Thank you for your interest in becoming a Trainee at the Rhode Island Free Clinic. The Clinic relies on dedicated volunteers, donors, and community partners to provide vital health care to uninsured adults. As a Trainee you will be held to high expectations as a part of the Clinic's corps of volunteer medical professionals while also gaining valuable experience working in a healthcare setting.

Please complete this application to begin the on-boarding process. Once you complete the form, click the submit button at the bottom. Applicants for Trainee placement must be at least 18 years old to volunteer at the Clinic.

What to expect next:
A Volunteer Coordinator will review your submission and contact you within 1 week about any next steps. You will then be expected to participate in a Trainee orientation, to be scheduled either at the Clinic or at your program.

***Please refer to the following website for further information on becoming a Trainee here: http://www.rifreeclinic.org/ahec***

Additionally, you MUST be in ONE OF THE FOLLOWING HEALTH PROFESSIONAL PROGRAMS to apply through this application:

Cardiology Fellows
Clinical Nutrition
Clinical Psychology
Dental Assistant or Hygiene Program
Dermatology (Residents)
Gynecology (Residents)
Health Information Technology
Health Services Administration
Medical Assistant Studies
Nurse Practitioner Studies
Occupational Therapy Assistant Studies
Pharmacy Studies
Physical Therapy Assistant Studies
Physician Assistant Studies
Primary Care (Residents)
Psychiatry (Residents)
Public Health (Graduate Studies)
Social Work

If you are a student, but NOT in one of the listed health professional programs, please apply through either the Administrative Volunteer or Professional Support Volunteer application.

Personal Information

Please fill out the following information about yourself.


Demographic Information

Please fill out the following demographic questions.


Education

Please tell us about the health professional program in which you are currently enrolled and the highest education you have achieved to date.


Field Placement Availiability

Please indicate your expected start and end dates for your field placement at the Clinic.


Disadvantaged Background

Please indicate whether you consider yourself as being from a disadvantaged background?

For a definition of "disadvantaged background," please visit the following link:
https://nhsc.hrsa.gov/downloads/disadvantagedbackground.pdf


Rural Background

Please indicate whether you consider yourself as being from a rural background?

To determine whether you are from a "rural background," please visit the following link. Enter your address and press the "run report" button. Please use the result that shows up for "FORHP - Grants Program."
https://www.ruralhealthinfo.org/am-i-rural


FOR RESIDENTS ONLY

Please enter your license and NPI information below.


Emergency Contact

Please list a contact we can reach out to in case of emergency.


Background Check

Have you ever been convicted of a felony or misdemeanor? If yes, please explain below. Please note a criminal history does not disqualify you from consideration as a RIFC volunteer.


Ethical Guidelines

Please read the statement below. Then, write your name in the box below. This will serve as a signature stating that you have read, understand, and agree to RIFC's Ethical Guidelines.

Ethical Guidelines for Providers of Rhode Island Free Clinic


Volunteer physicians, other providers, non-provider volunteers and staff of the RIFC recognize their considerable interdependence in providing care for the patients of RIFC. They further acknowledge the importance of communication, collaboration and teamwork to optimize outcomes in care management. It is the policy of RIFC that providers, volunteers, staff and patients must be treated in a dignified and respectful manner at all times.

Therefore, all providers, including physicians and non-physicians, agree to comply with the following principles and guidelines that inform behavior at RIFC:

1. I agree that all members of the provider team, volunteers, staff and all recipients of care should be treated in a respectful and dignified manner at all times. Language, non-verbal behavior and gestures, attitude, etc. shall reflect the respect and dignity of the individual.

2. I agree not to use language that is profane, vulgar, sexually suggestive or explicit, intimidating, degrading or racially/ethnically/religiously slurring in any setting at the RIFC.

3. I agree to refrain from any behavior that is deemed to be intimidating or harassing.

4. I agree to maintain complete confidentiality of patient care information at all times.

5. I agree to give all parties prompt, direct and constructive feedback when concern or disagreements arise.

6. I agree that the Director of the clinic or his/her designate serves as the senior authority during clinic hours. Any concerns about operational efficiency shall be directed in a respectful way to the Director (or designee) for resolution. Any decision in this regard will be the responsibility of the Director (or designee) and will be binding. Any disagreement about a decision rendered by the Director (or designee) will be directed to the Medical Director at a time when clinic is not in session.

7. I agree that if the Director deems that a breach of the above-mentioned behavior guidelines has occurred, I will be afforded a hearing before the medical Director and a provider member of the Board of Directors.

8. I agree that if I refuse to comply with behavioral guidelines, and cannot resolve an appeal at the hearing, I will terminate my volunteer service at RIFC.

