Agreement and Policies
Agreement
I understand and agree that submitting this application form does not automatically register me as an Amed Family Clinic Volunteer, and that there may be certain qualifications I must meet, including the acceptance of established policies and procedures before I may begin volunteering. I agree to provide annual HIPPA training certificate and updated immunization records.
Your services are donated to Amed Family Clinic (Amed Medical Group, PLLC) without contemplation of compensation or future employment and are given for humanitarian reasons. I realize I am never required to perform any services as a volunteer which I am uncomfortable doing or for which I have not been properly trained.
You shall not sell or attempt to sell good or services, request contributions, or to solicit persons to sign or distribute political petitions on AFC property.
You shall submit to examinations, which may include background screening, chest x-rays, skin tests, appropriate laboratory tests and/or immunizations that may be necessary as part of my volunteer service. I hereby authorize my doctor(s) to furnish Amed Family Clinic (Amed Medical Group, PLLC) information concerning my health. I also authorize the person(s) making tests or x-ray films to report the results to AFC.
You agree not to directly or indirectly seek, receive or accept any payment, reimbursement or other compensation whatsoever for your service as a volunteer or for any other health care goods or services provided at AFC. This means, among other things, that you will not accept payments from a patient, third party payer or any other source.
Confidentiality
If accepted as a volunteer at Amed Family Clinic, I pledge to hold in strict confidence all personal and official matters which come to my attention. It is my responsibility to respect and preserve the privacy of the patient as well as any details involved. I certify that all information provided is true and correct to the best of my knowledge and there is no expectation of monetary compensation for donating my services.
I shall hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients, doctors or personnel, and not seek to obtain confidential information from a patient. Additionally, I will not attempt to photograph or solicit an autograph from a high profile patient or visitor.
I authorize Amed Family Clinic (Amed Medical Group, PLLC). to use any photographs, images,or videos of me for a variety of purposes in any type of print, video, or digital media, including internet sites, without restriction. I agree that these images may be used without further notifying me. I understand that I will not be paid or rewarded for providing this authorization.
Liability
In order to induce Amed Family Clinic (Amed Medical Group, PLLC) to accept your enrollment as a volunteer, you hereby absolutely and unconditionally waive, discharge and release Amed Family Clinic (Amed Medical Group, PLLC) , and all of their respective officers, representatives and employees, from any and all manner of claims, actions, causes of action, suits, obligations, debts, demands, agreements, promises, liabilities, controversies, costs and expenses (including attorney’s fees), in law or in equity, whether foreseen or unforeseen, matured or unmatured, known or unknown, accrued or not accrued, past, present or future, which you may have by reason of any cause or matter whatsoever related to the Amed Family Clinic (Amed Medical Group, PLLC) or your service as a volunteer.
Privacy Statement
We are committed to protecting your privacy. We will only use the information that we collect about you lawfully in accordance with the United States law, AFC policies, and for the purposes listed below.
By providing your information, you agree to receive e-mails from us from time to time. You may choose to not receive these emails at any time. Your information will not be shared with other members or parties unless you give your explicit
The information we hold will be accurate and up to date. You can check the information that we hold about you by emailing us any time. If you find any inaccuracies we will delete or correct it promptly. The personal information that we hold will be held securely in accordance with our internal virtual security policy and the law.
When you give us your personal information online, we will not sell, trade, or rent this personal information to any third parties or share it without your explicit consent.
AFC may disclose the personal information of individual users if required to do so by United States law or in the good faith belief that such action is necessary, as when conforming to the edicts of the law, or acting in urgent circumstances involving personal or public safety.
If you have any questions/comments about privacy, you should contact us.
I understand and agree that submitting this application form does not automatically register me as an Amed Family Clinic Volunteer, and that there may be certain qualifications I must meet, including the acceptance of established policies and procedures before I may begin volunteering. I agree to provide annual HIPPA training certificate and updated immunization records.
Your services are donated to Amed Family Clinic (Amed Medical Group, PLLC) without contemplation of compensation or future employment and are given for humanitarian reasons. I realize I am never required to perform any services as a volunteer which I am uncomfortable doing or for which I have not been properly trained.
You shall not sell or attempt to sell good or services, request contributions, or to solicit persons to sign or distribute political petitions on AFC property.
You shall submit to examinations, which may include background screening, chest x-rays, skin tests, appropriate laboratory tests and/or immunizations that may be necessary as part of my volunteer service. I hereby authorize my doctor(s) to furnish Amed Family Clinic (Amed Medical Group, PLLC) information concerning my health. I also authorize the person(s) making tests or x-ray films to report the results to AFC.
You agree not to directly or indirectly seek, receive or accept any payment, reimbursement or other compensation whatsoever for your service as a volunteer or for any other health care goods or services provided at AFC. This means, among other things, that you will not accept payments from a patient, third party payer or any other source.
Confidentiality
If accepted as a volunteer at Amed Family Clinic, I pledge to hold in strict confidence all personal and official matters which come to my attention. It is my responsibility to respect and preserve the privacy of the patient as well as any details involved. I certify that all information provided is true and correct to the best of my knowledge and there is no expectation of monetary compensation for donating my services.
I shall hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients, doctors or personnel, and not seek to obtain confidential information from a patient. Additionally, I will not attempt to photograph or solicit an autograph from a high profile patient or visitor.
I authorize Amed Family Clinic (Amed Medical Group, PLLC). to use any photographs, images,or videos of me for a variety of purposes in any type of print, video, or digital media, including internet sites, without restriction. I agree that these images may be used without further notifying me. I understand that I will not be paid or rewarded for providing this authorization.
Liability
In order to induce Amed Family Clinic (Amed Medical Group, PLLC) to accept your enrollment as a volunteer, you hereby absolutely and unconditionally waive, discharge and release Amed Family Clinic (Amed Medical Group, PLLC) , and all of their respective officers, representatives and employees, from any and all manner of claims, actions, causes of action, suits, obligations, debts, demands, agreements, promises, liabilities, controversies, costs and expenses (including attorney’s fees), in law or in equity, whether foreseen or unforeseen, matured or unmatured, known or unknown, accrued or not accrued, past, present or future, which you may have by reason of any cause or matter whatsoever related to the Amed Family Clinic (Amed Medical Group, PLLC) or your service as a volunteer.
Privacy Statement
We are committed to protecting your privacy. We will only use the information that we collect about you lawfully in accordance with the United States law, AFC policies, and for the purposes listed below.
By providing your information, you agree to receive e-mails from us from time to time. You may choose to not receive these emails at any time. Your information will not be shared with other members or parties unless you give your explicit
The information we hold will be accurate and up to date. You can check the information that we hold about you by emailing us any time. If you find any inaccuracies we will delete or correct it promptly. The personal information that we hold will be held securely in accordance with our internal virtual security policy and the law.
When you give us your personal information online, we will not sell, trade, or rent this personal information to any third parties or share it without your explicit consent.
AFC may disclose the personal information of individual users if required to do so by United States law or in the good faith belief that such action is necessary, as when conforming to the edicts of the law, or acting in urgent circumstances involving personal or public safety.
If you have any questions/comments about privacy, you should contact us.