Which of the following areas would you be willing to volunteer in? (Please check all that apply)
Please include a copy of the requested documents below. These are kept on file for insurance/auditing purposes.
Physicians​ ​must​ ​send​ ​a​ ​copy​ ​of​ ​the​ ​cover​ ​sheet​ ​with​ ​the​ ​amount​ ​of​ ​coverage​ ​and​ ​policy​ ​number​ ​of​ ​their​ ​current​ ​medical malpractice​ ​insurance. This​ ​is​ ​used​ ​until​ ​you​ ​are​ ​vetted​ ​for​ ​the​ ​Federal​ ​Tort​ ​Claims​ ​Act​ ​medical​ ​malpractice insurance. This​ ​is​ ​in​ ​addition​ ​to​ ​a​ ​medical​ ​license​ ​which​ ​is​ ​also​ ​required​ ​for​ ​insurance/auditing​ ​purposes
Â
As a condition of volunteering, I give permission to the FernCare Free Clinic to conduct a background check on me. I hereby release and agree to hold harmless from liability the FernCare Free Clinic, the employees and volunteers hereof or any other person that may provide such information. I also understand that the FernCare Free Clinic is not obligated to appoint me to a volunteer position. If appointed, I understand that I am subject to suspension and removal for violation of FernCare Clinic policies and procedures.