Mission Trip Forms

FORMS AND RESOURCES

Completing the necessary forms are an essential part of the trip process. Please follow the instructions for submitting the forms needed for your mission trip. Additional resources and forms to help you prepare for your trip or needed for your project are included below.

MISSION FORMS FOR ALL TEAMS

Risk Waiver

Team leaders must scan and email signed forms from each team member or take to Haiti and submit to the trip coordinator.

Health History

Each team member needs to submit a completed copy to their Team Leader. Team Leaders are to retain copies until after your trip.

List of Donated Items for MICECC

Thanks for your contribution to our ministry. Please use this form to make a list of all items you are donating.

MISSION TRIP RESOURCES:

These resources will help prepare for your trip and while serving on the mission field.

Tips for working with Translators 

Mission Trip Vaccination Guide

First Aid for Teams (includes tips for a First Aid Kit)

Luggage Insert 

Please insert these in luggage used to transport project supplies and medications.

medical_missions

CLINIC FORMS FOR MEDICAL TEAMS

Patient Health Records 

Please print/take 25 double sided medical patient records per provider per day.

Patient Dental Records

Please print/take 15 double sided patient records per provider per day

Patient Vision Records

Student Health Record

Student Dental Record

For use in Student Health Screenings

Clinic Prescription and RTC  

You need 50 RX/RTC forms per provider per day.

Avery Labels 

Sun/Stars/Moon icons are helpful as many patients are illiterate. (Not needed if using the Blessings preprinted RX bags).

Patient Med Instruction Form  

Hospital Transfer Form 

Please print/take 10 copies

Pharmacy Worksheet 

Please print/take a copy to complete an end of week inventory.

Medical Trip Resources 

Click here to access additional resources.