Firma de paciente Fecha

In case of an emergency, please contact:

___________________________________________________ (________) ________________________ Apellido Telefono

CLEANING ~ FILLING ~ EXTRACTIONPatient ID #:

PATIENT RECORD / INFORMACION SOBRE EL PACIENTEDATE: FECHA:LAST NAME / APELLIDO

FIRST NAME / NOMBRE

SECOND/ SEGUNDO PHONE/TELÉFONO

MAILING ADDRESS/STREET ADDRESS CITY/ CIUDADSTATE/

ESTADO

ZIP / CODIGO POSTAL BIRTHDATE / FECHA DE NACIMIENTO

DIRECCIÓN

SEX MARITAL ESTATUS/ ESTADO CIVILRACE (CHECK ONE) RAZA (MARQUE UNO) HISPANIC HISPANO

MALE / FEMALE/ SINGLE/ MARRIED/ CAUCASIAN YES

HOMBRE MUJER SOLTERO CASADO AFRICAN AMERICAN NO

ASIAN

OTHER

NUMBER OF PEOPLE LIVING ANNUAL HOUSEHOLD INCOME: ___________________________ INGRESOS ANUALES DE LA FAMILIA

IN YOUR HOUSEHOLD: ________CURRENT EMPLOYMENT STATUS: FULL-TIME JORNADA COMPLETA

NÚMBERO DE PERSONAS QUE VIVEN EN SU SITUACIÓN LABORAL: PART-TIME JORNADA PARCIAL

CASA UNEMPLOYED DESEMPLEADO

RETIRED RETIRADO

SEASONAL POR TEMPORADA

DO YOU HAVE MEDICAL INSURANCE? YES NO

¿TIENE SEGURO MÉDICO?

DO YOU HAVE DENTAL INSURANCE? YES NO

¿TIENE SEGURO DENTAL?

REGULAR MEDICAL CARE/ LAST MEDICAL VISIT (WHEN,WHY)/ Dr's Name:________________________________

CUIDADO MÉDICO HABITUAL ÚLTIMA VISITA MÉDICA (CÚANDO, POR QUÉ) Nombre del Médico

YES NO

REGULAR DENTAL CARE/ LAST DENTAL VISIT (WHEN,WHY)/ Dr's Name:________________________________

CUIDADO DENTAL HABITUAL ÚLTIMA VISITA DENTAL (CÚANDO, POR QUÉ) Nombre del dentista: ____________________________________

YES NO HAVE YOU EVER ATTENDED A MISSION OF MERCY? YES NO

LOCATION OF PREVIOUS MISSION OF MERCY: _______________________________________________

¿HA VISITADO UNA "MISSION OF MERCY" ("MISIÓN DE CARIDAD) ANTERIORMENTE? YES NO

DIRECCIÓN DE LA "MISSION OF MERCY" ( LA MISIÓN DE CARIDAD) QUE VISITÓ.

MEDICATIONS YOU CURRENTLY TAKE/

MEDICAMENTOS QUE ESTA TOMANDO

DO YOU TAKE BLOOD THINNERS? YES NO

¿ESTA TOMANDO ANTICOAGULANTES?ANTICOAGULANTES?

MEDICAL HISTORY DRUG ALLERGIES Vital Signs and Lab Findings

DIABETES CURRENTLY PREGNANT NONE

HEPATITIS OSTEOPOROSIS PENICILLIN BP

HEART DISEASE HIV+ TCN/DCN PULSE

ASTHMA WEAR GLASSES/CONTACTS EMYCIN GLUCOSE

ARTHRITIS ANEMIA SULFA FASTING

SEIZURES CHICKEN POX FLAGYL

HEARING LOSS TOBACCO USE CEPHALOSPORIN PT/INR FINDINGS

VISION LOSS RADIATION TX SPECTINOMYCIN

TUBERCULOSIS HIGH/LOW BP FLUOROQUINOLONES

SCARLET FEVER EXCESSIVE BLEEDING LATEX

____________ SHUNTS __________ RHEUMATIC FEVER OTHER/OTROMITRAL VALVE PROLAPSE JOINT REPLACEMENT

DIABETES NINGUNA

CARDIOPATÍA HIV+/ SEROPOSITIVO TETRACYCLINE/DOSICICLINE

ASMA EMYCIN

ARTRITIS ANEMIA SULFA

CONVULSIONES FLAGYL

PÉRDIDA AUDITIVA

PERDIDA DE VISTA

TUBERCULOSIS

ESCARLATINA LÁTEX

____________ VÁLVULA DE DERIVACIÓN __________PROLAPSO DE VÁLVULA MISTRAL

USA TOBACO CEPHALOSPORIN

HISTORIAL MÉDICO ALERGIAS A MEDICAMENTOS Notes

EMBARAZADA

HEPATITIS

USA LENTES/LENTILLAS

VARICELA

OSTEOPOROSIS PENICILINA

PROTESIS ARTICULAR

RADIOTERAPIA SPECTINOMYCIN

PRESIÓN SANGUINEA ALTA/BAJA FLUOROQUINOLONES

SANGRA EXCESIVAMENTE

FIEBRE REUMÁTICA OTROS



DENTAL HISTORY TREATMENT/COMMENTS:

___ UNDER DOCTOR'S CARE Restorative: Include tooth #, surfaces, material, anesthesia…and any relevant notes

___ GUMS BLEED WHEN BRUSHING,FLOSSING Oral Surgery: Include tooth #, Surgical vs. Non Surgical, anesthesia…and any relevant notes

___ SENSITIVE TO HOT/COLD

___ WEARS PARTIAL, BRIDGE,DENTURES

TRIAGE NOTES:

RX? NAME & AMOUNT:___________________________ RX? NAME & AMOUNT:_______________________________________________________

TRIAGE DENTIST: _______________________________ ATTENDING DENTIST: ________________________________________________________

Date:_________________ Date:_________________

34 – Patient Registration Committee

Patient Registration Position Descriptions

Position Description: Interpreter Toensurenon-Englishspeakingpatientsgettheinformationandservicestheyrequire

Responsibilities/Activities: •Assistnon-Englishspeakingpatientsthroughtheclinicprocess,providingtranslationservicesas needed




____________________________________________________________________________________________________

Position Description: Patient Escort Tomanagepatientflow

Responsibilities/Activities: •Assistpatientsthroughregistrationprocess,medical/dentalscreenings,procedures,andexitingthe clinic




____________________________________________________________________________________________________


Position Description: Patient RegistrationTo register patients for services

Responsibilities/Activities: •Answerpatientquestionsaboutregistrationprocess •Collectnecessaryinformationforpatientcharts •Directpatientstoappropriateseatingarea •Collectdataaspatientexits • Ensurecompletedrecordsarefiledproperly


Supervision: • PatientRegistrationChief

Training: •Anynecessarytrainingwillbeprovidedon-sitebypatientregistrationleaders

____________________________________________________________________________________________________


Food & Beverage Position Descriptions

Position Description: Food Volunteer To ensure that volunteers and patients have the food/beverages that they need during project hours

Responsibilities/Activities: •AssisttheFoodandBeverageCommitteeinsettingupfooddistributionarea • Preparefoodforpatients/volunteers •Distributefoodtopatients/dentists


Supervision: • FoodandBeverageCommitteeChief


____________________________________________________________________________________________________


36 – Food & Beverage Committee

A Summary of Food Consumed by 400 Adults (Volunteers Only!)at the One-Day Piedmont Regional MOM

Food & Beverage Committee – 37

1,000softdrinks

4,000bottlesofwater

14gallonsoficedtea

15lbs.ofcoffee

3boxesoftea(10bagseach)

6qts.halfandhalf

180Bagels

320Breakfastwraps

200Kite’shambiscuits

150cupsofyogurt

200bottlesofassortedjuices

2casesofmelon

1caseofpreparedpineapple

2casesofgrapes

1caseofbananas

3flatsofstrawberries

32lbs.oforanges

50lbs.ofchickensalad

Case of tomatoes

Case of lettuce

2casesofbread

50lbs.ofpastasalad

250hotdogsandbuns

4 jars of relish

Case of mustard

Case of ketchup

Chopped onions

6casesofchips,pretzels

60-70dozendesserts(cookies, brownies, cakes, muffins)

6 gallons ice cream

125icecreamcones

100tootsierollpops

38 – Public Relations Committee

What is the MOM Piedmont Regional Dental Day? MOM stands for Mission of Mercy. The MOM Piedmont Regional Dental Day will provide free dental services

to as many uninsured adults in our area as possible in a one-day dental clinic. The clinic anticipates capacity to serve between 500 and 600 patients.

