Crow Indian Health Service (Billings, MT) – CROW
Immunizations Required
- MMR vaccine series, 2 doses or positive blood titer
- PPD skin test within the last 3 months of start date at CSU or can get PPD done first day at CSU at public health. Or has Quantiferon gold TB blood test within 3 months of start date.
- Varicella vaccine series, documented history of chicken pox disease or positive blood titers
- Hepatitis B series or positive blood titers
- Tetanus within the last 10 years
- Tdap within the last 10 years
- Seasonal influenza vaccine or waiver. If refused, declination form signed
- Yearly COVID vaccine or waiver
Immunizations Records Submit to and Date:
Immunizations must be received before working with patients. Please include a coversheet including your name, contact information and department (Optometry Clinic) that you will be working in. Preference is that immunizations are received one month before your arrival but can be brought in on the day of your arrival. Please mail a copy of immunizations to:
Dr. Emilie Mathiak
Optometry
Crow Northern Cheyenne Indian Health Service
10110 South 7650 East
P.O. Box 9
Crow Agency, Montana 59022
Email: Emily.Mathiak@ihs.gov
Documentation Required
Completion of all the student volunteer forms:
- Agreement to a Temporary Waiver of Character Investigation
- Berkeley MOU Student Responsibility Statement
- Childcare Position Provisional Authorization Memorandum
- Declaration for Federal Employment OF-306
- Addendum to Declaration for Federal Employment OF-306
- HHS-745 Form
- OFI Form 86C Childcare
- OPM General Release Form
- Optional Application for Federal Employment OF-612
- Student Responsibility Statement Volunteer Agreement
- General Release SF86
- Approved Forms of ID
- Provisional Authorization Memo Updated 11/02/2018
- Fingerprints – You will not be doing LIVESCAN digital electronic fingerprinting (that is, do not go to an outside entity or offsite such as UCPD). You will be doing the fingerprinting in Clinic Administration in March/April of your 3rd year. We will be taking your fingerprints on two hard-copy fingerprint cards provided by Crow IHS. When cards are available, Clinic Admin will send out an email to students to make an appointment with Elizabeth Doty or Dr. Yu to take the fingerprints.
Documentation Submit to and Date
- All documentation must be received one month prior to start date. Please send the completed volunteer forms to:
Dr. Emilie Mathiak
Optometry
Crow Northern Cheyenne Indian Health Service
10110 South 7650 East
P.O. Box 9
Crow Agency, Montana 59022
Email: Emily.Mathiak@ihs.gov
Phone: 406-638-3340
FAX: 406-638-3341
Absence Policy
- Students are permitted to be absent on the day of an NBEO exam without making up the day. Two travel days are allowed (1 day prior and 1 day after the date of Part 3).
- All other absences (including personal and illness) should be made up and can be done so in coordination with the four-day/week clinic schedule.