Our Mission

To share the love of God by providing free medical, dental and vision services to the great cities of the world.

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Email info.ybpth@ybpth.org

Volunteer Registration

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About Me

About Me

My Volunteer Preferences

About Me

My Volunteer Preferences

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Music Ministry

Availability

We appreciate every volunteer! We have found that for efficiency and clinic flow it is best if volunteers are able to be there throughout the clinic. However, we have given one and two day options as well for those who are only able to volunteer for one or two days.

Please note that the orientation on Tuesday evening is a required orientation for a smooth opening on Wednesday morning.

Please select all that apply from the options below.


As a Your Best Pathway to Health volunteer:
I agree to honor the service commitment I make, report on time as my department head requests, and to notify my department head as soon as possible if I am unable to attend.

I understand that every effort will be made to place me in my first choice of volunteer service, however that may not be possible.

I understand that, if I am applying with a professional license,  my license will be verified and further research will be conducted, if appropriate.

I understand that all patient information is considered private and cannot be shared (including, but not limited to: verbally, via text, phone, email and/or other electronic format, picture, Twitter or Facebook) or discussed except as needed for care of that patient. I understand that I will be asked to sign a HIPAA statement during the registration process and agree to abide by the terms therein.

I give YBPTH permission to use any photographs or videos reflecting my likeness and/or voice made during my service without obligation or compensation.

I hereby release Your Best Pathway to Health, a 501 (c ) (3) non-profit entity, and all of its respective officers, directors, employees agents, volunteers, contractors, heirs, successors and assigns from prosecution or presentation of any claim for bodily injury, damages, wrongful death or property loss or any other damage incurred in connection with my attendance and/or performance of health care services including ancillary services or related activities at the YBPTH events.

I certify that all the statements made herein are true and accurate to the best of my knowledge and belief.





Your Best Pathway to Health

Volunteer Waiver and Disclosure Form

Compliance:

I hereby attest that all information submitted on this application form and supporting documents (license/certificate) are currently in force and not restricted, suspended or revoked. I further attest that I will comply with Your Best Pathway to Health protocols, bylaws and manual. I agree to the mission of Your Best Pathway to Health and I am committed to patient care through Christ’s methods.

HIPAA has 3 Main Objectives:

HIPAA stands for Health Insurance Portability and Accountability Act of 1996, also referred to as Kennedy-Kassebaum Act. This statute called for the Department of Health and Human Services (DHHS) to adopt standards for electronic data interchange (EDI) and codes sets, uniform health care identifiers, and standards for the protection of privacy and security of patient data.

HIPAA has 3 main objectives:

1. Insurance portability

2. Fraud enforcement (accountability)

3. Administrative simplification (reduction of healthcare costs)

Essentially, anyone who receives health care can apply their patient rights under HIPAA. Applying these patient rights will help control how an institution can use or share information called ProtectedHealthInformation or PHI.

PHI is any health information that:

• directly or indirectly identifies a patient

• pertains to the past, present and future condition of the patient

• is transmitted verbally, in writing, or electronically

Examples of PHI is:


• name of patient and relatives

• birth date

• full face photos or

• certificates/license numbers

• marital status

comparable images

• vehicle identifiers and serial numbers

• address

• electronic mail

• insurance/medical record numbers

• finger and voice prints

addresses, URLs

• telephone and fax numbers

• social security numbers


The Privacy Patient Rights:

Right to Access – patients have the right to access, inspect and obtain a copy of PHI contained in their medical or billing record.

Right to Amend – patients have the right to request an amendment or change to the PHI contained in their medical or billing record.

Right to Disclosures – patients have a right to request a list of when and to whom their confidential information was released (called an accounting of disclosures).

Right to Request Restrictions – patients have the right to:

A. Request restrictions on how we use or share their PHI with others for treatment payment and health care operations.

B. Request restrictions on how much information should be shared with others in the facility directory of patient locator.

C. Request a restriction on the information shared with family or friends involved in the patient’s care.

We are not required to agree to a restriction, so DO NOT agree to arestriction!

Right to Request Alternative Communication – patients have the right to request that we send communications of PHI through an alternative means or to alternative locations. The Privacy Rule requires that we accommodate requests that are reasonable.

