Volunteer Application for:
Cottage in the Meadow, Home Health, and
Palliative Care
Volunteer Services - 2811 Tieton Drive - Yakima, WA 98902 - 575-8053
Welcome to Memorial's Volunteer Program
Thank you for your time and contribution!
As a volunteer in a health care setting, you must meet the same health requirements as employees. These requirements are for the safety of the patients we serve.
Health Requirements for Volunteers:
*Proof of vaccination or immunity by lab (titers) for: Measles, Mumps, Rubella
*Varicella (Chicken pox)
*Two Step Tuberculosis Skin Test
*COVID Vaccine *Influenza Vaccine
All volunteers must be vaccinated annually in a timely manner and in accordance with the annual influenza policy. You may provide documentation if you receive your shot elsewhere. (Hint: To locate records check with: previous employers, parents/baby book, high school/college, physician, military, local/state health department. If you are unable to obtain these health records, Employee Health orders blood tests and provides vaccinations and/ or Tuberculosis testing, at no cost to you.)
NOTE: There is a Volunteer Orientation file you will be required to download at the bottom of the application. Please ensure that you either have the ability to download the files to your computer or onto a jump drive, so you are able to review the documents while you take our online quiz. Once your application has been submitted, you will be automatically redirected to our Orientation Quiz.
Emergency Contact Information
Disclosure Statement
Pursuant to the requirements of RCW 43.43.834, YVM must ask you to complete the following Applicant Disclosure Statement. This information will be kept confidential. Please answer fully and accurately.
1. Crimes Against Persons and Crimes Relating to Financial Exploitation:
Have you ever been convicted of any of the crimes listed below?
If Yes, check all that apply and describe at number 4 below.
2. Drug-Related Crimes
Have you ever been convicted of a crime related to the manufacture of, delivery of, or possession with intent to manufacture or deliver a controlled substance?
3. Have you ever been found by any agency, court or disciplinary board final decision to have committed any of the following acts against a child, a vulnerable adult or developmentally disabled person:
Domestic Violence?
Sexually assault or abuse?
4. For all items where you have answered yes in 1-3 above, specify the conviction, finding or action date(s), specify the sentence(s) or penalty(ies) imposed, prison release date(s) and current standing (e.g., parole, work release). For all Items with an asterisk (*) above, provide a description of the victim including the victim's age. Please use text box, if needed.
5. Have you ever been convicted of any other crime? If yes please identify the offense(s), provide the date(s) of the conviction(s), the name of the court, (e.g., Yakima county Superior Court) and the sentence imposed.
Yakima Valley Memorial (YVM) is responsible for securing its computer systems, associated data, and communications network. In addition, YVM and affiliated agency employees are responsible for preventing the occurrence of inappropriate, unethical, or unlawful use of such systems and data.
Access to computer systems and networks owned or operated by YVM imposes certain responsibilities and obligations, and is granted subject to Hospital policies, and local, state, and federal laws*. Acceptable use is always ethical, legal, and maintains patient confidentiality, protects the Hospital's interests, and shows restraint in the consumption of shared system resources.
Acceptable use of information systems includes, but is not limited to:
*Using computing resources only for authorized purposes
*Protecting your computer equipment, user-ID, and password from unauthorized use. You are responsible for all activities associated with your user-ID, or that originate from your equipment.
*Accessing only files and data that are your own, which are publicly available, or to which you have been given authorized access
*Using only legal versions of copyrighted software in compliance with vendor license requirements and as approved by the VMM Information Systems Department.
Unacceptable use of information systems includes, but is not limited to:
*Using another person's user-ID or password
*Using another person's system, files, or data without permission
*Attempting to circumvent or subvert system or network security measures
*Engaging in any activity that might be harmful to systems, or to any information stored thereon, such as the creation or propagation of viruses, disruption of services, or damage to files
*Using Hospital systems for commercial, political, or extensive personal use
*Installing or using illegal copies of copyrighted software, or any other software without prior approval from the VMM Information Systems department
*Using mail or messaging services to harass, intimidate, or otherwise annoy another person
*Engaging in any other activity that does not comply with the general principles presented above
The Hospital considers any violation of acceptable use principles and guidelines to be a serious offense and reserves the right to copy and examine any files or information resident on the Hospital systems. Violators will be subject to appropriate disciplinary action as prescribed in other Hospital policies.
