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

List of documents needed for credentialing

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