Right to File a Complaint – if the patient feels that his or her privacy rights were violated, he or she has the right to file a complaint with the organization and the Secretary of the Department of Health and Human Services.

Right to Receive Notice – the patient has the right to receive a notice of the privacy practices of the organization. The notice must include how the organization uses and discloses the information, how to obtain records, and how to file a complaint.

This means that one should request only the (least amount) specific information needed to complete the task.

Minimum Necessary:

This means that one should request only the (least amount) specific information needed to complete the task.

Organized Health Care Arrangement (OHCA) is more than one entity that participates together in the sharing of PHI, uniform method of HIPAA compliance and monitoring processes, and uniform agreement of restrictions.

When PHI is requested, determine if it is being shared within the OHCA for:

• Treatment purposes

• Payment purposes

• Health Care Operations

If “Yes” to any of the above, then patient authorization is NOT needed.

If “No” to any of the above, then patient authorization IS required. You must forward the request for PHI to the Registration, Exit Management, or Medical Records Department.

* Health Care Operations, or Treatment/Payment/Operations (TPO),includes:

? quality assessment and improvementactivities

? population-based activities related to improvementactivities

? protocoldevelopment

(researchdoneforQualityImprovementpurposesistheonlyresearchconsideredTPO)

? case management and carecoordination

? contactinghealthcareprovidersandpatientswithinformationabouttreatmentalternatives

? review of competence/qualifications of health careprofessionals

? practitioner and provider performanceevaluation

? conducting trainingprograms

? other activities relating to health benefitcontracts

? medical review, internal legal and auditingfunctions

? business planning anddevelopment

? administrativeactivities

? activities relating to the sale, transfer, merger or consolidation of thecovered entity

? fundraising for the benefit of the covered entity (conditionsapply)

Breaches in Privacy:

Both individuals and organizations can be held liable for breaches in privacy. Intentionally releasing information would be punishable by a fine of up to $50,000 and one year in jail. Someone trying to sell information could face a $250,000 fine and 10 years in prison. Civil penalties of up to $100 for each unintentional violation, and up to a $25,000 limit per identical violation could apply.

Confidentiality:

I understand that while I am participating as a registered volunteer at YbPTH event, it is mandatory that I maintain the privacy and confidentiality of all patients. This pertains to all present and future digital, written and verbal communications referring to any YbPTH patient. I also understand that unless I am obtaining information strictly for patient registration, I will not ask a patient any questions regarding medical insurance coverage, Medi-Cal or Medicare.  I further agree not to photograph or record patients unless authorized to do so while at the YbPTH event. I acknowledge that I have read, understand and agree to adhere to this policy of confidentiality for YbPTH.

Release:

I hereby release Your Best Pathway to Health, a 501 (c ) (3) non-profit entity, and all of its respective officers, directors, employees agents, volunteers, contractors, heirs, successors and assigns (hereinafter the “Released Parties”) from prosecution or presentation of any claim for bodily injury, damages, wrongful death or property loss or damage incurred in connection with my attendance and/or performance of health care services including ancillary services or related activities at the YbPTH events.





Your Best Pathway to Health

Exposure Control Plan

Policy

Your Best Pathway to Health is committed to providing a safe and healthful work environment for our volunteers. This exposure control plan (ECP) is provided to eliminate or minimize exposure to Blood-borne Pathogens. The ECP is a key document to assist in protecting our volunteers. This ECP includes:

 Determination of volunteer staff exposure

 Implementation of various methods of exposure control, including

- Universal/Standard precautions

- Engineering and work practice controls

- Personal protective equipment

- Housekeeping

 Hepatitis B vaccination

 Post Exposure evaluation and follow up

 Communication of hazards and training

 Record Keeping

 Procedures for evaluating circumstances surrounding and exposure incident

The methods of implementation of these elements are discussed in the subsequent pages of this ECP.

Program Administration

• The Clinic Director or his/her designee is responsible for the implementation of the ECP. The Clinic Director or his/her designee will maintain, review and update the ECP when necessary to include new or modified tasks and procedures.

• Those who are determined to have occupational exposure to blood or other potentially infectious materials (OPIM) must comply with the procedures and work practices outlined in this ECP.

