Health Professional Volunteer Application

Thank you for volunteering for Remote Area Medical. By filling out this form, you will also be signed up through the www.ramusa.org website. As the host, CARE Coalition would like to know additional information that the RAM website does not ask. Not to worry about filling out two forms because we will sign you up through www.ramusa.org as soon as the registration is open. You will receive a confirmation and updates from RAMinfo@CARECoalitionNV.org. Closer to the event, you will receive information directly from Remote Area Medical.

Because patient are seen on a first come, first serve basis, volunteers are most needed early in the morning. Patients are let through the doors, register, and are triaged starting at 6am. Then they are directed to the different service areas, depending on their needs. The health care professionals will determine the end time to the services for that day. Based on past experience, it is usually around 4pm – 6pm. Volunteers are not assigned shifts. Instead, they are asked to come early, and stay as long as they feel up to performing the tasks. Volunteers will be given a RAM Las Vegas shirt to keep. A different color will be given on Friday, Saturday, and Sunday (collect all 3!). They will also be fed meals, snacks, coffee, and water.

DATES:

Thursday, October 1, 2015 (Setup)
Friday, October 2, 2015 (Clinic Open)
Saturday, October 3, 2015 (Clinic Open)
Sunday, October 4, 2015 (Clinic Open)

SCHEDULE:

5:10 – 5:30 am – RNs, LPNs, EMTs, & other triage professionals are asked to arrive
6:00 am – Dental professionals are asked to arrive
6:15 – 6:30 am – Vision professionals are asked to arrive
6:30 – 6:45 am – MDs, DOs, NPRs, and other medical generalists/specialists are asked to arrive

LOCATION:

Tarkanian Basketball Academy
2730 South Rancho Drive, Las Vegas, NV 89102
Off of Sahara and I-15, behind Palace Station

MEALS:

Breakfast will be served from 5am- 7am. If you have any questions, please contact RAMinfo@CARECoalitionNV.org or call (702) 900-2124.

Your Name (required)

Your Email (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Phone Number (required)

Type of profession or study

Specialty

Employer

State Of Licensure

License number

Expiration date

Do you currently or have you ever had health sciences licensure in another state? If no, please skip to the next question. If yes, please list the states of licensures.

Are you trained in blood borne pathogens?

I can volunteer on the following days (note you can volunteer for more than one day)

Expected arrival time

Will you be enjoying

Do you have any special needs or limitations you think we need to know about? If yes, please describe

I am interested in donating follow up care to patients whom are seen at the RAM clinic. Please email me more information about this

T-Shirt size

All Volunteers Please Read: All volunteers must fill out the CARE Coalition Registration Form. If you have volunteered with Remote Area Medical previously please click here and select the Las Vegas Clinic and register as your email is already in the RAM system and a confirmation email will be sent to you. If you have not volunteered for RAM previously you will be registered in the RAM system and a confirmation email will be sent to you.