Tele Mobile Clinic Volunteer Interest Form
This sign up sheet merely shows interest in getting involved with the Tele Mobile Clinic initiative and not a full commitment.
Volunteers must be either:
(1) UIHC staff medical providers MD, DO, PA, NP, etc
(2) Students on clinical rotations: Med/PA/DNP/2/3/4
Step #1: fill out this interest form
**Step #2: sign-up for a shift:
**Specialty staff (ex: OB/Gyn, pediatrics, ortho, etc) only need to complete step #1 and do not need to sign up for a shift. You will be emailed the day before if there is a patient with a complaint related to your specialty if you're available/willing to help staff.
~~~ QUESTIONS/COMMENTS? ~~~
First and Last Name
Cell phone number
What additional languages do you speak?
Please only mark off languages that you are fluent or advanced in. You must be comfortable conducting a medical interview in this language.
What is your role?
Student on Clinical Rotations (M2, M3, M4, PA2, PA3, MSTP, DNP) - conducts initial patient interviews
UIHC Staff (faculty MD, DO, PA, NP, etc) - supervises/staffs student clinics
***If UIHC staff, what is your role and department? (ex: MD in Family Medicine, PA in Internal Medicine, etc)
***If UIHC staff, what roles are you comfortable with? (Mark all that apply)
Triaging for COVID calls using a succinct flow chart
Managing chronic conditions (ex: hypertension, diabetes, etc)
Managing acute problems (ex: MSK, UTI, etc)
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