--~m=ed:i:ca:/~ce~~n:t:r~------------------e ~:~;;: river...testing. testing is done free of charge....
TRANSCRIPT
Indian River ---- ~~nte 1000 36th Street-~M=edica~Cer~------------------~~-------- Vero Beach FL 32960
7725674311 PHONE
7725625628 FAX
wwwirmccc
Thank you for your interest in becoming a Teenage Volunteer at Indian River Medical Center We are pleased that you want to give of your time to help others We hope that you will find it to be a most rewarding experience
Enclosed is an application to be completed and signed by at least one parent Please return it along with two (2) letters of recommendation from adults who are not family members
Becoming a Teenage Volunteer at IRMC is a commitment You will need to attend an orientation and be scheduled on a regular basis We require 40 hours of service to fulfill the requirements for the summer volunteer program In addition every volunteer must have a tuberculin skin test
We look forward to receiving your application which can be mailed or dropped off Thank you for your interest in volunteering
Sincerely yours
Bonnie Smith Teenage Volunteer Chairman 1000 36th St Vero Beach Fl 32960
Encl bsgeb
The Right Care Right Here
Indian River Medical Center
-APfgtt 1C1TTION- TEENAGE VOLUNTEER Indian River Medical Center
1000 36th Street Vero Beach FL 32960 7725674311 PHONE
7725625628 FAX
wwwirmccc
NAME____________________ Home phone________________
Cell Ph _ _ ____________E-Mail_______________________
Parents name-workcell phone foremergency use on ly _____________ ___________
ADDRESS _____________________________ _______
StreetP O Box CityState Zip
Age ___ Date of Birth _______Grade ___ Grade Point Average________
Hobbies-Special lnterest-----------------------------------shy
Name of SchooI_------------------------- -----------Clubs or Organizations ________________ _______________~--
Parents Names ____________________________________
Family Physician _____________________________________
How did you become interested in the TAVs ________ _____________ ___ _
List any teenagers you know who are TAVs______~------------------
Write a paragraph describing what volunteer work means to you and what you expect to gain from the program
Please enclose with application two letters of reference The letters should be from a teacher a neighbor an adult friend or a member of the clergy (None from relatives)
TAV must be 15 to 18 years of age and must maintain a grade average of C or better I am willing to submit to the training supervision and the rules and regulations of the TAV Program
IRMC conducts criminal record checks Falsification ofthis or any other information on this application is grounds for dismissal A conviction does not necessarily disqualify you from volunteering however omissions falsifications ormisrepresentations may be grounds for disqualifying you for consideration for volunteering
Have you ever been convicted of pied guilty nolo contend re or no contest or had any type of adjudication to a misdemeanor of felony YES NO
DATE _______
(Applicants signature)
The Right Care Right Here
We(I) approve our (my) daughters or sonss participation in the TAV Program and understand the conditions under which he~he may or may not qualify for consideration
(Parents signature)
PLEASE RETURN COMPLETED APPLICATION TO
Bonnie Smith TAV Chairman 1000 36th Street Vero Beach Fl 32960 middot
-middotmiddotbull~F~~middot-~__ Indian River fiedical Centi-r
Occupational Health Services Tuberculin Skin Test Questionnaire
Name_____ ___ _ _______Department Auxilli=ar=-y____-~== middot=
Please answer all questions by circling Yes or No
Do youbave now or are you being treated for Tuberculosis (TB) YIN
Have you ever had a positive Tuberculin Skin Test (TST) YIN
Have you ever had an allergic reaction to a TST or any other medication YIN
Have you ever taken INH (isoniazid) treatment for a positive TST YIN
Have you ever had a BCG (TB) vaccination (given in foreign countries for TB middot YIN prevention)
Are you ta1dng any imniunosuppressive drugs or steroids or do you suffer from YIN any immune system disorder
Have you had any serious illness in the past 6 weeks YIN
In the past 6 weeks have you received a vaccination for measles mumps YIN Rubella or MMR
Have you received immunoglobulin or other blood products or had a YIN transfusion in the past 3 months
FEMALES Are you pregnant or breastfeeding YIN
Please explain any Y answers ___ ___ ____ _ _ ___ _ ___ _
I have read or have had the infoIIDation about TST and TB screening explained to me I have had achance to ask questions that were answered to my satisfaction I understand the benefits and risks ofTST testing I request that the TST be given to me I agree to return in 48 hours for test interpretation and again in I week for step 2 if required
Signature _ ___ _ _ ___ _ ___ ____ _ Date _ _ _ _ _ _ _ _ _ _ _ _
PPDAux 83012
Tuberculosis Screening (PPD)
PARENTGUARDIAN INFORMATION
Hospital employees and auxilians must be tested for tuberculosis (TST) at the time ofjoining our organization except those with documentation of prior positive results in millimeters New auxilians whom do not submit proofof having been tested in the past year will receive a second TST one to three weeks after the first provided the first is negative Since our teenage volunteers are minors we will need your consent in order to proceed with testing Testing is done free of charge Should a chest x-ray be required that will also be done free of charge
Your child will need to return to have the test interpreted within 48-72 hours of administration ofthe test Ifit is not read within that time frame it will need to be repeated
Should you have any questions please feel free to call the Occupation Health Services at 772-567-4311 extension 2109
CONSENT
I consent to tuberculosis testing on my ____________
whose name is (Please print) _ _______ ________ _
Signature __________________ _ ___ _
Relationship ______________________ _
The Auxiliary of Indian River Medical Center Join One of These Service Committees
Cancer Center A volunteer acts as a receptionist for cancer radiation patients arriving for treatment Duty requirements include assisting patients with the registration process and providing waiting room comfort Basic computer skills are needed as well as the ability to assist with wheelchairs and walk to and from the hospital once per shift for mail
Computer Work - Various Departments
