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Department of Communications Sciences and Disorders Doctor of Audiology Program

Audiology Clinic Operational Procedures

SPRING 2012

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TABLE OF CONTENTS TOPIC PAGE Introduction 3 I. The Student 8 II. The Facility 13 III. Services Provided 16 IV. Patient Appointments 17 V. After Scheduling the Appointment 19 VI. Patient Fees 20 VII. IDX & Sycle 24 VIII. Collection of Fees 25 IX. Clinic Equipment 26 X. Patient Files 33 XI. The Appointment 37 XII. After the Appointment 43 XIII. Patient Reports 45 XIV. Requests of Patient Reports and Information 48 XV. Other Important Information 49 XVI. Grading, Clinical Assistance Program, 50 KASA Competencies, Practical Exam

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INTRODUCTION

The audiology practicum assignments are an essential educational component of the audiology doctoral program. In order to ensure success of clinical experiences for the audiology doctoral student, this handbook was designed as a guide covering all four years of the program. The handbook is organized so that general information is presented first; this is information that is related to students in all four years of the program. This is followed by sections containing information as it pertains to each year of the program. Questions related to first year clinical experiences are to be directed to Clinic Lab Instructors, Dr. Carr and Dr. Arnold, and second, third and fourth year experiences are to be directed to the Clinic Director, Dr. Hansel.

GENERAL INFORMATION

Non-Discriminatory Policy

Individuals must not discriminate in the delivery of professional services on any basis that is unjustifiable or irrelevant to the need for and potential benefit from services such as: race, sex, age, religion, national origin, sexual orientation, or handicapping condition.

Confidentiality

Students are required to follow departmental policies and Health Insurance Portability and Accountability Act (HIPAA) of 1996 policies regarding confidentiality. The requirements of HIPAA apply to the storage and/or electronic transmissions of patient related information, and are intended to ensure patient confidentiality for all health care related information.

In general, the rules state that any health care provider or insurance entity that maintains or transmits individually identifiable health information, referred to as “protected information,” about a patient is deemed a “covered entity” and is subject to HIPAA. An entity which collects, stores, or transmits data electronically, orally, in writing or through any form of communication, including fax, is covered under the HIPAA privacy rule, as is the information itself.

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University of South Florida Standards of Service-the following is derived from the University Of South Florida Standards Of Service Policy.

Service plays a critical role in everything we do at the University of South Florida. All who work at this university are committed to providing quality service in all we do. We commit to serve others and place the needs of others before our own personal needs. Our philosophy of service pertains to students and fellow workers alike. We hold as self-evident that a service does not exist until it is offered. We appreciate that our student body and workforce are diverse and that our diversity gives us strength and adds value to our university. We appreciate the powerful nature of written and spoken communication and understand that how we communicate with students and one another has a direct impact on the quality of the individual experience at USF. We also realize that each of us serves as an ambassador of this institution and that our attitude and actions reflect on us as individuals, and on USF. We are committed to support the University’s strategic plan by providing the very best service we can. As such, the University of South Florida is dedicated to the following goals and ideals:

We will treat students, visitors, and fellow workers with dignity and respect and assist them in a caring and helpful manner.

We will act in a manner that students, visitors, and fellow workers see us as a source of accurate and helpful information.

We will continually review our policies and procedures in an effort to simplify them and improve service.

We will continue to improve and update our knowledge, skills and abilities in order to best serve our students.

We will derive pride and satisfaction from solving problems, not passing them on, as we seek solutions not blame.

Logging Clinical Experience Each student clinician is responsible for recording on a daily basis the types of services and related activities completed during their assigned blocks of clinical practica on the “Audiology Clinical Experience Tracking Form” (See forms for USF hearing clinic as well as examples of related activities). Once a student obtains their 25 hours of observation (must be completed prior the end of the first semester in the Au.D. program), they can begin logging hours for their clinical experience. In order for the student clinician to receive credit for clock hours, the student clinician must obtain the supervisor’s signature at the end of each assigned block of time. If the student clinician’s performance was unacceptable during a scheduled block of time, the supervisor will not sign off on those hours.

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Yellow ASHA Hour Sheets

First and second year students must transfer the hours completed from the Audiology Clinical Tracking Form to the ASHA hour sheets located on the “P” drive, under audclinic, Daily and Yellow ASHA hour sheets, by the Friday of the last week of classes. Please save your form under the appropriate semester. Complete the appropriate form for each supervisor. The supervisor’s name can be found on each tab of the excel document at the bottom of the screen. On each form, please complete the following:

Semester and year of clinic (Summer 2012, Fall 2012, Spring 2013) Site of clinic assignment – i.e., USF (1st yr); USF (2nd yr) Hours – insert hours, bring down totals to the side and bottom of each section, round up to the nearest ¼ hour (i.e. .25, .5, .75) **If the name of a supervisor is not listed, please create a worksheet within the Excel file and rename the tab with the appropriate supervisor name.

1st and 2nd Year Students – The audiology clinic assistant will print out the ASHA forms for you.

Upon completion of the forms:

o Supervisors will sign both originals if the student has satisfactorily met all requirements for the clinical practica.

o The audiology office assistant will insert student data in the computer program for tracking of clinical hours

o The audiology clinic assistant will place one original in your student file and will return the other original to the student to keep for his/her records.

3rd and 4th Year Students – You will need 2 original signed copies of your ASHA

forms on yellow paper; give 1 copy to Dr. Hansel and keep another copy for your records.

Grand Rounds

Mandatory Grand Round meetings are held for all first, second and third year students enrolled in the Au.D. Program. Students will be notified of scheduled times and locations. Typically, Grand Rounds are held in PCD 4004 on a monthly basis during each semester. In specific cases, excuses can be given by the faculty member in charge of Grand Rounds. This will only be granted on a case by case basis

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Voluntary Clinic during Semester Breaks

During the breaks between semesters, supervisors continue to see patients. Students are strongly encouraged to participate. This participation is voluntary, but it is seen as part of the professional responsibility of “doctors of audiology.” Efforts will be made to accommodate student needs, and no student should have to volunteer more the two to three times at most, even during the longest break between summer and fall semesters.

Procedural Safeguards Accidents

If anyone has an accident or becomes seriously ill in the clinic, notify the supervisor or another faculty member, immediately. Call campus emergency (911) for assistance. In the event of minor injuries, a first aid kit is located in PCD 1014 (wet room). Even if the injury is minor, notify the supervisor and the audiology clinic assistant to document the accident. An incident report also needs to be completed by the supervisor and involved students. The incident report template is located in the “P” drive under BCS-CSD Pub and then under Audiology Clinic. The incident report is kept in a file by the clinic director.

Seizure Procedure

Keep calm and have someone notify the supervisor. A seizure cannot be stopped once it has started. Do not restrain the patient or try to revive him/her. Clear the area around the patient of hard, sharp or hot objects, which could injure him/her. Do not force anything between his/her teeth. If the patient’s mouth is open, place a soft object (i.e., handkerchief) between his/her teeth. Turn the patient’s head to the side and make sure the breathing is not obstructed. Loosen tight clothing. Carefully observe the patient’s actions during the seizure for a full medical report later. When the seizure is over, let the patient rest as he/she wishes.

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HIV

Because our clinic has a non-discriminatory policy, students may see an occasional patient with HIV. Unless the patient discloses this information during the interview or on the case history form the clinic faculty may not know the patient has HIV. Please read the information from ASHA to be an informed and knowledgeable professional.

Infection Control

Infection control procedures are covered in Audiology Clinic Lab I. Students are to read notes for a review. Recall that students are to wash hands thoroughly before and after the following:

Each patient The use of gloves Using the restroom Applying cosmetics Inserting contacts lenses

Students should wear gloves when cleaning and disinfecting after each patient. Cleaning and disinfectant materials are stored in each room. These products may be harmful if they come in contact with skin or eyes. Do not expose patients to these products. Remember to return products to their respective storing places. When running low on a product, see your supervisor.

Procedures for evacuation of the building

In the event of fire or emergency, warning indicators (strobe lights, siren, and voiced instructions) will engage. Faculty and staff should secure the clinical areas and building by giving directions to students and patients, making sure that all interior doors are closed, and assuring that everyone evacuates the building. Evacuation of the third and fourth floors will be completed using the stair well. Students should remain with their patient and assist them throughout the evacuation. Walk calmly and in an orderly fashion. Those on the first floor should use the main entrance to leave the building and should proceed to an area a safe distance from the building. Students, patients, and individuals in the waiting area on the second floor should exit using the stairs to the playground. When the stair well is cleared, students on the second floor should take patients who are not ambulatory (wheelchairs, walker, etc) to the second floor landing in the stair well. The stair well has a two hour fire wall. Remain with the patient until the fire/rescue team arrives. Notify the team that we have individuals who need to be evacuated. Do not use the elevator.

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I. The Student Professionalism

The USF Hearing Clinic is a recognized service provider in the Tampa Bay area. In addition, it serves as the primary facility for clinical training for graduate students enrolled in Audiology Practicum activities on campus. Students are required to conduct themselves in a professional manner reflected in demeanor, dress, verbal exchanges, and compliance with all policies and procedures associated with clinical assignments.

Audiology is a professional discipline. Professions require certain behaviors of their practitioners. Professional behaviors (which may or may not directly involve other people) have to do with professional tasks and responsibilities, with the individuals served by the profession and with relations with other professions. Included among professional tasks are education and training. The following conveys expectations about the behaviors of those who seek to join this profession.

1. You show up. 2. You show up on time. 3. You show up prepared. 4. You show up in a frame of mind appropriate to the professional task. 5. You show up properly attired. 6. You accept the idea that “on time,” “prepared,” “appropriate,” and

“properly” are defined by the situations, by the nature of the task, or by another person.

7. You accept that your first duty is to the ultimate welfare of the persons served by your profession and that “ultimate welfare” is a complex mix of desires, wants, needs, abilities, and capacities.

8. You recognize that professional duties and situations are about completing tasks and about solving problems in ways that benefit others, either immediately or in the long term. They are not about you. When you are called on to behave as a professional, you are not the patient, the customer, the star, or the victim.

9. You place the importance of professional duties, tasks, and problem solving above your own convenience.

10. You strive to work effectively with others for the benefit of the person served. This means you pursue professional duties, tasks, and problem solving in ways that make it easier (not harder) for others to accomplish their work.

11. You properly credit others for their work. 12. You sign your work. 13. You take responsibility for your actions, your reactions, and your

inaction. This means you do not avoid responsibility by offering excuses, by blaming others, by emotional displays, or by helplessness.

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14. You do not accept professional duties or tasks for which you are personally or professionally unprepared.

15. You do what you say you will do, by the time you said you would do it, and to the degree of quality you said you would do it.

16. You take active responsibility for expanding the limits of your own knowledge, understanding, and skill.

17. You vigorously seek and tell the truth, including those truths that may be less than flattering to you.

18. You accept direction (including correction) from those who are more knowledgeable or more experienced. You provide direction (including correction) to those who are less knowledgeable or less experienced.

19. You value the resources required to perform duties, tasks, and problem solving, including your time and that of others.

20. You accord respect to the values, interests, and opinions of others that may differ from your own, as long as they are not objectively harmful to the persons served.

21. You accept the fact that others may establish objectives for you. Although you may not always agree with those goals or may not fully understand them, you will pursue them as long as they are not objectively harmful to the persons served.

22. When you attempt a task for the second time, you seek to do it better than you did the first time. You revise the ways you approach professional duties, tasks, and problem solving in consideration of peer judgments of best practices.

23. You accept the imperfections of the world in ways that do not compromise the interests of those you serve.

24. You base your opinions, actions, and relations with others on sound empirical evidence and on examined personal values consistent with the above.

25. You expect all the above from other professions. Adapted from Chial, Michael. (1998). Audiology Today, 10, pg 25.

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Clinic Attire Students must select from the following options for clinic attire for all clinic assignments on and off the USF campus:

1. Attire when in the clinic: Affordable scrubs to be purchased by the student from I.Q. Outfitters located at 2554 E. Fowler Avenue, Tampa, Florida. Phone: (813) 631-7778. Pants: Cherokee brand in black or khaki. Top: Cherokee brand v-neck tunic in black or khaki to be embroidered with the Audiology USF logo, OR

2. Attire when off campus for program activities: The green USF polo shirt with khaki pants. The USF polo shirt may be purchased during orientation through the USF SAA Chapter.

If a student is not wearing appropriate attire, he/she will be asked to leave the clinic and will not receive clinical hours.

Cell Phones Cell phones must be turned off when students are in clinic. Under no circumstances should a student’s cell phone ring when attending to a patient.

Weekly Review Meetings with Clinic Supervisors

All student clinicians are required to schedule and attend weekly meetings with respective supervisors for all clinic assignments each semester. Students are to consult with their supervisors to arrange these meetings prior to the first day of clinic. This time is valuable to both the student and the supervisor. These meetings are important to the success of the students’ clinical sessions. As a result clinical sessions run more smoothly and a more professional atmosphere is created for the student clinician, supervisor, and patient.

Prior to attending the weekly meeting each student is to review patient files,

develop plans of action to be discussed, and review clinic equipment, procedures and programs that may be needed for the patient. In addition, the student’s performance on patients previously seen may be discussed. Supervisors will provide guidance and assistance as needed. Attendance Policy Attendance is mandatory at each clinical assignment for which you are scheduled. You are assigned to these time slots for the entire semester. On occasion, the student clinician may be asked to perform clinical activities during an unassigned time slot (would not interfere with other assigned duties the

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student may already have); this would occur in cases in which the student needed further experiences or to facilitate patient continuity.

If for any reason you cannot attend a session(s) due to illness, emergency, or other extenuating circumstances, notify your supervisor(s) directly ASAP via cell phone. Written verification may be requested. Absences are not excused unless they are specifically acknowledged by the respective supervisor on a case-by-case basis. In the case of an illness of greater than two days, a note from your physician will need to be submitted to your supervisor(s). Discuss missed assigned clinic sessions with your respective supervisor(s); missed sessions will need to be made up.

If a patient(s) is not scheduled in your assigned time slot(s), the student clinician is still required to attend clinic. The time will be spent performing clinic-related duties. See your supervisor for suggestions.

Student clinicians must arrive 30 minutes prior to their assigned clinic block to accomplish all pre-patient responsibilities, to include calibration, preparation of all materials and supplies, and any other duties required preparing for patients.

FIRST YEAR STUDENT

Prerequisites for clinic enrollment Speech-Hearing Screening

Each student in the Department must have a speech and hearing proficiency check prior to enrollment in practicum. This screening must be completed during the first semester of enrollment as an audiology doctoral student. Any student admitted to the program who has NOT had this check will not be enrolled in practicum. Typically, this screening is completed during new student orientation held in August of each year.

Observation Hours and CPR Certification

All students should have documentation of 25 hours of observation experience before being enrolled in clinic practicum. Documentation of the completion of these hours must be submitted to Dr. Carr by the end of the first semester of the first year of the audiology doctoral program. Documentation must be in the form of an observation log or letter, on letterhead, from the program confirming the observation hours. It must contain an original signature of the person who certified the hours as well as his/her ASHA number. Xeroxed copies will not be accepted.

In addition, all students must have documentation of training in community CPR (infant, child, and adult) and HIV or must complete training prior to

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initiation of practicum. Documentation must be submitted to Dr. Carr by the end of the first week of classes in the first semester of the first year of the audiology program.

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II. THE FACILITY Audiology Clinic

Address: 4202 E. Fowler Avenue, PCD 1017 Tampa, FL 33620-8200 Phone: (813) 974-8804 Fax: (813) 974-0822

The audiology clinic of the USF Speech, Language, and Hearing Center is located on the first floor of the west side of the PCD building. The following physical areas make up the audiology clinic:

Room Room #

Audiology suites 1008- A-D

Foyer 1008

Hearing Aid Room #2 1010

Hearing Aid Room #1 1014

Cochlear Implant Room 1005

Audiological Rehabilitation Room

1006

Audiology Student Mail Room 1020

Audiology Clinic Assistant’s Area

1017

Student Work Room 1015

American Institute of Balance 1001

Vestibular Evaluation Room 1002

Conference Room 1007

Clinical Supervisors’ Offices 1009

Audiology Suites

Four sound treated booths:

A and D are used when testing pediatric patients and CI patients B and C are used when testing adult patients Foyer

Contains an open area used for otoscopy and immittance testing. Conference Room

This room has many uses including interviewing/counseling, faculty and student meetings.

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Patient Window

This window, located in the PCD 1017 lobby is to be used by patients during the check-in and check-out processes. Students will escort patients to the window for check-out with completed routing slip, superbill, and patient’s file.

Audiology Clinic Assistant’s Area (PCD 1017)

This area houses the audiology clinic assistant’s workstation, clinic files, forms, etc. The CSD clinic billing assistant also has a workstation in this area. Student discussions and meetings with supervisors will not be held in this area. Other rooms will be available for this purpose. In addition, please do not wait in this area for patient files during check-in and check-out. Once the patient is checked in, the clinical administrative assistant will place the patient’s file in the Supervisor’s hot box in the perpendicular position. Once the clinical administrative assistant has completed the check-out process with the patient, the patient file will be placed in the student pick-up box or as designated by the routing slip. Students are to enter and exit this area from the student workroom side of PCD 1017 and not from the main waiting area side of the clinic. In addition, please knock on the door before entering this area.

Student Work Room

Student clinicians are to perform activities in this room related to clinic patients. These activities may include:

Wait for patient arrival Review of patient files Completion of patient files Review clinical and testing procedures Complete other supervisor assigned activities

Note: Readings and homework related to academic courses are not to take place in this room or on assigned clinic time.

Food and drink are allowed in this room only for the students on the first floor. Food and drink are prohibited in all clinic areas.

Center Playground Policy

The Center playground located to the south of the PCD building is for the exclusive use of patients and student clinicians. Patients must be accompanied by a student clinician at all times. Students should not take a patient to the playground without the consent of the supervisor. No parents or siblings are to

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use the playground unless accompanied by a student and/or supervisor. Please make sure the door to the playground remains closed at all times.

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III. SERVICES PROVIDED

Audiology Clinic Services

Services provided by the USF Audiology Clinic include, but are not limited to:

Audiological evaluations and re-evaluations Hearing aid evaluations, hearing aid consultations, and hearing aid repair Electrophysiological (audiologic and vestibular) evaluations Auditory Rehabilitation treatment Cochlear implant evaluations/mapping/programming Auditory processing evaluations. Tinnitus evaluation and treatment These services are provided to patients of all ages. Length of appointment may vary from 15 minutes to 1 ½ hours depending on the service(s) provided; this is at the discretion of the clinic supervisor.

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IV. PATIENT APPOINTMENTS A. Scheduling Patient Appointments

All services provided by the USF Audiology Clinic should be scheduled through the audiology clinic administrative assistant. It is important that the administrative assistant schedule the appointments to allow for smooth operation of the clinic and avoid overbooking of patients needing various services. In order to maintain quality of service provided to patients it is important that they are scheduled with the appropriate supervisor. Note: During Aud Clinic III, patients may be double booked to allow for solo experiences for students.

Appointments may be made over the phone, via email, or at the audiology clinic window located at PCD 1017. On occasion, patients may contact the clinic via the Florida Relay System. At the time the appointment is being made, patient contact information will be obtained. Also, for patients with insurance coverage, the administrative assistant will obtain the patient’s physician’s name, physician’s phone number, health insurance company, and health insurance policy number. The Audiology clinic administrative assistant will schedule patients using IDX, the USF Medical Clinic computerized scheduling program. Each student is to check the appointment calendar for appointment type and patient information. IDX can be viewed on any computer in the clinic. The clinic administrative assistant or supervisors will log in to IDX at the beginning of each day.

The audiology clinic administrative assistant will provide the patient with specific directions to the Psychology/Communication Disorders (PCD) building, information about where to park, and instructions for obtaining a parking pass upon arrival. Patients will be advised to arrive at least 15-30 minutes early to allow time for parking, checking in, and the completion of forms. As an alternative, the audiology clinic administrative assistant will mail or e-mail appropriate forms (map, case history, etc.) to the patient if there is sufficient time prior to the appointment. It is the responsibility of the student to check the clinic schedule frequently as it is subject to change.

B. Confirming Patient Appointments The audiology clinic administrative assistant or USF Health will handle confirmation of appointments. Appointments for patients seen Tuesday through Friday will be confirmed the day before the appointment at the latest and Monday’s appointments will be confirmed prior to the Friday before the

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appointment. Patients will be contacted via telephone, text or email. Confirmed appointments can be viewed in IDX.

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V. AFTER SCHEDULING THE APPOINTMENT

A. New Patients If the patient’s appointment is 7 or more days away the audiology administrative assistant will mail or e-mail all necessary patient forms; these may include a case history form, directions and map to PCD 1017, and a parking pass. A temporary patient file will be created by the assistant. This file will contain the “Patient Fee Statement” form and the “Record of Reports/Letters Sent” form. The patient’s name and date of the appointment will be written in pencil on the file’s tab. The file will be placed alphabetically in the “Scheduled for Evaluation” section in the filing cabinet designated for reports in progress and scheduled patients.

B. Returning Patients

The audiology office assistant will locate the patient’s file and place the file alphabetically in the “Scheduled for Evaluation” section in the filing cabinet designated for reports in progress and scheduled patients. The file for a patient who has received hearing aids from this clinic and hasn’t been seen in the past five years may be found in the “inactive hearing aid” filing cabinet located in PCD 1017.

C. Pre-authorization for Appointments

Pre-authorization will be needed for patients having health insurance or other third party funding. Self-paying patients do not need a prescription from their physician in order to be seen in the Audiology Clinic. Once the patient has been scheduled, the fiscal business assistant will contact the patient’s physician’s office to obtain a script in order for the patient to be seen in the Audiology Clinic. The patient’s health insurance company will then be contacted by the fiscal business assistant to obtain approval for the patient to be seen in the Audiology Clinic. Also, services that the patient’s insurance company will cover will be obtained. This information will be kept in the patient’s file.

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VI. PATIENT FEES

Fees for patients with insurance coverage are set up in the IDX billing system. Fees for self-paying patients are listed on the fee schedules located in the front of the “Biological Listening Check Notebook” found in each audiology suite and in notebooks in the AR room and CI rooms.

A. Diagnostic Services

A basic comprehensive audiologic evaluation consists of the following CPT Codes and descriptors: 92557 Basic Comprehensive Audio (air and bone pure tone audiometry

and speech audiometry) 92570 Acoustic immittance, includes tympanometry, acoustic reflex testing

& acoustic Reflex Decay 92587 Evoked OAE (limited otoacoustic emissions)

Because this is a student training facility and procedures are done by Au.D. students, all adult patients will be charged $125.00 rather than $265.00 for the basic comprehensive evaluation. The following exceptions will be made:

USF students – $25.00 USF faculty/staff – $62.50 Spouse/Family member of USF Faculty/Staff – $62.50

HCC students seen as part of their educational programs – $25.00

Patients seen from USF Physical Plant - $25.00 for baseline audio and $25.00 for annual

Patients seen from USF Comparative Medicine Department – $95.00 for

the baseline audio and $25.00 for the annual

B. Hearing Aid Clinic Fees are calculated individually according to manufacturer’s costs. The student clinician and the supervisor will inform patients of any costs related to new hearing aids, repairs, accessories, dispensing, fitting, and programming.

Refer to “Hearing Aid Charges” (See forms for the USF Hearing Clinic) for various charges for hearing aid clinic. These will be placed in the respective rooms as follows:

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Hearing Aid Room #2 (PCD 1010) - the fee schedule will be located inside the last cabinet door on the right. Hearing Aid Room #1 (PCD 1014) – the fee schedule will be located inside the cabinet door above the sink. These are also placed in the biological check notebooks in each audiology suite and in notebooks in the AR and CI rooms.

New Hearing Aid Purchases

As a general rule, total payment is due at the delivery of hearing aids. Patients will either pay the total at delivery or make a deposit at time of ordering with the balance due at delivery. On rare occasions, payment plans may be offered; these must be approved by the Audiology Clinic Director. This policy is also followed for FM system purchases. A few health insurance plans will pay a portion of hearing aids and hearing aid fees; contact the audiology clinic fiscal business assistant for assistance. Fees are as follows:

Total Hardware Cost - prices will depend on the level (basic, intermediate,

advanced) of the hearing aid. Students are to refer to the pricing sheets provided.

Total Accessories Cost – earmolds: Soft Shell/Lucite/Acrylic - $50.00

JB 1000 - $60.00 Refer to the Hearing Aid Clinic Price List for

other types of earmolds

Dispensing Fees - includes hearing evaluations and hearing aid checks for length of warranty at no charge, as well as one

session of Aural Rehabilitation (schedule after hearing aid fitting has been completed). Also included are a package of batteries for each aid, the LACE Program ($75 value), and a Dry & Store Global($110 value).

Follow-up visits

Patients with hearing aids under warranty

No charge for hearing evaluations and hearing aid checks for length of the warranty. Some supplies, such as wax guards, tubing changes, and minor repairs, are also provided at no charge during the warranty period. Major repairs are covered by manufacturer warranties and are also provided at no charge.

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The patient will be charged for all other accessories, supplies and products purchased, plus shipping. Patients with hearing aids out of warranty Refer to the Hearing Aid Clinic Pricing Sheet. The patient will be charged for all services, accessories, supplies, and products purchased, plus shipping.

Hearing Aid Repairs

Fees associated with hearing aid repairs are collected when the patient is refit with the repaired aid(s). Patients are to be notified of the cost of the repair and consent obtained prior to the repair being processed. If hearing aids are out of warranty, shipping charges will also apply.

C. Specialty Clinic - Cochlear Implant Clinic – subject to change Fees generated in the cochlear implant program are billed primarily through USF

Hearing and Balance Center, Dept. of Otolaryngology. Students will be required to complete the Dept. of Otolaryngology charge form. Dr. Muscato will assist the student when completing the Dept of Otolaryngology charge form as she must sign the form once it is completed.

D. Specialty Clinic - Newborn Hearing Screening Clinic

If the patient has no insurance, the patient is to be charged $50.00 if a resident of Hillsborough County or $125.00 if he/she resides outside of Hillsborough.

E. Specialty Clinic - Auditory Processing (APD) Clinic – some insurance will reimburse for APD evaluations. Prices below reflect “self-paying patients”. Initial Auditory processing disorders evaluation (APD)

For the basic comprehensive audiological evaluation, the patient is to be

charged: $50.00 (referred from speech clinic or patient resides in

Hillsborough County) or $125.00 (patient resides outside of Hillsborough County)

AND for the auditory processing disorders evaluation - $200.00 (includes testing, interpretation, & first half hour of consultation).

If an ABR was also performed charge the patient $225.00.

Re-evaluation of APD - Charge the patient - $100.00

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APD Consult – charge the patient each additional half hour - $50.00 Off-campus consults – Portal to Portal (total time away from USF) – charge the patient $100.00 per hour

F. Specialty Clinic - Auditory Rehabilitation (AR) Clinic Fees are free for USF patients and VA patients. Patients referred from other locations are billed $20.00 for 2 sessions of AR. Individual patients will be billed according to length of time enrolled.

H. Specialty Clinic - Tinnitus Clinic

Tinnitus assessment will be $200.00 and is collected at the time the patient is

checked in. One follow-up counseling session is also included in this cost.

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VII. IDX

IDX is the College of USF Health’s scheduling and billing system. This system allows the Audiology Clinic to bill health insurance. The superbills of patients having health insurance will be generated through this system. You will also use this system to view patient schedules. Please minimize the schedule when not actively viewing it in compliance with HIPAA regulations regarding patient privacy.

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VIII. COLLECTION OF FEES The audiology clinic administrative assistant/fiscal business assistant will collect co-payments for those patients having health insurance coverage and for self paying patients at the time the patient checks in for her/his appointment. Please be advised that all new hearing aid orders, hearing aid repairs, ear molds, and assistive listening devices are to be invoiced the day of order, generally the same day as the appointment. If ordering ear molds, payment is expected at the time of impression. The patient will be informed of any additional charges which may be incurred by the manufacturer.

NOTE: Currently, the only staff/faculty members of the CSD Department allowed to collect fees are the audiology administrative assistant, the fiscal business assistant, the speech administrative assistant, Dr. Carr, Dr. Hansel, and Dr. Zelski as recommended by the USF Cash Collections Office. If the audiology administrative assistant is not available consult your clinical supervisor. The audiology administrative assistant collects fees in either the form of cash, check, or credit card as follows:

Cash – Attach the tender to a copy of the invoice via paper clip and place in the locked box.

Check – Endorse the check with the required stamp

Write the check number on the invoice Attach the check to a copy of the invoice via paper clip and place in the locked box

Credit card – Swipe the patient’s credit card

Print two copies of the receipt from the credit card machine

- Patient signs one copy and this is attached to a copy of the invoice via paper clip and placed in the locked box

- The other receipt copy is stapled to a copy of the invoice and given to the patient

- Visa and Master Card will be accepted for private pay patients and Visa, Master Card, Discover, and American Express will be accepted for insurance co-payments and deductibles.

The audiology administrative assistant records the date, services rendered, amount due, amount paid, form of payment, health insurance as needed, and balance on the “Fee Statement” form located on the left side of the patient’s file.

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XI. Clinic Equipment

A. Available Equipment

Audiology Suites The audiology clinic has four formal audiologic test areas with sound treated booths. Each room is equipped with a diagnostic audiometer, compact disc player, headphones, insert earphones, bone oscillator, and soundfield system. Due to variations in equipment and physical arrangements with the test suites, certain rooms may be better equipped to service a particular patient (adult, pediatric, hearing aid, cochlear implant, wheelchairs, etc.). High frequency headphones, used for high frequency testing are located in Suites A and C. Please use the disposable protective covers when testing with these phones. Reminder: Students should use Audiology Suites A and D for pediatric patients and B and C for adult patients. Individual supervisors will assign these suites to students on a rotating basis.

Foyer

The foyer (the entry area to the four test suites) houses the video-otoscopes, the middle ear analyzers, the ultrasonic cleaner, and forms. The Med Rx video-otoscope system is to be used under direct supervision only. *As a courtesy, if the student notices supplies getting low, including clinic forms, the clinical administrative assistant or clinic graduate assistant should be notified as soon as possible.

Hearing Aid Clinic

Hearing aid clinic – PCD 1014 and 1010 are designated for hearing aid evaluations, fittings, and repairs. Hearing aid supplies, earmold impression materials, hearing aid forms, programming and electro-acoustic analysis equipment, and more are available in each room.

Pediatric Diagnostics/Pediatric Audiology Suites/CI Clinic Toys:

Toys are stored in the designated cabinets in the foyer. These are the first

two cabinets located on the right side of the foyer and the first cabinet on the left side. Toys are to be kept in these cabinets when not in use, not in

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the audiology suites. Please keep these cabinets neat and organized. If necessary disinfect before storing.

MLV screen:

In all test suites located near the audiometer there is an embroidery hoop covered with speaker fabric. This is to be used during MLV testing when performing SDT, SRT, WR, and other speech perception testing.

Room preparation:

Determine which room you will be using and make note on the white

board in PCD1015. Prepare the test suite prior to bringing your patient back for assessment. This will allow you to make use of valuable testing time.

For VRA, preparation for your patient may include the following: Gather a selection of toys for use as distracters Setting up the high chair Setting up the chair for the parent/guardian, Moving the table to the side to make room for the assistant’s chair Activating the reinforcement system Inserting patient information on the ILOv6 system Setting up the FM system (located in Suite A) for Suite A Plugging in the assistant’s monitoring headset for Suite D.

For CPA, preparation for your patient may include the following: Selection of toys for use as reinforcers Inserting patient information on the ILOv6 system

If using the portable audiometer, setting it up and arranging the chairs. If using the main audiometer, setting up the chair for the patient/parent/guardian, moving the table to the side to make room for the assistant’s chair, setting up the FM system (located in Suite A) for Suite A or plugging in the assistant’s monitoring headset for Suite D.

CI Clinic

Students assigned to CI practicum will be meeting as a group with the CI Clinic Supervisor on a weekly basis. You will be notified of this meeting time prior to clinic starting for the semester in which you are assigned to the practicum. Students should plan to prepare an audiological test suite for each session based on the age of the patient. Speakers need to be checked as part of the biological

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check and calibrated for HINT testing if not already completed and recorded on the chart located on the wall of the audiology suite. Computers in the CI Room (PCD 1005) should be turned on and logged in. At the end of each session, THESE COMPUTERS are to be TURNED OFF, unlike the other computers in the audiology clinic.

There are separate “TEST TOYS” and “play toys” for pediatric CI patients in room PCD 1005. If you take toys from the Audiological test suite area, be sure to return them to the proper location at the end of the session. A high chair can be found in the conference room for toddlers needing CI programming and for infants. Another high chair is located in suite A that is also usually available.

Please note: the computers located in PCD 1005 are NOT for general clinical use due to the nature of the data being stored on them. These computers do not back up to the H: drive as all other clinical computer files do. Audiological Rehabilitation

Students assigned to audiological rehabilitation (AR) are required to prepare the computer and materials prior to patients arriving. PCD 1006 is designated for AR sessions. At the conclusion of the session, equipment should be turned off and stored away. The locked cabinet has a key lock and needs to be locked at the end of each session. PCD 1006 also houses the assistive listening devices cart.

Conference Room

Used for interviewing and counseling of patients and their families. Also, houses toys for children to play with and books for children to read while parents are being interviewed or counseled.

B. Operation of Equipment

Student Practice

The equipment is very expensive and should be treated very carefully. As there are different pieces of equipment in each booth or room, it is important that the students learn to operate all of the equipment properly. It is the student’s responsibility to review and practice using the equipment as often as is needed.

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Sign-out of equipment and manuals Equipment manuals are available for student use; these are located on the shelving unit in the foyer. In order to check out equipment and/or manuals, first obtain the approval of a supervisor. Then, fill out the “Equipment/Manual Sign-out Sheet” (See forms for USF Hearing Clinic) located in a folder on the shelving unit. Use the same procedure to check out materials in the storage room, but complete the checkout form located there. This also applies to otoscopes. All equipment and/or manuals are to be checked out on an overnight basis and are to be returned the next morning by 8:30 am. Obtain approval from the audiology clinic director before checking out equipment. Oftentimes equipment is needed for hearing screenings so equipment must be returned for that use.

Expected student performance

If a student is found to be unable to operate a piece of clinic equipment during clinic that he or she is expected to be proficient on, he or she will be dismissed from clinic on that day. Also, any student demonstrating lack of preparedness on an infrequently used piece of equipment during clinic may be dismissed from clinic on that day. These dismissals will be made at the discretion of the clinical supervisor and no patient contact hours will be awarded. In addition, any dismissal from clinic will be reflected in the final grade for Clinic.

Equipment Start-Up

NOTE: All students assigned to clinic (including hearing aid clinic and CI clinic) are to assist in the calibration and set up of diagnostic equipment as needed.

Morning Clinic

Student clinicians assigned to morning clinic are required to arrive 30

minutes before their scheduled block of time to prepare clinic rooms, turn on equipment and computers, and to complete the biological listening checks of the equipment.

The equipment to be powered up may include the audiometers, CD players, immittance equipment, OAE equipment, and computers. Biological checks will need to be performed on the audiometers, immittance equipment, and OAE devices. See procedures below for calibration of equipment. Once the checks have been completed, the equipment is to be left on for the day; unless specified by the clinic

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supervisor. (Note: Capella OAE must be turned on prior to opening the NOAH module)

In addition, all computers should be restarted on a daily basis. After

rebooting, students should log each computer on to the audclinic network.

Immittance and OAE tips and non-disposable specula that were left to dry overnight are to be put away.

If using Suite A, the FM system needs to be assembled and the VRA system activated.

Afternoon Clinic Students assigned to afternoon clinics are to arrive 30 minutes prior

to the scheduled start time.

These students should check to ensure that the daily biological listening check has been performed and that all instrumentation needed for clinic that afternoon is fully operational.

It is the responsibility of the student to check the “Audiology Daily Biological Listening Check List” (See forms for USF Hearing Clinic) prior to testing to determine that the biological check has been completed.

How much equipment to start-up?

Students are advised to check with a clinic supervisor to determine which audiology suite(s) need to be calibrated.

Remember to follow the procedures as described above in morning clinic start-up. These checks are to be completed for equipment in each audiology suite needed for the day. If no patients are scheduled, at least one adult and one pediatric audiology suite must be prepared to accommodate walk-ins or retests via hearing aid clinic and cochlear implant clinic. Hearing Aid Clinic Students are to assist in the calibration of equipment when needed for

diagnostic clinic. They are also responsible for preparing materials, the room and/or equipment needed for scheduled hearing aid patients.

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Cochlear Implant Clinic

Students are to assist in the calibration of equipment when needed for diagnostic clinic. They are also responsible for preparing materials, the room and/or equipment needed for scheduled CI patients and will be provided with this information during the initial specialty clinic orientation.

Audiological Rehabilitation/APD Treatment Clinic Students assigned to audiological rehabilitation clinic are responsible for developing and writing lesson plans, preparing materials, preparing the room and/or equipment for patients scheduled for AR.

Daily Biological Calibration Check

The procedure for performing the daily biological checks is outlined in “Daily Biological Calibration Procedures” (See forms for USF Hearing Clinic). These are to be performed at the beginning of each clinic day.

A team of two students is needed to complete the checks. One student will act as the listener while the other operates the equipment as outlined in the procedures. If a Buddy (a student from SPA 4050) is assigned to the student, the Buddy can be the listener.

After performing the listening check, the student is to complete and initial the “Audiology Daily Biological Listening Check List” (See forms for USF Hearing Clinic) found in the notebook located next to the audiometer in each suite. The student is to record any problems in the log and report them immediately on the “Equipment Incidence Report” (See forms for USF Hearing Clinic) found in a filing tray located in the shelving unit in the foyer. Turn this form in to a supervisor when you have completed the top portion of the form. Note specific information and include evidence of the problem (an audiogram, immittance strip).

Equipment Shut-Down

Students assigned to the last evaluation of the day are responsible for turning off all equipment, even if no one was scheduled. Clean, rinse, and put out to dry items placed in the ultrasonic cleaners (Sporox-hydrogen peroxide solution). Start cycle and remove tips when the cycle is completed. Rinse the ear tips in cool water and place on a paper towel to dry. The Wavicide solution is changed every 30 days or sooner, and the current date is posted on the calendar in the foyer. All computers are logged off but left on.

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All clinical equipment except power amplifiers should be turned off. For students with morning clinic slots, if no patients are scheduled for an afternoon clinic, the students should check with their supervisor to determine if any or all equipment should be turned off. At the end of each Friday clinic, the batteries from each otoscope must be plugged in for charging over the weekend.

Monthly Biological Calibration Listening Check A designated supervisor will assign teams of students each month to complete monthly biological calibration listening checks of the audiometers during the last week of each month. You will be notified at the beginning of each semester regarding this assignment. Perform the listening check as stated in “Monthly Biological Calibration Check Procedures” (See forms for USF Hearing Clinic.) After performing the listening check, complete and initial the “Audiology Monthly Biological Listening Check List” (See forms for USF Hearing Clinic) found in the notebook located next to the audiometer in each suite. Inform the designated supervisor when these checks are completed. The student is to record any problems in the log, complete an “Equipment Incidence Report Form,” (See forms for USF Hearing Clinic) and turn in the report immediately to the supervisor.

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X. Patient Files

Confidentiality All parts of a patient’s file are considered confidential. Files and any parts of the file must remain in the PCD building. They may not under any circumstances be removed from the building. A student found removing files (or any portion of a file that identifies the patient) from the building may be subject to dismissal from the program. Copies of previous reports, audiograms, case history forms, and other documents needed for report writing, case presentation, or coursework are not to be copied nor removed from the clinic without approval from a clinic supervisor. A copy of the current audiogram may be provided to the student clinician by the supervisor with identifying information removed.

These copies are to be made by the clinic supervisor or audiology clinic administrative assistant. The audiology clinic administrative assistant will not make copies without approval from the supervisor.

The student is responsible for removing all of the patient’s personal identification such as name, file #, address, e-mail address, date of birth, and phone # from all copies. Information such as age, gender, and city of residence may be left on forms that are copied. Before copies leave the department, the supervisor must review them.

Please do not leave patient files open or unattended. As you move from room to room take the file with you. Under no circumstances are files to be left in a room with a patient unless the student or supervisor is present. Patients do have the right to look at their files, but the student clinician and/or supervisor should be reviewing the chart with the patient when doing so. Retrieve copies of patient data from printers ASAP and discard unwanted copies in the shredder bin located outside of the conference room. Also, before leaving computers make sure that no patient information, data, etc. (including sycle), is left on the computer screen by “locking” the computer. When using the computer in the presence of patients, please take care that other patients’ data, information, etc., does not appear on the screen.

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New Patient Files

The audiology clinic administrative assistant will prepare a temporary file for the new patient prior to his/her arrival. The file will contain the following forms (See forms for USF Hearing Clinic):

“Record of Reports & Letters Sent Log” “Patient Fee Statement”

File Organization Patient files are organized as needed into six sections on colored backings

(located in the audiology student workroom, PCD 1015). The student is to organize patient folders upon conclusion of the initial visit as follows:

Blue backing – case history, case history updates, release forms, intake forms, insurance information. Red backing – Audiograms and associated reports, immittance strips,

OAE data sheets, speech perception recording forms, and Evoked Potential tracings. This includes audiograms and reports from other agencies.

