Team Leader Please enable JavaScript in your browser to complete this form.Intro - Step 1 of 8We are so pleased that you have made plans to lead a team to Hospital Socorro de lo Alto.The responsibility of leading a mission team is one that takes a person who understands people and purpose, as well as insight into the overall situation into which you are taking a team. In these times, there are on-going changes and everyone must remain flexible and in communication with the Health Caring Services administration staff, as we will with you. THANK YOU for everything you do and please contact us with any needs you have. Important Next Steps:1) Submit the “Team Leader Commitment Form” below. This form provides the HCS Administration and the Hospital with the necessary information to support you in your leadership role. If, after you have submitted this form, any information changes, it is important that you let the administration staff know immediately. 2) Read the Team Leader and the Team Member Manuals linked here. As the team leader, you are responsible for the information contained in the Team Leader Manual AND the Team Member Manual, as well as making sure every team member has access to the Team Member Manual. If you are not administrating the team yourself, make sure your team administrator receives a copy of both manuals as well. Team Leader Manual (Word Document) // Team Member Manual (Word Document) 3) As TEAM LEADER it is your responsibility to confirm with all team members that their documents follow the stated guidelines before submission and that the application and documents are submitted and payment is made no later than the team closing date. NO person will be considered a team member until their application and required documents and payment are submitted by the due date. There will no exceptions due to the fact the hospital must submit your team information to proper Honduras officials within a specified time span to acquire the necessary permission to work in Honduras. Itineraries and Travel Insurance policies are due at least 4 weeks before the team departure date. You will receive a detailed information sheet with your team due dates and required documents when your commitment form is received. 4) Contact me with any questions – [email protected]. Blessings and thank you for serving in our beloved Honduras, the HCS administrative teamNextTeam Leader *FirstLastTeam Leader Email Address *Type of Team *Example: Orthopedic, General Surgery, Urology, etc.Contact for TeamThis may be an administrator or the Team Leader.Team Contact Name *FirstLastContact Email *Phone Number *BackNextMedical services offered by the team: *List physicians and their specialties or other services to be offered.BackNextTeam Arrival DatesIf any of the dates you enter below change after you have submitted this form you must immediately notify HCS administration: [email protected].Preparation TeamPreparation team includes any team members arriving prior to the primary working team’s arrival. Preparation team members should arrive all on the same day. Provide information only if applicable.Preparation team arrival date:Approximate Number of Preparation Team Members:Working TeamTeam Members should all arrive on the same day.Working Team’s arrival dates into Honduras:Approximate Number of Working Team Members:Starting date and ending date the team will be working in the hospitalThese exact dates will be used for clinic, OR and office staffing and advertising for your team; these are the days that the patients will come to the hospital. They must be accurate.Starting Work Date: *Ending Work Date: *Team's Departure DateAll team members must depart from the hospital on the same day.Team's Departure Date from hospital: *If you are planning an excursion after the team's working days at the hospital, provide the following information:What are your plans?What are the specific dates involved?Team leaders are responsible for making all the arrangements for the team tours.Tour must be paid for with unmarked, undamaged dollar bills. Please see the Team Leader Manual (Word Document) for information concerning planning your tour. If information is required to make these arrangements, contact Jill @ [email protected].Tours and CoffeeTeam leaders are responsible for the organization of all team tours and ordering of coffee for team members. See the Team Leader Manual (Word Document) for information on arranging tours and coffee orders. If more information is required to make these plans, please contact Jill: [email protected].Will your team be going on a tour after you have completed your work at the Hospital? Provide plans and dates.Will your team be ordering coffee to bring home?BackNextBy checking below, you understand that there will be team closing dates that must be observed in order to make the necessary arrangements at the hospital. ALL team members must have all of their applications, payments, and documents submitted at least 9 weeks prior to departure to Honduras. All team members’ itineraries and a copy of their travel insurance policies must be submitted 4 weeks prior to their departure to Honduras. You also understand that if a team member does not complete the application, payment and submission of the requested documents, itinerary and travel insurance policy by the closing dates, that team member will be dropped from the team roster, even if plane tickets have been purchased or other expenses were incurred. These will remain the team member's liabilities.As Team Leader, you agree to take the responsibility to communicate this information to the team members. *By checking this box, I accept the