• The Clinic Director or his/her designee will maintain and provide all necessary personal protective equipment (PPE), engineering controls (e.g. sharps containers), labels and red bags. The Clinic Director or his/her designee will ensure that adequate supplies of the aforementioned equipment are available in the appropriate sizes.

• The Clinic Director or his/her designee is responsible for ensuring that medical actions are performed to maintain appropriate volunteer health.

• The Clinic Director is responsible for training, documentation of training, and making the written ECP available to staff.

Volunteer Staff Exposure Determination

The following is a list of all volunteer classifications at our events in which all have or may have Blood-borne pathogen exposure:

• Dentist

• Dental Hygienist

• Dental Assistant

• X-ray Technician

• Physician

• Physician Assistant

• Nurse Practitioner

• Nurse

• Nursing student

• Environmental Services

Methods of Implementation and Control

Universal Precautions

All volunteers will utilize universal precautions

Exposure Control Plan

Volunteers will receive an explanation of this ECP during their initial training session. It

will also be reviewed as needed. All volunteers will have an opportunity to review this

plan at any time during their shifts, by contacting the Clinic Director or his/her designee.

If requested, we will provide volunteers with a copy of the ECP at no charge.

The Clinic Director or his/her designee is responsible for reviewing and updating the

ECP to reflect any new or modified tasks and procedures which affect blood-borne

pathogen exposure and reflect new or revised positions with blood-borne pathogen

exposure.

Engineering Controls and Work Practices

Engineering controls and work practices will be used to prevent or minimize exposure to

blood-borne pathogens. The specific engineering controls and work practice controls

are listed below:

• Eye wear with shields or full faces shields are to be used for surgeries

• Masks are to be used for surgeries

• Gloves are to be used

• Protective gown with long sleeves must be worn when the following equipment is used: slow speed and high-speed hand pieces, air water syringe, ultrasonic cleaner; also, during operator clean up and instrument processing

• Gloves must be worn whenever touching liquid human products such as blood and saliva, surgical gloves will be worn for surgery, exam gloves for regular operative procedures, and utility gloves for clean up when touching something wet or contaminated

• Personal protective equipment will not protect from sharps injuries

• Sharps are to be placed in sharps containers as soon as possible after use

• Instruments are to be passed carefully

• Use cotton pliers and hemostats to handle sharps. Use gloves to reduce your risk to exposure

• Sharps disposal containers are to be inspected and maintained by department staff and changes whenever necessary to prevent overfilling.

Changes in engineering control and work practices will be identified through review of incident reports, volunteer interviews and staff meetings. The Clinic Director or his/her designee will ensure implementation of these recommendations.

Personal Protective Equipment (PPE)

PPE is provided to our volunteers at no cost to them. If there is not an appropriate or adequate size of PPE available for you, contact the Clinic Director or his/her designee.

All volunteers using PPE must observe the following precautions:

• Wash hands immediately or as soon as feasible after removal of gloves or other PPE

• Remove PPE after it becomes contaminated, and before leaving the work area

• Disposable used PPE may be placed in lined waste containers for later disposal

• Wear appropriate gloves when it can be reasonably anticipated that there may be hand contact with blood or OPIM, and when handling or touching contaminated items or surfaces; replace gloves if torn, punctured, contaminated, or if their ability to function as a barrier is compromised

• Utility gloves may be decontaminated for reuse if their integrity is not compromised; discard utility gloves if they show signs of cracking, peeling, tearing, puncturing or deterioration

• Never wash or decontaminate disposable gloves for reuse

• Wear appropriate face and eye protections when splashes, sprays, splatters, or droplets of blood or other OPIM pose a hazard to the eye, nose, or mouth

• Remove immediately or as soon as feasible any garment contaminated by blood or OPIM, in such a way as to avoid contact with the outer surface

• Do not wear soiled PPE in lunch or other clean areas. (Also, do not touch clean areas with Dirty PPE). Remove PPE after it becomes contaminated, and before leaving the work area

The procedure for handling used PPE is as follows:

• Face shields and eyewear may be sprayed with soap and water or a disinfectant and then rinsed and dried between uses

• Single use gloves and masks are to be disposed of between each patient use

• Heavy duty nitrile gloves may be washed with soap and water and autoclaved

• Used resuscitation equipment is disposable and may not be reused.

