Columbia County Volunteers in Medicine Clinic, Inc. is a 501(c)(3) non-profit, EIN# 20-5695518
The mission of Columbia County Volunteers In Medicine Clinic is to improve the health of the medically underserved population in our community by offering free healthcare to the uninsured.
Patient Service Agreement
- I understand that Columbia County Volunteers in Medicine Clinic serves patients who have no insurance and fall within 300% of the Federal Poverty Guidelines. If I have insurance or my income changes, I agree to notify CCVIM. To continue using CCVIM services keeps other members of our community who need help from getting it, and could even cause the Clinic to close.
- I understand that CCVIM is not an Emergency Room, nor is it a walk-in clinic, and I must be responsible for my own safety and health by seeking out, and paying for, my own care in an urgent health crisis. I will treat the CCVIM clinic with the same respect as any other Primary Care Provider, by making, keeping, and cancelling appointments. I will inform CCVIM after any hospitalizations.
- I agree to follow the recommendations of the volunteer medical providers to the best of my abilities on medications, lab tests, referrals, and specialists for my condition. I understand that CCVIM will not be able to pay for these, and I will tell staff if I cannot afford them so CCVIM can look for ways I can get help.
- I agree to apply for any health insurance that I qualify for and to keep CCVIM informed of the progress.
- I understand that CCVIM does not have any narcotic medications (“pain killers”) at the clinic, nor does the clinic prescribe narcotics to our patients.
- I agree to take all medications as directed and keep in contact with CCVIM staff about medication changes, including if I stop taking it, or if I notice any side effects. I agree to try to contact CCVIM about refills before I run out.
- I understand that there may be times that CCVIM must cancel or reschedule my appointment due to circumstances beyond the clinic’s control such as weather, or volunteer staffing changes, and that the clinic will notify me of those changes as soon as they know.
- I understand that the majority of staff at CCVIM are volunteers who treat all patients with dignity and respect in a professional atmophere. If I am in any way unsatisfied with my interactions with staff or treatment at the clinic, I agree to ask to speak to a person in authority, or to call the clinic at 570-752-1780. Out of respect for the care provided to me, I agree to treat all staff with equal dignity and respect. I understand that if I am abusive towards CCVIM staff or property, with profanity, language, threats, actions, or violence of any kind, the clinic has the right to dismiss me from the clinic’s services, and may call the police and press charges, if needed. For the safety of everyone, weapons of any kind will not be tolerated at the clinic.
- I understand that CCVIM will use the same confidentiality practices as any other medical provider. Any information related to my care will not be shared with my family, friends, community members, employers, or outside agencies, except as authorized in writing by me.
The Medical Director of CCVIM is Dr. James Gallagher, MD.
Bipin Chopra is the Executive Director.
Cindy Rupp is the President of the Board of Directors.
In compliance with regulations, nonprofits must allow public inspection of these records during regular business hours at their principal offices.
You may also click the link below for a downloadable copy of the most recent 990 Tax Form:
In addition, people can request information from the IRS by writing a letter, including the name of the organization, the year, and the type of tax return requested, and send it to:
Commissioner of Internal Revenue
Attn: Freedom of Information Reading Room
1111 Constitution Avenue, NW
Washington, DC 20224