Courtesy Cart Volunteer drivers routinely transport lab work from the Ambulatory Services Center to the hospitals main lobby and also transport passengers to and from the parking lot as well as several other buildings on the hospital campus
Greeters Volunteers greet patients and visitors as they arrive at the main entrance They provide information offer assistance when needed and make an effort to control traffic They sometimes open car doors and when necessary provide wheelchair transport into the lobby
Emergency Department Volunteers assigned to the Emergency Department will assist staff in the waiting room registration minor care and acute care areas Volunteers greet and direct incoming patients and their families (Must be 16 years old)
Floor Services The volunteer acts as an a assistant for nurses and for the clerks located on each floor Typical duties include deliveries and pickups from the clerks errands to the Laboratory and wheel chair service for discharge patients
Imaging Sciences Volunteers transport patients to the appropriate imaging science area using wheelchairs stretchers or beds as directed
Magazine Closet Volunteers are responsible for distributing magazines through out the hospital They must be able to push the library cart and tolerate walking and standing Volunteers assist patients in selecting reading materials Paperback books are available on request
Patient Registration Ambulatory Services Center Volunteers serve as receptionists for patients coming into the Center for lab work or treatment They verify appointments notify the proper department that the patient has arrived and direct the patient to that department The Center is located diagonally across the street from the main entrance to the hospital
Main Building Volunteers serve as receptionists for patients coming into the hospitals Admitting Department
Patient Representatives Volunteers make daily visits to the patients to assist with needs and concerns They help resolve issues and also report compliments to the hospital staff Committee members should possess sensitivity good listening skills and oral and written communication skills while practicing the strictest confidentiality (Must be 16 years old)
Pharmacy Volunteers assist pharmacists and their staff with duties that include filing orders packaging pills in the label making machine collecting blue sheet order forms from the computer and giving them to the staff putting away medicine packing and unpacking the pneumatic tubes occasionally delivering medicine and delivering IVs They must be detail-oriented and able to stand for long periods of time
Pink Corner This is the hospital gift shop It is a major fund-raising committee and members must be able to operate the cash register (with on-site training) and possess excellent customer service skills
ReceptionEscortCourier Services Members rotate between the Lobby Reception Desk and the Auxiliary Office Duties include providing information transporting admitted and discharged patients escorting visitors and patients delivering flowers and running errands to various areas of the hospital campus They also assist the hospital staff with mailing collating and other projects Members must be able to push wheelchairs have good hearing and possess excellent customer relations skills Limited use of the computer is required with training provided
Auxiliary Office Desk The Auxiliary Office Desk is the center of activity and communications Good telephone skills are required Members answer the phone act as dispatchers and maintain a log of all calls They are also responsible for ordering office coffee and refreshment supplies
Store Room Delivering supplies
Stork Club Volunteers serve in the Womens Health Care Unit Duties include welcome new mothers with gifts photograph newborns collect food trays fill water pitchers and address other needs of the patients They must be able to push wheelchairs when discharging patients do extensive walking and be at ease with newborns
Surgical Services CPACU) Volunteers act as liaisons between the Recovery Room (PACU) and the Hospitality Rooms They keep a log of patients arriving and departing the Recovery Room answer the phone and run errands for the staff (Must be 16 years old)
Thrift Shop Volunteers sort price and sell items donated for resale The Hospital Auxiliary Thrift Shop has its own building at 1855 14th Avenue This service is a major source of fund-raising efforts New and used auxiliary uniforms are sold here middot
WAITING ROOMS CariacRadiology Hospitality Room Volunteers direct outpatients to the appropriate imaging science area and assist in filing x-rays and other records as directed
Surgery Hospitality Room Volunteers serve as liaisons between the Recovery Room and the patients family The waiting family is advised by the volunteer when the physician is available for consultation and informed of the patients room assignment (Must be 16 years old)
Rev 210 TAVServiceComm
Indian River Medical Center
-APfgtt 1C1TTION- TEENAGE VOLUNTEER Indian River Medical Center
1000 36th Street Vero Beach FL 32960 7725674311 PHONE
7725625628 FAX
wwwirmccc
NAME____________________ Home phone________________
Cell Ph _ _ ____________E-Mail_______________________
Parents name-workcell phone foremergency use on ly _____________ ___________
ADDRESS _____________________________ _______
StreetP O Box CityState Zip
Age ___ Date of Birth _______Grade ___ Grade Point Average________
Hobbies-Special lnterest-----------------------------------shy
Name of SchooI_------------------------- -----------Clubs or Organizations ________________ _______________~--
Parents Names ____________________________________
Family Physician _____________________________________
How did you become interested in the TAVs ________ _____________ ___ _
List any teenagers you know who are TAVs______~------------------
Write a paragraph describing what volunteer work means to you and what you expect to gain from the program
Please enclose with application two letters of reference The letters should be from a teacher a neighbor an adult friend or a member of the clergy (None from relatives)
TAV must be 15 to 18 years of age and must maintain a grade average of C or better I am willing to submit to the training supervision and the rules and regulations of the TAV Program
IRMC conducts criminal record checks Falsification ofthis or any other information on this application is grounds for dismissal A conviction does not necessarily disqualify you from volunteering however omissions falsifications ormisrepresentations may be grounds for disqualifying you for consideration for volunteering