responsibility, as stated, to ensure that team members complete the process fully and understand that if this is not done, they will not be able to participate on the team and will accept any financial loss encountered by their failure to complete the process by the closing dates for the team.BackNextHealth Caring Services is a Christian organization, as is Hospital Socorro De Lo Alto. Hondurans view alcohol consumption, cursing, smoking and drug use, as well as unmarried couples rooming together, as non-Christian behaviors. In light of our desired witness in the community, HCS asks you to refrain from consuming alcohol, smoking, cursing and drug use on or off the hospital campus while working with the hospital, as well as other behaviors that might prove offensive to our hosts, and compromising to the expressed Christian beliefs of HCS and Hospital Socorro de Lo Alto. Please help us respect the Hondurans and protect the ministry of HCS and the hospital.As Team Leader, you will bear the greatest responsibility to uphold the lifestyle statement for Health Caring Services and Hospital Socorro de Lo Alto. *By checking this box, I agree to abide by and uphold this lifestyle statement while I am in Honduras.BackNextTeam Leader Commitment Form Information and Agreement to: Taking a team out of the country while there are testing requirements for return to the USA is not to be taken lightly. As a team leader you must explain to your team members the consequences of testing COVID positive and not being able to return to the USA. (see the Team Member policy below) You must have a plan if one or more of your team members tests positive, i.e.- will you stay with them, what if the person who stays tests positive after the isolation period, what if someone becomes seriously ill and needs to be transferred to San Pedro Sula to the COVID hospital, etc. If you have questions or concerns, email Jill Wilson- [email protected] or Mary Kinsey- [email protected] COVID TRAVEL, TESTING AND ISOLATION POLICY FOR TEAM MEMBERSHealth Caring Services and Hospital Socorro de lo Alto will follow all requirements for air travel as designated by the Honduran and United States governments. If testing is required for air travel to the USA, those tests will be done at the hospital. Each team member will pay for all tests requested. If a team member does not meet the requirements for air travel to the USA, they will isolate at the hospital for the period of time as defined by the CDC. Each team member will pay for all expenses incurred due to the isolation, i.e. food, lodging, transportation, etc. When the needed isolation period is complete, as defined by the CDC, a letter of recovery for air travel will be provided by the medical staff at Hospital Socorro do lo Alto. If the team member requires medical care beyond what is able to be provided at Hospital Socorro de lo Alto, they will be transferred to the COVID hospital in San Pedro Sula. By signing in this box, I am agreeing to abide by the COVID TRAVEL, TESTING, AND ISOLATION POLICY FOR TEAM MEMBERS. *Clear SignatureBackNextHealth information is considered amongst the most sensitive and personal information that individuals possess. Just as patients must be able to trust their doctors with their lives and well-being, they should also be able to feel more than reassured that their health records are safe with the clinician. Besides caring for our patients, we must respect their dignity and privacy and protect their confidential information. Protected Health Information: Protected health information is the term given to health data created, received and stored. Individually Identifiable Health Information: Names (Full or last name and initial) Dates (other than year) directly related to an individual Phone Numbers FAX numbers Email addresses ID Numbers Biometric identifier (includes finger print) Full face photographic images and any comparable images Any other unique identifying characteristic (such as tattoos) Clinical Photography/video: NO CLINICAL PHOTOGRAPHY/ VIDEO MAY BE POSTED ON SOCIAL MEDIA. All departments of patient care are considered clinical photography/video areas. Clinical photography/video may be used in medical education. No patient’s identifiable health information may be on the photograph or video. Non-Clinical Photography/video: Non-clinical photography/video subjects refer to friends and family of patients who have accompanied them to the hospital. Non-clinical photography/video requires verbal consent from the subjects as a courtesy to individuals being photographed. Posting of non-clinical photos/videos to social media is acceptable if the person posting took the photos/video. Public Photography/video: Public photography/video refers to any photos taken in any place where people have no reasonable expectation of privacy. Public photography/video may be uploaded to social media. Violation of this policy is taken very seriously by the Health Caring Services Board and violations will be reviewed for appropriate discipline for the offending party.As Team Leader, you will be responsible for upholding the social media guidelines listed above. *By checking this box, I agree to abide by and uphold the social media statement above.Signature *Clear SignatureName of Signer *FirstLastToday's Date *Your Health Caring Services administration team thanks you for your desire to lead your team to Honduras. We are available to you for any help and support you might need. We are praying for you and your team, that God will strengthen you and give you all the wisdom you will need to be His instruments of grace and healing to the Honduran people. BackSubmit