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 level of responsibility of leading a mission team requires a person who understands people and purpose, as well as understanding and insight into the overall situation into which you are leading 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 be 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” (TLCF) below. This form provides the HCS Administration and the Hospital with the necessary information to support you in your leadership role. If you do not have all the specific information to complete this form, do not submit it. Contact HCS administration (Jill) and discuss options. If, after you have submitted this form any information changes, it is important that you let the administration staff know immediately. You will receive a Team Leader Information file with your team due dates and required leadership responsibilities and the Team Leader Manual when your Team Leader Commitment Form is received. You will also receive the Team Member Information file and the Team Member Manual that the team leader needs to pass along to teach team member when they are recruited. 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 and is encouraged to read 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 before submission that their documents follow the stated guidelines on the application 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 HCS Administration 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.Surgical procedures the team will operate: *N.B. Specialized equipment and supplies required for specialty surgery must be provided by the team. i.e. laparoscopic instrumentsSurgical procedures the team will NOT operate: *BackNextTeam DetailsThe information requested must be detailed. If you do not have the information, do not submit the form until you can fill it out completely. N.B. If a team member has to arrive or depart at a time that requires a separate trip to the hospital, there is an additional charge for that transport. If you do not have all the information as requested on the TLCF, contact HCS admin (Jill) and let her know the desired dates for the trip; the dates will be put on hold until you have your details for the TLCF. If another team leader asks for the same dates, the first team leader will be contacted to verify the desire to keep those dates. Decisions about dates will be determined from there. If any of the dates or information you enter below changes after you have submitted this form, you must immediately notify HCS administration: [email protected].Team Dates:Preparation Team Arrival Date-(if applicable) Preparation team includes any team members arriving prior to the primary working team’s arrival. Preparation team members should arrive all on the same day.Preparation team arrival date:Number of Preparation Team Members:Working Team Arrival date- Team Members should all arrive on the same day.Working Team’s arrival dates into Honduras:Approximate Number of Working Team Members:Working dates:Starting date and ending date the team will be working in the hospital- These 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. The first day of scheduled work is committed to clinic evaluation for the total day and must be staffed by the team. If you have enough staff to staff the clinic and surgery the first day, and want the hospital to schedule surgical cases the first working day, indicate here: Enough Staff to Staff Clinic and want to schedule surgical cases the first working day?YESNOThe hospital has to make arrangements for the processing of patients so as to be prepared to be operated on the first day.Starting Work Date: *Ending Work Date: *Team's Departure Date from Hospital: All team members must depart from the hospital on the same day.Team's Departure Date from hospital: *BackNext1. Are you anticipating having to order medications through the Hospital?This is not the preferred method of medication acquisition and there is no guarantee of availability or reasonableness of cost. All expenses are covered by the team. See the Team Leader manual for detailed procedure for obtaining medications through the hospital:Ordering Medications Through The Hospital?YESNO2. How many interpreters will be needed for your team?If you need help determining this number contact HCS administration. [email protected] The number of interpreters hired will be determined by their availability. 2. How many interpreters will be needed for your team?3. Mountain Ministry (MM) teams: (copy)What dates will the MM team work in the mountains:How many team members will be requiring a lunch while in the mountains:4. ToursTeam leaders are responsible for making all the arrangements for the team tours. If you are planning an excursion after the team's working days at the hospital, provide the following information: What are your excursion plans:What are the specific dates involved:Will you leave the hospital, go on your excursion and then go directly to the airport: YESNOORProvide the following information: After your excursion will you return and overnight at the hospital before going to the airport? Will you require a meal upon return to the hospital after the excursion? Give the specific dates involved.A quote may be requested for transportation to Copan. Transportation must be paid for before the tour begins. Contact HCS administration (Jill) for details. Are you interested in a quote: for transportation to Copan?YESNONumber of people needing transport:Specific dates of transport:5. CoffeeTeam leaders are responsible for the organization of the ordering of coffee for team members if there is a desire to bring coffee back to the USA.See the Team Leader Manual (Word Document) for information about coffee orders. If more information is required to make these plans, please contact HCS administration- Jill: [email protected].6. What other needs do you anticipate your team will have that we can help you with? 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 their applications, documents, and payments submitted by the due date specified and communicated to the Team Leader by Health Caring Services. 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.BackNextHealth 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.Name 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