Have you ever been convicted of pied guilty nolo contend re or no contest or had any type of adjudication to a misdemeanor of felony YES NO
DATE _______
(Applicants signature)
The Right Care Right Here
We(I) approve our (my) daughters or sonss participation in the TAV Program and understand the conditions under which he~he may or may not qualify for consideration
(Parents signature)
PLEASE RETURN COMPLETED APPLICATION TO
Bonnie Smith TAV Chairman 1000 36th Street Vero Beach Fl 32960 middot
-middotmiddotbull~F~~middot-~__ Indian River fiedical Centi-r
Occupational Health Services Tuberculin Skin Test Questionnaire
Name_____ ___ _ _______Department Auxilli=ar=-y____-~== middot=
Please answer all questions by circling Yes or No
Do youbave now or are you being treated for Tuberculosis (TB) YIN
Have you ever had a positive Tuberculin Skin Test (TST) YIN
Have you ever had an allergic reaction to a TST or any other medication YIN
Have you ever taken INH (isoniazid) treatment for a positive TST YIN
Have you ever had a BCG (TB) vaccination (given in foreign countries for TB middot YIN prevention)
Are you ta1dng any imniunosuppressive drugs or steroids or do you suffer from YIN any immune system disorder
Have you had any serious illness in the past 6 weeks YIN
In the past 6 weeks have you received a vaccination for measles mumps YIN Rubella or MMR
Have you received immunoglobulin or other blood products or had a YIN transfusion in the past 3 months
FEMALES Are you pregnant or breastfeeding YIN
Please explain any Y answers ___ ___ ____ _ _ ___ _ ___ _
I have read or have had the infoIIDation about TST and TB screening explained to me I have had achance to ask questions that were answered to my satisfaction I understand the benefits and risks ofTST testing I request that the TST be given to me I agree to return in 48 hours for test interpretation and again in I week for step 2 if required
Signature _ ___ _ _ ___ _ ___ ____ _ Date _ _ _ _ _ _ _ _ _ _ _ _
PPDAux 83012
Tuberculosis Screening (PPD)
PARENTGUARDIAN INFORMATION
Hospital employees and auxilians must be tested for tuberculosis (TST) at the time ofjoining our organization except those with documentation of prior positive results in millimeters New auxilians whom do not submit proofof having been tested in the past year will receive a second TST one to three weeks after the first provided the first is negative Since our teenage volunteers are minors we will need your consent in order to proceed with testing Testing is done free of charge Should a chest x-ray be required that will also be done free of charge
Your child will need to return to have the test interpreted within 48-72 hours of administration ofthe test Ifit is not read within that time frame it will need to be repeated
Should you have any questions please feel free to call the Occupation Health Services at 772-567-4311 extension 2109
CONSENT
I consent to tuberculosis testing on my ____________
whose name is (Please print) _ _______ ________ _
Signature __________________ _ ___ _
Relationship ______________________ _
The Auxiliary of Indian River Medical Center Join One of These Service Committees
Cancer Center A volunteer acts as a receptionist for cancer radiation patients arriving for treatment Duty requirements include assisting patients with the registration process and providing waiting room comfort Basic computer skills are needed as well as the ability to assist with wheelchairs and walk to and from the hospital once per shift for mail
Computer Work - Various Departments
Courtesy Cart Volunteer drivers routinely transport lab work from the Ambulatory Services Center to the hospitals main lobby and also transport passengers to and from the parking lot as well as several other buildings on the hospital campus
Greeters Volunteers greet patients and visitors as they arrive at the main entrance They provide information offer assistance when needed and make an effort to control traffic They sometimes open car doors and when necessary provide wheelchair transport into the lobby
Emergency Department Volunteers assigned to the Emergency Department will assist staff in the waiting room registration minor care and acute care areas Volunteers greet and direct incoming patients and their families (Must be 16 years old)
Floor Services The volunteer acts as an a assistant for nurses and for the clerks located on each floor Typical duties include deliveries and pickups from the clerks errands to the Laboratory and wheel chair service for discharge patients
Imaging Sciences Volunteers transport patients to the appropriate imaging science area using wheelchairs stretchers or beds as directed
Magazine Closet Volunteers are responsible for distributing magazines through out the hospital They must be able to push the library cart and tolerate walking and standing Volunteers assist patients in selecting reading materials Paperback books are available on request
Patient Registration Ambulatory Services Center Volunteers serve as receptionists for patients coming into the Center for lab work or treatment They verify appointments notify the proper department that the patient has arrived and direct the patient to that department The Center is located diagonally across the street from the main entrance to the hospital
Main Building Volunteers serve as receptionists for patients coming into the hospitals Admitting Department
Patient Representatives Volunteers make daily visits to the patients to assist with needs and concerns They help resolve issues and also report compliments to the hospital staff Committee members should possess sensitivity good listening skills and oral and written communication skills while practicing the strictest confidentiality (Must be 16 years old)
Pharmacy Volunteers assist pharmacists and their staff with duties that include filing orders packaging pills in the label making machine collecting blue sheet order forms from the computer and giving them to the staff putting away medicine packing and unpacking the pneumatic tubes occasionally delivering medicine and delivering IVs They must be detail-oriented and able to stand for long periods of time
Pink Corner This is the hospital gift shop It is a major fund-raising committee and members must be able to operate the cash register (with on-site training) and possess excellent customer service skills