Where and when will the MOM Piedmont Regional Dental Day take place? TheMOMPiedmontRegionalDentalDaywilltakeplaceMay1,2010,startingat7:00a.m.attheBarboursville

Fire House (5251 Spotswood Trail, Barboursville, Virginia 22923) .

Who sponsors the MOM Piedmont Regional Dental Day? MOM was created by the Virginia Dental Health Foundation (VDHF), an arm of the Virginia Dental

Association (VDA), to serve citizens with little or no access to dental care. The MOM Piedmont Dental Day is co-sponsored by the VDHF, Virginia Commonwealth University, and the newly established Orange County-based Piedmont Regional Dental Clinic (PRDC), with support from area Free Clinics.

What dental services will be delivered? Dental services provided will include: 1) Preventative dentistry—teeth cleaning, fluoride application, sealants, oral

hygiene, and nutritional counseling; 2) Restorative dentistry—fillings; and 3) Extractions, limited surgery. Each patient will receive at least one dental service. If the patient needs more than one service a list of other dental care resources where they may receive treatment will be provided.

Who is eligible to receive free dental services? MOM Dental Days are held in underserved areas of the state to serve working poor, underinsured, and uninsured

people in need of dental care. The Mission of Mercy serves people with no other dental care option. This Mission of Mercy project will serve adults over 18 years of age.

How can individuals receive dental services on May 1? Dentalcarewillbeprovidedonafirst-come,first-servedbasis.Becausethereissuchagreatdemandfordental

careinourregion,itislikelythattheclinicwillreachcapacitybyveryearlySaturdaymorning.It is strongly recommended that those wishing to receive service pre-register on Friday, April 30, 2010, at 2:00 p.m. at the Barboursville Fire House. Friday is for pre-registration only. Pre-registration on Friday does not guarantee dental serviceonSaturdayunlessthepatientisamongthefirst500-600patientsonsite.Nodentalserviceswillactuallybe performed on Friday.

Patientswhohavecompletedpre-registrationwillbeseatedat6:00a.m.onSaturday.Samedayregistrationstartsat7:00amonSaturday.TheSaturdayClinicisfirst-come,first-served.OnSaturdaymorningonceallthe patients who could be treated during the day are in line, the Clinic will be deemed at capacity. Additional patients will be turned away. (This may happen early Saturday morning .) A handout on additional dental resources will be provided to anyone wishing it.

MOM Piedmont Regional Dental Day

FACTSHEET

P.O.Box152•Barboursville,VA22923•540.748.3756•www.vaprdc.org

Public Relations Committee – 39

Who delivers the dental services? All dental services will be delivered by fully accredited dentists, dental hygienists, and supervised dental student

volunteers.

How can I support the MOM Piedmont Dental Day? You can support the MOM Piedmont Dental Day by volunteering in any one of a number of ways. More than

350 volunteers are necessary to make the day run smoothly. Volunteers are needed for many tasks, and any help you can give will be greatly appreciated: dental and medical professionals; patient registration; site set-up and take-down;parkingandtrafficcontrol;trashpickup;Spanishlanguagetranslators;crowdcontrol;fooddonationsanddistribution; records management and transcription, and event planning support. Please register as a volunteer at www.vadental.org for the Piedmont Regional Mission of Mercy.

If you cannot volunteer, you can help by donating money to help defray the cost of the event. Please visit www.vaprdc.orgtomakeadonationtoPRDC/MissionofMercyorsendyourcontributiontoPiedmont RegionalDentalClinic,P.O.Box152,Barboursville,VA22923.

# # #


A nation-wide need… Morethan100millionpeopleintheUnitedStatesarewithoutdentalinsurance.ManysufferfromwhattheU.S.

surgeon general calls “a silent epidemic of dental and oral diseases” caused by “profound” disparities in dental care.

“Those who suffer the worst oral health are found among the poor of all ages, with poor children and poor older Americans particularly vulnerable. Members of racial and ethnic minority groups also experience a disproportionate level of oral health problems,” the surgeon general wrote in a 2000 report.

…Reflected in Virginia The Virginia Employment Commission 2000 Population Projects estimated that one-in-five Virginians live in an

area underserved by dentists. Typically these are rural communities with a significant population living in poverty. Individuals in these areas are often left without any dental care to face extreme pain, discomfort, and embarrassment. They are most often people who are employed but poor, and people who are elderly, disabled, or uninsured.

