Tele Mobile Clinic Volunteer Interest Form

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This sign up sheet merely shows interest in getting involved with the Tele Mobile Clinic initiative and not a full commitment.

Volunteers must be either:
(1) UIHC staff medical providers MD, DO, PA, NP, etc
(2) Students on clinical rotations: Med/PA/DNP/2/3/4

Instructions:
Step #1: fill out this interest form
**Step #2: sign-up for a shift: tinyurl.com/TeleMobileClinicVolunteer

**Specialty staff (ex: OB/Gyn, pediatrics, ortho, etc) only need to complete step #1 and do not need to sign up for a shift. You will be emailed the day before if there is a patient with a complaint related to your specialty if you're available/willing to help staff.

~~~ QUESTIONS/COMMENTS? ~~~
Joyce Wahba
Email: joyce-wahba@uiowa.edu
Call/text: (408)510-2225

First and Last Name *

Email *

Cell phone number *

What additional languages do you speak?

Please only mark off languages that you are fluent or advanced in. You must be comfortable conducting a medical interview in this language.

Spanish

Arabic

French

Other:

What is your role? *

Student on Clinical Rotations (M2, M3, M4, PA2, PA3, MSTP, DNP) - conducts initial patient interviews

UIHC Staff (faculty MD, DO, PA, NP, etc) - supervises/staffs student clinics

Other:

***If UIHC staff, what is your role and department? (ex: MD in Family Medicine, PA in Internal Medicine, etc)

***If UIHC staff, what roles are you comfortable with? (Mark all that apply)

Triaging for COVID calls using a succinct flow chart

Managing chronic conditions (ex: hypertension, diabetes, etc)

Managing acute problems (ex: MSK, UTI, etc)

Other:

Questions/comments?

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