ReceptionEscortCourier Services Members rotate between the Lobby Reception Desk and the Auxiliary Office Duties include providing information transporting admitted and discharged patients escorting visitors and patients delivering flowers and running errands to various areas of the hospital campus They also assist the hospital staff with mailing collating and other projects Members must be able to push wheelchairs have good hearing and possess excellent customer relations skills Limited use of the computer is required with training provided
Auxiliary Office Desk The Auxiliary Office Desk is the center of activity and communications Good telephone skills are required Members answer the phone act as dispatchers and maintain a log of all calls They are also responsible for ordering office coffee and refreshment supplies
Store Room Delivering supplies
Stork Club Volunteers serve in the Womens Health Care Unit Duties include welcome new mothers with gifts photograph newborns collect food trays fill water pitchers and address other needs of the patients They must be able to push wheelchairs when discharging patients do extensive walking and be at ease with newborns
Surgical Services CPACU) Volunteers act as liaisons between the Recovery Room (PACU) and the Hospitality Rooms They keep a log of patients arriving and departing the Recovery Room answer the phone and run errands for the staff (Must be 16 years old)
Thrift Shop Volunteers sort price and sell items donated for resale The Hospital Auxiliary Thrift Shop has its own building at 1855 14th Avenue This service is a major source of fund-raising efforts New and used auxiliary uniforms are sold here middot
WAITING ROOMS CariacRadiology Hospitality Room Volunteers direct outpatients to the appropriate imaging science area and assist in filing x-rays and other records as directed
Surgery Hospitality Room Volunteers serve as liaisons between the Recovery Room and the patients family The waiting family is advised by the volunteer when the physician is available for consultation and informed of the patients room assignment (Must be 16 years old)
Rev 210 TAVServiceComm
We(I) approve our (my) daughters or sonss participation in the TAV Program and understand the conditions under which he~he may or may not qualify for consideration
(Parents signature)
PLEASE RETURN COMPLETED APPLICATION TO
Bonnie Smith TAV Chairman 1000 36th Street Vero Beach Fl 32960 middot
-middotmiddotbull~F~~middot-~__ Indian River fiedical Centi-r
Occupational Health Services Tuberculin Skin Test Questionnaire
Name_____ ___ _ _______Department Auxilli=ar=-y____-~== middot=
Please answer all questions by circling Yes or No
Do youbave now or are you being treated for Tuberculosis (TB) YIN
Have you ever had a positive Tuberculin Skin Test (TST) YIN
Have you ever had an allergic reaction to a TST or any other medication YIN
Have you ever taken INH (isoniazid) treatment for a positive TST YIN
Have you ever had a BCG (TB) vaccination (given in foreign countries for TB middot YIN prevention)
Are you ta1dng any imniunosuppressive drugs or steroids or do you suffer from YIN any immune system disorder
Have you had any serious illness in the past 6 weeks YIN
In the past 6 weeks have you received a vaccination for measles mumps YIN Rubella or MMR
Have you received immunoglobulin or other blood products or had a YIN transfusion in the past 3 months
FEMALES Are you pregnant or breastfeeding YIN
Please explain any Y answers ___ ___ ____ _ _ ___ _ ___ _
I have read or have had the infoIIDation about TST and TB screening explained to me I have had achance to ask questions that were answered to my satisfaction I understand the benefits and risks ofTST testing I request that the TST be given to me I agree to return in 48 hours for test interpretation and again in I week for step 2 if required
Signature _ ___ _ _ ___ _ ___ ____ _ Date _ _ _ _ _ _ _ _ _ _ _ _
PPDAux 83012
Tuberculosis Screening (PPD)
PARENTGUARDIAN INFORMATION
Hospital employees and auxilians must be tested for tuberculosis (TST) at the time ofjoining our organization except those with documentation of prior positive results in millimeters New auxilians whom do not submit proofof having been tested in the past year will receive a second TST one to three weeks after the first provided the first is negative Since our teenage volunteers are minors we will need your consent in order to proceed with testing Testing is done free of charge Should a chest x-ray be required that will also be done free of charge
Your child will need to return to have the test interpreted within 48-72 hours of administration ofthe test Ifit is not read within that time frame it will need to be repeated
Should you have any questions please feel free to call the Occupation Health Services at 772-567-4311 extension 2109
CONSENT
I consent to tuberculosis testing on my ____________
whose name is (Please print) _ _______ ________ _
Signature __________________ _ ___ _
Relationship ______________________ _
The Auxiliary of Indian River Medical Center Join One of These Service Committees
Cancer Center A volunteer acts as a receptionist for cancer radiation patients arriving for treatment Duty requirements include assisting patients with the registration process and providing waiting room comfort Basic computer skills are needed as well as the ability to assist with wheelchairs and walk to and from the hospital once per shift for mail
Computer Work - Various Departments
Courtesy Cart Volunteer drivers routinely transport lab work from the Ambulatory Services Center to the hospitals main lobby and also transport passengers to and from the parking lot as well as several other buildings on the hospital campus
Greeters Volunteers greet patients and visitors as they arrive at the main entrance They provide information offer assistance when needed and make an effort to control traffic They sometimes open car doors and when necessary provide wheelchair transport into the lobby
Emergency Department Volunteers assigned to the Emergency Department will assist staff in the waiting room registration minor care and acute care areas Volunteers greet and direct incoming patients and their families (Must be 16 years old)
Floor Services The volunteer acts as an a assistant for nurses and for the clerks located on each floor Typical duties include deliveries and pickups from the clerks errands to the Laboratory and wheel chair service for discharge patients
Imaging Sciences Volunteers transport patients to the appropriate imaging science area using wheelchairs stretchers or beds as directed
