FVHH Patient Care Volunteer Supervisory AgreementPlease enable JavaScript in your browser to complete this form.Patient Name *I commit to visiting the patient: *WeeklyEvery Two WeeksI understand that I will be expected to *Adhere to the functions and responsibilites outlined in the Patient Care Volunteer position descriptionContact this patient and/or family as needed by hospice team and by patient plan of careDocument each contact on a Patient Care Report form through FVHH.NETSubmit the Patient Care Report at least EVERY TWO WEEKSContact FVHH immediately with any critial chage to the patient's condition or your availablity to visit patient changesSchedule and attend all Volunteer Corners required for the yearAdhere to the FVHH code of Confidentiality and the HIPPA privacy Rule. I understand that a breach of confidentiality is grounds for dismissal as a volunteerReceive annual TB skin test and provide FVHH the resultsI understand that I MUST NOT *Provide ANY hands-on careAdminister medicationBe alone with or transport a minor under the age of 18I accept the following statements about my volunteer commitments:I accept the responsibilities as a Patient Care Volunteer and I feel I am able and willing to fufill all of these responsibilities currentlyI understand that if I am unable to perform these responsibilties my services as a Patient Care Volunteer may end. Further my volunteer activities may be discontinued by FVHH at their discretionIf at any time and for any reason I feel that I cannot honor my commitment to this patient, I will provide as much advance notice as possible to FVHH to allow for a transition to a new volunteer for my patient.Name (By typing your name you are agreeing to the above conditions) *FirstLastDate / Time *PhoneSubmit