The Mission of Mercy project In response to this need, the Virginia Dental Health Foundation (VDHF) launched the Mission of Mercy

(MOM) project, and began to “make caring visible.” The Mission of Mercy projects, staffed and organized almost entirely by volunteers, are one- to three-day dental clinics set up to provide a comprehensive range of dental services to those in need in Virginia. Most clinics are conducted in identified underserved areas of the state where there are not enough dentists and hygienists to serve the oral health needs of the community. Targeted to uninsured and underinsured children and adults, any individual who is able to show up on site is considered eligible to receive services. The intention is not to judge, but rather to serve.

To date, 46 MOM projects have been held across Virginia. For each MOM project, there are hundreds of volunteers who participate. To date, thousands of patients have been provided with more than $18 million of dollars worth of free dental care. Virginia’s MOM projects have broken records for the largest two- and three-day dentaloutreachclinicseverconductedintheUnitedStates.

May 1: A Local Mission of Mercy: Piedmont Regional Dental Day In response to the local need, the newly established Piedmont Regional Dental Clinic, along with the Virginia

Dental Association and Virginia Commonwealth University, and with support from area free medical clinics, will cosponsorthePiedmontRegionalMissionofMercyonMay1,2010,at7:00a.m.attheBarboursvilleFireHouse(5251 Spotswood Trail, Barboursville, Virginia 22923) .

Dental services provided will include: 1) Preventative dentistry: teeth cleaning, fluoride application, sealants, oral hygiene, and nutritional counseling; 2) Restorative dentistry: fillings; and 3) Extractions and limited surgery. All dental services will be delivered by fully accredited dentists, dental hygienists, and supervised dental student volunteers.

MOM Piedmont Regional Dental Day

BACKGROUNDER

P.O.Box152•Barboursville,VA22923•540.748.3756•www.vaprdc.org


The Piedmont Regional Dental Clinic The Piedmont Regional Dental Clinic (PRDC) is a new non-profit organization dedicated to providing low-cost

dental services to underserved residents in the Piedmont region of Virginia. The Clinic is modeled after the very successful Augusta Regional Dental Clinic. Although it is just getting started, when fully operational, the PRDC will have permanent offices and a full-time dental staff. The MOM Piedmont Regional Dental Day is the first project of PRDC.

The Virginia Dental Association and Virginia Dental Health Foundation The Virginia Dental Association (VDA) is a non-profit organization, affiliated with the American Dental

Association (ADA),whosevisionistocontinuallyimprovethequalityofdentaleducationandtreatmentwithinthe state of Virginia (www .vadental .org). The Virginia Dental Health Foundation (VDHF) is a charitable and educational organization established by VDA in 1996 to increase access to dental care for Virginians by generating and redirecting resources throughout the Commonwealth.

The VDHF believes that oral health is an intricate part of the overall health and well being of an individual. Neglectedoralhygienehasbothphysiologicalandpsychologicaleffects.Diseasesofthemouthcanleadtoother serious concerns such as diabetes and cardiovascular disease. Individuals who suffer from medical complications suchascancerandAIDSareatanincreasedriskfordevelopingoraldisease.TheprogramssupportedbytheVDHF help to alleviate individuals of pain, discomfort, malnutrition, embarrassment, low self esteem and depression that often result from poor oral hygiene.

MOM Dental Days in Virginia Thusfar,atotalof46MOMprojectshavebeenheldinWiseCounty,theEasternShore,NorthernVirginia,

Martinsville,Norfolk,Grundy,Roanoke,Emporia,Goochland,Petersburg,andNewOrleans,LA.Todate,33,897patients have been provided with more than $18 million worth of free dental care. In 2008, the Foundation spent $254,000 on its Missions of Mercy projects. Other states have used the Virginia Mission of Mercy as a model:Texas,Kansas,Arkansas,Nebraska,Colorado,WestVirginia,Connecticut,andNorthCarolina.

