ST. ANNA'S MEDICAL MISSION
Volunteer Forms
Instructions for In-State Volunteers:- ALL VOLUNTEERS must complete and submit the Volunteer Info and Medical Form as far in advance of your trip as possible to assure a spot for you.
- Send a legible copy of:
- A government issued photo ID (driver's license or passport)
- Health insurance card
- Proof of recent (within 1 year) TB skin test, if done to:
Email: diana@stannanola.org Mail: Diana Meyers Fax: 504.947.2122 1313 Esplanade Ave. New Orleans, La 70116
- Complete, print, sign and return (scan & email, fax or mail) the following releases:
- Physicians -Complete, print, sign and return (scan & email, fax or mail) the forms under "Physician Volunteer". Also send a legible copy of:
- Copy of your current Medical License
- Copy of current CPR card (if you have one)
- Reference Letter re: your work and appropriateness for this Mission
- Copy of your DEA number
- Nurses -Complete, print, sign and return (scan & email, fax or mail) the forms under "Nurse Volunteer". Also send a legible copy of:
- Copy of your current Nursing License
- Copy of current CPR card (if available)
- Reference Letter re: your work and appropriateness for this Mission
- Social Workers -- Complete, print, sign and return (scan & email, fax or mail) the forms under "Social Worker Volunteer". Also send a legible copy of:
- Copy of your current Nursing License
- Reference Letter re: your work and appropriateness for this Mission
To contact Diana with questions, please call (504) 947-2121. We can't thank you enough for your willingness to work with us to serve the people of New Orleans.