Magazine Closet Volunteers are responsible for distributing magazines through out the hospital They must be able to push the library cart and tolerate walking and standing Volunteers assist patients in selecting reading materials Paperback books are available on request
Patient Registration Ambulatory Services Center Volunteers serve as receptionists for patients coming into the Center for lab work or treatment They verify appointments notify the proper department that the patient has arrived and direct the patient to that department The Center is located diagonally across the street from the main entrance to the hospital
Main Building Volunteers serve as receptionists for patients coming into the hospitals Admitting Department
Patient Representatives Volunteers make daily visits to the patients to assist with needs and concerns They help resolve issues and also report compliments to the hospital staff Committee members should possess sensitivity good listening skills and oral and written communication skills while practicing the strictest confidentiality (Must be 16 years old)
Pharmacy Volunteers assist pharmacists and their staff with duties that include filing orders packaging pills in the label making machine collecting blue sheet order forms from the computer and giving them to the staff putting away medicine packing and unpacking the pneumatic tubes occasionally delivering medicine and delivering IVs They must be detail-oriented and able to stand for long periods of time
Pink Corner This is the hospital gift shop It is a major fund-raising committee and members must be able to operate the cash register (with on-site training) and possess excellent customer service skills
ReceptionEscortCourier Services Members rotate between the Lobby Reception Desk and the Auxiliary Office Duties include providing information transporting admitted and discharged patients escorting visitors and patients delivering flowers and running errands to various areas of the hospital campus They also assist the hospital staff with mailing collating and other projects Members must be able to push wheelchairs have good hearing and possess excellent customer relations skills Limited use of the computer is required with training provided
Auxiliary Office Desk The Auxiliary Office Desk is the center of activity and communications Good telephone skills are required Members answer the phone act as dispatchers and maintain a log of all calls They are also responsible for ordering office coffee and refreshment supplies
Store Room Delivering supplies
Stork Club Volunteers serve in the Womens Health Care Unit Duties include welcome new mothers with gifts photograph newborns collect food trays fill water pitchers and address other needs of the patients They must be able to push wheelchairs when discharging patients do extensive walking and be at ease with newborns
Surgical Services CPACU) Volunteers act as liaisons between the Recovery Room (PACU) and the Hospitality Rooms They keep a log of patients arriving and departing the Recovery Room answer the phone and run errands for the staff (Must be 16 years old)
Thrift Shop Volunteers sort price and sell items donated for resale The Hospital Auxiliary Thrift Shop has its own building at 1855 14th Avenue This service is a major source of fund-raising efforts New and used auxiliary uniforms are sold here middot
WAITING ROOMS CariacRadiology Hospitality Room Volunteers direct outpatients to the appropriate imaging science area and assist in filing x-rays and other records as directed
Surgery Hospitality Room Volunteers serve as liaisons between the Recovery Room and the patients family The waiting family is advised by the volunteer when the physician is available for consultation and informed of the patients room assignment (Must be 16 years old)
Rev 210 TAVServiceComm
-middotmiddotbull~F~~middot-~__ Indian River fiedical Centi-r
Occupational Health Services Tuberculin Skin Test Questionnaire
Name_____ ___ _ _______Department Auxilli=ar=-y____-~== middot=
Please answer all questions by circling Yes or No
Do youbave now or are you being treated for Tuberculosis (TB) YIN
Have you ever had a positive Tuberculin Skin Test (TST) YIN
Have you ever had an allergic reaction to a TST or any other medication YIN
Have you ever taken INH (isoniazid) treatment for a positive TST YIN
Have you ever had a BCG (TB) vaccination (given in foreign countries for TB middot YIN prevention)
Are you ta1dng any imniunosuppressive drugs or steroids or do you suffer from YIN any immune system disorder
Have you had any serious illness in the past 6 weeks YIN
In the past 6 weeks have you received a vaccination for measles mumps YIN Rubella or MMR
Have you received immunoglobulin or other blood products or had a YIN transfusion in the past 3 months
FEMALES Are you pregnant or breastfeeding YIN
Please explain any Y answers ___ ___ ____ _ _ ___ _ ___ _
I have read or have had the infoIIDation about TST and TB screening explained to me I have had achance to ask questions that were answered to my satisfaction I understand the benefits and risks ofTST testing I request that the TST be given to me I agree to return in 48 hours for test interpretation and again in I week for step 2 if required
Signature _ ___ _ _ ___ _ ___ ____ _ Date _ _ _ _ _ _ _ _ _ _ _ _
PPDAux 83012
Tuberculosis Screening (PPD)
PARENTGUARDIAN INFORMATION
Hospital employees and auxilians must be tested for tuberculosis (TST) at the time ofjoining our organization except those with documentation of prior positive results in millimeters New auxilians whom do not submit proofof having been tested in the past year will receive a second TST one to three weeks after the first provided the first is negative Since our teenage volunteers are minors we will need your consent in order to proceed with testing Testing is done free of charge Should a chest x-ray be required that will also be done free of charge
Your child will need to return to have the test interpreted within 48-72 hours of administration ofthe test Ifit is not read within that time frame it will need to be repeated
Should you have any questions please feel free to call the Occupation Health Services at 772-567-4311 extension 2109
CONSENT
I consent to tuberculosis testing on my ____________
whose name is (Please print) _ _______ ________ _
Signature __________________ _ ___ _
Relationship ______________________ _
The Auxiliary of Indian River Medical Center Join One of These Service Committees