ID Badge MUST be returned to Education Coordinator upon completion of internship.
CONFIDENTIALITY AGREEMENT
I understand that I may have access to protected health information (PHI) and confidential information about the business and financial interests (referred to as "Confidential Information" in this Agreement) of Yakima Valley Memoriall (YVM). I understand that Confidential Information is protected in every form, such as written records and correspondence, oral communications, and computer programs and applications.
I agree to comply with all YVM policies and procedures to protect the confidentiality of Confidential Information. I agree not to use, copy, make notes regarding, remove, release, or disclose Confidential Information, unless it is permitted by YVM policy.
I agree not to share or release any authentication code or device, password, key card, or identification badge to any other person, and I agree not to use or release anyone else's authentication code or device, password, key card, or identification badge.
I agree to notify the appropriate manager immediately if I become aware that another person has access to my authentication code or device, password, key card, or identification badge, or otherwise has unauthorized access to the hospital's information system or records.
I agree that my obligations under this Agreement continue after my employment or my time as a student or volunteer ends.
I understand that breach of patient confidentiality may result in civil or criminal penalties under state or federal law.
HEALTH INFORMATION COVERED:
Any information, whether spoken, electronic or written that relates to the health of the individual, the health care provided to that individual or payment for health care provided is considered protected.
*Knowledge of who has access to their health information
*Ability to access their medical record &/or amend incomplete or incorrect information
*Requirement of authorization before information is given, except as allowed by HIPAA
*May request an accounting of all disclosures in a six year period
*Recourse if their Rights are violated
Any information that relates to the patient's health cannot be disclosed unless authorized by the patient or someone acting on the patient's behalf or unless permitted by HIPAA regulation. The facility must limit access to only those individuals who need the information for a legitimate purpose. Any information that is shared should be limited to the minimum necessary, the least amount of information to accomplish the purpose of the request. However, this does not apply to the sharing of the medical record for treatment purposes.
YOUR ROLE IN PROTECTING PATIENT RIGHTS
*Protect all forms of Protected Health Information (PHI)
*Only access patient PHI for which you are authorized to perform your job duties. Do not access PHI of family members, friends or anyone else for whom you don't have a direct job related purpose
*Report any observed or suspected HIPAA breaches immediately to the Privacy Line (249-8676) or your facility's Privacy Officer.
Examples of potential breaches
*Workforce members accessing electronic health records for information on friends, neighbors or family members out of curiosity/without a business-related purpose.
*Medical record documents left in public access cafeteria
*Provider accessing the health record of divorced spouse for information to be used in a custody hearing
*Misdirected fax of patient records to a local grocery store instead of the requesting provider's fax.
*Workforce members access the electronic health records of a celebrity who is treated within the facility
*Stolen or lost laptop containing unsecured, protected health information
*Papers containing protected health information found scattered along roadside after improper storage in truck by business associate responsible for disposal (shredding)
*Posting of patient's HIV+ health status on Facebook by a laboratory tech that carried out the diagnostic study
*Misdirected e-mail of listing of drug seeking patients to an external group list
*Lost flash drive containing database of patients participating in a clinical study
*EOB (Explanation of Benefits) sent to wrong guarantor
*EMT takes a cell phone picture of patient following a MVA and transmits photo to friends
*Misfiled patient information in another patient's medical records which is brought to the organization's attention by the patient
*Medical record copies in response to the payers request lost in mailing process and never received
*Briefcase containing patient medical record documents stolen from car
*PDA with patient-identifying wound photos lost
When in doubt, report it immediately!
CLICK HERE to download our Volunteer Orientation ***IMPORTANT---This file will be used to complete your orientation quiz. It will open in a seperate tab in your browser.
Make sure to return to this page to finish submitting your application.***
