Sign-up: Refugee Clinic - January 8, 2022

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Thank you for your interest in signing up to assist with the special Refugee Clinic session that will be held at 150 Sargent Drive on Saturday, January 8th from 8:30am-12:30pm. Please complete the form below regarding your availability.

Name *

E-mail Address *

Phone Number *

Institutional Affiliation *

Yale School of Medicine

Yale School of Nursing

Yale School of Public Health

Yale New Haven Hospital - Internal Medicine Residency (Med-Peds/Primary Care/Traditional)

Other:

Language Interpretation Skills *

Dari

Pashto

I am not able to assist with language interpretation

Other:

Required

I am interested in volunteering for the following activities (check all that apply): *

Registration on January 8th - e.g. assisting with checking patients in and reviewing health records

Building navigation on January 8th - e.g. directing patients to exam rooms/lab

Child care on January 8th - e.g. providing supervision on site for children whose parents are being seen by providers

Transportation to and from the clinic on January 8th

Language interpretation PRIOR TO January 8th (to assist with preparing patients for the clinic visit)

Language interpretation during the January 8th clinic session

MEDICAL RESIDENTS ONLY: Seeing patients with faculty preceptors

ATTENDING PHYSICIANS ONLY: Precepting residents

Other:

Required

Please select the times that you will be available on January 8th (check all that apply) *

8-10:30am (includes set-up)

10am-12:30pm

12-2:30pm (includes clean-up)

Required

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