Cancer Center A volunteer acts as a receptionist for cancer radiation patients arriving for treatment Duty requirements include assisting patients with the registration process and providing waiting room comfort Basic computer skills are needed as well as the ability to assist with wheelchairs and walk to and from the hospital once per shift for mail
Computer Work - Various Departments
Courtesy Cart Volunteer drivers routinely transport lab work from the Ambulatory Services Center to the hospitals main lobby and also transport passengers to and from the parking lot as well as several other buildings on the hospital campus
Greeters Volunteers greet patients and visitors as they arrive at the main entrance They provide information offer assistance when needed and make an effort to control traffic They sometimes open car doors and when necessary provide wheelchair transport into the lobby
Emergency Department Volunteers assigned to the Emergency Department will assist staff in the waiting room registration minor care and acute care areas Volunteers greet and direct incoming patients and their families (Must be 16 years old)
Floor Services The volunteer acts as an a assistant for nurses and for the clerks located on each floor Typical duties include deliveries and pickups from the clerks errands to the Laboratory and wheel chair service for discharge patients
Imaging Sciences Volunteers transport patients to the appropriate imaging science area using wheelchairs stretchers or beds as directed
Magazine Closet Volunteers are responsible for distributing magazines through out the hospital They must be able to push the library cart and tolerate walking and standing Volunteers assist patients in selecting reading materials Paperback books are available on request
Patient Registration Ambulatory Services Center Volunteers serve as receptionists for patients coming into the Center for lab work or treatment They verify appointments notify the proper department that the patient has arrived and direct the patient to that department The Center is located diagonally across the street from the main entrance to the hospital
Main Building Volunteers serve as receptionists for patients coming into the hospitals Admitting Department
Patient Representatives Volunteers make daily visits to the patients to assist with needs and concerns They help resolve issues and also report compliments to the hospital staff Committee members should possess sensitivity good listening skills and oral and written communication skills while practicing the strictest confidentiality (Must be 16 years old)
Pharmacy Volunteers assist pharmacists and their staff with duties that include filing orders packaging pills in the label making machine collecting blue sheet order forms from the computer and giving them to the staff putting away medicine packing and unpacking the pneumatic tubes occasionally delivering medicine and delivering IVs They must be detail-oriented and able to stand for long periods of time
Pink Corner This is the hospital gift shop It is a major fund-raising committee and members must be able to operate the cash register (with on-site training) and possess excellent customer service skills
ReceptionEscortCourier Services Members rotate between the Lobby Reception Desk and the Auxiliary Office Duties include providing information transporting admitted and discharged patients escorting visitors and patients delivering flowers and running errands to various areas of the hospital campus They also assist the hospital staff with mailing collating and other projects Members must be able to push wheelchairs have good hearing and possess excellent customer relations skills Limited use of the computer is required with training provided
Auxiliary Office Desk The Auxiliary Office Desk is the center of activity and communications Good telephone skills are required Members answer the phone act as dispatchers and maintain a log of all calls They are also responsible for ordering office coffee and refreshment supplies
Store Room Delivering supplies
Stork Club Volunteers serve in the Womens Health Care Unit Duties include welcome new mothers with gifts photograph newborns collect food trays fill water pitchers and address other needs of the patients They must be able to push wheelchairs when discharging patients do extensive walking and be at ease with newborns
Surgical Services CPACU) Volunteers act as liaisons between the Recovery Room (PACU) and the Hospitality Rooms They keep a log of patients arriving and departing the Recovery Room answer the phone and run errands for the staff (Must be 16 years old)
Thrift Shop Volunteers sort price and sell items donated for resale The Hospital Auxiliary Thrift Shop has its own building at 1855 14th Avenue This service is a major source of fund-raising efforts New and used auxiliary uniforms are sold here middot
WAITING ROOMS CariacRadiology Hospitality Room Volunteers direct outpatients to the appropriate imaging science area and assist in filing x-rays and other records as directed
Surgery Hospitality Room Volunteers serve as liaisons between the Recovery Room and the patients family The waiting family is advised by the volunteer when the physician is available for consultation and informed of the patients room assignment (Must be 16 years old)
Rev 210 TAVServiceComm
Tuberculosis Screening (PPD)
PARENTGUARDIAN INFORMATION
Hospital employees and auxilians must be tested for tuberculosis (TST) at the time ofjoining our organization except those with documentation of prior positive results in millimeters New auxilians whom do not submit proofof having been tested in the past year will receive a second TST one to three weeks after the first provided the first is negative Since our teenage volunteers are minors we will need your consent in order to proceed with testing Testing is done free of charge Should a chest x-ray be required that will also be done free of charge
Your child will need to return to have the test interpreted within 48-72 hours of administration ofthe test Ifit is not read within that time frame it will need to be repeated
Should you have any questions please feel free to call the Occupation Health Services at 772-567-4311 extension 2109
CONSENT
I consent to tuberculosis testing on my ____________
whose name is (Please print) _ _______ ________ _
Signature __________________ _ ___ _
Relationship ______________________ _
The Auxiliary of Indian River Medical Center Join One of These Service Committees