SomepastMOMProjectsinclude: •GoochlandMOM,2009:207patientsreceivedanestimated$134,893infreedentalservices •EmporiaMOM,2009:958patientsreceivedanestimated$545,352infreedentalservices •GrundyMOM,2004-2007,2009:2,773patientsreceivedanestimated$1.6millioninfreedentalservices •WiseCountyMOM,2000-2009:12,191patientsreceivedanestimated$6.7millioninfreedentalservices •NorthernVirginiaMOM,2002,2004-2009:4,667patientsreceivedanestimated$1.3millioninfreedentalservices •EasternShoreMOM,2001-2009:6,213patientsreceivedanestimated$2.7millioninfreedentalservices •PetersburgMOM,2003,2005,2007:249patientsreceivedanestimated$80,407infreedentalservices •RoanokeMOM,2007-2008:1,965patientsreceivedanestimated$985,746infreedentalservices •MartinsvilleMOM,2003:876patientsreceivedanestimated$288,145infreedentalservices •NorfolkMOM,2003:305patientsreceivedanestimated$85,619infreedentalservices

Donations To make the Piedmont Regional Mission of Mercy event possible, financial support is needed. Donations to

support the Mission of Mercy projects may be made online at www.vaprdc.org or mailed to: PiedmontRegionalDentalClinic/MissionofMercyProject POBox152 Barboursville,VA 540.661.0008

42–Public Relations Committee

PublicRelations101

Publicrelationsistheartofusingvarioustechniquestocommunicatewithvariousaudiencesaboutyourproject.

Steps for Success

Step 1:Identifyyourkeyaudiences. • Projectpartners? •Donorsorpotentialdonors? • Patients/clients? • Localorstateofficials? •Generalpublic? •Other?

Step 2:Determinewhatinformationyouwanttocommunicate. • Projectimpactandvalue(data re: patients served, money saved and/or generated, health

outcomes, other project achievements). • Featurestorydescribingsomekeyaspectsofaproject •Generaldescriptionofproject(what it is/does, target population, hours, community partners/

supporters) • Specialeventsfortheproject(dedication, grand opening, etc.)

Step 3: Select the most effective medium for communicating the topic to the targeted audience • Television •Newspaper •Radio •Newsletter •Magazine

Step 4:Makecontactintheappropriateway •MediaAlert • PressRelease • Phonecalltoreported • Lettertotheeditor

Step 5:FOLLOWUP.Itisveryimportanttobuildrelationshipswithmediacontacts.Makesureyou alwaysfollow-upwithaphonecallaftersubmittingapressreleaseormediaalert.

707EastMainStreet,Suite1350•Richmond,VA23219

Phone:(804)828-5804•Fax:(804)828-4370•email:[email protected]

www.vhcf.org

Helpful Hints

•Alwaysknowthemessagethatyouwanttogetacrossthrougheachmediaactivity.Usedata tomakeyourcasewhenpossible.

•Recruit college students majoring in communications, local ad agencies, or public relations professionalstohelpyouwithyourefforts.

•Respondpromptlyifareportercalls.

• Follow-upwithreporterswhoarenotabletoattendtheevent.

•Duringaninterview,providethereporterwithrelevantdata,facts,andstatistics.Stay focusedonthepoint(s)youwanttomake.Youcanoftenshapeastory.

•Usetelevisionwhenyouknowyouwillhavegoodvisuals.Bepreparedtoonlyget10-15 secondsofcoverage.

•Whenusingthenewspapersenddigitalphotoswithpressreleasesandincludethefullnames oftheindividualspictured.

•Useanygoodpresstohelppromoteyourproject. • Sendcopiesofarticlestodonors,communitypartnersandothersignificantplayersinyour project.

•Keepanotebookorfileofallofyourpresscoverage. •Createan“IntheNewsPage”onyourwebsite.Postallpressreleasesandprovidelinksto publisharticlesorvideohighlightingyourproject.

• Sendcopiesofarticlestofundersassoonasyougetthem.



TipsforHandlingaMediaInterview

•Beknowledgeableabouttheissue.Anticipatelikelyquestionsandhaveanswersready.

•Wheneverpossible,supportyourstatementswithfacts,statistics,quotesfromexperts, comparisons,orpersonalexperiences.

•Talkfromtheviewpointoftheaudience.Don’tusejargonor“insider”terminologysuchas acronyms.

•Speakinpersonalterms.Tobemorebelievable,use“I”not“we.”

•Listencarefullytothequestionandalwaystellthetruth.

•Don’tbeevasive.Neversay“nocomment.”Ifyoucannotansweraquestion,alwaysgiveavalid reasonfornotbeingabletoanswer.

