Des Moines Area Medical Personnel Childcare and Household Management Resource Network
This form is intended to help collect information on individuals needing support and individuals willing to provide support in preparation for expanded closures and quarantines due to the COVID-19 outbreak. With this information we will work to make connections between health professional students and our community's front-line medical personnel (MD, DO, NP, PT, OT, PA, RN, Med Tech, Custodial Staff, etc.) so they may work together to provide care and disperse each other's workload.

WHO:The Students- Des Moines University (DO, PA, PT, DPM, and Master's students)
WHO: All Medical Personnel in the Greater Des Moines Metropolitan Area

WHERE: Greater Des Moines Metropolitan Area (Des Monies, West Des Moines, Ankeny, Urbandale, Windsor Heights, Johnston, Clive, Saylorville, Capitol Heights, Norwoodville, Marquisville, Pleasant Hill, Altoona)

HOW: After you fill out this form, We will look at our database and connect a household to 2-5 health professional students from DMU via e-mail. The healthcare personnel will then be able to connect with the students and make plans for how each one can support their needs.

DISTRIBUTIVE JUSTICE: Please note that as requests for support continue to come in, our Representatives must remain un-biased and provide fair and equal volunteer distributions. It is possible and likely that not all requests for support can be met. We will do our best to meet as many of your needs as possible, however we ask that everyone please be patient with us as our Resource Network develops.

PLEASE READ: If you or anyone in your household meets any of the following criteria, please do not fill-out this form. Due to the safety of everyone involved we will not be able to partner with you at this time and we apologize in advance.

- Experienced a fever in the past 2-weeks
- Experiences Shortness of Breath in the past 2-weeks
- Traveled outside of the US or to Washington State, New York State, California State in the last 2-weeks
- Had any contact with individuals diagnosed with COVID-19
- Anyone who is not fully immunized (standard immunizations for age group + Current influenza immunization)

ADDITIONAL COMMENT: Please remember to be safe during this Outbreak, continue to practice social distancing and keeping small social circles. All individuals should be checking their temperatures daily and should not seek assistance or go assist any households if they or their family-members have respiratory symptoms. Stay in touch with the individuals you are connected with and inform them if you develop symptoms. Be sure to seek medical care if you develop any respiratory symptoms as well.

If any information originally submitted on this form changes, there is an option for you to return to your originally submitted form and create an updated version. If you need the link to edit your form, please contact the DMU Representative who originally emailed you your Match assignment.

If there is any pertinent information that you need to share with organizers. Please email Sydney.N.Stanley@dmu.edu
Are you a medical personnel or student? *
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