Cancer Center A volunteer acts as a receptionist for cancer radiation patients arriving for treatment Duty requirements include assisting patients with the registration process and providing waiting room comfort Basic computer skills are needed as well as the ability to assist with wheelchairs and walk to and from the hospital once per shift for mail
Computer Work - Various Departments
Courtesy Cart Volunteer drivers routinely transport lab work from the Ambulatory Services Center to the hospitals main lobby and also transport passengers to and from the parking lot as well as several other buildings on the hospital campus
Greeters Volunteers greet patients and visitors as they arrive at the main entrance They provide information offer assistance when needed and make an effort to control traffic They sometimes open car doors and when necessary provide wheelchair transport into the lobby
Emergency Department Volunteers assigned to the Emergency Department will assist staff in the waiting room registration minor care and acute care areas Volunteers greet and direct incoming patients and their families (Must be 16 years old)
Floor Services The volunteer acts as an a assistant for nurses and for the clerks located on each floor Typical duties include deliveries and pickups from the clerks errands to the Laboratory and wheel chair service for discharge patients
Imaging Sciences Volunteers transport patients to the appropriate imaging science area using wheelchairs stretchers or beds as directed
Magazine Closet Volunteers are responsible for distributing magazines through out the hospital They must be able to push the library cart and tolerate walking and standing Volunteers assist patients in selecting reading materials Paperback books are available on request
Patient Registration Ambulatory Services Center Volunteers serve as receptionists for patients coming into the Center for lab work or treatment They verify appointments notify the proper department that the patient has arrived and direct the patient to that department The Center is located diagonally across the street from the main entrance to the hospital
Main Building Volunteers serve as receptionists for patients coming into the hospitals Admitting Department
Patient Representatives Volunteers make daily visits to the patients to assist with needs and concerns They help resolve issues and also report compliments to the hospital staff Committee members should possess sensitivity good listening skills and oral and written communication skills while practicing the strictest confidentiality (Must be 16 years old)
Pharmacy Volunteers assist pharmacists and their staff with duties that include filing orders packaging pills in the label making machine collecting blue sheet order forms from the computer and giving them to the staff putting away medicine packing and unpacking the pneumatic tubes occasionally delivering medicine and delivering IVs They must be detail-oriented and able to stand for long periods of time
Pink Corner This is the hospital gift shop It is a major fund-raising committee and members must be able to operate the cash register (with on-site training) and possess excellent customer service skills
ReceptionEscortCourier Services Members rotate between the Lobby Reception Desk and the Auxiliary Office Duties include providing information transporting admitted and discharged patients escorting visitors and patients delivering flowers and running errands to various areas of the hospital campus They also assist the hospital staff with mailing collating and other projects Members must be able to push wheelchairs have good hearing and possess excellent customer relations skills Limited use of the computer is required with training provided
Auxiliary Office Desk The Auxiliary Office Desk is the center of activity and communications Good telephone skills are required Members answer the phone act as dispatchers and maintain a log of all calls They are also responsible for ordering office coffee and refreshment supplies
Store Room Delivering supplies
Stork Club Volunteers serve in the Womens Health Care Unit Duties include welcome new mothers with gifts photograph newborns collect food trays fill water pitchers and address other needs of the patients They must be able to push wheelchairs when discharging patients do extensive walking and be at ease with newborns
Surgical Services CPACU) Volunteers act as liaisons between the Recovery Room (PACU) and the Hospitality Rooms They keep a log of patients arriving and departing the Recovery Room answer the phone and run errands for the staff (Must be 16 years old)
Thrift Shop Volunteers sort price and sell items donated for resale The Hospital Auxiliary Thrift Shop has its own building at 1855 14th Avenue This service is a major source of fund-raising efforts New and used auxiliary uniforms are sold here middot
WAITING ROOMS CariacRadiology Hospitality Room Volunteers direct outpatients to the appropriate imaging science area and assist in filing x-rays and other records as directed
Surgery Hospitality Room Volunteers serve as liaisons between the Recovery Room and the patients family The waiting family is advised by the volunteer when the physician is available for consultation and informed of the patients room assignment (Must be 16 years old)
Rev 210 TAVServiceComm
The Auxiliary of Indian River Medical Center Join One of These Service Committees
Cancer Center A volunteer acts as a receptionist for cancer radiation patients arriving for treatment Duty requirements include assisting patients with the registration process and providing waiting room comfort Basic computer skills are needed as well as the ability to assist with wheelchairs and walk to and from the hospital once per shift for mail
Computer Work - Various Departments
Courtesy Cart Volunteer drivers routinely transport lab work from the Ambulatory Services Center to the hospitals main lobby and also transport passengers to and from the parking lot as well as several other buildings on the hospital campus
Greeters Volunteers greet patients and visitors as they arrive at the main entrance They provide information offer assistance when needed and make an effort to control traffic They sometimes open car doors and when necessary provide wheelchair transport into the lobby
Emergency Department Volunteers assigned to the Emergency Department will assist staff in the waiting room registration minor care and acute care areas Volunteers greet and direct incoming patients and their families (Must be 16 years old)