•Don’tspeculate.Ifyoudon’tknowtheanswer,sayso,thenoffertofindout.

•Don’tanswerhypothetical“whatif”questions.Say“Wedon’tspeculate”andbridgetothereal issues.

•Ifyoudon’twantastatementquoted,don’tmakeit.There’snosuchthingas“offtherecord.”

•Don’tloseyourtemperorarguewithareporter.Youmaywinthebattle,butlosethewar.

•Ifaquestioncontainsnegativelanguage,don’trepeatitinyouranswer.

•Ifaskedseveralquestionsatonce,picktheonequestionyouwanttoanswer,answerit,andlet thereporterre-asktheothers.

•Withaforced-choicequestion,youdon’thavetoacceptthereporter’schoices,butyoucan offerathirdalternative.

Dealing with the Media: Know Your Rights!

When responding to media inquiries, you have the right to: •Knowwhoyou’retalkingto–askthereporter’snameandpublicationorstation. •Knowthetopicorstoryanglethereporterwantstopursue. •Changethelocationoftheinterview. •Haveaquestionrepeatedorclarified. •Sayyoudon’thaveananswerathand,butwillgetbacktothereportertoclarify.Findoutthe reporter’sdeadlineandhonorit. •Directareportertotheappropriatespokesperson.Besuretoalertthespokespersontoexpect acallfromthereporter. •Betreatedwiththesamecourtesyyouextendtothereporter.



www.vhcf.org


Communications Techniques & Strategies

I. Why do you want the media to talk to you?

•Morepeoplewilllearnaboutyourproject

•Moredonations

•Morepartners

•Morevolunteers

• Publicitywillhelpyousucceed

II. Who are the media?

•Broaderdefinitionof“media”thaneverbefore

• Traditionalmediaoutlets,suchasnewspapers,radio,andTV,arebeingincreasingly supplementedby,andoftenreplacedby,web-basedcontent,includingnewswebsites andblogs.

•Despitedropinsubscriberbase,newspaperscontinuetoattractkeyaudiencesandare important to cultivate

•Newspapersubscriberstendtobeolder,moreeducatedandhigherincome,andare goodtargetsforprojectsupportinitiatives.

•Younger,educated,affluentindividualsmaynotsubscribetoprintversionsofdaily newspapers,buttendtokeepupwithlocalnewselectronically,throughnewspapers’ websites. III. How do you reach the media?

•Createamedialistthatisbothcompleteandaccurate:

•Currentcontactinformationforeachmediaoutlet(update twice per year)

•Correct spelling of reporter/editor

•Morethanonecontactperoutlet

•AssignmentEditor

• FeaturesEditor

• Forblogs,specialtyradioandTVshows (e.g. Good Morning Richmond) and local/regional magazines,identifytheproduceroreditorinchargeoffeaturesandbreakingnews.

IV. How do you create a comprehensive media list?

•GotothelibraryandcheckforeitherBacon’sorBurrelle’smedialist(Online access to each can also be obtained for a fee through http://us.cision.com or http://www.burrellesluce.com)



www.vhcf.org


In the hard copy versions media outlets are listed by city – simply copy the pages you need andcalleachmediaoutlettoconfirmtheinformationiscorrect.

•UseGoogle.Searchwww.google.comusingthefollowingkeywords“medialisting(name of city/state)”–againyou’llneedtocalltoconfirmthatinfoiscorrect.

• Identifyblogsthatarerelevanttoyourprojectandbecomeanactiveparticipant

•Onceyouhavecreatedyourlistmakesureyouupdateiteverysixmonths(a great project for a volunteer or intern).

V. Now you have their names, but they need yours too!

•CreateaSourceSheetforusewiththemediathatincludes:

•Alinktoyourorganization’swebsite,ifyouhaveone

•Yourproject/organizationprimarycontact(includeworkandcellnumbers)

•Briefdescriptionoforganizationandmission

•Keystatisticsaboutyourproject(hours/daysofoperation,servicesprovided,demographic profileofindividualsserved,dataonnumberofpatientvisits,numberofpatients,etc.)