Waste Disposal

Regulated waste is placed in containers which are closable, constructed to contain all contents and prevent leakage, appropriately labeled or color coded, and closed prior to removal to prevent spillage or protrusion of contents during handling.

Sharp disposal containers will be removed and disposed as specified.

Regulated waste will be removed and disposed as specified.

Contaminated sharps are discarded immediately or as soon as possible in containers that are closable, puncture-resistant, leak proof on sides and bottoms and labeled or color-coded appropriately. These containers must be easily accessible and as close as feasible to the immediate area where sharps are used. Bins and pails (e.g., wash or emesis basins) are cleaned and decontaminated as soon as feasible after visible contamination.

Broken glassware which may be contaminated is picked up using mechanical means, such as a brush and dust pan.

Laundry - All PPE is disposable; no laundering will be performed

Labels - All laboratory dental cases that have not been decontaminated must be accompanied by a biohazard label when leaving the facility. All sharps containers must be marked with a biohazard label. The ultrasonic machine must be marked with a biohazard label. Dirty instrument containers must be marked with a biohazard label.

Hepatitis B Vaccination

By volunteering as a health care provider, whether excluded from licensure from the state in which the event is held or not, each individual health care provider acknowledges compliance with the state requirements of their respective States Law in regards to vaccinations for licensure and or certification within their jurisdictions.

Post Exposure Evaluation and Follow Up

Should an exposure incident occur, contact the Clinic Director or Medical Director.

An immediate confidential medical evaluation and follow up will be conducted by the Medical Director or his/her designee. Following the initial first aid (clean the wound, flush eyes or mucous membranes, etc.) the following activities will be performed:

• Document the routes of exposure and how exposure occurred

• Identify and document the source individual (unless the staffer can establish that identification is infeasible or prohibited by state or local law).

• Obtain consent and make arrangements to have the source individual tested as soon as possible to determine HIV, HCV, and HBV infectivity; document that the source individual's test results were conveyed to the staff member. (If the source individual is already known to be HIV, HCV, and/or HBV positive, new testing need not be performed).

• Assure that the exposed volunteer is provided with the source individual's test results and with information about applicable disclosure laws and regulations concerning the identity and infectious state of the source individual (e.g. laws protecting confidentiality)

• After obtaining consent, collect exposed volunteer's blood as soon as feasible after exposure incident, and test blood for HBV and HIV serological status

• If the volunteer does not give consent for HIV serological testing during collection of blood for baseline testing, preserve the baseline blood sample for at least 90 days; if the exposed volunteer elects to have the baseline sample tested during the waiting period, perform testing as soon as feasible.

Administration of Post-Evaluation and Follow-Up

The Clinic Director ensures that the health care professional responsible for volunteer's evaluation and follow up is supplied with information about blood borne pathogens.

The Clinic Director ensures that the health care professional evaluating a volunteer after an exposure incident receives the following:

 A description of the volunteer's duties relevant to the exposure incident

 Route(s) or exposure

 Circumstances of exposure

 If possible, results of the source individual's blood test

 Relevant staff medical records, including vaccination status

The volunteer should be provided with a written opinion of the evaluating health care professional within 15 days after the completion of evaluation.

Procedures for Evaluating the Circumstances Surrounding an Exposure Incident

The Clinic Director or his/her designee will review the circumstances of all exposure incidents to determine:

• Engineering controls in use at the time

• Work practices followed

• A description of the device being used

• Protective equipment or clothing that was used at the time of the exposure incident (gloves, eye shields, etc.)

• Location of the incident (work station, sterilization), etc.

• Procedure being performed when the incident occurred

• Volunteer's training

If it is determined that revisions need to be made the Clinic Director (or designee) will ensure that appropriate changes are made to this ECP. (Changes may include an evaluation of safer devices, etc.)

Volunteer Expectations

All volunteers who have exposure to blood borne pathogens receive training conducted by the Clinic Director (or designee).

Record Keeping

Records are kept of volunteers completing review.