MCO 10/26/19 West Philadelphia Outreach with Renewal Presbyterian Church
Medical Campus Outreach is partnering with Renewal Presbyterian Church on Saturday, October 26, 2019, to provide health screens for blood pressure and blood sugar, sharing the gospel through conversation and prayer with those we meet. During the outreach not only do we seek to provide health education to the community (working in teams in neighborhoods near the church), but the health care participants will be appropriately putting into practice how to share Christ's love in the health care context. Teams will each have an experienced student or professional as a team leader, and a brief training will be held the hour before we start. Medical referrals will be given to a local health center and the church will provide spiritual follow up to those who request it. After the outreach we'll have a group debriefing and enjoy fellowship with a potluck meal! Last day for sign up is Wednesday, Oct. 23.

Renewal is located at 4633 Cedar Ave., Philadelphia. Free parking can be found on the nearby streets, just make sure that there is not a time limit.

The location/schedule is as follows:

12:30-1:30 Medical and Evangelism Training
1:30-4:30 Medical Outreach
4:30-5 Restock Packs, Load Supplies, Debrief
5-6:15 Fellowship Potluck and Clean Up

*Participants doing the medical screens on the outreaches must have health insurance and immunizations. If you don't have health insurance and current immunizations, you may participate in the blood pressure screens but may not do the glucose finger-stick screens. If you have never performed a glucose screen you may not do the finger-stick on this outreach.

**Wear scrubs if you have them--we go out rain or shine! Looking forward to seeing you there!

Email address *
Name *
Your answer
Health Care Student, Professional, or Other? (please specify; if you are a student also specify what discipline and anticipated graduation year). If you are "Other" and not a health care student or health professional, please say "Other, non-medical" *
Your answer
School or Work Institution? *
Your answer
Phone *
Your answer
What is your gender? *
Do you speak Spanish? *
Do you have health insurance? *
Are your immunizations up to date? *
Have you received a tetanus vaccine in the last 10 years? *
Have you received 3 doses of the Hep B vaccine? *
Have you successfully received your federal and state child abuse clearances and background checks? (not required to participate but helpful for us to know in planning) *
Comfort level taking blood pressures? *
Are you trained to take blood sugars? (we only allow people who do blood sugar screens regularly as part of their job or have been trained previously by the Summer Medical Institute or Esperanza Health Center to do blood sugars) *
Comfort level going from talking about bps/health issues to spiritual issues? *
Willing to be a leader? *
Are you able to stay for dinner? *
Willing to bring a dish for the potluck? (pizza will be provided)
Can you help with any of the following?
Comments?
Your answer
Agreement
All Summer Medical Institute or Saturday Outreach student and faculty participants, please read and indicate “yes” below if you agree:

1) As a participant in Summer Medical Institute and/or its Saturday outreaches I understand that I am NOT to diagnose or treat illness. I am only to screen and advise.
2) The screens to be performed and the advice to be given will involve only those simple measurements and advice as delineated in the screening protocols approved by Esperanza Health Center.
3) Our purpose is to NOT come between a screened person and their usual doctor or local ER/Urgent Care. Screened people who may need further care will be referred to their usual clinician, Esperanza Health Center if they need a "usual clinician" for routine management, their local Urgent Care/ER, or to 911 services. Unless in the setting of extreme illness/incapacity, the screened person needing further help will be responsible for follow through.
4) As a participant in SMI/Saturday outreaches, I understand that except for my personal stethoscope, I must use the equipment provided. If the equipment does not function, I will not perform that particular screen until the equipment is repaired or replaced by SMI.
5) I have been or will be oriented to the equipment and screening forms to be used and know or will be informed of the contact info for Esperanza staff to call if I have an urgent question during the outreach.

I agree to work with in the above parameters and indicate so by clicking “yes” below.
Release From Liability
BY MY SIGNATURE BELOW, I release Esperanza Health Center, Medical Campus Outreach, Summer Medical Institute and Tenth Presbyterian Church, (hereinafter “Listed Organizations”) and their officers, agents, employees, principals, elders, ministry directors, project directors and any person or persons under their direction and control from any and all liability, claims, demands, actions, loss or expense, loss or damage whatsoever imposed by law upon the Listed Organizations for my acts and/or omissions.

I further hold the Listed Organizations harmless for, but not limited to, liability for transportation to and from the activities, the health screening activities themselves, and any activities taking place on the property of or sponsored by a Listed Organization. Furthermore, I promise not to initiate any action on my behalf seeking money damages for either acts or omissions of the Listed Organizations.

This Hold Harmless Agreement shall not apply to any Listed Organization's conduct which is determined by a court of competent jurisdiction to be grossly negligent, and/or constitute willful and/or intentional misconduct.

This agreement is binding on all of my heirs, guardians, assigns, and anyone else who may have legal capacity to otherwise sue the Listed Organizations on my behalf.

Intending to be legally bound, I give my consent by clicking "yes" below.
Photo Release
This is a legal release for Medical Campus Outreach (a ministry of Tenth Presbyterian Church) to take and use photos in publicity materials.

In consideration of my engagement as a model, upon the terms herewith stated, I hereby give Tenth Presbyterian Church (hereafter TPC), TPC’s legal representatives and assigns, those for whom the TPC photographer is acting, and those acting with TPC’s authority and permission:

a) the unrestricted right and permission to copyright and use, re-use, publish, and republish photographic portraits, video or pictures of me or in which I may be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations in conjunction with my own or a fictitious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever.
b) I also permit the use of any printed material in connection therewith.
c) I hereby relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed matter that may be used in conjunction therewith or the use to which it may be applied.
d) I hereby release, discharge and agree to save harmless TPC, TPC’s legal representatives and assigns, those for whom the TPC photographer is acting, and those acting with TPC’s authority and permission, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.
e) I hereby affirm that I am over the age of majority and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.
*Personal information will not be made public.*
After reading these releases, by checking "Yes" below I give my consent to MCO (and Tenth Presbyterian Church) *
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