VI. Next Steps

• Makepersonalcontactwithout“selling”

• Lookforcommoninterests

• Providesourcesheet

• Encouragecallorvisittoyourorganization

•Contactthemediawhenyouhaveanewsorfeaturestorytopitch

•Newsistimesensitive,important,hasabroadappeal

• Featuresareinterestingoruniquestories,mayhaveaseasonaltie,canbe“pitched” wellinadvance VII. How to handle a media interview

•Beagreatresource

•Bringsupportingdataandinterestingexamples

•Keepyouranswersbrief

•Relax,Smile

• Takeasmuchtimeasyouneed

• Ifyouneedtocorrectananswer–stop,pauseandstartfromthebeginning.

• Ifyoudon’tknowtheanswer,sayso–thentrytogetthereporterincontactwithsomeone whodoes.

• Ifyouarenervous…

• Practiceinfrontofamirror

•Avoiddistractinghabits,clothesorvocalizations

• Printcopiesofanyprintorwebstoriesorblogsandgettranscriptsofanyradio/TVinterviews

•Send copies of all media coverage to VHCF and to your employees, volunteers and supporters


News Rules

1. Be brief and be gone! Media Alerts and Fact Sheets are the best tools

Media Alert

•Who,what,when,where,why

• Shouldbesentinadvanceofevent

•Grabstheirinterest

• Listsacontactperson(important to have 24-hour contact phone, preferably cell as well as office)

Fact Sheet

•Bulletedsummaryofkeyfacts

• Includesonlyessentialinformation

• Indicateswhyyourstoryisimportant

•Containsharddata

• Providesanecdotaldatainbriefform

• Listsacontactpersonandcontactinformation

2. Give them what they want!

•Whentheycall,meettheirdeadlines

•Makesuretheyhavewhattheyneedtocoveryou 3. “Pitch” to the right person

• Isitavisualstory?

• Ifit’semotionalorcompellingandhas“action”thatwouldmakegoodvideo,pitchlocal TVusingafactsheet.

•Makesureyouworkwiththeassignmentdirectororhealthreporter.

• Ifit’slessinterestingbutstillvisual,goforaphoto…

• Takeityourselfusingadigitalcamera

• Sizeto5x7andsaveathighresolutionasaJPEG

• Emailasacolorphoto(the editors can change it to black and white if they choose to use it).

• Includeacaptionwhenyousenditincludingthedateoftheevent,thenamesandtitles ofthepeoplefeaturedabriefdescriptionofwhatwentonattheevent,andthecontact person’sname/number/emailaddress.

• Emailittothephotoeditoratthelocalnewsletterandincludeitwithcopiesofyournews release


• Sendanewsreleasetimedforreleasethedayoftheeventgivingthedetailsofthenews you’dlikepeopletoknow

• Sendthenewsreleasebothelectronically,viaemailtoyourcontacts,aswellasviathe mail – particularly if it includes visuals (photo)

• Inadditiontoannouncingyournews,includebackgroundinformationonyourproject (a copy of your fact sheet)andcontactinformation.

• Someideasfornewsreleasesare:

•Atie-inthatyourprojecthaswitha“day”or“month”–e.g.cancerscreeningsavailable atyourfreeclinicaspartofNationalCancerAwarenessmonth.

•Asignificantnewdonationtoyourproject

•Amilestone,suchasopeninganewfacility,addingnewcaregivingstaff,expanding hoursordaysofoperation,orexpandingservices

•Othermilestonescouldincludeachievinganewlevelintermsoftotalpatientscared for(ortotalpatients)eitherduringtheyearorduringyourproject’shistory

4. Follow up!

•Alwayssendafollow-uptothereporter/mediathatcoveredyourstory,thankingthem fortheirinterestandofferingtobearesourceforthemonfuturestories.

• Iftheygotsomethingwrong,neverbecritical.Ifitwasaseriouserror(for example, saying that your project served 250 people last year, instead of 2,500),askprint/websourcesifthey wouldmindcorrectingthefiguresothattheinformationiscorrectforthefuture.

•Newspapersandmagazineswillprintan“errata”correctingtheinformationandwill usually change the back copy online to correct it, so that future stories concerning that issuewillbecorrect.

•RadioandTVsourcesdonotaircorrections,sodropthemapolitenoteviaemail(or in the mail),thankingthemfortheirinterestandkindlycorrectingthefact/sinquestion.

Getting publicity is important to the success of your project. Make the commitment. You’ll see the results!

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mission of mercy: index of sample forms/materials · Montpelier Gift Bags/Items - $2,950 Patient Registration $2,400 $6,308 Office Supplies $200 $1,375 ... Mission of Mercy In-Kind