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Volunteer Annual Agreements 2022

(Check all that apply)

Please submit a copy of your insurance

Please submit a current copy of your auto insurance declaration page showing that you continue to carry liability coverage of at least $100,000. You can submit your copy in any of the following ways:

  • Scan and email to christie@carepartnersofcookcounty.org
  • Mail to: Care Partners of Cook County, Attn: Christie, PO Box 282, Grand Marais, MN 55604
  • Drop off at Care Partners office in the lower level of the Sawtooth Mountain Clinic during office hours (10am to 3pm, Monday-Friday) - please call first so we can arrange to meet you in the clinic parking lot
  • Contact Christie at (218) 387-3788 to make alternate arrangements

 

If you do NOT have $100,000 in auto liability coverage...

...please contact Care Parters Program & Volunteer Coordinator Christie John as soon as possible by calling (218) 387-3788 or emailing christie@carepartnersofcookcounty.org

If you have incurred MORE than 1 ticket or accident in the last three years...

...please contact Care Partners Program & Volunteer Coordinator Christie John by calling (218) 387-3788 or emailing christie@carepartnersofcookcounty.org

COVID Vaccination Status
We request that clients and volunteers be transparent about whether or not they have been vaccinated, so that both can make informed decisions about their risk. To protect personal medical information, we will do our best to ask volunteers and clients if they have a preference regarding vaccination status before they are matched.


Care Partners Confidentiality & Security Policy

ALL Care Partners of Cook County paid staff and volunteers must annually read and sign their acknowledgement of the following Confidentiality and Security Policy statement. 

Personal information obtained from an individual in conjunction with the project shall be disclosed in a form, which identifies an individual without the written, and informed consent of the individual concerned. Care Partners of Cook County paid staff and volunteers must read and sign their acknowledgement of the following statement.

The protection of Care Partner’s confidential information including the privacy and integrity of the information listed below is vital to the continued success of our organization.  This information includes but is not limited to the following examples:

  • Patient information or personal affairs.
  • All information seen or heard regarding patients, directly or indirectly.
  • The physical security of our office
  • The security of all technology that may hold client information

Paid staff and volunteers of Care Partners shall be accountable to the following:

  • Avoid accessing all information for which you do not have a need to know.  Access only information as it relates to the essential functions of your job.
  • Avoid discussing client information or sensitive business matters outside the circle of Care Partner’s meetings even with family or other employees or volunteers who are not involved with the client’s care.
  • Keep any written documentation concerning patients secure.

Failure to recognize the importance of confidentiality is a breach of Care Partner’s ethics and may be grounds for disciplinary action, including possible dismissal, but may also involve you in unwanted legal proceedings.


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Contact Information Change

Please let us know if any of the following contact information has changed in the last year: