Welcome to the AMA/NDLS™ Disaster Volunteer Physician Registry. The AMA intends to use the registry as a means to facilitate and coordinate the deployment of physicians willing to volunteer with federal and private sector response organizations to respond to the Haiti earthquake. Practicing physicians are eligible to register.
Please be aware that the health care infrastructure in Port-au-Prince and other areas affected by the Jan. 12 earthquake and subsequent aftershocks have suffered significant damage. Physicians must be prepared to provide care in a physically challenging, austere, resource-constrained environment. It is imperative that those involved in the relief effort be self-sufficient and are able to work independently. Not every physician who registers with the AMA’s volunteer registry will be deployed.
Please view an AMA webinar that can help you prepare to support the relief effort in Haiti. After watching the webinar, you should have a better understanding of the essential clinical and public health skills needed to manage individuals and populations affected by the earthquake. You also will want to address your professional liability coverage with the agency responsible for your deployment in connection with the disaster relief effort.
The information collected in this database is being used specifically for disaster response deployment to Haiti, but it may also be employed should future disasters occur around the world. The AMA may contact you with information about disaster response resources and updates on disaster preparedness medical education.
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Contact Information
* First Name
* Last Name Suffix (Sr., Jr., etc.)
* Date of Birth
* Medical Degree MD DO
* Telephone (xxx) xxx-xxxx — — Telephone type: Office Home Mobile Area Code
* E-Mail Address (e.g. username@domain.com)
Your e-mail address will not be shared, sold, traded, exchanged or rented. See our Privacy Policy for more information.
Credentials & Practice Information
* Medical Graduation Year
Primary Practice Specialty
Type of Practice
Active State of Practice Medical State License Number
Languages, Disaster Support Experience & Training
What languages do you speak? English French Creole Spanish Other
Do you have any experience in providing care in Haiti? Yes No
Are you of Haitian decent? Yes No
How long can you volunteer?
Deployment preference
When can you be available for deployment?
Have you ever been deployed to clinically support a public health emergency or disaster? Yes No
Which of the following disaster life support courses have you taken? Basic Disaster Life Support Advanced Disaster Life Support
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By clicking the submit button below you verify the above information is accurate, and that you are willing to be deployed to Haiti to support the relief effort. Further, you will want to address your professional liability coverage with the agency responsible for your deployment in connection with the disaster relief effort.