Floor Services The volunteer acts as an a assistant for nurses and for the clerks located on each floor Typical duties include deliveries and pickups from the clerks errands to the Laboratory and wheel chair service for discharge patients
Imaging Sciences Volunteers transport patients to the appropriate imaging science area using wheelchairs stretchers or beds as directed
Magazine Closet Volunteers are responsible for distributing magazines through out the hospital They must be able to push the library cart and tolerate walking and standing Volunteers assist patients in selecting reading materials Paperback books are available on request
Patient Registration Ambulatory Services Center Volunteers serve as receptionists for patients coming into the Center for lab work or treatment They verify appointments notify the proper department that the patient has arrived and direct the patient to that department The Center is located diagonally across the street from the main entrance to the hospital
Main Building Volunteers serve as receptionists for patients coming into the hospitals Admitting Department
Patient Representatives Volunteers make daily visits to the patients to assist with needs and concerns They help resolve issues and also report compliments to the hospital staff Committee members should possess sensitivity good listening skills and oral and written communication skills while practicing the strictest confidentiality (Must be 16 years old)
Pharmacy Volunteers assist pharmacists and their staff with duties that include filing orders packaging pills in the label making machine collecting blue sheet order forms from the computer and giving them to the staff putting away medicine packing and unpacking the pneumatic tubes occasionally delivering medicine and delivering IVs They must be detail-oriented and able to stand for long periods of time
Pink Corner This is the hospital gift shop It is a major fund-raising committee and members must be able to operate the cash register (with on-site training) and possess excellent customer service skills
ReceptionEscortCourier Services Members rotate between the Lobby Reception Desk and the Auxiliary Office Duties include providing information transporting admitted and discharged patients escorting visitors and patients delivering flowers and running errands to various areas of the hospital campus They also assist the hospital staff with mailing collating and other projects Members must be able to push wheelchairs have good hearing and possess excellent customer relations skills Limited use of the computer is required with training provided
Auxiliary Office Desk The Auxiliary Office Desk is the center of activity and communications Good telephone skills are required Members answer the phone act as dispatchers and maintain a log of all calls They are also responsible for ordering office coffee and refreshment supplies
Store Room Delivering supplies
Stork Club Volunteers serve in the Womens Health Care Unit Duties include welcome new mothers with gifts photograph newborns collect food trays fill water pitchers and address other needs of the patients They must be able to push wheelchairs when discharging patients do extensive walking and be at ease with newborns
Surgical Services CPACU) Volunteers act as liaisons between the Recovery Room (PACU) and the Hospitality Rooms They keep a log of patients arriving and departing the Recovery Room answer the phone and run errands for the staff (Must be 16 years old)
Thrift Shop Volunteers sort price and sell items donated for resale The Hospital Auxiliary Thrift Shop has its own building at 1855 14th Avenue This service is a major source of fund-raising efforts New and used auxiliary uniforms are sold here middot
WAITING ROOMS CariacRadiology Hospitality Room Volunteers direct outpatients to the appropriate imaging science area and assist in filing x-rays and other records as directed
Surgery Hospitality Room Volunteers serve as liaisons between the Recovery Room and the patients family The waiting family is advised by the volunteer when the physician is available for consultation and informed of the patients room assignment (Must be 16 years old)
Rev 210 TAVServiceComm
Pink Corner This is the hospital gift shop It is a major fund-raising committee and members must be able to operate the cash register (with on-site training) and possess excellent customer service skills
ReceptionEscortCourier Services Members rotate between the Lobby Reception Desk and the Auxiliary Office Duties include providing information transporting admitted and discharged patients escorting visitors and patients delivering flowers and running errands to various areas of the hospital campus They also assist the hospital staff with mailing collating and other projects Members must be able to push wheelchairs have good hearing and possess excellent customer relations skills Limited use of the computer is required with training provided
Auxiliary Office Desk The Auxiliary Office Desk is the center of activity and communications Good telephone skills are required Members answer the phone act as dispatchers and maintain a log of all calls They are also responsible for ordering office coffee and refreshment supplies
Store Room Delivering supplies
Stork Club Volunteers serve in the Womens Health Care Unit Duties include welcome new mothers with gifts photograph newborns collect food trays fill water pitchers and address other needs of the patients They must be able to push wheelchairs when discharging patients do extensive walking and be at ease with newborns
Surgical Services CPACU) Volunteers act as liaisons between the Recovery Room (PACU) and the Hospitality Rooms They keep a log of patients arriving and departing the Recovery Room answer the phone and run errands for the staff (Must be 16 years old)
Thrift Shop Volunteers sort price and sell items donated for resale The Hospital Auxiliary Thrift Shop has its own building at 1855 14th Avenue This service is a major source of fund-raising efforts New and used auxiliary uniforms are sold here middot
WAITING ROOMS CariacRadiology Hospitality Room Volunteers direct outpatients to the appropriate imaging science area and assist in filing x-rays and other records as directed
Surgery Hospitality Room Volunteers serve as liaisons between the Recovery Room and the patients family The waiting family is advised by the volunteer when the physician is available for consultation and informed of the patients room assignment (Must be 16 years old)
Rev 210 TAVServiceComm