Crow Indian Health Service (Billings, MT) – CROW
Immunizations Required
- MMR, 2 doses or titer
- Current PPD and status, completed with-in the last year (Interferon-gamma release assay, T-Spot or Quantiferon are also accepted)
- Flu – yearly. If refused, declination form signed
- COVID-19 (2 doses Pfizer/Moderna, 1 dose J&J) and bivalent VOID booster. All personnel working within IHS without a valid exemption are now required to receive the bivalent COVID booster. Please monitor ihs.gov website for changes in requirements
Immunizations Highly Recommended
- Tdap – within the last 10 years
- Hepatitis A and B
- Varicella or HX of Chickenpox
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. Emily 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
- OFI Form 86C Childcare
- OPM General Release Form
- Optional Application for Federal Employment OF-612
- Student Responsibility Statement Volunteer Agreement
- General Release SF86
- 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.