Green backing (HA) – Hearing aid notes and all forms related to hearing aids. Hearing aid summary forms will be placed on the top of this packet.

Pink backing – Cochlear implant Pre-evaluation. This includes ALL test forms, correspondence and audiometric data used in consideration of candidacy. There is a cover page located in the CI room (1005) in the hanging file.

Green backing (CI) – All programming notes and equipment forms for cochlear implant and speech processors are kept here.

Yellow backing – FM notes and all forms related to FM or Speech and Language reports if the patient is receiving Speech and Language Therapy Services in the USF/CSD Speech, Language and Hearing Center.

Peach backing – Includes parent inquires, letters for parents other than evaluation and all other information from other agencies including medical updates.

All reports and other materials are filed in chronological order from the oldest (on bottom) to most current (on top) on each backing. Punch holes as needed in all papers and organize appropriately after each patient is seen and secure with metal fasteners. The metal fasteners and two-hole punch are located in PCD 1015.

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NOTE: On the red backing, for each visit that a patient is seen for an audiological evaluation patient data information must be organized, when available, in the order from top to bottom as follows: audiogram, formal report, immittance strips, OAE data, and BKB-SIN/QUICK SIN recording sheets. For patients seen for APD testing organize patient data from top to bottom as follows: APD report, summary score worksheet, APD recording sheets, parent and teacher checklists. Follow the same organization for the audiological evaluation as stated above.

Patient Files

File locations:

Patient file folders will be located in the lateral filing cabinet located in PCD 1017 under “Scheduled for Evaluation (SFE)” or “Reports in Progress (RIP).”

Patient file folders may also be found in the inactive/hearing aid/cochlear implant/auditory processing disorders (HA/CI/APD) filing cabinet located in PCD 1017.

If a patient’s file folder cannot be located, see your supervisor or the audiology clinic administrative assistant.

Student clinicians may pull files from “Scheduled for Evaluation/Reports In Progress” filing drawer only. If files are removed from this drawer, they must be returned to the same location. Patient files must be returned to the “Routing File” by the end of each day. Students are not to keep patient files overnight in the student file box located in the audiology student workroom or in mailboxes. Remember to attach a completed routing slip to the outside of the patient file prior to placing in the “Routing File”. During the day, students may keep files in the student file box in the student workroom. Please remember to return to the “Routing File” by the end of the day. Files on the day of a patient’s appointment may be picked up from the “Supervisor Hot Box” located on the wall. These files must be returned to the “Supervisor Hot Box” prior to the patient’s arrival for check-in purposes. This enables the audiology clinic administrative assistant to efficiently “check-in” the patient upon arrival.

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Patient File Review If a patient has been previously seen in the clinic, it is the responsibility of the student clinician to read the file and become familiar with the case. Likewise, if a patient is new to the clinic, the student clinician must review Sycle to determine the type of appointment, referral source, etc. Patient files are typically located in the “Supervisor Hot Box” or the “Scheduled for Evaluation” file located in the 2nd drawer of the filing cabinet closest to the door. Upon completion of the file review, the student must return the file to the “Supervisor Hot Box” or “Scheduled for Evaluation” file, depending on the scenario. If the patient chart is from the “Scheduled for Evaluation” drawer, all files are kept alphabetically and should remain so.

USF Students A file is not created for USF students completing a course assignment if they have results within normal limits on all portions of the hearing evaluation. If a file does not need to be created, please indicate on the routing slip: “file not needed, USF student.” The audiology clinic administrative assistant staples the student’s intake, case history, and all test forms together and places them in a file labeled “Student Evaluation Year.” A file is created if any abnormal findings are present. On the routing slip indicate “please create a file.”

If services were provided for a student from the music department, the audiology administrative assistant will staple information together and place in a file labeled “Music Department.” If the services were provided for a hearing conservation program, the audiology

administrative assistant will maintain individual records as part of that group.

Industrial Audiology Patients

A file is created for each patient seen for Industrial Audiology. Files are color coded depending on the department the patient works for – orange for physical plant mechanical, grey for physical plant grounds, and manila for comparative medicine. In addition, an electronic copy of reports containing the test results is maintained on the computer in PCD1010.

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XI. The Appointment

Patient Check-in Upon arrival, the patient will sign-in on the clipboard located on the shelf outside the audiology clinic administrative assistant’s area in PCD 1017. If needed, the audiology clinic administrative assistant will provide the patient with a parking permit for her/him to place in the vehicle.

A case history form will be given to all new patients. The patient may bring the completed case history form that was emailed/mailed/faxed to them or will be given one to complete upon arrival to her/his first visit to the clinic. For returning patients, the audiology clinic administrative assistant will verify that address, phone number, etc. is correct. Changes will be made in Sycle. At this time, the administrative assistant/fiscal business assistant will create a computer generated superbill and collect co-payments from those patients with health insurance coverage. This superbill will be placed in a green plastic folder to be placed with the patient’s file. For those patients without health insurance coverage or who are self-paying patients, the administrative assistant/fiscal business assistant will place a printed superbill in “a color to be determined” plastic folder. Charges for these patients will be collected at the time of check out. Once the case history form is completed or identifying information updated, the audiology clinic administrative assistant will place the file in the assigned “Supervisor Hot Box” in the perpendicular position. This will be the indicator to the student that the patient is ready to be taken back for her/his appointment. In addition, a green (“greenie”) colored plastic folder containing the computer generated superbill for those whose services will be paid by insurance or a “color to be determined” plastic folder containing a “self-pay” superbill will accompany the patient’s file. The audiology clinic administrative assistant will direct the patient to the waiting area. She will also tear off the sticker with the patient’s name from the sign in sheet and place it on the patient log for privacy and tracking purposes. It will be the responsibility of the student to check on the patient’s arrival by noting the position of the file and the presence of a colored plastic folder in the “Supervisor Hot Box”, to obtain the file, inform the supervisor of the patient’s arrival, and greet the patient in a timely manner.

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Case History/Updates

Case History Forms The “Pre-evaluation Case History Form for Children” (See forms for USF Hearing Clinic) will be given to the parents/guardian of children seen for testing. The “Pediatric CI Case History Form for Children” is given to children who

are potential CI candidates or already have CI. The adult case history form, “Audiology Case History Form for Adults,”

(See forms for USF Hearing Clinic) will be given to all remaining patients. The “Supplemental CI Case History Form for Adults” is also given to

adults with existing CIs. The “Supplemental APD Case History Form” is given to patients when APD evaluations have been scheduled. The “Supplemental Tinnitus Case History Form” is given to patients scheduled for a tinnitus evaluation.

NOTE: The PATIENT MUST SIGN THE “Clinical Release Form” (See forms for USF Hearing Clinic) BEFORE TESTING CAN BEGIN. It is attached to the case history form. Case History Update

The student clinician is responsible for updating personal, medical, audiological, and other information from subsequent patient visits to the USF clinic on the “Case History Update” form (See forms for USF Hearing Clinic). If an address change is needed, record a note on the “Case History Update” form in addition to making the appropriate corrections on the “Case History” form and put the date next to the correction.

Dates and specifics of phones calls are also recorded here.

Hearing Aid Notes

Information regarding the patient’s hearing aids and updates are recorded on the “Hearing Aid Notes” tracking sheets (See forms for USF Hearing Clinic).

Dates and information obtained from phone calls are also recorded here.

Information regarding hearing aids sent in for repairs, returned from

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repairs, exchanges, and etc are recorded on this form. Include make, model,serial numbers, and style of hearing aids. This applies to FM systems as well.

****Please record make, model, serial numbers whenever making a reference to a patient’s hearing aid(s). This is so important for the tracking of hearing aids. ****

CI Notes

Used to record information; these are located in the CI room. These are for equipment and visit notes. Information obtained from phone calls are also recorded here. Information regarding speech processors sent in for repairs, returned from repairs, etc are recorded on this form. Please record

model and serial numbers each time a reference is made to the patient’s speech processor. This is so important for the tracking purposes. SOAP notes are not written here for CI patients, a separate report will be written.