9. I agree to comply with policies of the RIFC, which include, but are not limited to arriving at my assigned clinic session promptly; managing patients according to a time schedule agreed upon ahead of time (unless unforeseen circumstances require otherwise); adhering to RIFC guidelines with regard to teaching; using consultative and diagnostic services judiciously.


Policies and Procedures

Please read the statement below. Then, write your name in the box below. This will serve as a signature stating that you have read, understand, and agree to RIFC's Policies and Procedures.
TRAINEE EXPECTATIONS AND GUIDELINES:

The following expectations and guidelines are intended to assist our staff, volunteers, and patients in having a positive experience at the Rhode Island Free Clinic. Please consult a staff member or VISTA volunteer if you find yourself in a situation that makes you uncomfortable of if you are questioning a decision or situation that needs to be handled. Please refer to copies of these policies, located in the conference room. You are expected to abide by these policies; failure to do so may result in termination.

Policies include:

Discrimination – It is illegal and unethical to discriminate against or reject any person seeking care on the basis of race, color, religion, sex, age, sexual orientation, or disability.

Harassment – A fair and productive work environment shall be maintained, free of unlawful and improper harassment. Offenders are subject to disciplinary action. If harassment is personally experienced, a staff member or VISTA volunteer is to be contacted immediately. Examples of types of behavior that may be considered to be harassment are the following:
-Verbal harassment is derogatory or vulgar comments regarding a person’s race, sex, religion, ethnic heritage, or physical appearance. Distribution of written or graphic material can have the same effects.
-Physical harassment is hitting, pushing, or other aggressive action or threats to take such action.
-Sexual harassment is unwelcome sexual advances or comments, gestures or physical conduct of a sexual nature. It is also the use of one’s authority and power to coerce another individual into sexual relations or to punish the other for his/her refusal.

Drug-Free Workplace – Unlawfully manufacturing, distributing, possessing, using, or being under the influence of alcohol or controlled substances while on RIFC premises or during working hours is strictly prohibited and grounds for immediate termination.

Accidents and Incidents – Any and all accidents and incidents, no matter how minor, shall be reported in a timely manner to the Nurse Clinic Coordinator. A written, comprehensive narrative report must be completed by the involved volunteer and signed by the Nurse Clinic Coordinator.

Computer Policy – Applies to all individuals accessing the Internet/Email capabilities through Lifespan connectivity. The internet/email may be used only in accordance with this and other Lifespan policies, and during work hours from Lifespan and related facilities, only for legitimate business or research purposes. Personal use of the internet/email from Lifespan-based PC’s during an employee’s work hours is prohibited. Your use of these services and equipment is not private in any way. Misuse or abuse of the internet/email may result in the revocation of internet/email access privileges and/or disciplinary action, up to and including termination.

Security – Volunteers must wear ID badges at all times. The Rhode Island Free Clinic is not responsible for personal belongings. If you feel uncomfortable walking to your car or waiting for a ride you may ask the security guard to accompany you. The security guard is on duty every clinic evening until 10 pm. It is our policy that at night no volunteer or staff member should leave alone – in particular there should always be at least one other person leaving with the staff member who is closing the clinic at the end of the night. In the event of an impending security disturbance, contact a staff member or VISTA volunteer.

Fire Safety – There are two exits with illuminated exit signs, one at the front and one at the back of the clinic. Next to each exit is a fire extinguisher and a fire alarm pull box. There are also maps of the fire exits throughout the clinic. In the event of a fire the exit signs will light up. You are responsible for evacuating yourself and any patient you are directly working with. The staff and VISTA volunteers will be responsible for the general evacuation of all patients.

Confidentiality

For All Volunteers:

Volunteers at RIFC must maintain the confidentiality of all personal information about patients, other volunteers, and staff members that may be seen or overheard at the clinic. This includes but is not limited to contact information, medical information, financial information, living arrangements, substance abuse history, employment situation, sexual orientation, and relationships with families and others. No matter what the source, this information should not be disclosed to anyone other than RIFC employees or volunteers who have a legitimate “need to know.” Information may not be disclosed to volunteers or staff who do not need to know it for patient care. It is unethical to seek out information if it is not necessary. Further, personal information about patients can only be discussed on-site at the Rhode Island Free Clinic.

Read HIPAA Privacy Rule and complete and sign Confidentiality Statement included in volunteer packet.

