Forms

1) Clinical Observership Form

2) Volunteer Agreement

3) FTCA patient consent

4) Patient Consent

5) Notice of Privacy Practices 

6) Bylaws of Hope Street Free Clinic

7) Risk:

          Appendix A Incident Report Form

          Appendix B FTCA Educational Training Tracking Form

          Appendix C Annual Risk Management Training Plan

          Appendix D Quarterly Risk Assessment Template

          Appendix E Risk Management Action Plan

          Appendix F Confidentiality Agreement

          Risk Management Coordinator Job Description

          Risk Management Manual 2025

8) Quality:

          HSFC Quality Manual

          Quality (QI QA) Plan

          Quality Coordinator Job Description

9) Credentialing:

          Credentialing and Privileging Operating Procedures

          Credentialing Coordinator Job Description

          Fitness for Duty Form

          Peer Reference Form

          Provider Application form

          Provider Release and certification

10) Claims Management:

          Claims Management Operating Procedures

          Claims Management Coordinator Job Description

          Claims Appendix A -- Health Center Incident Report Form

          Claims Appendix B -- Health Center Claims Notification Form

          Claims Appendix C -- Patient Communication Template

          Claims Appendix D -- Health Center Action Plan

          Claims Appendix E -- Health Center Confidentiality Agreement

          Claims Appendix F -- Educational training tracking form

11) Board

         Board Application Guide

         Board Application Form

 12)   EEOC Statement

13)   Salary and Benefits Disclosure Statement

14) Job Descriptions:

         Executive Director

         Medical Director

         Claims Coordinator

         Quality Coordinator

         Risk Management Coordinator

         Credentials Coordinator

15) Organizational Chart

16) Intake Form