Interview

Students are to greet their patients in the waiting area using a formal greeting. The students should introduce themselves as “Mr./Ms./Mrs. _______ and state their title. For example, “Hi, I’m Ms. Smith. I am a 2nd year audiology doctoral student…” The student will then direct the patient to the conference room, foyer, or other available room for the patient interview. It is the responsibility of the student to verify the purpose of the visit with the patient and to then conduct the interview to obtain needed information. The student is to record information obtained on the case history form for new patients and case history update or hearing aid notes forms for returning patients. NOTE: if interviewing in the foyer, make sure other patients are not around. Remember patient confidentiality.

Responsibilities of Teamed Student Clinicians during a Diagnostic Session

1. Clinic I: When there is a team of student clinicians scheduled with the same supervisor and the same time block, the role of primary and secondary clinician is rotated between them for each patient. It is the responsibility of the student clinicians on the team to keep track of who is to be primary and secondary for each appointment. See “Standard Responsibilities for Primary and Secondary Clinicians” (See forms for USF Hearing Clinic). The supervisor may alter this division of responsibilities to improve the clinical experience for specific students.

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2. Clinic II and III: Check with individual supervisors regarding the role of the primary and secondary clinicians.

Evaluation

Procedures have been addressed in previous coursework, but the student clinician is to discuss these with the supervisor. The test battery or procedure chosen may consist of any of those discussed previously and may vary in sequence depending on the individual needs of the patient and the availability of equipment. Specific testing procedures and protocols can be found in the USF Audiology Clinic Testing Protocol Manual.

Counseling

When all test data has been collected for students in diagnostic clinic, the patient is directed to an available interview room or the patient waiting area. The student clinician discusses the results and recommendations with the supervisor. If time permits, the student will write the SOAP notes and the supervisor will review and sign the audiogram. The student clinician and the supervisor will then discuss information to be presented to the patient. Students are to counsel the patient as discussed with the supervisor. The student is to avoid presenting new information that wasn’t discussed previously with the supervisor. If additional thoughts occurred to the student during the conference with the patient, the student is to request that the supervisor step out of the room with the student for a consult. The student is to keep in mind that the supervisor may at times interrupt, in a professional manner, to present information in another way, make corrections, or provide additional information as it arises. These are to be taken as teaching tools used by the supervisor for the student.

Wrap Up

Upon completion of services and before taking the patient to check out, the student and the supervisor will complete the generated superbill or the printed superbill based on the services provided. The superbills are to be placed in their respective colored plastic sheets. In addition, if any hearing aid charges were incurred, these too will be determined. Hearing aid charges and other charges not covered by insurance are to be discussed with the patient prior to check-out. Whenever possible, attempt to complete the audiogram so that a copy may be given to the patient before leaving the appointment.

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There may be times in which SOAP notes will not be written prior to counseling the patient due to time constraints. In these cases, SOAP notes will be written at some time after the appointment and reviewed and signed by the supervisor. SOAP notes are required to be completed, signed and a copy attached to the front of the patient file on the day of the appointment.

The student is to complete the routing slip; this is to be attached to the outside of the patient’s file. In addition, if hearing aids are being purchased, attach the completed “Receipt of Hearing Aid(s)” form to the outside of the patient’s file as well. This allows the front desk people to insert the correct charges into the billing system.

The student is to check that the patient has signed the release to receive or send documents forms. If these are not signed reports or any other information may not be sent or requested by the USF Audiology Clinic. If the patient requests records to be sent to another party, all of the information must be completed (doctor’s first and last names, phone numbers, addresses, etc.) so the clinical administrative assistant can send the documents to the appropriate people. If the patient does not know the identifying information of the party they would like the information to be sent to, please direct the patient to call the clinical administrative assistant at a later time with the information.

To summarize, the following items are needed before taking the patient to check out:

1. Completed generated or printed superbill placed in its respective plastic sheet

2. If hearing aids are being purchased, the “Receipt of Hearing Aid(s)” is attached to the outside of the patient’s file

3. Completed routing slip attached to the outside of the patient’s file Patient Check Out

At the completion of the appointment, the student will accompany the patient to the audiology clinic administrative assistant’s window for “check out.” All patients must go to check out whether charges need to be collected or not. The student will provide the audiology clinic administrative assistant with the patient’s file, completed superbill, routing slip, and if needed the “Receipt of Hearing Aid(s)”. At this time the audiology clinic administrative assistant will: - Collect fees and provide the patient with a copy of the invoice - Schedule needed return appointments

- Make copies of the completed audiogram or hearing aid information for

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the patient when applicable. - Will enter the date of evaluation, type of services rendered, amount due,

amount paid on the “Patient Fee Statement” form. Time permitting, all patients are provided with a finished copy of the audiogram. If the audiogram summary is not completed within the time allotted for the session, the audiology clinic administrative assistant may mail the completed audiogram to the patient or hold it for the patient to pickup at a later date. The audiology clinic administrative assistant will record the date, type of correspondence (audio, report), and recipient on the “Correspondences Sent Log” form. Examples:

10/17/01 Audiogram Patient, physician 11/27/01 Report & Audiogram Parent

The file will then be placed in the location as specified by the student on the routing slip. Note: If the routing slip indicates “Return to student”, the file will be placed in the “Student Pick-up File”. Students can take the patient file at that time.

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XII. After the Appointment

File/Routing Slip After the audiology clinic administrative assistant has completed check out procedures for any given patient, the file will be placed in the location as specified by the student on the routing slip.

The “return to the student” line should be checked if items in the file folder are incomplete, in need of signatures, and/or need to be organized. It will be placed in the “Student Pick-up File” by the audiology clinic administrative assistant. The file folder will remain there until the student picks it up for completion. The student must pick up the file before the end of the day/shift. If files remain in the “Student Pick-up File” overnight, the files will be given to the appropriate supervisor the following morning. The “return to the supervisor” line should be checked if the supervisor needs to review the file and/or signatures are needed. Iit will be placed in the respective supervisor’s mailbox by the clinical administrative assistant. The “place in reports in progress” line should be checked if the file is organized, file items are completed, file has been reviewed by the supervisor and signatures are obtained, it will be placed in the “Reports in Progress” file by the audiology clinic administrative assistant awaiting completion of the report. Students will have 2 weeks in which to have reports completed and the patient file organized.

All file folders must be returned to the “Routing File” by the end of the day/shift. No file folders are to be kept outside the clinic office, including the student file box located in the student workroom overnight. The student must turn them in with a completed routing slip.

Infection Control/Room Cleaning

Supplies are located in each patient area. These include cavicide, gloves, paper towels, and sanicloth containers. Disinfection logs are found in each audiology suite as well as each patient area (CI, AR, Hearing Aid rooms). All clinicians should wash their hands before and after each patient appointment. Gloves should be worn:

If there is a risk of contacting bodily fluids (example: open wound on head, blood in the ear canal) If the clinician has any cuts or wounds of the hands Whenever cerumen management is performed.

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Student clinicians are responsible for keeping the test rooms in order. Please disinfect surfaces after each patient as follows:

1. Wash hands prior to disinfecting using liquid antibacterial soap.

2. Spray Cavicide on surfaces, table in the test suite, chairs in the test suite, the interviewing/counseling table and chairs, and the surface area and chair used during immittance testing.

3. Wipe sprayed surfaces using paper towels with a GLOVED HAND.

4. Spray the same surfaces again, this time allow the sprayed area to air dry, DO NOT

WIPE THEM DOWN THE SECOND TIME.

5. Using a Sani-Cloth towelette, wipe surfaces and cords of the earphones, the inserts, and the bone oscillator. Include the surfaces and cords of the portable audiometer if used.

6. Make sure used immittance tips are in the ultrasonic cleaning machine. Run the

ultrasonic cleaning machine for one round. Use more cleaning rounds as needed. Remove the tips from the machine with the strainer, rinse under running water, and then place on clean paper towels to air dry. Avoid coming into contact with the cleaning fluid, use a gloved hand. NOTE: The immittance tips are to be cleaned at the end of the morning and

afternoon sessions. Even if no patients were seen, check to see that there are no immittance tips in the cleaning machine. Tips should not be left in the cleaning machine overnight; the tips will become hard and brittle sooner when left in the machine overnight.

7. Disinfect toys as needed. Spray with Cavicide, wipe down using gloved hand with

paper towels, spray again, allow to air dry on clean paper towels.

8. Discard glove, paper towels, and towelette in a plastic lined trash receptacle.

9. Record date and time and initial on the Disinfection Log upon completion.

10. When supplies are in need of replenishment, complete the Restock supply form and give to your supervisor.

Logging Clinical Experience and Yellow ASHA Hour Sheets

See general information located at the beginning of the handbook.

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XIII. Patient Reports

Very important note: Students are responsible for completing the first draft of patient reports within 48 hours of the evaluation. Rewrites are to be submitted within 24 hours from the time the supervisor returned the first draft. Students have 2 weeks from the day of the patient’s appointment to complete all reports and organize patient files.

Sensitive Material: Care must be taken when writing reports. Sensitive information will include but will not be limited to the following areas: Information that could be considered social in nature with an attached social stigma, to include family history of mental illness, substance abuse, suicide or suicidal intent; marital discord or marital problems Information about the behavior or personality of another family member not provided by that person (e.g., mother describing her ex-husband as violent or abusive).

This information should be included in a report only if its inclusion is relevant to the diagnosis. For example, if a child is being evaluated for an auditory processing problem family history of speech and language problems, hearing problems, learning disabilities, and mental handicapping conditions are important in making the diagnosis of an auditory processing disorder.

Financial information should almost always be excluded from a report unless it is directly relevant to the diagnosis (e.g., financial problems causing the parents to be unable to obtain medical care). A formal written report is required for each patient new to the USF Hearing Clinic and includes:

Patients seen for AP testing Patients seen for electrophysiological testing USF students diagnosed with hearing loss Pre-evaluation CI candidacy and initial CI activation Other reports may be requested at the discretion of the clinic supervisor.

A SOAP note format type report must be written for each returning patient.

Reports are not needed for USF students scheduled for a hearing evaluation to fulfill a class requirement unless results are abnormal on any test. Once it has been determined the type of report to be written: The student clinician is to submit the initial typewritten, double-spaced report.

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This report is due to the supervisor within 48 hours of the evaluation. Rewrites are due to the supervisor within 24 hours. Include all drafts with

rewrites. Report templates will be available on Blackboard and on the computers in the clinic.

Reports for all audiology practica (including CI clinic) are to be submitted electronically to the audclinic network, this is located through the “audclinic” login in the “p” drive under the file “student reports.” Each student will have a separate file by semester within this student reports file sorted by supervisor. The path to reach your file is:

Login to “audclinic” Enter “my computer” Click on “P” drive Click on “student reports” Click on appropriate semester Click on appropriate supervisor Click on your reports folder Enter report in your file

Reports are not to be left on the hard drive when using clinic computers. If reports are found on the places other than under the designated “student reports” file, they will be deleted. Flash drives are not to be used when writing reports in the clinic. In addition to the electronic submission of reports on the “audclinic” network, individual supervisors have other requests for submission of reports, these are as follows:

Dr. Carr – the student is to send an email indicating that the report is on the “p”

drive.

Dr. Hansel - the student is to send an email indicating that the report is on the “p” drive Dr. Muscato – the student is to send an email indicating that the report is on the

“p” drive

Dr. Zelski – the student is to send him the report via email with identifying information omitted Reports written in clinic:

Reports may be written during the student’s scheduled clinic block of time, time permitting.

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The student clinician may use available computers located in the clinic. Computers are also available in the student workroom on the second floor. The report may be reviewed with the supervisor during the scheduled block, time permitting. Patient identifying information may be included in the report.

Reports written outside of clinic:

Reports may be written at home but you must insert them into the “audclinic” file via email. Remember to omit identifying information. Identifying information must be omitted. This includes the patient’s name, date of birth, address, social security number, phone number, and file number. In addition, remember that patient identifying information may not be sent via email. Anonymous codes generated by the student will be used in place of the patient’s name and other names throughout report. These code names must be entered in the report using a colored font of the student’s choice.

Final Draft of Reports

Once the supervisor has approved that the draft is ready for the final report the student clinician does the following: Completes all identifying information Changes to single-space format Signs the report

Returns the report to the supervisor attached to the patient’s file with all drafts.

Until the file is complete, the file will be kept in the “Reports in Progress” file drawer in PCD 1017.

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XIV. Requests of Patient Reports and Information “TO” and “FROM” this center

The audiology clinic administrative assistant and clinic supervisors are the only personnel authorized to send or distribute reports.

The audiology clinic administrative assistant will only distribute reports with approval of the clinic supervisor and authorization from the patient. Reports will not be sent to outside sources without patient signature or with incomplete information. If patients are requesting reports to be sent to another party, all information must be included on the form (doctor’s first and last name, phone number, fax number, etc.).

The patient must sign the “Authorization for Release of Information From USF/Authorization of USF to Receive Information” form (See forms for USF hearing clinic). Signatures are needed for each outside source requesting a copy of a report from this center or for this center to receive copies of patient reports and information from outside sources. This includes the referral source.

It will be the responsibility of the student clinician to check that these releases have been obtained. If they are not, the student will obtain them. Releases are needed for the referring person, pediatricians, and others as needed. The student clinician will record requests to send or receive information on the routing slip for the audiology clinic administrative assistant to process. If information is missing from the records request form, the file will be returned to the student to obtain the appropriate information from the patient. On occasion, it may be necessary for the audiology clinic administrative assistant to obtain authorization via fax.

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XV. Other Important Information Buddy/Mentor Program All students in SPA 4050 (Prepracticum) are assigned a graduate student as Mentor.

The Mentor/Buddy assignments are made during the second week of clinic. Graduate students are assigned Buddies by the Audiology Clinic Director. Undergraduate students participate in observation of their mentor on a weekly basis. The undergraduate students are eager to support graduate students in any way. They cannot be involved in the actual treatment or evaluation unless the mentor’s supervisor has approved their participation. As needed, they will ask questions and review files related to the patient. Graduate students are to accept this extra responsibility graciously and conscientiously.

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XVI. Grading, Clinical Assistance Program, KASA Competencies, Practical Exam Minimum Grade Policy All students are required to earn a B- or better grade in clinic. Grades less than a B- are considered as unsuccessful completion of the practicum. In addition, clock hours earned during the semester will not be awarded. If a grade of B- or better is not earned, the student must repeat the course.

Clinical Assistance Program (CAP) The CAP program is designed to provide extra clinical supervisory support to those students identified by their supervisors as needing extra assistance. The following procedures are implemented:

1. Initial identification of an at-risk student should occur and be officially documented no later than midterm evaluation week of the designated semester.

2. Criteria for initiating a CAP include the following, but may not be limited to: A score less than 80 (below a grade of B-) in any of the 5 skill areas assessed (Interpersonal Communication, Assessment, Written Documentation, Treatment ,and Professionalism/Problem Solving), as indicated by the USF Hearing Clinic Evaluation Form.

3. The student is notified in writing, via the Clinical Assistance Form (CAF) by the primary CAP supervisor.

a. The student and supervisor(s) are required to sign and date the CAF. b. The date indicated on the CAF becomes the official start date for any

CAP. c. A copy of the CAF will be forwarded to the Audiology Clinic Director.

The Clinic Director will attend the Clinical Intervention Plan (CIP) Conference along with the student and the CAP Supervisor(s) to establish the criteria for successful completion.

4. An individualized Clinical Intervention Plan (CIP) Conference is scheduled to establish the CAP criteria. The criteria for a CAP must include the following, but may not be limited to:

a. Specific skill areas targeted for intervention, e.g., Dx or Tx. b. Documented specific competencies to be developed within each skill

area. c. Cooperative development of specifically targeted competencies. d. Documentation of whether or not the criteria for each competency was

met, utilizing the CAP coding system (see CAP legend) by CAP Supervisor.

5. Criteria for Completion of a CAP. Completed criteria must reflect a + (met criterion) each competency goal and competency rating of greater than or equal to 80 (B-) in each of the applicable areas. Any student failing to meet this criterion may:

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a. Receive a grade of “C” or lower in the designated practicum. b. Be required to repeat the designated practicum. c. Be counseled by the CAP Supervisor, Center Director, and/or the

appropriate Academic Program Director, regarding future options.

Failure to meet KASA competency We are In the process of developing a formal procedure for situations in which a student may successfully complete a course but fail to meet a knowledge or skill competency at the expected level.

End of the Semester Practical Exam Each student will be given a practical exam to assess application of knowledge gathered from both classroom and clinical coursework to case management and case interpretation. The exam includes a written portion and an oral portion presented by the audiology clinic supervisors. The level of each case is in accordance with that of the clinic completed. The student is notified of the exam date at the beginning of the semester. Feedback of exam performance will be provided to the students within one week of the exam date.