KEEP Volunteer Downloads

Please download and print each of the forms below for any screening you will be volunteering at.  Bring them with you to the volunteer training OR bring them to the screening itself.

 The mandatory volunteer orientation is set for Friday, December 3 at 6:00 at Zion Hill.  If you have not volunteered at a KEEP screening this year, please plan to attend.  Anyone who would like to review the paperwork and station duties is also welcome to attend.

  December 4, 2010 - Zion Hill Missionary Baptist Church

Volunteer Profile - December 4, 2010

Volunteer Confidentiality Agreement - December 4, 2010

Volunteer Photo Release - December 4, 2010

Technical Volunteer Agreement - December 4, 2010 (for all medical volunteers)

KEEP SCREENING

A partnership between AHC Parish Nurse Program and National Kidney Foundation Wisconsin

7:30 am – 1:30 pm

Zion Hill Missionary Baptist Church, 1825 W. Hampton Ave., Milwaukee 53209    

Thank you for considering being a volunteer for the AHC Parish Nursing and National Kidney Foundation of Wisconsin Kidney Early Evaluation Program Screening (KEEP).

KEEP is a free health screening for individuals at increased risk of developing kidney disease.

The goals of KEEP are to: 

·         Raise awareness about kidney disease especially among “high risk” individuals

·         Provide free testing for people at increased risk for kidney disease

·         Encourage people “at risk” to visit a clinician and follow the treatment plan recommended

·         Provide educational information so that “at risk” individuals can prevent or delay kidney damage

·         Provide clinician referrals for follow-up care, if needed

·         Provide ongoing information and support

KEEP is only a screening service and not meant to provide a diagnosis or replace regular visits with PCP. 

One or more of the following services will be provided to participants at the screening:

·         Blood pressure, height, weight and waist circumference measurements

·         Blood and urine tests for signs of diabetes and kidney disease, including

-          Blood glucose check blood sugar

-          Hemoglobin check blood test for anemia

-          Albumin to creatinine ratio (protein in urine)

-          Serum creatinine (measures how well kidneys are filtering blood)

-          Estimated Glomerular Filtration Rate (test for kidney function)

-          Total cholesterol, HDL, LDL and triglycerides

-          Some participants will also have calcium, phosphorus, PTH and/or Hemoglobin A1c drawn

Test results are provided on site by a clinician.  Free educational materials are provided.

Volunteer support is needed to implement the KEEP Screening

Professional Volunteer Activities

• Assess and record height, weight, waist and BP measurement (2-3)
• Blood glucose collection – finger stick (2-3)

·         Blood drawn – 3 tubes (2-3), Centrifuge SST tubes (1-2)

·         Urine collection – Clinitek machine (2-3)

·         Clinician Consultation – MD, PA and NP (2-3)

Lay Volunteer Activities

•  Register participants
•  Administer screening questionnaire
•  Assist with paper work and record results
• Conduct height and weight measurements
•  Guide participants, assist clinicians
•  Hospitality

Sue Schaus, Manager, Parish Nurse Program

Aurora Health Care,  950 N. 12th Street, PO Box 342,   Milwaukee, WI  53201-0342

Office:  414.219.7289        Cell:  414-507-7465           Fax: 414.219.7709

sue.schaus@aurora.org

www.aurorahealthcare.org/services/parish/index.asp