Computer Confidentiality – All electronically stored data, including patient and volunteer information, is subject to the same Confidentiality and HIPAA Privacy regulations as paper data. You must always log into your own account – under no circumstance should anyone use another person’s ID, password, or login to access information. Signing on to systems via a user’s unique access code is equivalent to a legal signature: you are responsible for any actions performed within your account. If leaving the computer, even for a short period of time, you must log out of your account. For some programs you may initially be given a default password – you must change this password upon initial login. Users must choose passwords that cannot be easily guessed.

I understand the policies and procedures of Rhode Island Free Clinic and agree to abide by them. I have also received training in and understand the infection and exposure control policies of the Rhode Island Free Clinic. I understand that appropriate protective equipment will be provided to me at no cost by the Rhode Island Free Clinic should I be at risk. Further, I understand that the material contained in these policies is provided for informational purposes only, and the Rhode Island Free Clinic reserves the right to modify and delete any and all policies and procedures at any time. I understand that the receipt of these policies is not a contract for employment, benefits, or otherwise, and that my involvement with Rhode Island Free Clinic may be terminated, with or without notice or cause, by me or the Rhode Island Free Clinic. I further understand that no representative of Rhode Island Free Clinic, other than the executive director and clinical coordinator, has the authority to enter into any volunteer relationship on behalf of the agency for a specific period of time. Any such agreement will be unenforceable unless it is an express written contract signed by the executive director or clinical coordinator.


Confidentiality Statement

In order for Rhode Island Free Clinic (RIFC) to provide quality health care, our patients need to share personal and sensitive information. In doing so, patient expect, and have the legal right to, confidential handling of that information. Information regarding the patient’s diagnosis and treatment, as well as personal and financial affairs, is confidential and that confidentiality must be respected.

While performing assigned duties, a volunteer may acquire confidential patient information from the written medical record or from conversations with the patient, family members, other health care providers, or RIFC staff. No matter what the source, this information should not be disclosed to anyone other than RIFC employees or volunteers who have a legitimate “need to know.” RIFC forbids the access, disclosure, or use of any data for one’s own personal gain or profit, for the personal profit or gain of others, or to satisfy personal curiosity.

In the interest of limiting the occasions for information being overheard all conferences about patients should be held in a room and not in the hallway. Patients should be interviewed in closed rooms.

I, the undersigned party, understand that in the course of my work with RIFC I may learn facts about individuals being served by RIFC that are of a highly personal and confidential nature. Examples of such information include medical condition and treatment, finances, living arrangements, substance abuse history, employment situation, sexual orientation, and relationships with families and others.

I understand that all such information must be treated as completely confidential; the information may not be mentioned or discussed with anyone other than RIFC employees or volunteers, and then only if the discussion is necessary in the operation of the clinic. Specifically, confidential information may not be shared with spouse/partners, roommates, friends, family members, other volunteers, or other RIFC patients.

I agree to speak with the Director of Clinical Operations or Chief Executive Officer about any situation in which I have questions about confidentiality and/or my possible violation of such confidentiality. I will discuss alleged, apparent or potential breaches in patient confidentiality with the nurse clinic coordinator or executive director.

I understand that a breach of confidentiality may be grounds for dismissal from RIFC.


Volunteer Agreement

Your dedication allows us to help the many uninsured Rhode Islands. We appreciate your compliance with the following policies to allow us to keep helping others.

I request to be a volunteer at Rhode Island Free Clinic (RIFC). I understand that as a volunteer I represent RIFC to patients, families, visitors, and the community.

I understand that this is an application to become a volunteer at the Rhode Island Free Clinic and that it is subject to approval and under no circumstance does it guarantee a volunteer position at the clinic. I also understand that as a RIFC volunteer applicant and/or volunteer I may be asked to provide a BCI (Bureau of Criminal Identification) at any time.

I understand that any false statements, concealment or withholding of information on this application or in any aspect of the application process is sufficient cause for withdrawing an offer to participate in the volunteer program or dismissal if I am already placed in a volunteer position.

- I will wear a RIFC identification badge whenever I am at RIFC.
- I will follow the clinic dress code (casual professional).
- I will call the Volunteer Coordinator with with sufficient notice in the event of an absence.
- I will complete all duties required of me for the clinic session and I will ask the Volunteer Coordinator (or other RIFC staff member) any questions or concerns regarding my responsibilities, during my shift, etc.
- I will arrive to clinic on time and notify the Volunteer Coordinator as soon as possible if I am unexpectedly delayed.
- I agree to attend the Volunteer Information Session prior to the beginning of my volunteer service.
- I agree to follow HIPAA confidentiality rules, and I have signed the RIFC Confidentiality statement.
- I understand that failure to comply with the above duties will result in dismissal per RIFC policy.
- I agree to act respectfully toward patients, other volunteers, and the RIFC staff.