SPEECH-LANGUAGE PATHOLOGY SUMMARY OF CLINICAL SPEECH-LANGUAGE PATHOLOGY SUMMARY OF CLINICAL PRACTICE

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  • SPEECH-LANGUAGE PATHOLOGY

    SUMMARY OF CLINICAL PRACTICE HOURS

    TOTAL HOURS OF CLIENT CONTACT (hours to be rounded up to nearest quarter hour)

    Name:_________________________________ Unit and Dates: ________________________________ Placement Site: ____________________________________ ASSESSMENT/

    IDENTIFICATION (Ax) TREATMENT/

    MANAGEMENT (Tx)

    Client Specific Services

    Client Related Services

    Client Specific Services

    Client Related Services

    Clinical/Professional Activities

    Sub-Total Hours

    Total All Age

    Min. Req. Hours

    AGE GROUP:

    C = Child

    A = Adult

    C

    LANGUAGE Developmental

    A

    40

    C

    LANGUAGE Acquired

    A

    30

    C

    DYSPHAGIA A

    10

    C

    ARTICULATION/ PHONOLOGY

    A

    20

    C

    MOTOR SPEECH A

    10

    C FLUENCY

    A

    10

    C VOICE/RESONANCE

    A

    10

    40

    C

    OTHER – approval needed Clinical Education Coordinator

    A

    C

    AUDIOLOGY-MINOR A

    20

    Ax Minimum Required Tx Minimum Required Maximum: 50 Hours

    TOTAL HOURS

    C/20

    C/20

    C

    50

    TOTAL HOURS

    A/20

    A/20

    A

    50

    TOTAL CLIENT HOURS

    ASSESSMENT HOURS (Min. Required = 100) :

    TREATMENT HOURS (Min. Required = 100):

    GRAND TOTAL:

    350 2014

    _______________________________________________ ____________________________________________________________ ________________________________

    Signature (Student) Signature (Clinical Educator Signs) Date

    smithkri Typewritten Text CLINICAL PROFESSIONAL TOTAL:

    smithkri Typewritten Text

    smithkri Typewritten Text

    Lang Dev - Child - Specific - Assessment: Lang Dev - Child - Related - Assessment: Lang Dev - Child - Specific - Treat: Lang Dev - Child - Related - Treat: Lang Dev - Child - Clinical: Lang Dev - Child - Subtotal: Lang Dev - Adult - Specific - Assessment: Lang Dev - Adult - Related - Assessment: Lang Dev - Adult - Specific - Treat: Lang Dev - Adult - Related - Treat: Lang Dev - Adult - Clinical: Lang Dev - Adult - Subtotal: Language Developmental - Total: Language Acquired - Total: Lang Acq - Child - Specific - Assessment: Lang Acq - Child - Related - Assessment: Lang Acq - Child - Specific - Treat: Lang Acq - Child - Related - Treat: Lang Acq - Child - Clinical: Lang Acq - Child - Subtotal: Lang Acq - Adult - Specific - Assessment: Lang Acq - Adult - Related - Assessment: Lang Acq - Adult - Specific - Treat: Lang Acq - Adult - Related - Treat: Lang Acq - Adult - Clinical: Lang Acq - Adult - Subtotal: Art/Phono - Adult - Related - Treat: Motor Sp - Child - Specific - Assessment: Motor Sp - Adult - Specific - Assessment: Motor Sp - Child - Related - Assessment: Motor Sp - Child - Specific - Treat: Motor Sp - Adult - Specific - Treat: Motor Sp - Child - Related - Treat: Motor Sp - Adult - Related - Treat: Motor Sp - Child - Clinical: Motor Sp - Adult - Clinical: Motor Sp - Child - Subtotal: Motor Sp - Adult - Subtotal: Fluency - Child - Specific - Assessment: Fluency - Adult - Specific - Assessment: Fluency - Child - Related - Assessment: Fluency - Adult - Related - Assessment: Fluency - Child - Specific - Treat: Fluency - Adult - Specific - Treat: Fluency - Child - Related - Treat: Fluency - Adult - Related - Treat: Fluency - Child - Clinical: Fluency - Adult - Clinical: Fluency - Child - Subtotal: Fluency - Adult - Subtotal: Motor Speech - Total: Voice/Res - Child - Specific - Assessment: Voice/Res - Adult - Specific - Assessment: Voice/Res - Child - Related - Assessment: Voice/Res - Child - Specific - Treat: Voice/Res - Adult - Specific - Treat: Voice/Res - Child - Related - Treat: Voice/Res - Child - Clinical: Voice/Res - Adult - Clinical: Voice/Res - Child - Subtotal: Voice/Res - Adult - Subtotal: Fluency - Total: Voice / Resonance - Total: Motor Speech + Fluency + Voice / Resonance - Total: Dysphagia - Child - Specific - Assessment: Dysphagia - Child - Related - Assessment: Dysphagia - Child - Specific - Treat: Dysphagia - Child - Related - Treat: Dysphagia - Child - Clinical: Dysphagia - Child - Subtotal: Dysphagia - Total: Dysphagia - Adult - Specific - Assessment: Dysphagia - Adult - Related - Assessment: Dysphagia - Adult - Specific - Treat: Dysphagia - Adult - Related - Treat: Dysphagia - Adult - Clinical: Dysphagia - Adult - Subtotal: Art/Phono - Child - Specific - Assessment: Art/Phono- Child - Related - Assessment: Art/Phono - Child - Specific - Treat: Art/Phono - Child - Related - Treat: Art/Phono - Child - Clinical: Art/Phono - Child - Subtotal: Art/Phono- Adult - Specific - Assessment: Art/Phono - Adult - Related - Assessment: Art/Phono - Adult - Specific - Treat: Art/Phono - Adult - Clinical: Art/Phono - Adult - Subtotal: Articulation / Phonology - Total: Other - Child - Specific - Assessment: Other - Adult - Specific - Assessment: Other - Child - Related - Assessment: Other - Adult - Related - Assessment: Other - Child - Specific - Treat: Other - Adult - Specific - Treat: Other - Child - Related - Treat: Other - Adult - Related - Treat: Other - Child - Clinical: Other - Adult - Clinical: Other - Child - Subtotal: Other - Adult - Subtotal: Other - Total: Audiology - Child - Specific - Assessment: Audiology - Adult - Specific - Assessment: Audiology - Child - Related - Assessment: Audiology - Adult - Related - Assessment: Audiology - Adult - Specific - Treat: Audiology - Child - Specific - Treat: Audiology - Child - Related - Treat: Audiology - Adult - Related - Treat: Voice/Res - Adult - Related - Treat: Audiology - Child - Clinical: Audiology - Adult - Clinical: Audiology - Child - Subtotal: Audiology - Adult - Subtotal: Audiology - Total: Total Child Specific - Assessment: Total Child Related - Assessment: Total Child Specific - Treatment: Total Child Related - Treatment: Subtotal - Child: Total Adult Related - Assessment: Motor Sp - Adult - Related - Assessment: Voice/Res - Adult - Related - Assessment: Total Adult Specific - Assessment: Total Adult Related - Treatment: Total Clinical Activities - Adult: Total Clinical Activities - Child: Subtotal - Adult: Total Adult Specific - Treatment: Assessment Hours: Treatment Hours: Grand Total: Total Prof Hours: