Our Heartbeat

HelpCare Clinic is powered by over 200 community volunteers with both medical and non-medical backgrounds. Read our volunteer descriptions below to learn if a role at HelpCare will work for you.

Volunteer Roles

Provider

Treats patients professionally within their scope of practice (must hold a current medical license—MD, DO, PA or APRN).

Nurse

Visits with patients to take vital signs and medical history, as well as clinic set up (must hold a current nursing license—RN, LPN, MA or CNA).

Lab Technician

Prepares and performs medical laboratory testing for patients (must hold a current medical laboratory license).

Scribe

Assists volunteer providers in recording patient data in our electronic medical record (EMR) system.

Interpreter

Interprets between patients, clinical staff and providers to break down language barriers.

Resource Navigator

Meets with patients to determine and provide resources and referrals for patients’ social needs.

Hospitality

Provides food and refreshments for volunteers during clinic hours.

Volunteer Application

Thank you so much for your interest in volunteering at HelpCare Clinic! Please fill out the form below, and we will be in touch to set up orientation and shadowing. Reach out to Lisa with any questions at director@helpcareclinic.com.

"*" indicates required fields

Step 1 of 9

11%

Your Personal Information

Volunteer Positions

Volunteer Position*

Which position(s) would you like to volunteer for?

Nursing (RN, LPN, CNA)

Medical Provider (MD, DO, APRN, PA)

Behavioral Health

Lab Technician

Interpreter

Scribe

Hospitality

Greeter

Resource Support

Name*

First Middle Last

Other Names Used

Address*

Street Address Address Line 2 City State ZIP Code

Contact

Cell Phone Number*

Home Phone Number

Email*

What is the best way to reach you?*

Cell Phone (text)

Cell Phone (call)

Home Phone

Email Address

Date of Birth*

DOB is being requested to verify identity and conduct a criminal background check. Details and consent below.

MM slash DD slash YYYY

Birth Place*

Gender*

Social Security Number*

SSN is being requested to verify medical licensure (if applicable) and conduct a criminal background check. Details and consent below.

Professional or Education Experience

Employment Status*

Licensure*

APRN

LPN

CNA

LMHP

PsyD

Other

License Number*

NPI*

Are you credentialed through CHI Health Partners (formerly Uninet)?*

Yes

Unsure

May we contact you at work?*

Yes

Business Phone Number

What school are you attending?*

What are you studying?

What year are you?*

Are you volunteering for a class?*

Yes

Previous Occupation

Volunteer Reporting

Is there an agency, school, or other organization that will need documentation of your volunteer hours?*

Yes

What is the name of the organization?*

Organization Phone Number

Skills and Talents

Language(s) Spoken*

English

Spanish

Other

Other Languages Spoken

Select any skills or talents that apply:

Customer Service

Computer Competency

Telephone Communication

Patient Interaction

Administrative Work

Fundraising

Medical Terminology

Other

Other Notable Skills, Talents, Certifications, or Licenses

Availability

Is there a team from your church that currently volunteers at HelpCare?

Yes

Not sure

Name of Church:

Days Most Often Available*

Monday

Tuesday

Wednesday

Thursday

Friday

Time Most Often Available on MONDAYS*

Morning

Afternoon

Time Most Often Available on TUESDAYS*

Morning

Afternoon

Time Most Often Available on WEDNESDAYS*

Morning

Afternoon

Time Most Often Available on THURSDAYS*

Morning

Afternoon

Evening

Time Most Often Available on FRIDAYS*

Morning

Medical History

Do you have any allergies (environmental, latex, etc.)?*

Yes

Please list allergy and type of reaction:*

Do you have any medical conditions that we should be made aware of?*

Yes

Please list medical condition and necessary accomodations:*

Immunization and Immunity Testing*

I attest to having had the diseases listed in the document provided below or to having been adequately immunized.

Immunization and Immunity Testing Records

If accessible, please upload your immunization and immunity testing records here indicating the necessary immunizations as outlined in the document provided below.

Max. file size: 512 MB.

Download our Immunization and Immunity Testing Form by CLICKING HERE.

Emergency Contact

Name*

First Last

Relationship to You?*

Phone Number*

Alternative Phone Number

Additional Forms and Consent

Please download and review these additional forms. When you are finished, check each box consenting to your understanding of the information provided.

Applicant's Consent and Release*

I agree to the terms outlined in the Applicant’s Consent and Release provided below.

Download our Applicant’s Consent and Release by CLICKING HERE.

Criminal Background Check Authorization and Release*

I agree to the terms outlined in the Criminal Background Check Authorization and Release provided below.

Download our Criminal Background Check Authorization and Release by CLICKING HERE.

Release and Consent for Credentialing*

I agree to have my licensure credentialed as outlined by the Release and Consent for Credentialing provided below. I understand that additional materials to verify my credentials will be sent to me by CHI Health Partners.

Download our Release and Consent for Credentialing by CLICKING HERE.

Be a Local Missionary

Get involved with HelpCare today!

Volunteer!

We have a variety of volunteer opportunities for people with or without a medical background. Come help us out during clinic hours - checking patients in, keeping the clinic organized, and seeing patients. We also have volunteer opportunities in the office all week long.

LEARN MORE

Donate!

Our free clinic runs on support from generous community members. Both financial and in-kind donations are incredibly helpful to help us keep serving our patients. We're a 501(c)3 nonprofit organization, so your donation is tax-deductible.

LEARN MORE

Refer!

We provide free medical care to the uninsured, impoverished residents of Buffalo, Kearney and Phelps counties. We have a few qualifying questions for our patients. If you know someone who meets our qualifiers and needs medical care, send them our way!

LEARN MORE

Our Heartbeat

Volunteer Roles

Provider

Nurse

Lab Technician

Scribe

Interpreter

Resource Navigator

Hospitality

Volunteer Application

Your Personal Information

Volunteer Positions

Contact

Professional or Education Experience

Volunteer Reporting

Skills and Talents

Availability

Medical History

Emergency Contact

Additional Forms and Consent

Be a Local Missionary

Volunteer!

Donate!

Refer!

Subscribe to Our Mailing list & Stay Updated

You are successfully subscribed!

"I was sick, and you cared for me."

(308) 224-2392

(308) 224-2392

3015 Avenue A, Kearney

Office@HelpCareClinic.com